Doctors and Nurses
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?
Michelle Obama Enters the Health Reform Debate: The Best of the Weekend
Published September 20, 2009 @ 11:33PM PT
Every weekend, I showcase the three videos or articles that best enhanced my own understanding of the health care reform debate. After all, when you’re talking about a topic that touches each of our lives and intersects policy, politics, medicine, taxes, the legal system, our economy and budgets ranging from a blue-collar family in Pennsylvania to the federal government of the United States -- well, a fellah sometimes need a little help understanding it all!
Although I don’t normally lead off with a political story, this one is well worth it:
1.) Health Reform Watch: “Because She Said So: Michelle Obama Wants Women to Stand Up for Health Care Reform”
Fellow Change.org blogger Jen Nedau posted the First Lady’s speech on the Women’s Rights blog. During the campaign, the president had often referred to Michelle as “the closer” -- the one whose impassioned “from the heart” speeches could close the deal. The White House has determined the only way to escalate the cause of health reform over and above an address to both houses of Congress is to have the First Lady also make the issue her own. It’s not a moment too soon, writes blogger and law professor Pooja Awatramani:
One of the biggest issues Michelle Obama seemed to have with the current system was gender rating; it continues to force women to pay much higher premiums than men in private insurance plans. The actuarial argument, that women’s health care needs require regular preventive care (which in reality, women and men alike should be getting) is significantly undermined by the research which shows the ultimate cost benefits of preventive care–for both women and men. It seems both ironic and counter-productive that this justification is used to punish with higher premiums those who embark upon the proactive health maintenance which so many agree is both the key to ultimate health care cost control and one of the primary goals of health care reform. Hopefully, Obama’s optimism that such gender rating will be removed through the current reform process will prove true.
With so many challenges aligned against women, it is apparent that, as stated by the Congressional Joint Economic Committee, “The status-quo health insurance system is serving women poorly.” Perhaps this is why the Obama administration, in its drive to convince Americans that the issue of health care can no longer be pushed aside, is turning to women. A smart choice, whichever way you look at it, since women as a whole are one of the groups most strongly supporting health care reform.
Read the full analysis on the Health Reform Watch blog.
2.) Washington Post, “You Have No Idea What Health Costs”
Blogger Ezra Klein has an article in this Sunday’s paper spotlighting why it’s so hard to make those of us with employer-based benefits sit up and take notice of escalating costs. Since our employer picks up the lion’s share and the rest is usually deducted from our payroll, it’s difficult for us to realize just how unsustainably premiums are rising each year. If we did, Ezra writes, we’d be more forcefully supporting reform.
The average health-care coverage for the average family now costs $13,375, according to Kaiser. Over the past decade, premiums have increased by 138 percent. And if the trend continues, by 2019 the average family plan will cost $30,083.
Three years of slightly above-average health insurance will cost a solid six figures.
Those are numbers to marvel at. Those are numbers to fear. But they are not the numbers that loom in the minds of most Americans. And therein lies the problem for health-care reform.
Read the full article on WashingtonPost.com
3.) Movin’ Meat, “Feeling Wonkish”
When I'm not quite sure of how proposed policy changes look to someone “in the trenches” of our medical system, I often turn to this blog written by Shadowfax, an Emergency Medicine Doctor who writes eminently readable snap-analyses of health care reform. And for Shadowfax, a lazy weekend at home apparently turned into analyzing the proposed amendments for the Senate Finance Committee from the perspective of an ER doctor.
The other thing that I gained from reading this is a real appreciation of how tricky lawmaking really is. This bill, after modification to some greater or lesser degree in committee, will need to be merged with the HELP committee bill and then (one hopes) with the House bill. That's a real challenge! Sure, there will be the big partisan battles, but all the little line items are the hard parts, I think. When you come to a provision like, say the Stabenow amendments, which have no clear partisan bias and a marginal effect on cost -- and bear in mind that there may be hundreds and hundreds of these in each bill -- how do you decide which are worthy of keeping, and which get tossed? Presumably you can't keep them all, and many are probably in direct conflict. Unless the advocate for a particular bill is at the conference table, it's gotta become a little arbitrary.
