Daily Health Policy Report

Wednesday, May 8, 2013

Last updated: Wed, May 8

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles


Health Reform

Capitol Hill Watch

Women's Health


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Capsules: Harkin Withdraws Hold On Tavenner; Reid Says Timing For Vote Is Unclear; Study Models Three Big Changes To Medicare

Now on Kaiser Health News' blog, Mary Agnes Carey reports on movement on Capitol Hill regarding the nomination of Marilyn Tavenner to head Medicare: "Sen. Tom Harkin Tuesday removed the hold he had placed on the nomination of Marilyn Tavenner to head the Centers for Medicare and Medicaid Services and said he would no longer stand in the way of a Senate vote despite actions by the Obama administration that he said violate 'both the letter and the spirit' of the 2010 health care law. But after Harkin announced his decision on the Senate floor, Majority Leader Harry Reid said it was unclear when the Senate would vote on the nomination" (Carey, 5/7).

Also on the blog, Ankita Rao reports on how three Medicare models could play out: "A study from the Rand Corporation, a nonprofit research organization, compared the impact of three proposals that have been discussed by Congress or the White House to curb the costs of the government health care program for seniors and the disabled. The study is published in the May issue of Health Affairs" (Rao, 5/7). Check out what else is on the blog.

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Political Cartoon: 'Out Of Patience?'

Kaiser Health News provides a fresh take on health policy developments with "Out Of Patience?" by Rex May.

Meanwhile, here is today's health policy haiku:


Chris Christie's lap band...
Will he run for president?
Guess we'll weight and see.

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Spending And Fiscal Battles

'Grand Bargain' Budget Deal Appears Increasingly Unlikely

News outlets report that pressure is diminishing as the federal government's "red ink" recedes, leaving Democrats far less likely to consider major changes and trims to Medicare that Republicans view as the building block for any such agreement.

The Washington Post: As Red Ink Recedes, Pressure Fades For Budget Deal
In the meantime, Republicans face a listless summer, with little appetite for compromise but no leverage to shape an agreement. Without that leverage, House Budget Committee Chairman Paul Ryan (R-Wis.) said Tuesday, there is no point in opening formal budget negotiations between the House and the Senate, because Democrats have no reason to consider the kind of far-reaching changes to Medicare and the U.S. tax code that Republicans see as fundamental building blocks of a deal (Montgomery and Goldfarb, 5/7).

The Associated Press/Washington Post: As Deficit Bargain Remains Elusive, Pessimism Abounds At Annual Fiscal 'Summit'
But barely 100 days into President Barack Obama's second term — supposedly a time of peak possibility in a divided capital city — a bipartisan squad of Washington's budget big shots was decidedly downbeat on the chances of following up January's big tax increase on the wealthy with a follow-up deal. "A 'grand bargain' implies you're going to fix the problem, but when you have the majority party in Washington unwilling to embrace the kinds of reforms that make Medicare solvent or make Social Security solvent ... I don't see a grand bargain happening,” said House Budget Committee Chairman Paul Ryan, R-Wis., a frequent attendee at Peterson's event (5/7).

The Wall Street Journal: Ryan Sees No 'Grand Bargain' On Budget
A top House Republican lawmaker said he didn't think that a "grand bargain" on a broad deficit-reduction agreement would be reached in the near term, casting new doubts on the chances for such a deal. House Budget Committee Chairman Paul Ryan (R., Wis.) said that he thought the parties were too far apart on the question of overhauling major entitlement programs like Medicare and Medicaid, saying this would prevent a major deal from being concluded (Boles, 5/7).

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Hospital Billing Varies Widely For The Same Procedures, Medicare Data Show

Data being released for the first time by the Centers for Medicare & Medicaid Services show how billing varies not just between regions, but among hospitals in the same city.

The New York Times: Hospital Billing Varies Wildly, Government Data Shows
Data being released for the first time by the government on Wednesday shows that hospitals charge Medicare wildly differing amounts — sometimes 10 to 20 times what Medicare typically reimburses — for the same procedure, raising questions about how hospitals determine prices and why they differ so widely. The data for 3,300 hospitals, released by the federal Center for Medicare and Medicaid Services, shows wide variations not only regionally but among hospitals in the same area or city (Meier, McGinty and Creswell, 5/8).

