Navigating the New Field of International Health Law, Featuring Gian Luca Burci, Legal Counsel for WHO

This lecture, “Navigating the New Field of International Health Law,” will explore the intersection of health and international law and the emergence of International Health Law as a practice area. Featuring Gian Luca Burci, Legal Counsel for the World Health Organization, this program will focus on the growing interactions between health policy and various areas of international law, including international business transactions, intellectual property, international security, and human rights law. The program is sponsored by the Seton Hall Law Center for Health & Pharmaceutical Law & Policy and the International Law program at Seton Hall Law.

The event will take place at Seton Hall Law, Newark, NJ, on Wednesday, February 22, 6 to 7 p.m.  There is no charge. 1 New Jersey CLE credit will be available. Click here to make your reservation or for more information, please contact Sara Simon, Director, Healthcare Compliance Certification Program, at sara.simon@shu.edu or call 973-642-8190.

Online Graduate Certificate Programs

The next sessions for the Seton Hall Law Online Graduate Certificate Programs will commence in February 2012. These 8-week non-degree programs are designed for individuals who seek a greater understanding of key aspects of the health care field.

The Pharmaceutical & Medical Device Law & Compliance Program will begin on February 12, addressing the legal, regulatory and ethical issues related to the pharmaceutical and medical device industries. Priority application deadline is January 26.

The Health and Hospital Law Program will commence online on February 26 and offers an exploration of the legal, regulatory and ethical issues regarding health care delivery. Priority application deadline is February 2.

Click here to learn more about these programs and apply. For information, please contact Helen Cummings, Assistant Dean for Graduate Programs, at helen.cummings@shu.edu or call 973-642-8380.

Professor Frank Pasquale featured in The Record on ‘A Constitutional Right to Health Care’

Professor Frank Pasquale wrote a featured Op-ed in The Record, New Jersey’s most awarded newspaper, regarding a constitutional right to health care. Professor Pasquale, who is Associate Director of the Center for Health & Pharmaceutical Law & Policy and Editor in Chief of HRW, writes:

SHOULD the Supreme Court weigh in on America’s great health care debate? Yes. It should declare a constitutional right to health care.

This right is already enjoyed by prisoners. Law-abiding citizens deserve it, too.

The United Nations’ Universal Declaration of Human Rights states, “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including… medical care.”

Many advanced countries have adopted - and lived up to - similar commitments.

Of course, that’s not on the Supreme Court’s agenda. Instead, it will decide whether to cripple last year’s health reform, known as the Affordable Care Act, by declaring the individual mandate unconstitutional.

I understand objections to the mandate. Cash-strapped Americans don’t deserve one more drain on their resources. I’m also not a fan of making people buy health insurance from private insurers. They waste a lot of money, and are one reason why U.S. doctors’ administrative costs are a whopping 400 percent higher than those in Canada.

If I designed the ACA, I’d have given everyone a public option, modeled on Medicare.

But I didn’t write the bill, Congress did. In precedents going all the way back to the 1819 case of McCulloch v. Maryland (and affirmed as recently as 2010), the Supreme Court has deferred to Congress’s constitutional powers to solve national problems.

Politics

The court risks looking political if it abandons that approach now. It has already jettisoned once-venerable holdings on campaign finance, equal protection and antitrust.

Read the full Op-ed here.

The Good News is that Health Care Spending is Down

The bad news is that the country’s too broke to be sick. The New York Times reports that health care spending rose just 3.9% in 2010, totaling $2.6 trillion or 17.9% of the Gross Domestic Product. The information was derived from the latest report from the government’s National Health Expenditure Accounts (NHEA), which are, according to the Center for Medicare & Medicaid Services, “the official estimates of total health care spending in the United States. Dating back to 1960, the NHEA measures annual U.S. expenditures for health care goods and services, public health activities, government administration, the net cost of health insurance, and investment related to health care. The data are presented by type of service, sources of funding, and by type of sponsor.”

The Times notes:

Health spending normally grows much faster than the economy. But in 2010 growth rates were similar, so that health care accounted for the same share of total economic output in 2009 and 2010.

“U.S. health spending grew more slowly in 2009 and 2010″ than at any other time in the 51 years the government has been collecting such data, said Anne B. Martin, an economist in the office of the actuary at the Department of Health and Human Services.

How bad is it? The data is, well, record-breaking.

The Times:

In 2010, the study said, hospitals reported a decline in admissions and slower growth in emergency room visits and outpatient visits. Likewise, it said, doctor’s office visits declined, and spending for doctors’ services grew just 1.8 percent, to $416 billion in 2010. Total health spending averaged $8,402 a person, up 3.1 percent from 2009, the report said.

Doctors often prescribe drugs during office visits, and the decline in visits helped slow the growth of drug spending, as did the use of lower-cost generic medications. The number of prescriptions filled rose just 1.2 percent in 2010, and total retail spending on prescription drugs also grew 1.2 percent, to $259 billion, the slowest rate of growth in a half-century, the report said.

