In today’s Dose:
Health care reform
(Obama’s AMA speech; Underlying issues; David Brooks on Obama; Robert Samuelson’s take; WSJ fiction)
Health news
(Benefits of alcohol?; Ritalin and unexplained deaths)
Tobacco
(Litigating over free speech; Is the FDA demoralized)
Health care reform
- The American Medical Association (AMA) came out last week against any government sponsored insurance plan, but a few days later they back pedaled a bit, saying they’d been misinterpreted and that they were simply opposed to “any public plan that forces physicians to participate, expands the fiscally challenged Medicare program or pays Medicare rates.”
So there was a great deal of anticipation surrounding President Obama’s address to the AMA’s annual meeting in Chicago yesterday. Here is a video of the address, compliments of C-SPAN and Kaiser Health News (the clip is about 8 minutes), or if you prefer, you can read the speech as text at the Wall Street Journal.
- Coverage of Obama’s AMA speech in the New York Times was overshadowed by Monday’s downbeat report from the Congressional Budget Office (PDF).
[T]he president’s speech on Monday was the latest example of an oft-used ploy to press his case: appearing before skeptical audiences, confident of his powers of persuasion but willing as well to say what his listeners do not want to hear. …
“The public option is not your enemy,” Mr. Obama said. “It is your friend, I believe.” Saying it would “keep the insurance companies honest,” the president dismissed as “illegitimate” the claims of critics that a public insurance option amounts to “a Trojan horse for a single-payer system” run by the government. …
Mr. Obama assured skeptics in the audience: “You did not enter this profession to be bean counters and paper pushers. You entered this profession to be healers. And that’s what our health care system should let you be.”
- Ezra Klein’s Washington Post column, It’s the Doctors, Stupid, riffs off Steven Pearlstein’s column, where he complains about doctors. It’s refreshing to hear Klein point out that much of the current discussion about health care ignores the underlying issues.
It’s one of the dysfunctions of the health reform debate that the attention different actors get is related more to their unpopularity than to their actual impact on the system. Insurers, for instance, are likely to get a lot of new regulations, as they’re very unpopular. … Doctors, conversely, aren’t going to see that many changes, because they’re very popular. But reforms to, say, the way doctors are paid would actually do much to change the drivers of health-care spending.
- David Brooks had an intelligent and well-written op-ed piece in the Times yesterday on Obama and health care called “You Be Obama”.
Let’s say that you are President Obama. … Because you have a lofty perspective on things, you know there are basically two ways to fix this mess. There is the liberal way, in which the government takes over the health care system and decides who gets what. And then there is the conservative way, in which cost-conscious consumers make choices in the context of a competitive marketplace. You also know that these two approaches have one thing in common. They are both currently politically unsellable.
- Robert Samuelson, who’s ordinarily too conservative for my taste, has a good editorial on health care in the Washington Post, Wrong Way on Health ‘Reform.‘
The central cause of runaway health spending is clear. Hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, either private or governmental. The open-ended payment system encourages doctors and hospitals to provide more services — and patients to expect them. It also favors new medical technologies, which are made profitable by heavy use. Unfortunately, what pleases providers and patients individually hurts the nation as a whole.
That’s the crux of the health-care dilemma, and Obama hasn’t confronted it. His emphasis on controlling costs is cosmetic. The main aim of health-care “reform” being fashioned in Congress is to provide insurance to most of the 46 million uncovered Americans. This is popular and seems the moral thing to do. After all, hardly anyone wants to be without insurance. But the extra coverage might actually worsen the spending problem.
It’s good to see commentators pointing out the short-sidedness of so much of the current health care debate. This is something intelligent conservatives do well.
- Speaking of conservatives, there was a fun piece in the Wall Street Journal. It’s an argument for a free-market economy solution to health care in the form of a fictional retrospective from the year 2070. It’s by Holman Jenkins, and it’s called “The Death and Life of Health ‘Reform’: A glimpse of a future without nationalized health care.”
A highly symbolic moment, however, came when Mr. Obama, who had put on weight in office and now tipped the scales at nearly 300 pounds, returned from a speaking tour on the virtues of nonproliferation to audiences in the Islamic Republic of Palau. Having overindulged in local delicacies, he was surprised when the White House medical office handed him a Wal-Mart debit card and sent him to a nearby Wal-Mart supercenter boasting “Everyday Low Prices on Gastric Bypass Surgery.”
Health news
- Are you someone who drinks a little red wine every day simply because you believe it’s good for your health? The New York Times has a story yesterday on how unscientific the evidence is for the benefits of drinking alcohol.
No study … has ever proved a causal relationship between moderate drinking and lower risk of death — only that the two often go together. It may be that moderate drinking is just something healthy people tend to do, not something that makes people healthy.
“The moderate drinkers tend to do everything right — they exercise, they don’t smoke, they eat right and they drink moderately,” said Kaye Middleton Fillmore, a retired sociologist from the University of California, San Francisco, who has criticized the research. “It’s very hard to disentangle all of that, and that’s a real problem.”
- Physician’s Watch, a daily email service, alerted physicians this morning about the connection between Ritalin and unexplained deaths in children. A study funded by the FDA and the National Institute of Mental Health compared children who had died a sudden and inexplicable death with demographically similar children who had died in traffic accidents. Five times as many children in the first group were taking stimulant drugs compared to the children who had died in accidents. It was a small study. The actual numbers were 10 children in the first group and two in the second. There’s a story in the Washington Post, and the published article from the American Journal of Psychiatry is available online as a PDF file.
Tobacco
- Last week Congress passed legislation that gives the FDA the authority to regulate the production and marketing of tobacco products. Even before the bill passed, there were murmurs from the tobacco industry about fighting the legislation on free speech grounds. Those sounds are now more audible.
One of the issues is whether protecting children from advertising interferes with a legitimate right to communicate with adults. Advertising restrictions include no outdoor advertising within 1,000 feet of a school or playground and the requirement that ads be limited to black and white in stores and in many forms of print advertising. Even the ACLU is opposed to the restrictions.
The counter-argument is that children respond to advertising directed at adults. Henry Waxman, the prime sponsor of the legislation in the House, said: “The bill has been carefully drafted, and I am confident that the provisions will be upheld.” There’s an article on this in yesterday’s Times, Tobacco Regulation Is Expected to Face a Free-Speech Challenge.
- There was an interesting post from Merrill Goozner on the FDA and tobacco. He quotes the editor of the FDA Webview, Jim DIckinson:
The impact of this bill internally will be like a death sentence, steadily killing the agency’s old public health spirit and replacing it with a strange hybrid. This new ethos will have to blend public health and safety with toleration for and husbandry of death-dealing products that have no plausible relationship to the diverse family of other products regulated by FDA.
This would confirm what Senator Mike Enzi was saying when he objected to the bill: “[The] FDA approves cures, not poisons.” See my recent post, Whatever you say, Phillip Morris.
Dickinson predicts that tobacco won’t be under FDA control for long. Goozner, a respected journalist who’s very familiar with the FDA and the pharmaceutical industry, made an appeal for anonymous inside information from anyone at the FDA. Let’s hope he gets a response.
Sorry, comments are closed for this post.