NPA members Rupin Thakkar and Bob Crittendon were appointed a member of the Workforce Advisory Group and Lisa Plymate has been appointed to the Low Income Populations Committee of the Health Reform Implementation in Washington State. Congratulations to both! NPA appreciates your commitment to health care reform implementation.

The Los Angeles Times reports that since the passage of the Affordable Care Act many providers across the country are working together to create alliances which provide coordinated care for patients. In San Antonio, for example, three hospitals are competing to form alliances with local doctors, who are giving up private fee for service practices in order to be on the team.  This is a wonderful example of the type of unified approach to medical care which may result in improved quality and efficiency of care with reduced costs.  See the article here.

NPA President, Dr. Valerie Arkoosh spoke to the Pennsylvania HCAN group on July 21. She provided an overview of the changes that health care reform will bring to Pennsylvania. Check out this piece on her speech.

Families USA recently released a guide to the implementation of health care which highlights the important dates over the next 90 days. This guide highlights effective ways to make health care reform a reality in a consumer-friendly way. The guide highlights the provision which will allow young adults to stay on their parents insurance plans until age 26.

The guide also highlights the fact that small businesses with fewer than 25 employees are now eligible for a tax credit if they pay 50% of their employees health premiums.  Information on calculating the credit is available here.

Please check out the guide to see how you can make a difference in the next 90 days!

A recent CNBC segment posed the question of whether healthcare is a right. They brought on commentators to argue in favor and against, one from the Cato Institute and one from the National Physicians Alliance. (you can see the clip at curethis.org)

The host started by posing the question to the conservative commentator, Michael Cannon. “I think it should be a right,” he replied. “And therefore I think physicians should work for nothing.” Sarcasm notwithstanding, his point was clear: healthcare cannot be a right because it involves payment. The exchange of goods and services for money equals capitalism, which puts healthcare squarely in the category of commodity.

Mr. Cannon backed up his point by contrasting healthcare with other things we commonly think of as human rights, like freedom of speech and religion. No one has to be paid in order to let us speak freely and worship freely, he implied, which is why they are rights and healthcare is not.

This argument is persuasive. We like to think that a human right is something you are born with, not something that has to be given. The very phrase ‘freedom of speech’ suggests its simplicity: just let people speak! It’s not that hard! Healthcare, on the other hand, is not accomplished by standing aside and letting citizens exercise their freedoms. For healthcare to be your human right, something has to actively be done to you.

But is it true that freedom of speech requires no involvement by the government? Let’s imagine taking a trip to place where there is very little government, for example Somalia. You might have the basic human right to freedom of speech there, but it’s not worth much. If you stand on a milk crate (assuming you can find one) and give a speech that others find disagreeable, those people may choose to gag you, stuff you in the trunk of a car, drive you 20 miles out of town, and perhaps kill you. The government has done nothing to take away your freedom of speech, but they haven’t done anything to protect it either.

We often ignore the role of infrastructure, such as our police force and civil and criminal court system, in allowing rights like freedom of speech and religion to flourish. The U.S. legal system is a highly complex bureaucracy, and it plays an important role in keeping the right to free speech alive.

The same principles apply in healthcare. We have a complex bureaucracy in place — doctors, nurses, hospitals — to protect our right to health. There’s no difference, in principle, between free speech and healthcare, so why is one an unquestioned human right while the other is relegated to a commodity?

In fact, no matter what human right you can name, there is an infrastructure in place to protect and defend it. And the professionals who manage that infrastructure need to get paid. So it’s foolish logic to argue that since doctors are paid a salary, healthcare cannot be a right.

Now, an opponent of the idea that healthcare is a right could argue that sure, the legal system keeps freedom of speech alive. But it also does other things. We would need cops and judges around to deal with violent crime, even if society had no right to free speech. So the added cost to society from having freedom of speech is pretty minimal.
But the same argument could be made for healthcare. The medical industry has to exist regardless of whether healthcare is a right or not. Once again we can see that healthcare and freedom of speech are identical.