Those numbers of slowed growth are even more incredible given the context of a slowed generation of aging baby boomers.

But in the inimitable words of R. Hunter and J. Garcia,

Talk about your plenty, talk about your ills
One man gathers what another man spills

The Times notes:

For the first time in seven years, total private health insurance premiums grew faster than insurers’ spending on health care benefits, the administration said. Premiums totaled $849 billion in 2010, while spending on benefits totaled $746 billion. The difference includes administrative costs and profits.

There are a number of other interesting points to be found in the New York Times article, not the least of which is the growth in federal expenditures. It’s well worth a read.

Of provident kidney stones, health insurance and a CT Scan that may have saved my life

As we bid farewell to 2011 while ushering in the new year, some thoughts about health care — my own — emerge. I underwent major surgery this last year, having had roughly 15% of one kidney–or, more precisely, the cancerous portion of one kidney– removed. I chose to blog about the experience, chronicling the process from the onset, back when the tumor was initially thought to be a kidney stone or a cyst. But found early, it was small, they say they got it all and that it had not spread. I was lucky. A relatively rare form of the disease (roughly 50,000 cases per year), the survival rate for kidney cancer is not great because it is largely asymptomatic and is not generally tested without a family history for such.  Often, by the time someone wanders into a doctor’s office with complaints of an aching lower back or bloody urine, the tumor has grown to the size of a baseball, the cancer has spread, and the prognosis is not optimum. My tumor was found, as is so often the case, “incidentally” as they were looking at something else.

And that something else has me thinking; without it I’d be walking around with a ticking time bomb firmly ensconced and concealed in my kidney.  Which brings me to July of this past year when I awoke torn by excruciating pain from what I was to later discover were two kidney stones. Wave after wave of fortunate pain brought me to the emergency room. A CT scan discovered the stones–and something else– that ultimately turned out to be that cancerous tumor approximately 2.2 cm, lying in wait.

And there’s the rub. I had health insurance. Without health insurance I might have still gone to the hospital–the pain was immense– but I would have refused the CT scan.  I know of what I speak. A lack of health insurance is a state of affairs and a mindset that is distinctly different from that of having health insurance: as one deprives Peter to pay Paul “home medicine” takes on new meaning. And if forced to see a doctor, one minds the bottom line always ready to refuse treatment, especially avoiding diagnostic tests such as x-rays, CT scans and MRIs as they are the well traveled road to poverty if not bankruptcy.

And there it is. Without health insurance I would have refused the CT scan which may well have saved my life.

Instead, I ultimately had one of the nation’s top surgeons (the brilliant Dr. Paul Russo, most recently described by Maureen Dowd in the NY Times as “exuberantly blunt”) at Sloan-Kettering pluck the ticking time bomb from my body, while saving the affected kidney and me.

In the hands of a less skilled surgeon, my entire kidney may have been removed (it’s easier), and even if alive I’d have spent the rest of my life at a  increased risk for hospitalizing events from chronic  kidney disease, heart disease, and even hip fractures. The bill for my stay and surgery was roughly $27,000; my co-pay merely double digits (thank you Cigna).

And as I sit here reflecting on my good fortune and the providence of kidney stones timely sent, I cannot help but think of all those men and women across America without health insurance (or with junk insurance) who are left to face this coming year with health issues and hard economic choices each day–choices which will lead many to practice “home medicine” when faced with excruciating pain and the hidden harbingers of disease. Choices which will leave prescriptions unfilled. Choices which will lead many to refuse that costly x-ray, CT scan or MRI which might have saved their lives.

There but for the Grace of God–and a job with good health insurance.

And that’s not hyperbole: it’s a new year; it’s estimated that 45,000 people in America will die in it due to lack of health insurance.

Money Out of Politics?

Christmas has just passed and Hannukah now draws to its candled conclusion as Kwaanza begins, heralding the start of a brand new year. These times naturally encourage reflection, and with my twenty-year old prodigal daughter, Lexi, about to return to Occupy D.C. after a holiday respite, I find myself considering the positions of her compatriots who think, foremost, that the influence of big money should be removed from politics–they are championing a constitutional amendment to do so, and there are close to 300,000 signatures petitioning as a prelude to such change. It’s an ambitious and interesting thought this– what would the political landscape look like if legislators and executives voted their conscience without having to calculate the impact upon scores of their largest benefactors? What would health reform look like?

Occupy is also courting statutory change. The Brian Lehrer Show of NPR’s WNYC Radio tells us that Occupy Albany “is actually looking to follow the example set by Maine and its clean elections law.”

Of the Maine Clean Election Act, Matthew Edge of the Occupy Albany Political Strategy Working Group told Lehrer that “It allows for everyone running for office to essentially have the same amount of money to run. So they can win based on their ideas, and not based on just how much money they can raise. And once they’re elected, since agreeing to opt into the public funding system, the clean elections system requires them to agree not to accept any private contributions. So that seems to be — while it’s not the end all, be all — the first step.”

