Consumer Power Report Preventive Rationing?

Reuters reports:

U.S. men who have surgery for prostate cancer seem to fare better if they have private insurance rather than public coverage through Medicare or Medicaid, a new study finds.

Researchers determined that among more than 61,000 men who had their prostates removed to treat cancer, those with private insurance had fewer complications from surgery and were less likely to die in the hospital.

Men covered by Medicare or Medicaid were more likely to need a blood transfusion to treat blood loss: almost eight percent and 11 percent, respectively, had a transfusion, compared with just over five percent of men with private insurance.

Their overall risk of surgical complications was also higher, researchers report in the journal Cancer.

After surgery, 13 percent of Medicare patients had a complication, such as heart or breathing problems or incontinence. That compared with just under 10 percent of men with private insurance.

There were similar gaps when the researchers looked at men covered by Medicaid, the government insurance program for the poor: 13 percent had some type of post-surgery complication.

Few men in the study died, but the risk was higher for those on Medicaid, 0.3 percent of whom died in the hospital.

Linda Gorman has a useful report on Medicaid block grants, outlining some key facts about waiver requests and the costs per enrollee.

State and local government Medicaid spending is projected to rise rapidly from $130 billion in 2009 to $357 billion by 2020. Federal Medicaid spending is projected to increase from $254 billion in 2009 to $574 billion by 2020. Total Medicaid spending is expected to rise to $930 billion by 2020 and will account for 20 percent of all U.S. health expenditures.

There are two major reasons for this growth. One is that the federal government matches all state spending on federally allowed Medicaid services. This encourages excess spending. The second reason is the program’s complexity. There are seven specific groups of people that state Medicaid plans must cover, and any combination of nine optional populations states have the option to cover. There are 13 mandatory service categories that must be covered and states can add any combination of 17 optional services.

States can also apply for federal Medicaid waivers that allow them to test policy innovations, to limit enrollees’ choice of individual provider, and to provide long-term care services in a community setting.

Waivers, state spending differences, coverage of mandatory and optional populations and services combine to ensure that no two states have exactly the same Medicaid program. For example, as of July 2007, maximum annual income Medicaid eligibility thresholds for a family of three with one working parent ranged from $3,360 in Louisiana to $47,232 in Minnesota. Medicaid payment rates also vary. In 2001, for example, fees to a physician performing an appendectomy ranged from $160 in New York to $799.87 in Nevada. Thus, the average cost per Medicaid enrollee was $5,163 in 2007, but varied from $3,168 in California to $8,796 in Rhode Island.

This is very depressing news.

At a time when many infectious diseases are making a comeback, about 13% of parents are skipping or delaying their children’s immunizations and following an “alternative” vaccination schedule that puts kids at serious risk, a new study says.

And many parents who follow their pediatricians’ advice have doubts about vaccines’ safety, according to a study in Monday’s Pediatrics. For example, even among parents who fully vaccinate their children, 28% believe that an alternate schedule — which spaces out vaccines to avoid giving several shots at once — is safer, the study says.

Health officials are concerned about the trend. Unvaccinated people have fueled an outbreak of measles, which sickened nearly 200 people in the first eight months of this year, according to the Centers for Disease Control and Prevention. The USA also has battled outbreaks of whooping cough and mumps in the past two years.

The study’s results reflect widespread skepticism and confusion about vaccine safety, fueled partly by a 1998 study in The Lancet linking vaccines to autism that has since been revealed to be fraudulent, says Ari Brown, a doctor and spokeswoman for the American Academy of Pediatrics. “I was stunned at the high number of parents who choose a selective vaccination schedule,” she says. “That number is much higher than the number of parents who do this in my office.”

In Science, Andrew Grove, former CEO of Intel, writes in support of Heartland’s Free to Choose Medicine approach to FDA reform.

The biomedical industry spends over $50 billion per year on research and development and produces some 20 new drugs. One reason for this disappointing output is the byzantine U.S. clinical trial system that requires large numbers of patients. Half of all trials are delayed, 80 to 90% of them because of a shortage of trial participants. Patient limitations also cause large and unpredicted expenses to pharmaceutical and biotech companies as they are forced to tread water. As the industry moves toward biologics and personalized medicine, this limitation will become even greater. A breakthrough in regulation is needed to create a system that does more with fewer patients.

Avik Roy outlines questions on health care for each candidate. I wish someone would actually ask these! The one for Santorum is particularly good. But here are the ones for the current top three candidates in the RCP average of national polling.

Governor Romney: You’ve repeatedly stated that the individual mandate is needed as a matter of “personal responsibility” so that taxpayers aren’t paying for the care of others. But in Massachusetts, under your plan, the state has reduced uncompensated care by $250 million a year, and increased insurance subsidies by over $800 million a year. Doesn’t that mean that, under your plan, there are more free-riders today than there were before?

Governor Perry: You believe that states could do a better job of running Medicare and Medicaid than Washington does. But Texas has the highest proportion of uninsured residents in the United States. If Washington wasn’t standing in your way, how would you achieve universal coverage in Texas?

Mr. Cain: You haven’t spoken at all about what you would do to rein in Medicare and Medicaid spending. Where do you believe that entitlement reform ranks in terms of priorities for the new President? If you believe it ranks highly, why have you not proposed a single idea to address the problem?

Drugmakers fear becoming “captive suppliers” for distressed governments.

When cash-strapped Greece last year told Danish drug maker Novo Nordisk A/S it planned to cut the prices it paid for certain insulins by more than a quarter in an effort to slash its spending, Lars Rebien Sorensen, the company’s chief executive, responded by halting deliveries of the products.

The cut-off lasted a few weeks, until Greece agreed to less-hefty price reductions. Novo Nordisk continued supplying lower-cost insulin to the country throughout, and says the insulin it stopped shipping was never in short supply because Greek pharmacies had reserves.

But the decision didn’t endear Mr. Sorensen to Greeks or pharmaceutical-industry watchers, who blasted the company on blogs and diabetes-themed Web sites, calling the move “brutal blackmail” and a “violation of corporate social responsibility.” Some Novo Nordisk employees also raised concerns, Mr. Sorensen said during a weekend interview in London. Like many companies in Scandinavia, Novo Nordisk says it has a strong commitment to ethics. “How can this be patient-oriented?” he recalls some of his employees asking of the Greek situation.

The 57-year-old Dane says he went to “great lengths” to explain the company’s position, replying to letters of complaint from distressed patients and also interacting with his own employees. Novo Nordisk, he says, cannot be a “captive supplier.”