Still, let’s be generous. Let’s say we do accept the distinction that Mr. Cannon was trying to make when he drew a bright line between healthcare and freedom of speech. I think what he was trying to get at was that there are two types of rights. And actually, he’s correct. Philosophers and ethicists commonly refer to them as “positive” rights and “negative” rights.

In the U.S., we are very comfortable with the latter category. Negative rights are when a person has the right not to have something done to him. For example, the right not to be tortured, not be persecuted for your religion, and not to be thrown in jail for disagreeing with the government.

Healthcare falls into the category of positive rights, for obvious reasons. (i realize, by the way, that i’m not using the strict philosophical definition of these terms. If you really care, check out Wikipedia.) We Americans, when polled on this subject, have always been uncomfortable with positive rights. Positive rights seem to imply whininess, laziness, petulantly asking others for help.

But positive rights are actually a strong part of our tradition. Universal public education was introduced in the U.S. in the late 1800s, and today it is as American as apple pie. Ask any fourth-grader if she has a right to go to high school, and you’ll get a quizzical look because the answer is so obvious. We still fight about ways to improve education in the U.S., but no one has seriously proposed abolishing the public school system. Why? Because we understand what an incredible boon to our country it has been to have a well-educated workforce.

So we’ve established that healthcare, from the standpoint of principles, is no different than other accepted human rights. And from a practical standpoint, we see that Americans already support rights that are very similar to healthcare, like education.

So it seems to me that healthcare is a right. Other people, of course, can disagree. What they can’t do is pretend that there are objective, empiric differences between healthcare and other accepted human rights.

Ok, eye catching title, but I admit this has nothing to do with Sex, Lies and Videotape, other than what we need for healthcare may be what this movie did for independent film (to revolutionize it).

Nor do I want to suggest any of the described below are lies…. this is for readers to decide….

This just in from the New York Times: Richard L. Scott, a conservative that ran a company convicted of defrauding the government of hundreds of millions of dollars in the 1990′s (yes, he is still filthy rich), and whose investment firm claims “integrity” as one of its principles, now is embarking on a campaign à la Swift Boat Veterans against the Obama health plan. Which health plan? The one currently being developed by Congress, aka The People?

Hard to believe that someone with such a history will be taken as credible, so many of us who want affordable health care for all may welcome his attempt to influence the public…. Richard Kirsch, campaign manger for HCAN, of which the NPA is a partner, is quoted as saying: “We cannot have a better first person to attack health care reform than someone who ran a company that ripped off the government of hundreds of millions of dollars.”
Scott’s mantra “Choice, Competition, Accountability and Personal Responsibility” hardly disguises his “businesslike approach to health care” which is “bottom-line-driven”, and has seems to have helped make him a very wealthy man. And calling his organization “CPR” just seems too corny.

It is easy to offer urgent care services for “respiratory illness, headaches, sore throats, sprains or fractures, cold or flu symptoms, burns, cuts, ear and eye infections, pulled or strained muscles, coughs, and childhood illnesses; and physicals, including school or sports, pre-op, and basic check-ups“, as Scott’s company Solantic does, and leave true, costly emergencies for hospitals to deal with. This will not fix our healthcare system, nor have choice and competition taken care of the 46 million uninsured and many more underinsured people stuck with high deductible plans so far (of course Scott is quick to tell you its the governments fault).

Rick, we all agree our healthcare system is too expensive and not sustainable. Other than that, you seem to have little in common with me. I would suggest we all work on a solution that puts more money in people’s pockets, not in yours or mine. Let other, more credible folks (patients, health care professionals and dedicated law makers such as Kennedy come to mind) worry about how to fix healthcare.

