Archive for November, 2009
Some experts challenge White House claims of health reform cost savings
WASHINGTON – One of the White House’s biggest boasts about the health care legislation now moving through Congress is that it should reduce health care costs for both government and society.
Many prominent experts are skeptical, however, and some say that the Obama administration is wrong.
“There are no provisions to substantively control the growth of costs or raise the quality of care. So the overall effort will fail to qualify as reform,” Dr. Jeffrey Flier, dean of the Harvard Medical School, wrote in the Wall Street Journal on Nov. 18. “In discussions with dozens of health care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health care spending rather than restrain it.”
Most Capitol Hill Democrats cheered last week when the nonpartisan Congressional Budget Office estimated that the Senate bill, which lawmakers will begin to debate next week, should reduce federal budget deficits by $130 billion over the next 10 years and perhaps more after 2020, even as its costs are put at $848 billion over a decade.
Embedded in the CBO’s analysis were a lot of blinking yellow lights, however. The CBO figured that deficits would drop by $136 billion from 2010 to 2014, as tax increases go into effect but major health care changes don’t. However, once the policy changes start kicking in, beginning in 2014, the CBO estimated that the deficit would rise by about $6 billion over the next five years.
From 2020 to 2029, while the CBO said that health care savings should cause deficits to drop sharply, it also warned that any precise forecasts “would not be meaningful because the uncertainties involved are simply too great.”
As a result, “the honest answer is that nobody knows” whether meaningful savings are possible, said Robert Bixby, the executive director of the Concord Coalition, a bipartisan budget watchdog group.
Many of the same uncertainties cloud the nearer-term picture. Analysts ask how anyone can calculate patients’ medical needs in the future. Will the bulging, aging baby-boomer population create new strains on doctors and hospitals? What kind of medical advances could bring down costs – or increase them?
Those are just the health-related questions. Who’ll be president beyond 2012? Which party will control Congress? How will the economy perform?
“The problem is that historically, Congress has not been able to keep its word on constraining costs,” said Amitabh Chandra, a professor of public policy at Harvard University’s John F. Kennedy School of Government.
None of these questions is stopping the Obama administration and its supporters from insisting that health care costs can be brought under control.
Robert Greenstein, executive director of the Center on Budget and Policy Priorities, a liberal research group, called the bill “a stark and welcome change” because of its attempts to balance spending and revenues.
Other analysts, though, say that supporters lack strong answers to the most vexing questions.
Foremost is the future of the government-run health insurance plan, or public option, that would compete with the private sector. The Senate bill would permit states to opt out of the program.
The CBO predicted that the public plan is likely to charge higher premiums than private competitors do, as it absorbs consumers that private insurers don’t want. After the plan gets government start-up money, premiums are supposed to cover costs.
But, said Sen. Blanche Lincoln, D-Ark., “If in fact premiums don’t cover the cost of the public plan, it is taxpayers in this country who are faced with the burden of bailing it out.”
That raises another question: What if more people sign up than expected? How many people would need government subsidies, which are to go to those who earn less than 400 percent of the poverty level, or currently about $88,000 for a family of four? If the economy turns sour, the cost of that aid could soar.
The Obama administration says that savings would come not only from tax increases, but also from a series of changes in how doctors, hospitals and other health care providers are reimbursed. The public option would negotiate rates with providers, presumably resulting in rates that don’t grow more than the rate of inflation, rates that private insurers could be compelled to adopt.
The White House also cites three other major proposed changes in the way that doctors, hospitals and other providers are paid that could yield savings: more electronic record-keeping; new ways of promoting quality care; and an Independent Medicare Advisory Board that would recommend changes aimed at limiting the program’s growth.
El Dorado H1N1 clinic set
The El Dorado County Health Services Department will hold its first community flu shot clinic offering the H1N1 vaccine.
The clinic for high-risk individuals is scheduled from 1 to 3:30 p.m. Dec. 2 at the El Dorado County Fairgrounds, 100 Placerville Drive, Placerville.
