Citizens' Council on Health Care
CCHC HEALTH eNEWS
Thursday, November 8, 2001
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Providing news and commentary on health care
policy,
health insurance issues, and medical confidentiality.
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* MARTIAL LAW PLAN FOR MEDICAL CARE PROPOSED
* NATIONAL ID WON'T STOP TERRORISTS; ALL HAD SOCIAL SECURITY CARDS
* MSAs COULD REPLACE MANAGED CARE
* CENTRALIZED DATABASE FOR "AUTHENTICATING" DOCTORS PROPOSED
* CHILDREN'S MENTAL HEALTH RECORDS EXPOSED ON INTERNET
* CONGRESS DISCUSSES COMPUTERIZED DISEASE SURVEILLANCE SYSTEMS
* MAINE VOTES IN SUPPORT OF A SINGLE PAYER SYSTEM
* SCIENCE NOT SO SCIENTIFIC: MORE CONTROVERSY ON MAMMOGRAMS
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* CCHC Commentary included
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MARTIAL LAW PLAN FOR MEDICAL CARE PROPOSED
Patients could be forced to take medication, be vaccinated, or be
isolated under model legislation proposed by the U.S. Centers for
Disease Control and Prevention (CDC). The model legislation, called
the Model State Emergency Health Powers Act, written by Lawrence
Gostin, professor at Georgetown University Law Center and drafted
by an "academic panel" who are not listed in the document, was
commissioned by the CDC prior to the terrorist attack, but put on
a fast track after September 11th.
Only people without contagious diseases would be allowed to appeal
the orders for treatment. All those who didn't comply could be
quarantined. All people with or without disease would be allowed the
right to appeal the decision to quarantine them, but those who are
ill would remain quarantined until the appeals process was completed.
Governors would be given "emergency powers" to suspend normal
government temporarily to address disease epidemics or natural
disasters such as earth quakes.
Gostin claims that the panel tried to balance the need to control
disease with the individuals' civil rights. States could avoid civil
liberties violations if they enact law to penalize citizens with
penalties other than incarceration, such as loss of income or public
benefits, says R. Alta Charo, a professor at the University of
Wisconsin Law School.
Source: "Model health law empowers states: Drugs, quarantine could
be forced," (Bloomberg News), Boston Globe, 10/31/2001.
http://www.boston.com/dailyglobe2/304/business/Model_health_law_empowers_states+.shtml
Draft document: http://www.publichealthlaw.net/MSEHPA/MSEHPA.pdf
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CCHC COMMENTARY: Although we have yet to fully read the document,
it is noteworthy to understand that the Act:
- is not meant just for terrorism, but for all
for natural
disasters, a term not defined in the document.
- People who fail to comply with guarantine orders will be charged
with a misdemeanor.
- Failure to comply with treatment orders will also yield a
misdemeanor charge.
- the police would have the authority to enforce treatment
requirements.
- All health care providers, medical examiners, coroners, and
pharmacists would be required to make illness, death and use of
medication reports to the State.
- Providers are required to give treatment against the patients'
wishes
- state health authorities are allowed to ration care.
The rather broad definition of "public health
emergency" is
"an occurrence or imminent threat of an
illness or health condition,
caused by bioterrorism, epidemic or pandemic disease, or novel and
highly fatal infectious agent or biological toxin, that poses a
substantial risk of a significant number of human fatalities or
incidents of permanent or long-term disability. Such illness or
health condition includes, but is not limited to, an illness or
health condition resulting from a natural disaster.
To fully why this document was written, here is the stated
PURPOSE
of the model legislation:
a) To authorize the collection of data and
records, the control of
property, the management of persons, and access to communications
b) To facilitate the early detection of a health emergency, and
allow for immediate investigation of such an emergency by granting
access to individuals' health information under specified
circumstances.
c) To grant State officials the authority to use and appropriate
property as necessary for the care, treatment, and housing of
patients, and for the destruction of contaminated materials.
d) To grant State officials the authority to provide care and
treatment to persons who are ill or who have been exposed to
infection, and to separate affected individuals from the
population at large for the purpose of interrupting the
transmission of infectious disease.
e) To ensure that the needs of infected or exposed persons will
be addressed to the fullest extent possible, given the primary
goal of controlling serious health threats.
f) To provide State officials with the ability to prevent, detect,
manage, and contain emergency health threats without unduly
interfering with civil rights and liberties.
g) To require the development of a comprehensive plan to provide
for a coordinated, appropriate response in the event of a public
health emergency.
