Medicare, the free market, and a drug that doesn’t work

This story will make you discouraged about BOTH the government AND the free market when it comes to healthcare.  Peter Whoriskey reports:

The U.S. health-care system is vastly overspending for a single anemia drug because Medicare overestimates its use by hundreds of millions of dollars a year, according to an analysis of federal data. The overpayment to hospitals and clinics arises because Medicare reimburses them based on estimates rather than the actual use of the drug.

The government for years has tried to rein in spending on the prescription drug, Epogen, which had ranked some years as the most expensive drug to taxpayers through the Medicare system.

Medicare’s current estimates are based on Epogen usage in 2007 for dialysis treatments. But since then, use of the drug has fallen 25 percent or more, partly because of Food and Drug Administration warnings about its perils and partly because Congress removed the financial incentives for clinics and hospitals to prescribe the drug. Because Medicare continues to reimburse health-care providers as if the dosing levels haven’t changed, the significant savings in doses has not translated into savings for the U.S. Treasury.

The amount of the overspending is more than $400 million annually, according to calculations done separately by The Washington Post and experts.

“I think we probably left money on the table,” said Rep. Pete Stark (D-Calif.), a critic of the way the drug had been used who helped shepherd through legislation that removed the financial incentives for bigger doses beginning in 2011.

The overpayment for Epogen reflects both the promise and difficulty of large-scale government reform of health-care spending.

For years, Epogen was one of a trio of anemia drugs — all manufactured by Amgen, a California biotech firm — that cost Medicare as much as $3 billion annually. Overall U.S. sales of the drugs exceeded $8 billion.

Nearly two decades after the drugs were first approved in 1989, their purported benefits were found to be overstated, and the FDA issued a series of stern warnings about their potentially deadly side effects, such as cancer and heart attacks.

At least some of their popularity stemmed from the fact that hospitals and clinics made lots of money using them: The spread between what they paid for a dose and what Medicare paid them to administer one reached as high as 30 percent, according to the Medicare Payment Advisory Commission.

The incentives drove up usage. By 2007, about 80 percent of dialysis patients were getting the drugs at levels beyond what the FDA now targets as safe.

Congress pushed Medicare to revise its payment system to remove the incentives for larger doses. Under the new system for dialysis patients, Medicare pays a set fee for a bundle of dialysis services and drugs.

via Medicare overspending on anemia drug – The Washington Post.

So Medicare reimbursed based on ESTIMATES rather than actual usage?  And hospitals and doctors prescribed the drugs so much in part because “they could make so much money using them”?

Of course, the reason the drugs were so lucrative is because Medicare paid so much for them, so it’s the unholy alliance between the government and the private sector–which is at the heart of Obamacare– that is to blame.  Still, this dashes further the assumption that our medical treatment is always based on objective considerations of patient care.

Are business practices that work in other profit-making enterprises fitting for health care?  For example, why are all of these prescription drugs being advertised on television?  Are patients now “consumers” who are expected to demand certain medicines from their physicians, in which case, what happens to objective determinations in the practice of medicine?  Or are the physicians the target of these marketing campaigns, in which case, again, what happens to objective determinations in the practice of medicine?

Give fetuses anesthetics before aborting them

On Thursday, Arizona’s law forbidding abortion after 20 weeks went into effect.  It prohibits abortions performed after the point at which science shows that the fetus can feel pain.  The Arizona law was upheld by a court, and similar “fetal pain” bills are in the works in other states.  A small victory, perhaps, but it does underscore the fact that the fetus in the womb is a human being.  But pro-abortion zealots cannot tolerate even this small concession.  Harvard law professor I. Glenn Cohen offers a different solution for fetal pain:

As proof that fetuses are capable of feeling pain, Nebraska’s law notes that physicians often administer anesthesia to fetuses. This is done to relax muscles or to prevent neurodevelopmental problems later on — not, medically speaking, to control pain. But if these fetuses were capable of feeling pain, administering anesthesia would likely prevent any sensation of pain, just as it does in children and adults. Thus, there is no legal reason to prohibit abortion at 20 weeks: We can prevent fetal pain during an abortion — without burdening a woman’s right to that abortion — by requiring the administration of anesthesia to the fetus.

via The flawed basis behind fetal-pain abortion laws – The Washington Post.

 

Obamacare provisions that go into effect today

As of today, women can get free contraceptives and abortifacients, as well as other goodies that their insurance will have to give them without co-pays to doctors:

Democrats hailed the Aug. 1 introduction of these Affordable Care Act services as a turning point at which the American public would finally grasp the magnitude of healthcare reform.

The new services that will be required to be offered under insurance plans without a co-payment are well-woman visits, gestational diabetes screening, domestic violence screening and counseling, contraception and contraceptive counseling, breastfeeding support and supplies, HPV DNA testings, sexually transmitted infections counseling, and HIV screening and counseling.

via PJ Media » Dems Seize Message on Hill Hours Away from Contraceptive Mandate.

Health & Human Services considers “morning after pills,” “week after pills,” and other measures that prevent the embryo from attaching to the womb or that cause expulsion to be “contraceptives.”  For those who believe life begins at conception, that is abortion.  And we are all going to be paying for that, even if your religion forbids it.

