Posted by Dr Fox on Sunday, August 30, 2009 at 2:13 pm
I’ve been tormented about whether to compromise on my support for single payer health insurance. It makes so much sense to me. It’s popular among physicians. Six months ago national health insurance seemed popular in national polls. But we keep being told that it’s “not on the table” by six senators in the senate finance committee (whose constituents represent less than 3% of the US population), and it has failed to gain momentum.
Well, even though I feel betrayed by our “Democratic” process, I think a health care bill needs to pass that covers everyone and guarantees an affordable option, and I’ve decided to put my energy into promoting this even if it doesn’t mean single payer.
Now, I certainly understand people being less passionate about a vague public health insurance option than single payer, but I also think there is misinformation on “our side” about the current health care bills.
Even if HR3200 is not ideal, I can think of several of my patients who would benefit from exchanges and a public option; the industry regulations are not meaningless and would protect people from being denied insurance or dropped from their insurance for prior conditions; expanding Medicaid would help millions; the development of a center for comparative effectiveness research will improve quality and help control costs; and there will be some improvements to the primary care infrastructure.
Whether its single payer or a public health insurance option, I’m going to stay positive and support the efforts for universal coverage.
There were 3000 people in Times Square yesterday (according to the police) in support of reform, and I think we need to stop fighting about who is most right and just get out there.
Yesterday, I spoke to lots of people about both single payer and the current bills being considered. I spoke at a community meeting last week and people had questions about both. Our NYC group with the National Physicians Alliance has met with most of our Congressional representatives and they are mostly on the same page – they’ll push for single payer but don’t look at a strong public health insurance option as failure.
I just don’t think it will work to tell people that single payer health insurance is the only option for high quality health care (I’m not an expert on comparative health systems, but I don’t think it’s true either – France, Germany, Japan, and other countries have well functioning health care systems without single payer; And if we’re talking about good outcomes with low costs and health equity, it seems like Cuba would be a much better example than Canada).
I believe that profits have no place in health care, so I feel like a sell out in supporting a bill that does little to address this, but I also think my patients, patients in states with limited Medicaid coverage, small business owners, people without employer sponsored coverage, and even people with private insurance will benefit from HR 3200, so I can put my politics aside for now. People are dying or going bankrupt because of our health care system, so lets get out there and do something about it.
Category: Uncategorized
Posted by anjali on Saturday, August 29, 2009 at 7:02 pm
Today, 3000 New Yorkers joined together at Times Square to support healthcare reform. Among them were quite a few National Physicians Alliance members, and Dr Jonathan Arend spoke at the event. These and quite a few other photos below are from casperr’s diary at dailykos.
Above: Dr Jonathan Arend, of the NYC National Physicians Alliance group, speaking to the crowd.
Above: Some of the physicians who were present at the rally.
Above: braving the rain, 3000+ people show up for the event.
Category: high quality health care for all,media
Posted by BMS on Sunday, August 23, 2009 at 11:27 pm
Let’s practice saying: Americans Want a Free Market Economy for Health Care!
I had a recent discussion over coffee in our cath lab’s break room. I was faced by about 3 or 4 techs and nurses and somehow we got talking about health care reform. It did not go so well for the reform side. “I am from Canada, and my aunt needed to come to the the States to get radiation therapy”; “Have you read the bill – our politicians haven’t, they do not even know what’s in it!” (hey, probably true, but nor did this nurse); “I read that we needed to use our imaging equipment 75% of the time – that means I have to work weekends!?” May I quote H.R 3200, Section 1147: “In computing the number of practice expense relative value units (…) with respect to advanced diagnostic imaging services (…), the Secretary shall adjust such number of units so it reflects a 75 percent (rather than 50 percent) presumed rate of utilization of imaging equipment” – it says nothing about running it 75% of the time.
So, let’s say for argument’s sake that we are switching over the single payer exactly like Canada – wow, we would get 1.5% less infant mortality, on average 2.6 more years of life, for half the money and $300 per capita less (not per case, per capita of the population, including those who never see a doctor!) in out of pocket spending, according to 2006 data. Just imagine what we could do with what we are spending now!
