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3 posts from August 2018


Essay Concerning the United Nations' Recent Extreme Poverty in the US Report (August 22nd)

Today, the Health Care Blog posted my essay, "The UN's Extreme Poverty Report: Further Evidence US Healthcare Is Divorced From Reality."  It is at: http://thehealthcareblog.com/blog/2018/08/22/the-uns-extreme-poverty-report-further-evidence-us-healthcare-is-divorced-from-reality/.

It begins: In May Philip Alston, the United Nation’s Special Rapporteur on Extreme Poverty, and John Norton Pomeroy Professor of Law at New York University Law School released his, “Report of the Special Rapporteur On Extreme Poverty and Human Rights on His Mission to the United States.”  The 20-page report was based, in part, on Alston’s visits this past December to California, Georgia, Puerto Rico, West Virginia and Washington, D.C.  After reading the report and the response to it, one is again forced to question how legitimate is our concern for the health and well being of the poor, or those disproportionately burdened with disease.




Medicare For All: A Conversation with Professor Gerald Friedman (August 8th)

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According to a recent Kaiser/Washington Post survey 59 percent of Americans support Medicare for All (M4A).  Per a March New England Journal of Medicine poll 61 percent of physicians said single payer would make it easier for them to deliver cost-effective, quality health care.   Currently, before the House is legislation titled the "Expanded and Improved Medicare for All Act" with over 120 sponsors.  (The legislation has been introduced every session since 2003.)   The House has recently also formed a Medicare for All caucus with 70 Democratic members and if the Democrats win back the House this November they have promised M4A hearings.  The Senate has a parallel bill, the "Medicare for All Act of 2017," currently with 16 cosponsors, several of whom are potential 2020 presidential candidates.  Though there is, again, substantial criticism of M4A, e.g., CMS Administrator, Seema Verma, recently denounced it as "government run socialized health care" (an odd complaint since that is exactly what the current Medicare and Medicaid programs are).  Because of the disruption, dismantling or sabotage of the ACA under the Trump administration and moreover because health care continues to be ever increasingly unaffordable (and bankrupt, the Medicare Part A Trust Fund is now projected to be insolvent in 2026), as is frequently phrased, M4A is, again, on the table. 

During this 37 minute conversation Professor Friedman provides a general definition of Medicare for All healthcare, how it would be financed and how savings be derived and what amount.  He explains what is current public opinion, what are credible criticisms of M4A and what promising single payer efforts are underway in the states.   

Dr. Gerald Friedman is Professor and Undergraduate Program Director of Economics at the University of Massachusetts at Friedman
Amherst.  Prior to, he worked as research staff for the International Ladies' Garment Workers' Union.  Professor Friedman is the author of multiple books and articles on labor relations and healthcare economics.  He has been a correspondent to television and media outlets, a consultant to labor unions and has drafted funding plans for campaigns for single payer health insurance in several states including New York, Maryland, Pennsylvania, Colorado, Oregon and Washington and a federal plan for the US.  He serves on the Board of Advisers to the Business Initiative for Health Policy.  Professor Friedman earned his undergraduate degree from Columbia College and his Ph.D. in economics from Harvard. 


Reforming the Physician Self-Referral Law (Stark Law): A Conversation with Amy Hooper Kearbey (July 31st)

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Over the past several years the Congress and Medicare regulators have discussed reforming the 1989 Ethics in Patient Referral Act.  Otherwise known as the physician self-referral or more commonly termed Stark law (named after the former California House member, Pete Stark, the initial sponsor of the bill).  Stark law is today widely viewed as an impediment to care coordination or payment models that financially incent providers to improve care, care coordination and reduce spending growth, or moreover Accountable Care Organizations (ACOs) and bundled payment arrangements, because as implied the law prohibits physicians from referring patients to receive "designated health services" payable by Medicare or Medicaid from entities with which the physician or immediate family member has a financial relationship.  Beyond the complexity of the law, its strict liability provision, potential substantial fines imposed under the law, exposure to False Claims liability and Medicare exclusion, there has been increasing sentiment the law generally does not have a place in today's pay for performance or pay for value world.   Most recently, this past June 25th DHHS published a Request for Information (RFI) soliciting stakeholders to offer comments on improving Stark law and most recently, or on July 17th, the House Ways and Means heard related testimony.      

During this 27 minute conversation Ms. Hooper Kearbey discusses her work related to Stark law, the numerous current problems with the law and areas where the law can be improved.  She notes the current DHHS Stark RFI, e.g., to what extent improved transparency about a physician's financial relationships could help improve the law and and makes comment on the use of gainsharing in current pay for performance arrangements.    

Ms. Amy Hooper Kearbey is a attorney and partner with the DC-based law firm, McDermott Will & Emery.  Her practice Kearbey_amy_07935_tfocuses on providing Medicare regulatory coverage, coding, reimbursement and compliance as well as advice regarding federal fraud and abuse regulations and clinical research compliance.   She is a member of the District of Columbia Bar Association, the American Health Lawyers Association and the National Blood Clot Alliance.  She earned her law degree from the Duke University School of Law and her AB from Dartmouth. 

The Stark RFI is at: https://www.gpo.gov/fdsys/pkg/FR-2018-06-25/pdf/2018-13529.pdf and related July 17 testimony by four witnesses before the House Ways and Means Committee is at: https://waysandmeans.house.gov/event/hearing-on-modernizing-stark-law-to-ensure-the-successful-transition-from-volume-to-value-in-the-medicare-program/.