http://www.calpirg.org/newsroom/health-care/health-care-news http://www.calpirg.org/newsroom/health-care/health-care-news/calpirg-calls-out-pharma-on-dubious-marketing-practices CALPIRG released a new analysis today examining drug companies’ self-imposed limits on their marketing to doctors – efforts that include lavish wining-and-dining and thousands of dollars worth of gifts. The report, Playing By Their Own Rules: An Analysis of Drug Company Gifts to Doctors, finds that these limits are riddled with exceptions, and that some companies have evaded even the least restrictive limits on their marketing. “Patients need to know that prescriptions are being written on the basis of science, not high-priced meals and upscale gifts,” said Michael Russo, Health Care Advocate with CALPIRG. “Strong limits on these marketing efforts are necessary to protect patients – and our research shows that the limits the drug companies have chosen for themselves amount to no limits at all.” Drug company marketing showers doctors with fancy dinners and costly giveaways, aimed at convincing them to prescribe the latest, most expensive, least-tested drugs – forcing patients to pay top dollar, and subjecting them to potentially unknown side effects. Current California law requires drug companies to choose, and then abide by, dollar limits on the value of gifts and free meals they give to doctors as part of their marketing efforts. But CALPIRG’s analysis shows that these “limits” often allow the companies to give as much as they wish. Key findings include: Drug companies fail to count some meals and other payments as “gifts,” and therefore they are not subject to the limit; Some companies reserve the right to exceed their limits if they so choose; Others assert that they are following a limit, but do not disclose what that limit actually is, while a few fail even to post their policies at all; Since 2005, 5 of the largest companies have raised their limits, by an average of $1,100 dollars per doctor per year. “It’s disappointing that the drug industry hasn’t even been able to comply with their own rules,” said Russo. “We’ve let the foxes guard the henhouse long enough.” When drug company marketing succeeds, it induces doctors to over-prescribe the newest, priciest drugs, inflating the cost of prescription drugs. Also, because the newest drugs have been on the market for the least time, they may have potentially unknown side effects. “By playing by their own rules, the drug companies have let themselves get away with whatever they want,” said Russo. “It’s time we set a hard, enforceable limit on doctor gifts, and require those gifts to be publicly disclosed. Patients need to have confidence that when a doctor decides which drug to prescribe, drug company marketing isn’t part of the equation.” CALPIRG’s analysis shows that some companies by all appearances are not complying with California law governing drug company marketing to doctors. “We urge the Attorney General to investigate our findings, and take appropriate action to make sure these companies follow the law,” said Russo. # # # http://www.calpirg.org/newsroom/health-care/health-care-news/calpirg-calls-out-pharma-on-dubious-marketing-practices Fri, 28 Mar 2008 13:49:28 -0500 http://www.calpirg.org/newsroom/health-care/health-care-news/calpirg-statement-on-assembly-passage-of-abx1-1 Statement by Mike Russo, Health Care Advocate and Staff Attorney for CALPIRG: “CALPIRG applauds the Assembly’s passage today of the comprehensive health care reform bill, ABX1-1. The reform will greatly expand coverage, contain the surging costs of health care, and give consumers a fair shake when buying insurance. The bill:· Creates a large purchasing pool to let many Californians who currently lack access to group coverage gain access to the risk-sharing and bargaining power a pool provides.· Organizes the chaotic insurance market into five tiers, and gives consumers the tools they need to buy the coverage that’s right for them by providing clear benchmark plans.· Gives all consumers, sick and healthy, access to health insurance, preventing insurance companies from discriminating against those who need coverage the most.· Expands coverage across the board by strengthening the Healthy Families and Medi-Cal programs.· Contains the rising costs of health care through bulk purchasing of prescription drugs, robust transparency provisions, and requiring insurers to spend 85 percent of premiums on care.“We commend the Governor and the Speaker for their hard work turning the vision of health care reform into a reality. Besides helping all Californians obtain quality coverage, ABX1-1 will also finally bring some law and order to the unregulated, Wild West insurance market. And because it will bring in matching federal dollars and new health care dollars from providers, employers, and a tobacco tax that will improve Californians’ health, it will also help with the looming budget deficit.