Clinton undermines her health-care plan with one terrible policy call

HILLARY CLINTON rolled out several modest but serious health-careproposals last week. This week she canceled out any claim to responsibility on the subject by calling for repeal of the “Cadillac tax” on employer health-care plans.

The tax, set to take effect in 2018, is a key component of President Obama’s health-care plan and its most effective means of controlling health-care costs. Without it, Obamacare becomes one more entitlement program facing ever-rising health-care costs that the country will eventually be unable to afford. Ms. Clinton said she would find ways to make up the revenue the tax would generate, but that would not repair the principal damage. She also would have to find alternate ways to control health-care costs, and that seems unlikely. As the Huffington Post’s Jonathan Cohn wrote , “The Congressional Budget Office made it clear that, without something like the Cadillac tax, the health care law was unlikely to reduce health care spending.”

To understand why, you have to understand that health benefits are a form of employee compensation that the federal government doesn’t tax: The government subsidizes employer-provided health insurance, in other words, but not wages. This encourages firms to compensate people in health plans instead of in dollars, and the resulting distortion tends to irrationally push up health-care spending.

The Cadillac tax wouldn’t scrap the tax preference for employer health benefits, but it would cap it; employers would pay a tax on particularly expensive health plans. Unions that have negotiated generous plans naturally oppose this, but there’s no rational reason that taxpayers, including many struggling to pay for their own insurance, should subsidize this particular inequality. The tax would restrain health-care spending over time as companies sought to keep their plans from being subject to the tax; they would be more apt to channel compensation into wages instead. The tax also would raise $87 billion over a decade to help pay for the Affordable Care Act’s health-insurance expansion.

It’s hard to say which would be more discouraging: that Ms. Clinton knows this is a poor policy call and made it to appease politically influential unions, or that she doesn’t know this is a bad choice. Her latest about-face, coming just after her turnabout on the Keystone XL pipeline, is even more of a pity because she had recently proposed several sound ideas to improve access to health care. These include changes in health insurance rules to help patients with chronic illnesses afford their drugs and to allow people to see their doctor three times a year without triggering their deductible. She also endorsed an end to “pay-for-delay” arrangements that keep cheaper generic drugs off the market.Yet, of all the health-care proposals Ms. Clinton has offered, ending the Cadillac tax is perhaps the most likely to become law because the tax is as unpopular as it is essential. Mr. Obama was content to have it take effect only after he left office, leaving the leadership challenge to his successor. One would-be successor has just flunked that challenge.

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Tinder Clashes With AIDS Healthcare Foundation Over STD Billboard

The popular dating app Tinder was miffed by a new campaign promoting free testing for sexually transmitted diseases launched by the Los Angeles-based AIDS Healthcare Foundation. The advertisements in question—which an AHF spokesman says appear on more than 20 billboards and 100 bus benches in the L.A. area—depict two pairs of silhouettes: “Tinder” faces “chlamydia,” and “Grindr” looks at “gonorrhea.” On the right-hand side, the ad directs people tofreeSTDcheck.org.

“Mobile dating apps are rapidly altering the sexual landscape by making casual sex as easily available as ordering a pizza,” Whitney Engeran-Cordova, senior director of AHF’s public health division, is quoted as saying in the foundation’s press release describing the campaign’s September 18 launch. He continued:

In many ways, location-based mobile dating apps are becoming a digital bathhouse for millennials wherein the next sexual encounter can literally just be a few feet away—as well as the next STD. While these sexual encounters are often intentionally brief or even anonymous, sexually transmitted diseases can have lasting effects on an individual’s personal health and can certainly create epidemics in communities at large. We want to remind sexually active adults—especially young people—how easy it can be to contract an STD and the importance of undergoing regular screenings to protect their sexual health.

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According to The Guardian, an attorney for Tinder sent the foundation’s president, Michael Weinstein, a cease and desist letter, the same day the campaign began, saying the billboard was “falsely associating Tinder with the contraction of venereal diseases.”

