Majikthise

Weekly Pulse: Obama gives GOP rope to hang itself at health care summit

Tomorrow, President Obama will gather with Republicans for the long-awaited televised health care summit. Obama will promote his health care proposal, the Republicans will demand that we start over.

Even House Minority Leader John Boehner dimly senses that the GOP is walking into a trap. The public is thoroughly sick of the health reform process, but people still like the idea of health care reform. So, the GOP can't just say "kill the bill" in public. Instead, Republicans have to make disingenuous speeches about "starting over," knowing full well that if health care reform dies now, it'll stay dead.

Boehner must realize that starting over is about as appealing as National Root Canal Week at the DMV. But what can he do? The Republicans have no ideas beyond "tax cuts cure cancer." And they can't boycott the summit, or they'll lose the "bipartisan" blinking contest.

So, when Obama gets on TV and lays out his reasonable-sounding plan, complete with protections against private insurers who want to hike your premiums 39% overnight, he's going to sound good and the Republicans are going to sound crazy.

Brilliant tactician Boehner is now exhorting Republicans to "crash the party" they've already been invited to.

It's a trap, alright.

What is the appeal of home birth?

I've never understood why anyone would choose to give birth at home, rather than in a birthing center attached to a hospital. a) Why not go somewhere where you don't have to wash the sheets? b) If there's even a remote chance that you need emergency surgery, why not arrange to be seconds away from an operating room rather than minutes, or longer? 

I know that childbirth isn't a disease. On the other hand, if I had a non-disease where there was a small chance that I'd need emergency surgery within the next 72 hours, I'd prefer to park myself as close to an OR as possible. 

I understand that every woman has the absolute right to make her own decisions about where and how to give birth. I'm not trying to influence anyone else. (Hivemind, be nice to each other, okay?)

Just to reassure people, like my mom, who might be following along at home, this is a purely academic question for me. I ask because Jill & Emjaybee's blog is thought-provoking.

Video: My GRITtv interview with Laura Flanders

Yesterday, I sat down with Laura Flanders of GRITtv to talk about the alleged phone-tamperers who were arrested last week for dressing up as phone repairmen and attempting unsuccessfully to access to the main telephone cabinet for Sen. Mary Landrieu's office. One of the four, Stan Dai, is a former assistant director for a intelligence recruiting program funded by the Office of the Director of National Intelligence. My fellow guest, Dr. David Price is an anthropologist who monitors the intelligence community's attempts to insinuate itself into academia.

Media Consortium outlets have been scooping the established press left and right on the phone tampering story. Check out some of the highlights in the latest edition of The Weekly Pulse.

If we want to expand Medicaid, we've got to enhance it

I've heard several progressives suggest that Democrats abandon comprehensive health care reform and just expand Medicaid to cover everyone who can't afford insurance. Expanding Medicaid could provide coverage for 35-45 million Americans and ultimately save billions of dollars.

Now that the Democrats' filibuster-proof majority is toast, reformers are brainstorming alternative routes to reform. According to one school of thought, the House should just pass the Senate bill, or a modified version thereof. Another camp maintains that the bill should be broken down into smaller, less controversial chunks which the Republicans wouldn't dare filibuster. Be skeptical of any political strategy predicated on the assumption that something is so universally beloved or obviously beneficial that the GOP wouldn't dare obstruct it.

Indulging Bart Stupak is literally not an option

Digby writes:

Yes. And I'm guessing [whether House and Senate Dems can pull together and pass a health care reform bill through budget reconciliation] depends upon whether or not pro-choice women (and men) in both houses are going to have the heinous Bart Stupak amendment forced down their throats as part of the reconciliation "fix." I can't see any way that Stupak and his boys will capitulate otherwise and unless they do, this will not pass the House.

What do you suppose the odds are of that happening?

I'd say the odds are bad. Senate rules wouldn't allow the Stup-ification of the health care bill through budget reconciliation.

Compared to the Stupak Amendment to the House health care bill, the Senate bill would impose fewer restrictions on participating private insurers as to what kind of abortion coverage they can offer.

