Pulling a Condi By Ross at 12:33 PM
The game of gotcha over the true cost of the Medicare Modernization Act is getting even uglier, thanks to the White House "pulling a Condi" with their highest-ranking health care staffer.
A senior White House official and the former Medicare administrator, central figures in a controversy over the cost of the new prescription drug law, declined to appear before a House committee Thursday, defying Democrats who had sought their testimony. .... Citing executive privilege, the White House refused to send Doug Badger, special assistant to the president for health policy, to testify before the House Ways and Means Committee. The former Medicare administrator, Thomas A. Scully, who no longer works for the government, wrote the committee a letter saying he had been busy traveling and would be "unable to appear." .... The development infuriated Democrats, who are trying to investigate accusations by the chief Medicare actuary, Richard S. Foster, that Mr. Scully, as administrator, threatened to fire him if he shared his prescription-cost estimates with Congress last year, before the legislation was enacted. Mr. Foster has suggested that Mr. Scully was acting on orders from the White House, possibly from Mr. Badger. .... On Thursday, Mr. Doggett called Mr. Badger "the Condoleezza Rice for health care."
Ouch.
Incidentally, I never thought "pulling a Condi" could be used in situations often enough to merit consideration for widespread use. But the White House, knowing a losing PR strategy when they see one, doesn't hesitate to pull the same bonehead play out of their playbook.
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Thursday, April 01, 2004
Measles: The Continuing Story of the Iowa Importation By Ross at 12:23 PM
You may recall the story from earlier this month, where an unvaccinated college student, exposed to measles while abroad in India, ignored requests of public health officials and returned home via airplane (India to the Netherlands to Detroit to Cedar Rapids, Iowa), potentially exposing hundreds of people to the measles along the way.
The Desmoines Register reports on further developments in that case:
State health officials are scrambling to prevent the spread of measles, a highly contagious and potentially fatal disease that most Iowans haven't given a second thought since they or their children were vaccinated.
Dr. Patricia Quinlisk, state epidemiologist, said two cases of measles have been confirmed in eastern Iowa. A possible third case is being investigated.
"This is a disease that scares us," Quinlisk said Monday. "This is not a mild disease that you say, 'Oh well.' It's one we want to make sure doesn't spread."
It started with a measles sufferer flying on a plane to Cedar Rapids on March 12. Eight days later, one of the other passengers started feeling ill. Even though they had been notified of their exposure to measles, they didn't worry because they had been vaccinated.
Between March 22 and 24, while the second person was contagious, they potentially exposed hundreds of other people, visiting Coral Ridge Mall, Iowa City's downtown pedestrian mall and University of Iowa medical and dental clinics, health officials said.
Neither person has been identified by health authorities.
Public health officials have sent warnings to doctors, searched for people who have might been exposed and are considering requiring home quarantines.
Boston cops in the midst of interviewing victims of a scam involving SARS research in China lucked into an arrest yesterday when one witness pointed out the alleged culprit bickering with another mark in the Dana-Farber Cancer Institute cafeteria, police said.
The former Dana-Farber researcher and Harvard University professor allegedly bilked 35 students, co-workers, friends and Internet pals out of $600,000 he claimed would help launch a SARS research institute in China.
"These are co-workers who trusted him and believed in him and took him for his word,'' said Boston police Detective Steve Blair of the major case unit.
Weldong Xu, 38, began the scam in July - at the height of the SARS scare - convincing mostly Asian acquaintances to lend him money for the research center, police said.
One friend took a second mortgage out on his home to give Xu the money. Xu was busted arguing with another man who had given him $5,000, police said.
Xu admitted to detectives he took the money and handed over a notebook that contained information about the donors.
Dana-Farber officials alerted police to the possible theft recently after Xu, a cancer and AIDS researcher since 1999, was terminated for an unrelated reason.
Dana-Farber and Harvard officials, who police said knew nothing of the scam, could not be reached for comment.
But in a twist happy ending almost too good to be true, the scammer was hoist with his own petard:
Xu claims he used the money to invest in a questionable Nigerian business offer he received via e-mail that promised a $50 million profit.
"The scammer's been scammed,'' Blair said.
"He wouldn't acknowledge he'd been scammed. I tried to tell him he'd been scammed, but he never caught on.''
As an example of Jordan's great work, check out his post from late last week on how a major occupational safety organization, by following the public health flavor of the day and focusing their big public service campaign on obesity, missed a golden opportunity to bring greater attention to workplace safety issues.
Every year the American College of Occupational and Environmental Medicine (ACOEM) identifies a topic for its "Labor Day Checklist" which is designed to provide "quick tips on a timely topic to improve the health and safety of workers, the workplace, and the environment." In past years, ACOEM has chosen hearing loss, occupational asthma, eye safety, communicable diseases, back injuries and ergonomics. Not a bad list.