“We urge Senate President Pro Tem Perata to pass ABX1-1 through his chamber as well – California can’t afford to wait any longer for health care reform.”CALPIRG is a statewide membership-based public interest group that stands up to powerful interests, working to win concrete results for Californians’ health and well-being. With researchers, advocates, organizers and students, we advocate on behalf of consumers and all California’s residents. ### http://www.calpirg.org/newsroom/health-care/health-care-news/calpirg-statement-on-assembly-passage-of-abx1-1 Mon, 17 Dec 2007 20:03:23 -0600 http://www.calpirg.org/newsroom/health-care/health-care-news/much-needed-health-care-reform-headed-for-a-vote Statement by Mike Russo, Health Care Advocate and Staff Attorney for CALPIRG: “With the Assembly convening on Monday and new amendments made to the health care reform bill, the pieces are in place for California’s leaders to close a deal on reforms that could greatly expand coverage, contain the surging costs of health care, and give consumers a fair shake when buying insurance.“Reform is more important than ever in the face of a 14 billion dollar state budget deficit next year. Without reform, that deficit could mean savage cuts to health care programs that serve the neediest Californians. This plan would help prevent that by bringing new money to the table, through federal matching funds and an employer contribution to the costs of health insurance.“There are some details that need to be ironed out, but it’s time for our leaders to make good on the promise of 2007 as the year of health reform."CALPIRG is a statewide membership-based public interest group that stands up to powerful interests, working to win concrete results for Californians’ health and well-being. With researchers, advocates, organizers and students, we advocate on behalf of consumers and all California’s residents. ### http://www.calpirg.org/newsroom/health-care/health-care-news/much-needed-health-care-reform-headed-for-a-vote Mon, 17 Dec 2007 14:19:15 -0600 http://www.calpirg.org/newsroom/health-care/health-care-news/calpirg-statement-on-democrats-health-care-reform-compromise-plan http://www.calpirg.org/newsroom/health-care/health-care-news/calpirg-statement-on-democrats-health-care-reform-compromise-plan Wed, 07 Nov 2007 12:56:05 -0600 http://www.calpirg.org/newsroom/health-care/health-care-news/calpirg-members-speak-out-on-health-care Health care reform is at the top of California’s agenda, and everyone agrees the system is broken. It’s harder to know which problems are the most important, and easy to lose sight of what’s really at stake in the abstract policy debates. That’s why CALPIRG recently conducted an email survey of 575 of our members, to find out what kind of reforms are most important to them, and gather their stories about the health care system. While largely satisfied with current insurance, 69 percent of participants are insecure about the future of their health insurance. A large majority of the participants – 88 percent – currently have health insurance, and 73 percent say they are either satisfied or very satisfied with the quality of the coverage they have. However, more than two-thirds do not feel secure that good coverage will always be there for them – 33 percent said they were concerned, 36 percent very concerned, about the future of their health insurance. The told us that they worried about getting dropped if they develop health problems, and about what will happen when they – or the family member through whom they obtain coverage – retire. Even for people who already have good health insurance, comprehensive reform is a critical issue. 74 percent thought obtaining health insurance on the individual market was difficult, as well as being confusing to navigate, largely unaffordable, and sometimes unavailable. Twenty one percent of our members bought their coverage as individuals, rather than as part of a group plan – a process 74 percent said was difficult or very difficult. One CALPIRG member who works in the health care field found buying a plan on the individual market “extremely confusing and difficult.” Making the same point, another said choosing a plan was like “trying to compare oranges with apples.” And some lack even this dubious luxury of choice – one member was only offered a single plan by a single insurer, while a second said that due to the difficulty obtaining individual coverage, the only option was the government high-risk pool, which has premiums of over $1,000 per month. Reforms need to bring people into group coverage by opening up eligibility in group purchasing pools, so no-one is forced onto the individual market. 