Cuts in Medicare payments backfire as doctors prescribe more unnecessary procedures

The New York Times is reporting on a study that indicates  cancer treatment specialists, who prior to the cuts in allowed Medicare payments  were often making a handy 20% profit on the cancer drugs they prescribed and administered, responded to cuts in the allowed compensation amounts intended to curtail that profit-taking by physicians by prescribing more treatments — increasing volume to make up for a drop in windfall profit.

The study, which will be published in the July issue of Health Affairs, examined changes in payments for certain cancer drugs as part of Congress’s 2003 overhaul of Medicare.

The issue was the large sums that cancer specialists made from the difference between what they paid for the chemotherapy drugs they gave to patients and how much Medicare reimbursed them for those drugs. In some cases, a doctor could buy the drugs for about 20 percent below the price Medicare set for the drugs, which are given intravenously in a doctor’s office.

There was an upside, though. Critics had worried that the change in price structuring might mean that doctors would stop prescribing needed chemotherapies, sloughing them off to clinics.

But what happened was that doctors began prescribing more chemotherapy — apparently to make up for lost revenue.

“In sum, far from limiting access,” the changes under the law “actually increased the likelihood that lung cancer patients received chemotherapy,” the study concluded.

Doctors responded by treating more patients because they had been making so much money under the old system, Professor Newhouse said. “These markups were a substantial portion of their income,” he said.

It wasn’t all upside, though, since some doctors decided to deal with cuts in markups by switching to more profitable treatments — with little or no regard for the efficacy or appropriateness of treatment:

The study found that doctors frequently switched to more expensive options, like increasing their reliance on drugs like docetaxel, where doctors were paid roughly $2,500 for giving a standard monthly amount. “The financial incentive seemed to have an effect where there’s not strong evidence or more than one equally good treatment option,” Dr. Earle said.

But at the same time, Dr. Earle said, he thinks some cancer doctors left private practice for positions in hospitals because of the lower reimbursement rates, which made them no longer able to afford being independent.

“When you squeeze the system in a little place, there is a lot of change,” he said, “but not always the way one would expect.”

Tea Party candidate Sharron Angle hints at armed revolt

Speaking on a conservative talk show, Tea Party favorite Sharron Angle, running for Senate in Nevada and hoping to unseat Senate Majority Leader, Harry Reid, suggested that — if Congress doesn’t get the Tea Party message — that some will be looking to what she called “Second Ammendment remedies.”

Here are some of her comments, quoted here by ScrippsNews:

She said the purpose of the right to bear arms is to check the federal government. But she stopped short of saying that she would support an armed uprising.

“Our Founding Fathers, they put that Second Amendment in there for a good reason, and that was for the people to protect themselves against a tyrannical government,” Angle told conservative talk show host Lars Larson in January. “In fact, Thomas Jefferson said it’s good for a country to have a revolution every 20 years. I hope that’s not where we’re going, but you know, if this Congress keeps going the way it is, people are really looking toward those Second Amendment remedies.”

Nev. Senate hopeful Sharron Angle talks of armed revolt

More racist nonsense from Arizona

When the director of Prescott, Arizona’s Downtown Mural Project was overseeing a mural on the side of a school that was designed and painted with the help of students at the school and drawn from images of the children’s faces at the school, he says he and the student artists were continually barraged by racist taunts and insults from those  driving by.

When Steve Blair,  Prescott city councilman and talk show radio host — who says he “can’t stand” the word diversity — mounted a campaign against the mural, calling the mural “graffiti” and complaining that the most prominent face on the mural seemed to be that of a black person, and citizens writing in to the local paper described the mural as “ghetto,” the school had had enough.

They courageously stepped up and did the right thing.

They asked the mural project team to lighten the color of the children’s faces in the painting.

Blair has since been fired from his afternoon radio talk show host job, but continues to represent his constituency on the Prescott City Council.

An island of sanity…

Arizona police officer Martin Escobar, a 15 year veteran of the Tucson police department, is setting out to challenge that state’s not-yet-implemented anti-illegal-immigrant law, which opponents call oppressive and predict will backfire, endangering public safety by causing the state’s large immigrant population to avoid reporting crimes, since doing so will make those reporting crimes subject to arrest and possible deportation.