“These unprovoked and wholly unsubstantiated accusations are made to irreparably damage Tinder’s reputation in an attempt to encourage others to take an HIV test offered by your organization,” wrote Jonathan D. Reichman of the law firm Kenyon & Kenyon LLP. “While Tinder strongly supports such testing, the billboard’s statements are not founded upon any scientific evidence and are incapable of withstanding critical analysis.”

The letter demanded a written response from the foundation assuring the company it would remove all references to Tinder and “cease making any and all false and disparaging statements against Tinder.”

In the response, dated September 23, the foundation declined to remove references to the dating app and said that “AHF has not made any false or disparaging statements against Tinder and therefore has no reason to cease making any such statements,” wrote Laura Boudreau, chief counsel for operations at AHF.

“As part of its mission, [AHF] speaks out on current, important issues that impact the public health,” she added, citing a May report from the Rhode Island Department of Health that said cases of syphilis, gonorrhea and HIV rose sharply from 2013 to 2014 and linked the rise, in part, to the use of social media to arrange casual or anonymous sex. Boudreau also references Vanity Fair’s “Tinder and the Dawn of the ‘Dating Apocalypse’” story, whichprovoked a Twitter rant from Tinder.

Grindr, it seems, reacted less harshly to the campaign, although the foundation says Grindr dropped its paid advertisements for free STD testing. “We were surprised at the approach [the foundation] took and paused the campaign in order to speak with them and assess our relationship,” the company told theLos Angeles Times.

But the foundation does not plan to back down. “We have no intention of taking them down,” Weinstein tells Newsweek. “We’re not against these apps, we’re not trying to shut them down, and we’re not trying to stigmatize them. We’re trying to bring the health issue into the mix,” he adds, saying that the foundation would prefer to work with apps like Tinder and Grindr to address public health issues.

“They’re tone-deaf,” Weinstein told The Guardian. “It would have been much wiser for them to say that they’re concerned about their customers and look forward to working with us to help people get the checkups that they need.”

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Tattoo-like electronic health patches are now easy to make

However much you like the idea of a wearable electronic patch monitoring (or improving) your health, it’s not all that practical. Making just one patch using current tech can take days, and you’d better believe that the result will be expensive. University of Texas researchers may have licked this problem, though. They’ve developed a “cut-and-paste” manufacturing method for tattoo-like patches that whittles the assembly time down to 20 minutes, and should reduce the cost in the process. The technique involves little more than cutting shapes out of metal placed on polymer sheets, and then printing the electronics on to polymer adhesives. Effectively, it’s 3D printing in reverse — you’re taking material away until you get the design you want.

The invention sounds simple, but it could do a lot to make wearable tech a mainstay of the medical world. If patches are both simple to make and inexpensive, you’re much more likely to get them as part of your treatment. You could even get disposable patches that track short-term conditions (say, a bad flu) to make sure that they’re not signs of something much worse. It could take a long while before you see these cheap-and-easy devices in service, but they may well become commonplace.

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Federal health program for Sept. 11 responders expires

WASHINGTON –  A law that provides medical monitoring and treatment for Sept. 11 first responders expired at midnight Wednesday due to the failure of Congress to act.

For now, first responders who rushed to the World Trade Center after the 2001 terrorist attacks, worked for weeks and now suffer from illnesses like pulmonary disease and cancers will still be able to get their health care. But federal officials who administer the program say it will face challenges by February and will have to start shutting down by next summer.

Letting the program expire creates “enormous anxieties and fears in the minds of very sick people,” said Sen. Kirsten Gillibrand, D-N.Y., who has been lobbying her colleagues to make the program permanent and recently was joined by comedian Jon Stewart.

New York City Mayor Bill de Blasio said it was unacceptable for Congress to let it expire.

“Congress must stop putting politics ahead of our heroes’ health,” he said in a statement.

The Sept. 11 program is one of several that will expire at midnight due to congressional inaction. While Congress moved toward passing legislation to keep government agencies open, there are some programs that depend on further action to operate long-term.

John Feal, a former World Trade Center demolition worker and leading advocate for sick responders, has pressed lawmakers to pay attention to the Sept. 11 program.

“People are dying and suffering, and Congress can easily close this wound,” Feal said. “But they continue to add salt to it.”

