Daily Health Policy Report

Monday, June 10, 2013

Last updated: Mon, Jun 10

KHN Original Reporting & Guest Opinion

Health Reform

Health Spending And Fiscal Battles

Capitol Hill Watch


Health Information Technology

Health Disparities

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

A Doctor Goes Viral -- On Purpose

Kaiser Health News staff writer Ankita Rao, working in collaboration with USA Today, reports: "Using satire, rap and sometimes, a Michael Jackson glove, hospitalist Dr. Zubin Damania takes his alter ego, ZDoggMD, to YouTube to sing about everything from insurance paperwork to prostate cancer. The result is hundreds of thousands of online views, and comedy that parodies pop culture (he does an excellent Yoda impersonation) and pushes some boundaries" (Rao, 7/9). Read the story.

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Obama: Health Law 'Working The Way It's Supposed To' (Video)

In this Kaiser Health News video clip, President Barack Obama speaking in California praised the health law benefits already in place and talked about the state's health insurance marketplace. He also placed a special emphasis on touting the law to the state's Latino population (6/7). Watch the video or read the transcript of his remarks.

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Political Cartoon: '(No) Waiting Room?'

Kaiser Health News provides a fresh take on health policy developments with "(No) Waiting Room?" by Aaron Bacall.

Meanwhile, here is today's health policy haiku:


Making public health
information go viral...
Laughter leads to change?

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 Reform

The Enrollment Push Is On

During a Friday speech in California, President Barack Obama touted the health law's benefits -- highlighting the Golden State's progress so far -- in his effort to encourage young people and Latinos to sign up for coverage that will be available through new online insurance exchanges.

The Wall Street Journal: Obama Pitches Health Law
With the launch of the 2010 health-care law's main provisions approaching, Mr. Obama used a trip to California to make his pitch and urge the uninsured to sign up for coverage. The state, which has nearly six million uninsured people and is the largest insurance marketplace in the U.S., is considered critical to the success of the law (Nelson and Mathews, 6/7).

The Associated Press/Washington Post: Obama Pleads For Californians, Latinos, Young People to Get Coverage Under New Health Care Law
President Barack Obama on Friday encouraged the uninsured or those paying high prices for health insurance to sign up for coverage under his health care law and urged opponents to stop wasting time continuing to fighting its implementation. Obama used a trip to California to highlight how the state is implementing the Affordable Care Act and rebut continuing criticism over his signature legislative achievement. He touted an effort in the state to recruit Hispanics in particular to the health care exchanges that are being created to help millions of now-uninsured consumers afford coverage (6/7).

Kaiser Health News: Obama: Health Law 'Working The Way It's Supposed To' (Video)
In California Friday, President Barack Obama praised the health law benefits already in place and talked about the state's health insurance marketplace. He also placed a special emphasis on touting the law to the state's Latino population (6/7).

Reuters: President Obama Takes Health Pitch To California After Rate Row
President Barack Obama insisted on Friday his healthcare overhaul is already proving worthwhile as he promoted the plan in California, where an argument is raging over whether it is living up to its name as the Affordable Care Act (Holland and Spetalnick, 6/7).

CQ HealthBeat: Obama Launches High-Profile, High-Stakes Campaign To Sell Health Law
Marking the opening round of what’s likely to be steel cage political combat over the impact of the health care law on insurance rates, President Barack Obama said on Friday in a speech in California that the overhaul is ushering in a new era of vigorous competition among plans in the state and elsewhere resulting in reliable, affordable coverage (Reichard, 6/7).

The Hill: Obama: Health Law Is Working Despite GOP Critics 'Fearmongering'
President Obama touted his signature healthcare law Friday, dismissing Republican "fearmongering" and arguing that the law is working…Obama's pitch for the healthcare law comes at a crucial time. The administration, along with state governments, is just months away from opening new insurance marketplaces and beginning to enroll millions of people in new coverage options (Baker, 6/7).

The Fiscal Times: Insurance Premiums A Mixed Bag Under Obamacare
President Obama on Friday touted California as a prime example of how his signature Affordable Care Act already is working, with state officials gearing up to provide an array of affordable health care policies and protections for the uninsured and defying the predictions of "doom and gloomers" of skyrocketing premium costs (Pianin, 6/7).