85 percent of those that did not have health insurance cited costs. Most of our members have health insurance, but those who did not overwhelmingly lacked it because they could not afford it. Only 15 percent of members were self-insured or used Health Savings Accounts; the rest simply could not pay the premiums for coverage. County-based care was used by several as a safety net, but one member was forced to sell her property in order to qualify for it and get the breast cancer surgery she needed. Getting more people covered means giving them assistance, since very few people are uninsured as a matter of choice. 25 percent of survey participants had been refused coverage by an insurance company, and 55 percent of survey participants knew someone who couldn’t find an insurance company willing to cover them. A full quarter of our members were denied coverage for having a pre-existing condition. One person who had had bypass surgery found getting insurance impossible; so did another member, self-employed and diagnosed with AIDS. But the rationales insurers used for rejection can verge on the farcical, from citing “short stature” to taking a member to task for the “elective surgery” they underwent to remove a tumor. And even if it had not happened to them, 55 percent of our members know someone rejected by insurance companies, including one member whose acquaintance, an uninsured 60-year-old with a digestive disorder, died last month. Requiring insurance companies to take all comers is a necessary element of reform. 65 percent of survey participants had been surprised by a bill that they thought was covered by their insurance. Health care reform has to contain the skyrocketing costs of health care. Several participants said that they didn’t go to the doctor as often as they’d like in order to control costs – including one who told us that she skipped her yearly mammogram because of high copays. Insurance company refusal to cover certain treatments imposes even more costs on consumers – multiple members had been billed directly by hospitals after their insurers refused to cover emergency services, including one who was charged almost $7,000 for 2 hours in an ER. All told, 65 percent of our members had been surprised by a bill for services they thought their insurance would cover. Preventing providers from billing insured consumers directly will protect them from being surprised by large bills and being forced into debt. While there are significant differences between the reform proposals put forth by the Governor and the Legislature, there are also significant areas of agreement. These survey results are one more indication that most Californians, even those who are satisfied with their current health insurance, are insecure about the future and need California’s leaders to come together and pass reforms that contain rising costs, expand coverage, and give consumers a fair shake on the market. CALPIRG is a statewide, membership-based organization that stands up to powerful interest, working to win concrete results for Californians’ health and well-beings. With researchers, advocates, organizers and students, we advocate on behalf of consumers and all California’s residents. For more information about this survey, contact Michael Russo, Health Care Advocate and Staff Attorney, at (213)251-3680 x332, or mrusso@calpirg.org. http://www.calpirg.org/newsroom/health-care/health-care-news/calpirg-members-speak-out-on-health-care Fri, 23 Nov 2007 12:55:06 -0600 http://www.calpirg.org/newsroom/health-care/health-care-news/calpirg-statement-on-governors-proposed-health-care-legislation Statement by http://www.calpirg.org/newsroom/health-care/health-care-news/calpirg-statement-on-governors-proposed-health-care-legislation Wed, 10 Oct 2007 11:52:57 -0500 http://www.calpirg.org/newsroom/health-care/health-care-news/calpirg-statement-on-assembly-health-committee-hearing-on-governors-health-care-reform-proposal http://www.calpirg.org/newsroom/health-care/health-care-news/calpirg-statement-on-assembly-health-committee-hearing-on-governors-health-care-reform-proposal Wed, 31 Oct 2007 13:39:12 -0500 http://www.calpirg.org/newsroom/health-care/health-care-news/health-care-reform-good-for-our-health-good-for-the-budget Facing a projected $14 billion budget shortfall, California lawmakers are right to consider how the landmark health care reform bill, ABX1-1, will affect the deficit. But ABX1-1 brings in new money for health care that could not be used to plug the gap in the general fund, as well as limiting health care costs moving forward. And as the past shows, if it is not passed, short-term cuts without an eye towards systemic reform are likely to increase costs down the road, effectively mortgaging California’s health care budget with no end in sight. As a result, Senate passage and voter approval of ABX1-1 are the responsible way to put our health care system on a secure footing. ABX1-1’s funding mechanisms do not starve the general fund. The bill creates money for health care by opening up new funding sources that would otherwise go untapped. Employer contributions: ABX1-1 requires businesses that do not cover their employees to pay a fee to the state. The fee will raise