The Washington Post: One Hospital Charges $8,000 — Another, $38,000
Consumers on Wednesday will finally get some answers about one of modern life’s most persistent mysteries: how much medical care actually costs. For the first time, the federal government will release the prices that hospitals charge for the 100 most common inpatient procedures. Until now, these charges have been closely held by facilities that see a competitive advantage in shielding their fees from competitors. What the numbers reveal is a health-care system with tremendous, seemingly random variation in the costs of services (Kliff and Keating, 5/8).

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Health Reform

GOP Supermajority In Missouri Scuttles Medicaid Expansion Plans

Lawmakers opt to set up committees to study the issue instead. In Texas, some tea party-affiliated lawmakers threaten to reject the state budget if negotiators include a rider that would allow discussions about expanding coverage with the federal government. Efforts in California, meanwhile, move forward with a $26.5 million injection from the California Endowment.

Politico: Missouri Lawmakers Torpedo Medicaid Expansion
Republican supermajorities have all but scuttled Medicaid expansion in Missouri, defeating — at least for this year — efforts supported by the Democratic governor to extend basic health coverage to an estimated 250,000 low-income state residents. State lawmakers are set to finalize their annual budget this week, and neither chamber included expansion in their blueprints. They’ve opted to create committees to study the issue for the rest of the year and to report on the impact of expansion in early 2014, delaying any decision until after the Jan. 1 start date (Cheney, 5/8).

The Texas Tribune: As Clock Ticks, Chance For Medicaid Expansion Dwindles
Some members of the Tea Party faction in the House are prepared to vote down the 2014-15 budget — and potentially send the Legislature into a special session — if budget negotiators include a rider that would open the door to discussions with the federal government to expand health care coverage for the state’s poorest adults (Aaronson and Batheja, 5/8).

California Healthline: Medi-Cal Outreach Gets Big Boost
If the state won't pay for it, one private donor will. The California Endowment yesterday committed $26.5 million to fund the state's Medi-Cal expansion outreach under the Affordable Care Act. The Assembly Budget Subcommittee on Human Services yesterday voted unanimously 3-0 to accept the contribution and directed state officials to apply for federal matching funds for a total of $53 million in outreach money (Gorn, 5/7).

And in state news regarding health exchanges -

Health Policy Solutions (a Colo. news service): Despite Outrage, Health Exchange Wants Additional $125 Million
Despite outrage from some lawmakers who called review of Colorado's health exchange a "mockery," a bid for an additional $125 million in federal dollars is likely to move forward by next week. … [State Sen. Irene] Aguilar anticipated "sticker shock" over such high costs, but as chair for the legislature's exchange review committee, she and vice-chair, Rep. Beth McCann, D-Denver, can authorize the grant request (Kerwin McCrimmon, 5/7).

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The Challenge Young People Pose To The Health Law

HealthyCal reports on the importance of enrolling the so-called "young invincibles" in health care plans. Meanwhile, Bloomberg reports on a new court case against the health law based on arguments the plaintiff says were not part of the Supreme Court's review last summer.  

HealthyCal: What Does Obamacare Mean For Young People
Most young people feel like they have years of good health in the bank. They are, as a group, so unlikely to buy insurance that insurance companies dubbed them the young invincibles and in some cases gave up on trying to enroll them in health care plans. Some young adults, inevitably, will be proven wrong in their optimistic evaluations of their health (Shanafelt, 5/8).

Bloomberg: Texas Doctor Sues U.S. Over Affordable Health Care Act
A Texas doctor sued the U.S. over President Barack Obama’s health-care reforms on claims the U.S. Supreme Court overlooked when it upheld the Affordable Care Act last year. Steven Hotze of Houston claims the law, the Patient Protection and Affordable Care Act, violates the U.S. Constitution's origination and takings clauses, which weren't part of arguments before the Supreme Court. (Calkins, 5/7).

