The Disruptive Women in Health Care blog continually aims to encourage discussion and debate among readers about emerging issues and topics in the health care world. Historically, one of the ways that we have done that is through our weekly round-ups – that is, posts containing summaries and links to some of the big stories in health care news for the given week, with some original commentary and content sprinkled in as well. The way we see it, there is just too much happening in this burgeoning industry; it’s hard to keep up, especially when you’re busy disrupting and making headlines in the health care world yourselves. We know the weekly round-ups have been on hiatus for a while, but are happy to report that they’re finally making a comeback. Each week, we’ll be gathering some of the biggest health care news you can use from at home and abroad for posting on Wednesdays. Feel free to comment on what’s included and send us some links to articles to be considered for next week!

Has your week been too disruptive for you to keep up with the news?  Disruptive Women are on the case!  Here is this week’s round up of some of the most pressing issues here in America and around the world.

Here at Home:

Thanks to a provision of the Affordable Care Act (ACA), women are now able to receive free birth control, but only if it’s prescribed.  The New York Times explains how Catholic Colleges are using this loophole to combat contraception.

And, speaking of the Catholic Church and the ACA, USA Today says that Obama’s decision on Friday not to expand the conscience exemption to include religious institutions has been met with outrage from Church leaders and parishioners.

Remember that moment of panic you had when the swine flu epidemic came to the United States?  CBS News reports that swine flu numbers are rising again in Mexico. Will the US be next?

Susan G. Komen for the Cure, the nation’s leading breast cancer charity, announced Tuesday that it is halting its partnership with Planned Parenthood (per NPR) – a controversial decision that ignited a backlash from some of its supporters.

Here’s one perspective on Komen’s decision. What do you think? Will this impact your decision in giving donating to Komen, or another breast cancer non-profit in the future?

Sick? Took a sick day?  Is that enough of a reason for you to wind up unemployed?  HuffPo explains how an issue as simple as recovery from the flu has reached the Supreme Court.

With nearly two million women lacking health insurance and a quarter of a million unplanned pregnancies per year, Florida has a lot of challenges in terms of women’s healthcare.  Here’s what the state is doing to try and move ahead.

Around the World:

Brazil is calling for a registration of all pregnant women.  What does this mean for a woman’s right to choose within Brazil?

Japan’s population is shrinking. As more women choose a career over family, Japan faces declining birth rates. Could the United States be next?  ABC News takes a look.

Check back each week for the latest health care news!

Newly minted Obama Chief of Staff William Daley was certainly speaking his mind when he talked health care on the Sunday shows this weekend. He wanted his message made loud and clear – that the Administration has no intention of “reopening last year’s vitriolic health overhaul debate.” Full details here.

I’m glad that Daley is so steadfast in his conviction not to reopen the health care debate, but take one look at this morning’s headlines and it is clear this is not likely to happen. From Florida to New York, court battles to legislative infighting, debates over various aspects of the Affordable Care Act are dominating the news (and the roundup).

Before Daley’s assertion, though, President Obama told attendees at the Health Action 2011 conference exactly how he felt while defending his health care reform efforts last week. Full text of his remarks available here and analysis here and here.

And if that’s not enough Obama-care news for you, a special Health on the Hill this week, analyzing his State of the Union health care remarks, and what they mean for the Administration, Congress and, of course, for 2012.

Speaking of the State of the Union, I hope one of your drinking game words  wasn’t “innovation” because I think everyone can agree it came up a lot Tuesday night. But the Administration’s newfound love of all things innovate-able won’t be limited only to job creation and the technology sector. According to the National Journal Health Blog, 2011 will see the emergence of a “core part” of the health care law – focusing on innovation. [If you recall, this very blog did an entire series on innovation and health care – before Obama made innovation the “it” topic of 2011. Read our series here.]

So we all know how most stakeholders (be they politicians, insurance executives, doctors or anyone else in between affected professionally by health care reform) feel about the Affordable Care Act, but what do the majority of American citizens think these days? Check out the latest polling via Kaiser Health News here.

Keep an eye on Pensacola, Florida today – where U.S. District Court Judge Roger Vinson is “expected to rule on the health care lawsuit brought by governors and attorneys general from 26 U.S. states, almost all of whom are Republicans” (per Reuters). Not only does this have the potential to be the second unfavorable ruling on the constitutionality of the Affordable Care Act, but considering that the plantiffs in this particular case represent more than half the U.S. states, it has more prominence and significance than the some two dozen lawsuits filed in federal courts since the legislation’s passing in March 2010. Another point of note — “Since a full legislative repeal seems like a non-starter in the current Congress, legal experts all agree the real battle over reform is destined for the Supreme Court.” We expect Vinson to take his stand before COB today.

And while the courts duke it out over the constitutionality of the Affordable Care Act, politicos back in DC struggle to identify ways to pay for it. Making headlines this week, the newly established Medicaid and CHIP Payment and Access Commission (MACPAC) is off to a less-than-stellar start – and panelists have been making their worries known. Tasked with offering recommendations to HHS, Congress and the states on consolidating and simplifying these programs, committee members spoke out on Friday to express concern over the direction of the recommendations and the associated costs (per Politico). And, as Kaiser Health News reported, if the federal government does not step in and help fund some of these programs (created by the Affordable Care Act), we could be headed for a showdown between states and the federal government (an issue many governors are certainly not staying quiet on). For all the details on the commission, analysis and more, see the Kaiser Health News roundup here.

Another panel convening on health care reform this week is tackling a different, but equally murky, set of issues. This committee, convened by the Institute of Medicine, is tasked with determining what constitutes an “essential” medical need [when it comes to insurance coverage]. Perhaps the hottest topic up for debate? Infertility treatment. Full details, via WaPo, here.

While many states are gearing up for a fight, at least one governor is choosing to take matters into his own hands and act now. As Kaiser Health News explains, newly elected New York Governor Andrew Cuomo recently announced his intention to trim NY’s $53 billion Medicaid program (“one of the most generous in the country”). Full explanation of the plan, the identified areas to cut and its potential implications here.

Back in DC, a big announcement from NIH — the creation of a new drug development center (per National Journal Health Blog ). While “the drug center, called the National Center for Advancing Translational Sciences, aims to cross what supporters call the “valley of death” that can occur between basic NIH discoveries and the sometimes risky and expensive undertaking of translating those findings into actual treatments,” not everyone agrees with this decision – especially Republicans in Congress, who have been making sure their malcontent is very well known. As Sen. Richard Burr (R-NC) explains, “I think it flies in the face of what the president said the other night, which is we don’t want to stymie innovation in this country, we want the private sector to flourish, we want jobs to be created.”

This coming at the same time as the Wall Street Journal’s Health Blog reports, “How will 2011 be a difficult year for drug makers? Let us count the ways! The patent cliff. Weak economies. Pricing pressure from European governments. The effects of U.S. health-care overhaul. Tough regulators.” Several drug companies – including Johnson and Johnson and Abbott — reported bleak outlooks in the wake of all of these things and lower-than-anticipated fourth quarter earnings reports last week. More details here.

One thing we can always rely on, a unique perspective on health care reform and repeal from Washington Post’s Ezra Klein. Don’t take it from me though; let him explain his take on the situation for himself (mostly because I can’t do his imagery – a numbers salad anyone? – the justice it deserves).

Steering away from the politics, lung cancer activists spoke up this week, asking for more than just an “anti-tobacco” message (per the Washington Post ). Considering that lung cancer is America’s deadliest form of the disease – killing 158,683 people in 2007 alone –, a “growing number of lung cancer survivors, victims’ relatives and advocacy groups calling for a greater, more comprehensive focus on the disease – similar to the multi-pronged approach to breast cancer,” with special emphasis on early detection and treatment measures.

And, the Bill and Melinda Gates Foundation spoke out on their fight to eradicate polio today. The Foundation hosted a webcast on “Polio Eradication and the Power of Vaccines” this morning from (appropriately) FDR’s home in New York. The webcast hosted a panel including Pulitzer Prize-winning historian Dr. David Oshinsky; Dr. Ciro de Quadros, Executive Vice President, Sabin Vaccine Institute; and Professor Helen Rees, University of Witwatersrand, South Africa and Chair, WHO’s Strategic Advisory Group of Experts on Immunization with Diane Sawyer of ABC News moderating and included an address from Gates himself on the need for increased efforts to eradicate the polio epidemic. You can watch the full webcast here.

Got 5 minutes? Check out this Wall Street Journal Health Blog’s quiz here on what medical specialists are and aren’t medical doctors (aka MDs) and compare your results to those collected in a recent American Medical Association poll. The results may surprise you!