approximately $2.5 billion each year, with the size of the contribution scaled to the size of the employer. But the logic of the pay-or-play fee only makes sense in the context of health care; these revenues could only be used for health care. · Federal funds: some of ABX1-1’s health care expenditures will draw down $4.4 billion in matching funds from the federal government. Giving employees buying insurance on their own the ability to deduct their health care expenditures from their federal income tax also acts as a de facto injection of federal cash. This money can only be used for health care purposes – failing to pass ABX1-1 leaves money on the table. · Hospital fees: under ABX1-1, hospitals will pay a fee to the state which will then return to them in the form of increased Medi-Cal payments. Hospital organizations currently support the fee, which will generate $2.5 billion for the state to pay for the corresponding Medi-Cal increases. But again, as a fee, the money would be unavailable for other purposes. · Tobacco tax: a $1.75 a pack cigarette tax is expected to bring in $1.5 billion for health care. While in theory tobacco taxes can raise money for any purpose, voters have resisted balancing the budget on the backs of smokers, voting for tobacco taxes only where the money raised goes to health and smoking-cessation programs. For example, polling in 2005 showed 37% of voters in favor of using tobacco tax revenue to expand coverage to all children, 32% preferring to spend the money on emergency rooms, while only 15% supporting use of the funds to extend college scholarships, despite 45% thinking such a program was a good idea. ABX1-1 will limit health care costs moving forward. Disease management and prevention programs will reduce the costs of chronic illnesses to the system. Electronic record-keeping and e-prescribing will reduce administrative costs. Transparency and quality programs will ensure that the state, as well as consumers, buys cost-effective care. Last year’s budget fight shows that health care cuts lead to short-term savings with long-term costs. The budget impasse last summer is a preview of what to expect if ABX1-1 doesn’t go through – a future of penny-wise, pound-foolish cuts that only increase the deficit in the long run. And since balancing the budget last year required $700 million in cuts, while this year’s tally is $14 billion, the damage could be even greater if ABX1-1 isn’t passed and health care put on the path to long-term stability. Here are some of the programs cut in 2007: · The prescription drug negotiation program set out by AB 2911, which aims to save money by helping the state get at least a 40% discount on the prescription drugs it purchases, was left unfunded.· Cuts were made to children’s coverage enrollment efforts, leading to more uninsured kids lacking preventive care and higher costs when they do get covered.· Community clinics, which act as the front line of the public safety net, were underfunded, forcing overreliance on expensive, inefficient emergency-room-only care. Finally, ABX1-1 is not a suicide pact. It does not inflexibly chain the state to billions of dollars of spending regardless of facts on the ground. First, the current budgeting packages in $170 million as a reserve against unanticipated cost overruns. But even if there isn’t enough revenue to cover all of its programs in a given year, the companion ballot initiative gives the legislature broad authority to balance the books and ensure that the most critical programs are funded without driving the state into the red. Even in this worst-case-scenario, there will still be billions more health-care dollars available to prevent the savage cuts of previous years. Because ABX1-1 will not go into effect until it is approved by the voters in November, it unfortunately cannot fix this year’s deficit. But its package of new revenues and cost containment strategies will relieve pressure on the general fund in the future, by insuring that health care is stable and adequately funded, rather than remaining dependant on ad-hoc, year-to-year cuts. Fixing the perennial structural deficits requires the state’s spending to be put on a secure footing – which is exactly what ABX1-1 does for health care.CALPIRG is a statewide, membership-based organization that stands up to powerful interest, working to win concrete results for Californians’ health and well-beings. With researchers, advocates, organizers and students, we advocate on behalf of consumers and all California’s residents. For more information about this fact sheet, contact Michael Russo, Health Care Advocate and Staff Attorney, at (213)251-3680 x332, or mrusso@calpirg.org. http://www.calpirg.org/newsroom/health-care/health-care-news/health-care-reform-good-for-our-health-good-for-the-budget Mon, 14 Jan 2008 19:47:29 -0600 http://www.calpirg.org/newsroom/health-care/health-care-news/president-signs-prescription-drug-safety-bill