Los Angeles Times: Bill Clinton Challenges California To Lead On Healthcare Overhaul
Former President Clinton challenged California to make the federal healthcare overhaul work to silence naysayers and win over states that are still on the fence. Clinton, addressing an audience of doctors and healthcare executives in downtown Los Angeles on Friday, said he remains optimistic about the rollout of the Affordable Care Act despite unease among the American public and persistent Republican opposition (Terhune, 6/7).

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Counting Down To Online Insurance Marketplaces

The Wall Street Journal reports that consumers should start investigating the health law's insurance exchange options.   

The Wall Street Journal: Prepare For Big Piece Of Health Law
It's time to get ready to buy insurance. The biggest part of the health-care law—online exchanges that offer insurance to individuals—kicks in next year. And beginning this October, states will start selling those health-care plans, which adhere to a new set of standards, though online marketplaces. But there already are many ways that you can start investigating options ahead of the rollout. This summer is prime time to educate yourself about your options, say health-insurance experts (Johnson, 6/8).

Meanwhile, news outlets provide health law implementation news from D.C., California and Massachusetts -

The Washington Post: D.C. Offers A Peek At The Health Insurance Prices Proposed For New Exchange
In the first glimpse of what District residents and small business owners can expect to pay for health-care coverage under Obamacare, officials on Friday released a snapshot of the proposed plans from four major insurance companies. ... officials say a preliminary look reveals a large range of options at prices consistent with current rates (Vargas, 6/7).

Los Angeles Times: Town Hall Explains Healthcare Reform To Los Angeles Residents
Hundreds of L.A. County residents attended a town hall meeting at Cal State L.A. on Friday afternoon to learn about the state’s new insurance exchange, which will begin enrolling people this fall. Peter Lee, executive director of the health exchange called Covered California, explained what health plans were participating, what benefits were covered and how the enrollment would occur before taking dozens of questions from audience members (Gorman, 6/7).

Boston Globe: State May Fill Gap In Federal Health Care Coverage
A congressional mistake that could cause nearly 4 million people to be ineligible for federal subsidies in President Obama's health care law has prompted Massachusetts officials to launch a new effort to try to close the gap. Under what has become known as a "glitch" in Obama’s health plan, eligibility for insurance subsidies will be based on how much it costs workers who buy an individual plan, not the far more expensive family plan. ... Governor Deval Patrick’s administration has proposed a pilot program to allow workers at small businesses who cannot afford family coverage under their employer-sponsored health plans to qualify for subsidies (Jan, 6/10).

In other state news related to the health law -

Arizona Republic: Medicaid Expansion Gets Hearing In House
Facing a looming budget deadline and a bitterly divided Republican caucus, the state House today takes up Gov. Jan Brewer’s plan to expand Medicaid along with a controversial abortion bill some say is designed to kill the governor’s top legislative priority. The House Appropriations Committee will hold what is expected to be a contentious hearing on the two bills, likely ending with the defeat of Senate Bill 1492, which outlines Brewer’s plan to broaden Medicaid eligibility under the federal health-care overhaul (Reinhart, 6/10).

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Health Spending And Fiscal Battles

Sequester's Budget Cuts Slowing Alzheimer's, Other Research

And the bite on non-discretionary spending could be even bigger in 2014. Also, the urgency surrounding a budget deal may have faded.

The New York Times: Research Forgotten By Budget Cuts
Many Republicans, and Democrats, never thought the automatic across-the-board spending cuts known as sequestration would take effect. with After all, they might produce dangerous, if unintended, consequences like potentially bankrupting the U.S. health care system, … Because the cuts only affect the margins of a wide array of defense and domestic discretionary programs, there mostly hasn’t been an immediate pinch; the public backlash has been minimal. But the long-term consequences, in more than a few cases, are ominous. There is no better case study than Alzheimer’s disease. With the enforced cuts at the National Institutes of Health, research to find a cure or better treatment is slowing (Hunt, 6/9).