The Zadroga Act, named after a responder who died after working at ground zero, first became law in 2010 after a debate over the bill’s cost. Proponents are seeking the law’s permanent extension in part because some illnesses may not manifest until years later, after the statute of limitations for worker’s compensation or certain state laws may have run out.

House Republicans have been supportive of the program but have opposed its permanent extension because they say they want the chance to periodically review it and make sure it is operating soundly. The Senate has not moved a bill.

In a letter to the Senate, Centers for Disease Control and Prevention Director Tom Frieden said if the law isn’t extended, the World Trade Center Health Program “will begin to face significant operational challenges” by February. By next summer, the program’s 72,000 enrolled beneficiaries will have to be notified that they may not receive health care beyond September 2016 and the program will have to start to shut down. Frieden said that process could cause patients additional stress.

Earlier this summer, Dr. John Howard, the administrator of the CDC program, told a House panel that extending the law would help clinicians treat victims and allow administrators to better plan patient care.

“It’s stressful to be told on a year-to-year basis that your care might be taken away,” Howard said. “From the administrative perspective, it’s stressful because we have to constantly prepare for when this may end.”

Other laws set to expire at midnight tonight:

—Federal Perkins Loan Program. The House passed a bill Monday to extend the student loan program, which provides low-interest loans as one alternative to more expensive private student loans. But Sen. Lamar Alexander, R-Tenn., on Wednesday blocked an attempt to extend the law in the Senate.

Alexander said the rate for Perkins loans is higher than other loans and he wants Congress to replace the program with simpler loans that have lower interest rates and more generous repayment plans. He said students who have Perkins loans now will not be affected.

Education Secretary Arne Duncan has called on Congress to expand and better target the program. “Perkins is an important campus-based financing tool to help lower and middle income students cover any remaining need after other aid has been applied,” he said.

—Land and Water Conservation Fund. The Interior Department program invests earnings from offshore oil and gas leasing to protect federal public lands and waters. Expiration will mean that the government isn’t authorized to collect some of the offshore royalties, decreasing revenues for local conservation, restoration and historic preservation projects across the country.

—Child nutrition. Renewal of the 2010 law that oversees school meal programs, summer feeding programs, the Women, Infants and Children program and other government institutional food aid has been stalled as lawmakers debate its cost and whether rules making school meals healthier should be changed. The programs will continue even if the law expires, as long as congressional spending bills provide the dollars.

According to the Agriculture Department, one program will be shut down by expiration — the USDA National Hunger Hotline, which helps hungry people find local food resources.

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Social Determinants of Health Issues Take Center Stage

Delegates to the 2015 Congress of Delegates here addressed social determinants of health-related issues such as gentrification, poverty and nutrition, and discriminatory policing, among other topics, and adopted a number of resolutions during the Sept. 29 business session.

Speaking in support of a resolution on gentrification, member constituency delegate Venis Wilder, M.D., of New York, N.Y., explains that anecdotally, it’s known that gentrification impacts health but there has been very little research on the topic.

Gentrification

During the Reference Committee on Health of the Public and Science hearing on Sept. 28, delegates discussed a resolution from the New York State AFP that directed the AAFP to request that the Robert Graham Center for Policy Studies in Family Medicine and Primary Care investigate how gentrification impacts health outcomes and, potentially, create policy recommendations that could improve the health of the most vulnerable populations.

Resolution co-author and member constituency delegate Venis Wilder, M.D., of New York, N.Y., said, “As a practicing physician and new homeowner in Harlem, New York City, I can tell you that gentrification is real. It’s not just a concept or casual observation in our cities — our patients are being affected by this process.”

Wilder went on to explain that gentrification has resulted in people being displaced from the neighborhoods their families have been a part of for decades as rents have increased and mortgages have become unaffordable. Upscale markets such as Whole Foods and Trader Joe’s have moved into gentrified neighborhoods, but their food isn’t always affordable for low-income families, and consequently, food deserts persist. These new neighbors increasingly become strangers, leading to isolation that causes additional stress, she said.