The Maine Clean Election Act? This is how the Act is described by the State of Maine at http://www.maine.gov/ethics/mcea/index.htm

The Maine Clean Election Act (MCEA) established a voluntary program of full public financing of political campaigns for candidates running for Governor, State Senator, and State Representative. Maine voters passed the MCEA as a citizen initiative in 1996. Candidates who choose to participate may accept very limited private contributions at the beginning of their campaigns (seed money contributions). To become eligible, candidates must demonstrate community support through collecting a minimum number of checks or money orders of $5 more made payable to the Maine Clean Election Fund (qualifying contributions). After a candidate begins to receive MCEA funds from the State, he or she cannot accept private contributions, and almost all goods and services received must be paid for with MCEA funds.

It is, notably, a voluntary program–though participation has markedly increased since the Act’s inception: legislative candidates in the year 2000 totaled 33% (116 of 350); in 2006 & 2008 that number rose to 81% (313 of 386 and 303 of 373 respectively); and in 2010 the number leveled out to 77% (295 of 385). Participation by state senate candidates is even higher, and interestingly, the participation rate of incumbents is high as well–even for those who had won in close races the previous cycle.

Equal money? Consider this from OpenSecrets.org about the 2008 elections:

In 93 percent of House of Representatives races and 94 percent of Senate races that had been decided by mid-day Nov. 5, the candidate who spent the most money ended up winning, according to a post-election analysis by the nonpartisan Center for Responsive Politics. The findings are based on candidates’ spending through Oct. 15, as reported to the Federal Election Commission.

Continuing a trend seen election cycle after election cycle, the biggest spender was victorious in 397 of 426 decided House races and 30 of 32 settled Senate races. On Election Day 2006, top spenders won 94 percent of House races and 73 percent of Senate races. In 2004, 98 percent of House seats went to the biggest spender, as did 88 percent of Senate seats.

But of course, as the Maine Ethics Commission responsible for overseeing the MCEA has recently noted,

In June 2011, the U.S. Supreme Court ruled in Arizona Free Enterprise Club’s Freedom Club PAC v. Bennett that the way Arizona awarded matching funds to candidates was unconstitutional.  The Court’s decision upheld the constitutionality of publically funded campaigns but ruled that the “triggering” of matching funds based on the spending by other candidates or independent spenders was a violation of the First Amendment. Maine, like Arizona, has a full public funding program for candidates; therefore, the Supreme Court’s decision had an impact on Maine’s MCEA program.

A retooling is said to be underway for the MCEA. As it stands, matching funds have been jettisoned. According to the Maine Commission: “The loss of matching funds presents a challenge for the program. In the last four election cycles, 40% - 50% of legislative MCEA candidates received some matching funds. However, the core function of the program remains unchanged.”

Given the reality of an electorate system in which money seems to almost guarantee office, coupled with the strictures of  Arizona Free Enterprise Club’s Freedom Club and Citizens United– is calling for a constitutional amendment outlandish?

Godspeed Lex.

Will Durant, The Story of Civilization, and Immunization and Human Subject Research, or “I Never Promised You a Rose Garden”

I am reading Will Durant’s Story of Civilization as of late–actually, I’ve been reading the splendid 11 volume set off and on since I first bought it at a garage sale some twenty years ago. The work of a lifetime, Durant and his collaborating wife, Ariel, published these volumes between 1935 and 1975–and few things are so well written. A gifted storyteller, Durant’s prose is lively, personal and terribly witty;  the march of civilization not so much an inexorable plodding of dates, but a series of movements punctuated by the fits and starts, foibles and peccadilloes of an all too human race. For the work, in effect “a biography of civilization” which is said to have put its publisher,  Simon & Schuster, on the map, Durant and his wife were awarded the Pulitzer Prize for General Non-Fiction in 1968 and the Presidential Medal of Freedom in 1977. It is no small point of alumni pride that for a number of years, early in his career, Will Durant attended and taught at Seton Hall.

At present I am reading The Age of Napoleon, and I cannot help but offer here some characteristic lines from Durant’s work. Of Benjamin Constant (1767- 1816), sometime aide to Napoleon, he writes:

… born in Switzerland, educated in a dozen cities, and finally embattled in France, so littered his life with unpaid debts, discarded mistresses, and political somersaults that it would hardly be profitable to dally with him here had he not come close to history in many frays, been loved to distraction by notable women, and been able to describe his faults with such eloquence, subtlety, and impartiality as might help us understand our own….

He came of a titled Swiss-German family that traced its pedigree through 800 years. We need go back no further than his father, who was so occupied with his own sins that he had little time to supervise his son’s…  On October 25, at Lausanne, [Henriette de Chandieu] gave birth to Benjamin; a week later she died, the first of many women who suffered from his irregularities. The father entrusted the boy to various tutors, carelessly chosen. One tried by beatings and fondlings to make the boy an infant prodigy in Greek. When the beatings endangered Benjamin’s health, he was transferred to a second tutor, who took him to a brothel in Brussels. His third tutor gave him a good knowledge of music, and, for the rest, relied on him to educate himself through reading. Benjamin read eight or ten hours a day, permanently injuring his eyes and his faith. He spent a year at the University of Erlangen, then he was transferred to Edinburgh, where he felt the final flurry of the Scottish Enlightenment; but there too he took to gambling, which became second only to sex in disordering his life. (p. 302-304, footnotes omitted).

