Public support for universal health insurance is declining, according the latest New York Times/CBS News Poll. About half (51%) said the federal government should guarantee health insurance for all Americans, down slightly from 55% in July and 64% in June. Support for universal health insurance drops to 38% if it is suggested that the cost of health insurance would increase, and to 36% if taxes went up. In addition, only 33% said the United States should guarantee health insurance for all its citizens if the federal budget deficit would increase as a result.
Medical professionals say the fundamental problem in the nation's healthcare system is the widespread misuse and overuse of tests, treatments, and drugs that drive up prices, have little value to patients, and can pose serious risks. They say the question is not whether there will be rationing, but rather what will be rationed, and when and how. "More is not necessarily better," Bernard Rosof, chairman of the board of directors of New York's Huntington Hospital and a board member of the independent National Quality Forum, told the Washington Post. "In many cases, less is better."
Carolinas HealthCare System and Novant Health Inc. will not allow visitors under 18 at their Charlotte-area hospitals in an effort to safeguard patients, staff members, and adult visitors from H1N1. Officials at the healthcare systems are providing the same guidance to their affiliated regional hospitals in North Carolina and other states in response to concerns about the H1N1 virus.
Kaiser Permanente announced that a unit of the federal Department of Health and Human Services has given it a $1 million, three-year grant to help fund its internal Simulation Program, which lets nurses and other caregivers practice life-saving skills and decision making in a simulated environment. The grant allows Kaiser to open its new Medical Simulation Lab at its new Broadway Medical Office Building in Oakland, part of its Oakland Medical Center campus, which is being expanded and upgraded for seismic and other reasons.
While attention will be focused this week on the Senate Finance Committee healthcare reform hearings, work on reform legislation also has been proceeding on the other side of the Capitol.
House leaders are meeting behind closed doors this week to iron out—and eventually prepare for the House floor— provisions in the tri-committee versions of the House's reform measure, HR 3200.
Unlike the Senate panel, there will be no arguing over inclusion of a public insurance option—because it is already found in the bill. At her weekly press conference, House Speaker Nancy Pelosi (D-CA) reaffirmed her support for a public option, calling it "the strongest lever one can use to get the best possible outcomes."
However, there are still questions about what to pay providers in a public plan, an issue which is likely to come under intense discussion throughout the week.
The initial House bill called for a public plan that would pay providers 5% over Medicare reimbursement rates. However, in negotiations in July with the self-described fiscally conservative Blue Dog Democrats, the House Energy and Commerce Committee approved an amendment that requires the Department of Health and Human Services (HHS) Secretary to negotiate rates with providers.
Overall, that version of the plan will save $25 billion over a 10-year period. However, early estimates by the Congressional Budget Office (CBO) found that the initial formula would save approximately $85 billion over that 10-year period.
The House leaders are paying close attention to these numbers as they seek to whittle down the 10-year projected cost of the healthcare reform plans from $1.1 trillion to $900 billion—as requested earlier in the month by President Obama.
To pay for reform provisions, the House Ways and Means Committee proposed a surtax on upper income taxpayers those individuals with more than $250,000 annual income and couples earning $350,000 a year or more. However, amid protests that the surtax could impact individuals in high cost states, such as California and Illinois who are not really rich, Pelosi has suggested that the income threshold could be raised to $500,000 for individuals and $1 million for couples.
However, more revenue may be needed. Pelosi said last week that another option taxing insurance companies that offer expensive health policies known as "Cadillac" plans—might be considered. With the current provision found in the Senate Finance bill, a 40% tax would be placed on insurers offering plans valued at $21,000 for families and $8,000 for individuals.
This tax, though, is likely to meet opposition from labor groups, for instance, who say that the higher-priced insurance policies are sold to companies with employees who are involved in high risk occupations or who had given up higher pay for better benefits.
For anyone focused on the corporeal side of medicine, it's always a grim reminder to see just how much of the healthcare bill stems from treatment of maladies of the mind.
A report from the federal Agency of Health Research and Quality analyzed numerous research papers published in the last three years to conclude that mental disorders, including violent behavior between intimate partners, were one of the five most costly conditions in the U.S. in 2006.