“Gentrification is a social determinant and we anecdotally know it impacts health, but there is little research on the topic,” Wilder said. “As a result, there haven’t been policies put into place to protect our most vulnerable populations in our inner cities. I am hoping the Academy will recognize that with its unique position at the intersection of primary care and public health, it could take the lead on this issue.”

Ultimately, the reference committee offered a substitute resolution, which delegates adopted, that asked the AAFP to partner with public health, policy centers and/or research organizations to investigate how gentrification impacts health outcomes and use this information to possibly create recommendations to help improve the health of these vulnerable populations.

Poverty and Nutrition

A resolution submitted by the Washington AFP asked the AAFP to include in its strategic objectives the “reduction of income, education and nutrition inequality” and also to create formalized and sustainable partnerships with public health agencies to achieve this goal and to help fight overall obesity and poor health in low-income communities.

Co-author and Washington delegate Alexander Brzezny, M.D., M.P.H., of Ephrata, testified during the reference committee hearing that the measure fit into the AAFP’s vision to transform health care to achieve optimal health for everyone.

“If our patients are poor, they have worse health outcomes and poor nutrition,” he said.

Nutrition inequality is seen when low-income patients consume high-calorie, nutrient-deficient foods, which leads to obesity and other poor health outcomes, Brzezny explained. “We hope that putting patients first also means addressing the true reasons for their problems, which are poverty and poor nutrition,” he said.

Washington delegate Alexander Brzezny, M.D., M.P.H., of Ephrata, explains that nutrition inequality is seen when low-income patients consume high-calorie, nutrient-deficient foods in their diets, which leads to obesity and other poor health outcomes.

General registrant Patricia Czapp, M.D., of Annapolis, Md., who serves on the Commission of the Health of the Public and Science and chairs its subcommittee on health equality, suggested during the hearing that more actionable language be added to the resolution and said that the AAFP already has strong relationships with public health agencies and also has a workgroup on the integration of primary care and public health.

“What we need to do is better leverage those relationships so that we can reach the goal that has been outlined,” said Czapp, lead author of the Academy’s recently issued Poverty and Health position paper.

General registrant and former AAFP Speaker Carolyn Lopez, M.D., of Chicago, also supported the resolution’s intent, lending her perspective as the president of the Chicago Board of Health. Lopez suggested that although the spirit of this resolution was well-intentioned, she thought AAFP members might have more success in following through with this goal at the local level.

“This should be a call to action for all of us,” she said. “We may not be able to write a prescription for food, but there are other things we as family physicians can do locally. Because that’s where the changes will come … one ordinance at a time.”

Delegates eventually adopted a substitute measure that asked for the inclusion of the “reduction of the negative effects of income, education and nutrition inequality” in the Academy’s strategic goals and for collaboration with public health agencies to help achieve this objective.

Discriminatory Policing

A third resolution addressed the red-hot topic of discriminatory policing as a public health concern.

A similar resolution adopted during the 2015 National Conference of Constituency Leaders in April requested that the AAFP review the recommendations of President Obama’s Task Force on 21st Century Policing and introduce a resolution on this topic in the AMA House of Delegates.

Member constituency alternate delegate Shani Muhammad, M.D., of Fresno, Calif., spoke in support of the new resolution, saying, “This resolution is asking that we as an Academy recognize excessive or unnecessary force (used by police officers) is a public health issue. Violence impacts one’s health — both mental and physical — and it doesn’t matter where that violence comes from.”

Muhammad said that as of June, 490 people had been killed this year by police in the United States, and nearly 30 percent of them were African American. “This is a significantly disproportionate number considering that African Americans make up only 12 percent of the U.S. population,” she said.

Multiple delegates of color took turns at the microphone telling personal stories and those relayed by their patients of discrimination, and in some cases serious abuse, at the hands of police officers.

General registrant Marie-Elizabeth Ramas, M.D., of Mount Shasta, Calif., recounted that she and her husband were stopped by police late one night and her husband was handcuffed before the police even asked them any questions. When Ramas asked why they were being detained, the officer called for backup and held them for 15 minutes before letting them go, explaining their car had been mistakenly identified as a recently stolen vehicle.