Of a woman more than twice Constant’s age (the intellectual beauty, Isabella van Tuyll, who famously rejected Boswell decades prior) twice taken to educating the young man in “the wiles of women and the lies of men,” Durant tells us that she told Benjamin,

If I knew a young and robust person who would love you as much as I do, and who is no more stupid than I am, I would have the generosity to say ‘Go to her!’

Durant: “To her surprise and indignation, he soon found a young and robust person.”

And what does this have to do with Health Reform? Absolutely nothing, except to say that Durant’s work, which happens to chronicle the advances as well as the missteps of medicine in every age and most places, would make a great addition to your library.

Consider this account of vaccinations for small pox in England, while thinking a moment about human subject research, informed consent, and the foundation of experimental medicine and immunology:

In 1806 London recorded a singular event: it had gone a full week without a death from smallpox– that pustulous, feverish, face-marring, and infectious disease which had once been epidemic in England, and might again at any time swell into a deadly plague.

A modest English physician, Edward Jenner–addicted to hunting, botany, composing poetry, and playing the flute or the violin-made the miracle week possible by a decade of inoculations that finally overcame the conservatism of British society. The prevention of smallpox by inoculation with weakened virus from a smallpox-infected human being had been practiced by the the ancient Chinese; Lady Mary Wortley Montagu had found it customary in the Constantinople of 1717; on her return to England she recommended the procedure there. It was tried upon criminals, then upon orphans, with considerable success. In 1760 Drs. Robert and Daniel Sutton reported that in thirty thousand cases of smallpox inoculation they had twelve hundred fatalities. Could a surer method of preventing smallpox be found?

Jenner was led to a better way by noting that many milkmaids in his native Gloucestershire contracted cowpox from infected nipples of cows, and that these women were thereafter immune to smallpox. It occurred to him that a like immunity might be established by inoculating with a vaccine (vacca is Latin for cow) made from a virus of pox-infected cow. In a paper published in 1798 Jenner recounted a venturesome procedure which laid the foundations of experimental medicine and immunology.

…I selected a healthy boy, about eight years old, for the purpose of inoculation for [with] the Cow Pox. The matter was taken from a sore on the hand of a dairymaid who was infected by her master’s cows, and it was inserted, on the 14^th of may, 1796, in the arm of the boy…. On the seventh day he complained of uneasiness…. And on the ninth he became a little chilly, lost his appetite, and had a slight headache…. On the following day he was perfectly well….

I order to ascertain whether the boy, after feeling so slight an affection of the system from the Cow Pox virus, was secure from the contagion of the Small Pox, he was inoculated, the 1^st of July following, with variolous matter [variola is Latin for smallpox] immediately taken from a pustule…. No disease followed…. Several months afterwards he was again inoculated with variolous matter, but no sensible effect was produced in the constitution.

Jenner went on to describe twenty-two other cases of similar procedure with completely satisfactory results. He met with condemnation for what seemed to be human vivisection, and he tried to atone for using a consenting minor by building a cottage for him and planting a rose garden for him with his own hands. In 1802 and 1807 Parliament voted Jenner £ 30,000 to improve and spread his methods. In the course of the nineteenth century smallpox almost disappeared from Europe and America, and when it occurred it was in unvaccinated individuals. Vaccination was applied to other ailments, and the new science of immunology shared with other medical advances, and with public sanitation, in giving modern communities as much health as is allowed by the harassments of poverty, the fertility of ignorance, the recklessness of appetite, and the patient inventiveness of disease. (p. 392-2, footnotes omitted).

As for the leap in immunology, Jenner’s work, was not universally acclaimed– at least not early on. In addition to the above mentioned moral approbation he weathered with the help of the time-tested gift of roses, the feared potential “side-effects” of his vaccine were chronicled in this caricature from 1802, entitled “The COW-POCK– or– The Wonderful Effects of the New Inoculation! Vide– the Publication of y Anti-Vaccine Society,” which is said to depict Jenner vaccinating patients who feared it would make them sprout cowlike appendages.

Update Report, Africa Surgery, Inc., Tom Johnson, Jr., Sierra Leone, December, 2011.

[Ed. note: I had the honor of meeting Tom Johnson a few years back, here at Seton Hall Law when I was still a student and he held a fundraiser through the school. AfricaSurgery, Inc. does God's work-- and I'm well pleased to publish his updates here on HRW. With the help of others, he does a lot-- with very little.]

