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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?

The history of eugenics

The History News Network posts an earlier article by Edwin Black on the American eugenics movement and what it accomplished.  Twenty-seven states adopted eugenics laws, with the biggest program to sterilize the “unfit” being established in California.   Major funding for the eugenics movement came from the Carnegie Institute and the Rockefeller Foundation.   Black shows how the American eugenics movement spread to Germany and was championed–and later implemented on a massive scale–by Adolf Hitler.

Read the whole article, but here is a chilling sample:

Eighteen solutions were explored in a Carnegie-supported 1911 “Preliminary Report of the Committee of the Eugenic Section of the American Breeder’s Association to Study and to Report on the Best Practical Means for Cutting Off the Defective Germ-Plasm in the Human Population.” Point eight was euthanasia.

The most commonly suggested method of eugenicide in America was a “lethal chamber” or public locally operated gas chambers. In 1918, Popenoe, the Army venereal disease specialist during World War I, co-wrote the widely used textbook, Applied Eugenics, which argued, “From an historical point of view, the first method which presents itself is execution… Its value in keeping up the standard of the race should not be underestimated.” Applied Eugenics also devoted a chapter to “Lethal Selection,” which operated “through the destruction of the individual by some adverse feature of the environment, such as excessive cold, or bacteria, or by bodily deficiency.”

Eugenic breeders believed American society was not ready to implement an organized lethal solution. But many mental institutions and doctors practiced improvised medical lethality and passive euthanasia on their own. One institution in Lincoln, Illinois fed its incoming patients milk from tubercular cows believing a eugenically strong individual would be immune. Thirty to forty percent annual death rates resulted at Lincoln. Some doctors practiced passive eugenicide one newborn infant at a time. Others doctors at mental institutions engaged in lethal neglect. . . .

Only after eugenics became entrenched in the United States was the campaign transplanted into Germany, in no small measure through the efforts of California eugenicists, who published booklets idealizing sterilization and circulated them to German official and scientists.

Hitler studied American eugenics laws. He tried to legitimize his anti-Semitism by medicalizing it, and wrapping it in the more palatable pseudoscientific facade of eugenics. Hitler was able to recruit more followers among reasonable Germans by claiming that science was on his side. While Hitler’s race hatred sprung from his own mind, the intellectual outlines of the eugenics Hitler adopted in 1924 were made in America.

During the ’20s, Carnegie Institution eugenic scientists cultivated deep personal and professional relationships with Germany’s fascist eugenicists. In Mein Kampf, published in 1924, Hitler quoted American eugenic ideology and openly displayed a thorough knowledge of American eugenics. “There is today one state,” wrote Hitler, “in which at least weak beginnings toward a better conception [of immigration] are noticeable. Of course, it is not our model German Republic, but the United States.”

Hitler proudly told his comrades just how closely he followed the progress of the American eugenics movement. “I have studied with great interest,” he told a fellow Nazi, “the laws of several American states concerning prevention of reproduction by people whose progeny would, in all probability, be of no value or be injurious to the racial stock.”

Hitler even wrote a fan letter to American eugenic leader Madison Grant calling his race-based eugenics book, The Passing of the Great Race his “bible.”

via History News Network.

Testing unborn babies for 3,500 genetic disorders

Medical researchers have developed a non-invasive test that can potentially identify not just Downs but thousands of other genetic disorders.  That could mean thousands of other excuses for abortions.  And thousands of reasons for a government-run health care system to–someday–require them.

A team has been able to predict the whole genetic code of a foetus by taking a blood sample from a woman who was 18 weeks pregnant, and a swab of saliva from the father.

They believe that, in time, the test will become widely available, enabling doctors to screen unborn babies for some 3,500 genetic disorders.

At the moment the only genetic disorder routinely tested for on the NHS is Down’s syndrome.

This is a large-scale genetic defect caused by having an extra copy of a bundle of DNA, called a chromosome.

Other such faults are sometimes tested for, but usually only when there is a risk of inheriting them from a parent.

By contrast, the scientists say their new test would identify far more conditions, caused by genetic errors.However, they warned it raised “many ethical questions” because the results could be used as a basis for abortion.

These concerns were last night amplified by pro-life campaigners, who said widespread use of such a test would “inevitably lead to more abortions”. . . .

As well as testing for thousands of genetic defects, the scientists said their test could give a wealth of information on the baby’s future health.However, they warned: “The less tangible implication of incorporating this level of information into pre-natal decision-making raises many ethical questions that must be considered carefully within the scientific community and on a societal level.

“As in other areas of clinical genetics, our capacity to generate data is outstripping our ability to interpret it in ways that are useful to physicians and patients.”

Josephine Quintavalle, founder of the Pro-Life Alliance, put it more baldly.

She said: “One always hopes, vainly, that in utero testing will be for the benefit of the unborn child.

“But, whilst this new test may not itself be invasive, given our past track record, it is difficult to imagine that this new test will not lead to more abortions.”

via Unborn babies could be tested for 3,500 genetic faults – Telegraph.