That’s all for this week. A happy early Super Bowl Sunday to all my football fans out there. But, if I may be frank (after all, everyone else is) a word of caution especially for you diehard Packers and Steelers fans, watch with care. According to this piece from CNN Health, there may be a lot more at stake during those four quarters than just the National Championship… 

Enough of the housekeeping, now to get down to business. Not even the deepest hibernation in the most remote cave – or even the most recent bout of ice and snow — could keep me from hearing the news – the GOP is going to try and repeal health care reform (or what they refer to as Obamacare). And with health care the number one issue in the news right now I thought, what could be better than a special Health Care News Roundup: Repeal Edition?

In fact, all week I, along with our esteemed Disruptive Women, will be posting news, information and especially reactions and analysis to what’s going on on the Hill – though no one knows quite yet just what that will turn out to be. Whatever this week brings with the Repeal Act and subsequently proposed bills, rest assured that we will have all the health care news you can use (and then some!).

The day has finally arrived, just a week or so later than expected. Delayed by, of course, the tragedy in Tuscon, but also by sleet and snow and ice, bureaucracy and decorum and all those other factors that prevent much if anything from ever getting done in Washington, the day we have all been waiting for is finally upon us. Only the start of the day was delayed until 2 pm (thanks DC ice storm). What day, you ask? Why, the day that the House will begin hearings on “Repealing The Job-Killing Health Care Law Act” (and if you, like me, are thinking that that is the dumbest name for a bill ever in the history of our republic, you will probably also, like me, get a kick out of this article ).

Hearings have been underway for a little while now, though the final vote is not expected until sometime late tomorrow, per CSPAN. And if you just can’t get enough of the repeal hearings, you can watch them and/or read a liveblog here.

Certainly if you have enough time to watch CSPAN, you have enough time for a little extra reading, and if that’s the case I would strongly recommend this piece from Kaiser Health News, explaining one of the most common health care mystery terms, Accountable Care Organizations (ACOs).

Now, this repeal business may seem at face value to be bad (read: very, very, very) bad news for the Democrats, but not everyone on the Left is looking at the glass as half empty. Per Politico, some Dems – HHS Secretary Kathleen Sebelius chief among them – see the beginning of the repeal hearings as a good thing (no, you didn’t read that wrong, I did type a good, g-o-o-d good thing). As Sen. Chuck Schumer (D-NY) explained, “‘We welcome, in a certain sense, their attempt to repeal it because it gives us a second chance to make a first impression.’” Whether this is true, we shall see…

Breaking News from Modern Healthcare this morning, according to an HHS report released this morning, “Repeal could leave 129 million without coverage.” Read more about the report and its specific findings here.

Meanwhile, as Politico reported this morning, the health care lobby has remained uncharacteristically quiet leading up to the repeal hearings. Considering how hard they pushed against the bill’s original passage, some questioned whether their silence indicated a shift in policy, or perhaps an ice-storm-induced power outage. But, it appears instead that, “The health care industry’s biggest trade groups have remained uncharacteristically neutral on the Republican effort to repeal the health care reform law, choosing instead to save their political capital for smaller, more targeted changes that have a chance at becoming law.” The pharmaceutical lobby has taken a similar approach.

And, proving once again to have everything completely turned around, leaders in California gathered this morning (thanks to the time difference and the East Coast snow, more or less at the exact same time as leaders in the House did) to discuss not repealing the Affordable Care Act, but rather steps towards rapidly implement it.  Per Politico, because Californians “are always out in front” (like being the first state to go bankrupt!) and because they prefer to reject the status quo (Venice Beach, enough said), CA HHS Secretary Diana Dooley told reporters that she forsees California being the “pace car” of health care reform for the rest of the nation (well, considering DC is also having a bad day with rail cars, maybe Dooley is on to something here).

If you’re eager for a different take on the health care debate (outside of the job killing and the rapid implementing), two great pieces to check out – first on rebranding “Obamacare”  and second on redefining reform, both care of Kaiser Health News.

I hope you will check back over the next few days as we invite not only our Disruptive Women bloggers but also any interested readers to weigh in and give their take on the many stages of the repeal. Leave a comment, post a link to your own writing on the topic, whatever you like to let the rest of us know what you think! Certainly, no matter whether you are in favor of repeal or not, no one is apathetic on an issue as critical as this one. I may be biased (I do write for a health care blog), but I think most people will agree with me that health care reform/repeal is an issue that touches most if not all aspects of our lives – personal, physical, financial, etc – and, especially in this economy, no one can afford to stay quiet. So speak up! And look out for more interactive content, including polls, as the week (and the repeal process) goes on. In the meantime, be sure to check this out for a repeal-themed laugh.

All this talk about the possibility of repeal was enough to wake me from my hibernation, not just for the week but for good, so look out for the return of your weekly Health Care News Roundups on an all new day (Mondays). Until next time!

You’ve heard it before, and you’ll hear it again. Y2K, 2012, the alleged Zombie Apocalypse that keeps popping up on my Facebook newsfeed. The end of life and the world as we know it is here – at least it is if you work in the insurance industry. As Politico reported yesterday, “State insurance commissioners approved rules shaping how insurance companies will have to account for their medical spending beginning next year.” This final step comes as a means of paving the way for one of the biggest components of health care reform to be implemented – the provision that requires insurance companies to “spend 80 to 85 cents of every dollar they collect in premiums on medical care or items that improve quality.” Everyone agrees that the passing of these rules marked a bad day for the insurance industry. The Wall Street Journal’s Health Blog  called it a loss for insurance brokers nationwide.

We saw two weeks ago the first midsize insurance provider (Principal Financial – for full story, see here) discontinue its health care coverage in anticipation of this law’s implementation. Two weeks ago, when the story broke, many said it was only the beginning of the descent, a foreshadowing of what was to come. Whether this is true remains to be seen. But no one will deny that the passing of the rules was a significant step towards it.

There is still one ray of hope – the final recommendations must go before and be approved by HHS. As WSJ reported, “Terry Headley, president of the National Association of Insurance and Financial Advisors, said in a statement his group is hopeful regulators and HHS ‘will side with consumers by recognizing that agents need to be compensated for the vital assistance they provide consumers in managing day-to-day health-care issues.’”

Also this week, some Democrats, running for office, hoping and expecting to get reelected by their constituents, have been… wait for it… voicing their SUPPORT for health care reform?! It’s true! A select group of Democrats found a new way to talk about health care, according to this week’s Health on the Hill roundtable – watch the video here.

It’s even more surprising that the Dems are coming home to the party on health care reform considering these poll numbers, courtesy of Politico, showing another dip for support of health reform.

And on this edition of Law and Order: Health Care Reform, a collection of articles covering what Kaiser Health News calls the “Massive Medicare Fraud Operation” in Miami, which reportedly netted millions of dollars. Only in Miami would a sting operation be needed to bust a covert Medicare crime ring (okay, the last part may be an exaggeration). Read more here and then realize that this might be related to Florida’s exceptionally bankrupt (yes unfortunately, the exceptionally is necessary to differentiate between Florida and every other also-bankrupt-but-somewhat-less-so state).

In a very appropriate Halloween post, The New Republic’s Jonathan Cohn attempts to take the spook out of the individual mandate provision of health care reform. Read his fresh take – and especially his explanation for why this is actually a libertarian policy – here.

Ezra Klein offers a somewhat different – and more importantly, less gloomy – take on how health care reform will impact not only health coverage but the economy in his blog. Written as a response to Tenessee Governor Philip Bredesen’s op-ed in the Wall Street Journal from earlier this week, Klein not only refutes a few of Bredesen’s arguments (mainly his claim that the current reform law will unravel the employer based health insurance market) but ties the entire back-and-forth to a much larger issue about the complexities, ambiguities and misunderstandings surrounding health care reform.

On a more fun note, carrot farmers are out to prove that it really is all in the packaging. As the WSJ Health Blog reports, these farmers are attempting to make carrots “cool” using marketing tactics typically associated with candy and junk food. Their latest move is “scarrots” — a “Halloween promotion that includes single-serving packages and ‘25 temporary glow-in-the-dark tattoos of masquerading baby carrot characters.’”

And, because everyone (especially anyone working in health insurance) needs a laugh, this week’s political cartoon.

That’s all from here for this week! Be sure to check back next week for what I’m sure will be an especially newsworthy edition of the Health Care News Roundup – the last before Election Day!

We start with sick children again this week, but on a good note, for a change. HHS announced this week that about $100 million of the Affordable Care Act will be allocated towards building or renovating school-based health centers. As the Modern Healthcare article  explains, “the centers enable children with chronic illnesses to attend school, and they also help improve overall health and wellness for all children through health screenings, health promotion and disease-prevention activities.”

We’re taking a hiatus from the political hubbub this week (well… mostly taking a break), but if you want your fix of health care and the Midterms, take a look at this week’s Health on the Hill roundtable as they discuss how Democrats are approaching “the health care issue” on the campaign trail, reactions of employers to new laws and more. You can also take a look at Kaiser Health’s roundup of how health reform is impacting selected state races here.

The Fiscal Times tackled the issue of health care on the campaign trail this week (last election story, I promise). To read their analysis, click here.