In its analysis, the agency makes the following points in a series of bulleted items based on published research during the last three years:
One in four adults in the U.S. suffers from a mental disorder in any given year, and one in 17 suffers from a serious mental illness, which typically takes a toll on overall health leading to death 25 years earlier than for those in the general population.
Care for mental disorders rose from $35.2 billion in 1996 to $57.5 billion in 2006.
Substance abuse and domestic violence affect nearly one in three U.S. adults. About 1.3 million women are abused physically by their intimate partners each year. And of those women who seek care in hospital emergency rooms, one in four has an injury related to domestic violence. More than one in four men have been victims of intimate partner violence in their lifetime. An estimated 551,000 older adults are victims of family abuse or neglect.
One million abused children are identified each year, with 1,500 dying of abuse and neglect. Abused children are more likely to have behavior problems, developmental delays, and school failure.
Those who have been abused are more likely to be depressed, have issues with substance abuse, attempt suicide, and those who are women have poor pregnancy outcomes.
Settings where patients are treated for these illnesses are changing. Primary care clinicians instead of psychiatrists are more likely to diagnose and treat children and adults, and "telepsychiatry and new medications are extending the reach and type of treatment available."
Access to mental health care is an ongoing problem, especially for people in rural or frontier areas of the country. And many of those who know they should seek help don't do so because of inability to pay, belief that the problem will go away or lack of time.
In a second category of research, the agency looked at access to care and cost of care issues as they relate to mental health. It concluded that the cost of treatment for mental health issues is not well appreciated. For example, individuals nationwide spent an average of 10% of family income out-of-pocket for mental health or substance abuse treatment.
The report contains significant findings important findings in a series of bullets on access and cost of care:
The five most costly children's conditions in 2006 were mental disorders, asthma, trauma disorders including fractures, acute bronchitis and infectious diseases. Treating depression and other mental illnesses in children cost $8.9 billion compared with $8 billion for asthma and $6.1 billion for trauma-related disorders. And Medicaid paid for more than one third the bill for mental disorders although private insurance paid the largest percentage.
The number of people using services for mental disorders nearly doubled from 19.3 million to 36.2 million from 1996 to 2006.
People with psychotic and bipolar disorder are 45% and 26% less likely, respectively, to have a primary care doctor than those without mental disorders. Those with psychotic, bipolar or major depressive disorders had 2.5 to 7 times greater odds of any barriers to care. For example, they are more likely to delay care or get a needed prescription filled.
States have a wide variation in allowing people with mental illness to be admitted to nursing homes. For example, homes in Connecticut, Ohio, and Massachusetts had the highest rates of admission for such patients while homes in Wyoming, Nevada, Arkansas, and South Dakota had the lowest.
As part of the effort to change the nation's $2.6 trillion healthcare system, President Obama has proposed expanding comparative effectiveness research as a way to lower costs. Private medical groups, including Kaiser Permanente and the Mayo Clinic, have been comparing procedures for years. Because of studies conducted by the organization, Kaiser estimates that it saved $550,000 from 2001 through 2008 by reducing the number of joint replacement surgeries that had to be performed again.
The Tennessee Department of Human Services said it accidentally sent the wrong fax number to 100 medical providers across the state, leading them to erroneously send sensitive patient information to an Indiana businessman. Bill Keith, owner of SunRise Solar Inc. in Indiana, has been receiving hundreds of confidential medical faxes from doctors' offices and other medical providers in Tennessee for three years. The state sent an e-mail blast to 29,000 medical providers with the correct toll-free fax information on Sept. 28.
About 50 patients affected by the planned closing of Atlanta-based Grady Memorial Hospital's outpatient dialysis clinic will receive three months of treatment at Fresenius Medical Care at no cost to them. The costs will be picked up by the Grady Memorial Hospital Corporation while other arrangements are worked out. The outpatient clinic is expected to close at the end of business on Oct. 3. The clinic is outdated, and loses between $2 million and $4 million a year, Grady officials have said.
In the latest Wall Street Journal/NBC News poll, half of 18- to 34-year-olds said they support a public insurance option, with 43% opposed. It was the only age group in which more respondents supported than opposed a public option. But the poll suggested many young adults didn't know what was in the legislation, with 48% saying they didn't understand or understood only somewhat what was being debated.
