'Health Care' Archive
As President-Elect Obama prepares to take office in January, new research has added a weapon to his health care reform arsenal. A report, just published by the journal Health Affairs, supports Obama’s contention that Medicare Advantage — a program that allows private insurers to offer Medicare-funded health plans — is wasteful and ineffective. Obama has pledged to make cuts to the program, a move that would have serious implications for many private insurers.
Among other things, the Health Affairs report finds evidence that Medicare Advantage plans are considerably more expensive for the government and don’t improve health outcomes for senior citizens or produce efficiencies that lower health care costs.
Nearly a quarter of all Medicare beneficiaries belong to private Medicare plans, a number that has grown enormously since the Medicare Modernization Act of 2003 gave incentives to private insurers to expand access to such plans. The theory behind Medicare Advantage, popular with Republican lawmakers, is that private insurers can more efficiently provide coverage, thus lowering costs for seniors and the government.
The problem is, that hasn’t happened. The federal government pays about 13% more for each Medicare Advantage enrollee than it does for an enrollee in traditional government-run Medicare. MA participants may receive additional benefits from their private plan — like fitness club memberships and vision benefits — but non-MA seniors and taxpayers are the ones who foot the bill for those extras.
In the last presidential debate, Obama called the extra money going to private MA insurers “a giveaway.” And it’s true that the expansion of Medicare Advantage has been a boon for many private insurers, which have enrolled millions of retirees when other new customers were hard to come by. UnitedHealth, Humana, and Kaiser Foundation Health Plan are the largest providers of private Medicare plans, though Humana might be hit the hardest by any cuts to the program. The company has grown its Medicare Advantage business aggressively and now depends on it for more than 40% of revenues. WellCare Health Plans and HealthSpring are also mightily beholden to Medicare Advantage members.
Needless to say, those companies aren’t going to be happy with cuts to Medicare Advantage, though there are other parts of Obama’s health care reform agenda — namely, the expansion of health coverage to more than 45 million uninsured Americans — that might soften the blow. Still, I wouldn’t expect them to give up their government paychecks without a fight.
Max Baucus sure doesn’t waste any time. While Sarah Palin is still returning her $150,000 wardrobe and President-Elect Obama is measuring the White House drapes, the Democratic senator from Montana made a play for leadership on health care reform with a policy paper outlining his plan to revamp the health care system and provide coverage for all Americans.
Perhaps not surprisingly, his plan is similar, though not identical, to Obama’s. Among other things it would:
- Expand Medicaid and SCHIP coverage
- Temporarily allow those over 55 to buy into Medicare
- Create a national marketplace called the Health Insurance Exchange, where individuals and small firms could buy health coverage; private insurers and a public program modeled on Medicare would compete for customers
- Require employers to either cover their workers or pay into a health care fund
- Give individuals and small businesses subsidies to get health insurance, and
- Require that every person have health insurance.
That last bullet point — the controversial mandate for everybody to buy in — was a key point of contention between Obama and his Democratic rival Hillary Clinton during the primaries. Obama’s plan didn’t include a mandate for adults to buy coverage. Baucus’ plan does, and, as Maggie Mahar points out, it’s for a good reason.
The reason is that the Baucus plan forbids insurance companies to deny coverage or hike premiums on people with pre-existing conditions. Without a mandate, the young and healthy would likely opt out of getting coverage, but insurers would still be forced to cover the sick, who use a lot more expensive health care. It’s not viable for insurers to do that and remain profitable. Hence, the mandate.
Whether health care reform ends up looking anything like Baucus’ blueprint remains to be seen, of course. Numerous other voices will have to be heard. And, as Baucus himself admitted in a press conference yesterday, it would take several years for all his proposals to take effect, even if Congress and the new president were to act on Obama’s first day in office. Nevertheless it’s heartening to see movement on systematic health reform after years of stop-gaps and indifference. I, for one, am looking forward to the debate ahead.
Over the past couple of decades, the moderate intake of red wine has been touted as having benefits over health issues including cholesterol, heart disease, and cancer. In recent years, sharp biotechnologists have investigated the use of red wine in their pharmaceutical development efforts, and the results seem to point toward the possible emergence of a miracle drug.
Resveratrol, a chemical found in red wine, is being researched for a variety of ailments. One biotech development firm, Sirtris Pharmaceuticals, was snapped up by pharma bigwig GlaxoSmithKline (GSK) at an 84% premium earlier this year largely due to its resveratrol development programs, which aim to treat health conditions including diabetes, muscular disorders, and cancerous tumors.
A team of scientists in France (in partnership with Sirtris) is looking at resveratrol as a possible new weight loss therapy, a particularly poignant topic since sales of Sanofi-Aventis’ anti-obesity drug Acomplia were suspended in the EU market last month. However, all of the drug candidates under investigation are in early stages of research or clinical trials.
The general theory behind resveratrol is that the substance activates sirtuin enzymes — these enzymes are believed to trigger anti-aging properties and ward off degenerative diseases associated with aging. Which means that in addition to treating specific age-related diseases (in areas including metabolism, inflammation, neurology, and cardiology), resveratrol has the potential to increase patients’ overall life spans.