How do you communicate with your doctor? Chances are, not by email, according to a report from the Center for Studying Health System Change. As Modern Healthcare  reports, “Despite indications that e-mail access to physicians increases patient satisfaction, only 6.7% of office-based physicians routinely use e-mail to communicate with their patients.” What’s more – only about a third of respondents indicated that their doctors’ offices were equipped to handle electronic communication! Though privacy issues are cited as a major factor in this statistic, doctors also indicated a concern about the potential for an increase in their workload should they begin communicating with patients via email. As virtually all other aspects of our lives go “2.0”, it will certainly be interesting to see how the medical field reacts.

Good news for Obama on the health reform front. Per the Wall Street Journal Health Blog, “A federal judge yesterday refused to grant a request for a preliminary injunction against the health-care overhaul law, saying Congress’s imposition of the individual mandate isn’t unconstitutional.” In his amicus brief, Judge George Steeh explained that, he “found that the individual mandate, the provision that requires everyone to have health coverage, was essential to the act’s larger goal of regulating ‘the interstate business of health insurance.’”

Last week, we discussed recently announced state-level Medicare cuts – the combined result of more people needing Medicare (thanks recession/skyrocketing unemployment) and the increase in people eligible/the amount that they are eligible to receive (by 2014, per health care reform laws) – which have now stripped many states of their tax revenue. As Politico explains this week, all of this, combined with the political turmoil of election season and the preparations to begin the first expansion steps in November (as health reform legislation requires) has the potential to cause a lot of turnover in state houses across the country.

And if you are more of a visual learner, here  is a graph of Medicare cuts, courtesy of Washington Post’s Ezra Klein.

Who ever thought morning sickness could be a good thing? According to Reuters, women who experience morning sickness tend to have healthier pregnancies and are less likely to miscarry. As for a medical explanation why this may be the case, Dr. Ronna Chan, one of the study’s authors, explains, “‘Some postulate nausea and vomiting during pregnancy is a mechanism to help improve the quality of a pregnant woman’s diet or a way to reduce or eliminate potentially harmful substances from the mother in order to protect the fetus.’” As for a medical explanation for pickles-and-ice-cream cravings, the jury is still out…   

Finally, just like Columbus discovered America 518 years ago, I too made a discovery of an equal or possibly greater caliber – the Kaiser Health News Political Cartoon Archives! Here are two of my recent favorites to start your three-day weekend: 1 and 2.

 Until next week, enjoy your pleasant health care news, unseasonably warm weather and three day weekend (hopefully you have one)!

Sick children are the subject of this week’s most prominent Administration v. Insurance Industry fight. As Politico reported earlier this week, several agencies have announced their intention to stop selling “child-only” policies, because “the overhaul requires them to accept all applicants, even if they apply for coverage at the last minute before treatment. Insurers say the provision, which went into effect Sept. 23, allows patients to game the system.”

HHS Secretary Kathleen Sebelius fired back quickly, claiming that the insurers were acting in bad faith. She offered the temporary solution of allowing agencies to raise premiums based on health condition – that is, until this practice becomes illegal in 2014. There has also been discussion of returning to the limited “open enrollment period” model, assuming that participating agencies promise to offer child-only policies. And so the battle wages on…

Some insurance agencies aren’t stopping at nixing child-only policies, though; they’re getting out of the health insurance industry altogether! As Reed Abelson of the New York Times reported yesterday, Principal Financial Group, which currently provides health insurance to almost a million people, plans to stop selling health policies, period. As the article explains, Principal Financial – whose primary venture is asset management – did not feel justified in making the investment to remain a competitive provider.

Though UnitedHealth group did agree to renew all Principal policies as they expire, per the Wall Street Journal, Principal’s announcement has broader implications beyond those for its customers.

As several health care writers speculated, per Kaiser Health News, we can expect to see this trend continue through the fall. According to industry insider Robert Laszewski (per this NYT article), one of the stipulation that came into effect last week requires agencies to spend 80 cents of every dollar collected in premiums on customer welfare, and “smaller players like Principal will not be able to compete because they do not have the resources and economies of scale.” He is worried that “the ensuing concentration is likely to lead to higher prices because large players will no longer face the competition from the smaller plans” leading him to quip: “It’s just the UnitedHealthcare full employment act.”

And when it rains, it pours; this week, states had to make significant cuts to Medicaid in the wake of surging enrollment. As Kaiser Health News reports, enrollment in the state-federal program rose by 8.5 percent and state spending on Medicaid jumped an average of 8.8 percent. This has effectively stripped states of tax revenue and left them with little choice but to cut corners. See a list of state-by-state cuts here.

Rain, rain go away! No luck with that for the White House (and not just because of Tropical Storm Nicole). See this Health on the Hill clip analyzing the latest health care-related polling data (hint: NOT good news for Mr. President). A Kaiser Health News analysis of their six month tracking poll showed similar findings. With the midterms only a month away, it doesn’t seem like the rain is clearing anytime soon over Pennsylvania Ave.

In other news, the Government Accountability Office (GAO) announced the appointment of 15 new members to its newly formed National Health Care Workforce Commission.

HHS also announced a new appointment this week, Dr. Richard Gilfillan will step in as the acting director of the Center for Medicare and Medicaid Innovation. Gilfillan comes to HHS following a stint as CEO of the Geisinger Health Plan, which lawmakers often point to as a “model” health system. Officials hope he will draw on this experience to help Medicare and Medicaid become “model” programs as well.  

One ray of sunshine to end this cloudy week – per Washington Post Health : “For the first time in more than a decade, the federal government is funding sex education programs that aren’t based solely on abstinence.”

That’s all for today! I see the sun is coming up as I post this, so here’s hoping for a sunny weekend – in weather and health care reform news! Until next week, stay dry!

First, some major provisions of the health care bill go into effect today – though exactly how many seems to be up for debate (I credit the crystal clear, completely straightforward, not even remotely ambiguous language of the bill for that.) Democratic House Caucus chairman John Larson outlines the 10 new reforms and how they will impact health care policy here. Meanwhile, Kaiser’s Health on the Hill blog explains the eight new laws (and their subsequent seven caveats) here. Interpret away.

And for answers to all your questions about health care reform – including the latest 10 provisions, check out this Q&A with HHS Secretary Kathleen Sebelius.

Also worth a read, National Journal’s Meghan McCarthy offers a more thoughtful look at health care reform – six months later.

The Republicans unveiled their Pledge to America (full text) yesterday, a 21 page document outlining their revised vision for the country and especially for health care reform. All the details of their intentions and vision here and Jonathan Allen’s analysis of it here.

We know things haven’t been going so well for Obama, especially on the health care front, but how bad are they really? Well, if this Politico headline is any indication, pretty darn bad. One of the headlines in their health care section: Barack Obama seeks divine intervention on health care reform. Read the story here.

Not everyone is quite as pessimistic though. According to Kaiser Health News writer Jenny Gold, Democrats’ best bet at selling health care reform is going back to the basics. As Democratic pollster Peter Hart told Gold, Democrats need to start saying, “’Here’s what the bill’s about. Here’s why it makes a difference. Here’s why it’s good for you and it’s good for America.’” Read more analysis here.

Post reporter/blogger Ezra Klein offered his own analysis on the situation and advice to Obama this week – his was a bit more straightforward than Hart’s. Klein’s take on the ever-complex and highly complicated situation: cut Medicare first. The second most straight-forward advice Obama has ever gotten on HCR, after “REPEAL.” Well, it’s something at least.

Going outside of the Beltway, an interesting story in the Wall Street Journal blog about how many lives mammograms actually save. Hint: not as many as you think! Great news to break on the day that a law goes into effect mandating insurance companies cover mammograms. Maybe Politico wasn’t so off on the divine intervention jibe.

Another interesting blog entry, this one from Washington Post’s The Checkup – do abortions cause depression? Not in teens says a new study, contrary to previous research on the subject.

And, shifting focus to another politically charged health debate – genetically modified salmon. Are they safe for human consumption? Will allowing them into our food source jeopardize our ecosystems? Will these genetically superior salmon be capable of actually swimming upstream? Read the Washington Post analysis here.

On another note, Disruptive Women in Health Care turns two this month; a big thank you to all our bloggers and readers for making these past two years truly disruptive!

The big news this week – census data is out and the percentage of people with health insurance is down for the first time in over two decades. More on the report and its findings from the Wall Street Journal Health Blog.

Ding-ding! And we’re back in the ring for another round of fight-that-doesn’t-end on the Hill. With election season officially upon us, both sides are jumping at the chance to offer their solution to the health care issue.

But first, in case you’re confused by just what health care reform is and isn’t in effect, a “Consumer’s Guide to the Health Law, Six Months In,” by Kaiser Health News.

The White House is planning a full-scale PR strike to promote both the original bill and their additional proposals that will be coming up for a vote in the next few weeks, according to Politico. Loyalist Democrats launched the Health Information Center this week, a multi-million dollar effort to promote all of this and supplement White House efforts with more down-in-the-dirt, War Room style tactics. Gritty reports from the trenches to follow, no doubt.

