Deval Patrick: Massachusetts Health Care Law Signed

A few days ago, Massachusetts Governor Deval Patrick signed into law one of the nation's strictest limits on gifts given to medical professionals by drug salespeople. Applauded by some and excoriated by others, the law attempts to curtail the influence of marketing in health care.

Hitting another health care issue near and dear to our hearts here at Health Care Reform Now!, it also supplies $25 million to promote the transition to electronic medical records. Other sections of the law give regulators the power to hold hearings over rises in health insurance premiums and also require the state university to increase the size of its classes in order to produce more primary care doctors.

Despite having more doctors per capita than anywhere else in the country, Massachusetts is still facing a shortage -- one predicted to worsen as more people gain insurance and enter the health care equation. This is a critical aspect of the big picture since primary care doctors are the ones who make the initial care decisions.

Still, with all the variety of measures embraced, the one which is causing the most stir is the limit on corporate gift giving. The pharmaceutical industry's trade group Pharma has stated that lawmakers could regret their efforts, citing the fact that it would create a chilling effect on researchers if their research grants were posted on a public listing of industry gifts.

Via Scott Allen at The Boston Globe:

[Sen. Mark] Montigny [New Bedford Democrat] had hoped that, after failing twice, he might succeed in banning gift-giving between salespeople and healthcare professionals altogether. However, representatives of the drug and medical device industry successfully argued that the measure went too far, potentially banning money paid to doctors and hospitals to conduct medical research. Though the Senate passed the full ban, the House backed only restrictions.

Still, the limits in the law put Massachusetts at the forefront of states in cracking down on the use of financial incentives to persuade doctors to prescribe particular drugs or medical devices. In addition to banning some gifts and requiring disclosure of others, it calls for the state to develop a code of conduct for industry representatives that includes a $5,000 fine for each violation.

The great experiment of Massachusetts continues!

SOURCE: "Leaders nip, tuck healthcare policy - Limits enacted on drug firm gifts" 08/11/08
photo courtesy of limako used under its Creative Commons license

Veterans Vs. The VA: Health Care Showdown

Vietnam. Iraq. Afganistan. Names that evoke a variety of emotion laden memories, and stridently held opinions.

Neil MacFarquhar of The New York Times tells us how these memories and opinions have entered the courtroom in a federal case pitting the Office of Veterans Affairs (VA) against Veterans for Common Sense and Veterans United for Truth. The reason for this face off? You guessed it, health care issues:

"Our ultimate goal is guaranteed health care, timely health care, timely decisions on disability payments," Gordon P. Erspamer, the lead lawyer representing the two veterans groups, said in an interview.

"The system is choking on the claims; the delays are unconscionable," Mr. Erspamer said.

The trial, before Judge Samuel Conti, an Army veteran of World War II, does not seek monetary damages but asks the court to appoint a special master or otherwise intervene to make the department run more efficiently.

Claims for help from the department jumped 25 percent in recent years, hitting 838,000, Richard G. Lepley said in his opening statement for the government.

The defense said the jump was generated by a combination of veterans returning from Iraq and Afghanistan, where head injuries that can lead to stress problems are a signature issue, as well as an upswing of Vietnam veterans seeking help for medical conditions associated with aging. News coverage from the current wars has also led to new mental health problems among Vietnam veterans, said Kerri J. Childress, a spokeswoman for the veterans department in Palo Alto, Calif.

So the aging of the Baby Boomers is creating one wave of new patients as the survivors of Vietnam begin retiring while another wave of young and injured soldiers is returning home from the Iraq/Afganistan theater of operations. Meanwhile, the VA is stuck in the middle and drastically understaffed.

Kerri J. Childress, a spokeswoman for the veterans department in Palo Alto, California, quoted the number of suicides among veterans over the past year at 6,600. That's 20% of all suicides, or one in every five suicides occurring in the United States. Combine that with extended wait times for treatment caused by lack of personnel and it paints a grim picture indeed for our soldiers.

Some of the statements made at the trial paint a grim initial picture of the VA defense:

The number — 126 suicides a week, higher than the 120 published in previous studies — was in a December e-mail message from Dr. Ira Katz, the head of mental health services for Veterans Affairs, to Dr. Michael J. Kussman, the under secretary for the Veterans Health Administration in the department. Mr. Erspamer displayed the message in his opening argument.

The department has long been reluctant to release specific numbers regarding suicides or suicide attempts, lawyers for the veterans groups said. "We certainly think there was a cover-up in some sense," said Heather Moser, a lawyer for the plaintiffs.

A second department e-mail message from Dr. Katz shown at the trial starts with "Shh!" and refers to the 12,000 veterans per year who attempt suicide while under department treatment. "Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?" it asks.

This is one story that bears watching.

SOURCE: "In Federal Suit, 2 Views of Veterans’ Health Care" 04/22/08
photo courtesy of Jurek D., used according to its Creative Commons license

Eight States to Sue Administration Over Child Health Care

As the time approaches for President Bush to veto the current SCHIP legislation, as he has repeatedly promised, the adversarial nature of the debate is turning litigious. Tom Hester at Newsday reports:

New Jersey on Monday joined seven states in filing separate lawsuits against the Bush administration's challenge of proposed federal rules the states say will force poor children to lose health coverage.

The lawsuit for New Jersey was filed Monday morning in federal court in Trenton, state Attorney General Anne Milgram said. New Jersey joins Maryland, Arizona, California, Illinois, New Hampshire, New York and Washington in filing similar litigation.

"The Bush administration has gone beyond its regulatory rights," New Jersey Gov. Jon S. Corzine said as he announced the lawsuit at an East Orange health center.

At the core of the conflict are rules issued by the Center for Medicare and Medicaid Services which the suits claim exceed the statutory authority set forth in Title XXI of the Social Security Act. The SCHIP legislation currently facing veto would remove these new strictures. What new strictures, you ask? Ralph Thomas at the Seattle Times brings us the following clarification:

Under the restrictions, before states can start enrolling kids above 250 percent of the poverty level, they must make sure they are covering at least 95 percent of kids at or below 200 percent of the poverty level.

[Washington State Governor] Gregoire said no state has been able to reach that mark. She said Washington has one of the nation's highest coverage rates, at about 91 percent.

"We just do not believe that is achievable and in fact was put in place to guarantee that we couldn't go above 250 percent of poverty," she said.

The restrictions also require new enrollees above 250 percent of the poverty level to go a year without insurance before they could enroll in SCHIP.

These strictures are being cast as beyond the legal limitations on federal power, and more states continue to bring suit agaisnt them.

"The federal government lacks the authority to do what it is trying to do," [NJ Attorney General] Milgram said, adding that New Jersey's plan has been approved eight times, including five times by the Bush administration.

[New Jersey Gov. Jon S.] Corzine has said the rules could risk health insurance coverage for 10,000 New Jersey poor children.

SOURCE: "8 States Sue Bush Over Children's Health Insurance" 10/01/07
SOURCE: "State to Sue Feds Over Childrens Health Insurance" 10/02/07
photo courtesy of Scott Ableman