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Capitol Hill Watch

Harkin Lifts Hold On Tavenner Nomination To Lead CMS

But Senate Majority Leader Harry Reid, D-Nev., said the timing for a Senate vote on her confirmation as head of the Centers for Medicare & Medicaid Services is unclear.

Kaiser Health News: Capsules: Harkin Withdraws Hold On Tavenner; Reid Says Timing For Vote Is Unclear
Sen. Tom Harkin Tuesday removed the hold he had placed on the nomination of Marilyn Tavenner to head the Centers for Medicare and Medicaid Services and said he would no longer stand in the way of a Senate vote despite actions by the Obama administration that he said violate 'both the letter and the spirit' of the 2010 health care law. But after Harkin announced his decision on the Senate floor, Majority Leader Harry Reid said it was unclear when the Senate would vote on the nomination (Carey, 5/7).

CQ HealthBeat: Harkin Lifts Hold On Tavenner To Head CMS
Iowa Democrat Tom Harkin Tuesday lifted the hold on Marilyn Tavenner's nomination to be administrator of the Centers for Medicare and Medicaid Services after making another impassioned plea on the Senate floor that the Obama administration stop taking money out of the health care law’s prevention fund (Reichard and Norman,5/7).

Medscape: Harkin Lifts Block On Vote For CMS Administrator
While blasting the White House for reneging on its commitment to prevention programs, Sen. Tom Harkin (D-Iowa) on Tuesday said he won't block a vote on the confirmation of acting Centers for Medicare & Medicaid Services (CMS) administrator Marilyn Tavenner. Harkin, chairman of the Senate Health, Education, Labor and Pensions Committee, placed a "hold" on the nomination last month to protest the Obama administration's budget plans to divert money from the prevention fund to instead help enrollment in new health insurance exchanges under the Affordable Care Act (Crane, 5/7).

Quad City Times: Harkin Releases Hold In Battle Over Wellness Funds
U.S. Sen. Tom Harkin, D-Iowa, said Tuesday he would allow the nomination for a key administration post to go forward, even as he accused the Obama administration of reneging on its commitment to a part of the Affordable Care Act. Harkin said on the Senate floor Tuesday he would release the hold he had put on Marilyn Tavenner to be the new head of the Centers for Medicare and Medicaid Services, an important agency in the implementation of the law (Tibbetts, 5/7).

Modern Healthcare: Harkin Lifts Hold On Tavenner Nomination To Head CMS
Sen. Tom Harkin (D-Iowa) on Tuesday lifted the hold he placed on the nomination of acting CMS Administrator Marilyn Tavenner to be confirmed as the agency's permanent administrator. On the Senate floor, the Iowa Democrat said he placed the hold on Tavenner's nomination before a congressional recess late last month because Tavenner had signed a directive in March that channeled funds away from the health reform law's Prevention and Public Health Fund (5/7).

The Hill: Harkin Lifts Hold On Top Healthcare Nominee
Harkin was upset about cuts the administration has made to the healthcare law's prevention and public health fund. He reiterated those objections during a floor speech Tuesday but said he would allow Tavenner's nomination to move forward (Baker, 5/7).

Des Moines Register's Iowa Politics: Harkin Drops Hold On Obama Nominee, But Still Bitter About Raid On Health-Care Fund
The Iowa senator championed Obama's Affordable Care Act when it passed Congress in 2010. But he used sharp words on the Senate floor today to criticize his fellow Democrat's decision to raid the prevention fund. ... Last month, Harkin invoked his frustrations by using his Senate power to delay confirmation of Marilyn Tavenner as administrator of the Centers for Medicare and Medicaid Services, which is implementing much of the Affordable Care Act. The senator announced today that he was lifting his hold on the nomination, but he made clear that he’s still upset about the issue (Leys, 5/7).

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Doctors Praise GOP's Plans For Medicare Pay But Seek Uniform Quality Measures

At a Capitol Hill hearing, physicians offered thoughts about Republican efforts to change the way they are paid by Medicare. Meanwhile, Speaker John Boehner said the House may again consider a bill that would use money slated for prevention efforts to fund high-risk insurance pools.