Meanwhile the GOP is planning a slightly simpler approach – as House Minority Leader John Boehner told an editorial board earlier this week. Knowing that a repeal of the original bill is unlikely, Boehner plans instead to just cut off all funding required to implement it. “They’ll get not one dime from us. Not a dime,” he promised. And the war wages on…

Ezra Klein of the Washington Post reports that across the board, health care reform is polling poorly as did the Wall Street Journal blog, citing one report that more Americans would vote for a candidate that supported repealing the health care reform act than wouldn’t.

With all this in mind, it doesn’t come as much surprise that Democratic congressional candidates are wary – to say the least – of jumping on the Obamacare bandwagon. In fact, according to a report out today, they’re actually spending more money on ads opposing health care reform than ads promoting it. Per Politico, “Since the beginning of Congress’s August recess, Democratic candidates have poured $930,000 into ads deriding the health overhaul but just $300,000 in pro-reform spots, according to Evan Tracey at Kantar Media,”  And, according to The Hill, one Democratic candidate has even gone so far as to sign the GOP repeal pledge.

Only one thing about health care reform and the midterm election is clear at this point – it’s going to be a long six weeks.

On a different but equally politically charged topic, a CDC report out this week indicates that almost one-third of all sex education courses for teens discuss birth control – different methods, how they are used, etc. As a Washington Post blog entry on the report explains, lessons about saying no and STDs were much more common.

Ever felt bad coughing, sneezing or otherwise exposing your doctor to your germs while in for a visit? Think again. As USA Today reported, more than half of doctors and nurses they surveyed would and do come to work when they themselves are sick. Talk about a germy situation!

And, just in time for fall, new tips on how to track the flu, per the WSJ Health blog.

Finally, in the age of Big Business, Big Government and Big Brother, a piece on the plight of the community hospital and its fight to remain independent.

That’s all for this week; check back every Friday for your weekly roundup of health care news you can use.

The top headline this week is President Obama jumping into the ring for round 1000 (at least) of the fight to reform health care. Bloodless so far, Obama said he was “cautiously optimistic” after meeting with Senate Democrats on Tuesday this latest bill would pass without the drama of another all-out, gloves off floor fight. As he told the Post: It’s clear that we are on the precipice of an achievement that’s eluded Congresses and presidents for generations, an achievement that will touch the lives of nearly every American. There are still some differences that have to be worked on. This was not a roll call. This was a broad-based discussion about how we move forward.

Meanwhile, Health on the Hill  sought out to debunk rumors about this latest legislative push. Watch their myth-buster roundtable here for a final answer on the legality of taxing health care benefits and much, much more!

Coming at the same time as Obama’s latest push is this report that government spending on health care will go UP, not DOWN like Obama insisted that it would back in March. Though experts forecast that the increase will be modest, the political fallout is expected to be intense. According to AP reporter Ricardo Alonso-Zaldivar, “for critics, the numbers show that the law didn’t solve the cost problem, although Obama repeatedly said he wanted to bend the spending curve down.” Read the full article here.

And, according to this piece from the Fiscal Times, it isn’t just the federal government feeling the cost effects of health care reform. State governments – many of which are already in dire shape thanks to that pesky recession – are collapsing under a mountain of Medicare bills, an unfortunate consequence of soaring unemployment. And some analysts say the only solution is for the federal government to shoulder a larger portion of the financial burden.

On the more serious (and less political) side of things, this New Yorker article on hospice and our society’s approach to end-of-life decision making is a must-read . As author and doctor Atul Gawande profoundly summarizes: The simple view is that medicine exists to fight death and disease, and that is, of course, it’s most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.

On a lighter note (literally), apparently laser pointers are dangerous when pointed at one’s eyes (who knew?!) and one doctor even went so far as to call them a “‘legitimate public health menace.’” As this Post article explains,  dangerously high-powered versions of these contraptions are available online (and evidently did not go out of vogue in the 90s like we all thought) and can cause serious damage when not used appropriately.

A study out this week suggests that primary care does not necessarily guarantee better health. Per the Kaiser Health News blog story. Dartmouth researchers found that people on Medicare who saw a primary care doctor at least once a year were just as likely to end up in the hospital for a chronic illness as those who didn’t have a regular checkup or visit. A visit to a primary care physician didn’t make it any less likely that someone with serious diabetes or peripheral vascular disease would get a leg amputated, their study concluded.

 Maybe laughter really is the best medicine (or at least the only kind that comes without a hefty co-pay anymore). If all this health reform hubbub and financial disarray has you a little tense, check this out.

That’s it from us! Be sure to check back every Friday for your weekly roundup of health care news you can use. And don’t be shy – leave a comment and let us know what you think of the roundup, and what you’d like to see covered more or less.

Please help me welcome our newest Disruptive Women:

• Debbie Myers, Founder, VirtuArte
• Estee Solomon Gray, Self-described Inveterate Boundary Straddler
• Grace Bender, President, infinisity, inc.
• Julie Murchinson, Founder, Health 2.0 Accelerator & Managing Director, Manatt Health Solutions
• Mary Grealy, President, Healthcare Leadership Council
• Rozalynn Goodwin, Director, Policy Research, South Carolina Hospital Association and Founder, the Motherhood Priority

Take a moment to read the bios of these amazing women and prepare to be dazzled.

I am very proud to share that our blog has been named one of the Top 100 Health Care Blogs and has been nominated by readers of the Huffington Post as one of the 100 People Who are Using New Media to Change the World.

Today, I am pleased to say that our network consists of 40 incredible, very diverse, Disruptive Women bloggers, including our 4 newest:

• Diana Long, Developer of BrandDance TM & Principle, DML Consulting
• Diane Jones, President, Camden Counsulting
• Lisa Korin, Masters of Public Health Candidate, Johns Hopkins University Bloomberg School of Public Health
• Stephanie Cohen, Co-Founder, Golden & Cohen

In addition, we have our own You Tube Channel, Facebook Fan Page with hundreds of fans, thousands of Twitter followers and have hosted several briefings and events and published an e-book on Comparative Effectiveness Research.

As we look ahead to the coming year, we have many interesting briefings in the works, new e-books underway, and more Men of the Month who will be contributing.

We welcome your feedback and input, suggestions and ideas as we continue to disrupt health care.

Brave New Films, the American Academy of Family Physicians (AAFP), and Herndon Alliance, have produced a new video, “450,000 Can’t Be Wrong About Health Care Reform,” that features family doctors voicing support for health care reform:

Meanwhile, Americans United for Change, an organization dedicated to supporting President Obama’s health care initiatives, has released a new TV ad called “GOP Rx”:

Kaiser Health News‘s Jackie Judd spoke with Eric Pianin in this edition of Health on the Hill:

Dr. Joseph Kim, of Medicine and Technology, highlighted the following CNN report on an EHR system that is helping improve care and reduce mistakes:

Embedded video from CNN Video

Sens. and Drs. John Barrasso (R-WY) and Tom Coburn (R-OK) are answering email questions about health care reform on their YouTube program, The Senate Doctors Show. Check out the latest episode:

Anthony Cirillo, on his Musings on Aging and Health Care blog, discussed the heroic nature of long term care workers who provide Person Centered Care:

Capital Journal columnist Jerry Seib discussed people’s apprehensions about changing the health care system:

Finally for this week, an important discussion on GRITtv about the uncertain future of abortion providers:

• Patients
• Providers
• Innovators
• Caregivers
• Policymakers
• Rare Diseases
• Minorities
• Gender

While there is tremendous potential in the power of CER, there remain a number of troubling issues and difficult questions.  The promise and the pitfalls are reflected in the new CER ebook we put together, which encapsulates each of the posts.  To download a free copy, please click here.

HHS announced [Wednesday] in the Federal Register that the Health IT policy committee would recommend a policy framework to develop and adopt nationwide infrastructure to permit the electronic exchange of health information.
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The Health IT standards committee would make recommendations around data and technology standards, implementation specifications and certification criteria for the electronic exchange and use of health records.
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Previously, HHS had similar committees addressing policy and standards. But the Recovery Act, which included more than $19 billion for health IT, required HHS establish these new committees with a different makeup.

(See the complete article for more details about membership of the committees.)

The HHS Department’s focus on health IT this week also included a two-day hearing on “Meaninful Use” of Health Information Technology, hosted by the National Committee on Vital and Health Statistics. It’s no surprise, then, that Health IT and the “meaning of meaningful use” have dominated health discussions around the Web this week.

Josh Seidman on the Center for Information Therapy blog highlighted two organization’s issue statements regarding meaningful use:

The [Markle Foundation] statement appropriately highlights patient access to clinically relevant electronic information. It could further by clarifying that such information should be accessible to consumers in a way that they can understand and use it, and also that facilitates action on their part, or as [the Consumer Partnership for eHealth (CPeH)] puts it, “access their personal health information, receive prompts and reminders, and use patient decision support without sacrificing privacy.”

