Thursday, January 15, 2009

Extra! Extra! Read all about it! Health care to get billions in federal dollars

Today, Representative David Obey (D-WI) released the contents of the economic stimulus bill that will be considered next week by the Appropriations Committee. According to a press summary released by his office, the bill includes tens of billions of funding for health care, including:

- Health Information Technology: $20 billion to jumpstart efforts to computerize health records to cut costs and reduce medical errors.
- Training Primary Care Providers: $600 million to address shortages and prepare our country for universal healthcare by training primary healthcare providers including doctors, dentists, and nurses as well as helping pay medical school expenses for students who agree to practice in underserved communities through the National Health Service Corps.
- Prevention and Wellness Fund: $3 billion to fight preventable chronic diseases, the leading cause of deaths in the U.S., and infectious diseases.
- Healthcare Effectiveness Research: $1.1 billion for Healthcare Research and Quality programs to compare the effectiveness of different medical treatments funded by Medicare, Medicaid, and SCHIP.
- Community Health Centers: $1.5 billion, including $500 million to increase the number of uninsured Americans who receive quality healthcare and $1 billion to renovate clinics and make health information technology improvements.
- National Institutes of Health Biomedical Research: $2 billion, including $1.5 billion for expanding good jobs in biomedical research to study diseases such as Alzheimer's, Parkinson's, cancer, and heart disease - NIH is currently able to fund less than 20% of approved applications - and $500 million to implement the repair and improvement strategic plan developed by the NIH for its campuses.
- COBRA: $30.3 billion to extend health insurance coverage to the unemployed, extending the period of COBRA coverage for older and tenured workers beyond the 18 months provided under current law.
- Medicaid Coverage for the Unemployed: Provide 100 percent federal funding through 2010 for optional State Medicaid coverage of individuals (and their dependents) who are involuntarily unemployed and whose family income does not exceed a State-determined level, but is no higher than 200 percent of poverty, or who are receiving food stamps.

The funding priorities seem to be consistent with ACP priorities: more money for health information technology, medical research, primary care training programs, prevention, comparative effectiveness, and health insurance coverage.

Of course, the devil will be in the details and distributing the money so that it has the biggest impact will be a challenge. (For example, just throwing money at health information technology will not do a lot of good, if it doesn't get directly to the physicians who need the most help, or if it ends up being spent on health information systems that don't have the functions needed to improve outcomes.) I will have more to say about the stimulus bill in tomorrow's blog.

Today's questions: At first glance, do you agree with the health care funding priorities in the stimulus bill?


Anonymous said...

It seems like an odd distribution. $0.6B to redistribute primary physicians throughout the world of medical care but twice that for effectiveness research? I assume there will be a lot more people with high incomes applying the healing hands than tediously teasing out what happens to the patients who received that treatment. And cobra's investement is 50 times the primary care investment. Might be better just moving to universal health care so people don't need cobra when their job disappears, as the designers of this stimulus predict or there would not have been a need for such a generous allottment.

rich the furrydoc

PCP said...

No amount of funds to "train" primary care doctors or other providers will do any good if the conditions are not improved for them.
When I look at the breakdown of the funds, I find it appalling that so few funds are applied to supporting primary care doctors in practice, and so much effort is made to paper over a problem that is so much more deep. Unless we can make primary care careers attractive, on par with specialty careers in both income, prestige and work/life balance, we might as well be whistling in the wind.
I realize that this is just a temporary stimulus measure, however unless your life's dream is to be employed working at a CHC alongside many mid-levels with administrators who have all the control over your working conditions, I doubt you would find any solace in these measures. I hope that is not the solution that the ACP is advocating for as the future of Internal Medicine.