CNN Money: Spending Cuts Likely Deeper In 2014
There's been a lot of concern about the effects of the spending cuts under the so-called sequester this year. But it's likely that federal spending will soon go down even further in many ways. That's because, barring action by lawmakers, the cap on total defense and domestic "discretionary" spending is set $19 billion lower for fiscal 2014, which begins Oct. 1. … Social Security, Medicaid, food stamps and several other mandatory programs will be exempt. But others are not -- including federal extensions of unemployment benefits, farm subsidies and WIC, a supplemental nutrition program for women and children (Sahadi, 6/10).

The Washington Post: Urgency On Debt Fades With Big Issues Unsolved
But nearly half the improvement forecast for the coming decade is due to factors unrelated to the budget battles, including lower-than-expected health-care costs and a recovering economy, according to a Washington Post analysis of congressional budget data. The brighter budgetary outlook is recasting the political debate. ... Lawmakers, meanwhile, have done nothing to improve the finances of Social Security and Medicare, programs that already account for more than a third of federal spending (Montgomery, 6/7).

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Capitol Hill Watch

Grassley Continues Focus On Medicare Decision Trading Probe

Sen. Charles Grassley, R-Iowa, says that hundreds of people had access to information about a Medicare decision before it was announced, which triggered a spike in Wall Street trading. Also on Capitol Hill, compounding pharmacies are lobbying against pending legislation and a draft proposal on Medicare's 'doc fix' draws criticism.

The Washington Post: Hundreds In Government Had Advance Word Of Medicare Action At Heart Of Trading-Spike Probe
Sen. Charles E. Grassley (R-Iowa) told The Washington Post late last week that his office reviewed the e-mail records of employees at the Department of Health and Human Services and found that 436 of them had early access to the Medicare decision as much as two weeks before it was made public. The number of federal employees with advance knowledge is surely higher; the figures Grassley’s staff compiled did not include people at the White House's Office of Management and Budget who also saw the information. The e-mail records of those employees have not been made available to Grassley (Hamburger and ElBoghdady, 6/9).

The Hill: Pharmacies Say Harkin Bill Would Give FDA Unprecedented Powers
Compounding pharmacies are mounting opposition to a Senate bill they say would give the Food and Drug Administration unprecedented authority over their operations, including the power to ban hormones used to treat a wide variety of ailments. The bill, approved unanimously by the Senate Health, Education, Labor and Pension Committee late last month, would give the FDA increased regulatory power over compounding manufacturers who tailor drugs’ dosages or other properties to fit specific patient needs (Goad, 6/7).

MedPage Today: Wrinkles Emerge In SGR Repeal Debate
As Congress inches toward a change in the way physicians are paid under Medicare, an early-stage Republican proposal drew criticism this week for not going far enough. Rep. Allyson Schwartz (D-Pa.) called the latest draft proposal to reform Medicare's sustainable growth rate (SGR) formula "disappointing" because it mostly retains fee-for-service payments while using alternative payment models as an option to boost reimbursements. … But the latest draft, which drew the criticism of Schwartz, is "not a complete reform proposal," Rep. Joe Pitts (R-Pa.), chair of the Energy and Commerce Health Subcommittee, said (Pittman, 6/7).

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The 'Parallel Challenge:' Coordinating Care For Mental And Physical Health Issues

While the Los Angeles Times reports on the challenges of helping patients who struggle with physical and mental illnesses, the Boston Globe reports on a creative approach to reduce hospital readmissions. 

Los Angeles Times: Treatments Of Physical And Mental Health Are Coming Together
Physicians and therapists traditionally haven't collaborated much when treating the same patient, but the federal healthcare law is spurring a change. ... As the nation seeks to extend healthcare coverage to millions of new and in many cases chronically ill patients, ... [o]fficials expect many newly insured patients arriving at doctor's offices and urban and rural clinics to have mental health complications. Beginning next year, some 2.3 million additional people may require mental health services through Medicaid, the public health insurance program for the poor, according to a study published in the American Journal of Psychiatry (Gorman, 6/9).

