Doctors and Nurses
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The Prescription for Revolutionary Healthcare Delivery Reform
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How to Shame Senate Healthcare Obstructionists
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Your Doctor's Health Advice, Brought to You by Coke
Understand Healthcare Reform in 2 Easy Steps
Published November 01, 2009 @ 05:00AM PT
If you’re tired of ignorant political sound bites in the healthcare debate, I have the cure. Better yet, it’s virtually free of public and private insurance discussions, with their associated pointed fingers. The film Money-Driven Medicine explores the reasons why the US spends more than twice what the next developed country does on healthcare, with terrible health outcomes. The story is told by in-the-trenches doctors, patients and their family members, a physician healthcare improvement leader, and a medical ethicist. It’s unique, highly educational and fascinating.
Join the Watch-In! for America’s Health now through November 10 for a systemic look at what’s really driving the cost and quality of our healthcare. Find out what’s compelling our healthcare spending, and why tweaking around the edges of our public health disaster won’t change a thing. In a nutshell, our country is unique in turning patients into profit centers.
Why join the Watch-In? Because Money-Driven Medicine:
“help(s) viewers distinguish between structural change and sham reform. It will convince them that a sound, sustainable medical infrastructure is crucial not just to their personal futures but to the economy and society as a whole – why curing America’s healthcare crisis could be a matter of national life and death.”
I couldn’t have said it better myself. Make a pledge to join the Watch-In! for America’s Health today. Of course, if you can stand more discourse on the insurance industry and public versus private insurers and providers, read and watch on.
I made the mistake of watching T.R. Reid’s special, Can We Really Fix U.S. Healthcare?, about his experience exploring international universal healthcare systems, the night before the House revealed its new bill, HR 3962. As a result, I’m feeling a bit underwhelmed by Nancy Pelosi’s hard-fought victory. The LinkTV special is a summary of Reid’s book, The Healing of America, which explores both the how and the why of these healthcare systems. It’s an excellent primer on the 4 main types of healthcare systems, distinguished by who pays for and who provides the care. Watch it and be both entertained and sobered simultaneously, when you consider how far we have to go to even catch a glimpse of the best ones on the horizon.
Reid is also the creator of PBS’ special Sick Around the World, which gives an excellent summary of 5 international universal healthcare systems. No, it’s not just theory: he took his injured shoulder around the world with him, to see how each healthcare system would treat it.
But remember, before you click over to Reid’s insurer-patient-provider view of true developed nations, join the Medicine For Profit Watch-In for a refreshing, insurance-light look at some root problems in American health "care". Thanks to Change.org member CherokeeGirl for Change, who alerted me to both very worthwhile programs.
Photo http://farm4.static.flickr.com/3174/2689975613_187194cdaa.jpg //CC BY 2.0
"Doc Fix" Shows (AGAIN) Why the House's Health Reform Bill Is Better Than the Senate's
Published October 21, 2009 @ 11:03AM PT
The last House committee to work on comprehensive health reform finished at the end of July. The last Senate committee (Sen. Max Baucus's Senate Finance Committee) finished last week. But the House has not been idle. News comes today that an initial score from the Congressional Budget Office says the House has refined its bill to only cost $871 billion over 10 years. Of course that is likely to get overshadowed by the train wreck in the Senate concerning Medicare's "Doc Fix." So many commentators are focused on the political clumsiness of pushing a separate bill in the Senate to fix the Medicare Sustainable Growth Rate (SGR) that they may miss what this Three Stooges-esque vignette tells us about the policy strength of these House and Senate bills.
Simply put, the House has its act together. The Senate's got a lot of work to do.
The SGR was an attempt to curb skyrocketing costs in Medicare which has not only failed, it's become the second-worst accounting trick in the federal budget over the past decade (the worst being leaving the costs of the wars in Iraq and Afghanistan out of the budget every year of the Bush Administration so the deficit wouldn't look so big.) A brainchild of the Gingrich Congress and an amendment to the 1997 Balanced Budget Act, the SGR is a formula intended to prevent physician compensation for Medicare from rising above the rate of growth in GDP each year. If physician fees were threatening to go higher, all doctors' fees across the board in Medicare would be cut to keep them within that limit. Not inherently a bad idea, but it has a huge flaw -- in most years, medical costs rise at several times the rate of growth in GDP whether you're talking public coverage or private insurance. The net result is that SGR would guarantee a major cut to Medicare nearly every year, at least until we get an explosive economic growth like we had in the 1990s. And we're not talking obvious waste like Medicare Advantage subsidies for HMOs or those motorized scooters you see in ads on cable TV -- we're talking doctors' fees. You know, the whole point of having health coverage.
So every year, Congress passes a one-year moratorium on the SGR. Every year, all Democrats in the Senate vote for it. Every year, almost all Republicans vote against the moratorium and for the cuts to take place (including every single one of the conservatives who are making "how dare we cut Medicare in any way, shape or form!" their rallying cry for defeating reform. Gotta love that blatant disregard for consistency.) Every year, doctors' fees in Medicare continue to rise at roughly the same "way, way over inflation" rate they do for private insurance, meaning if the cuts took place this year, it'd yield a 21% cut across the board. But every year, the cut never actually happens. It's like a bad sitcom whose punchline you can see coming from miles away. It's absurd. And it needs to be fixed.