http://www.calpirg.org/newsroom/health-care/health-care-news/president-signs-prescription-drug-safety-bill Thu, 27 Sep 2007 17:29:51 -0500 http://www.calpirg.org/newsroom/health-care/health-care-news/house-passes-prescription-drug-safety-reforms http://www.calpirg.org/newsroom/health-care/health-care-news/house-passes-prescription-drug-safety-reforms Wed, 19 Sep 2007 15:51:24 -0500 http://www.calpirg.org/newsroom/health-care/health-care-news/calpirg-statement-on-senate-passage-of-health-care-reform-bill http://www.calpirg.org/newsroom/health-care/health-care-news/calpirg-statement-on-senate-passage-of-health-care-reform-bill Mon, 10 Sep 2007 19:11:10 -0500 http://www.calpirg.org/newsroom/health-care/health-care-news/new-report-finds-consumer-friendly-ways-to-bring-health-care-costs-under-control With Californians increasingly concerned about rising health care costs, CALPIRG Education Fund today released a report identifying billions of dollars of unnecessary, wasteful spending in the state’s health care system. The report, Diagnosing the High Cost of Health Care: How Spending on Unnecessary Treatments, Administrative Waste, and Overpriced Drugs Inflates the Cost of Health Care in California, identifies three strategies to reduce costs without affecting patient health. Reducing unnecessary treatments and over-hospitalization, cutting administrative waste, and restricting drug company marketing provide a consumer-friendly approach to simultaneously lightening the burden of health care costs on working Californians and promoting high-quality care. “More health care spending doesn’t always equal better health,” said Michael Russo, Health Care Advocate with CALPIRG. “Our research found that there’s a smart, consumer-friendly way to rein in rising premiums – target unproductive spending that drives up costs but doesn’t provide any improvement in patient health.” In 2004, California spent $167 billion on health care, and spending rose 56 percent between 2000 and 2006. These runaway costs have made it harder for consumers, businesses, and the state to afford health care, but more dollars have not bought better health. The report examines three areas where billions of dollars are spent without providing any benefit to patients: the overuse of invasive treatments, intensive services, and hospitalization; excessive administrative costs; and the marketing of prescription drugs that encourages the use of unnecessary, more expensive drugs. “We took a broad look at all the ways health care dollars get spent, and found these three areas where, as far as patients are concerned, the money might as well be thrown into a dumpster,” Russo continued. “And in fact, some of this spending can actively harm a patient’s health, for example when an unnecessary hospital stay exposes a patient to an antibiotic-resistant infection, or when a misleading drug commercial causes a patient to ask for a prescription that isn’t right for them.” Among the report’s findings: In some parts of the state, patients are hospitalized far more often and for longer stays without resulting in better health. Hospitals in Sacramento are more likely to provide proper care for patients suffering from heart disease, congestive heart failure, and pneumonia than hospitals in the Los Angeles region. But care in Los Angeles is much more intensive, and therefore expensive: compared to Sacramento patients had three times more visits to specialists, spent twice as many days in intensive care, and were hospitalized 1.6 times longer, ultimately leading to a 67% cost increase, all for no health benefit. Reducing this excess through initiatives like ensuring that chronically ill patients get low-cost, high-benefit treatments, and reforming our payment systems so they reward effective rather than high-volume care would save at least $700 million annually. While some administrative spending – such as maintaining high-quality patient records – can improve patient health, billions of dollars are spent on administrative tasks that do not help patients. California’s costs for billing and insurance related activities come to more than $9 billion annually – over $350 per insured Californian. Policy solutions include moving towards a standardized billing and payment system that would be shared by the state’s insurers and providers. Pharmaceutical company advertising is often misleading, and encourages physicians to prescribe and consumers to purchase billions of dollars of potentially unnecessary medicine every year. And because drug advertising encourages the use of newer, more expensive medications, even if they are no more effective than existing ones, consumers can end up paying much more than they should. The industry spends an estimated $2.5 billion on advertising in California each year – and with the costs of unnecessary drugs added in, the true price of this advertising is higher still. To cut these wasteful costs, we recommend requiring better disclosure of and