On Monday, November 5, Minnesota's Rep. Tom Huntley (D-Duluth)
announced at a state bioterrorism hearing his intent to introduce
legislation aimed at implementing the Gostin plan in Minnesota.
- Citizens' Council on Health
Care
- November 8, 2001
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NATIONAL ID WON'T STOP TERRORISTS; ALL HAD SOCIAL SECURITY CARDS
Of the nineteen terrorist hijackers, 13 obtained Social Security
Number and cards by legal means.
House members of the Ways and Means subcommittee on Social Security
heard from the Social Security Administration (SSA) that the integrity
of the Social Security number (SSN) has not been protected adequately.
Armed with a SSN, terrorists were able to "operate below the radar"
They had autonomy to open bank accounts, get credit, obtain driver's
licenses and apply to flight schools.
James G. Huse Jr., inspector general of the SSA said one problem is
that the SSA and the Immigration and Naturalization Service do not
have a link to quickly check the validity of visas or other immigration
documents that non-U.S. citizens must submit with the applications,
according to the Washington Post.
Source: "19 Terrorists Obtained Social Security Cards,"
(Associated
Press), The Washington Post, Page A19, November 2, 2001;
- Citizens' Council on Health Care
- November 8, 2001
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MSAs COULD REPLACE MANAGED CARE
When Medical Savings Accounts (MSAs) were first introduced 10
years ago, they stirred up a fuss -- and took a back seat to the
concept du jour, managed care, which it was thought would control
costs and deliver optimum health care.
Ten years later, patients believe managed care saves money by
depriving them of services they want and need; physicians believe
it prevents them from providing the best care; and employers
realize it hasn't saved money -- just delayed cost increases for
a few years.
For the same reasons managed care hasn't worked, Medical Savings
Accounts and other consumer-driven programs are attractive:
o MSAs reduce the influence of third-party payers in the
health care system, while managed care makes the third-
party payer the predominant actor.
o MSAs allow patients to pay more to see a better doctor,
while managed care tends to pay all participating doctors
the same, regardless of their skill.
o MSAs help reduce costs by lessening the administrative
burden on everybody, while managed care greatly increases
the amount of health care dollars that are devoted to
administration.
o MSAs work to restore the patient to a position of
influence in the health care system, while managed care
leaves the patient as a passive recipient of other
people's decision-making.
o MSAs help to restore the patient/physician relationship,
while managed care weakens those relationships -- and
encourage innovation in health care while managed care
encourages "cookbook" medicine.
Finally, MSAs greatly reduce soaring administrative costs;
control expenses from the demand side; encourage people to seek
preventive care; control low-cost routine expenses (something
managed care does not do very well); and -- contrary to their
detractors' statements, don't pull the healthy out of the market.
Source: Greg Scandlen, "MSAs Can Be A Windfall For All,"
Backgrounder No. 157, November 1, 2001, National Center for
Policy Analysis.
For text http://www.ncpa.org/pub/bg/bg157/index.html
Source: taken directly from the Daily Policy Digest, National
Center for Policy Analysis, 11/5/01, http://www.ncpa.org
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NATIONAL PROVIDER CREDENTIALING DATABASE IN THE WORKS
A coalition of 26 of the nation's largest health plans and
insurers announced plans to create a database of more than
600,000 providers to simplify the credentialing process. The
Coalition for Affordable Quality Healthcare (CAQH) will launch
the effort next spring.
"One of the most time-consuming tasks facing providers and payers
is the paperwork associated with credentialing," said Jay Gellert,
president and chief executive officer, Health Net, and chair of the
Administrative Simplification Committee for CAQH.
The organization noted that a typical provider contracts with 10
to 20 healthcare organizations, each of which requires the provider
to complete an extensive credentialing application. Using the CAQH
system, each provider will submit a single application to one central
database to meet the needs of all of the health plans and hospitals
participating in the CAQH effort.
Source: taken directly from PRIVACYSECURITYNETWORK
Site Update for the week of October 29, 2001
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CHILDREN'S MENTAL HEALTH RECORDS EXPOSED ON INTERNET
Four hundred (400) pages of detailed psychological records of
at least 62 children and teenagers were accidently posted on
the Internet for eight days. Visits, sessions, diagnoses, and
demographic data was available for all the world to see.