Now that the Democrats have lost their filibuster-proof majority in the Senate, the best hope for passing health care reform is to have the House pass the Senate's bill. Speaker Nancy Pelosi has already made it clear that that can't happen unless the Senate first makes some changes. In order to avoid a filibuster, those changes would have to be approved through budget reconciliation, where they can be passed by a simple majority.

The thing is, you can't just pass any old legislation through budget reconciliation. As the name suggests, only items that mainly affect the budget can be passed that way, i.e., they must "principally affect federal revenues." It would be procedurally straightforward to use reconciliation replace the excise tax on "Cadillac plans" with an income tax on high earners. By the same token, since a strong public option would reduce the deficit, the Senate parliamentarian might deign to let the Senate add a public option through reconciliation.

The Stupak Amendment isn't like that. At its rotten core, the Stupak Amendment is about preventing private insurance companies from selling abortion coverage to private citizens who pay for it with their own money. It has no impact on the budget, or taxes, or the deficit. So, there's no way to buy off Stupak and his cronies through budget reconciliation. Pelosi's going to have to get those votes somewhere else.

The Institute for Liberty isn't free

Ken Silverstein points to a remarkable piece of investigative reporting in the Washington Post, a story about the murky finances of some of the most prominent anti-health reform groups. Post reporter Dan Eggen found that the conservative Institute for Liberty has truly, if inexplicably, blossomed in the last year:

The Institute for Liberty, for example, was a one-man conservative interest group with a Virginia post office box and less than $25,000 in revenue in 2008. Now, the organization has a Web site, a downtown Washington office and a $1 million advocacy campaign opposing President Obama's health-care plans.

Andrew Langer, the group's president, said the organization receives no funding from health-care firms but declined to provide details. "This year has been really serendipitous for us," he said. "But we don't talk about specific donors." [WaPo]

It's not clear exactly where IFL's money is coming from, but the group is clearly plugged into the national GOP money machine.

The IFL has recruited some big conservative names, like Kerri Houston Toloczko, a senior analyst at the Alliance for American Manufacturing and a board member of GOPUSA.

In September of 2009, Politics magazine billed Toloczko as the policy director of another national anti-reform group, Conservatives for Patients' Rights, the brainchild of walk-in clinic mogul Rick Scott who has reportedly raised $20 million to oppose health care reform. Conservatives for Patients rights works closely with CRC Public Relations, the GOP-linked firm that orchestrated the notorious "swiftboat" campaign against John Kerry in 2004.

Continuing Medical Propaganda Education

A little known provision in the House health care bill would require the $1 billion continuing medical education (CME) industry to disclose more about what it's teaching the nation's doctors:

WASHINGTON—Health legislation moving through Congress would force drug makers to disclose how much they spend on continuing medical education classes for doctors, sparking some resistance from the industry.

For-profit continuing medical education companies have seen revenue fall by double digits in the last year, according to industry statistics, following congressional investigations into the influence of drug makers on medical research and course content. [WSJ]

Good.

I used to write CME modules on high blood pressure drugs, sleeping pills, anti-malaria medicines, anti-depressants, hepatitis vaccines, and other remedies. Keep in mind that I quit medical writing several years ago and the rules have changed a lot since I left.

Sometimes these CME modules were financed by drug companies. In which case, they'd often consist of PowerPoint slide decks summarizing industry-funded research, which had been presented by industry-funded experts at industry-funded conferences.

The drug companies would give these training modules away. Doctors could answer multiple choice questions to earn points towards renewing their medical licenses. Sometimes CME companies would commission CME modules to sell to doctors for a profit. Some CME is produced by non-profit corporations and/or independent academic or professional outlets.

The drug companies did hire real doctors and lawyers to make sure that non-doctors like me didn't accidentally recommend anything lethal or fictional. This was called "med/legal review." Med/legal sent stuff back to us all the time when creative excess got the better of us and we started making claims that were "too promotional." This was a necessary check because we answered to marketing executives.