These patient-centered definitions of meaningful use are critically important for ensuring that ARRA HIT provisions actually change how health care is delivered in this country.

For HealthLeaders Media, Janice Simmons highlighted additional definitions released by related organizations:

Under the new stimulus law, Medicare incentive payments can be made up to four years to hospitals and up to five years for physicians who meet “meaningful use” and “meaningful user” criteria of certified EHRs. The Healthcare Information and Management Systems Society (HIMSS), after input from its membership, released new definitions April 27 to specify what is meant by that term. To be eligible for the incentive payments, the HIMSS definition said that hospitals and physicians must use the technology in a meaningful manner, exchange electronic health information to improve the quality of care, and submit clinical quality measures—and other measures—as selected by the Health and Human Services (HHS) secretary.
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Farzad Mostashari, MD, assistant commissioner of the Primary Care Information Project, within the New York City Department of Health and Mental Hygiene, said “the transformative potential of health IT is to provide the information necessary for organized care delivery and drive transparency in healthcare outcomes.” The endpoints for meaningful use can include incentive payments tied to measures “that matter and that will sustain improved clinical outcomes,” such as blood pressure control, evidence based care (smoking cessation therapy and aspirin use), patient safety, continuity of care, patient satisfaction, and compliance with public health reporting, Mostashari added.

Elliott Fisher, MD, of Dartmouth University, said his personal history in healthcare as a physician, manager, and patient has “lead me to believe that meaningful use of HIT can best be realized through implementing systems that have basic functionalities that facilitate the care of patients by physicians, nurses and other providers,” he noted. “These systems need not necessarily be extremely complicated.”

On The Health Care Blog, Adrian Gropper, MD, discussed the issue of regulating “consumer-driven research and advice” when it comes to health data mining:

At the National Committee on Vital and Health Statistics executive subcommittee hearing on “meaningful use” of health information technology, Carolyn Clancy, director of the Agency for Healthcare Research and Quality testified “We haven’t reached a system-based approach where the right thing to do is the easy thing to do.” The meaningful use of health information technology will free patients to organize to accelerate research and deliver advice independent of any particular doctor or health plan. Data mining opportunities traditionally restricted to doctors and health plans as a side-effect of their essential services will now be available to anyone that gains the trust of a patient-consumer including, for example, not-for-profits and Internet social networking groups. Suggesting or confirming “the right thing to do” involves coordinating disparate information that includes mining patient data for decision support (to search and display guidelines), for comparative effectiveness research (to find and group similar cases), for bio-surveillance (to find cases that match a profile) and for informed consent (to quantify the risks of alternative treatments).

On the BNET Healthcare blog, Ken Terry wrote:

The consensus of physician and industry representatives was that meaningful use should include interoperability, the ability to report standard quality measures, and advanced clinical decision-making. The ability of EHRs to communicate with one another still has a long way to go, and so does their ability to report quality measures based on clinical data (as opposed to claims data). But the biggest problem is in the area of clinical decision support (CDS).
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At a recent conference of HIMSS, the association of health IT professionals, CDS experts admitted that the technology needs much more work. Dr. Blackford Middleton of Partners Healthcare in Boston noted that best-practice guidelines need to be integrated into EMRs or “standard web services” that physicians can use at the point of care. Dr. Dean Sittig, a professor of medicine at the University of Medicine and Dentistry of New Jersey, said that CDS should go beyond alerts and reminders; it needs to be woven into EHR templates, default values, order sets, and other parts of the program. That’s all fine—but CDS must also be reliable, so that patients always get the best and safest care.

If we are going to make “meaningful use” the bedrock of health IT planning, we better make sure that it is applied only to well-tested components of current EMRs—along with worthy adjuncts such as electronic registries. Otherwise, we may get both more and less than we bargained for.

The health-care industry is a study in contrasts. On one hand, it employs the best that medical science has to offer. On the other, it is one of the least automated sectors from an IT standpoint.

All of that is about to change, however, spurred as much by the federal government’s push for cost control and accountability in health care as the industry’s own need for modern information exchange. The task for implementing those changes will fall on CIOs at hospitals and clinics, as well as the companies that outsource records and information for doctor’s offices and outpatient facilities.

Read the interview with Geoff Brown about health IT and hospitals

Matthew Holt conducted and posted three interviews relevant to two sides of the current health IT/EHR debate about, to use Holt’s words, “whether the HITECH act should pay for and dictate a specified, certified type of EMR product use OR pay for data and outcomes and not specify how providers get there.” Holt spoke with Glen Tullman, CEO of Allscripts, Mark Leavitt, Chair of CCHIT, and Jonathan Bush, CEO of AthenaHealth during HIMSS09. Describing his take on the two sides of the debate highlighted in these three interivews, Holt explained:

The “cats” support certification and EMR mandating (more or less). The “dogs” think that existing EMRs are often counterproductive and that a mix of other data sources, processes, and patient outreach technologies will get us where we need to in terms of improving outcomes much quicker.

Below is Holt’s interview with “cat” Mark Leavitt:

Find all three interviews on The Health Care Blog

On the NOW! blog, and at Left in the West, Jason Rosenbaum discussed how rural Americans are among those more severly affected by health care inequities and other problems, focusing specifically on Montana residents:

We are far more likely to pay higher out-of-pocket medical costs and incur greater expenses for emergency room care, and we are 70% more likely to be underinsured, according to a research paper published in Health Affairs entitled “Out of Pocket Health Spending and the Rural Underserved.” As Lil Anderson, Jim Paquette, and Nicholas Wolter – all Montanan health care providers – explained in the Billings Gazette last week, one in five Montanas is uninsured, rising health care costs are squeezing even families that have health insurance, and Montana’s small businesses and by extension, our families, are suffering…
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Montanans are suffering in a large part because there is no meaningful competition in our state’s health care market. According to the American Medical Association [PDF], one insurer, Blue Cross Blue Shield of Montana, controls 75% of the market. With competition like that, no wonder prices are soaring even faster here than in other regions of the country!

Read Rosenbaum’s complete, original post

Children’s Defense Fund President Marian Wright Edelman explained how a public insurance plan option could ensure health care coverage for children:

It’s plain that our nation’s health insurance system is broken: 46 million people in America lack health coverage–nine million of them children–and the number of uninsured is growing during the current recession.
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Our health care system is crying out for reform, and our families and children are crying out for help. Reform must include a public health insurance plan option that competes with private insurers to extend comprehensive benefits through first-rate health care providers at an affordable price. Without this public plan choice, the health of our children will continue to be held hostage to profit-driven insurance companies.

A public health insurance plan option would encourage competition on the basis of cost and quality, not by avoiding the sick and denying care, as is the current practice. The plan will also keep costs down by negotiating bulk discounts from providers and drug companies through pooling on the model of the Veteran’s Administration. A public health insurance plan option could be available nationwide to people who want it and deliver services through private health providers as Medicare does. Those satisfied with their current insurance could keep it.

The editors of the ScienceBlog Effect Measure (senior public health scientists and practitioners) called the lack of universal health care in America “morally and fiscally bankrupt”:

The idea that if the United States joins the rest of developed nations and finally adopts a universal health care system it will bankrupt itself is not based in reality. The reality is that the US spends a larger proportion of its Gross Domestic Product (GDP) than any other developed nation. By far. Not even close. CDC has just documented it from data collected by the Organisation for Economic Co-operation and Development (OECD) in its 2008 health data yearbook (statistics and indicators for 30 countries). It suggests we are being bankrupted by our lack of a universal health care system:

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The simple truth is that one of the major reasons we have such a lousy health care system and receive such bad value for our money in the US is that we placed health care financing into the hands of the same folks who helped make our economic system such a disaster: private insurance companies, who are little more than disguised investment banks with the added incentive not to pay back their depositors (the premium payers). We don’t need health care reform with a public option. We need one with public financing by default, perhaps with a private option for those who wish to and can pay extra for it.

Also discussing health care costs, Ezra Klein commented on OMB Director Peter Orszag’s discussion of a new study about hospital readmissions from the New England Journal of Medicine:

The peg here is a New England Journal of Medicine study that found “that approximately 20 percent of Medicare beneficiaries discharged from a hospital were rehospitalized within 30 days. The authors estimate rehospitalizations accounted for about $17.4 billion of the $102.6 billion in hospital payments from Medicare in 2004.” Health policy experts tend to think that many of those rehospitalizations are unnecessary, and substantial money could be saved by preventing them. In particular, Orszag notes that “the study found that rehospitalization rates vary substantially by geographic area…”
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This gets to a point Orszag has made before: A lot of attention accrues to international health spending comparisons. France spends X and we spend Y. But given differences in culture, system structure, doctor payment, population health, and much else, there are a lot of confounding variables in such comparisons. There are also, however, massive differences between different states in America. South Dakota and Florida aren’t the same, of course. But they’re not that different. And if we could get Florida to spend more like South Dakota, that alone would be a huge improvement.