The potential benefits of drinking red wine regularly (again, in moderation) have also been increasingly studied in recent years. Studies conducted in 2008 have linked wine consumption to the prevention of lung cancer and liver disease. While I imagine that these benefits will continue to be debated for a long while (especially weighed against the general pitfalls of alcohol consumption), it will be interesting to see whether resveratrol pans out as a true blockbuster drug candidate. GSK has certainly placed its bet on the optimistic side, but drug development trials, burdened by regulatory scrutiny and high costs, often fail. From where I’m standing though, the natural process of grape fermentation looks beneficial and profitable in more ways than one.
The Centers for Disease Control (CDC) reported earlier this month that about 25% of teenage girls in the US have received at least one dose of Merck’s Gardasil vaccine, which is considered a fairly high success rate for a new vaccine. Gardasil gained FDA approval in 2006 for females between the ages of 9 and 26. However, sales of Gardasil have dropped in 2008 due to a variety of criticisms including cost, effectiveness, and potential side effects.
The vaccine is designed to ward off four out of six strains of human papillomavirus (HPV), which are believed to be a primary cause of cervical cancer, and requires three doses at a cost of about $120 per dose. While the CDC recommends the vaccine for girls 11-12 (as well as “catch up” vaccines up to age 26), health insurance companies don’t always cover vaccines, and Gardasil’s newness and cost have many women hesitating to receive the vaccine. State and government agencies that have mandated the vaccine for certain groups (such as immigrants and Texas teens) have also experienced a good level of backlash over requiring such a high-cost and highly debated vaccine.
Also at issue is whether the vaccine will prove to serve its purpose. Scientists wonder whether its effectiveness will wear off and require booster vaccines in later years. And while the vaccine is believed to be effective in preventing HPV, there is a good amount of speculation over whether a cancer prevention vaccine is even possible at this time.
As with all new vaccines and medicines, it is difficult to foresee what side effects could come to light over time. A CDC report released last week stated that, based on an evaluation of adverse event reports, Gardasil is safe to use and is effective against HPV. The report shows that serious events and deaths associated with use of the vaccine have largely been attributed to other causes. While the report is reassuring, the CDC’s continued monitoring of the vaccine is necessary as some side effects can remain undiscovered for years.
GlaxoSmithKline (GSK) also has a cervical cancer vaccine (Cervarix) on the market in other countries that is under FDA review for sales approval in the US. Whether the GSK vaccine has any success in the market partially depends on how much acceptance grows for the Gardasil vaccine. Merck itself has a lot riding on the vaccine’s success.
Whether the vaccine has any effect on cervical cancer infection rates can only be proven over time, but when it comes down to it, the vaccine’s apparent success at preventing HPV is a valuable health benefit on its own and makes it a viable candidate that women in the recommended age group should consider when weighing their health care options.
First the Bush administration gave us the doctrine of preemptive war. Now they want to give us the legal precedent of preemption. But they’re going to have to shout down the Journal of the American Medical Association before they can get their way.
Preemption refers to a legal argument stating that, in cases where people are harmed by defective drugs, federal law (that is, FDA approval of the products) preempts state laws governing drug safety. If preemption were the law of the land, consumers who suffer injury from harmful drugs would have no legal right to sue the pharmaceutical companies who made and sold them.
Next month, the Supreme Court will decide on the issue in the case of Wyeth vs. Levine, in which a woman is suing the drug company, claiming that improper labeling of a drug cost her part of her arm. In a parallel case involving medical devices made by Medtronic, the Court agreed with the preemption doctrine. Now, drugmakers everywhere are on pins and needles to see if they, too, can escape liability.
JAMA just published an editorial arguing against preemption, following the New England Journal of Medicine’s denunciation of the principle earlier this year. The Bush administration and the pharmaceutical lobbying group PhRMA both support preemption.
I will admit, there’s a certain obvious logic to the thinking behind preemption: If the FDA has already deemed a drug or medical device to be safe, why should a company be punished for selling it sometime down the road?
There are a couple of major problems with that theory, however. One is that the clinical trials the FDA bases its decisions on are largely short-term studies that provide no information on what a drug’s long-term side effects might be. Who is to be held responsible if a drug proves harmful over time? Second, those studies are conducted by the drugmakers themselves, and they’ve been known to withhold a piece or two of critical information from the public about a drug’s dangers.
One such recent case, involves Johnson & Johnson, who just this month settled a slew of cases involving its birth control patch Ortho Evra. The patch releases significantly more estrogen into the body than the birth control pill, something the company knew but at first failed to tell patients (its label has been revised several times since it was approved in 2002). The higher levels of estrogen increase a woman’s risk of blood clots and stroke; in the hundreds of lawsuits recently settled, some 4,000 women complained of injury from using the drug, mostly in the form of blood clots in the legs and lungs. Some of the lawsuits involved women who died.
If the drug companies have their way — and they look pretty likely to — those women and their families wouldn’t be allowed to have their day in court, and drug companies would have little reason not to withhold crucial safety data from the public or the FDA. The only thing that’s preempting is justice.