E-DMN - June 23, 2008

June 23, 2008

Editor's Column: Why Is Health Care Reform Different Now
Proton Therapy Veto Opens Door For Beaumont
House To Vote On Modified Medicare Pay Bill
Urge US Senate To Stop Medicare Cuts
Don't Let Smoke-Free Bill Go Up In Flames
Pressure House To Stop Chiropractic Scope Expansion
New AMA Pres Makes Pledge To Uninsured
Health Care Poses Challenge For Candidates

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Editor's Column: Why Is Health Care Reform Different Now

By JOSEPH WEISS, MD
In an article in Health Affairs, May/June, p. 989-962, Ron Wyden, US Senator from Utah, argues that the political climate has changed sufficiently to pass the S 334, a bill titled The Healthy American Act.

The act would require that every person buy health coverage with the federal government providing subsidies for those unable to afford the cost of insurance. Other provisions in the bill provide for health care administration by private insurance companies acting in state and regional areas.

The two sponsoring senators say that their expectation for passage stems from the following:

Bipartisanship in Congress. Now both Republicans and Democrats support comprehensive health reform legislation;
An ideological truce. Both Democrats and Republicans agree on universal coverage, and sufficient numbers of Democrats concede a role for private insurance companies to implement that coverage;
States cannot provide care alone. Experience indicates the individual states do not have the financial power to develop programs to achieve universal coverage;
Loss of employer-based health care. Global competition is causing more employers to drop the expense of employee health care insurance.

This bill takes advantage of the moment. When analysts talk about incremental changes, they mean slowly filling the gaps of universal coverage.

However, the term “incremental” can take on another meaning. Incremental can become a strategy for completing the access-cost-quality triad needed to achieve health care for the country.

The first increment is coverage (access to care). The public has determined this is the first priority. Once the nation provides its population with coverage, then the concern becomes cost and the physician’s contention that reimbursement is unreasonable will receive the attention it deserves.

When questions of access and cost are answered, then the medical community can concentrate on quality; how to recognize it and how to reward it.

Trying to jam coverage, cost and quality into one bill or one session of Congress is too great a burden. Taking it step-by-step as the Healthy American Act does, is the better way.

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Proton Therapy Veto Opens Door For Beaumont

Gov. Jennifer Granholm vetoed a move by the state’s Certificate of Need Commission to restrict the provision of proton-beam therapy to a consortium of the state’s largest cancer providers in order to head off duplication of the expensive technology, according to Modern Health Care’s Daily Dose.

The move hasn’t deterred six organizations that stepped forward to create such a collaborative, said a spokesman for one of the members. They “still believe in and support the value of working together,” Henry Ford Health System spokesman Dwight Angell said in a written statement.

In a letter explaining her decision, Granholm cited the potential unintended consequences of creating special treatment for proton therapy over competing technologies that might benefit patients. She also cited comments from the Justice Department’s Antitrust Division, which concluded that “the proposed standards are likely to harm competition and will potentially result in harm to cancer patients in Michigan,” as well as present a possible violation of federal antitrust law.

Granholm’s veto creates a new opening for Beaumont Hospitals to win approval for its application for a proton-beam facility on its Royal Oak, Mich., campus, a $159 million joint venture with Bloomington, Ind.-based ProCure Treatment Centers, which the CON Commission must act on by July 1. Beaumont President and Chief Executive Officer Ken Matzick said he is in favor of a collaborative approach to the service and is in talks with two other Michigan health systems. “We didn’t think that mandating who should work together was a very rational approach to bringing proton-beam therapy to the state,” Matzick said.

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House To Vote On Modified Medicare Pay Bill

The House on June 24 is scheduled to vote on a modified version of Senate Finance Committee Chair Max Baucus' (D-Mont.) legislation (S 3101) that would eliminate a 10.6 percent reduction to Medicare physician fees scheduled for July 1, CQ Today reports. According to CQ Today, "If the House moves a bill, it will put pressure on Senate Democrats and Republicans to reach an accord."

The House measure is similar to Baucus' bill, delaying the fee reduction for 18 months and increasing payments by 1.1 percent in 2009, but it will be introduced as a new piece of legislation because Baucus' bill failed to pass in the Senate. The measure would "rework several elements of the Baucus bill to cut down on the overall cost," according to CQ Today. It would remove a $1.1 billion "Medicare Improvement Fund." It also would eliminate several provisions that would create bonus payments for physicians and other Medicare programs. The bill also includes provisions that would delay for one year a Medicare competitive bidding program for durable medical equipment and authorize $4 billion in spending over five years on beneficiary programs (Armstrong, CQ Today, 6/20). The measure also includes an electronic prescribing initiative and a provision to ensure pharmacies are paid promptly for drugs they distribute to beneficiaries (Edney, CongressDaily, 6/20).