Descriptions of children's problems were given in detail:
"[She] has 'extreme mood swings'" or "She has been cruel to
animals, . . . often refuses to eat and will make herself vomit."
A University of Montana student of a technical employee may
have done it, said officials. The incident is under investigation,
but Raymond Ford, the University of Montana technology manager,
said that the university must depend on the vigilance and care
of the system's users. (KSTP radio in Minnesota reported today
that a University of Minnesota psychologist accidently placed
the records online)
Most of the records were from children receiving care in
Minnesota. "I'm shocked. I have no idea how this can happen.
Obviously, this information is confidential, and we go to great
lengths to keep it confidential," said Bonnie Carlson-Green, a
psychologist at Children's Hospital in St. Paul, Minn., the
source of some of the patient records.
Still, David Aronofsky, the University of Montana's attorney,
said accidental online releases of private legal or medical
information are not unusual and are corrected quickly. Paul
Appelbaum, president-elect of the American Psychiatric Assn.,
said patients should be given the option of having their
information kept on paper, according to the Los Angeles Times.
Source: "Web Mishap: Kids' Psychological Files Posted, Charles
Piller, Los Angeles Times, November 7, 2001
http://www.latimes.com/news/nationworld/nation/la-110701private.story
- Citizens' Council on Health Care
- November 8, 2001
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CONGRESS DISCUSSES COMPUTERIZED DISEASE SURVEILLANCE SYSTEMS
Wanting to improve the federal government's ability to
respond to a large-scale bioterrorist attack, members of the House
Energy and Commerce Subcommittee on Oversight and Investigations on
Nov. 1 heard several proposals for bolstering the nation's disease
surveillance system using computers, USA Today reports. The
government currently relies on physicians to notify health
departments -- in writing -- about certain diseases, including
anthrax. The doctor who diagnosed the first case of the anthrax last
month -- in American Media Inc. editor Bob Stevens, who later died --
alerted health officials about the presence of the bacteria, possibly
saving other lives. But according to subcommittee Chair James
Greenwood (R-Pa.), the current system is antiquated and might not
work in the event of a greater bioterrorist attack. "It is the
equivalent of relying on the Pony Express in the age of the World
Wide Web," he said, adding, "The anthrax outbreak is our fire bell in
the night. We may not get another warning." Some of the
early-warning systems under consideration include:
*The CDC's National Electronic Disease Surveillance System, or NEDSS,
will be launched in 20 states next year. NEDSS is a "kind of
electronic vacuum" that looks for disease trends by examining medical
records, lab test results and "local vital statistics." Critics,
however, say the system is "too complex" for doctors to use.
*Sandia National Laboratories, the University of New Mexico and the
state's health department have developed a Web-based system called
RSVP that allows doctors to enter details about "perplexing case[s]"
into a Web site and then receive advice on how to treat the patient.
The system also "automatically notifies the local health department."
*North Carolina-based Quintiles, which compiles insurance claims data
for pharmaceutical companies, says it can "tap into" this system to
track disease outbreaks (Sternberg, USA Today, 11/2). A report from
PBS' "Newshour" on how local public health systems are responding to
threat of bioterrorism is available online. Note: You will need
Real Audio to listen to the report. Also, a HealthCast of the
hearing is available online.
Source: Taken directly from "House Panel Discusses Development of
Computerized Disease Surveillance Systems, KAISER DAILY HEALTH
POLICY REPORT, Friday, November 2, 2001
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MAINE VOTES IN SUPPORT OF A SINGLE-PAYER SYSTEM
On November 6, Maine residents voted in favor of universal
health care by a margin of 52% to 48% (Sharp, Associated Press).
The non-binding resolution requires the Portland City Council
to send a resolution to the state legislature in support of a
universal health care system (Reuters Health, 11/2) and require
the state health department to issue an annual report to the
council on the benefits of a single-payer system. Anthem Blue
Cross and Blue Shield has spent $380,000 to defeat the
initiative. Maine supporters want Maine to be the first state
to establish a government-run health care system for all
citizens. Last year, Maine's legislature defeated a $3.4
billion single-payer system.
Source: "Maine Voters Pass Universal Health Care Referendum
By 'Narrow' Margin," Kaiser Daily Health Policy Report,
November 7, 2001
-Citizens' Council on Health Care
-November 8, 2001
Deeper Perspective:
The debate [on single payer, held in Maine]
was instructive,
though, for learning how ideological the Single Payer crowd is.