The Senate’s Republicans blocked a vote to avoid a cut in Medicare reimbursement starting next week. I hear part of the problem was that money to pay for avoiding the cut was going to come from funding Medicare Advantage Plans. Basically, this is federally subsidized private health insurance for Medicare elegible people and is generally 10 to almost 20% more expensive for tax payers than traditional Medicare. I see that there a probably some profits from donors to protect…. according to the New York Times, Bush has threatened a veto because

 “… it would finance a small increase in payments to doctors next year by reducing payments to insurance companies that care for some Medicare beneficiaries.”

Go figure. Let’s just say the insurance industry has about a 10% profit while my practice’s has been exactly 0.

OK, so many of you may think: doctors make enough money – what is a 11% cut going to do, they can’t buy there second Porsche? No, my friends. I am not clairvoyant, but here are some facts and what (I am pretty sure) will happen:

• Doctors are already working longer hours for less money than a few years ago. Believe it or not, many doctors already provide some free healthcare (maybe not as much as they want you to believe, but my mechanic doesn’t work for free either). While there has been a small increase in average worker’s wages over the past decade, reimbursment of many doctors has dropped by as much as 20% (or even more). Most doctors are dedicated to their patients, but they are also deeply indebted with school loans, and may not want to sell their home or have their kids drop out of college just to be able to do their job. Money is just a reality.
• Doctors offices will reduce costs, which means cutting down on overhead (firing the assistant, the nurse, the receptionist), which means longer waits and worse care.
• Doctors will avoid seeing new Medicare patients – good luck, Baby Boomers (just remember to vote in November!).
• There is already a severe shortage of doctors in poor and rural areas. As these tend to have more people dependent on Medicare and Medicaid, there will be further exodus from these regions – wouldn’t you be at least considering another job if you salary was cut by 10%? There are plenty of opportuities elsewhere.
• Primary Care doctors, already facing probably the lowest reimbursment, may as well be hanging up their coat and go into more lucrative jobs…  like at McDonalds…. ever tried to get preventive healthcare from a Dermatologist?
• The education of resident doctors is tied to Medicare, so we’ll see cuts there, and thus in a few years, probably a decline in quality.

In other words, please do not make a screwed up system worse. What we truly need is an overall reform, like Universal Healthcare, not a patchwork of legislation and rules that is so intransparent, I am sure many legislators have no clue what is going on, especially that they live in cities with pelnty of physicians to choose from and their healthare is paid for!

On a recent trip to Zambia, a vacation, I had many chances to see the health care system at work.   As a country with universal health care, deeply affected by HIV/AIDS, and limited resources to expand its health care workforce, there are both opportunities and challenges within its current system.   

Zambia offers health care to all of its residents. Given that so many people live in poverty (about 70%), it is the only way most residents can receive care.   Indeed, even though the country it is stuck by the massive HIV/AIDS epidemic, the government is committed to ensuring that all HIV+ individuals have access to ARVs and other medicines that help treat the symptoms of HIV, help the infected live productive lives, and prevent the spread of disease.  I met many people who lived on less than one dollar per day, but had access to the medicines need to maintain a healthy lifestyle with HIV.   There are still many people in need, but the country is making progress in getting medicines to its countrymen.

At the same time, there is an utter dearth of health care workers, making it hard for individuals to receive quality treatment or the preventive education that they need.  Because many individuals cannot afford the time and money that it takes to go through schooling to become a health professional, there is a major shortage of physicians and right now many of the nursing staff only have a limited range of schooling.   The ones that do receive training are many times wooed to other countries, where there are nursing shortages.  In one visit to the hospital, there was not a doctor to be found and the nursing staff could not speak the local language of the patients, making effective communication and treatment very difficult.  

This experience really reinforced why we should be investing in more training of health workers across sub-Saharan Africa and in other areas of the world where the workforce has been reduced.  Until we do so, U.S. funding and dollars will only have limited impact on how each nation’s is able to ensure that their countrymen can take advantage of universals health care systems and ensure that each resident has the opportunity to achieve their personal best health status.

