Ronald DePinho, M.D.
Posted on 12/11/2013 10:45:04 AM PST by ShadowAce
Just recently, the University of Texas MD Anderson Cancer Center was announced as one of an elite group of six cancer research and treatment centers throughout the world who will participate in an ongoing collaborative effort to fast-track the advancement of cancer treatment development as part of a new GlaxoSmithKline initiative. It is just one in a series of many examples of how MD Anderson is the preeminent cancer research and treatment center in the United States, if not the world.
According to a new report in the Financial Times, new healthcare plans are being nudged by the statutes of the Affordable Care Act, otherwise known as Obamacare, so that they will exclude in-network coverage for patients to visit top cancer hospitals for advanced therapy — including MD Anderson — when the plans go into full effect next year.
Under the new healthcare plans, a cancer center like MD Anderson will not be included as part of the choices within patients’ covered networks. Instead, visiting MD Anderson for cancer treatment would be “out-of-network,” meaning that very little of the cost would be covered by insurance; most would come out of pocket.
According to the FT report, the shift by insurers to exclude coverage to top treatment centers has everything to do with the new statutes handed down by Obamacare, which seeks to balance costs through what critics see as rationing of care and limiting choices for patients:
“One of the biggest goals of ‘Obamacare’ was to make subsidized healthcare plans that are being sold on the new exchanges as affordable as possible, while also mandating that certain benefits, like maternity care, were covered and that people with pre-existing medical conditions could not be denied access.
Amid these new regulatory restrictions, says Tim Jost, a health policy expert, insurance companies have had to come up with new ways to cut the cost of their products. In this new era, limiting the availability of certain facilities that are seen as too expensive – in part because they may attract the sickest patients or offer the most cutting edge medical care – is seen as the best way to control costs.”
The Obama administration has moved aggressively to characterize this lack of coverage as the fault of insurance companies, and that Obamacare in an of itself has not dictated that top research and treatment centers explicitly be excluded from plans that conform to the law’s new rules, with an HHS spokesperson noting that, “Decisions about which private health insurance plans cover which doctors is a decision currently made by insurers and providers and will continue that way.”
Yet, industry experts explain that, because new Obamacare statues have constrained healthcare insurers’ ability to maintain profitability, the only recourse is to narrow healthcare networks to include only the most cost-effective providers. Because of this, top cancer centers like MD Anderson, whose healthcare prices billed to insurers — and ultimately patients — are higher due to its faculty of world-renowned researchers and medical practitioners, are too expensive to include in networks.
Supporters of Obamacare have sought to portray these research institutions’ price points less as a result of their excellence, and more because of institutional inefficiencies. However, Thomas Priselac, president and chief executive officer of Cedars-Sinai Health System in California, explained to the FT, “There is confusion between price and efficiency,” adding, “The major teaching and research hospitals are more expensive not because they are inefficient but because of what they do.”
Ronald DePinho, M.D.
While Obamacare is already facing the prospect of the so-called “death spiral” in striking a balance in solvency with the risk of the healthy, young “invincible” generation rejecting the coverage, thus hyper-inflating healthcare costs for the rest of Americans, the risk of reducing revenues to research and treatment centers such as MD Anderson is that Americans could lose access to critically important specialized treatments, as well as experimental research that in necessary in continuing to advance new treatments and possibly cures for deadly diseases such as cancer.
Dr. Ronald DePinho, CEO of MD Anderson, offered what can now be seen as a prophetic set of comments on this issue back in May, when he said in a candid memo to the institution: “We can’t run the institution at an operating loss, especially at a time when the health care field faces external challenges from implementation of the Affordable Care Act, the budget sequester and continuing federal deficits. If we don’t make changes now, we potentially will find ourselves in a crisis that will force us to take drastic measures that could hurt our ability to meet our mission.”
If this was Dr. DePinho’s position in May, certainly it has sharpened in the months since the rollout of Obamacare.
[UPDATE 12/9/2013 1:15pm CST: An MD Anderson spokesperson issued the following statement to the press in response to the Financial Times article:
“All patients deserve access to top tier cancer care. MD Anderson and the nation's other top cancer centers play a key role in the fight against cancer, and particularly aggressive forms of the disease or rare cancers where expertise is limited to only a small number of facilities worldwide.
In addition, our country's leading cancer centers help bring down the cost of care for all patients by conducting research that leads to new and better treatments, better cancer fighting strategies and increased efficiencies that lead to cost savings. This knowledge is shared among all cancer care providers to benefit patients in the US and beyond our borders.
While every cancer patient may not need to come to MD Anderson, we believe both insurance providers and our health care system must work together to ensure patients have that option so that all of us have the best chance of beating cancer.” ]
Obamacare: If you don’t like you cancer, you can keep you cancer.
