There are some harsh words for Democrats trying to overhaul health care in the Washinton Post this morning.

Comprehensive health care has been lost. If it fails, as appears possible, Democrats will face the brunt of the electorate’s reaction. If it passes, however, Democrats will face a far greater calamitous reaction at the polls. Wishing, praying or pretending will not change these outcomes.

Such rhetoric is common coming from Republicans these days, but this is different. The broadside comes in an opinion piece from Patrick H. Caddell and Douglas E. Schoen, pollsters for the last two Democratic presidents, Jimmy Carter and Bill Clinton. The pollsters agree that health care needs to be retooled, but they say that horse has left the barn.

Health care is no longer a debate about the merits of specific initiatives. Since the spectacle of Christmas dealmaking to ensure passage of the Senate bill, the issue, in voters’ minds, has become less about health care than about the government and a political majority that will neither hear nor heed the will of the people.

Bottom line, write Schoen and Caddell: “Unless the Democrats fundamentally change their approach, they will produce not just a march of folly but also run the risk of unmitigated disaster in November.”

Illustration: Getty Images

Some wrinkles in the health-overhaul orchestrations are in the news this morning:

Washington Democrats are working on an idea to pair the health-care bill bill with another Democratic priority of increasing federal aid for college students. The notion isn’t a firm plan, but as Senate Budget Committee head Kent Conrad told the Washington Post, “I’d say yes, we’re leaning toward it.”

Mixing the health and education bills might seem a stretch, but Democratic backers figure it might give them a 2-for-1 legislative bang. Dems already plan to use the reconciliation process in the Senate to make fixes to the version of the health bill passed by the Senate on Christmas Eve.

Adding the education package to the reconciliation vote, which requires a simple majority for passage, could mean both pieces of legislation would clear the Senate without a filibuster. The overhaul of the student loan programs in the education bill is another of the Obama administration’s domestic priorities.

As for the health overhaul, Democrats remain vexed about how to handle abortion restrictions, but party leaders appear willing to write off the votes of a dozen or so antiabortion Dems in the House if need be, the New York Times reports. The House abortion foes want tougher language to ban using federal subsidies to pay for abortions than those contained in the current Senate legislation.

One compromise would be for the House foes to accept the Senate language initially and then tighten the provisions later. But doubts persist. “I’m not going to trust that [tougher language] is going to pass the House and Senate” after the original bill passes, said Dem Rep. Daniel Lipinski told the WSJ.

Just when health-care bills will be put to a congressional votes remains up in the air. Lawmakers haven’t seen the latest draft texts and the Congressional Budget Office hasn’t calculated estimated costs. A March 18 target, which President Obama had hoped for, isn’t workable at this point, everyone was saying yesterday.

But House leaders now want the vote to occur before a two-week spring break scheduled to start on March 26, the NYT said. More meetings by House Democrats are slated for today.

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Connecticut’s Quinnipiac University announced earlier this year that it wanted to open a medical school, beginning a push that will take until 2013 or 2014 to get the first med students in the door.

The new school would be located in several buildings that the university, located near New Haven, purchased in nearby North Haven from WellPoint’s Anthem unit for $32 million several years ago. Read more on the plans here.

Schools like Quinnipiac that want to grant MD degrees go through a lengthy process required by the Liaison Committee on Medical Education. The panel is made up of med-school officials, practicing docs, public members and med students. It currently has 132 fully accredited schools in the U.S. schools and 17 in Canada.

Seven new schools — two each in Michigan and New Jersey and one each in California, Florida and South Carolina — have reached applicant status with the committee, meaning they has gotten through the preliminaries and paid a $25,000 fee. Another, Hofstra University in New York, is currently the only one at the next step in the process when the first site visit by the LCME takes place,

Six schools now have preliminary accreditation, meaning they can recruit and accept students. This group now includes two more Florida schools and others from Michigan, Pennsylvania, Texas and Virginia.

One last level (no schools currently here), a few more hurdles like a final vote and at last — it’s accreditation time. For lists of the schools at different levels on the accreditation journey, see here.

Image: iStockphoto

By BOB WACHTER One of my interns was “running the list” with me last week (giving me a thumbnail update on the plans for each of our inpatients). It was standard stuff until he got to Ms. X, a 80ish-year-old…

By Matthew Holt I met with Bob Quinn the CTO and Geoff Rutledge, the CMO, of Epocrates at HIMSS last week. The company has a big footprint in mobile (and web) reference content for physicians. The big news is that…

Fast-growing spending on imaging tests in Massachusetts gives a closeup view to the many-sided question of whether improved technology is really worth the extra cost.

The facts, as laid out by the Boston Globe this morning: Spending on MRIs, mammograms, and other imaging tests for privately insured Massachusetts residents jumped 20%, or $214 million, between 2006 and 2008, according to consultants hired by the state. Doctors ordering more tests was one reason for the added spending.

Digital mammography was another prime driver as some insurers pay more for these breast-screening tests and hospitals have invested upward of $400,000 for such new machines, compared with $100,000 for earlier units. The digital technology is faster and can be used with electronic health records.

But there hasn’t been any evidence that digital mammograms hold a significant edge in detecting cancer in most women compared with older tests, the Globe says. It also turns out that more imaging tests these days are being done in hospitals, which charge more for the services than independent clinics.

“A scan done in a hospital is of no better quality and is not being read by a more qualified radiologist than one done in a freestanding clinic,’’ the paper quotes an official at insurer Harvard Pilgrim Health Care as saying. On the other side, the Globe writes that hospital officials believe

the state’s consultants overstated the role higher provider fees are playing in pushing up costs. And, they said, the increase in the number of scans has slowed significantly since 2008, as more insurers began requiring preauthorization for certain scans.

A company that manages radiology benefits for insurers also tells the Globe that makers of imaging equipment lobbied Congress for higher payments from Medicare to encourage service providers to buy the new technology and helping generate premium payments from private insurers for tests done with digital gear.

Photo: Associated Press

The annual meeting of the American College of Cardiology gets underway this weekend and some heart-related items are in the news this morning:

Documents from leading medical-device makers suggest some companies seem to have encouraged the use of surgical ablation to treat atrial fibrillation, a front-page article in the WSJ reports. The problem, of course, is that the devices that can carefully destroy heart tissue linked to A-fib troubles aren’t FDA-approved for that purpose. A-fib is the most common type of faulty heartbeat.

The Justice Department is investigating and has won settlements with two lesser-known device makers. A former device saleswoman who brought those two cases has also sued Boston Scientific, Medtronic and St. Jude Medical. The DOJ hasn’t joined in those cases and the companies say none of their top execs were involved in any illegal marketing of the devices. More on the situation is here.

Coronary angiograms, widely used tests to detect artery blockages in the heart, often turn up little or no evidence of disease, a study in the New England Journal of Medicine found. That suggests that the more than a million U.S. patients who undergo the diagnostic test each year at a cost of about $10,000 each, are frequently exposed to unneeded risks of a costly procedure, the WSJ says in another article.

The study of nearly 400,000 angiograms performed between 2004 and 2008 in the U.S. found that 62% of the patients didn’t have evidence of significant obstructions, while 38% had important blockages. Of course, a clean angiogram can still provide useful informaton and the findings don’t apply in cases when there is established heart disease or the threat of an imminent heart attack. Patients included in the study weren’t previously diagnosed with heart disease and represent about 20% of those who get angoigrams.

Still, the data indicate overuse of angiograms. “We’ve got to get much smarter about how we’re ordering and interpreting these tests,” a Mayo Clinic cardiologist told the WSJ.

Image: iStockphoto

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