Because they had intestinal worms and the hemoglobin level of their blood was low, two of the four children we wanted to send from Sierra Leone to Ghana for spinal surgery had to be held back.   I learned of this shortly before I was to depart for Sierra Leone myself on October 25.  I was able to replace one child with an eight-year-old girl in danger of paralysis just in time for her to join the other two patients, a boy and a girl, and two escorts as they left for Ghana on October 28.  I was able to fill the other slot with a young man who was also in danger of paralysis due to the deterioration of some vertebrae by an infection.  We sent him alone on a plane to Ghana in time for surgical treatment by the team from the Foundation of Orthopedics and Complex Spine (FOCOS) in November.  The fifth surgical candidate, a young woman with a severe scoliosis, decided not to have surgery and so was not sent at that time.  The two boys who were held back have had their worms treated and are currently being built up with medications and a nutrient-rich dietary supplement so that they might be able to go for surgery in February, if funds will be available.

All four patients who were operated on are now out of pain and the danger of paralysis.  They are all reported to be walking although one is still having some difficulty moving one leg; hopefully this will clear up with time and physical therapy.

While I was in New Jersey this past year, Foday, one of my Sierra Leonean counterparts, continued to bring people suffering with eye ailments to the Baptist Eye Hospital.  Six of these patients received cataract surgeries which preserved and in some cases restored their vision.  Others were treated medically for infections or as a routine after-surgery follow-up.  Foday and I have so far brought 13 new cases to the eye hospital.  Six of these have undergone surgeries for cataracts, two of these were also surgically treated for pturygiums, a growth-like condition that causes the outside of the eye to be slowly covered with a mesh of over-grown blood vessels which block the vision.  The other five patients are being treated for eye infections.  Two of these, a man 26 years old, and a boy 12 years old, have already lost one eye each to infection.  The goal now is to protect their remaining eyes.

We brought Zinab Sherif, a girl age six, to be seen by Dr. Fritjof, an orthopedic surgeon, and his team who were in Sierra Leone in November on a working visit from Germany.  A bone in Zinab’s right forearm was infected, causing puss to drain out through orifices that would open up after painful periods of swelling.  Needless to say Zinab was making little use of the arm.   Dr. Fritjof cleaned out the infected bone twice and the wound was closed up by a plastic surgeon member of his team.  Zinab was discharged from the hospital on November 28 and her prognosis is good.

A team of plastic surgeons were here at the Holy Spirit Hospital-Catholic Mission in late November.  In five days they preformed 32 procedures.  Because the team included two surgeons who are members of the British Society for Surgery of the Hand (BSSH),  we provided them with: a young boy whose fingers on his left hand are restricted with scar tissue from an accidental scalding, a three-year-old girl with the toes of her right foot contracted due to a burn by fire ashes, and a girl, age six, whose head, face, arms, hands, and one ankle were burnt when a mosquito net caught fire and fell upon her.   We also brought to the team a woman and a young man, both having deep ulcerated sores on their lower legs that required skin grafts.  All five of these cases are still having their dressings changed by nurses at the hospital.  Two will require some physical therapy.

Yabu Kanu, the girl who suffered the multiple burns, and her mother are staying with us at our two houses in Masongbo village because they are from a distant village and are very poor.  There are now 21 spinal surgery children also staying with us at Mansongbo.  We have almost finished the Christmas shopping for them.  They will each be getting a new set of used clothes and new shoes and some items I brought over or had shipped from America including coloring books, used crayons, and drawing paper.  They will each get a pen, a pencil, a note book, and a few hard candies.   There will be dolls for the younger girls costing about $2.00 each, and used toy cars for the younger boys each costing about 45 cents.  There will be a couple soccer balls to be shared by the middle and older boys.  My used National Geographic magazines will go to those not physically able to play ball and for the older girl who is quite bright.  The girls will get little sewing kits and some finger nail sticker-art donated by a friend in New Jersey.  I keep telling them all that “Christmas no go day for bad pikin dem.” (there will be no Christmas for naughty children).   Their behavior has been pretty good lately.

Thank you for all of your help with this work. We have a new website that you might want to visit: www.africasurgery.org.  May you and yours all have a Merry Christmas and a Blessed New Year.

Tom

Dr. Donald M. Berwick, Formerly of CMS: an Exit Interview Worth Considering

It is received wisdom amongst Human Resource professionals that the exit interview–that which is had when an employee is departing –is an invaluable tool in understanding and improving an organization.

That said, Dr. Donald Berwick has left the Centers for Medicare and Medicaid Services, after 17 months of serving as its head.

His parting assessment?

According to the New York Times Dr. Berwick says

that 20 percent to 30 percent of health spending is “waste” that yields no benefit to patients, and that some of the needless spending is a result of onerous, archaic regulations enforced by his agency.

The official, Dr. Donald M. Berwick, listed five reasons for what he described as the “extremely high level of waste.” They are overtreatment of patients, the failure to coordinate care, the administrative complexity of the health care system, burdensome rules and fraud.

“Much is done that does not help patients at all,” Dr. Berwick said, “and many physicians know it.”

According to the U.S. Census Bureau, in 2009 we spent $2.4863 trillion on health care.

