Single Payer (Healthy California Act, SB 562, Lara & Atkins) wins Senate Health Committee support

SB 562 or Healthy California Act is better known as the Single Payer Act. Senator Ricardo Lara's position is that "healthcare is not a privilege, it's a human right."

1) SB 562 promises to cover all Californians for "all medical care, including inpatient, outpatient, emergency care, dental, vision, mental health, and nursing home care;

2) Co-pays and deductibles will be eliminated;

3) Californians will choose their doctors from "a full list of health care providers, not a narrow network chosen by insurance companies" (now we'll just have to worry about who makes up these lists of providers -- physicians should now understand why MOC is such a hot potato);

4) Referrals will not be required for members to see "any eligible provider" (shades of 1998: the undersigned spoke on this topic at the White House when President Clinton signed off on allowing federal HMO members to go directly to specialists without having to see a primary care doctor first); 

5) Californians will be covered when they travel;

6) The bill will say that "physicians and nurses will make decisions about care, and have the ability to override computers or clinical practice guidelines in the best interest of the patient" (notice that this provision mentions "physicians and nurses" and avoids designating MDs and RNs); 

7) The bill says that "Healthy California will be governed by a nine-member, unpaid board appointed by the governor and legislature and a public advisory committee (italics added ) of doctors, nurses, other health care providers, and consumers" (in other words, kind of like the Independent Payment Advisory Board of Obamacare).

In fact, SB 562, specifies under Chapter 2, Governance, that one of the board members will be a "representative of a labor organization representing registered nurses." It is proper that Registered Nurses get this recognition.  

It would be a good idea to make sure that physicians and surgeons with MD degrees also get such recognition. Under SB 562 they do not -- in fact, they almost get ignored. SB 562 states that the governing board will include "at least one representative of the medical provider community." The "medical provider" community includes many kinds of providers of services, e.g, physical therapy, massage, non-RN nurses, nurse anesthetists, physician assistants, naturalists, chiropractors, acupuncturists, etc. 

An additional amendment this writer recommends is that SB 562 should require that "at least two California licensed representatives will be medical physicians/MDs, one surgeon and one internist or family physician."

As for the public advisory board, it will also be obliged to meet certain statuatory requirement, it would be required of the board "to seek all necessary waivers, approvals, and agreements to allow various existing federal health care payments to be paid to the Healthy California program which would then assume responsibility for all benefits and services previously paid for with those funds." 

In the words of too many pundits to count, SB 562 still needs work.

Reference

"SB 562," 17 April 2017, The Weinmann Report, www.politicsofhealthcare.com 

Senate Bill 790 (McGuire): Me too legislation on gifts and benefits

Once again we see a loose cannon approach to limiting gifts and benefits from manufacturers of prescribed products or distributors of medical devices to health care providers. Physicians are the main target of this legislation despite the authors' unctuous assertion that "the vast majority of medical professionals in California do their job well and put the needs of their patients first."

Nonetheless, Sen. McGuire finds that "current voluntary efforts are not enough to ... protect patients from overpriced prescriptions. SB 790 will restrict pharmaceutical gifts and help control drug costs."

On this basis Sen. McGuire seeks to regulate food and beverages served by pharmaceutical companies at meetings of medical professionals -- these meetings are usually dinnertime functions with educational presentations by prominent and respected physicians. It is correct that the participants dine at the expense of the sponsoring company. The pitch in favor of the bill is that "SB 790 gives California an opportunity to put patient care and drug affordability before corporate profits. The bill would significantly restrict the manufacturer (of a prescribed substance or device) from offering or giving gifts and incentives such as travel and lodging, consulting fees and expensive meals and alcohol to health care providers." Sounds good, doesn't it?

There are problems with this expansive bill. For instance, physicians know that the speakers at these commercial enterprises are actual clinicians with field experience, physicians whose lectures are known to be knowledgeable and reliable. Thanks to the pharmaceutical companies we don't have to buy risky tickets on airlines that routinely overbook. Education is brought to our doorsteps. These benefits would be thrown out with the dish water were SB 790 to become law. 

This bill will redistribute the wealth so that medical centers and health plans will still be allowed to put on seminars, dinner and wine included, in other words, will be allowed to advertise their own clinical services while foisting lower level and comparatively inexperienced faculty on attendees, e.g., it is not unusual for medical centers to put on these dinner meetings and draft junior faculty as speakers. The idea is to have attendees at such symposia use the sponsors' hospitals, clinics, and healthcare plans. THAT is not precluded by SB 790  which actually plays into their hands.

Actually, there is an approved exception: conferences or seminars accredited by the Accreditation Council for Continuing Medical Education (ACCME)  or comparable organizations would be allowed to offer these conferences provided the sponsor is not the manufacturer of prescribed products. In other words, courses given by the American Boards or their separate but contiguous professional associations or academies would be exempt (compare our previous items on Maintenance of Certification or MOC and rue the day you left the hen-house for protection by the fox). 

Finally, many of the physicians who attend dinner-meetings put on by pharmaceutical companies do not use or prescribe the products discussed: they come to hear experts discuss the mechanism of action of new medications and techniques and to enjoy the company of colleagues in an environment where there's no "911" calls. 

Where this battle needs to be fought is in the courts and in Congress which so far have allowed Medicare and other entities to avoid negotiating with suppliers for better prices. 

As written, SB 790 also shows flagrant ignorance on how drug profits are actually made, e.g,, Senator McGuire's press release from 4/25/17 says that the current "interaction with the pharmaceutical industry is associated with negative consequences that includes unnecessary drug prescriptions, drug cost increases borne by the patient and less availability of generic drugs (italics added)."

What the authors fail to mention is that the mark-up or profitability of generics is often more than trade name medications. That is because the so-called "filler molecules" entailed in their making are less regulated since they're not the active substance. In other words, generic drugs are not by definition  "bioequivalent" to their brand name counterparts but may be more profitable nonetheless. 

Our suggestion to McGuire and Monning: try again, without grandstanding.