The vaccine is offered free of charge and will be administered based on availability. Additional clinics will be scheduled as more vaccine is received, according to a county Health Department news release.
Individuals targeted to receive the vaccine at the Dec. 2 clinic include pregnant women; household contacts and caregivers of infants younger than 6 months; people 6 months through 24 years old; people 25 through 64 who have medical conditions that put them at risk for flu-related complications; and health-care workers and emergency medical personnel.
For updated information on H1N1 flu, see the Web site at www.edcgov.us/publichealth.
Severed leg in Sutter now probed as discarded medical waste
Sutter County authorities said Tuesday that a severed leg found Sunday near a popular Feather River destination apparently had been removed in a medical procedure.
As a result of tests by a forensic pathologist and other examiners, what began as a homicide investigation has turned into a probe into the possible disposal of a medical specimen.
Sutter County sheriff’s investigators Tuesday contacted hospitals and surgical centers in the Yuba and Sutter County region, but they were unable to determine where the leg may have come from.
The severed limb was found at the base of a levee near “Beer Can Beach,” a river destination at Garden Highway and Lee Road.
Authorities announced that they would be expanding their search to other medical facilities in the Central Valley.
The Sheriff’s Department said some hospitals retain human material in a frozen state for up to six months before disposal.
Meanwhile authorities searched the river region Tuesday with boats, divers and aircraft for additional clues.
Sacramento County H1N1 vaccination clinics
Tuesday marked the last day that Sacramento County’s free H1N1 vaccination clinics were limited to high-risk groups. The flu clinics that resume next week are open to all county residents.
The county has changed some locations and dates from its previously published schedule. Here is an updated list of clinics through mid-January.
• Monday: 3-7 p.m., Scottish Rite Masonic Center, 6151 H St., Sacramento.
• Tuesday: 3-7 p.m., North Highlands Community Center, 6040 Watt Ave., North Highlands.
• Dec. 2: 4-8 p.m., Isleton Elementary School, 412 Union St, Isleton.
• Dec. 3: 10 a.m.-2 p.m., Samuel Pannell Community Center, 2450 Meadowview Road, Sacramento.
• Dec. 5: 10 a.m.-2 p.m., American River College, 4700 College Oak Drive, Sacramento.
• Dec. 7: 3:30-7 p.m., Sheldon High School, 8333 Kingsbridge Drive, Sacramento.
• Dec. 9: 3:30-7:30 p.m., Maita Toyota, 3800 Florin Road, Sacramento.
• Dec. 10: 10 a.m.-2 p.m., Citrus Heights City Hall, 6237 Fountain Square Drive, Citrus Heights.
• Dec. 11: 3:30-7:30 p.m., Florin High School, 7956 Cottonwood Lane, Sacramento.
• Dec. 12: 10 a.m.-2 p.m., Franklin High School, 6400 Whitelock Parkway, Elk Grove.
• Dec. 14: 3-7 p.m., Mesa Verde High School, 7501 Carriage Drive, Citrus Heights.
• Dec. 15: 3-7 p.m., Folsom High School, 1655 Iron Point Road, Folsom.
• Dec. 16: 10 a.m.-2 p.m., St. Rose Parish, 5961 Franklin Blvd., Sacramento.
• Dec. 17: 3:30-7:30 p.m., Sacramento High School, 2315 34th St., Sacramento.
• Dec. 18: 3:30-7:30 p.m., Encina High School, 1400 Bell Ave., Sacramento.
• Dec. 21: 3:30-7:30 p.m., Rosemont High School, 9594 Kiefer Blvd., Sacramento.
• Dec. 22: 3-7 p.m., Natomas High School, 3301 Fong Ranch Road, Sacramento.
• Dec. 28: 10 a.m.-2 p.m., Robertson Community Center, 3525 Norwood Ave., Sacramento.
• Dec. 29: 10 a.m.-2 p.m., Sears-Florin Mall Drive-Through, 7000 65th St., Sacramento (no walk-ins, vehicles only).