limits on drug company gifts to doctors. “Cutting costs doesn’t have to mean cutting care. With gas prices at record highs and problems in the housing market, Californians need commonsense solutions like these to protect their health, and their pocketbooks,” Russo concluded. “Getting costs under control is a necessary part of the comprehensive health care reform California needs.” CALPIRG (California Public Interest Research Group) Education Fund conducts research and public education on emerging public interest issues. # # # http://www.calpirg.org/newsroom/health-care/health-care-news/new-report-finds-consumer-friendly-ways-to-bring-health-care-costs-under-control Wed, 09 Jul 2008 14:11:29 -0500 http://www.calpirg.org/newsroom/health-care/health-care-news/calpirg-calls-for-patients-to-be-taken-out-of-the-middle-of-hospital-insurer-disputes IRVINE—CALPIRG Health Care Advocate Michael Russo testified today at a Department of Managed Care hearing in Irvine, calling for the enactment of new regulations to protect patients from balance billing. When patients are taken to the hospital for emergency treatment, they may be treated by doctors who are not part of their insurance plan’s network. When this happens, some hospitals send a surprise bill directly to the patient. Usually the exorbitant bills are not meant to be paid, but rather help the doctors get a higher rate out of insurers when they negotiate over rates, as patients put pressure on their insurance company to pay the bill. “Consumers – patients – are being used as bargaining chips in negotiations between health plans and hospitals,” said Russo. “The legal obligation to pay for these services rests on the health plan, not the patient. And yet day after day, insured Californians get surprised with these gotcha bills.” The Department of Managed Health Care is currently considering regulations that would bar providers for balance billing patients for emergency services. Russo urged the department to enact the regulations. “Almost 2 million Californians were surprised by balance bills last year,” he said. “Working families already have a hard time paying for health care – the last thing they need is to be stuck paying bills they should never have gotten.” Some provider groups oppose the regulations because they say insurers will not pay them a fair rate unless they are able to use patients as leverage. “Insurers need to play by the rules too,” said Russo, “but that’s no reason to keep patients trapped in the crossfire between the providers and the plans.” The California Public Interest Research Group (CALPIRG) is a statewide membership-based public interest group that stands up to powerful interests, working to win concrete results for Californians’ health and well-being. With researchers, advocates, organizers and students, we advocate on behalf of consumers and all California’s residents. For more information, contact Michael Russo, CALPIRG Health Care Advocate, at (213)251-3680. http://www.calpirg.org/newsroom/health-care/health-care-news/calpirg-calls-for-patients-to-be-taken-out-of-the-middle-of-hospital-insurer-disputes Thu, 15 May 2008 17:12:37 -0500 http://www.calpirg.org/newsroom/health-care/health-care-news/calpirg-expresses-deep-disappointment-in-senates-failure-to-pass-health-care-reform CALPIRG Expresses Deep Disappointment in Senate’s Failure to Pass Health Care Reform We are deeply disappointed in the lack of action by the Senate Health Committee today. The failure to vote for health care reform was in effect a vote for the status quo. Our current health care system, with skyrocketing costs and six million uninsured Californians, is unacceptable and unsustainable. To add to current problems, today the Senate Pro Tem and many others noted that in the near term, health care will get worse in the short-term, as state coverage programs could face up to $1.1 billion in cuts in the upcoming budget. The faltering economy makes health insurance all the more tenuous for many California residents, bolstering the need for reform even more. While we are frustrated and saddened that the Senate bypassed the huge opportunity today, we hope this is not the end of the conversation about health care reform in 2008. It is imperative that California contains the rising costs of health care, expands coverage, and protects consumers in the health insurance market. CALPIRG is a statewide, membership-based organization that stands up to powerful interest, working to win concrete results for Californians’ health and well-beings. With researchers, advocates, organizers and students, we advocate on behalf of consumers and all California’s residents. For more information, contact Michael Russo, Health Care Advocate and Staff Attorney, at (213)251-3680 x332, or mrusso@calpirg.org. http://www.calpirg.org/newsroom/health-care/health-care-news/calpirg-expresses-deep-disappointment-in-senates-failure-to-pass-health-care-reform Mon, 28 Jan 2008 19:52:28 -0600