Two Years of Health Reform: What Would You Change?
Friday marks the second anniversary of the health reform law. Just three days later, what Republicans like to deride as "Obamacare" will face the biggest challenge it has ever seen: oral arguments at the Supreme Court on whether the law is constitutional. Democrats are spending the week telling voters just how they've benefited from the law, and what they'd lose if it is overturned. Republicans are keeping on their message that the law is an unprecedented government intrusion into Americans' health care. In the meantime, states are scrambling to get insurance exchanges up and running while every facet of the health industry--from insurance companies to doctors to hospitals--are making significant changes to their businesses to adhere to the law's new rules.
If you were implementing the law, what would you have done differently? What would you keep the same? In the battle for public opinion, who is winning: Democrats or Republicans?
March 23, 2012 12:43 PM
The Real Cost of ‘Sunshine’
By Doug Peddicord
Executive Director, Association of Clinical Research Organizations
The goal of any health care reform legislation should be to expand access, increase quality and lower costs. For the most part, the landmark health reform bill signed into law by President Obama does just that. For example, it contains provisions that prohibit the use of “pre-existing conditions” to deny coverage and create health insurance exchanges that will encourage a more competitive marketplace.
But at least one part of this law represents serious government overreach and begs for significant rethinking or perhaps even repeal.
Section 6002, the Physician Payments Sunshine Act, is intended to bring transparency to potential conflicts of interest and, theoretically, reduce pharmaceutical companies’ influence on physicians’ prescribing behavior. This is a fine goal and sounds relatively simple in concept but is actually quite complex in practice, especially, for instance, in the case of payments made for medical research. The complexity of this law caused CMS to miss the statutory deadline for issuing its rule. The subsequent delayed i...
The goal of any health care reform legislation should be to expand access, increase quality and lower costs. For the most part, the landmark health reform bill signed into law by President Obama does just that. For example, it contains provisions that prohibit the use of “pre-existing conditions” to deny coverage and create health insurance exchanges that will encourage a more competitive marketplace.
But at least one part of this law represents serious government overreach and begs for significant rethinking or perhaps even repeal.
Section 6002, the Physician Payments Sunshine Act, is intended to bring transparency to potential conflicts of interest and, theoretically, reduce pharmaceutical companies’ influence on physicians’ prescribing behavior. This is a fine goal and sounds relatively simple in concept but is actually quite complex in practice, especially, for instance, in the case of payments made for medical research. The complexity of this law caused CMS to miss the statutory deadline for issuing its rule. The subsequent delayed implementation continues to cause a great amount of regulatory and business uncertainty. CMS estimates it will cost upwards of $200 million annually to comply, but experts predict the cost will be up to four times that amount.
Arguably, payments for bona fide research should be exempt from the law altogether, as they are in several states that have similar statutes. The public disclosure of payments or “value transfers” (like bagels brought to a physician’s office), and the great potential for misreporting and misinterpretation serves as a major disincentive for physicians to participate in medical research. Given the opportunity, I would remind President Obama that not all medical research takes place within the hallowed halls of the National Institutes of Health or within academia. In fact, the biopharmaceutical industry spends more than double the NIH budget on research and development each year. If the United States is to have a robust, innovative biopharmaceutical industry, private sector research is a must and an activity that should be encouraged rather than tainted with a phony “conflict of interest” label.
Make no mistake, the burden to comply with this law will not fall solely on pharmaceutical companies, but will capture physicians and hospitals as well, effectively distracting doctors from patient care so they can focus on nonsensical accounting and diverting hospital resources from activities like increasing nursing staffs to hiring more compliance officers. Counting bagels is not healthcare reform and a billion dollars spent on “sunshine” requirements that do not increase access or the quality of care is not progress. On at least this one provision of the healthcare law, we suggest that common sense should prevail.
Read More
March 20, 2012 3:26 PM
The Supreme Court Case That Shouldn’t Be
By Gene Steuerle
Fellow, Urban Institute
There really is no excuse for the case now before the Supreme Court on individual mandates. I am not speaking to the legal merits of each side but to the inability of Republicans and Democrats to come together to fix anything. The individual mandate is really a penalty for not buying insurance. As one of those writing on individual mandates over the years, I had suggested before and during the health reform debate that it be assessed simply as a condition for receiving certain other government benefits. If done that simpler way, there would be no court case. No one disputes the government’s right, even necessity, to set the conditions for receiving various benefits.
Instead, disregarding lessons from tax and welfare systems in the past, the Democrats decided they would rather add on some new, separately enforceable, and cumbersome tax and welfare systems along the way to passing health reform. Many of these new systems do not work well. Meanwhile, Republicans currently seem to be insisting on vitiating all parts of the reform, as if leaving tens of millions of unin...
There really is no excuse for the case now before the Supreme Court on individual mandates. I am not speaking to the legal merits of each side but to the inability of Republicans and Democrats to come together to fix anything. The individual mandate is really a penalty for not buying insurance. As one of those writing on individual mandates over the years, I had suggested before and during the health reform debate that it be assessed simply as a condition for receiving certain other government benefits. If done that simpler way, there would be no court case. No one disputes the government’s right, even necessity, to set the conditions for receiving various benefits.
Instead, disregarding lessons from tax and welfare systems in the past, the Democrats decided they would rather add on some new, separately enforceable, and cumbersome tax and welfare systems along the way to passing health reform. Many of these new systems do not work well. Meanwhile, Republicans currently seem to be insisting on vitiating all parts of the reform, as if leaving tens of millions of uninsured in a crumbling system is a solution to anything.
The partisan divide isn’t just about partisanship, it’s about the preference of both sides for a good fight even over compromises that meet objectives of both sides.
Read More