HT:  Grace

Obama’s data mining

Yesterday we posted about mining “big data,” how corporations, politicians, and researchers are delving into Twitter, Google,  Facebook, and other online information to forecast trends, target customers, and gain various competitive advantages.  Well, it turns out that the Obama campaign is mining such data on voters on a massive, unprecedented scale.  Politico’s Lois Romano reports:

On the sixth floor of a sleek office building here, more than 150 techies are quietly peeling back the layers of your life. They know what you read and where you shop, what kind of work you do and who you count as friends. They also know who your mother voted for in the last election.

The depth and breadth of the Obama campaign’s 2012 digital operation — from data mining to online organizing — reaches so far beyond anything politics has ever seen, experts maintain, that it could impact the outcome of a close presidential election. It makes the president’s much-heralded 2008 social media juggernaut — which raised half billion dollars and revolutionized politics — look like cavemen with stone tablets.

Mitt Romney indeed is ramping up his digital effort after a debilitating primary and, for sure, the notion that Democrats have a monopoly on cutting edge technology no longer holds water.

But it’s also not at all clear that Romney can come close to achieving the same level of technological sophistication and reach as his opponent. (The campaign was mercilessly ridiculed last month when it rolled out a new App misspelling America.)

“It’s all about the data this year and Obama has that. When a race is as close as this one promises to be, any small advantage could absolutely make the difference,” says Andrew Rasiej, a technology strategist and publisher of TechPresident. “More and more accurate data means more insight, more money, more message distribution, and more votes.”

Adds Nicco Mele, a Harvard professor and social media guru: “The fabric of our public and political space is shifting. If the Obama campaign can combine its data efforts with the way people now live their lives online, a new kind of political engagement — and political persuasion — is possible.”

Launched two weeks ago, Obama’s newest innovation is the much anticipated “Dashboard” , a sophisticated and highly interactive platform that gives supporters a blueprint for organizing, and communicating with each other and the campaign.

In addition, by harnessing the growing power of Facebook and other online sources, the campaign is building what some see as an unprecedented data base to develop highly specific profiles of potential voters. This allows the campaign to tailor messages directly to them — depending on factors such as socio-economic level, age and interests.

The data also allows the campaign to micro-target a range of dollar solicitations online depending on the recipient. In 2008, the campaign was the first to maximize online giving — raising hundreds of millions of dollars from small donors. This time, they are constantly experimenting and testing to expand the donor base.

via Obama’s data advantage – Lois Romano – POLITICO.com.

Do you think all of this data the president’s campaign is collecting is a game changer or ultimately trivial?  Does gathering so much information about you for political purposes bother you?

Pentecost & Memorial Day

Two big holidays this weekend, one in the church year and the other national.  I hope you had a meaningful Pentecost on Sunday and that you will have a meaningful and enjoyable Memorial Day today.

So let’s play a holiday game.  Connect the dots.  What connections can you make between what we celebrate on Pentecost (the gift of the Holy Spirit, the birthday of the Church) and what we celebrate on Memorial Day (the sacrifice of our troops, in some locales the memory of those in general who have died, the beginning of the summer vacation season)?

Chen and his cause

The blind Chinese activist Chen Guangcheng, whom we have been blogging about, has been released and has arrived in the United States, where he will be a fellow at New York University.  Melinda Henneberger writes about the human rights issue Chen has been battling:

The day of Mei Shunping’s fifth forced abortion in China was “the saddest day of my life,’’ she told a congressional subcommittee this week.

The cause that human rights activist Chen Guangcheng has so long championed is often glossed over in this country, where we tend to focus on how cool it is that a blind guy scaled a fence and escaped his captors like some kind of action hero. But Mei spelled out the gory particulars for the House Committee on Foreign Affairs subcommittee on Africa, Global Health and Human Rights.

This undated photo provided by the China Aid Association shows blind Chinese legal activist Chen Guangcheng, right, with wife Yuan Weijing and son, Chen Kerui in China. (AP)

On a monthly basis, she told those of us in the hearing room, she and all other female employees in the textile factory where she worked were subjected to humiliating physical exams to document that they weren’t pregnant; otherwise, under China’s one-child policy, they weren’t paid. And when any woman not approved for childbearing was even suspected of missing a period, co-workers were quick to inform on her, because when one became illegally pregnant, all were punished.

On the worst day of Mei’s life, not only was she physically dragged to the hospital, she said, but she collapsed in pain after complications following the procedure. She had no one to lean on, either, since her husband had been thrown in jail for arguing with the doctors: “My young son didn’t know what was happening and kept crying for his father. I didn’t know what to do and could only hold my son and cry with him. Even now, when I think of all this, my heart shudders and the pain throbs.”

via Why Chen fights, and why U.S. abortion rights supporters should care – She The People – The Washington Post.

If those who believe in abortion are really “pro-choice,” as opposed to pro-abortion, why aren’t they protesting forced abortion?


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