Chief of British death panel gets a knighthood

The controversial head of the Government body which rations NHS drugs and treatments is today knighted despite patient anger over his organisation’s decisions. Andrew Dillon, chief executive of the National Institute for Health and Clinical Excellence (Nice), received the honour for “services to healthcare”.

Nice is responsible for assessing the cost effectiveness of drugs available on the NHS and has been widely criticised for blocking or delaying potentially life-saving treatments.

Nice has been particularly criticised for blocking access to some Alzheimer’s drugs. Mr Dillon was the founding head of the organisation more than a decade ago and is widely respected in Whitehall for his considered handling of his controversial brief.

Other senior health officials also receive knighthoods. They include Professional Michael Richards, the Government’s cancer tsar responsible for developing the country’s cancer plan. David Nicholson, the chief executive of the NHS, also becomes a knight.

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NHS not looking good for the new year

The scale of NHS cuts will become apparent as the year progresses. Already hospitals have been told that they will receive no increase in the amount of money that they are paid per procedure, essentially a real terms cut in the cash they will receive. Overall, the health service has also been set a goal to make between £15 million and £20 million of efficiency savings over the next four years.

The fact that McKinsey, the management consultancy firm, estimates that to achieve such that a goal would take making 10 per cent of NHS staff redundant and abandoning procedures such as varicose vein operations suggests the scale of the challenge.

Nice: Patients' groups will continue to keep a close eye on the Government’s drugs rationing body in 2010. Over the last year the National Institute for Health and Clinical Excellence (Nice) began looking more favourably on drugs which prolong life for terminal patients, as it was instructed to do so by Government.

2009 also saw a number of drug companies come forward with innovative deals that allowed the NHS to pay less for some medicines. But with expensive drugs for cancer and other illnesses coming through the pharmaceutical pipeline at all times patients will continue to monitor how Nice makes decisions about which drugs it will allow on the NHS.

Obesity: The Government will scale up its Change4Life campaign, which so far has concentrated on children and families, to focus on adult obesity. Despite data which suggests that rises in childhood obesity could be levelling off, ministers and health planners are still worried about the strain on the NHS if predictions that half of adults could be heavily overweight by 2050 come true.

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Mayo Clinic in Arizona to Stop Treating Some Medicare Patients

The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little.

More than 3,000 patients eligible for Medicare, the government’s largest health-insurance program, will be forced to pay cash if they want to continue seeing their doctors at a Mayo family clinic in Glendale, northwest of Phoenix, said Michael Yardley, a Mayo spokesman. The decision, which Yardley called a two-year pilot project, won’t affect other Mayo facilities in Arizona, Florida and Minnesota.

Obama in June cited the nonprofit Rochester, Minnesota-based Mayo Clinic and the Cleveland Clinic in Ohio for offering “the highest quality care at costs well below the national norm.” Mayo’s move to drop Medicare patients may be copied by family doctors, some of whom have stopped accepting new patients from the program, said Lori Heim, president of the American Academy of Family Physicians, in a telephone interview yesterday.

“Many physicians have said, ‘I simply cannot afford to keep taking care of Medicare patients,’” said Heim, a family doctor who practices in Laurinburg, North Carolina. “If you truly know your business costs and you are losing money, it doesn’t make sense to do more of it.”

Medicare Loss

The Mayo organization had 3,700 staff physicians and scientists and treated 526,000 patients in 2008. It lost $840 million last year on Medicare, the government’s health program for the disabled and those 65 and older, Mayo spokeswoman Lynn Closway said.

Mayo’s hospital and four clinics in Arizona, including the Glendale facility, lost $120 million on Medicare patients last year, Yardley said. The program’s payments cover about 50 percent of the cost of treating elderly primary-care patients at the Glendale clinic, he said. “We firmly believe that Medicare needs to be reformed,” Yardley said in a Dec. 23 e-mail. “It has been true for many years that Medicare payments no longer reflect the increasing cost of providing services for patients.” Mayo will assess the financial effect of the decision in Glendale to drop Medicare patients “to see if it could have implications beyond Arizona,” he said.

Nationwide, doctors made about 20 percent less for treating Medicare patients than they did caring for privately insured patients in 2007, a payment gap that has remained stable during the last decade, according to a March report by the Medicare Payment Advisory Commission, a panel that advises Congress on Medicare issues. Congress last week postponed for two months a 21.5 percent cut in Medicare reimbursements for doctors.

National Participation

Medicare covered an estimated 45 million Americans at the end of 2008, according to the Centers for Medicare & Medicaid Services, the agency in charge of the programs. While 92 percent of U.S. family doctors participate in Medicare, only 73 percent of those are accepting new patients under the program, said Heim of the national physicians’ group, citing surveys by the Leawood, Kansas-based organization.

Greater access to primary care is a goal of the broad overhaul supported by Obama that would provide health insurance to about 31 million more Americans. More family doctors are needed to help reduce medical costs by encouraging prevention and early treatment, Obama said in a June 15 speech to the American Medical Association meeting in Chicago. Reid Cherlin, a White House spokesman for health care, declined comment on Mayo’s decision to drop Medicare primary care patients at its Glendale clinic.

Medicare Costs

Mayo’s Medicare losses in Arizona may be worse than typical for doctors across the U.S., Heim said. Physician costs vary depending on business expenses such as office rent and payroll. “It is very common that we hear that Medicare is below costs or barely covering costs,” Heim said.

Mayo will continue to accept Medicare as payment for laboratory services and specialist care such as cardiology and neurology, Yardley said.

