The Obama Administration is unveiling its budget today. His remarks, released this morning, regarding health care included:

Because of crushing health care costs and the fact that they drag down our economy, bankrupt our families, and represent the fastest-growing part of our budget, we must make it a priority to give every single American quality, affordable health care. That’s why this budget builds on what we have already done over the last month to expand coverage for millions more children, to computerize health records to cut waste and reduce medical errors, which save, by the way, not only tax dollars, but lives.

With this budget, we are making a historic commitment to comprehensive health care reform. It’s a step that will not only make families healthier and companies more competitive, but over the long term it will also help us bring down our deficit.

Yesterday news had already broke about a major componant of the Administration’s proposal. The New Republic‘s Jonathan Cohn reported from the Hill:

Officials from the Obama administration on Wednesday briefed both members of Congress and advocates from the health care community about the budget proposal they’ll unveil formally on Thursday… they are proposing to allocate $634 billion over ten years towards health care reform, the bulk of it to expand insurance coverage. And since that won’t fully fund universal coverage, they propose to work with Congress on finding the remaining money.

At the WSJ Health Blog, Sarah Rubenstein detailed some of the policies expected to be included:

Medicare Advantage: Democrats have been vocal critics of these private plans within Medicare, claiming they’re taxpayer-subsidized profit centers for insurers… The administration is expected to proposed cutting federal payments to insurers that run the plans by requiring them to competitively bid to offer plans.
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Drugs: The generics industry’s trade group tells the WSJ it’s hearing the proposal will set up a regulatory pathway for companies to create generic versions of biotechnology drugs, which currently can’t be made into copycat versions… The administration also wants to curb a practice by makers of traditional branded drugs by which they extend the patent-protected life of existing products by changing them slightly… Finally, Obama wants upper-income seniors to pay more for Medicare drug plans…
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Hospitals: Obama wants to create one bundled Medicare payment to cover both a hospital stay as well as care for the patient for 30 days after release, a change estimated to save $17 billion over 10 years… The administration is also proposing to cut payments for hospitals that routinely readmit patients after they have been discharged. It’s meant to save $8.4 billion over 10 years…

Ezra Klein presented further details about the plan: (more…)

As more and more older, professional women are trying to get pregnant — the demand for donated eggs has gone up. And people are paying higher fees.

Since women donating their eggs have to inject themselves with hormone shots — and getting the eggs is a painful process — people argue that women should be compensated for their time and discomfort. But the controversy lies in just how much is too much to pay a woman for her eggs. The American Society Reproductive Medicine has suggested that women receive no more than $5,000-$10,000. But some egg brokers are ignoring the cap since it isn’t federally regulated.

Some believe these women are altruistic helping other women have babies — others argue that women are doing it just for the money, which can be dangerous since they’re more likely to ignore the risks of the procedure.

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While many people celebrate Barack Obama being the first African-American president, I was celebrating having intelligence back in the White House. He’s so smart, he’s surrounding himself with other smart people. The latest “smart” appointment is Mary Wakefield, PhD, RN, FAAN, to head the Health Resources and Services Administration. I’ve known Mary for a number of years and can tell you that she is sharp as a tack. She’s been the Director of the Center for Rural Health at the University of North Dakota, but her credentials include chairing the Institute of Medicine Committee on Health Care Quality for Rural America, serving on the other quality commissions of the IOM, and serving as Staff for United States Senator Kent Conrad (D-ND) from January 1993 to January 1996 and as Legislative Assistant and Chief of Staff to Senator Quentin Burdick (D-ND). HRSA has oversight of the nation’s community health centers and other initiatives that will be key to building a coordinated health care system with improved access and quality. We are in very good hands.

It seems like the childhood obesity epidemic is in the news nearly every day–as America’s kids seem to be super sized. In New York City, a judge upheld the city’s 2007 regulation requiring most major fast-food and chain restaurants to prominently display calorie info on their menus.

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I looked at the outline of the new federal Stimulus package for pieces that would help people like me–caregivers and families of stroke survivors–something over and above what other families might receive in tax credits, etc. It’s always in the fine print. The only direct item I could find related to Unemployment Compensation:

If you lose your job, your former employer cannot try to get you disqualified from receiving unemployment benefits if “separation from employment…is for compelling family reasons…[including]: illness or disability of an immediate family member… The Labor Secretary would define immediate family member.” [Source: Conference Committee Report posted on Thomas.gov]

If you lose your job, there is some help for continuing health care under COBRA–particularly important if the caregiver’s insurance is covering the stroke survivor. Once you change insurers, it is almost impossible to get health insurance coverage for family members who have “pre-existing conditions” like stroke.

There are some additional funds for direct health care services through the Medicaid program and federally-supported community health centers. Also, additional funds for home-delivered food/nutrition services under the Administration on Aging programs, if you qualify.

