By Janet Fang
Posting in Food
Today, the US Supreme Court ruled to uphold almost all of President Obama's Patient Protection and Affordable Care Act. A look at how that will impact the science of medicine.
Today, the US Supreme Court ruled to uphold President Obama’s Patient Protection and Affordable Care Act in a 5-4 vote.
This includes the controversial provision requiring uninsured people to buy health insurance or face a penalty. On this so called ‘individual mandate,’ Chief Justice John Roberts writes [pdf]:
Those subject to the individual mandate may lawfully forgo health insurance and pay higher taxes, or buy health insurance and pay lower taxes. The only thing they may not lawfully do is not buy health insurance and not pay the resulting tax.
With the law upheld, the following provisions relevant to biomedical research and commercialization are preserved, Nature News explains:
- The establishment of an abbreviated approval pathway at the US Food and Drug Administration for ‘biosimilar’ drugs: generic versions of large, protein-based drugs whose makers have long lobbied to be able to compete with makers of brand names.
- The authorization of the Cures Acceleration Network at the National Institutes of Health (NIH). This is an effort to speed high-needs cures from lab to bedside. The network is a flagship component of the agency’s new National Center for Advancing Translational Sciences. While authorized to receive up to $500 million annually, in 2012 Congress appropriated just $10 million for the network.
- The establishment and funding of the Patient-Centered Outcomes Research Institute (PCORI) for conducting comparative effectiveness research (explained in detail below). PCORI issued its first grants, worth a total of $30 million, earlier this month.
- The launch of a new requirement that drug and device companies publicly post all payments to physicians of $10 or more in cash or kind. Called the Physician Payment Sunshine Act, it’s expected to go into effect in late 2014.
- Also preserved, a $153 billion in Medicare and Medicaid payment cuts to teaching hospitals over 10 years ending in 2021.
Because teaching hospitals at academic medical centers provide a disproportionate amount of charity care, lawmakers reasoned that, with an insurance mandate in place, they will begin to be paid for that care, allowing the government to recoup the $153 billion.
And just a bit more on PCORI… it goes back to the question, what kind of care patients would receive with their insurance? New Scientist explains.
Evidence-based medicine is when medical procedures are performed because there is good scientific evidence that they can make a difference. Many standard practices – like annual physicals – are largely unjustified, but they’re performed because of a pay structure that incentivizes physicians to offer more tests and procedures.
So the plan is to use ‘comparative effectiveness research’ to assess how useful common medical practices really are: comparing 2 similar drugs or 2 different methods, like surgery and a drug. PCORI will target areas lacking solid scientific knowledge and fund projects to help clarify which methods are the most effective and how patient care in those areas can be improved.
Image: Public Law
Jun 28, 2012
I can't believe the arguments people are making here. I can also bet that all of them are relatively healthy and or enjoy employer paid health insurance benefits. I can also bet that they too will do a flip flop - Romney style - if someone in their family meets with some mishap and needs the state sponsored/assisted services not covered by their current insurance. We in India have everything. Free health services for the masses, insurance bases medical services for those who can afford it and out of pocket paid services for those who are generally healthy. I have lived in the US for 6 years and have seen first hand how it is practiced and charged for. The biggest culprits are the stupid judges who award ridiculous malpractice awards and the fat-cat lawyers who get even fatter on other peoples' misery. The medical practice is so defensive that more than 50 % (by cost) of the tests done are just to preclude any grounds for malpractice suits. Take the cost of medicines. Even without converting for foreign exchange rates they are cheaper in India. and at par in quality and effectiveness. We have medical tours coming from European countries, especially from UK where full medical procedures + post procedure recovery + genuine 5 star tourism + air fare costs less than just the procedure alone in their home country. These include knee / hip replacements, Lasic eye surgeries and what have you. A while back I watched a documentary on legalising euthanasia for cancer and other terminally ill patients in the state of Oregon, I believe. Most objections came from Hospices and Doctors who saw it as loss in potential income. Until the Americans start empathising with their fellow citizens there is no hope! All those involved in the medical field - doctors, nurses and especially the pharma companies - have to become less greedy if the lot of the general American citizenry is to improve.