Robert Berenson, a fellow at the Urban Institute’s Health Policy Center in Washington, D.C., said physicians’ claims of inadequate reimbursement are overstated. Rather, the program faces a lack of medical providers because not enough new doctors are becoming family doctors, internists and pediatricians who oversee patients’ primary care. “Some primary care doctors don’t have to see Medicare patients because there is an unlimited demand for their services,” Berenson said. When patients with private insurance can be treated at 50 percent to 100 percent higher fees, “then Medicare does indeed look like a poor payer,” he said.

Annual Costs

A Medicare patient who chooses to stay at Mayo’s Glendale clinic will pay about $1,500 a year for an annual physical and three other doctor visits, according to an October letter from the facility. Each patient also will be assessed a $250 annual administrative fee, according to the letter. Medicare patients at the Glendale clinic won’t be allowed to switch to a primary care doctor at another Mayo facility.

A few hundred of the clinic’s Medicare patients have decided to pay cash to continue seeing their primary care doctors, Yardley said. Mayo is helping other patients find new physicians who will accept Medicare. “We’ve had many patients call us and express their unhappiness,” he said. “It’s not been a pleasant experience.”

Mayo’s decision may herald similar moves by other Phoenix- area doctors who cite inadequate Medicare fees as a reason to curtail treatment of the elderly, said John Rivers, chief executive of the Phoenix-based Arizona Hospital and Healthcare Association. “We’ve got doctors who are saying we are not going to deal with Medicare patients in the hospital” because they consider the fees too low, Rivers said. “Or they are saying we are not going to take new ones in our practice.”

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13 GOP AGs threaten health bill suit

Thirteen Republican state attorneys general are threatening to file a lawsuit challenging the constitutionality of the Senate health care bill.

In a letter sent to House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid on Wednesday, South Carolina Attorney General Henry McMaster said he had “grave concerns” about the deal Senate leaders cut with Sen. Ben Nelson (D-Neb.) to secure his crucial vote for the health care package.

“The current iteration of the bill contains a provision that affords special treatment to the state of Nebraska under the federal Medicaid program,” writes McMaster. “We believe this provision is constitutionally flawed. As chief legal officers of our states we are contemplating a legal challenge to this provision and we ask you to take action to render this challenge unnecessary by striking that provision.”

“In addition to violating the most basic and universally held notions of what is fair and just, we also believe this provision of H.R. 3590 is inconsistent with protections afforded by the United States Constitution against arbitrary legislation,” writes McMaster.

Under the terms of the agreement with Nelson, the federal government will pick up the full tab for all new Medicaid enrollees in Nebraska, a deal that’s expected to cost about $100 million over the next 10 years.

In the letter, McMaster argues that the Nebraska provision should be removed in the upcoming conference committee negotiations.

“We ask that Congress delete the Nebraska provision from the pending legislation, as we prefer to avoid litigation,” writes McMaster. “Because this provision has serious implications for the country and the future of our nation’s legislative process, we urge you to take appropriate steps to protect the Constitution and the rights of the citizens of our nation. We believe this issue is readily resolved by removing the provision in question from the bill, and we ask that you do so.”

Democrats have derided the legal analysis as politically motivated. Several of the state attorneys general that signed the letter — including McMaster — are running for governor.

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Yes, Someone Has To Pay for Health Care

Most Americans already have health care insurance, but many middle-class Americans are afraid of losing what they have. The fear is especially profound when a person can work hard and steadily for years, only to find him-or-herself suddenly out of a job and without the means to pay for a costly illness.

There have been too many horror stories about people who responsibly buy personal health plans, only to find out that the plans don't really cover large medical bills. If a person gets a job that provides health care benefits, his or her current health problems may not be covered because they are pre-existing conditions. Washington's catchphrase for the above situation has been, as the fiscal-watchdog group the Concord Coalition wrote in its recent report on health care reform, "doing nothing is not a responsible option."

The other half of the equation, however, is, as the report continued, "It does not follow, however, that doing anything would improve the situation." Alas, doing anything seems to be the one thing at which Washington excels.

Now, I've got issues with the bills passed in the House and Senate when Speaker Nancy Pelosi and Majority Leader Harry Reid kept tossing in benefits while promising to reduce the country's health care tab.

But my new fear is that during conference committee, lawmakers will throw in even more goodies and then, to make everybody happy, reduce the tax increases necessary to fund the plan. The closer they come to President Obama's 2008 campaign rhetoric -- universal health care that only rich people pay for -- the more red ink they will pass on to the next generation.

The House proposes a 5.4 percent tax on workers earning more than $500,000 annually, or $1 million for couples. The Senate relies heavily on what is called hide-the-tax -- excise tax on so-called Cadillac health care plans. The Senate also would increase Medicare taxes on families earning more than $250,000.

The problem with soaking the rich to pay for a health care plan? This is the fastest-shrinking tax imaginable when the economy sours. If California can serve any useful function in this debate, it should be as a warning to the dangers of over-relying on taxes on the rich.

Besides, as the Concord Coalition noted, broadly based taxes "spread the notion that all must contribute something for government benefits -- imposing an important breaker against 'free lunch' spending giveaways." Hence the coalition's support for the tax on so-called Cadillac health care.

While critics on the left complain that the Cadillac tax will squeeze union workers and the middle-class, I have issues with taxing those with health care benefits to pay for those who don't. Better to pass a value-added tax, but at least this excise eventually would make everyone pay for a universal benefit.

Concord Coalition Policy Director Josh Gordon believes, "Once people start feeling the cost of their insurance, they start getting concerned about premiums being too high." He added that if negotiators remove the Senate excise-tax and cost-control measures, the Concord Coalition would have to brand a final bill as "irresponsible legislation."

Note to anti-tax Republicans: If Washington passes a bill, someone has to pay for it. The only question is who, when and how much. Note to soak-the-richers: You can't say that universal health care is a moral imperative, but only other people should pay for it.

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