Archive for the ‘Healthcare’ Category
The eruption of the VA scandals showed clearly that the government does a poor job of investigating its programs. And now Medicare has been found to simply accept large-scale fraud, seemingly making no effort whatsoever to detect and punish fraud—until newspapers write stories about it. Charles Ornstein has an infuriating article in ProPublica:
The fraud scheme began to unravel last fall, with the discovery of a misdirected stack of bogus prescriptions — and a suspicious spike in Medicare drug spending tied to a doctor in Key Biscayne, Fla.
Now it’s led to two guilty pleas, as well as an ongoing criminal case against a pharmacy owner.
Last year, ProPublica chronicled how lax oversight had led to rampant waste and fraud in Medicare’s prescription drug program, known as Part D. As part of that series, we wrote about Dr. Carmen Ortiz-Butcher, a kidney specialist whose Part D prescriptions soared from $282,000 in 2010 to $4 million the following year. The value of her prescriptions rose to nearly $5 million in 2012, the most recent year available.
But no one in Medicare bothered to ask her about the seemingly huge change in her practice, Ortiz-Butcher’s attorney said. She stumbled across a sign of trouble last September, after asking a staffer to mail a fanny pack to her brother. But instead of receiving the pack, he received a package of prescriptions purportedly signed by the doctor, lawyer Robert Mayer said last year. Ortiz-Butcher immediately alerted authorities.
Since then, investigators have uncovered a web of interrelated scams that, together, cost the federal government up to $7 million, documents show.
In February, the U.S. Attorney’s office for the Southern District of Florida charged Maria De Armas Suero, who had been a secretary at Ortiz-Butcher’s Island Clinic from March 2011 to September 2013, with 11 counts of conspiracy, fraud and aggravated identity theft.
Suero subsequently agreed to plead guilty to two counts of conspiracy and identity theft. In a recounting of her wrongdoing, called a factual proffer, she acknowledged using Ortiz-Butcher’s paper prescriptions to “create fraudulent scripts for numerous Medicare beneficiaries…The prescriptions falsely represented that the Medicare beneficiary was seen by [Ortiz-Butcher] and that the listed prescriptions were medically necessary.”
Suero acknowledged that she was paid $100 for each prescription she generated. . .
Paul Krugman has a good blog post with links to graphs and stats about Obamacare. From one of his links:
In the NY Times Adam Liptak points out the Catholic old boys on the Supreme Court have now expanded significantly the restricted Hobby Lobby ruling. That didn’t take long, did it?
In a decision that drew an unusually fierce dissent from the three female justices, the Supreme Court sided Thursday with religiously affiliated nonprofit groups in a clash between religious freedom and women’s rights.
The decision temporarily bars the government from enforcing against a Christian college part of the regulations that provide contraception coverage under the Affordable Care Act.
The court’s order was brief, provisional and unsigned, but it drew a furious reaction from the three female justices — Justices Sonia Sotomayor, Ruth Bader Ginsburg and Elena Kagan — who said the court had betrayed a promise it made on Monday in Burwell v. Hobby Lobby Stores, which involved for-profit corporations.
“Those who are bound by our decisions usually believe they can take us at our word,” the dissent, written by Justice Sotomayor, said. “Not so today.”
At issue in the order, involving Wheaton College in Illinois, are federal forms that groups must fill out and send to their insurers and plan administrators as an alternate way to deliver free contraception to be offered to female workers under the Affordable Care Act.
Monday’s majority opinion in the Hobby Lobby case, written by Justice Samuel A. Alito Jr., seemed to suggest that the accommodation in which the forms played a role was an acceptable alternative to having employers pay for the coverage. He referred to it when he said the government already “has at its disposal an approach that is less restrictive than requiring employers to fund contraception methods that violate their religious beliefs.”
The difference between a form sent to insurance companies and plan administrators on the one hand and a letter sent to the government on the other mattered, the college told the justices, “because it believes, as a religious matter, that signing the form would be impermissibly facilitating abortions and therefore forbidden,” the brief said.
Monday’s “Hobby Lobby” decision was just the latest challenge to the Affordable Care Act. Details on the 5-4 decision and other challenges that could — if successful — have even deeper implications.
Video Credit By Carrie Halperin on Publish Date June 30, 2014. Image CreditDoug Mills/The New York Times
“To be sure, free citizens in a diverse nation will have different views about whether signing the form makes someone complicit,” the college’s brief said. “But that is a question of ‘religious and moral philosophy’ for Wheaton,” not the government. The quoted phrase came from the Hobby Lobby decision.
The court’s majority said Wheaton College need not fill out the forms. Instead, the order said, the college could just notify the government in writing. The government, it said, remains free “to facilitate the provision of full contraceptive coverage.” . . .