So what to choose this year? It's probably not an easy decision. Look around. We have an epidemic of immigrant worker death, injury and illness. Asbestos-related illness remains a serious nationwide problem, and millions of workers face harmful exposure to toxic chemicals about which we know very little. Year after year, OSHA "enforces" the same forty year old chemical standards for a tiny fraction of the chemicals used in this country. Meanwhile, OSHA, the only government agency charged with enforcing safe workplace conditions is rapidly turning into a poorly funded business consulting association while thousands of workers die every year from perfectly preventable "accidents."
So what should ACOEM choose for its 2004 Labor Day list? So much to choose from. So few opportunities to make a splash. Definitely not an easy decision.
Or maybe it can be an easy decision. Why not just peruse the news and see what's popular these days? How about OBESITY? Yeah, that's the ticket.
Congratulations, Jordan, and thanks for bringing your passion, compassion and humor to bear on such vital concerns.
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Saturday, March 27, 2004
Tort Reform: The Texan's Tall Tales By Ross at 2:59 PM
As we're all too well aware, the Bush White House strategy for policy change revolves around the President and other High Ranking Officials repeating something with conviction at every possible opportunity, in an effort to get it burned into peoples' brains. As Frank Rich describes the Administration's history of "infoganda" (thanks to the Daily Show's Rob Corddry for that perfect term):
There's no point in bothering with actual news people anyway, when you can make up your own story and make it stick, whatever the filter might have to say about it. No fake news story has become more embedded in our culture than the administration's account of its actions on 9/11. As The Wall Street Journal reported on its front page this week — just as the former counterterrorism chief Richard Clarke was going public with his parallel account — many of this story's most familiar details are utter fiction. Mr. Bush's repeated claim that one of his "first acts" of that morning was to put the military on alert is false. So are the president's claims that he watched the first airplane hit the World Trade Center on TV that morning. (No such video yet existed.) Nor was Air Force One under threat as Mr. Bush flew around the country, delaying his return to Washington.
Yet the fake narrative of 9/11 has been scrupulously maintained by the White House for more than two years. Although the administration has tried at every juncture to stonewall the 9/11 investigative commission, its personnel, including the president, had all the time in the world for the producer of a TV movie, Showtime's "DC 9/11: Time of Crisis." The result was a scenario that further rewrote the history of that day, stirring steroids into false tales of presidential derring-do. Kristen Breitweiser, a 9/11 widow, characterized one of the movie's many elisions in Salon. To show the president continuing to sit and read with elementary school kids "while people like my husband were burning alive inside the World Trade Center towers," she wrote, "would run counter to Karl Rove's art direction and grand vision."
More often than not, the infoganda foisted by the Administration upon the public is flat-out wrong, and at the same time wildly successful.
In the tort reform debate, the early mantra was: tort reform = health insurance coverage. Cap damages now, and we can make sure people can afford to keep their health insurance.
It was thought that this message would get hammered home during Bush's State of the Union Address, as the Republicans prepared to mount another charge up the Hill to get a medical malpractice damage cap passed after failing last summer.
But then, on January 8, the Congressional Budget Office came out with an Economic and Budget Issue Brief titled Limiting Tort Liability for Medical Malpractice (pdf file). In that report, the CBO said the following:
Savings [from capping malpractice damage awards] would not have a significant impact on total health care costs, however. Malpractice costs amounted to an estimated $24 billion in 2002, but that figure represents less than 2 percent of overall health care spending. Thus, even a reduction of 25 percent to 30 percent in malpractice costs would lower health care costs by only about 0.4 percent to 0.5 percent, and the likely effect on health insurance premiums would be comparably small.
In other words, tort reform does not equal health insurance coverage.
In the State of the Union Address, Bush carefully backed away from claiming that tort reform would improve health insurance coverage:
On the critical issue of health care, our goal is to ensure that Americans can choose and afford private health care coverage that best fits their individual needs. To make insurance more affordable, Congress must act to address rapidly rising health care costs. Small businesses should be able to band together and negotiate for lower insurance rates, so they can cover more workers with health insurance. I urge you to pass association health plans. I ask you to give lower-income Americans a refundable tax credit that would allow millions to buy their own basic health insurance.
By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care. To protect the doctor-patient relationship, and keep good doctors doing good work, we must eliminate wasteful and frivolous medical lawsuits.
("Applause" parentheticals redacted)
Donald Johnson at The Business Word has alerted me that Bush is once again trotting out the lies (either that, or some very bright people like Donald are woefully or willfully misinterpreting Bush's remarks):
Bush: Malpractice suits cause health care costs to soar; slow hiring
President Bush blamed trial lawyers for both the rapid rise in health care costs, which, in turn, are one reason for slower than expected hiring of more workers.
To a degree, he's right. Tort reform would slow the rate of growth in health care costs, and a slower rate of growth would slow the rate of increase in the number of uninsured.
Here are a few impact graphs from CBSMarket Watch:
"The costs of health care, the rising costs of health care, for a lot of reasons, are affecting the ability of the Pattys to be able to be comfortable in her relationship with her employees and expand her business," Bush said, referring to participant Patty Orzano, who owns a 7-Eleven franchise in Massapequa, N.Y.