CQ HealthBeat: Medicare Doctors Pay Legislation Still In Planning Phase In House
House members continue to build agreement on replacing the formula that dictates payments to Medicare physicians but have not yet come out with a timeline for advancing a proposal. Witnesses at a House Ways and Means Health Subcommittee hearing on Tuesday largely praised the outline from GOP committee leaders that would put in place a three-part system for Medicare physician payments (Ethridge, 5/7).

Medpage Today: Uniform Quality Measures Sought For An SGR Repeal
Doctors need quality measures from a single source and more avenues to qualify for value-based payments under a post-Sustainable Growth Rate (SGR) reimbursement system, physician groups told Congress Tuesday. As Washington lawmakers work to repeal and replace the SGR, which determines physician payment, and replace it with a system that rewards high-quality care, medical societies offered their views on how to measure quality in a hearing before the House Ways and Means Health Subcommittee. Multiple panelists voiced support for National Quality Forum (NQF) Standards. The NQF is a Washington-based body formed in 1999 to review, endorse, and recommend health care performance standards (Pittman, 5/7).

And in other news -

The Hill: GOP Weighs Second High-Risk Pools Vote
Speaker John Boehner (R-Ohio) indicated Tuesday that GOP leadership could bring back a bill to strengthen part of ObamaCare. The measure to shore up the law's temporary high-risk insurance pools, lacking enough support for passage, was recently pulled from the House floor before its final vote (Viebeck and Baker, 5/8).

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Women's Health

Federal Judge Criticizes FDA Regarding Plan B Contraception Decision

Judge Edward R. Korman said the Food and Drug Administration's efforts to delay his ruling regarding the so-called morning-after pill was "nonsense" and would hurt poor and minority women.

The New York Times' The Caucus: Judge Criticizes Obama Administration As It Appeals Contraception Decision
A federal judge on Tuesday angrily accused the Obama administration of hurting poor and minority women by seeking to restrict their access to morning-after contraceptive pills. Lawyers for the Justice Department appeared before Judge Edward R. Korman in an effort to delay his previous order that the drug be made available to girls of all ages without a prescription. The department announced last week that it planned to appeal the ruling (Shear, 5/7).

Reuters: Judge Criticizes FDA Move On Plan B, Agency Warns Of Precedent
A federal judge criticized the Food and Drug Administration over its refusal to make emergency contraception available to girls of all ages without a prescription, saying the agency's move to restrict distribution to consumers aged 15 and older was not realistic. U.S. District Judge Edward Korman on April 5 ordered the FDA to lift age restrictions on all levonorgestrel-based emergency contraception - also known as the "morning-after" pill or "Plan B" - to prevent unwanted pregnancies (Dye and Clarke, 5/7).

The Hill: Reports: Judge Hammers FDA Over 'Nonsense' Limits On Plan B
A federal judge slammed the Food and Drug Administration on Tuesday over its handling of the birth-control pill known as Plan B. Judge Edward Korman accused the FDA of putting politics above science and described its regulation of Plan B as "a lot of nonsense," according to media reports (Baker, 5/7).

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NIH Official Raises Concerns About New Psychiatry Manual

The director of the National Institute of Mental Health says the American Psychiatric Association's DSM-5 lacks validity, and his organization plans to launch a possible replacement diagnostic tool.

Medscape: NIMH, APA Clash Over Upcoming DSM-5
Two of the biggest organizations in the field of psychiatry are clashing over the soon-to-be-released Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which will be released by the American Psychiatric Association (APA) on May 18. ... In a blog post published on the National Institute of Mental Health (NIMH) Web site, the organization's director, Thomas Insel, MD, states that the upcoming manual is reliable but lacks validity and that "patients with mental disorders deserve better." ... Dr. Insel also reported that the NIMH is launching the new Research Domain Criteria (RDoC) project as a possible replacement diagnostic tool sometime in the future and as "a first step towards precision medicine." It will incorporate genetics, imaging, and other data into a new classification system. In addition, the organization noted that it "will be re-orienting its research away from DSM categories"  (Brauser, 5/7).