View a map of Medicare spending across the US from the CBO on Klein’s post

In his new post, he will be in charge of nearly $20 billion in the economic stimulus package to build health IT, including encouraging more doctors and hospitals to use computers.

Also among Blumenthal’s responsibilities, Healthcare IT News reported:

Blumenthal will lead the implementation of a nationwide, interoperable, privacy-protected health information technology infrastructure, as called for in the American Recovery and Reinvestment Act…

For more on Blumenthal, check out his National Journal Health Care Experts blog biography, and for more about his future position at HHS, see the HHS News Release.

Reacting to the news, Life as a Healthcare CIO blogged:

[Blumenthal has] created numerous organizations, collaborations, and study groups to better understand the effective use of information technology in healthcare. In his youth, he worked on Kennedy’s staff in Washington. He’s advised Presidents. He understands the need to create policy and technology in parallel.

David will ensure the stimulus effort gets off to a great start. Although I have not heard directly, I presume Dr. Rob Kolodner will continue to serve a role at ONCHIT to ensure all the deliverables specified in ARRA for 2009 get done on time.

At The Health Care Blog, Matthew Holt remarked that Blumenthal is “known slightly more for being a policy wonk than a geek (or perhaps known best for being a wonk about geek issues!)…” He also noted that Blumenthal was not one of the five names David C. Kibbe, Brian Klepper and John Moore suggested for the ONC position earlier this month. Who was on their list, and why? Who: Farzad Mostashari, MD MPH, Carol Diamond, MD, MPH, Peter Basch, MD, Carolyn M Clancy, MD, and Adam Bosworth. Why:

We believe the key question for the Office of the National Coordinator (ONC), as the Secretary of HHS’ principal Health IT adviser, is centered on whether and how health policy encourages innovation.
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Here are five individuals, each of whom, we believe, as National Coordinator, would encourage innovation and change from the status quo. All of these people have demonstrated a vision of health care connectedness, quality, and efficiency that are in the common, rather than the special, interest, and each has the administrative skills and savvy to bring that vision to fruition.

On a related note, just yesterday on Public Radio International’s To the Point, Warren Olney hosted a discussion about health IT and the $19 billion in health IT funding in President Obama’s stimulus bill. Participating in the conversation were Dr. Farzad Mostashari, Assistant Health Commissioner in the New York City Health Department, Stephen Soumerai, Director of the Drug Policy Research Program at Harvard Medical School, Anne Armstrong-Coben, Assistant Clinical Professor of Pediatrics at Columbia University, and Tom Sullivan, former President of the Massachusetts Medical Society. Listen to the discussion here, or download the audio here (mp3).

What kind of individual do you think should hold the ONC position? What do you think about the choice of Rosenthal? What do you hope he will bring to the position, and what kind of role do you hope he will play in the Obama Administration’s crafting of health care and health IT policies? Share your reactions in the comment area below.

The Obama Administration has chosen former NYC health commissioner Margaret “Peggy” Hamburg to head up the FDA. The White House wants the new FDA commissioner to be “somebody who will focus the agency on its core mission of public health,” according to the Wall Street Journal. From Sarah Rubenstein’s profile of Hamburg at the WSJ Health Blog:

In New York, [Hamburg] instituted a needle-exchange program to help prevent the spread of HIV. She also set up a program, later mimicked by health departments around the world, in which health workers went to tuberculosis patients’ homes to help them manage their drug regimens.

Hamburg, a Harvard Med School grad, was an assistant secretary of health and human services during the Clinton administration and now works at the Nuclear Threat Initiative, which tries to cut the threat from nuclear, chemical, and biological weapons… Among other things, she opposed a “morality oath” demanded by the Board of Education in 1992 while the city was debating abstinence-focused sex education in schools.

On Wednesday, President Obama signed an Executive Order establishing the White House Council on Women and Girls. Valerie Jarrett will be the council Chair, with Tina Tchen as Executive Director. The official press release explains, “The mission of the Council will be to provide a coordinated federal response to the challenges confronted by women and girls to ensure that all Cabinet and Cabinet-level agencies consider how their policies and programs impact women and families.” One of the council’s main objectives is to improve women’s health care.

Watch President Obama’s announcement here:

On Essential Estrogen, Lynda provided text of Obama’s remarks, and lists of female members of Congress and representatives from advocacy groups in attendance.

On the Care2 Women’s Rights blog, Ximena R. presented a few advocacy groups’ reactions, as well as her own:

The Council will work to uncover the “untapped potential” of all women and girls that has led to crazy injustices like women earning only 78 cents for every dollar earned by a man, women making up only 17% of the U.S. Congress although they make up half of the population, women heading only three percent of the Fortune 500 companies despite the fact that they are 49% of the nation’s workforce.
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It is high time that a more concerted effort be made to highlight issues that affect women because the domino effect (issue affects woman, affects child, affects husband, affects family, affects work, affects community, affects society, affects world . . .) is clear. By putting women and girls on an even playing field with men and boys we will all reap the benefits. It’s about time someone took action.

At Feministing, Courtney presented a “wish list” for the new council:

President Obama has created a bonafide Council that is supposed to focus on issues affecting women and girls… early signs indicate that it will prioritize looking at work policy and parity and political representation. I think that in such tight times, it’s imperative that this Council really move forward with some powerfully specific and strategic goals in mind. Here are three pressing issues that are overdue for a federal focus:
1. End child prostitution in the U.S. For more, check out my post on doc film Very Young Girls.
2. Curb the HIV/AIDS infection rate among African American women.
3. Nationalize a comprehensive sexual education policy that gives young women (and their partners) the knowledge they need to make informed choices about their sexual health.

Women’s Glib featured a thank-you-letter to President Obama expressing “newfound hope”:

Thank you for creating the White House Council on Women and Girls. Thank you for breaking this country’s pattern of ignoring discrepancies in the advancement of women.
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Thank you for describing what a women’s issue is, for informing America that women’s issues do not only effect women, but that also effect men, boys, girls, and everyone in between. Thank you for committing to make your own cracks in multiple looming glass ceilings. Thank you for understanding a cause worth fighting for.
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I sincerely wish that this commitment toward gender equality will extend through your administration to a commitment toward equality on the basis of sexuality, race, class, ethnicity, religion, and beyond. I now have faith in the potential of this country to fight for equality.

On Daily Kos, mcjoan had strong praise for the Administration:

What a refreshing change from the empty rhetoric and out-and-out lies of the previous administratiion. We know how that turned out.

Having Valerie Jarrett, Assistant to the President and Senior Advisor, as the chair of this council ensures that it’s not just a pat on the head to the nation’s women in recognition of this day that’s supposed to be about us. It shows that the Obama administration is serious about making policy changes that don’t leave women behind. That’s particularly critical when it comes to economic and health care reform, and it’s good to know that women’s interests will be front and center in the policy-making process.

Autumn Sandeen at Pam’s House Blend was also energized by this event:

Conservative women’s groups apparently felt snubbed… the White House left representatives of the Concerned Women For America and the Independent Women’s Forum off the guest list. However, one woman who was invited as a representative for folk like me was Mara Keisling of the National Center For Transgender Equality (NCTE). Apparently, the President wanted to send a message to the trans community that he considers trans women to be among the women included in the goals of this initiative.
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Truly amazing. This kind of inclusivity into America’s political mainstream is what I hoped for in an Obama Presidency. In this case, making sure that a trans woman was invited to this kind of White House ceremony is important in both in its symbolism and the possibilities for wider equality for trans people under the law. This is change I can believe in.

At RHRealityCheck.org, Amie Newman expressed her optimism:

Clearly, establishing this office is the right thing to do. It’s the right thing to do for women and girls in this country, sure, but more than that it’s the right thing to do for this country. The issues that affect women and girls primarily, affect everyone ultimately. Pay equity? Pay discrimination is harmful not just to women but to the families that rely on that paycheck regardless of whether it’s a single or two parent family. Work-life balance for working women? We’ve certainly set up a society in which there is no balance – unsupportive professional environments for mothers who want to return to work after the birth of a child, lack of support for nursing mothers, unaffordable child care, and more. These challenges create a ripple effect where we all end up paying for our country’s refusal to address these so-called “women’s issues.”

Hopefully, this is not, as Chris Cillizza writes in The Fix, simply a “symbolic” gesture for those close to the President and for the women who voted for him but a concrete manifestation of Obama’s understanding that, as Martin Luther King, Jr. said, inequality anywhere is a threat to equality everywhere. The establishment of a White House Council for Women and Girls signals, to me, a new approach to understanding how to remedy the inequities that exist, still, for women and girls in this country.