• Dec 30: 10 a.m.-2 p.m., St. Anthony’s Church, 14012 Second Ave., Walnut Grove.
• Jan. 4: 10 a.m.-2 p.m., First Baptist Church, 4401 San Juan Ave., Fair Oaks.
• Jan. 5: 3:30-7:30 p.m., Elk Grove High School, 9800 Elk Grove-Florin Road, Elk Grove.
• Jan. 6: 3-7 p.m., Grant Union High School, 1400 Grand Ave., Sacramento.
• Jan. 7: 10 a.m.-2 p.m., Sunrise Mall Drive-Through, 6041 Sunrise Blvd., Citrus Heights (no walk-ins, vehicles only).
• Jan.8: 3-7 p.m., Inderkum High School, 2500 New Market Drive, Sacramento.
• Jan. 11: 3:30-7:30 p.m., Valley High School, 6300 Ehrhardt Ave., Sacramento.
• Jan. 12: 10 a.m.-2 p.m., Sacramento Japanese United Methodist Church, 6929 Franklin Blvd., Sacramento.
• Jan. 13: 10 a.m.-2 p.m., Christ Community Church, 5025 Manzanita Ave., Carmichael.
• Jan. 14: 10 a.m.-2 p.m., Sacramento City Public Safety Center, 5770 Freeport Blvd., Sacramento.
• Jan. 15: 10 a.m.-2 p.m., County Administrative Center, 700 H St., Sacramento.
Doctors who treat kids and seniors are the happiest, UCD study shows
A new UC Davis study on physician job satisfaction found differences among medical specialties, with the happiest doctors caring for children and the elderly.
That doctors treating seniors are among the most satisfied contradicts trends in medical schools, where students mostly avoid the specialty because it’s perceived to be unprofitable and unglamorous.
“Satisfaction ought to be a factor to students when they select their specialty,” said Paul Leigh, lead author and a professor in the UC Davis Center for Healthcare Policy and Research.
The study, which culled data from a 2004 to 2005 nationwide survey of 6,500 physicians across 42 specialties, was published online in BMC Health Services Research.
Geriatrics, a specialty within internal medicine dealing with the elderly, had the second-most satisfied doctors, behind pediatric emergency medicine.
Yet last year, nationwide, there were only 250 medical school graduates trained in geriatrics. California had about 700 certified geriatricians total, said Dr. Cheryl Phillips, president of the American Geriatrics Society.
“We don’t do a very good job of exposing students to geriatrics,” she said. “And when medical students are exposed to it, they say, ‘Gee I could be a geriatrician and make $160,000 or a dermatologist and make $500,000.’ “
Geriatrics requires an additional year of training after an internal medicine residency, and geriatricians receive 20 percent less pay than if they had taken a general internist position, Phillips said. That’s because the specialty requires long visits with patients and relies heavily on reimbursements from Medicare.
Yet geriatricians are happy.
“We work very closely with the rest of the health care team, as opposed to many other specialties where physicians are often isolated,” said Phillips.
This “team sport” idea also is reflected in pediatric emergency medicine, the specialty with the most satisfaction.
Pediatric emergency medicine specialists mostly work within an academic setting, where doctors have plenty of intellectual stimulation and people with whom to share ideas, said Dr. Nathan Kuppermann, chairman of emergency medicine at UC Davis and a specialist in pediatric emergency medicine.
Additionally, researchers found work-life balance is becoming more important among doctors, Leigh said.
“In the past medical students have been very attracted to income,” Leigh said. “But having a controllable lifestyle is becoming more important.”
Geriatrics is one specialty where doctors have control over their work hours, because elderly patients in nursing homes have flexible hours, Phillips said.
Other study findings:
• There’s no difference in satisfaction between male and female doctors.
• There’s no difference in satisfaction among races. Leigh said studies show that in other careers, Latinos and blacks tend to be more unhappy than whites.
• Doctors younger than 44 – and older than 65 – tend to be more satisfied. Those in between are among the most unhappy.