Boston Globe: Meals To Help Patients In The Healing Process
Since she was diagnosed with heart failure earlier this year, Betty Winstead, 84, has become a familiar face at Carney Hospital. ... Last Monday, Steward Health Care launched a new approach for Winstead and patients like her. … Steward is spending $66,000 to buy food for one month for 55 heart failure patients, focusing on a disease with one of the highest readmission rates. One-quarter to one-third of these patients land back in the hospital within 30 days of being sent home, and many physicians believe too much salt is one culprit (Kowalczyk, 6/10).

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Health Information Technology

Going Viral With Public Health Messages

Kaiser Health News reports on how one doctor is using YouTube to communicate public health messages while The Washington Post reports on how a data event leads to consideration of health care cost solutions. 

Kaiser Health News: A Doctor Goes Viral -- On Purpose
Using satire, rap and sometimes, a Michael Jackson glove, hospitalist Dr. Zubin Damania takes his alter ego, ZDoggMD, to YouTube to sing about everything from insurance paperwork to prostate cancer. The result is hundreds of thousands of online views, and comedy that parodies pop culture (he does an excellent Yoda impersonation) and pushes some boundaries (Rao, 7/9).

The Washington Post: Health Data Event Draws Companies Promising Cost Savings
As technology companies apply data analytics to virtually everything from Web traffic to movie recommendations, many are seeing health care as the next frontier. Companies from established contractors to start-ups are pitching data analysis as a critical way to improve the way doctors, patients, insurers and government bodies manage health care. The rush of fresh ideas encompasses a range of solutions, but the marketing is often the same: They all purport to address the rising cost of health care (Censer, 6/9).

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Health Disparities

Medical Bills Higher For African Americans

NPR: African Americans Remain Hardest Hit By Medical Bills
For many years, high medical bills have been a leading cause of financial distress and bankruptcy in America. That pressure may be easing ever so slightly, according to a survey released earlier this week by the Centers for Disease Control and Prevention. But one in five Americans still face hardships due to medical costs — and African Americans continue to be the hardest hit (Neighmond, 7/10).

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State Watch

State Roundup: Calif. Inches To Budget Deal; Iowa's Medicaid Abortions May Need Gov. OK

A selection of health policy stories from Colorado, Virginia, California, Iowa, Pennsylvania, Florida and Kansas.

The Associated Press: State Laws Varied On Gun, Abortion Laws
The U.S. Supreme Court says women in America can terminate a pregnancy and that every citizen has an individual right to own a firearm, but those rulings have done little to settle political arguments over abortion and guns. The result is an uneven medley of state laws, which means that just how you can exercise those constitutional rights depends on where you live, and the differences often turn on whether a state is run by Democrats or Republicans (Barrow, 6/8).

Stateline: Majorities Drive Sweeping, Divergent Changes Across States
Gun curbs? Colorado got it done. Driver’s licenses and in-state tuition for immigrants in the country illegally? Done. A new school-spending plan, an elections overhaul, Medicaid expansion? Done, done and done. Democrats, with a majority in both houses of the Colorado legislature after years of shared control, seized all they could in a whirlwind legislative session that Senate Majority Leader Morgan Carroll described as "historically productive." …  Of course not all decisions have been darkly shaded in red or blue. In Colorado, lawmakers came together to tax and regulate marijuana, which voters last year approved for recreational use. … And in Virginia, legislators reached across the aisle to find billions in new revenue for long-needed transportation projects. Under a compromise with Democrats, Republican Gov. Bob McDonnell, who championed the package, promised to expand Medicaid under certain conditions. However, he has since refused expansion (Malewitz, 6/10).

Los Angeles Times: Negotiations Could Yield Health Care Deal In Capitol
County officials and Gov. Jerry Brown's administration are inching toward a compromise on health care funding. The potential deal is the result of intense negotiations, including face-to-face meetings, phone calls and late-night text messages (Megerian and York, 6/7).

The Associated Press/Washington Post: In Iowa, Payments For Medicaid-Funded Abortions May First Need OK From Anti-Abortion Governor
Iowa's Medicaid program covers a small number of abortions each year due to rape, incest, fetal deformity or to protect a mother's life. Currently handled by the state Department of Human Services, the Medicaid reimbursements cost the state less than $20,000 last fiscal year. The change in who approves the payment is a result of Iowa's unusual political landscape (6/7). 