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:

According to documents obtained by The Prospect, the budget also says that “the President looks forward to working with the Congress over the coming year, and as he does, the President will adhere to the following set of eight principles:”

• Guarantee Choice
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• Make Health Coverage Affordable
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• Protect Families’ Financial Health
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• Invest in Prevention and Wellness. The plan must invest in public health measures proven to reduce cost drivers in our system… as well as guarantee access to proven preventive treatments.
• Provide Portability of Coverage. People should not be locked into their job just to secure health coverage, and no American should be denied coverage because of preexisting conditions.
• Aim for Universality
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• Improve Patient Safety and Quality Care
  …
• Maintain Long-Term Fiscal Sustainability

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“Affordability” and “financial health” should be understood as answer a question that has been, I’m told, central to the health teams’ deliberations: What are we doing for the insured? They mean to sell this plan not just as a rescue package for the uninsured but as aid to the 85 percent of Americans who currently have health care coverage.
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This budget release has broad outlines: The full budget, which comes in April, might provide somewhat more detail. But the administration has now passed the ball to Congress. The question is what Congress does with it.

Paul Krugman found this news “encouraging”:

The supposed commitment of $634 billion to health care reform isn’t quite enough to pay for the subsidies that are an essential part of a universal-care system, but it’s not ridiculously short, either. It’s beginning to look as if Obama’s really going to go through with this — and if he gets us to universality, his legacy will be secure.

Chris Bowers was similarly pleased with the Obama Administration’s health reform reserve idea:

The basic idea appears to be securing much of the funding for health care reform in the budget process, and then working out the details of the reform later on… I like this approach. $634 billion over ten years is not as much as we need to successfully overhaul the health care system, but it is a good first step that will make any further requests for more money in future months and years easier. It appears to be, quite literally, a down payment for health care reform.

On The Treatment blog, Jonathan Cohn discussed the value and significance of $634 billion for reforming our health care system:

How big an investment is that? It’s pretty big—more, I believe, than any president has proposed setting aside for coverage expansions to the non-elderly since Clinton tried for universal health insurance in the 1990s. And it confirms that Obama is serious about pursuing health care reform, beyond small incremental steps. Even so, the amount will not enough to finance full universal coverage, as discussed previously here and elsewhere.
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[Ceci Connolly] says experts predict the full cost of universal coverage could approach $1 trillion over ten years. I think it could actually cost a good bit more, although—again—it depends on how quick, and how sweeping, the coverage expansions are. But that doesn’t change the fact that Obama is proposing a huge investment.

In The Wonk Room, Igor Volsky concluded that even though $634 billion is “A Boat Load Of Money,” “Good Health Reform Demands Even More”:

Details are slowly leaking about the health care provisions in Obama’s budget and so far, the news sounds promising.
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They believe that there is enough waste in the health system to finance at least part of the down payment for reform… Overall, the fund is a good start, but it’s certainly not enough to reach universal coverage. Still, the Obama administration has learned from the mistakes of past reform efforts. Unlike the Clinton strategy, which didn’t include any money for health reform in the budget, and left Congress to digest a 700+ page health plan, Obama and Congress will fill in the details of reform… This leaves a lot of room for compromise, but in working out the details of reform, progressive principles of true universality and affordability must remain intact.

On his medinnovationblog, Dr. Richard Reece commented:

What does this mean for doctors? I do not know. Some of it, of course, will come form higher taxes on doctors making over $250,000. Some may come from forcing doctors to “bundle bills” with hospitals. Some may come from only paying those doctors who use EMRs. Some of it may be indirect, as HMOs tighten financial screws on doctors to compensate for Medicare HMO losses. Little mention yet of how much is to be saved from prevention, EMR use, and lower Medicare fees for high ticket items that “don’t work” according to comparative effectiveness. Curiously, no mention of single-payers or universal coverage which will impractical unless costs are lowered.

Politico’s David Rogers analyzed the general plans for coming up with the $634 billion for health care:

Hard on the heels of Obama’s speech to Congress, administration officials began briefing lawmakers Wednesday on their proposals including the healthcare reserve fund: half of which would come from health-related expenses and half by scaling back the value of itemized deductions for wealthier taxpayers. By itself, the $634 billion won’t be enough to finance the president’s ambitious health plans. But it represents a major commitment upfront, with the administration promised to work with lawmakers to find additional savings as legislation is developed this year.

Obama’s focus on high-end households is consistent with his larger philosophy — both in taxes and spending. Within the $2 trillion in savings, for example, the budget is expected to limit agriculture subsidies to farms earning more than $500,000, resulting in an estimated saving near $16 billion. Large charitable deductions—used to shelter income—would face new limits, and Bush-era tax cuts for the wealthy would expire after 2010.

On The Daily Finance, Douglas McIntyre pointed out:

The new Obama health care reform package is based on two key programs. One is the taxation of the rich over the next ten years. The other is more competitive bidding among health-care providers that want to get big blocks of business.
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Forcing health-care companies to drop rates if they want to keep large customers may be easier than taxing the rich. That is based on the fact that there may be fewer rich to tax… The government may be assuming that in a recovery the number of people with annual incomes over $250,000 dollars will grow again. If the industries where most made their money never return to tremendous profitability, the headcount of people who are truly rich could stay depressed for more than a couple of years. You can’t tax what isn’t there.

Finally for this week, at The Health Care Blog, Robert Laszweski pointed out:

Interestingly, the Obama budget reportedly calls for creating a system where the private Medicare plans will bid market to market to compete with the traditional Medicare plan rather than continuing the current system where the government tries to set the rates for them. Ironically, that was the original Republican idea for using the competitive value of managed care to reduce long-term Medicare costs and is what should have happened in the first place rather than this temporary system of overpayments the HMO industry has been fighting to keep permanent.

With $318 billion in tax increases and another $175 billion in Medicare HMO cuts, the $634 billion “down payment” only contemplates a total of another $141 billion in federal health care cuts over ten years… That is hardly a rounding error… If the Obama administration is serious about not “kicking the can further down the road” then any overhaul of our health care system has to do more than fritter around the edges with spending reductions.
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As the budget details come out over the next few days the question we all need to be asking is, Just what is this administration willing to do to make health care affordable over the next ten years? Affordability will have a lot more to do with the how this administration deals with the $2.5 trillion we already spend every year not whose taxes we can raise.

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:

In my last post, I told you a little story about using science- and evidence-based medicine to improve health care… A researcher came up with a plausible idea for an intervention, studied it, and found it to be successful… But we don’t really have an easily accessible repository of evidence-based interventions. Every field has its own standards, its own literature, and its up to each individual practitioner to interpret the data on their own… and while we follow evidence-based guidelines in much of our care, there are many times when evidence isn’t just hard to find but is actually unavailable.

Give our “evidence gap,” I was heartened to see this story in the New York Times. The Times reports that the economic stimulus bill will include over a billion dollars to fund research into medical evidence. This is a good thing, but it’s bound to be controversial… there’s a lot of predictable objections about this; people are worried about physician autonomy and government interference.

… Republican lawmakers and conservative commentators complained that the legislation would allow the federal government to intrude in a person’s health care by enforcing clinical guidelines and treatment protocols.

And so what? Right now, my patients’ insurance programs do exactly the same thing…

If we have more evidence to work with, we can continue to make even better decisions regarding care. It may seem intrusive, but it’s not very different from what we do already. And honestly, I’d like to know if I’m more likely to get relief of my lumbar radiculopathy from surgery or from conservative therapy… It rings rather hollow when people protest against gaining more knowledge… Once we have the data, we can sit down for a good, heated discussion about what to do with it. But putting our collective heads in the sand is probably not a useful response.

On his HealthBlawg, David Harlow discussed one of the health IT provisions of the stimulus package President Obama is expected to sign today:

One of the many stimuli included is the HITECH act, a $19 billion electronic health records funding provision. This sort of action by the federales was long promised by Obama on the campaign trail: spending federal dollars to jump-start the leveraging of technology in order to improve health care quality at lower cost.
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On the one hand, it’s designed to subsidize EHR adoption by physician practices and hospitals that otherwise might not be able to afford them (to the tune of up to $40K per doc). To the extent that we believe that EHR adoption will promote efficiencies in excess of their costs (and yes, you do detect a note of healthy skepticism), that’s a good thing. On the other hand, it will almost certainly result in further entrenchment of current market leaders, to the possible detriment of providers and patients who do not necessarily need the high-cost offerings now on the market that are characterized by some observers as having limited “data liquidity” — which, if we’re looking for interoperability, is a key thing to have.
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There’s an awful lot of money on the table. Let’s hope that it can be spent wisely, on a variety of approaches to an intractable problem: the wiring of this country’s health care providers for the benefit of their patients and the collective fisc.

In the Think Progress Wonk Room, Igor Volsky covered a new Wonk Room report:

Some new figures out on the surge in the number of Americans losing health insurance:

The final stimulus package, which the President is scheduled to sign later this afternoon, includes a fair number of health provisions. Yet it’s not a total victory for progressive health advocates. In the run-up to the passage last week of the American Recovery and Reinvestment Act, negotiators compromised on some key health components… even as millions of Americans were losing their jobs and health insurance. In fact, according to a forthcoming analysis by James Kvaal and Ben Furnas, as the unemployment rate grew by 0.8 points in December and January, nearly 100,000 people a week or 14,000 people a day lost their health coverage:

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The ranks of the uninsured will grow as the recession persists, in spite of conservative obstructionism. As Jacob Hacker points out, the stimulus “won’t provide the cure. What we need is a new New Deal.”