The new state law mandates that state and local police must ascertain the legal residency of anyone they make legal contact with and act on any illegal immigrants they find, even if the illegals are witnesses or victims.

Escobar is one of two Arizona police officers who have taken it upon themselves to file lawsuits challenging the Arizona law in federal court.

Israel attacks humanitarian aid flotilla — at least ten killed

The Israel Defense Force attacked an unarmed humanitarian aid flotilla in international waters earlier today, killing ten barricade running protesters.

When IDF soldiers attacked,  rappelling onto the largest ship of the flotilla, they were reportedly met by resistance in the form of protesters with metal bars or sticks.

The IDF opened fire on the protesters with machine guns, killing at least ten.

International condemnation has been swift and near-universal, with virtually only the United States among modern western nations  hesitant to condemn the attack and killings.

This writer just returned from, where he strongly urged an end to that hesitancy. This vicious attack against those trying to deliver humanitarian aid to suffering civilians in the Gaza should not be allowed to stand without the strongest international condemnation — and international legal action against the Israeli government.

Claiming coinage of important new consumer tech term here, boss!

PC World seemed to be struggling, trying to figure out what to call new a new pad/slate device from dell here.

So, in their comment section, I offered what I hope will become the term of choice for such very small slates/overgrown phones: a padlet.

Checking Google, I see that I’m out in front on this one.

Just wanted to go on record…

Doing nothing in the face of evil…

From Reuters:

A Chinese man who hacked to death seven young children and two adults in the latest in a series of deadly assaults on schools lashed out after an argument over a kindergarten lease, neighbors and state media said.

Bystanders fled and hid from the man, armed only with a cleaver, as he exploded in apparent rage over a rent dispute with the kindergarten:

Wu Huanming, the owner of the two-storey building with a walled, concrete courtyard, wanted the kindergarten to vacate the property when the lease ran out in April, Xinhua news agency said. Wu Hongying wanted to keep the school running until the summer.

In rural China, villagers often have the same surname, but may not be closely related.

Wu Huanming ran back into his home to grab a cleaver and onlookers were too afraid to stop him, said one villager.

“I saw him holding a cleaver up in his right hand. I ran out, there was shouting everywhere,” Li Yufen, a resident of rural Nanzheng county, told Reuters.

“Then a few women came out, but we were not enough, so I went back into the house. The killer walked straight past me. He glanced at me but walked on and I closed the door and stayed inside.”

Wu Huanming hacked five boys and two girls to death with the cleaver, and also killed Wu Hongying and her 80-year-old mother. He returned home and committed suicide, Xinhua news agency said.

It’s tempting to draw facile and presumably superficial conclusions from events like these — I just erased a couple hundred words of the beginning of one — but I find myself with the nagging notion that even beyond the all too typical human fear to be the first to act in such circumstances — something we’ve seen the perplexing, seemingly perverse evidence and tragic results of here in the west — the Chinese state apparatus’ carefully maintained image of social control and ultimate omnipotence has further hobbled the impulse of individual bystanders in such cases to break the ’social surface tension’ to act out to protect themselves and others.

And it may also be overly facile to point to the incidents aboard Flight 93 on 11 September 2001 — the heroism of those who, even knowing they themselves were doomed, banded together to attack the hijackers and bring down the plane, ending their own lives but saving countless others on the ground — as a turning point, a moment of sea change.

Yet as I look back on the US’s own history of terrible public attacks, mass-shootings and attempted massacres, I can’t help but see the effects of new attitudes and a greater willingness to initiate action, even in the face of very real and menacing danger. 20 years ago such an event often went the gunman’s way — people cowered, unwilling, afraid or simply unable to act for reasons they couldn’t express — today, on the other hand, while we still, sadly, have far too many such incidents, many of them are stopped early rather than late, when bystanders overcome what some researchers have described as a form of social intertia to act against the attackers. The impulse to act is presumably individual — but quite often, as we’ve continued to see, others immediately follow suit and, while good samaritans are sometimes hurt or killed, greater tragedies are often averted.

We all must balance pure self-interest with various social or altruistic impulses in many instances of our daily lives.

But there *is* an enlightened self-interest in many of these seemingly most dire circumstances in the impulse to do the right thing.