A relative of mine had cancer, they lived for many years due to the advance medal care available to them. Lived well into their 80’s, died form old age and not cancer. Under Obama they would have died approx. 15 years earlier.
Amen! MD Anderson has performed miracles for so many people.
Hope you have a great Christmas!
Give them all a bacon enema!
Our nations health care system was sent on a path of destruction by the Late Senator Teddy The Swimmer who was never anything but the best health care taxpayers could buy. The HMO Act which is what mainly killed off affordable private insurance. HMO's will be the ones managing whatever sort of abomination this all works out too.
18 years ago before I had to retire I had decent health care insurance. My employer a health care facility with about 200 employees was self insured. Even at lower wages the $500 deductible a year I could absorb. I chose any doctor I wanted and any hospital. The company was also protected by a catastrophic policy they carried when it hit the $10K yr mark on an individual.
What angers me most was most of the underlying causes of high health care cost were never addressed to start with. One was the HMO ACT. The next of course was Tort Reform for doctors and hospitals. The FDA also needed to make it much easier, quicker, and a fraction of the cost to get newer drugs on the market.
The doctors have been made out to look like greedy monsters in all of this. My doctor still makes hospital rounds. When my wife is in the hospital he shows up about 6:00am. I know for a fact he's still seeing patients in his office at 5:00pm. In 28 years of dealing with many doctors for my wife's ongoing issues only two doctors she ever saw should have been disciplined. One was a dentist doing procedures he was not trained to do and other was a Moron in an ER who did not do a simple PDR on medications and adverse reactions. The ER doctor I took care of not by suing but by contacting hospital Chief Of Staff and telling him what happened.
We've done been through several health care non availability crisis after our state in about 1995 went to a HMO System on Medicaid thnks to a DEM governor and a RINO to follow as well as the help of Gore. We lost two doctors in about a year and none would take my wife because of dual eligibility. I was smart enough to have enough on hand the have to have medications to cover the six month plus Gaps.
I believe that unless the 2014 election produces some very major turnover in congress including the booting out of the current GOP leadership sell outs McConnell and BooHooner our health care system as we knew it before the PelosiCare/ObamaCare Tyranny will be in complete chaos.
We need term limits in Congress. Eight years lifetime for REPs and no more than Twelve years lifetime for senators. Perhaps it's also time to start electing Federal Judges rather than having appointed Feral Judges on the bench. There should be no lifetime appointments in any court.
I do think, however, that there may be some creative solutions that emerge. The one thing MDA has is a lot of money and a lot of influence. It would not surprise me if they teamed with certain selected insurers and came up with their own plans (which may include a penalty to have to be paid to the looter government) that would allow access to MDA under the current law. They also may take the tack of suing FedGov over this for things such as monopolistic practices, unfair restraint of trade, unfair price fixing/price manipulation, or things of that nature. They should have standing for lawsuits of these types because of the financial damage that will be done to them by the looter government.
......and I am so thankful you and all of us have access to such fine hospitals.
I understand your anger...
Just recently my husband was spared because his doctor refered him to the Mayo Clinic...
I can't imagine not having the choice of our great hospitals.
Daily, our citizens are inundated with more c-r-a-p from this administration.
We are all at the breaking point.
What a waste of bacon!!!
;-)
Hope your doing well, Jeff!
Thank you. I am.
I have known about this for well over a year and contacted MD Anderson, my Congressional Rep and my US Senator.
This was going to go into effect this calender year (2014), but becuase of the mid-terms, Obama pushed it back a year to 2015 because this and many other provisions of the group mandate (like it did with the individual mandate) are going to directly impact millions of people and he did not want to further exacerbate and already bad situation for the DNC.
These people who are ofisting this on America are a bunch of slovenly, slick tongued, bastards and scheisters. I say this not so much because of its impact on me, but more because of the hundreds and hundreds of children I have seen down there over the years who are being helped by the unbelievable talented and compassionate people at MD Anderson and other places who now will not be able to get that level of cre.
And it is the intent of these little fascists and progressives to hurt the health care of America...not improve it. Even though they wrap it up in such names as the “Affordable Health Care Act.”
So, this year will be my last visit to MD Anderson for care. I will have to use the Idaho facilities who already told me they did not want to try and treat such a rare cancer. I am sure they will do their best now.
As I figure it, there is a God in Heaven, and the affiars of man are under His watch. If He wants me home, there is no power on earth that will keep me here. if He wants me to stay, there is no power on earth that can take me. I gladly turn my well being and future over to Him whoi is moghty to save. And will be happy with His decision either way.
God’s speed...and thanks for asking.
I saw a doctor’s bill to my son this week. He’s ‘self-pay’ and for such earns something like a 50% ‘discount.’ Nice!
MD Anderson will accept Blue Cross Blue Shield PPO Bronze, Silver, Gold and Platinum plans from the healthcare exchange in 2014.
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