“As family physicians, it is our duty to speak up for those who are not heard,” she said. “It is our mission to take care of our patients within their context. This resolution puts (the AAFP) on the map and says, ‘No other medical associations are bold enough to do this, but as family physicians we will not take injustice (for our patients) any longer.'”

Ultimately, delegates adopted two of the resolution’s four resolved clauses and referred the other two to the Board.

The first clause adopted asked the AAFP to create a policy statement recognizing that any use of force beyond that reasonably necessary to accomplish a lawful police purpose poses a serious ongoing public health issue that disproportionately affects minority communities.

The second clause adopted asked the Academy to support promoting communication, transparency and accountability in everyday interactions between the police and public.

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VA Sees Drop in Health Data Breaches; Other Orgs Report Breaches

 

Computer-aided detection during mammograms is meant to help mark areas of concern radiologist may miss, but the tech does not appear to change detection rate, according to a recent study.

The study, led by Constance Lehman of Massachusetts General Hospital in Boston, found that radiologists correctly detected breast cancer 85 percent of the time, and that didn’t change with CAD technology, according to a Reuters article.

In addition, the researchers determined that radiologists found fewer cancers when using CAD. Article

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VA Sees Drop in Health Data Breaches; Other Orgs Report Breaches

Last month, the Department of Veterans Affairs experienced a 72.8% decline in veterans whose protected health information was affected by a health data breach, according to VA’s August report to Congress, Health IT Security reports.

According to the report, 431 veterans were affected by a health data breach incident in August, including 237 who had their protected health information compromised. That figure is down from the 872 veterans who were affected by protected health information-related breaches in July.

Of the 431 veterans affected by a data breach in August:

• 148 involved incorrectly mailed documents;
• 117 involved lost or stolen Personal Identity Verification cards;
• 84 involved “mishandled incidents;”
• 47 involved lost or stolen devices; and
• One involved items incorrectly mailed by a pharmacy (Heath, Health IT Security, 9/25).

Other Recent Health Data Breaches

Meanwhile, several other U.S. health care organizations recently disclosed data breaches, potentially affecting thousands of individuals.

Molina Healthcare Data Breach

California-based Molina Healthcare is alerting more than 54,000 patients to a breach of their protected health information after a CVS employee copied records from company computers to a personal computer, Clinical Innovation & Technology reports (Walsh, Clinical Innovation & Technology, 9/23).

CVS, which manages Molina Healthcare’s over-the-counter benefits, notified the managed care company of the breach, which occurred in late March, on July 20 (Jayanthi, Becker’s Health IT & CIO Review, 9/22). The breach affects the personal information of both current and former members of Molina Healthcare’s Medicare Options Plus HMO plan in 10 states:

• California;
• Florida;
• Illinois;
• Michigan;
• New Mexico;
• Ohio;
• Texas;
• Utah;
• Washington state; and
• Wisconsin (Clinical Innovation & Technology, 9/23).

Stolen information included:

• CVS IDs and ExtraCare Health Card numbers;
• Full names;
• Member IDs;
• Prescription plan numbers and states; and
• Start and end dates (Becker’s Health IT & CIO Review, 9/22).

Surgical and Medical Group Data Breach

Last month, the California-based Silverberg Surgical and Medical Group discovered a two-year-old security lapse that exposed patient health records on the Internet, Health IT Security reports.

The medical group reported the incident, which began on Sept. 10, 2013, to the California Office of Attorney General.

According to a notification letter, a document scanning device “inadvertently exposed some patient health records to the Internet.” Potentially exposed information includes patients':

• Addresses;
• Beneficiary numbers;
• Dates of admission;
• Dates of Birth;
• Email addresses;
• Health plan data;
• Medical information;
• Medical record numbers;
• Names; and
• Telephone and fax numbers.

In some cases the exposed information included:

• Full face photographic images;
• Social Security numbers; and
• State License numbers.

Silverberg did not disclose how many patients were affected, but it noted that it took down the information immediately, launched an investigation and is providing one year of identity monitoring to those affected (Snell, Health IT Security, 9/28).

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