Then again they went “Canada“, “Canada” and yeah, I almost forgot “SOCIALIZED MEDICINE!” This is when it occurred to me: while I was busy taking care of American patients that pay $5000 per year out of pocket and a 20% copay, I missed the Obama/Kennedy/Baucus/Pelosi press conference where Obama seems to have said “And to end it all, we have a bill that make the United States part of Canada, so we all get the same health care system, and yeah, BTW, we will socialize everything top down…”
I am joking of course, because I am not delusional this may actually work, and I guess I had it all wrong – the government is the problem! They so clearly have an interest to kill you off as soon as you are worthless, count your number of Viagra® pills, and tell you to have to see that doctor – something no insurance companies ever does!
So again for argument’s sake, let’s say we change over to free market economy soon and got rid of these pockets of government subsidized health care we have. Let’s start with
1. the VA system – it’s gotta go! Single Payer if we ever had one. The system is overrated anyhow. All those vets are in good employment with insurance benefits, right?
2. Medicare – we just change over to Medicare Advantage and Medicare Part D, but let our seniors pay the premiums completely on their own. We’ll call it Medidontcare (Ok, get it? Med – I don’t care?). Who would not want to spend their life savings on health care premiums! Then it does not really matter if we cannot negotiate drug prices for our seniors.
3. Medicaid – please…. as Marie Antoinette allegedly said “if they don’t have bread, let them eat cake?” But let’s just say that we are not completely heartless and we’ll keep it – for now.
Furthermore, my colleagues and I will not see any more patients without assuring they can pay everything, either via co-pay and insurance or out of pocket. There will be a branch of Citi Bank in our office so people can take out the mortgage on their house, hand over the title for their cars. We want to be paid in full, up front, because we provide a “service” to the “consumer”. If you cannot pay? Well, you would not expect to drive a new car off the lot (or have your broken one fixed) for free, would ya? Just look form someone who is cheaper (note: next cardiology practice is 200 miles south – what, monopoly you say? price gouging? Nah…).
The good side (for me): after people have sold their houses, lost their savings, I will have become very rich (that is if I still have a job), because now my practice is recouping 90 cents on the dollar billed, instead of just 43 (the 10 cents missing are accounted for that some people actually still have insurance, which never pays the billed amount and actually – wow – denies to pay for some services that patients and doctors feel they need, and that some people I sent collectors to actually have nothing left).
Then, health care will become cheaper… a lot. Many people will eventually have Medicaid. The government would want to raise taxes, but can’t, because that would mean certain defeat in the next election by people who give even less about health care (they’ll run on the “At least we are no Soviets and we can carry guns anywhere” ticket). Can Medicaid reimbursement actually becomes net negative? The dilemma of course is that the states get shafted, but because as of now, August 2009, many are only paying hospitals with play money anyhow, and soon will probably cut payments to those practices that still see Medicaid patients, this issue soon gets solved, too. No one will see Medicaid patients anymore, unless held at gunpoint. So costs will be saved. Life expectancy hopefully will plummet to below 65, because some daring liberals want to revive Medicare once in a while. Eventually, the nation’s 800,000 physicians will cater to the nation’s richest few million in a concierge doctor fashion. The only way for everyone else to get any care will be emergency rooms, unless EMTALA is revoked, where wait times will be now up to 36 ot 48 hours. Stabilized patients will be treated and discharged until they end up dying from now incurable diseases such as cervical, prostate and breast cancer, or preventable heart disease, or diabetes, to name a few.
Guess what – there is even a website called freemarkethealthcare.com. But you’re still sure you want it?
Category: high quality health care for all,just for fun
Posted by anjali on Friday, August 21, 2009 at 2:40 pm
Really. President Obama’s healthcare reform proposal ranks highly among least understood policy proposals in current politics. What follows is a concise and easy to understand explanation of the popular but often muddled “public option” that is contained in national legislation and that forms the centerpiece of President Obama’s proposal. This one is great for cocktail parties and loud bars, because it’s so easy to explain.
