30% Off Health Care

April 27, 2009 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Federal Healthcare Reform, Health System Reform, Politics / 4 Comments

I get lots of emails. Some are interesting. Others are Spam – such as the one offering to double my gas mileage by showing me how to run my car on water. (Don’t they know that cars run on air not water!!!!!)

And last week I got one promising to cut health care expenses by 30%. Not just my health care expenses, but the entire countries spending on health care. (See their promotional coupon below.)

As you can see, this is really a call for people to support a public plan as part of health reform. This is a great message and marketing gimmick, but the problem is that nobody has agreed on the definition of a “public health insurance option.” …

Culture of Health Reform

April 13, 2009 / Michael D. Miller MD / Access to Healthcare, Economics & Financing, Federal Healthcare Reform, Politics, State-Level Healthcare Reform / 2 Comments

One of the challenges for health reform legislation is the culture of the policy and political community.

Massachusetts’ insurance and coverage initiatives have been cited as lessons for health reform at the Federal level and other states. However, while observing a meeting of the state’s Special Commission on the Health Care Payment System last Friday, I was struck by how the culture of this group was very different than what I have often seen in Federal processes or within other states.

The Commission had agreed at their previous meeting that global payments should replace fee-for-service as the main payment route for medical services and products. …

Managing Expectations for Federal Health Reform

January 28, 2009 / Michael D. Miller MD / Access to Healthcare, Federal Healthcare Reform / 1 Comment

One of the challenges facing health reform legislation are the expectations of different stakeholder groups – many of whom were strong supporters of the Barack Obama’s campaign. Although the new Administration has only been in office a week and a day, a number of signs point to the fact that health reform legislation will not be quickly formed and passed – including an article in today’s Boston Globe titled, “Some fear window is narrow for healthcare overhaul.”

But not rushing health reform was both predictable and a good thing. First, the reasons why it won’t happen quickly:

It takes time for the new Administration and Congress to get organized – and they are rightly prioritizing actions to address the economic “situation”
The US system of government is designed to be deliberative and not speedily make major decisions
For reasons that are not fully apparent, the Senate is taking longer to confirm Tom Daschle as Secretary of HHS – although there are no signs that this won’t happen soon
Senator Kennedy’s health has been a question mark, but his staff has been working diligently to prepare legislative framework and language in conjunction with other Congressional offices such as the Finance Committee
Congressman Waxman’s taking over the Chairmanship of the Energy and Commerce Committee will likely mean some staff turnover in that Committee which also takes time – particularly since Congressman Waxman is known for getting some of the best and brightest staff in Congress

And second, not rushing health reform legislation through the process may be a good thing because no matter what scope and details the legislation eventually includes, getting more groups comfortable with its goals, priorities and specifics will make it more likely to succeed. …

Improving Cancer Care and Medicare’s Cancer Coverage

January 28, 2009 / Michael D. Miller MD / Access to Healthcare, Comparative Effectiveness, Innovation, Medicare / 2 Comments

The New York Times and Wall Street Journal both had articles yesterday about a new rule clarifying how Medicare would decide whether or not to pay for off-label uses of medicines to treat cancer. These articles describe controversies around Medicare relying on several compendia containing information about such off-label uses to make these coverage decisions, how some of the compendia may have industry connections, and how the new rule might increase Medicare spending.

I have a long history with this issue. As a Legislative Assistant working for Congressman Sander Levin in the early 1990s, I was very involved in writing the legislation that first changed Medicare law to require Medicare Part B to pay for off-label used of medicines to treat cancer. …

Health Reform and the Economy: 4 Spheres to Consider

January 25, 2009 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Health System Reform / 2 Comments

Many people and pundits have opined on the effects that the economic downturn will have for the likelihood of health reform: On the Federal level, how much money will be available for expanding insurance coverage, and how much money will be included in the “stimulus package” – and for what? And in the States, how much will be cut from Medicaid programs and government employees’ benefits? In addition, there have been news stories about the economic downturn leading to loss of insurance coverage secondary to job-loss, as well as people forgoing direct medical care, healthy activities, and wellness behaviors.

These points illustrate how the multiple parts of our health care “system” interconnect, (particularly financing effecting delivery), and everything existing within the overall economic environment. …

Groups Seeking Funds in Health Reform

January 12, 2009 / Michael D. Miller MD / Economics & Financing, FDA, Medicaid, Medicare, Politics / No Comments

With all the anticipation about health reform happening soon, many groups are expecting increased Federal funding for different things, e.g. electronic medical records, expansion of SCHIP and Medicaid (or at least great funding assistance to States), more emphasis on personalized medicine, more resources for FDA to help them with their expanding domestic and international responsibilities, closing the donut hole in the Medicare outpatient prescription drug benefit, fixing Medicare’s physician payment formula, etc.