Philadelphia Inquirer: Cooper Health To Team With Houston Cancer Center
In a move with potential to shake up the health care market in Philadelphia and beyond, Cooper University Health Care in Camden is expected to announce on Monday a partnership with the MD Anderson Cancer Center of Houston, one of the nation's top-ranked treatment and research facilities. Cooper officials said they had signed a letter of intent to form the partnership with MD Anderson, which will manage a new $100 million cancer treatment center at Cooper's hospital campus in Camden (Mondics, 6/10).

Health News Florida: Who Forgot To Fix Compounding Law?
The 2013 Legislature could have fixed a tiny gap in Florida law that blocks health officials from regulating hundreds of out-of-state compounding pharmacies that ship high-risk drugs into this state. But that didn’t happen. No bill was ever filed (Gentry, 6/7).

Kansas Health Institute: State Officials Submit First Quarterly KanCare Report To Feds
Kansas officials this week made public their first quarterly report to federal authorities on the progress of KanCare, Gov. Sam Brownback's initiative to move virtually all the state's Medicaid enrollees into privately run managed care plans. The initiative was launched Jan. 1 with federal approval as part of a so-called Section 1115 Medicaid waiver intended to demonstrate that the Kansas plan can curb program costs while improving outcomes for the state's more than 380,000 Medicaid beneficiaries (Shields, 6/7).

California Healthline: DHCS Transparency Bill Moves Forward
The Senate Committee on Health this week approved a bill that would set new standards of accountability and transparency at the Department of Health Care Services. AB 209 by Assembly member Richard Pan (D-Sacramento) received unanimous committee approval Wednesday and now heads for a Senate floor vote, the step before it can be sent to the governor's desk. The bill wants to hold the department accountable for problems that arise with patients moving to Medi-Cal managed care plans with stronger, measurable benchmarks, Pan said (Hart, 6/7).

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Editorials and Opinions

Viewpoints: Selling Obamacare In Arizona; 'Hassle-Free' Marketplace; Seeking The 'Grand Bargain'

Arizona Republic: Actually, You Like Obamacare. Just Ask Brewer
You may not admit it, but you are a fan of Obamacare and Gov. Jan Brewer knows it. The Republicans who run the Arizona legislature don’t like Obamacare. And the Republicans who control the U.S. House of Representatives don’t like it. But you do. You may deny it. You may not even know it. But you do. And that will help the governor get her Medicaid expansion plan through the legislature (EJ Montini, 6/6).

Los Angeles Times: Health Insurance: Can It Be Made Simple?
The success of the 2010 federal health care law depends in part on more uninsured Americans obtaining coverage. So it's crucial that when the uninsured try to sign up for policies, they don't get a bureaucratic runaround or wind up in phone-tree hell. Yet that's what may happen in California. It's up to state lawmakers and the Brown administration to make sure that counties and Covered California, the state's new insurance-buying exchange, can provide hassle-free customer service (6/7).

The Washington Post: We Still Need A Grand Bargain
When the Great Recession hit in December 2007, the United States' publicly held debt amounted to less than 40 percent of gross domestic product -- well within the normal range since World War II, when the figure temporarily, and necessarily, soared above 100 percent. Consequently, the federal government was well-positioned to fight the plunging growth rate by spending more and taxing less; it had ample "fiscal space" (6/9).

The Washington Post: Trust Funds Are Least Of Social Security, Medicare Problems
The just-released annual trustees' reports for Social Security and Medicare are supposed to keep the public well informed about these popular programs. In reality, they do just the opposite: They confuse and mislead. Worse, they allow politicians to duck the hard issues surrounding both programs. What we ought to be debating is how much spending on retirees will dominate government. Instead, we focus on the actuarial soundness of the trust funds, a baffling subject (Robert J. Samuelson, 6/9).

The New York Times: The Culprit Behind High U.S. Health Care Prices
Alas, in their self-appointed role as purchasing agents in health care, American employers have arguably become the sloppiest purchasers of health care anywhere in the world. The chaotic price system for health care is one manifestation of that sloppiness. For more than half a century, employers have passively paid just about every health care bill that has been put before them, with few questions asked. And all along they have been party to a deal to keep the chaotic price system they helped create opaque from the public and even from their own employees (Uwe E. Reinhardt, 6/7).