The speaker is Chris Hayes, DC editor of The Nation magazine, and the setting is the Netroots Nation blogger/media conference in Pittsburgh, August 2009.
After the conference, a blogger named Nicholas Beaudrot transformed Hayes’ flowchart-gesturing and converted it into an easy to read and share flowchart about the public option. Click on the image to enlarge it.
FINALLY, easy to understand, right? Precisely why you should share it with your colleagues, friends, and foes alike. What do you think docs, shall we print out these charts and put them up in our medical offices?
(cross-posted at CureThis)
Category: high quality health care for all
Posted by bafoster on Wednesday, August 19, 2009 at 2:35 pm
An article today discussed the measure of Americans’ confidence in reform of our current health care system – confidence is down just in case you were wondering. Much of what was cited in the article was fear of change. That fear was found to be based on mistaken beliefs about the current proposals – a government take-over of health care, covering all ‘illegal immigrants’ etc.
On a daily basis, whether practicing medicine in the clinic or the hospital, we as physicians counsel patients on their diagnoses and best choices of therapies. Recently, I talked to a mother about getting a spinal tap done to rule out meningitis in her young son with fever. She had significant fears about what this meant and what the risks were. I listened, tried to address those fears and any questions she had while advocating that this was the best therapeutic choice. We are all trained in this, either formally or informally, and it is essential to practicing good medicine.
In discussing the health care reform process, some of us seem to be forgetting some of the basic tools that we use to encourage patients to follow what we see as the best choice of therapy. Listening, addressing questions and concerns in plain language and taking into account where the person is coming from while advocating for what we see as the best option are things we should consider applying to our engagement in the current debate.
There are significant fears in people’s minds about health care reform as the article pointed out. I think a lot of that fear can be assuaged through using language that is neutral yet accurate – others have proposed talking about ‘a family doctor for every family’ or a ‘pediatrician for every child’ instead of ‘universal health care.’ Specifically asking what is it about government-run health care that people are afraid of and then addressing whatever fear that is – bureaucrats will not be taking the place of your doctor.
As physicians, we counsel patients on a daily basis to take medications and undergo procedures that have inherent risks, that they have fears about but that we think are the best option. We have the training to do so. While this is nothing new, this study I think serves as a good reminder that we should use the training that we have to advocate for the health care reform that we see as best for our patients and try not to fall back on political rhetoric (even if instigated by the ‘opposing side’), confusing terminology or brush off people’s concerns and fears. I believe that the current proposal with a public health insurance option is the best for my patients, but the patients have to want it too.
Alex Foster, MD, MPH
Category: coalition-building
Posted by viraj on Tuesday, August 18, 2009 at 8:47 pm
Here’s a former insurance PR exec insider look at some of the ways the private insurance companies are trying to kill the debate: http://www.cnn.com/2009/POLITICS/08/17/potter.health.insurance/index.html?iref=newssearch. It’s insane to see to what extremes they’re going to try to control and kill the reform!
Category: Uncategorized
Posted by Dr Fox on Sunday, August 16, 2009 at 9:20 pm
Wasn’t it just last year that we heard from political pundits that arugula munching Barack Obama was out of touch with average Americans. Well apparently John Mackey, CEO and co-founder of Whole Foods Market, not only shares President Obama’s concern with the price of arugula but also the price of health care in America. In a Wall Street Journal op-ed piece, he shares an eight point plan for controlling health care costs, some of which is derived from his own experience in providing health insurance for his employees. His plan includes promoting high deductable health insurance plans, deregulating health insurance markets and strengthening the individual market, and solving the problem of 46 millions uninsured Americans through charity. Well sorry, Mr. Mackey, like many of the luxury goods at Whole Foods Market, your health reform ideals are out of touch with the lives of many Americans.
High deductable health insurance plans, or consumer directed health reform, where individuals are responsible for the first $1,000 – $2,500 of health care that they consume (not including premiums) and the insurance company covers catastrophic care, is not a new innovation introduced by Whole Foods and other forward thinking entrepreneurs. These plans have been around for decades, and while they are certainly less expensive than comprehensive health care benefits, evidence so far shows that they have only had a moderate effect on controlling costs and their impact on quality of care is unknown.