Another area looking for increased emphasis and funding – both as part of health reform and economic/jobs stimulus – are biomedical researchers. The Boston Globe and Mass High Tech had articles last week describing how the Massachusetts Life Sciences Collaborative is lobbying for more NIH grant money. …

Health Reform – Achieving Universal Coverage

January 5, 2009 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Health System Reform, Medicaid, Public Health / 5 Comments

During the holidays the Obama Health Transition Team urged people to organize discussions about health care in their homes and communities – and then to report back. Reading about these discussions – including the one that Secretary Designee Tom Daschle attended in Indiana – made me think about what things are going to be needed to make health reform actually work.

My end-of-year reflections and ruminations led me to conclude that one of the most challenging parts of health reform will be to actually get more people enrolled in whatever expanded coverage plans are developed and implemented. Enrollment barriers are not new, but they are frequently not highlighted because they may present great political and fiscal risks.…

Health Reform – How Much Expansion?

December 12, 2008 / Michael D. Miller MD / Access to Healthcare, Economics & Financing, Public Health / 1 Comment

Morton Kondracke, a columnist for Roll Call newspaper, (sorry on-line subscription required to read the full article), had a very interesting and insightful piece yesterday where he outlines some of the reasons that health reform in 2009 will be more expansive than in might have been a few years ago.

He makes two very concrete and connected observations. First, that the economic downturn will increase the number of people without health insurance by 5-6 million, and probably add a similar number to the rolls for Medicaid and SCHIP – which will add to States’ budgetary problems. And second, that the costs of health reform are likely to be much greater than expected – assuming of course that there isn’t a dramatic economic rebound. …

Personalized Medicine – Fulfilling the Promise of Genetic Research

November 17, 2008 / Michael D. Miller MD / Access to Healthcare, Comparative Effectiveness, Delivery of Healthcare, FDA, Information & Communications, Innovation, Quality of Care & Safety / No Comments

It has been 55 years since the discovery of the structure of DNA, and 40 years since James Watson published his account of that discovery in his book, “The Double Helix.” (A picture of my autographed copy is below.)

Ever since DNA was discovered to code for the structure of most living things, there has been the hope that understanding abnormal genetics would lead to the ability to treat or cure a vast array of illnesses. Unfortunately, that progress hasn’t been as rapid as originally hoped. But medical science is now beginning to put genomic research discoveries into actual medical practice, and start customizing medical treatments based upon each individual patient’s genetic makeup – the fundamental concept of “Personalized Medicine.”…

Medical Homes, Hammers and Nails

November 10, 2008 / Michael D. Miller MD / Access to Healthcare, Clinician-Patient Relationships, Comparative Effectiveness, Delivery of Healthcare, Health System Reform, Information & Communications, Quality of Care & Safety / 2 Comments

Medical homes are being promoted as a way to improve health care delivery by increasing the coordination of patient’s primary and specialty medical care. The goal of medical homes is to ensure that patients’ care is comprehensive, appropriate and patient-focused.

One of the benefits to the patients and the healthcare system is that medical homes can help sort out the confusion that can arise from the phenomenon sometimes described as, “When you’re a hammer, everything looks like a nail.”

In healthcare delivery what this means is that sometimes the diagnoses or treatment recommendations from specialized clinicians will reflect their expertise – and thus their may be inconsistencies or conflicts in the recommendations coming from several specialists.…

Communicating Health Information and this Blog’s Goals

October 30, 2008 / Michael D. Miller MD / FDA, Health Policy and Communications Blog, Information & Communications, Quality of Care & Safety / No Comments

Noting that I’ve written about a wide variety of health and biomedical research issues, someone recently asked me about the focus of this blog. My response was that my goals are two-fold: First, to present synthesized information – created by combining different sources and analyses – in ways that provide new perspectives on important issues so that people have both broader and deeper understanding of these issue. And second, to reach multiple audiences with this information and perspectives so that the spectrum of healthcare stakeholders can better communicate and understand each other. Which is just stating in a different way what I wrote in my first posting, that the reason I started this blog was “to provide stakeholders of all types, (such as patients, clinicians, administrators, payers, researchers, regulators, legislators, etc.)…

Direct to Consumer Advertising: Drugs, Hospitals, Research….

October 23, 2008 / Michael D. Miller MD / Access to Healthcare, FDA, Information & Communications, Politics / 4 Comments

A very contentious health policy issue is that of advertising. Usually the specific topic is the advertising of medicines directly to patients – known as “Direct to Consumer Advertising.” There have been proposals to limit or ban this activity, and some states have, (or have proposed), limiting or requiring disclosure of other marketing activities by pharmaceutical companies – such as marketing directly to doctors and hospitals.

However, I’ve found it intriguing that many other components of the healthcare industry advertise directly to patients. For example, the Boston area free daily paper, Metro, contains lots of ads recruiting people to participate in medical research trials. …

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