The New York Times: The Weird World of Colonoscopy Costs
Colonoscopies are one of three standard ways to screen for colorectal cancer. So it is disturbing to learn that the cost of this routine procedure, performed on more than 10 million Americans each year, differs radically from state to state and even within the same metropolitan area. ... Under the reform law, insurers have to pay for preventive services like colonoscopies without cost-sharing. But, in most cases, giving patients more information could help. ... High costs are no guarantee of high quality (6/8).

Roll Call: Mindful Of Previous Defeat, Cantor Pushes To Increase Pediatric Research
House Majority Leader Eric Cantor and his staff are working behind the scenes to avoid another embarrassment this month when they bring to the floor a bill that would increase funding for pediatric research. The measure is part of the Virginia Republican’s agenda to soften the Republican image. But it is running up against the same hardline conservatives who forced leaders in April to pull from the House floor a bill (HR 1549) that would have reprioritized funding within President Barack Obama’s health care law (Newhauser, 6/7).

The New York Times: Governor Cuomo Fights For Women
Gov. Andrew Cuomo of New York, who coaxed legislators into allowing same-sex marriage two years ago, has challenged them to broaden and strengthen the rights of women, including abortion rights. Should he persuade the Legislature to go along, he would stand in striking contrast to Republican governors across the country who are doing just the opposite (6/9). 

The Miami Herald: Toughing Out Mental Illness Not An Option
I cannot write this the way I want. Doing so would invade the privacy of too many people. But I can’t be silent, either. Last week, you see, President Obama spoke before a conference of mental health advocates at the White House. It is necessary, he said, to remove the stigma of mental illness and make sure"people aren't suffering in silence," that they know they are not alone, but are supported by the rest of us as they face this challenge. It would seem a plain vanilla thing to say. But in this endless era of smash mouth politics, nothing is plain vanilla anymore (Leonard Pitts Jr., 6/10).

The Washington Post: D.C. Taxpayers On The Hook For $43 Million In Unpaid Health Bills
Thompson was also the sole owner of D.C. Chartered Health Plan, a business that had been the city's dominant Medicaid provider, serving more than 100,000 low-income residents. It's fair to say that the city's health care system has been compromised by the collapse of D.C. Chartered, which was forced into receivership last fall after auditors found financial irregularities and low funding reserves. A small army of local health care providers have been saddled with unpaid claims (Colbert I. King, 6/7). 

Medpage Today: Face Up To Front Office Challenges
Your front office staff are the face of your practice -- an expression of your practice's philosophy, attitude, and values. So it should be a top priority to hire and retain top-quality people to fill such roles as receptionists, phone operators, medical secretaries, and transcriptionists. But it can be a challenge to keep these people and keep their morale high because these positions often include high levels of stress for low pay. So try something different, right from the start: Pay more for the right candidate. If you pay someone more than they think they're worth, they'll work up to that level. If you pay people less, they'll work down to that level (Rosemarie Nelson, 6/8).

Boston Globe: A Fingerprint Does Not Contain Your Genetic Code
The power of genetic information has shaped virtually every aspect of medicine. On one hand, we have learned about diseases and treatments that are now defined by patients' genomes. Certain genes can predict colorectal cancer with near certainty and, in women, the BRCA mutations, famously discussed by Angelina Jolie, can denote a greater than 80 percent risk of developing breast cancer. We can screen newborns for dozens of genetic diseases and immediately know which diets to avoid giving them or which medications to begin early. Physicians are using genetic markers to better tailor therapies to individual patients. We are certainly entering a new era (Nathaniel Morris, 6/10).

Forbes: Why We Should Be Spending More On Pricey Cancer Drugs
Here's a heretical statement: We don't spend enough on high-priced cancer drugs. In recent months, there have been provocative editorials by leading academic cancer doctors arguing that the price of many new cancer drugs is too high. But what if the high price of new drugs is a reflection of the value that these medicines bring to not only individual patients, but also our health care system? Doctors can reject the early data available at the time of initial FDA approval of a particular drug (Scott Gottlieb, 6/10).

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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.