On that note, the National Journal Health Care Experts blog asked about the degree to which the stimulus package could help newly unemployed and uninsured Americans, pointing out:

• It includes $87 billion in federal money to help states with Medicaid.
• It subsidizes COBRA premiums at 65 percent for people who want to continue coverage from their previous employer.
• It does not temporarily open Medicaid to unemployed workers who lose their jobs.

American Medical Association President Nancy H. Nielsen responded:

In this tough economy, expanding Medicaid and COBRA benefits is a necessary stop-gap measure. It’s hard enough to be unemployed; we don’t want the unemployed to also be uninsured. The investment in the safety net through more support for Medicaid will maintain the program that cares for some of our most vulnerable populations… Short-term COBRA premium assistance for the unemployed will keep health insurance coverage in reach for many people who lose their jobs.
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These temporary extensions of health care benefits during this time of economic turmoil, however, represent only the first step in a long process to meet a persistent national need. We must continue to work together on comprehensive health system reforms to ensure that all Americans have access to high-quality, affordable health insurance.

Center for Health Transformation Founder Newt Gingrich shared a different perspective:

The stimulus legislation is like putting a band-aid on a heart attack: It does very little to address the fundamental problems we face in health. Consumers will still find barrier after barrier to getting insurance coverage if they lose it… States will be back in the exact same predicament when the bailout money runs out. What we need to do is not throw good money after bad, but address what governments can and should be doing differently that will help get us out of this spiral.

Government should provide the framework for everyone to obtain health insurance… Governments at all levels should prioritize, measure, and incorporate successful models into their public programs and through their role as employers… Government should be flexible in providing new opportunities for states to expand insurance coverage and access to high-quality, cost-effective care.

Until we make real changes to allow the private market to actually work along side effective, quality-centered public programs, bailouts will be the norm, not the exception.

Finally for this week, the findings of a Nurses’ Health Study are good news for coffee-drinking women, as The Women on the Web reported:

Coffee drinking can be good for you. A new study found that women who drink four cups of coffee a day can reduce their risk of stroke by 20 percent compared to women who drink less than one cup per month. Women who drink two to three cups every day reduce their risk by 19 percent and women who drink five to seven cups a week reduce risk by 12 percent.
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Caffeine doesn’t appear to be behind the reduction, since researchers found that women who drink tea and caffeinated soft drinks didn’t enjoy the same reduction in strokes. “This finding supports the hypothesis that components in coffee other than caffeine may be responsible for the potential beneficial effect of coffee on stroke risk,” said Esther Lopez-Garcia, lead author of the study and assistant professor of preventive medicine at the Universidad Autonoma de Madrid, Spain, in a news release. “Antioxidants in coffee lower inflammation and improve blood vessel function.”

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, Elana Schor detailed key differences between the two stimulus bills’ COBRA and Medicaid provisions:

The House stimulus provides $40 billion to create a 65% government subsidy for COBRA, the health insurance program for unemployed Americans — but the Senate centrists sliced that in half for their stimulus, cutting COBRA to $21 billion or a 50% subsidy.
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But how many people would get health care under the 65% [House COBRA] subsidy? Pelosi asked the non-partisan Congressional Budget Office that question, and she got her answer last night. 7 million adults and dependent children would get the subsidized COBRA by the end of this year… Another 1.2 million people also would get health coverage under the House stimulus, the CBO said, thanks to a provision that secures Medicaid coverage for low-income workers who lose their jobs and have no other option. Unfortunately, the Senate didn’t touch the Medicaid issue in their stimulus.

(Read the letter from CBO to Speaker Pelosi here [PDF])

On The Health Care Blog, National Partnership for Women & Families HIT Project Director Eva Powell offered her take on the economic stimulus and health care information technology:

We know that HIT is a tool, and that like any tool, it must be used properly to be most effective. Consumer and patient advocates view the privacy issue as part of the framework required for effective use of HIT.
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Years of discussing how best to approach the privacy issues in HIT and HIE, and many attempts to write legislation haven’t yielded many solutions. Previous attempts either seemed to be mere tinkering that didn’t result in meaningful protection, or seemed to be overreaching attempts likely to create unintended barriers to safe and effective health care. Finally, consumer advocates and privacy advocates feel that the privacy provisions included in the House version of the Economic recovery bill offer a solid start for addressing privacy issues in an electronic health care environment. These provisions lay an important foundation for building a framework of privacy protections… This foundation includes:

1. Closing a loophole in the HIPAA Privacy Rule that allows direct marketing to individuals using their personal health information without their knowledge or permission.
2. Giving patients the right to be notified if their personal health information is breached.
3. Requiring providers to account for disclosures of personally identifiable health information so that individuals and organizations can be held accountable in the event of a breach of information.
4. Giving patients the right to obtain an electronic copy of their health information for a reasonable cost.
5. Improving enforcement of privacy violations.

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The lingering question about health reform is one of will. Amidst all the discussion about reform and indications of a unique opportunity to make innovative changes, is there actually a will on the part of all stakeholders to do what’s in the best interest of achieving better health and health care, or will we continue to cling to the interests that have prevented positive change in the past? Perhaps the issue of privacy protections in the stimulus bill is the first test of our collective will.

Ezra Klein pointed out that “some fairly important public health measures were eliminated from the stimulus when Susan Collins and Ben Nelson worked their centrist magic”:

The cuts came in comparative medical research, smoking cessation, HIV prevention and testing, diabetes screening and detection, pandemic flu preparedness, health information technology, and much else. So yes, in case you’re wondering, the centrist compromises not only cut jobs and increased the long-term cost of health care, but also ensured the preventable deaths of thousands of people.
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In response to these cuts, Harold Pollack and more than 600 other health care practitioners, scholars, and analysts have signed a letter opposing the cuts. It’s the sort of document that the conference committee should take seriously. The sums being discussed are fairly small in terms of the stimulus, but would do quite a lot to harm the affected communities at a time when the social supports they rely on will be falling out from beneath them… A decent society doesn’t spent $70 billion on an upper-class tax cut and then cut costs around around the edges by eliminating public health programs that save the lives of the working poor and ease the lives of the chronically ill.

At The Corner, William Winkenwerder, Jr. and Grace-Marie Turner criticized the health care-related aspects of the stimulus bill, particularly the House version:

As part of the stimulus bill, the House wants to pump least $160 billion into our already-bloated health sector… The health-related provisions take a sharp turn toward greater government control over our health sector, without any hearings or serious debate in Congress and without telling the American people what the changes would mean for their personal health care.
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For starters, the bill would create a 15-member federal health board, composed entirely of federal employees appointed by the president, charged with running “comparative effectiveness” research to assess which drugs and other medical treatments are most effective.
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The bill would also establish a $400 million slush fund, which the secretary of health and human services would use to give government, not doctors and patients, more control over health-care decisions.

There will be a substantial burden on employers: The bill would impose a back-door mandate for them to continue providing health insurance to workers long after those workers have left.
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Also, having already repositioned SCHIP as a program for middle-income children, Congress wants to do the same with Medicaid. The House bill would have the federal government pay 100 percent of the costs for states to extend Medicaid coverage to unemployed workers and their families, no matter what the families’ income or assets. Under this definition, President Bush and members of his cabinet would be eligible for Medicaid.

Finally, the bill would allocate more than $20 billion to health information technologies, despite the fact that no one has been able to come up with a workable plan to spend even a fraction of that amount wisely.
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The U.S. already spends $2.2 trillion a year on health care, and it is widely acknowledged that we are not getting anything close to our money’s worth… The health-related provisions of this bill are too consequential to be rushed through in this gigantic spending bill.

At his Healthcare IT Blog, healthcare journalist Neil Versel took issue with a Chicago Tribune lead editorial’s characterization of the proposed “expansion of health-care entitlements” in the House stimulus bill:

According to the Trib: “The House version of the stimulus package would … shower $20 billion on computer experts to help doctors convert to electronic medical records. That will create jobs but probably not quickly enough to make a difference in this struggling economy.”

To me, the word “shower” suggests an undeserved windfall. Yes, there are risks of wasting $20 billion on a poor implementation of health IT, but are people really seeing this as a giveaway simply meant to create work? This is about reining in runaway healthcare spending and, ultimately, saving lives, right?

Right?

Finally for this week, reminding us about another critical ongoing issue on The Treatment blog, Jonathan Cohn explains what the Obama administration can learn from baseball “as they assemble a team to manage what would’ve been Daschle’s portfolio.”

TNRtv: What Baseball Teaches Us About Health Care Reform