I’m going to write that out because as I’ve long maintained, most people (myself included) have difficulty understanding what a billion dollars is (ten, one hundred millions, or a thousand million), no less a trillion (ten, one hundred billions or a thousand billions )–nor 2.4863 of them.

That’s

$2,486,300,000,000.

Let’s just think conservatively for the moment and suppose, hypothetically, that contrary to all that Human Resources talk about frankness in departure, Dr. Berwick was disgruntled and doubled his numbers:

So instead of 20 to 30% waste we’re looking at 10 or 15%

10% = $248.63 billion or $248,630,000,000  in waste.

15% = 372.945 billion or $372,945,000,000 in waste.

And if he’s approximately right? If somewhere between “20 percent to 30 percent of health spending is ‘waste’ that yields no benefit to patients”

25% = $621.575 billion or $621,575,000,000 in waste.

Some context is in order. What can you do with a wasted (10%) 248 or (25%) 621 billion dollars?  This below, is from the Congressional Budget Office. The 2009 numbers are actual, the rest of the years are outlay projections– in billions. And no, that’s not a typo– Social Security cost $678 billion, Medicaid $251 billion.

Still Alive and Well

For those of you keeping track at home, an update of sorts is in order. My surgery went well on Monday. I awoke from the anesthesia, and I now write this without the roughly 15% of my kidney which had shown itself to be stubbornly  non-compliant. I am told “they got it all” and that it doesn’t look as though any further remedial therapy (i.e., chemo, radiation) will be necessary.

I’m told I awoke from the operation talking law, which had at least one surgeon laughing and saying that I was “hopeless” while muttering something else (she was right)  about lawyers. Having had my stomach muscles cut through in what appears to be about a ten inch gash, it hurts to cough or laugh but not anymore to walk–slowly. To leave the hospital I needed to walk a total of 14 laps around, equivalent to one mile.  I did either 20 or 21 and was discharged after 2 and a half days.

My stomach is strangely distended and, because of the cut to the core muscles, no longer symmetrical: it looks like an oddly flattened but fully inflated beachball. I’m told this will dissipate in time. But really– I woke up– surrounded by friends and family, still alive, the rest is just details.

But I am struck by how lucky I was– if I hadn’t had health insurance I probably wouldn’t have went to the hospital when struck by a pair of kidney stones in the first place, despite the excruciating pain. And even if I did go, I would have balked at the expense of the CT Scan which initially found the tumor. In addition (thank you Cigna), after a second opinion I was able to articulate my needs and have a world class surgeon in a world class hospital perform my surgery. The tumor, though small, was in a tricky spot– and a less skilled surgeon could have opted to have taken the whole kidney, a result which bears far greater risk for hospitalizing events over time, everything from heart problems to fractured hips.

Not everyone is so lucky.

The twelve-year survival rate for partial nephrectomy patients similarly situated to me is 96%. As the tumor grows and the stage progresses, that number drops significantly. And unfortunately, kidney cancer is largely asymptomatic. Men age 40 to 60 are most susceptible, and the most common symptoms are lower back pain and exhaustion. I know very few middle aged people for whom those aren’t just the symptoms of life. The other major symptom is, sometimes, blood in the urine–which is often pushed aside as just the result of kidney stones. And so undetected, the tumor grows. But, thank God, not this time.

And for all of you who offered your kind thoughts, advice, experience and prayers throughout this– thank you so very very much– it made it all so much easier.

Livestream Podcast, Seton Hall Law Review ACO Symposium

In conjunction with the Center for Health & Pharmaceutical Law & Policy, this year’s SETON HALL LAW REVIEW Symposium explored recent changes in the structure of health care delivery, in particular the rising popularity of Accountable Care Organizations (ACOs).

Legal scholars and practitioners from around the country presented in panel discussions on structural development, public health implications and lessons learned from state ACO programs. The luncheon keynote speaker was Dr. Jeffrey Brenner, founder of the Camden Coalition of Healthcare Providers.

Streaming Audio Podcasts of Each Panel are Below, Beside the Radio in Blue–Just Click and Listen

Panels & Panelists

Introduction to Accountable Care Organizations

Introduction to ACOs Panel, Seton Hall Law Review_Symposium_1.asx

Jorge Lopez (Partner, Akin Gump Strauss Hauer & Feld LLP): Promise and Pitfalls: Health Reform’s Medicare ACO Shared Savings Program

Hal Teitelbaum (CEO and Managing Partner, Crystal Run Healthcare): The Prospect of Being Hanged: Focusing the Physician Mind on ACOs

Michael Kalison (Chairman of Applied Medical Software, Inc.; Of Counsel, McElroy, Deutsch, Mulvaney, & Carpenter): The Lessons of Gainsharing

ACOs in Theory: Issues Raised by Integrated Delivery

ACO Theory: Issues, Seton Hall Law_Review_Symposium_2.asx,,

Jessica Mantel (Co-Director, Health Law & Policy Institute, University of Houston, Law Center): ACOs: Can we have our cake and eat it too?