In his recent NY Times Magazine piece, Danny Carlat confesses to have taken 30k from Wyeth for ‘educating’ physicians about Effexor. Way to go, this takes a lot of courage. Read some of the comments he received on his Blog, or par example the WSJ health  blog, and you know why. He was called a ‘cheap thief’, ‘hypocrite’, ‘pathetic liar’. However, I admire him for his chuzpa without hesitation! What we need in healthcare is more physicians like him , and less of the all those physicians that have relation(ship)s with the pharmaceutical companies, to compromise their ethics.

 Do I say that there should be no marketing? No. The pharmaceutical industry has developed great drugs and they have every right to be proud (I am not counting the myriad of “me too” drugs, obviously). They need to be sold and thus marketed. But I expect more ethics from them than from a sleazy used car salesmen. If you buy  a Hummer, the slaesman probably won’t voluntarily discuss MPGs. With gas at an all time high, that does not sell well. If you believe your friendly neighbourhood drug rep gives you full disclosure, think of how many patients would have received Vioxx if docs had been told it caused heart attacks….. and what was a major pain medcine prescribed until 2005? If you guessed generic Ibuprofen, you guessed wrong.

I think any reader is able to tell that my question was purely rhetoric…..

Danny Carlat plans to pay back his 30k in academic detailing, also called – maybe not quite accurate – counter detailing. This is a great, constructive idea. Basically, one goes out and gives talk to health care providers based on unbiased evidence, rather than a sales pitch. Read about it on Danny’s Blog here. Looking for an academic detailer to come to you? Maybe Danny is in the area, our you could ask us at the National Physicians Alliance….

cross posted at Stupor Cordis.

From Democracy Now, August 30th:

AMY GOODMAN: I’m here in the Lower Ninth Ward… Hurricane Katrina flooded about 80% of New Orleans and killed well over 1,600 people, displacing another one-and-a-half million people from the Gulf Coast. Only two-thirds of the region’s population has returned home.

Few areas in New Orleans were as hard hit by Hurricane Katrina as the Lower Ninth Ward, where we’re broadcasting from today. This predominantly African American working-class neighborhood remains largely in ruins two years later.

In a moment, we’ll be joined by Malik Rahim, cofounder of the Common Ground Collective, and Alice Craft-Kerney of the Lower Ninth Ward Health Clinic…

ALICE CLARK-KERNEY: …Charity was the safety-net provider for the medically indigent patients in the community, and with that being destroyed, with that infrastructure being destroyed, we knew that many people were going to be caught – the uninsured were going to be caught without any type of medical care. We saw people really just dying on both sides of the street, just because they didn’t have access to medical care. And we decided we weren’t going to wait. We saw people dying at Convention Center Boulevard, the Superdome, just waiting for the bus, and we decided we weren’t going to wait for the healthcare bus. So we determined we were going to open this clinic.

And the clinic was opened by people giving their time, their talent. And what happened was we had folks from all over the country who came to renovate the building, and we had supplies, medical supplies and equipment that was sent down to us, contributions from folks like yourself, as well as some foundations, that got us started. And so, that’s how the clinic actually started and opened.

AMY GOODMAN: What do you need now?

ALICE CLARK-KERNEY: Right now we need money for operating funds. We’re dealing with a scarcity of healthcare professionals, because, just like my family left the region, many of the healthcare providers left the region.

AMY GOODMAN: Did I see a figure, something like 90% of doctors gone?

ALICE CLARK-KERNEY: I’m not going to say 90%, but there was a large number that actually left, never to come back again. And we’re not just talking about doctors, we’re talking about nurses, nurse practitioners, physical therapists, pharmacists, anybody in the healthcare field. All of these folks are gone, and many of them are not going to return. So that leaves us here with a few healthcare professionals, and they can basically name their salary. So we’re competing against hospitals with wonderful fringe benefit packages, sign-on bonuses. And it’s very difficult at this point. So we need funds so that we can actually attract good people to the clinic.

Check out the rest of the interview, it’s powerful. Also, here’s the website of the Common Ground Collective. Support them as you can.