Once more we see expectations contradicted by experience. Paul Krugman notes in his blog:
For reference: I count at least six distinct predictions of Obamacare doom made by the usual suspects, not one of which has come true. Here they are:
1. Enrollment will be very low, and
2. Even if people sign up, they won’t pay their premiums.
Reality: Signups exceeded expectations, and the vast majority paid.
3. More people will lose coverage cancelled by Obamacare than gain it.
Reality: Sharp drop in the number of uninsured.
4. Rate shock.
Reality: Like it says, affordable care.
5. Young people not signing up, and death spiral.
Reality: Pretty good demographics.
Reality: Health costs are below anyone’s expectations.
It’s quite an impressive track record, actually. And what’s even more impressive is that none of the usual suspects will even consider admitting having been wrong.
Krugman has a good column today in the NY Times. From the column:
The goings-on at Veterans Affairs shouldn’t cause us to lose sight of a much bigger scandal: the almost surreal inefficiency and injustice of the American health care system as a whole. And it’s important to understand that the Veterans Affairs scandal, while real, is being hyped out of proportion by people whose real goal is to block reform of the larger system.
The essential, undeniable fact about American health care is how incredibly expensive it is — twice as costly per capita as the French system, two-and-a-half times as expensive as the British system. You might expect all that money to buy results, but the United States actually ranks low on basic measures of performance; we have low life expectancy and high infant mortality, and despite all that spending many people can’t get health care when they need it. What’s more, Americans seem to realize that they’re getting a bad deal: Surveys show a much smaller percentage of the population satisfied with the health system in America than in other countries.
And, in America, medical costs often cause financial distress to an extent that doesn’t happen in any other advanced nation.
How and why does health care in the United States manage to perform so badly? There have been many studies of the issue, identifying factors that range from high administrative costs, to high drug prices, to excessive testing. The details are fairly complicated, but if you had to identify a common theme behind America’s poor performance, it would be that we suffer from an excess of money-driven medicine. Vast amounts of costly paperwork are generated by for-profit insurers always looking for ways to deny payment; high spending on procedures of dubious medical efficacy is driven by the efforts of for-profit hospitals and providers to generate more revenue; high drug costs are driven by pharmaceutical companies who spend more on advertising and marketing than they do on research.
Other advanced countries don’t suffer from comparable problems because private gain is less of an issue. Outside the U.S., the government generally provides health insurance directly, or ensures that it’s available from tightly regulated nonprofit insurers; often, many hospitals are publicly owned, and many doctors are public employees.
As you might guess, conservatives don’t like the observation that American health care performs worse than other countries’ systems because it relies too much on the private sector and the profit motive. So whenever someone points out the obvious, there is a chorus of denial, of attempts to claim that America does, too, offer better care. It turns out, however, that such claims invariably end up relying on zombie arguments — that is, arguments that have been proved wrong, should be dead, but keep shambling along because they serve a political purpose.
The chart above, showing the US in its usual dead-last position for healthcare among developed countries, is from this report by The Commonwealth Fund. The first paragraph of the executive summary:
The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity. In this edition of Mirror, Mirror, the United Kingdom ranks first, followed closely by Switzerland (Exhibit ES-1).
Emphasis added. It’s too bad that Congress cannot get its act together to improve our national healthcare system. There’s much that needs to be done.
The report is well worth reading, and Lenny Bernstein has an article on it in the Washington Post:
A report released Monday by a respected think tank ranks the United States dead last in the quality of its health-care system when compared with 10 other western, industrialized nations, the same spot it occupied in four previous studies by the same organization. Not only did the U.S. fail to move up between 2004 and 2014 — as other nations did with concerted effort and significant reforms — it also has maintained this dubious distinction while spending far more per capita ($8,508) on health care than Norway ($5,669), which has the second most expensive system.
“Although the U.S. spends more on health care than any other country and has the highest proportion of specialist physicians, survey findings indicate that from the patients’ perspective, and based on outcome indicators, the performance of American health care is severely lacking,” the Commonwealth Fund, a New York-based foundation that promotes improved health care, concluded in its extensive analysis. The charts in this post are from the report.
The data for the 2014 report was collected before the Affordable Care Act (aka Obamacare) went into full effect, so that reform may eventually boost the U.S. out of last place by providing health insurance to some of the 50 million people who lacked it. But, according to the study, the problems of our health-care system remain so pervasive that it will take more than better access and equity to resolve them.
Karen Davis, a professor in the Bloomberg School of Public Health at Johns Hopkins University and lead author of the study, said overall improvement “is a matter of accountability, having information on your performance relative to your peers and being held accountable to achieving a kind of care that patients should expect to get.” . . .
