A year later, still no cure for politics in health care

McClatchy NewspapersMarch 23, 2011 

WASHINGTON — The good doctor was frustrated.

Dr. David Cull, a prominent vascular surgeon in Greenville, S.C., had invented a small valve system that could spare 300,000 dialysis patients across the country enormous suffering — and save American taxpayers billions of dollars in Medicare costs.

Yet, Cull's hometown senator, Jim DeMint, refused to write a letter supporting the surgeon's application for a federal grant under the landmark health care bill that President Barack Obama signed into law a year ago this week.

As a hardcore conservative with a growing national following, DeMint opposes most federal spending.

Backing a doctor's grant application under the law — even from a constituent who lives in the same city as DeMint — would leave the senator open to charges of hypocrisy.

And DeMint, who vowed in 2009 to make health care Obama's "Waterloo," is leading Republican efforts in Congress to repeal the law to provide medical coverage to 31 million uninsured Americans — or, if that can't be done, to deny it funding.

"Senator DeMint opposed President Obama's government takeover of health care because he believed it would lead to higher insurance premiums, less choices for patients, and that it was unconstitutional," said DeMint spokesman Wesley Denton. "And that's exactly what has happened, and why ObamaCare must be repealed."

The dynamic between Cull and DeMint shows that a year after the law took effect, political warfare between its opponents and supporters continues to trump the search for better and more affordable health care.

To Cull, who's about to start clinical trials with 12 human subjects for his Hemoaccess Valve System, DeMint's stance on his fledgling device — and on health care more broadly — is pennywise but pound-foolish.

"It's a good sound bite on Fox News, but he's looking at it so simplistically," Cull said. "He's completely ignoring the huge (possible) savings."

Cull got the $249,479 Therapeutic Discovery Grant without DeMint's help — though the senator's aides say they provided guidance on applying for it — under a little publicized part of the Patient Protection and Affordable Care Act aimed at encouraging cutting-edge biomedical research.

A similar dynamic is playing out in other states, where GOP lawmakers who stridently oppose Obama's health-care initiative collect campaign donations from constituents who receive research grants and other benefits provided under the law.

In Texas, top executives of Lynntech Inc., a pioneering research and technology firm that holds dozens of patents on the frontiers of science, contributed more than $20,000 to Sen. John Cornyn's successful 2008 re-election campaign.

As the head of the National Republican Senatorial Committee, Cornyn was a leader of his party's failed bid to block the health care legislation.

In the year since the law's passage, Lynntech has obtained 19 Therapeutic Discovery grants, totaling $1.4 million, to develop a laser human-tissue welder, a cervical disc prosthesis and other potentially breakthrough medical products.

Nationwide, physicians and biomedical firms have obtained $1 billion in grants for projects ranging from biomarkers to detect concussions for a Florida group to a new drug to prevent chemotherapy-induced vomiting in cancer patients being developed by a California company.

Cull's valve system would replace a plastic stent that's been used for a half-century for patients with acute kidney failure.

Once inserted under the skin, blood flows through the tiny tube all the time, even though a kidney patient undergoes dialysis only nine hours a week on average.

The constant blood flow causes numerous painful complications, among them circulation impairment, clot formation, gangrene, finger ulcers and severe arm swelling.

A typical dialysis patient will undergo 10 to 12 operations over a lifetime to treat the complications, with 1 million performed each year — all paid for by Medicare.

With dialysis one of the few medical conditions covered by Medicare regardless of a patient's age, such surgeries cost taxpayers one-fifth — $15,000 — of the $75,000 a year the federal program pays per person with acute kidney failure.

Cull's valve system, by contrast, can be closed when not used for dialysis, cutting off the blood flow and thus decreasing or even eliminating the costly and painful complications.

The grant Cull got from the federal government supplements money from private investors.

"This is money that, in my view, was very well spent," he said of the grant. "If our valve doesn't work, the government will have lost $250,000. If it does work, they will have saved a gazillion dollars."

The partisan divide over the health care overhaul has moved from Congress to the courts.

Two Republican judges have deemed the law at least partially unconstitutional, while three Democratic judges have upheld it in a case expected to end up before the U.S. Supreme Court.

But even in states that are challenging the law, key agency heads are preparing for its implementation if it's upheld in Congress and the courts.

New South Carolina Gov. Nikki Haley, a rising star in the GOP firmament, has challenged Obama over the law in two face-to-face White House confrontations in recent months.

Yet back in her home state, Haley is using a $1 million grant obtained under the health care law to move toward setting up an insurance exchange as the law mandates.

Three states — California, Massachusetts and Utah — already have some forms of insurance exchanges.

Massachusetts' exchange, set up under its 2006 first-in-the-nation mandatory health insurance law — and championed by former Gov. Mitt Romney, a Republican — buys private policies and then resells them to its residents.

Utah, by contrast, has a more restrained exchange that acts as a clearinghouse for insurance firms to sell their products in a transparent setting based on comparison shopping with uniform rules.

Using some of the law's grant money, a task force created via Haley's executive order will summon experts from those and other states to relay their experiences with the exchanges.

"Right now the law of the land is health-care reform," said Tony Keck, head of the South Carolina Health and Human Services Department. "Although we're fighting it and looking to produce our own alternatives, we also have to prepare to implement it to meet the deadlines. The risk of not preparing for any eventuality is simply too high in the form of penalties from the federal government and interruption to care."

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