House Whip Roy Blunt (R-Mo.) indicated concerns regarding the bill's offsets, which could result in "at least a veto-sustaining number on our side" voting against the measure. The bill includes offsets that would reduce payments for indirect medical education under Medicare Advantage, require so-called private fee-for-service plans to form networks with health care providers and reduce payments to DME suppliers. The measure would not include additional reductions to power wheelchair and oxygen providers, as the Baucus bill did (CQ Today, 6/20). The bill also would impose levies on Medicare providers who are late in paying their taxes (CongressDaily, 6/20).

The House vote could be called off if the "Senate appears ready to move quickly and send over a compromise bill," according to CQ Today. Baucus has been in private meetings with Finance Committee ranking member Chuck Grassley (R-Iowa) to settle differences between his bill and Grassley's measure (S 3118), which failed to receive consideration (CQ Today, 6/20).

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Urge US Senate To Stop Medicare Cuts

In its most recent action, the US Senate voted on a motion to debate S. 3101, the "Medicare Improvement for Patients & Providers Act of 2008," but failed to gather the 60 votes needed for passage. The situation will remain fluid and change quickly, so please watch email and www.msms.org for updates on the legislation as we move forward. Although Senators Carl Levin (D-MI) and Debbie Stabenow (D-MI) both voted "yea" on the motion, the work to pass this bill is not done. TAKE ACTION – Use the MSMS Action Center to send a message now to Sen. Levin and Sen. Stabenow, thanking them for their vote on the recent motion and asking for their continued support of the bill.

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Don't Let Smoke-Free Bill Go Up In Flames

MSMS continues to fight for the comprehensive smoke-free workplace bill (HB 4163), which would ban smoking in all workplaces with no exceptions, that the Senate recently passed and sent back to the House for concurrence. TAKE ACTION NOW – Use the MSMS Action Center to send a message to your own state representative, urging him/her to support the more comprehensive bill (HB 4163) and support a healthier Michigan.

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Pressure Houses To Stop Chiropractic Scope Expansion

MSMS opposes House Bills 5759 and 6201, introduced by House Health Policy Committee Chair Rep. Kathy Angerer (D-Dundee), that seek to change the scope of practice of chiropractors to include the entire body instead of just the spine and related areas. Among other things, the legislation seeks to change the existing language in the Michigan Public Health Code to expand chiropractic scope of practice from the "spinal column" to the "musculoskeletal system." TAKE ACTION NOW – Use the MSMS Action Center to send a message to members of the House Health Policy Committee, asking them to protect patients by voting "no" on HB 5759 and 6201.

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New AMA Pres Makes Pledge To Uninsured

American Medical Association President Nancy Nielsen last week during her inauguration speech at the annual meeting of the group promised to use "all of the power" of her position and the group "to let the nation know that we must cover America's uninsured," the Chicago Tribune reports.

According to the Tribune, Nielsen, only the second female president of AMA, will serve until next June during an "intense political year when health coverage is front and center," and, in "pressing for coverage for the uninsured, doctors expect that she will have a less adversarial relationship with the health insurance industry than her predecessors" because of her background. Nielsen, who has served as a primary care physician for more than 20 years, until last year served as chief medical officer for Independent Health and currently serves as the senior associate dean at the State University of New York-Buffalo School of Medicine and Biomedical Sciences.

Physicians also maintain that her background provides Nielsen with experience on the development of report cards used by health insurers to rate physicians on quality and patient safety measures. Nielsen said that she supports such report cards, although she wants physicians to have a larger role in their development. She said, "To be fair, some health plans have been fairly innovative and collaborative" in the development of such report cards, adding, "But it's time for all of them to be" (Japsen, Chicago Tribune, 6/22).

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Health Care Poses Challenge For Candidates

The major presidential candidates have made a number of promises on health care and other issues in their campaign speeches, but whoever "wins the White House this fall ... is likely to have a tough time enacting expensive new initiatives" because "tax collections are slowing, the budget deficit is rising and the national debt is approaching $10 trillion," the Washington Post reports. According to the Post, at the end of the fiscal year, the federal deficit will reach an estimated record high of $400 billion, and, without "major policy changes, Medicare and Medicaid are projected to devour half of all federal spending by 2050."

An analysis recently conducted by the Tax Policy Center found that the tax proposals of presumptive Democratic presidential nominee Sen. Barack Obama (Ill.) would reduce federal revenue by almost $900 billion during his first term. "That analysis excludes some expensive proposals, including promises to close the gap in prescription drug coverage for Medicare recipients (estimated to cost about $400 billion over 10 years)" and to "introduce government-funded health insurance for the uninsured (which the campaign estimates would cost as much as $65 billion a year)," among others, according to the Post.

The analysis also found that the tax proposals of presumptive Republican presidential nominee Sen. John McCain (Ariz.) would reduce federal revenue by more than $1.1 trillion during his first term. However, McCain has promised to "balance the budget ... by slashing spending projections for troops abroad, domestic programs and health care -- reductions unlikely to pass muster with a Democratic Congress" -- and has discussed the "need to reform Social Security, Medicare and Medicaid since the race began," the Post reports (Montgomery, Washington Post, 6/21).

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