This is why government is so important: the government is not profit-oriented, so it can provide products and services without those having to generate (ever-growing) profits, unlike private capitalism industry. Capitalism is no doubt good for some things, but it’s hardly a universal solution. (A moment of silence to allow Libertarians to catch their breath.)
Here’s an excellent example, in a Gizmodo article by Robert Sorokanich:
In the Soviet Union, western antibiotics couldn’t make it past the Iron Curtain. So Eastern Bloc doctors figured out how to use viruses to kill infectious bacteria. Now, with antibiotic-resistant bugs vexing doctors, that eerie yet effective method might come our way. In post-antibiotic world, infection cures you!
The technique actually dates back thousands of years, in a very rudimentary form: people observed that the water from certain rivers could cure infectious diseases like leprosy and cholera. In the early 20th century, scientists figured out that these waters contained very specific types of viruses, which killed the bacteria that caused the infections. No bacteria, no infection.
You already know this from high school biology (of course), but a virus works by injecting its DNA into a living cell, hijacking the cell’s replication machinery to make more viruses. When the cell can’t hold all those replicated viruses any more, it explodes, releasing the baby viruses to continue the cycle again—and of course, killing the cell.
Bacteriophages are a type of virus that targets, you guessed it, bacterial cells. Starting in the 1920s, scientists in both the U.S. and Georgia (the country, not the Peach State) began purifying bacteriophages and using them to treat bacterial infections. But right around WWII, western medicine latched on to the miraculous power of antibiotics, leaving the Soviet Union to perfect what’s now called “phage therapy.”
(Tip: pronounce “phage” to rhyme with “rage.” Or rhyme it with “lodge” if you’re fancy.)
Fast forward to today. Western medicine’s (over)reliance on antibiotics has led to the evolution of new superbugs that can resist even our most powerful bacteria killers. And as Nature reports, that’s got researchers looking into phage therapy:
In March, the US National Institute of Allergy and Infectious Diseases listed phage therapy as one of seven prongs in its plan to combat antibiotic resistance. And at the American Society for Microbiology (ASM) meeting in Boston last month, Grégory Resch of the University of Lausanne in Switzerland presented plans for Phagoburn: the first large, multi-centre clinical trial of phage therapy for human infections, funded by the European Commission.
And there are some serious benefits to phage therapy. While antibiotics work indiscriminately, killing both the disease causing bacteria and the healthy, necessary bacterial bystanders, each type of phage is precisely targeted to one very specific type of bacteria.
The downside is . . .
And the key paragraphs on how capitalism fails for this beneficial treatment:
There are, of course, drawbacks. Isolating, purifying, and storing phages is a much more finicky and time-consuming process than producing traditional antibiotics. And then there’s the most practical of concerns: money. Since phages occur naturally, and their therapeutic use is nearly a century old, it would be incredibly difficult for a drug company to patent a phage therapy cocktail as intellectual property.
Indeed, the U.S. Supreme Court ruled last year that naturally-occurring genes cannot be patented, a law which would likely extend to phages. Like it or not, pharmaceutical companies are unlikely to invest in a therapy when they cannot ensure they’ll make that money back with a patent-protected product that can’t be copied by the competition.
Emphasis added. One can readily understand why companies will not invest in offering treatments that can cure millions if they cannot guard against competition. Despite the name “free private enterprise,” most companies detest free private enterprise, because it leads to competition, which can cut profits. Thus “free private enterprise” turns to the government in order to secure protection against competition by, for example, getting the government to issue patents. (Capitalists rely on government a lot, despite their protestations to the contrary.)
In the case of these therapies, there is clearly a role for the government to develop and produce the phages, since (a) private enterprise will not, and (b) phages are desirable for the general public welfare.
I don’t think government production of phages will happen in the US, however. Corporations and oligarchs have enough control of the government to kill anything that might threaten their profits, regardless of the benefits to the public. Note that the countries that use this (highly effective) therapy are Poland, Russia, and Georgia, all of which are accustomed to a more vigorous government role that the US lately will allow.
This is quite similar to the strong resistance pharmaceutical companies have shown about using marijuana as a treatment for various disorders (epilepsy, MS, PTSD, and so on): although marijuana usage has been demonstrated to be an effective therapy, there’s no money to be made from it—anyone can grow marijuana plants. So Big Pharma really does not want this sort of treatment around because it deprives them of an income stream from selling expensive meds for the same ailments. (Interestingly, Big Pharma also does not allow the government to compare effectiveness of new medications: new medications have to shown to be better than a placebo, but they do not have to be shown to be better than current medications already on the market.)