Longer looks: Tough health care questions for GOP presidential contenders; Robotics help spike use of prostate treatment

May 20 2011

Every week, Kaiser Health News reporter Jessica Marcy selects interesting reading from around the Web.

The Economist: Romney And Cognitive Dissonance
For my money, the most interesting thing about Mitt Romney's health-care speech last week wasn't his struggle to defend Romneycare and distance it from Obamacare, but the largely hostile reception of the speech from the right. … Mr Romney may have failed last week to satisfy wonkish politics junkies, but his federalist case for state experimentation in health-care policy sounds both sensible and conservative—at least if one doesn't push on it too hard, and most voters won't. Perhaps most importantly, when he talks about this issue, he comes off as an impressively capable man. … Conservatives who wish to continue pretending Obamacare does not significantly resemble conservative health-care proposals circa 2006 may want Mr Romney to disappear, and that certainly doesn't help his cause, but it's not enough to make me write him off (5/17).

MedPage Today: AUA: Robotics Blamed For Spike In Prostate Surgery
Adoption of robotic technology fueled rapid growth in the use of prostatectomy at a time when the incidence of prostate cancer decreased, investigators reported here. The annual prostatectomy volume in the United States increased by almost 50% from 2005 to 2008, after remaining stable during 1997 to 2004. The dramatic uptick in prostatectomy volume coincided with rapid adoption of robotic-assisted laparoscopic prostatectomy (RALP), which accounted for 15% of all prostatectomies in 2004 but more than 80% in 2008. … [James Montie, MD, of the University of Michigan in Ann Arbor said]: "Why is that, in an era when the incidence is going down and there is no reason to believe that the disease is a lot more dangerous than it used to be?" (Charles Bankhead, 5/15).

The Atlantic: Why HIV Treatment Needs 10 Times Its Current Funding
On Friday I chaired a lively meeting of the Institute of Human Virology at the University of Maryland School of Medicine, founded by leading AIDS researcher Dr. Robert C. Gallo. … I thought about how much had changed since Bob had co-discovered the AIDS virus in 1984 and since 1996 ... While researchers are still struggling to develop a preventive vaccine, the treatment of HIV/AIDS has drastically changed. For most of the developed world, HIV/AIDS has been transformed from a death sentence to a chronic disease. … Now we need to accelerate our efforts to treat everyone infected with HIV. About 31 million people are infected worldwide, and we're only treating 3 million (Kathleen Kennedy Townsend, 5/17).

National Review: Who Is The Republican Health-Care Candidate?
The Wall Street Journal and most NRO writers have pretty much written off both Mitt Romney and Newt Gingrich as acceptable Republican presidential candidates because of perceived weaknesses on health care. ... Until recently, a Republican could churn out crowd-pleasing sound bites about fixing health care but never put the pedal to the metal by investing political capital in a serious proposal for reform. Republicans understood that when the talk turned to health care, Democrats won the debate and Republicans lost. … Campaign bromides won't work this time. The winning Republican candidate will have to prove beyond any shadow of a doubt that he (or she) will immediately sign the one-page (health law) repeal bill  (John R. Graham, 5/17).

Mother Jones: Debunking the Right's Health Waiver Conspiracy 
Is House Minority Leader Nancy Pelosi helping companies in her district get around new health care rules? Conservatives seem to think so, but their evidence is spotty at best. ... In fact, the recent waiver applications from businesses in Pelosi's district were not even received by the minority leader's office. Rather, they were submitted directly to the Obama administration through a third-party company (Suzy Khimm, 5/18).

American Medical News: Insurer-Owned Clinics Bid To Offer More Patient Care
Recently, many of those insurers have expanded that branch of business, with a focus on care provided by nurse practitioners or physician assistants. Some are targeting plan members within a specific demographic, such as Medicare or chronically ill patients. Others are targeting communities where they believe members have few options, outside of emergency departments, for urgent care. What's in it for the plans? Analysts say insurers believe they can get more direct control of medical costs by actually providing care. Also, they have an opportunity to market their names to the millions who will be shopping for individual insurance, required under the Patient Protection and Affordable Care Act by 2014. And the insurers can keep for themselves some of the 80% to 85% (depending on the health plan) they are required to spend on patient care (Pamela Lewis Dolan, 5/16).

Related, earlier KHN story: Health Insurers Opening Their Own Clinics To Trim Costs (Weaver, 5/4)

Hospitals & Health Networks: Health Coaching
Achieving effective communication between two specialty groups is an accomplishment; managing five at once is nearly miraculous. But Coon has a partner on the inside—Dave Swieskowski, M.D., CEO of Mercy Clinics in Des Moines. Swieskowski is a data hound who believes that systems must be redesigned to better harness technology developed over the last 50 years. And he strongly believes patients must be more involved in their own care. … Mercy has been tracking patient outcomes for about 15 years, and success is equal parts patient and provider effort. Through the health coach and shared decision-making programs, patients are trained to become active participants in their care. Health coaches ask patients to set health behavior goals versus outcome goals, and together, coach and patient develop a behavior-change plan with one- to two-week follow-up compared with the typical three months (Tracy Granzyk Wetzel, May 2011).