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On the New Health Dialogue blog, Paul Testa analyzed the ongoing public debate about comparative effectiveness research:

The New York Times‘ Robert Pear examines the content and contentiousness of the comparative effectiveness provisions of the $787 billion stimulus package. HR 1 provides $1.1 billion (pdf starting on page 156) to AHRQ, NIH and the HHS to evaluate the relative effectiveness of different health care services and treatment options. The goal is to create a process of funding and disseminating comparative effectiveness research that is transparent, professional and free from conflicts of interests. As the Dartmouth Atlas’ Elliott S. Fisher, MD, tells Pear, the funding would be used to try to answer questions such as:

… What is the best combination of “talk therapy” and prescription drugs to treat mild depression?
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Is it better to treat chronic heart failure by medications alone or by drugs and home monitoring of a patient’s blood pressure and weight?

In health care, though, simple questions rarely have simple answers. Nor will answers be static; biomedical science changes at a pretty astonishing clip. We wrote about this topic twice last week, and we expect to hear more about it as the health reform debate intensifies. Last week Kyle Noonan wrote about some of the alarmist rhetoric surrounding the issue, and Joanne Kenen wrote a longer piece about how comparative effectiveness fits into “health” as well as health care reform. We also want to point out Bob Laszewski’s posts at the Health Care Policy and Market Place Review, which has provided interesting coverage on this topic.
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Beginning to measure what works best for what patients or populations under what circumstances can provide a baseline. Providers and patients will have access to information that will help them better understand their choices and the likely consequences. Providing that information in a manner that is transparent, credible, and easily understood will go a long way to ensuring that all Americans receive the most effective care whether they live in Florida or Nebraska or California.

At Science-Based Medicine, Peter Lipson shared his perspective on comparative effectiveness research: (more…)

For several years, my family has held a grab bag holiday get-together. People are to bring inexpensive gifts, often intended more for laughs than for use. My extended family includes nieces and nephews ranging in age from 15 to 30, some with children and others who are sexually naïve, even if not virgins. Mine is not a family that discusses sex. My living siblings are reborn Christians, who deem appropriate only discussions of abstinence for those youth not yet married. However, as a nurse, I’ve made it clear that their auntie will not shy away from sexual discussions. I have been known to initiate such conversations with a niece or nephew and even their friends when I have some time with them.

“ONE PREMIUM LUBRICATED Lifestyles® LATEX CONDOM”

So this year, one of my grab bag gifts was condoms. My courage to make this a visible ‘gift’ at the holiday party arose from New York City’s model of making condoms available anywhere and everywhere. The city has rightfully been aggressive in distributing condoms since Thomas Frieden assumed the position of Commissioner of the Department of Health and Mental Health and saw that a large proportion of people in the city who are HIV-positive don’t know it and can be spreading it unintentionally by having unprotected sex. In 2007, the city launched a NYC-branded condom and has since given out over 70 million of them for free. (more…)

One of the best things about blogging is the opportunity it provides to “meet” some incredible people. I’d like to introduce you to one of them, Carrie Ostrea, Hannah’s mom. Hannah was born with Gaucher’s Disease—a rare disease. Carrie is on a mission—she shared the following with me and asked if I would help “get the word out” about her efforts, her Hannah, and her hope to make change. A Disruptive Woman in every sense of the word.

To learn more, read on:

It is so important to me that awareness be created regarding the Ryan Dant bill as well as rare diseases such as Gaucher’s Disease. That is why I’ve dedicated my blog not only to sharing updates with family and friends, but to create awareness for rare diseases, legislation, and other life experiences raising a child and family with unique special needs.

Here are some details regarding the Ryan Dant bill. I have actually been emailing with Mark Dant, Ryan’s Dad, about getting Hannah very much involved.

Basically, the bill will remove the income requirement for Medicaid if the applicant’s medical treatment would cost more than $250,000 a year (Hannah’s medication will cost about $250,000 to $300,000 a year as an adult, and that doesn’t include doctor’s fees, other procedures, therapies, and surgeries). If Hannah was a young adult, she would have to get a low-paying job (poverty level) in order to get Medicaid for her treatments because there are very few insurance companies that would accept an adult with that kind of insurance cost.

Here is a copy of my letter.

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Seismic shifts are inherently discomforting. I think we are in one, and the health care system seems a little Cro-Magnon in its response to this discomfort. We seem uniquely able to slog along, business as usual, without innovately entering into the dialog. The demise of Tom Daschle simply intensifies this sensation, as “our” anointed “leader” at the White House table is removed from the dialog. The problems that created his demise look a bit dated too. We seem stuck in trying to create a future while hanging on for dear life to the past.