The Public Option: Popular Everywhere But the U.S. Senate
Published September 14, 2009 @ 10:34PM PT
Many sound notes of exasperation that the public option continues to be the focal point of the health care fight, both on the right and the left. But at this point, their exasperation is itself becoming exasperating. At its core, we’re talking about a policy point that, despite eight months of pummeling, remains popular except in the halls of the United States Senate and the corridors of the headquarters of the insurance companies. It is the latest incarnation of the people vs. the powerful -– and I’d say folks have a right to be angry that the people seem to be losing.
Two bits of news today reinforce the unmistakable trends of continues popularity and support. Washington Post-ABC News released their latest poll, finding support for health care reform in general is split right down the middle. But giving people the choice of private insurance or the ability to voluntarily buy into a high-quality, government-administered public health insurance plan, similar to Medicare, scores better at 55%. But that’s the tip of the iceberg! When actually described correctly as being an option available only to those who don’t already have insurance, support jumps to 76%. It’s like the August of our discontent never happened.
One of the canards about the public option is that physicians won’t support it because they’ll refuse its presumably lower negotiated payment rates. But today’s New England Journal of Medicine should put the lie to that once and for all. A survey by email and phone of 2,130 physicians (well above the 800-1,000 sampling of most polls) finds tremendous support among doctors for the public option -– 63% of doctors support health reform that incorporates a choice between public and private coverage, whereas only 27% prefer reform where private insurance is the only option. Even surgeons, slightly more conservative and skeptical of reform by nature, come in at 59%.
Oh, and tomorrow the AFL-CIO is set to endorse a public option formally, after their incoming president has warned darkly about primary challenges for Democrats who vote against it.
Now I should note that popularity does not always correlate to the right policy, particularly on something as complex as health care. But let’s review. All three major Democratic nominees for president endorsed a public option two years ago. This year, so did the leadership in the House and the Senate, as did all but one committee chair with jurisdiction over health care. The last committee chair released a blueprint with a public option months ago, before changing his mind. 100 members of the House are threatening to vote against a health care bill that doesn’t contain it. The Senate Majority Leader is for it, as are the number two (Durbin) and the number three (Schumer) Democrats in the Senate. A still-popular President of the United States devotes a significant portion of his health care stump speech to it. Progressives are for it. Labor is for it. Doctors are for it. The American people are for it.
What’s on the other side? Entrenched Republican resistance that has already said jettisoning the public option isn’t enough for them to vote for the bill. And an insurance industry that’s dishing to Business Week about their ability to influence centrist senators like Baucus and Conrad and Blue Dog congressman like Ross.
It’s one thing to year in and year out lost to the lobbyists and special interests whose money and influence control the levers of power. It’s quite another to have our noses rubbed in it.
(Photo credit: The White House, via Sen. Max Baucus' web site.)
"You Mean My Treatment ISN'T Based on Evidence?": The Best of the Weekend
Published September 13, 2009 @ 11:13PM PT
Every weekend, I present the three articles or videos that best enhanced my own understanding of the myriad issues that go into the general umbrella of health care reform. While most reports this weekend were focused on political strategy, shades of grey, and exactly how pompous Sen. Kent Conrad can make himself sound on television, there was also plenty of nuanced, thoughtful analysis, particularly on how we can improve the quality of the care we receive.
1.) Health Care Policy and Marketplace Review, “What Voters Really Think About Evidence-Based Care”
I don’t always see eye-to-eye with Bob Laszewski, but he knows his stuff and has an uncanny ability to cut through the bull and focus on what will really reduce costs and improve quality. His commentary on the Campaign for Effective Quality’s recently-released poll of California voters about their attitudes towards "evidence-based medicine" -- the notion that treatment options should be grounded in the latest scientific evidence and not just “Well, this is how we’ve always done it” -- is nearly as insightful as the survey results themselves.
The bad news is that patients think their health care treatment is generally evidence-based even though that assumption is highly questionable. The good news is that patients want it to be evidence-based.
At a time when we hear anecdotal evidence, particularly from town hall meetings, that people don't want any "interference" between them and their doctors they do seem to appreciate the need to get all of the facts when making a treatment decision.