Review was thorough because the company didn't want to get sued. But a CME module that will stand up in court isn't automatically a quality teaching tool for your doctor. The standard for a true claim was basically whether the statement had been accurately paraphrased from an approved source, typically a peer-reviewed study. Usually, the drug company would tell us which papers to use. More often than not these were write-ups of research sponsored by the company. 

It was obvious to me at the time that this was no way to go about educating the nation's doctors. It wasn't that the information was false, it was just profoundly biased in favor of whoever was selling the drug. The drugs with the most money got the most exposure. Doctors could learn about the latest blockbuster for free, but they'd have to pay out of pocket to learn about a less heavily marketed alternative. So, doctors being much busier versions of normal people, were more likely to learn about whatever the industry literally put in front of them.

The overriding goal was to familiarize doctors with the key sales points for that drug. The specific claims were backed up by research, but at the end of the day doctors were getting a heavily-footnoted sales pitch. The primary object of the exercise was to hype a product, not to disseminate scientific truth.

At a time when the future of health reform depends on cost control, it might not be such a good idea to let pitchmen educate doctors.

More transparency in the CME industry can only be a good thing. The public might not like what it sees.

Lawmakers delivered talking points written by drug company lobbyists

Robert Pear of the New York Times exposes an old fashioned bipartisan scandal; Genentech lobbyists wrote talking points for legislators and dozens of legislators used them:

WASHINGTON — In the official record of the historic House debate on overhauling health care, the speeches of many lawmakers echo with similarities. Often, that was no accident.

Statements by more than a dozen lawmakers were ghostwritten, in whole or in part, by Washington lobbyists working for Genentech, one of the world’s largest biotechnology companies.

E-mail messages obtained by The New York Times show that the lobbyists drafted one statement for Democrats and another for Republicans.

The lobbyists, employed by Genentech and by two Washington law firms, were remarkably successful in getting the statements printed in the Congressional Record under the names of different members of Congress.

Genentech, a subsidiary of the Swiss drug giant Roche, estimates that 42 House members picked up some of its talking points — 22 Republicans and 20 Democrats, an unusual bipartisan coup for lobbyists. [NYT]

I am dismayed to learn that my congresswoman, Yvette Clark (D-NY) was one of the legislators Pear caught cribbing extensively from Genetech's notes. 

Cervical cancer vaccine didn't kill U.K. teen

It turns out that the Cervarix cervical cancer vaccine was not responsible for the tragic death of 14-year-old Natalie Morton of Coventry who died earlier this week within two hours of receiving the shot.

An autopsy showed that the young woman died from a previously undiagnosed chest tumor. Doctors said it was an advanced malignant growth that was so far gone that it could have killed her at any moment.

Statistically, if you give a vaccine to enough people, a certain percentage will end up dying within hours, even if the vaccine doesn't kill anyone. Such deaths must be investigated, especially if they happen to young healthy people with no apparent risk of sudden death.

This case is a reminder of the risks of conflating correlation and causation in advance of the facts.

[Podcast] Journo: I love my "socialist" kidney

Most people think of single payer health care in America as something akin to science fiction--a bold idea that might be possible someday, but certainly not an option in the here and now.

Journalist Jennifer Nix points out that the U.S. already has single payer care, not only for the aged (Medicare) and the poor (Medicaid) but also for patients with end-stage renal disease (kidney failure) who need dialysis or a transplant.

Nix has a unique perspective on Medicare ESRD, as the latter program is known. It saved her father's life in 1973 and her own life this year. Nix found out in 2008 that she inherited the same cystic kidney disease that put her dad on single payer dialysis in the seventies. Medicare ESRD covered a stint on dialysis, her kidney transplant, and anti-rejection drugs for a limited period after surgery (her private insurance covers them now).

Since its inception, Medicare ESRD has enabled over 1 million people survive regardless of their ability to pay. If your kidneys failed tomorrow you won't be left to die because you can't afford dialysis or a transplant. Wouldn't it be nice if all Americans could enjoy the same level of security for their hearts and other organs?

Here's my podcast interview with Nix at the Daily Pulse.