People mention us a good deal, of course, largely noting that we are alternately broken, inefficient, dysfunctional, too expensive, held hostage by insurance companies, unfair, unsuccessful…there is a long list here. We apparently need to change. This occurs in a larger context, both nationally and globally, and there we find what Yeats described so well: “Things fall apart; the center cannot hold”. The poem was called “The Second Coming”.

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Genetic Alliance staff engaged in a conversation recently about transformation of the healthcare system.  Although we intended to point without us, and find challenges and opportunities for the new administration to ‘fix’, we discovered what many are discovering these days — change begins with me, with us.

The Genetic Alliance staff has a strong interest in health.  We are individuals familiar with the healthcare system: whether through our own personal experiences or those of our family members, our work in health systems, diverse stakeholder engagement, and our commitment to improving the lives of individuals, families, organizations, and communities affected by genetic conditions.  We also have a unique vantage point through our dedication to accelerating the translation of research discoveries to treatments and therapies.  We identify disruptive innovation as a tool for achieving great beneficial impact on systems — we are disruptive women and men.

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As members of the House and Senate work to craft a mutually acceptable economic recovery plan, everyone is talking about the good and the bad of the health care provisions in each version of the bill. MedPage Today correspondent Emily P. Walker explained:

The Senate version would provide $1 billion less for technology upgrades than the House version, but $19 billion is still a significant outlay to make upgrades in the medical record system that many healthcare providers have long been calling for.
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The Senate bill allocated about $19 billion to upgrade hospitals’ electronic records systems and limited how much an individual hospital could receive to $1.5 million. The House version allocated $20 billion and contained no cap on individual hospitals’ share.
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The Senate’s stimulus package also includes $8 billion more for the National Institutes of Health than the House version, a total $10 billion. It would go toward facility upgrades, equipment, and research.
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The Senate version dropped nearly all the money contained in the House version that would have gone toward preventing illness through health screenings, education, immunizations and nutrition counseling.
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One area where the Senate was more generous was a provision allowing higher payments to hospitals who take in a disproportionate number of low-income, Medicaid, and uninsured patients. This provision was not in the House bill.

At Talking Points Memo DC, (more…)

Disruptive Women in Health Care is pleased to present our first ever Man of the Month post.

We received many worthy suggestions (keep them coming, please) and have quite a line up to share over the next few months.  Today, Google’s Missy Krasner, a founding Disruptive Women in Health Care blogger, interviews Matthew Holt, Co-Founder (along with Indu Subaiya) of Health 2.0.  Matt also serves as editor of The Health Care Blog.  If you have an interest in, or want to learn more about Health Information Technology, how the Internet can improve health outcomes, the wisdom of crowds, and Matt’s pick for HHS Secretary, you are in for a treat.

Let us know what you think.

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On Jan. 26, Los Angeles mom, Nadya Suleman, made national news giving birth to octuplets. Now she’s stirred up controversy and debate about whether fertility treatments should be regulated. It turns out Suleman is 33, single, unemployed, lives with her mother — and already has six children. Knowing this, should her doc have allowed her to try and have eight babies at once? According to her mother, she only wanted “one more girl.”

Since the goal of most fertility treatments is to get one healthy baby — doctors usually implant a smaller number of fertilized embryos.

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Come hear Sharon Terry, Disruptive Women in Health Care blogger and President & CEO of Genetic Alliance, speak at the DONAGHUE FOUNDATION 2009 CONFERENCE.

BEYOND EUREKA!
Innovation in the quest for better health:
Patient-driven transformations in research, technology and treatments

Wednesday, April 29
Hartford Marriott Farmington
Farmington, Connecticut
8:00am – 2:00pm

In the health arena, patients and health care consumers are developing technology-enabled tools for better, faster access to information and driving change in medical research, treatments and cures.

The conference will highlight the work of innovators who are forging these new models and already reshaping doctor-patient relationships, research paradigms and health care policy and delivery. Anyone interested in using interactive, web-based exchanges to create change is invited to attend.

Click here to learn more and register.

House Resolution 406, a call from Congress to incorporate Wellness programs into the American health care system was introduced at the end of last term, and has been introduced without further action every year for the past 4 years. You can see the text and track the status of the current resolution here.  Under the Obama administration, there is a greater likelihood now more than ever that wellness legislation will become a reality.  Why wait another day? We can all take action for the sake of our own wellness.

10 Things you can do for yourself to improve your health:

1. Breathe deeply & slowly
2. Create your vision for your health
3. Eat more greens and less sugar
4. Drink more water and less caffeine
5. Move your body in a new way; try yoga or tai chi
6. Get in touch with your body; try massage
7. Rest your mind; try meditation
8. Laugh; look for humor
9. Learn something new every day
10. Sun yourself from outside as well as the inside