As part of his six-point plan for the economy, Bush wants Congress to pass legislation that would limit the amount of damages health care companies found guilty of malpractice would have to pay to victims.
"For the sake of good health care, for the sake of job creation, for the sake of expanding -- an expanding economy, we need medical liability reform now," Bush said.
There are some colorable arguments that can be made in favor of tort reform, but making health insurance premiums meaningfully more affordable isn't one of them. But as with so many issues under this Administration, that won't stop the claim from being made until it becomes the "reality" of the tort reform debate.
A few years ago, the conventional wisdom was that the Internet was going to undermine the power of states, and empower private actors (firms, individuals) in their stead. Sometime Conspirator David Post co-wrote a classic paper arguing that because the Internet crossed national borders, it would be very hard to apply traditional nation-state based law to it. Instead, we'd likely see individuals creating their own forms of law-like order on the Internet, through self-regulating groups and the like. This isn't a very popular argument these days - critics (including Dan Drezner and I) point to an abundance of evidence that states are still in the driving seat.
Still, the jurisdictional problems that David Post and others talked about haven't gone away. States still have problems in regulating certain Internet activities, because they disagree on fundamental issues of regulation. In the case at hand, the US banned its citizens from Internet gambling. However, because Antigua and other countries didn't join the US in banning it (they saw it as a way to make lots of money), US citizens with access to the WWW could evade the law by gambling at offshore locations. For various reasons, it's exceedingly difficult for the US directly to block access to these sites.
Faced with this problem, certain authorities within the US decided on an unorthodox solution. They couldn't shut down offshore gambling sites or prevent US citizens from accessing them. What they could do was to hold credit card companies and banks - which had been a crucial intermediary between gambers and offshore gambling sites - responsible as accessories. The New York state attorney-general's office was especially zealous in prosecuting financial intermediaries, although in fairness, many banks and credit card agencies were happy to comply for their own reasons. US credit card companies started to refuse transactions with offshore gambling websites. This sent Antigua's gambling industry, which relied heavily on US customers, into a tailspin. Hence Antigua's successful WTO action against the US (which is about to be appealed to a disputes panel).
It's a nice case-study in the modern politics of the Internet.
I agree. Read the whole thing for the rest of Henry's outstanding analysis, and for his use of the term "cock a snook."
This is an issue I've written about (both here and on paper) as a possible way the US government could rein in the Internet pharmacy trade; however, the WTO's ruling could throw a monkey wrench into such a plan.
Matthew Holt has an outstanding post describing the 36 million Americans (nearly half of whom have health insurance) who have no basic access to health care.
I'm very familiar with the facts and laws surrounding domestic violence, and know that often times domestic violence begins with pregnancy, and that the number one killer of pregnant women is domestic violence.
However, I'll give a gold star to the first person who can explain how, exactly, this law will decrease violence committed against pregnant women by a single case.
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Aggregation, Baby! Aggregation... By Ross at 10:37 AM
Tony Kornheiser, the host of the greatest daily sports radio show around (although it was rarely about sports), has just signed off the air. Does anyone know if the new Progressive Radio Network kicking off next week has contacted him yet? He'd make an outstanding addition to their lineup.
RSS: Feed Me Again! By Ross at 12:57 PM
I'm not the most technologically savvy person, but I'm techno-curious, and I'm always trying to offer better free ice cream to my readers, so:
Does anyone have recommendations on a good free RSS Feed I could add to The Bloviator?
Also, does anyone know of a way to add a free news aggregator to this page that would allow new health-related news story headlines to appear (say, in the left hand column)?
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Remaking the CDC By Ross at 12:39 PM
In the wake of the anthrax attacks on the U.S. and the creation of the Department of Homeland Security, many questions have been raised about the mission and makeup of the Centers for Disease Control and Prevention. Under Director Julie Gerberding, the agency has been taking a hard look at itself, and soon, she will be revealing her vision for the future of the nation's highest public health authority.
I received the following news from the CDC's health law folks about the process:
This month, an army of CDC administrators, scientists, and planners is crowding into committee rooms all over the agency?s Atlanta campuses. They are on orders from CDC Director Julie L. Gerberding to create a set of strategic recommendations for the agency's future and deliver them to her by March 31. After that, Gerberding is expected to announce her decisions on the Futures Initiative, a new strategic plan for CDC. "The primary motivation for the Futures Initiative was the belief that by modernizing its strategy, CDC could enhance its overall impact on the health status of Americans," Gerberding said. The committee meetings are the culmination of six months of planning activity at the agency as it solicited hundreds of suggestions from employees, stakeholders, and external and federal business partners, including its parent agency, the U.S. Department of Health and Human Services. If successful, the Futures Initiative will increase CDC?s ability to help communities prepare themselves against infectious, environmental, and terrorist threats, and will bolster the agency's health promotion and prevention efforts. Implementation of the Futures Initiative will begin in April.
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