Most of us avoid using the term "socialist" to describe these
folks, because it seems inflammatory. But after experiencing
Dr. Ross,[John Ross, M.D., president of Physicians for a
National Health Plan] and studying the PNHP web site, I would
say "socialist" is too mild a term.
These people are clearly Marxist in ideology, and don't mind using
extremist terminology. Dr. Ross, for instance, kept equating
"for-profit" with "right-wing." There is a quotation at the
head
of the PNHP web site that reads. "Rats and roaches live by
competition under the laws of supply and demand. It is the
privilege of human beings to live under the laws of justice and
mercy." A Karen Palmer has a presentation posted that includes
this sentiment -- "Whether we like it or not, we are going to
have to deal with the persistence of the narrow vision of middle
class politics. Vincente Navarro says that the majority opinion
of national health insurance has everything to do with repression
and coercion by the capitalist corporate dominant class." Maybe
it's time to start calling a spade a spade.
SOURCE: http://pnhp.org
Source: Taken directly from "PNHP'S Extreme Rhetoric,"
Scandlen's
Health Policy Comments, National Center for Policy Analysis, 11/5/01.
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MORE CONTROVERSY OVER MAMMOGRAPHY STUDY
(see original eNEWS posting below)
Last week I reported on the Washington Post article on the new
study about mammography screening by Peter Gotzsche and Ole
Olsen. This week, let me give you the direct link to the Lancet
articles about this study. It is worth reviewing these for the
insights they provide, not only on the research, but on the
political manipulations of medical editors. In this case, the
editors of the Cochrane Breast Cancer Group "disowned Gotzsche
and Olsen's (original) work," according to the Lancet, because it
was not, "a Cochrane Collaboration systematic review." Now the
authors have completed their review according to the Cochrane
protocols, and the Lancet has published the work, but the editors
of the Cochrane Breast Cancer Group still find the results
"unwelcome" and have inserted their own opinions, over the
objections of the authors. An editorial in the Lancet says,
"editors who insist on inappropriate analyses that seem to
support a particular point of view hurt not only themselves and
the institution they represent but also the credibility of the
science they claim to value" - these are fighting words in the
world of academia.
More important, and more relevant for the issues we deal with here,
is the debunking of the academic conceit that science is pure and
objective, and therefore all physicians should be required to follow
"evidence-based" medicine developed by academicians. In fact,
academics are also subject to group-think and peer pressure. They
discard inconvenient evidence, and embrace those studies that support
their biases. They are free to be political advocates if they want to,
but they should not try to require doctors to practice in accordance
with such advocacy.
SOURCE:
http://www.thelancet.com/journal/vol358/iss9290/full/llan.358.9290.editorial_and_review.html
Source: Taken directly from Scandlen's Health Policy Comments,
National Center for Policy Analysis, 10/29/01.
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ORIGINAL INFORMATION SHARED BY CCHC ON OCTOBER 23, 2001:
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DANISH STUDY - MAMMOGRAMS USELESS IN PREVENTING BREAST
CANCER DEATHS
Speaking of health care costs, a new report says that there is no
credible evidence that "mammograms reduce the risk of dying of
breast cancer in women of any age," according to the Washington
Post. The report was authored by the very well-respected Danish
Cochrane Collaboration. They reviewed each of seven large
mammography trials, involving half a million women, and found
that five of them were either of poor quality or so flawed as to
be discounted altogether. The two remaining studies were found to
be "of medium quality" and found no reduction in breast cancer
deaths. The Post article quotes Maryann Napoli of the Center for
medical Consumers in New York, as saying, "mammography causes
more harm than good...we have been sold a bill of goods." And
that is based solely on the clinical results, without
consideration of costs. If the cost of mammography were added to
the equation, the conclusion would have to be that it is a
gigantic rip-off. And yet, virtually every state has enacted
mandate benefits that require insurance companies to pay for
periodic mammography screening. So someone is making a fortune
off the procedure.
Source: Scandlen's Health Policy Comments, National Center for
Policy Analysis, 10/22/01
http://www.washingtonpost.com/ac2/wp-dyn/A18705-2001Oct18
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NOTE: These news items have been taken directly
from email received by CCHC or from Internet
newspaper publications. Titles in ALL CAPS are
CCHC creations except for those heading articles
from the National Center for Policy Analysis,
the Health Law Pulse, PrivacySecurityNetwork,
and LIST.HEALTHPLAN. Credit to the sending
organization or news service is listed at the
end of each article.
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