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Tevi Troy's Blog

Five Takeaways from the Obama HIV/AIDS Plan

Here are five things you should know about the Obama administration's new HIV/AIDS policy and its just-released strategy and implementation plan on the subject:

1. The plan is more open about the issue of racial and gender disparities among HIV-positive people than a report from a Republican administration likely would have been. According to the report:

Significant racial disparities in HIV infection exist in the United States. According to CDC, the overall rate of HIV diagnosis for Blacks was roughly eight times the rate for Whites in 2006. The HIV diagnosis rate for all Black males (119.1 per 100,000 population) remains the highest of any racial/ethnic group and is more than seven times that for White males, twice the rate for Latino males, and twice the rate for Black females. Additionally, the diagnosis rate for Latino males was approximately three times that for White males. The HIV diagnosis rate in 2006 for Black females and Latinas was more than 19 times and 5 times (respectively) the rate for White females. Disparities in HIV infection also exist between gay and bisexual men and heterosexual populations. Recently, the CDC announced that gay and bisexual men in the United States are 44 to 86 times more likely to become infected with HIV than heterosexual men, and 40 to 77 times more likely to become infected than women.

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By Tevi Troy  |  Tue, July 13, 2010 1:00 PM  |  Permalink

Baucus on Berwick

The White House's plan to lay all of the blame for the Obama administration's recess appointment of Dr. Don Berwick on recalcitrant Republicans appears to have been upended by Democratic senator and Finance Committee chairman Max Baucus, who has criticized the Berwick recess appointment: "Senate confirmation of presidential appointees is an essential process prescribed by the constitution that serves as a check on executive power and protects . . . all Americans by ensuring that crucial questions are asked of the nominee — and answered."

This did not sit well with the Daily Kos' Joan McCarter, who wrote that his comments demonstrate that "Max Baucus proves, yet again, that he's a major obstacle to any improvement in our nation's health-care system. Now he's throwing a hissy fit over Obama's recess appointment of Donald Berwick." McCarter is wrong. Baucus's comments are not about Baucus's views on health care but his prerogatives as chairman of the relevant committee.

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By Tevi Troy  |  Thu, July 8, 2010 11:48 AM  |  Permalink

Berwick Blues

As one who generally believes that administrations should receive deference in their personnel selections, I found the recess appointment of Dr. Donald Berwick to be the administrator of the Centers for Medicare and Medicaid Services (CMS) disturbing. When the Obama administration came into office in January of 2009, it was no secret that an ambitious health-care overhaul was one of their top priorities. Once legislation of the magnitude they were planning passed, implementation of the new system became vital to making it work, and CMS, an enormously important agency with a budget larger than that of most countries, was going to be at the heart of that implementation process.

With this in mind, it was incumbent upon the administration to have a confirmed CMS administrator in place and ready to get started before any health-care legislation passed. The administration failed to do this. Instead, it waited until after the health-care bill passed in March to proceed. It waited in part because of fears that a confirmation battle would interfere with the health-care legislative battle, and in part because Dr. Berwick reportedly would only take the job if a health-care overhaul passed Congress.

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By Tevi Troy  |  Wed, July 7, 2010 3:14 PM  |  Permalink

Obama to Insurers: Don't Use Regulations as an Excuse to Hike Costs

President Obama's speech today seemed designed to reassure us that all is well with the new health-care law, from both the implementation and the policy perspective.

Unfortunately, all is not as well as he is making things out to be. On the implementation side, as I wrote last week, the administration is facing a host of serious logistical challenges, and has already missed a series of early implementation deadlines.

The policy side, however, is more important, and it is becoming increasingly clear, even to the White House, that the new bill is likely to drive premiums upward. According to to an AP story this morning, the White House is worried that "escalating premiums will force more people drop their policies before the law is fully implemented." Administration officials are right to be concerned, but they are also making the problem worse, as the president announced a series of regulations that will exacerbate insurance costs.