In other news about medical quality issues -

Reuters: Many Medical Guidelines Don't Consider Costs
Professional medical societies don't often consider costs when they're developing their treatment guidelines for specific conditions, according to a new study. Researchers found that just over half of the top medical societies with at least 10,000 members considered costs when developing best practices. The other half either implicitly considered costs or didn't address them at all (Seaman, 5/7).

Modern Healthcare: HHS To Providers: Check Lists Of Excluded Medicare Personnel
HHS maintains a list of 51,588 people who are categorically excluded from providing even indirect care to Medicare patients, and new guidelines that will be published today recommend healthcare providers check their personnel rosters against the list once a month. That obligation extends to temporary nurses and doctors who work under contract from staffing firms. And it might not hurt to print out screen shots proving that the list was checked, the new guidance says (Carlson, 5/8).

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State Watch

Calif. Senate Leader Readies Mental Health Service Expansion

The California Senate leader is proposing increasing mental health services to reduce how many end up in jail or ERs. In Massachusetts, officials plan greater scrutiny of how insurers cover mental health care.

Los Angeles Times: California Senate Leader Proposes Mental Health Program Expansions
State Senate leader Darrell Steinberg (D-Sacramento) on Tuesday proposed a plan to significantly increase mental health services in California with the goal of reducing the number of people ending up in prison, jail and emergency rooms. Steinberg said the plan is in response to the Newtown, Conn., school massacre, in which a gunman killed 20 students and six adults, as well as a scandal involving a Nevada hospital dumping patients in other states, and the recent order by a federal court to further cut the number of inmates in California prisons (McGreevy, 5/7).

Boston Globe: State Vows Scrutiny For Insurers On Mental Health Coverage
Seven health insurance companies have agreed in recent years to pay the state and consumers $5.6 million for failing to cover mental health care and other services that state law requires. Last month, U.S. Fire Insurance Company agreed to pay $625,000, and Transamerica in March said it would pay more than $1.3 million after the state alleged the companies failed to cover maternity care, pap tests, mammography, preventive care for children, along with mental health services (Conaboy, 5/7).

And in Georgia, nursing homes have cut their "off-label" use of antipsychotic drugs in nursing homes --

Georgia Health News: Nursing Homes Rein In Use Of Antipsychotic Drugs
Georgia nursing homes have cut their "off-label" use of antipsychotic medications by 16 percent, the biggest reduction in the nation, industry officials say. The Centers for Medicare and Medicaid Services has pushed for a decrease in the use of antipsychotics in managing dementia patients in nursing homes. Prescribing these drugs for behavior problems is considered "off-label" use, meaning they are being employed in a way that's different from their FDA-approved purposes. Off-label prescribing is a legal and very common practice (Miller, 5/8).

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State Roundup: Ala. Lawmakers OK Shift To Medicaid Managed Care

A selection of health policy stories from Alabama, Pennsylvania, Oregon, Connecticut, North Carolina and Georgia.

The Associated Press: Ala. Medicaid Reform Bill Ushers In Managed Care
A bill that restructures the way Medicaid is administered passed the Alabama Legislature Tuesday and now awaits the governor's signature. The State Medicaid Agency now pays doctors directly for services provided to Medicaid patients. Under the new policy, there will be several regions managed by privately owned, for-profit Regional Care Organizations that will contract with doctors and other providers (Wingard, 5/7).

The Associated Press: Abortion Debate Flares Up In Pa. Senate Committee
The latest stop for a Republican-penned bill to limit insurance coverage of abortions sparked an angry debate Tuesday among senators, reviving arguments over President Barack Obama's health care law and the case of a Philadelphia abortion doctor accused of killing a patient and four babies. The bill passed the Senate Banking and Insurance Committee after barbed exchanges that made for the most heated committee meeting in memory, several senators said (5/8).

Oregonian: Oregon House Narrowly Approves Workplace Protections For Domestic Workers
Oregon's estimated 10,000 domestic workers would be guaranteed certain workplace protections, such as overtime pay and eight hours of sleep, under a bill approved by the House on Tuesday. House Bill 2672 passed 32-28. It heads to the Senate. … The vast majority of domestic workers are women and people of color, Gelser said. Such workers often fail to report mistreatment by their employers for fear of losing their jobs, she said. An employer's spouse, parent, or child under 21 would not count as a domestic worker under the bill (Zheng, 5/7).