Unlike CEO Mackey, as a physician, I am not just worried about health care costs, but also the quality of care for my patients. In the 1970’s, the RAND health insurance experiment studied the impact of different types of health plans, including free care and plans where patients had increasing levels of responsibility for the costs of their care. Families who were randomly assigned to higher levels of cost sharing consumed less health care than those receiving free care, but they did so by avoiding both necessary and unnecessary care. For the poorest families, going without care may have saved money, but it also had a real health impact. In just a decade, it was estimated that the option with free care reduced deaths by 10% for patients with hypertension and low socioeconomic status. While high deductible plans are attractive to the young and healthy, like those who work at Whole Foods markets, we need to provide high quality health care that is affordable to everyone, especially those who are sick and struggling economically. In a review of consumer directed health care reform, including high deductible plans with health savings accounts, health economist M. Gregg Bloch, “if consumer-directed plans achieve market dominance, disparities in care by class and race will probably grow.”
Case in point, this week I saw Ms D, who works as a mental health counselor and receives health insurance through her employer. Her plan covers office visits, but she has high co-pays for her medications, which she cannot afford. Her blood pressure and cholesterol have been very elevated, and she requires medication to reduce the risk of heart attack and stroke. This past visit her blood pressure was great, but her cholesterol had not responded to medications, so I inquired more. It turns out that she chose to purchase the blood pressure medications because they are cheaper. While empowering patients in health care decision making is a noble intention, my patient’s decision is one that no one should have to make.
Mr. Mackey uses his op-ed forum to criticize socialized medicine and emphasize personal responsibility, but creating a dichotomy where “government controlled” health care is bad and individual health care decisions are good serves more as a political tool for inciting rage, rather than a model to improve our current dysfunctional health care system. The bill being debated in the House of Representatives is a compromise between a single payer government plan and one that favors private health insurance, and it seeks to improve the health care system not make a political point.
I agree with Mr. Mackey’s emphasis on healthful living and disease prevention, but not everyone can afford to shop at Whole Foods and purchase organic produce. I recommend a healthful diet to all my patients, and many tell me that fresh fruits and vegetables are either too expensive or unavailable in the local convenience shops or “bodegas” where they do most of their shopping. To respond to the need for affordable produce, the City Council and Department of Health in New York City have developed programs to promote green markets throughout the city and provide incentives where food stamps recipients can use their benefits cards to purchase fresh produce and healthful foods. Sometimes, the government can do good, and there are provisions for strengthening the federal public health infrastructure within the House health reform bill.
In terms of increasing health care costs, one of the problems shared by both Medicare and private insurance is expanding use of new technologies, and the perverse incentives for doctors to provide more care whether it is beneficial or not. The House proposal seeks to address these perverse incentives, first, with its funding of comparative effectiveness research, which would help doctors understand which treatments and technologies are of high value, and second, with its Medicare reimbursement reforms, which would pay doctors for improving health outcomes not simply for performing procedures. To control growth in health expenditures, we should be making it easier for people to access high value care while limiting payment for care with limited or no value. For example, cutting co-payments for extremely effective cholesterol lowering medications could save $1 billion per year by preventing patients from skipping doses due to costs and therefore preventing heart attacks and strokes. Sometimes providing free care SAVES MONEY. Patients should also be involved in deciding what care is of high value, but suggesting that a patient with cancer could rationally decide what care is worth the costs is unrealistic.
Socialism and personal responsibility are value laden terms, but we should not let our ideology get in the way of reform that would improve the lives of millions. Charity is a nice idea, and Americans are very giving in times of need, but patients should not have to grovel for health care when they are sick; healthful living and prevention is a must, but there are millions of people in need of immediate medical care and who have no means to pay for it; the argument over the “right” to health care has already been decided – people cannot be turned away from emergency rooms if they are ill. Now, we need to create a rational health care system that serves all Americans, emphasizes healthful living and prevention, and controls the growth in health care costs, not simply one that fits the fantasies of free market ideologues.
