Author Archives: Scott Hensley

Scott Hensley

About Scott Hensley

Scott Hensley runs NPR's online health channel, Shots. Previously he was the founding editor of The Wall Street Journal's Health Blog and covered the drug industry and the Human Genome Project for the Journal. Hensley serves on AHCJ's board of directors. You can follow him at @ScottHensley.

Pay for the person – not the procedures

When people talk about health reform it’s often shorthand for covering the uninsured. But improving access without tackling costs is a recipe for a fiscal crackup.

Just take a look at Massachusetts, a pioneer in universal coverage, where the cost of medical care is growing at more than 8 percent a year. Ballooning subsidies for coverage of the poor are one problem. Another is heavy use of high-priced hospital care.

costs
Photo by skpy via Flickr

The Boston Globe reports on the recommendations of a state commission to pay doctors and hospitals a set amount for each person’s care for a year. (Read the report here.)

Some might call it capitation redux. The payment approach, once popular with managed care, aims to curb incentives for doctors and hospitals to do more to get paid more. Previous attempts at capitation were too stingy and inflexible and remain worries this time around, critics say.

On the national front, the cost of health reform is moving to the fore, galvanizing opposition to the plans advanced in Congress. The Washington Post reports that the head of the Congressional Budget Office “delivered a devastating assessment” of the fiscal consequences of the proposals because they don’t do enough contain the fast-growing costs of government health programs.

Popular bypass technique may raise risks

There’s nothing too glamorous about bypass surgery. Your chest gets cracked wide open and the surgeon probably uses veins stripped from your legs to reroute blood around the blocked arteries that feed your heart.

broken-heart
Photo by CarbonNYC via Flickr

The good news is that when those new pipes are put in properly they can last a decade or longer. But when minimally invasive techniques are used to pluck those veins from the legs instead of the more painful direct approach, the outcome of bypass might not be as solid, according to a study just published in the New England Journal of Medicine.

Patients whose bypass grafts were obtained the less invasive way were more likely to have reclogging after a year than those whose veins were obtained the old-fashioned way. (46.7 percent vs. 38.0 percent). Worse, at three years patients with endoscopically harvested veins were more likely to have had serious problems, including death.

The less invasive approach to extracting blood vessels for use as replacements for coronary arteries is popular – used about 70 percent of the time – because it doesn’t hurt as much and infection rates are lower. But this study, despite its limitations (it was observational and not prospective) raises questions about the best way to go. “The decision about the best way to harvest veins for [bypass] has just gotten a lot more complicated,” writes cardiologist Harlan Krumholz for Journal Watch.

Health reform scrapes by on $1 trillion

You might think that more than $1 trillion, even when spread over 10 years, would be enough to cure all manner of problems in health care.

U.S. Capitol
Image by BlankBlankBlank via Flickr

But USA Today’s Susan Page reports the “eye-popping price tag” that’s the budgetary line in the sand for proposals kicking around Capitol Hill right now won’t come close to fulfilling every reformer’s wish.

Most of the money would go to expanding coverage for the uninsured. But a House bill wouldn’t subsidize coverage for as many families as previously expected and would jack up Medicaid costs for states, USA Today reports. A decade from now 15 million to 20 million people would probably still be uninsured.

All right. But we’re still wondering where all that cash, limited as it now seems to be, is going to come from? Medicare savings are supposed to provide a big wad. And then there’s a proposal from House Democrats to soak the rich, which the Washington Post explains, would slap a surtax on families earning more than $350,000 a year and individuals pulling down more than $280,000.

None of the scenarios matter if nothing becomes law. The White House appears intent on pushing ahead, despite growing Republican opposition. David Axelrod, Obama’s top political strategist, told Bloomberg, that a bipartisan approach would be nice but not absolutely necessary. “We’d like to do it with the votes of members of both parties,” he said. “But the worst result would be to not get health-care reform done.”

Update

Health reform marched ahead on a Senate health committee vote along party lines that approved legislation to expand health coverage. In a statement, President Obama said, the milestone “should provide the urgency for both the House and Senate to finish their critical work on health reform before the August recess.”

Swine flu blues: Vaccinations could be delayed

Summertime and forgetting about swine flu is easy. But the World Health Organization yanked us back to reality.

The H1N1 virus isn’t taking a vacation. Dr. Marie-Paule Kieny, WHO director of the Initiative for Vaccine Research, said the “pandemic is unstoppable” and “all countries will need to have access to vaccines” in a briefing yesterday.

But making a swine flu vaccine looks more difficult than expected, which could delay when folks could get immunized against the bug.

Even when a vaccine becomes available there won’t be enough to go around. So WHO recommends that health-care workers get jabbed first.

A big problem remains that there simply aren’t enough vaccine factories to supply the world’s needs, WHO Director General Margaret Chan said today. She defended the patent system and called for incentives to encourage innovation by drugmakers.

Generic biotech is coming – eventually

When people carp about the high prices of drugs, the poster kids are often the biotech wonders that can cost tens of thousands of dollars a year.

Sure, a nifty new cancer medicine may be worth a lot of money to the person whose life it lengthens. But should the maker of drugs like those enjoy a price monopoly indefinitely?

herceptin
Image by Andrew Ryzhkov via Wikimedia Commons

For biotech drugs – proteins produced by living cells – the answer in the United States has pretty much been yes because there’s no simple path for the Food and Drug Administration to approve generic versions of blockbusters such as Genentech’s Herceptin (annual cost: $48,000) or Johnson & Johnson’s Remicade (annual cost: $20,000).

As part of health reform, Congress is wrestling with rules to clear the way for so-called follow-on biologics. The main sticking point: how long should the inventor of a biotech medicine be protected from rivals?

The Wall Street Journal’s Alicia Mundy reports that the biotech industry appears to be getting its way, with extra protection that could last as long as 13½ years.

The lengthy protection period is being championed by the Senate health maven Ted Kennedy (D-Mass.) and is nearly twice as long as the seven years proposed by the White House. Others in Congress, including Sen. Chuck Schumer (D-N.Y.), have pushed for 5½ years.

Why does the number matter so much? Competition. The Federal Trade Commission concluded in a recent report that protection lasting 12 to 14 years “is unnecessary to promote innovation” and would inhibit the introduction of more biotech options at lower prices.

Update

In a win for the biotech industry, the Senate’s Health, Education, Labor and Pensions Committee voted 16-7 to protect biotech medicines from generic competition for 12 years. The term could still be changed by the full Senate or in negotiations with the House.

JAMA drops gag rule for whistle-blowers

Disclosure of potential conflicts in health care always seems like a great idea until people start asking questions about you.

The editors at JAMA, the Journal of the American Medical Association, found the tables turned when they sought to keep people who bring complaints about conflicts of study authors from going public with the allegations while the journal investigates. (To read the back story and the online JAMA editorial about the change, see this post from The Wall Street Journal Health Blog.)

Well, the JAMA editors have relented and an editorial published in the current issue of the journal drops the gag language while affirming the other elements of conflict policing.

In April, the Association of Health Care Journalists weighed in with a letter to JAMA calling the
policy “counterproductive” because “it could discourage potential whistle-blowers from coming forward with crucial information that physicians and the general public urgently need to make informed decisions about medical care.”