Enter health care reform -- an obvious spot to fix it.
Pay for Performance: Why You Should Care (Part 2 of 3)
Published October 20, 2009 @ 06:00AM PT
Part 2: Empowered Patients
Last time we dug into what P4P actually is. Today we'll give you the P4P tools to become an empowered patient, and introduce you to their quality metrics basis. This will allow you to pay for quality versus average or sub-par care.
Ready? Quick! You’re having a heart attack. Your family called 911, and now the paramedics are asking which hospital you want to go to. How do you know? Your life may depend on it.
Pay For Performance: Why You Should Care (Part 1 of 3)
Published October 16, 2009 @ 07:00AM PT
Part 1: What Is It?
Earlier this year, amid all the yelling, name calling and finger-pointing, there was a small quiet force moving through US healthcare. It was the early adopter crowd of doctors, hospitals and health systems, girding up to become providers of coordinated, quality, and evidence-based care. I called this little-noticed movement the Silent Revolution. That loud screech I'm now hearing is the revolution reaching the mainstream.
We’ll get to the noise in Part 3 of this three-part series. First, today we’ll dig into what Pay For Performance (P4P) actually is, and in Part 2 we’ll look at how it can empower you as a patient.
Hospital Facility Fees Pick Your Pocket
Published October 14, 2009 @ 12:00PM PT
Imagine you board a flight on new carrier Post-Pay Airlines, where you pay a to-be-determined amount for your flight after you take it. Since it’s a “choose your own seating” model, you wander back and randomly select aisle seat 20C. Another passenger claims 20D across the aisle. When you arrive at your destination and deplane, a cashier hands you both a bill. Yours includes charges for the flight and the seat, $700 total, while 20D is charged $250 for the flight only. What?!
It turns out that the airline owns seat 20C, while an airplane mechanic owns 20D. Post-Pay claims it has to adhere to more stringent standards than the mechanic, though neither you nor your row-mate could tell the difference in seat quality. What’s more, the seats weren’t even labeled differently – there was no sign disclosing a surcharge. And unlike typical airline fees for baggage, food, drinks, and itinerary changes, sitting in the seat isn’t optional – it’s required to take the flight.
New Healthcare Versus Old Healthcare: Mirror Images?
Published October 12, 2009 @ 06:00AM PT
This weekend I was in the Bay Area for a trail race, but I got to experience more than the scenic views from the Oakland hills. The bonus was a personal evaluation of Berkeley’s emergency care (yes, only a healthcare consultant could possibly see it that way.) It earned a “C”, meaning it was average US healthcare: not really good, not terrible, and anxiety-producing for all the wrong reasons. So what would change under proposed healthcare reform?
First, some background. For two days before the race I had vague abdominal discomfort, but chalked it up to female cyclical issues. A few hours into the race I was no longer able to breathe, much less move, without severe, stabbing abdominal pain. I was bloated, nauseated, lightheaded, and clammy. Later I learned it was a large ovarian cyst, extremely inflamed by the constant pressure of my hydration pack belt. It left me unable to ingest anything so I became dehydrated, which made existing kidney stones symptomatic. My race was over, but the fun had just begun.
Democrats Borrow the Tea Party Approach
Published October 08, 2009 @ 10:59AM PT
Rachel Maddow just announced an amazing three-part Democratic strategy to ensure healthcare reform, and it’s an attention-getter (see the first 4:50 of the video clip.) We’re all fairly familiar with part three, using the reconciliation process to pass a bill with just 51 votes, instead of 60. But it’s the first two steps that borrow from the Tea Party approach.
It’s power broker time, ramping up techniques to dramatically increase political pressure for healthcare reform. That pressure is specifically aimed at 6 key Democratic senators who must allow a vote. What's the first step? Massive free health clinics in Arkansas, Louisiana, Nebraska, Nevada, and Montana. Hoping to shame senators Max Baucus, Mary Landrieu, Blanche Lincon, Mark Pryor, Ben Nelson, and Senate Majority Leader Harry Reid, doctors and nurses will donate their time to provide free care to thousands of the senators’ constituents who can’t afford it, making for a dramatic and heart-wrenching third-world spectacle. Houston’s recent clinic drew 1,500 people seeking treatment.
Second, if seeing thousands of their constituents in need of care doesn’t shame them, two major (and nameless) power brokers are encouraging a Senate strategy to revoke Democratic chairmanships if they block healthcare reform. Specifically, committee chairmen and sub-committee chairman who allow Republicans to force a 60-vote requirement, regardless of whether these chairmen ultimately vote in favor of the bill, will have their leadership positions revoked. Yep, that would be busting a Lieutenant Colonel down to Private in a very public demotion. It’s head-cracking time!
Last but not least, they will invoke the reconciliation rules. Just like the Republicans did to pass the $1.3 trillion and $350 billion Bush tax cuts. Apparently Republican Senator James Inhoff can’t remember that period in history, so it must have been in some other country. Maybe Canada?