An Aurora victim whose life was spared

A former student wrote me after the Aurora shootings saying that a friend of his was in the theater and had been shot.  He said she was from an active homeschooling family, a leader in the Colorado homeschool debate league, and a committed Christian, very much like our other students.  He was distraught about it, and the parallels with our other students made the shootings disturbingly real to me.

A few days later, my student updated me about how his friend’s life was providentially, if not miraculously, spared.  I’ll let NBC News tell the story:

Petra Anderson, one of 58 people injured in the Aurora movie theater attack, is lucky to be alive.

Anderson, a 22-year-old aspiring music professor, was hit by a shotgun blast during the assault that killed 12 people. Three pellets struck her arm and one rocketed through her head, but it missed the brain’s many blood vessels and key sections controlling vital functions, according to her doctor.

“If the pellet had wavered a millimeter, really in any direction from what it actually took, then she would have likely either died or been severely injured,” said Dr. Michael Rauzzino, a neurosurgeon at The Medical Center of Aurora who operated on Anderson to remove the pellet. “I would say this is definitely a miracle,” he said, while showing an MRI of Anderson’s brain.

The MRI reveals a faint trace of the pellet’s path after it entered the left side of Petra’s nose, broke through the front of her skull, and passed through her brain, before lodging in the back of her head. . . .

“It would be hard to create a path similar to this where it goes all the way from the front to the back and misses every single blood vessel, doesn’t bother any of the major structures, and leaves her able to talk and move everything and not be paralyzed or dead,” he added. “Never in my entire career have I seen a case where a bullet has traversed the entire brain like this and not caused severe damage or death.”

via Shotgun pellet’s ‘miracle’ path spared Aurora victim’s life – U.S. News.

At first the report was that she was saved by a birth defect–a channel in her brain that the pellet exactly followed–but the doctor says now that this was not the case.  The pellet just went through her brain missing every blood vessel and vital structures.  That’s miraculous enough.   I know it’s hard to talk about such things, given the people who were not spared, but still, this is remarkable.

Individuals and the Obamacare mandate

Discussion about the Obamacare contraception/abortifacient insurance mandate has centered on the religious liberty of church-related institutions.  But what about the religious liberty of pro-life individuals who own businesses?  That, in fact, is the case before the courts that might have a ruling today.  (I’m on the road so I might have trouble monitoring it.  If anyone hears about a ruling, mention it in a comment.)  Here are details about that case, with a rather chilling statement about how the Obama administration sees religious liberty:

Hercules Industries is a Colorado based corporation that makes heating and air conditioning equipment. Hercules is a family-owned business. Its owners, the Newland brothers — William (pictured), Paul and James — and their sister, Christine Ketterhagen, take their Catholic faith seriously. The business provides good jobs for 265 people and Hercules Industries tries hard to be a good member of the community. The siblings who operate the business have always assumed that they had the right to live according to their faith, like other businesses across our nation.

In those parts of New York City that have a high percentage of residents who are Orthodox or Hassidic Jews, businesses close when the sun sets on Friday and stay closed until sunset on Saturday, in observance of the Sabbath. Kosher butchers do not sell pork and Kosher delis do not make pork sandwiches. This sort of religious freedom is not peripheral to religious Americans of all professions. It is central to their idea of the American dream.

This is consistent with what the Newlands believe. The health benefits packages that Hercules Industries provides to its employees is very generous, but it does not include sterilization, artificial contraception or abortifacients. Individuals who work for the company are free, of course, to obtain these at their own expense or to secure insurance coverage outside the company health plan that covers those types of expenses.

The Newlands have brought suit against Health and Human Services Secretary Kathleen Sebelius for regulations she has promulgated that require that any company employing more than 50 people must include those medical procedures and drugs in the health plan. The Hercules Industry lawsuit states:

The Catholic Church teaches that abortifacient drugs, contraception and sterilization are intrinsic evils. Consequently, the Newlands believe that it would be immoral and sinful for them to intentionally participate in, pay for, facilitate or otherwise support abortifacient drugs, contraception, sterilization, and related education and counseling as would be required by the Mandate, through their inclusion in health insurance coverage they offer at Hercules.

The Obama administration has resisted the Hercules lawsuit by claiming that the company is secular, and therefore entitled to no First Amendment protection, with the Department of Justice telling the court:

The First Amendment Complaint does not allege that the company is affiliated with a formally religious entity such as a church, nor does it allege that the company employs persons of a particular faith. In short, Hercules Industries is plainly a for-profit, secular employer. By definition, a secular employer does not engage in any “exercise of religion.” It is well established that a corporation and its owners are wholly separate entities, and the Court should not permit the Newlands to eliminate that legal separation to impose their personal religious beliefs on the corporate entity or its employees.

via Colorado Company Fights to Maintain Catholic Values.

UPDATE:  The court issued an injunction against the government penalizing the company.  Click here for details.

The insurance mandate goes into effect August 1

The Obamacare mandate that requires pro-life institutions and business owners to provide insurance for their employees that gives free contraceptives and abortion drugs goes into effect this Wednesday, August 1.  Perhaps you didn’t realize this was so imminent.

On Friday, a court is scheduled to issue a ruling on the case, which might overturn the mandate or might affirm it.

 

August 1: The Day the U.S. Definition of Religious Freedom Changes – By Kathryn Jean Lopez – The Corner – National Review Online.


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