Priscilla Keith (Adjunct Professor and Director of Research and Projects, Hall Center for Law and Health, Indiana University School of Law - Indianapolis): The Impact of Accountable Care Organizations on Public Health

Tara Ragone (Research Fellow, Seton Hall Law School): The Role of Competition in Integrated Delivery: ACOs, Federal and State Antitrust Law, and the State Action Doctrine

Keynote

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Jeffrey Brenner, M.D., Founder & Executive Director, Camden Coalition of Healthcare Providers

Jeffrey Brenner is a family physician and has practiced in Camden for eleven years as a front-line primary care provider for patients of all ages. Having owned a private practice in Camden, he has experience in implementing electronic health records and running a paperless office, open-access scheduling, as well as first-hand knowledge of the various challenges facing primary care in the current health system.

He currently serves full-time as the Coalition’s Executive Director, where he spends much of his time meeting with stakeholders and policymakers, advocating for the models of care the Coalition has developed and demonstrated through data centric results. Jeff is a faculty member of the Robert Wood Johnson Medical School in Camden and is also a former resident of Camden, having lived in the city for over 8 years. He is a graduate of Vassar College and the Robert Wood Johnson Medical School.

ACOs in Practice: Research on Current Implementation of ACOs

ACOs in Practice, Current Implementation Research, Seton Hall Law_Review_Symposium_3.asx

Louise Trubek (Adjunct Professor of Law, Seton Hall Law, Clinical Professor Emerita, University of Wisconsin Law School), Barbara Zabawa (Whyte Hirschboeck Dudek, S.C); Felice Borisy-Rudin (University of Wisconsin Law School): Accountable care organizations in two states: A preliminary analysis

Sallie Sanford (Assistant Professor of Law, University of Washington - School of Law & School of Public Health): State-based ACO and Medical Home Pilots: Early Lessons from the Other Washington

John Jacobi (Faculty Director & Dorothea Dix Professor of Health Law & Policy, Seton Hall University School of Law), Lessons from ACO Implementation in New Jersey.

Thomas Greaney (Chester A. Myers Professor of Law and Director, Center for Health Law Studies, Saint Louis University School of Law), Accountable Care Organizations: A New New Thing with Some Old Problems.

A Symposium Law Review with papers from the event is forthcoming. For more information regarding the Symposium, please contact Gianna Cricco-Lizza, Symposium Editor, at gianna.criccolizza@student.shu.edu

Introducing Professor Zack Buck to Health Reform Watch

We are pleased to introduce and welcome Professor Zack Buck to Health Reform Watch. He is a Visiting Assistant Professor here at Seton Hall Law and specializes in various health law topics, focused primarily on issues surrounding mental health law and public health law. Professor Buck teaches health law courses, including mental health law and healthcare fraud and abuse. He holds a J.D. from the University Pennsylvania Law School (2009), a Masters of Bioethics from the University of Pennsylvania (2009), and a B.A. with highest distinction, in Political Science and Journalism, from Miami University (2006). Prior to joining Seton Hall, Professor Buck was a litigation associate at Sidley Austin LLP in Chicago. He is a member of the bar of Illinois (2009) and is a former legal writing instructor at Penn Law (2008-09).

His first post, ACA Litigation, Implications for Medicaid and Mental Health Care, may be found below.

ACO Symposium: Professor Tim Greaney to Present Accountable Care Organizations: A New New Thing with Some Old Problems

In conjunction with the Center for Health & Pharmaceutical Law & Policy, this year’s Seton Hall Law Review Symposium on October 28, 2011, will explore recent changes in the structure of health care delivery, in particular the rising popularity of Accountable Care Organizations (ACOs). For more information or to register, click here.

The keynote speaker will be Dr. Jeffrey Brenner, founder of the Camden Coalition of Healthcare Providers, and legal scholars and practitioners from around the country will present panel discussions on structural development, public health implications and lessons learned from state ACO programs. One such distinguished presenter is  Thomas Greaney, Chester A. Myers Professor of Law and Director, Center for Health Law Studies, Saint Louis University School of Law, who has been a frequent contributor to HRW,  will take part in the panel on “ACOs in Practice: Research on Current Implementation of ACOs,” and will be presenting Accountable Care Organizations: A New New Thing with Some Old Problems.

A nationally recognized expert on health care and antitrust law, Professor Thomas (Tim) Greaney has spent the last two decades examining the evolution of the health care industry and is a vocal advocate for reforming the health care system and protecting consumers. He also has a strong interest in comparative antitrust law, having been a Fulbright Scholar in Brussels and a visiting lecturer at several European law schools.

After graduating from Harvard Law School, Greaney began his career as a legislative assistant on Capitol Hill and as a law clerk with the Federal Communications Commission. He then moved on to the Antitrust Division of the U.S. Department of Justice where he was a trial attorney and became the assistant chief in charge of antitrust matters in health care. His career at Justice spanned ten years and involved him in civil and criminal antitrust litigation in health care, banking, communications and other regulated industries as well as policy formulation and legislative matters.