Read the whole blog post on Health Care Policy and Marketplace Review.
2.) Boston Globe, “Vermont tests team approach for aiding chronically ill”
I’ve mentioned the “medical home” model of delivering care a few times. Since the bills moving in Congress would include more pilot programs to test out the medical home in Medicare and the public option would do likewise, it’s worth seeing how we’re implementing them in a few areas -- including Vermont -- today. A lot of people think the notion of having one doctor as a “home base” to coordinate all specialist care sounds uncomfortably close to managed care. In practice, however, it’s almost the exact opposite experience.
But when [diabetes patient Rita Pinard’s] blood sugar shot up in January, her doctor took more aggressive action, turning her over to a nurse, a dietician, and a diabetes educator who nagged and encouraged her to try to control her disease.
The extra help is part of a state effort to improve care and reduce costs for the chronically ill in Vermont. Under the approach, primary care doctors get extra money to put together teams to treat people with illnesses such as diabetes, asthma, and heart disease. They get bonuses if their patients show progress.
This coordinated approach, called “medical homes,’’ is being tried in Pennsylvania, Wisconsin, Maryland, and other states, and Congress is considering adopting it nationwide as part of the health care overhaul being debated in Washington.
Read the whole article on Boston.com
3.) NY Times, “In Health Care Battle, a Truce on Abortion”
In writing about this weekend’s anti-big-government protests in Washington DC, Matt Yglesias noted that the mood seemed to be as much anti-abortion as anti-health reform. He makes the observation, “Except for the fact that the health reform plans in congress wouldn’t actually do this. The anti-abortion side, in other words, already won this argument. Except nobody told them.” Actually, it’s more remarkable than that. As NY Times “Beliefs” columnist Peter Steinfels shows, health care reform has given rise to a fragile and remarkable between pro-choice and pro-life communities -- but one that could fall apart at any time.
Administration foes, like the National Right to Life Committee or the Catholic League for Religious and Civil Rights, were quick to declare that the president could not possibly mean what he said [when he said no federal dollars will be used to fund abortions].
But others, like officials of the United States Conference of Catholic Bishops and some religious leaders with concerns about abortion, welcomed his words. When it comes to health care overhaul, a surprising number of people on both sides of the abortion war have declared a limited truce.
The key words are “abortion neutral.”
Read the whole article on NYTimes.com
(Photo credit: http://www.flickr.com/photos/thenationalguard/ / CC BY 2.0 )
What Is the Public Option?
Published September 06, 2009 @ 05:51PM PT
The public option has become the central front in the fight for health care reform. It’s become a litmus test on the left and the right, with the House Progressive Caucus saying they won’t vote for a reform bill that omits it, and with Republicans generally united against it, even one with a delay or a trigger that would kick its implementation down the road. It’s been discussed almost constantly since February 2007 when John Edwards made it part of his health care plan, with both Barack Obama and Hillary Clinton soon following suit. It’s become a proxy fight for health care reform in general. But for all that, many people are still confused as to what it is, who would have access to it, or why it might be a good idea in the first place.
It is not, in and of itself, the entirety of the health care reform proposal in Congress, or what President Obama proposed on the campaign trail as a fix for our broken health care system. Reform encompasses everything we need to do to finally begin controlling our health care costs, expanding access and improving quality. All three of these goals are the focus of the House bill (HR 3200) and the Senate Health, Education, Labor and Pensions Committee.
The moving parts of this bill covers an incredibly wide gamut of issues, from developing new doctors and new nurses, particularly in primary care; to giving tax credits to small businesses in order to allow them to afford benefits for their employees; to filling in the “doughnut hole” in the Medicare prescription drug program to provide cheaper drugs to seniors; to creating regulation or prevent or curb the most abusive practices of the insurance industry.
The House bill is 1,018 pages long and the whole package is estimated to cost $1 trillion over 10 years -- all or most of which is already paid for by savings and new revenue earmarked in the bill. But the whole package is not “the public plan” or the “public option.” Of the 1,018 pages, only 12 of them deal with the establishment of a public health insurance option.