- - Those subject to the individual mandate may lawfully forgo health insurance and pay higher taxes, or buy health insurance and pay lower taxes. The only thing they may not lawfully do is not buy health insurance and not pay the resulting tax. - - Everything he calls a tax is actually called a FEE in the health care law. He put the true face on the law. That it does raise taxes on the middle class and the poor to pay for health care for all. They just called them fees to get past objections in Congress.
Something just doesn't pass the smell test on this. Folks, this is going to cost us a arm and a leg for less care. I'm worried about the future for our kids. Somebody has to pay for this and it's gonna come down to the middle class folks who work and sweat everyday. I agree with CaptD- who decides what works and what doesn't work. The Supreme Court may have give us their verdict but the verdict on this one is far from being reached.
Different people are affected by medical treatment in different ways, yet unsaid in the above ruling is allowing for wide treatment "latitude" to be considered... A great example is how some folks react to additional physical therapy while others do not, who gets to make the decision and what hoops will patients have to jump through to get the treatment they really need vs "average health care"?
First the number of legitimate malpractice cases that are brought forth are only the tip of an iceberg of what is Really out there ( this information came from a the Maine PA Meeting a few years ago Secondly studies show awards have not gone up. Take for instance in Caifornia from 1991 - 2001 awards went from 600,000 to approximatley 700,000 this fact is from research in the 2001 presidential election when the VP candidate was John Edwards. So no your malpractice. info IS ALL WRONG get your facts straight.
The Massachusetts health care act as implemented by Deval Patrick is a shadow of what Romney signed in 2006. The Democrat majority that has held the state house for decades worked with Democrat Patrick to expand the plans coverage far beyond what Romney had mapped out. To the point where health care is almost 1/3 of the state budget. The program has been kept afloat by billions in federal subsidies under the various stimulus plans. I have seen my health care premiums go up the following since the health care law was passed because of expensive mandates the working class must cover. 2007 - 28 percent, 2009 - 26, 2010 - 31, 2011- 18, 2012 - 14. I had seen a grand total of a 7 percent increase across the previous 10 years before the law. My co-pays have gone up from $10 to $20. I now have to pay an additional state mandated co-pay for any diagnostic visit. There are additional specific co-pays that only apply to tests for women. The state has 40,000 less doctors today than it did in April of 2006 when the law was signed. Older doctors are retiring early because the state is reimbursing them so little for state insured patients they are losing money. Younger doctors taught in Massachusetts schools are leaving the state in droves. Every hospital in the state is short doctors which is driving up saleries, which further drives up costs. 6 non-profit hospitals had to sell out to a for profit company after they went bankrupt waiting on $120 million in state health care reimbursements that were with held because the state was too broke to pay them. Another 5 local hospitals are on the brink of bankruptcy while a lawsuit against the state over missed state care reimbursements flounders in the court system. I guess coverage for all means never getting paid. The cost of malpractice insurance has skyrocketed because doctors have strict limits on diagnostic tests that they can run. There is a growing shortage of trained therapists because they are also leaving the state in droves. It can be as long as 3 weeks from when you have surgery until you can start therapy because of the shortage. I hope those of you who support this looming national nightmare are happy when the s*#t hits the fan.
Risks are substantially higher in MA because of the state mandated testing limitations placed on doctors treating people covered by state funded plans. So here is the bases of the mess. State reimbursements rates to doctors and hospitals have dropped since 2006.. State reimbursements have been criminally slow to the point of driving hospitals and doctors out of business. Those same doctors that are getting paid less are paying higher malpractice rates because the threat of suits is higher because state insured patients are not getting the testing they feel they are entitled to because of state mandated limitations on testing. Another huge issue that was not resolved we the excessive burden on emergency rooms. Low income people covered by state funded plans have long felt entitled to walk into ERs demanding routine care as vaccinations, annual physicals and the like. One of the main goals of the reform was to get uninsured and state insured people out of the ERs and into primary care offices. Instead they have expanded the number of people who now show up in the ER waving their state insurance card demanding to see THEIR doctor because they have a sore throat. One hospitals attempt at setting up a nearby walk in clinic to take such patients was met with howls of racism and other such nonsense when it was reported they were shuttling routine care patients from the ER down to the clinic. They were forced to abandon the program. When it comes to Massachusetts health care and the impact of the 2006 health care reform, I know what I am talking about because I live with it. Maine and California are another story.