Greaney came to SLU LAW in 1987 after completing two fellowships and a visiting professorship at Yale Law School. Professor Greaney became Chester A. Myers Professor of Law in 2004 and was named Health Law Teacher of the Year by the American Society of Law, Medicine and Ethics in 2007. His academic writing has been recognized six times by the Thompson Coburn Award for SLU Faculty scholarship.

Professor Greaney’s extensive body of scholarly writing on health care and antitrust laws encompasses articles published in some of the country’s most prestigious legal and health policy journals. Professor Greaney has authored or co-authored several books, including the leading health care casebook, Health Law. A frequent speaker in academia and the media, Professor Greaney has also offered expert testimony at hearings sponsored by the Federal Trade Commission on the issues of applying competition law and policy to health care, and submitted invited testimony to the U.S. Senate on competition policy and health care reform.

ACO Symposium: Professor John V. Jacobi to Present: Lessons from ACO Implementation in New Jersey

In conjunction with the Center for Health & Pharmaceutical Law & Policy, this year’s Seton Hall Law Review Symposium on October 28, 2011, will explore recent changes in the structure of health care delivery, in particular the rising popularity of Accountable Care Organizations (ACOs). For more information or to register, click here.

The keynote speaker will be Dr. Jeffrey Brenner, founder of the Camden Coalition of Healthcare Providers, and legal scholars and practitioners from around the country will present panel discussions on structural development, public health implications and lessons learned from state ACO programs. One such distinguished presenter is John V. Jacobi , Faculty Director, Center for Health & Pharmaceutical  Law & Policy,Dorothea Dix Professor of Health Law & Policy, Seton Hall University School of Law. Professor Jacobi, who frequently contributes to HRW,  will take part in the panel on “ACOs in Practice: Research on Current Implementation of ACOs,” and will be presenting Lessons from ACO Implementation in New Jersey.

Professor John Jacobi’s work is primarily in the areas of Health Insurance and Access, Mental Health Law, and Disability Law.

Professor Jacobi received his B.A., summa cum laude, from the State University College of New York at Buffalo and his J.D., magna cum laude, from Harvard Law School. He teaches Health Law, Health Finance, Disability Law, Public Health Law, Mental Health Law, and Torts. Professor Jacobi spent five years working for the New Jersey Department of the Public Advocate as Special Assistant to the Commissioner, where he worked on health, civil rights, and disability issues through litigation and advocacy in legislatures and regulatory agencies. He then became a Gibbons Fellow at the law firm of Gibbons, Del Deo, Dolan, Griffinger & Vecchione, where he pursued health, prisoners’ rights, and disability issues. During 2007-2008 he was on leave from the law school, serving as Senior Associate Counsel to N.J. Governor Jon S. Corzine on Health, Human Services, and Chrildren’s Issues.

Professor Jacobi writes and speaks on issues including disability rights, health access and finance, public health, and mental health. His recent and current scholarly projects include examining the improvement of chronic care in health systems, the funding and structure of Early Intervention Services for children with disabilities, examining the obligations of government to provide services to people with serious mental illness, the clash of disability rights and public health interests, and the prospects and social effects of “consumer-driven” health insurance models on health costs and rights of access for the poor and people with disabilities. He served on the Governor’s Task Force on Mental Health, the Board of Advisors of the New Jersey Office of Child Advocacy, the New Jersey Olmstead Advisory Council on disability rights, and on other government and non-profit boards and committees.

ACO Symposium: Professor Sallie Sanford to Present: State-based ACO and Medical Home Pilots: Early Lessons from the Other Washington

In conjunction with the Center for Health & Pharmaceutical Law & Policy, this year’s Seton Hall Law Review Symposium on October 28, 2011, will explore recent changes in the structure of health care delivery, in particular the rising popularity of Accountable Care Organizations (ACOs). For more information or to register, click here.

The keynote speaker will be Dr. Jeffrey Brenner, founder of the Camden Coalition of Healthcare Providers, and legal scholars and practitioners from around the country will present panel discussions on structural development, public health implications and lessons learned from state ACO programs. One such distinguished presenter is Sallie Sanford, Assistant Professor of Law, University of Washington — School of Law & School of Public Health. Professor Sanford will take part in the panel on “ACOs in Practice: Research on Current Implementation of ACOs,” and will be presenting State-based ACO and Medical Home Pilots: Early Lessons from the Other Washington.

Professor Sanford teaches Health Law both at the law school and the School of Public Health. Her research interests include health care delivery systems, health administration law, Medicare and Medicaid, comparative health law, and medical and administrative ethics.

Professor Sanford began her legal career as a law clerk for The Honorable Robert R. Beezer of the United States Court of Appeals for the Ninth Circuit. She then served for six years as an Assistant Attorney General representing the University of Washington Medical Center, Harborview Medical Center and the UW’s health sciences schools. Professor Sanford is a member of the Order of the Coif and is admitted to practice in Washington and the U.S. Court of Appeals for the Ninth Circuit. She is the president of the Washington State Society of Healthcare Attorneys.

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