CT Mirror: Fighting To Preserve A Safety Net For People With Disabilities
Joseph Duffy worries about what will happen when he dies and is no longer around to fight budget cuts that threaten services for his 29-year-old developmentally disabled daughter, Katie. Despite her disabilities, Katie has a state-supported job at Cigna and has a weekly social outing. But nearly $40 million in proposed state budget cuts would threaten her delicate safety net, he said. "She has a small world, but it is everything to her," Duffy said. "If it is broken apart, it will destroy us." Duffy, of Wethersfield, was a speaker at a panel discussion Tuesday at the Capitol held to raise awareness of how $39.4 million in budget cuts would affect the lives of people with disabilities and their caretakers (Merritt, 5/7).

North Carolina Health News: Teen Medical Restrictions Bill Passes House Committee
A bill that would require adolescents seeking health care to get parental consent before talking to a doctor advanced Tuesday in the General Assembly. The bill, House Bill 693, would make North Carolina the only state in the country to require teens under the age of 18 to be accompanied by either a parent or guardian when seeking care for a pregnancy, sexually transmitted infection, substance-abuse problem or mental health issue (Hoban, 5/8).

Medpage Today: Ga. Law: Federal Metrics No Basis For Medical Liability
A physician's failure to meet federal quality improvement metrics cannot be used against him in a medical malpractice suit, according to a law signed this week by Georgia Gov. Nathan Deal (R). The law -- believed to be the first of its kind -- prevents federal quality-of-care or payment-reform metrics from being admissible in court, used as the standard of care, or used as a presumption of negligence in any medical malpractice lawsuit in the state. … Supporters of the bill, which Deal signed Monday, point to nearly a dozen provisions of section 3512 of the Affordable Care Act (PPACA) that patients might use to establish liability in medical malpractice cases, including hospital readmission measures, hospital-acquired conditions initiative, value-based payment modifiers, and shared savings measures (Pittman, 5/7).

The New York Times: Otis R. Bowen, Health Secretary Under Reagan, Dies At 95
Otis R. Bowen, who served two terms as governor of Indiana and later became the first physician appointed as secretary of health and human services, serving under President Ronald Reagan amid the rising debate about AIDS, died on Saturday in Donaldson, Ind. He was 95 (Yardley, 5/7).

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Editorials and Opinions

Viewpoints: Capitol Hill Antics On Budget; A Mom's Concern About Plan B Decision

The Washington Post: Child's Play With The Budget As Democrats And Republicans Battle
Republicans, after berating Democrats for enacting Obamacare and other bills behind closed doors with extra-parliamentary procedures, are insisting that any talks with Democrats be behind closed doors with extra-parliamentary procedures. Democrats, meanwhile, have suddenly become allergic to closed-door meetings and are insisting on a public "conference committee" and the "regular order." Republicans, after branding President Obama a tyrant, are now demanding that he show more leadership. Obama's aides, who overrode the legislative process whenever it was convenient, are now piously insisting on its integrity (Dana Milbank, 5/7).

The Washington Post: The Administration's Plan B Blunder
As a mom, I can't help but cringe. As a thinking adult, I can't help but reconsider. I'm referring to the continuing controversy over making emergency contraceptives available, without a prescription, to — and here is the standard, incendiary formulation — girls as young as 11 (Ruth Marcus, 5/7).

Politico: Primary Physician Shortage Calls For Intervention
Instituting major reforms in primary care and enabling people to see a doctor when they need one will save lives, ease suffering and save billions of dollars in wasteful health care costs. What should we do? First, we need to substantially increase the number of primary-care practitioners. ... Second, we must implement a major change in the culture of our medical schools. Some medical schools do an excellent job educating primary-care physicians, but too many do too little and some — believe it or not — do nothing at all. In 2011, about 17,000 doctors graduated from American medical schools. Only 7 percent of those graduates chose a primary-care career (Sen. Bernie Sanders, 5/8).

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The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.