- Aaron Fox, MD
NYC Local Action Network
Category: Uncategorized
Posted by Howard Grossman on Thursday, August 13, 2009 at 10:59 pm
John Mackey, CEO of Whole Foods is embarking on a public campaign against healthcare for all people, with the first salvo being a Wall St. Journal op-ed piece which you can read here:
http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html
In his piece he advocates the same old tired right-wing “pull-yourself-up-by-the-bootstraps” message on healthcare and continues to advocate a system that denies people care.
I think every doctor on this blog knows one very simple truth—it is always people like Mr. Mackey, the folks who scream the loudest against single payer and public health care, who are the most amazed when they get sick and the current system fails them completely. They are always just so stunned and want to know how long this has been going on and why no one has fixed it.
Many people are choosing today to speak with their wallets and boycott Whole Foods. Such action has been advocated by Single Payer Action at
http://www.singlepayeraction.org/blog/?p=1327
Your choice—but be informed.
Category: Uncategorized
Posted by Howard Grossman on Thursday, August 13, 2009 at 10:39 pm
Robert Reich has some interesting advice for the administration and others looking to fight off the irrational arguments of the right-wing against healthcare reform.
Here’s the link:
http://tpmcafe.talkingpointsmemo.com/talk/blogs/robert_reich/2009/08/how-to-fight-heathcare-fearmon.php/
It is time for all advocates of change to start speaking in very clear, specific terms that folks can understand. We need simple messages and Mr. Reich has them. Here are some more:
1) The current system is seriously broken
a) Rationing of healthcare is happening now
b) Everyone will get sick some time and need access to care which is increasingly denied by private companies
c) It is in the interest of private insurance companies to take your premiums and not give anything back
2) American business cannot compete with the current health insurance system.
a) If $1800 of every new care produced goes to pay healthcare, how we we ever compete in the world?
b) No change means more lost American businesses
3) Anti-health reform forces do not want you to have a say in what happens if you get sick or have a terminal illness. It is in the interest of for-profit care to keep doing tests and procedures on you whether you want them or not.
We must educate the vast majority of Americans who, right now, are confused.
Category: Uncategorized
Posted by Howard Grossman on Wednesday, August 12, 2009 at 5:22 pm
Many words have been spent in the media discussing how the Obama administration is “losing” the healthcare debate. The reality is, however, that it is the media–mainstream, viral, blogged and all—who will actually be responsible if no real health reform is accomplished. Howard Dean’s Huffington Post blog of 8/10/09 should serve as an opening salvo in getting the media to wake up to its responsiblities.
http://www.huffingtonpost.com/howard-dean/the-medias-treatment-of-p_b_255878.html
There was a day not so very long ago when news reporters felt that a large part of their job was to educate the public. Clearly this kind of professional ethic has been on the decline, but the last few weeks have shown it to be on terminal life support. Many, many citizens are confused about what health care reform will bring. My parents, both educated people in their 80′s who read 3 newspapers a day and are quite liberal, just feel completely at sea on this issue. Many of their friends feel the same.
What has the media done to educate folks like my parents? Nothing. Instead they spend endless hours talking about Sarah Palin’s outrageous statements about “death squads,” repeating right-wing propaganda as if they were anything but the most egregious, unethical, debased lies, and providing public forums for birthers, deathers and every other crazy, fact denying lunatic.
If the media spent even 10% of the time it has spent giving legitimacy to these folks on educating the American public we would be in a very different place in this debate.
Clearly there is that segment of the population out there who is completely immune to facts—-no matter how many times President Obama says, “if you’re happy with your current health plan you can keep it,” they are going to insist that the government is taking over. There is no rational debate with such people and we need not even try. Their objections are really about racism, Republican angst and fear of a pluralistic society. But the overwhelming numbers are Americans who are confused and need to be educated. We must demand with letters and posts and phone calls that people in the media return to a place where they choose responsible reporting over ratings.
Category: Uncategorized,media