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By Tevi Troy  |  Tue, June 22, 2010 3:16 PM  |  Permalink

Vaccine Wars

AP medical writer Maria Cheng has the best story on Andrew Wakefield's expulsion from the ranks of British doctors for his flawed study purporting to link the measles, mumps, and rubella (MMR) vaccine with autism. Cheng goes beyond the action against Wakefield and talks about the implications of his claims. She correctly notes that as a result of Wakefield's study, "legions of parents abandoned the vaccine, leading to a resurgence of measles in Western countries where it had been mostly stamped out."

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By Tevi Troy  |  Tue, May 25, 2010 5:00 PM  |  Permalink

Long Delay

Multiple sources are reporting that the Obama administration is poised to nominate Dr. Donald Berwick as the administrator of the Centers for Medicare and Medicaid Services (CMS). The agency has not had a permanent head since 2006, when Mark McClellan left, in large part because the Democratic Senate refused to confirm the well-regarded career official Kerry Weems to the post. Weems closed out the Bush administration in an acting capacity.

The Berwick choice itself is not very contentious. He is a quality expert who believes that we can get more value out of our system — higher quality for lower cost. But the timing is problematic. Berwick was reportedly slated to get this appointment well over a year ago. The Obama administration, however, held off on going forward until health care was done before making the announcement and pursuing the confirmation, presumably because they — and possibly Berwick, according to Politico — wanted to avoid another health battle while they were pursuing their overhaul bill.

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By Tevi Troy  |  Mon, March 29, 2010 11:21 AM  |  Permalink

Game On

This week will be one of the most consequential weeks ever for the American health-care system. At stake are two conflicting visions for a system that touches every single American, and without doubt needs to be improved in order to dispense care properly and appropriately. Yet recognition of the need for improvement by no means accepts Democratic arguments that their proposal is the only possible path, and that opposing their proposal is tantamount to accepting the status quo. We have learned far too much in the last 15 months to fall into this false dichotomy.

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By Tevi Troy  |  Mon, March 15, 2010 9:22 AM  |  Permalink

Health-Care Politics: Short- and Long-Term Problems for the Democrats

I have a new piece online from the April Commentary, which argues that contrary to the conventional wisdom, health care has been a poor political issue for the Democrats, and that a measured approach has tended to work better. Given this two-decade history, Democrats should be very wary of the politics of voting yes on their trillion-dollar overhaul.

In addition to the historical politics of the issue, the short-term politics are problematic for the Democrats as well. Today's CBO score should not be very reassuring to the Democrats on a number of fronts:

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By Tevi Troy  |  Thu, March 11, 2010 2:09 PM  |  Permalink

Scylla, Charybdis, or My Way

By my count, President Obama's health-care speech today was at least his 40th speech focusing on health care; as part of his effort to push his health-care plan, he has had seven major "stop the presses" events on the subject: his White House health-care forum last March; his ABC infomercial with Charlie Gibson and Diane Sawyer in June; the joint session of Congress speech in September; his State of the Union address in January; last Monday's release of his new eleven-page proposal; the health-care summit last Thursday; and now his 1:45 pm speech today.

Unsurprisingly, given how many times we have heard him on this subject, the speech today did not provide any new revelations. He asserted that all agree on the problem, but then tried to triangulate the fix by saying that he did not support a government-run system, nor did he support giving "the insurance industry even freer rein to raise premiums and deny care." (Note: In case you were wondering who supported giving the insurance companies "freer rein," he probably meant you, dear reader, since only about 40 percent of Americans back the president's approach.)

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By Tevi Troy  |  Wed, March 3, 2010 3:54 PM  |  Permalink

Jogging Through History

Bill Bennett's A Century Turns is out this week, and it is an entertaining read. The book will especially reward those who peruse the footnotes at the bottom of the pages (marked by asterisks throughout) as they contain Bennett's funniest, most personal, and often most biting asides. My favorite is about Bill's experience jogging with Pres. George H. W. Bush. After the jog, reporters shouted questions at Bennett, but he was too out of breath from maintaining the presidential pace to reply, so Bush — 19 years older but fresh as a daisy — jumped in and saved him with a non-gasping answer while Bennett recovered.

By Tevi Troy  |  Tue, March 2, 2010 1:36 PM  |  Permalink