It's About the Middlemen

Published in the September 26, 2009 edition of the New York Times is a letter from a reader, Jack Luft. He acknowledges the complexity of the debate, proposals and the fixes.

But he truly hits the nail on the head with this point, "the difference this time is that the ... debate isn’t about the product, which is delivered by private-sector doctors and hospitals. It is about the middleman, who acts as arbiter of how health care is paid for."

link to Jack Luft's letter

Health Plans Cost Physicians $31 Billion A Year!

Physician practices report that overall the costs of interacting with insurance plans is $31 billion annually and 6.9 percent of all U.S. expenditures for physician and clinical services.

Funny Video Link

Link to Article

Baucus Bungle?

well, we finally have bipartisan support! there is support from both sides that 'there’s no way I can vote for the Senate package'

how long can these guys sit at the table anyway? is the food at this table that hard to swallow? the places that i eat have a thing called last call.

Link to NYTimes article

too lazy to read? try these (entertaining) video links:

Link to Bill Maher "BJ" to the health care industry

Link to Keith Olberman on Baucus

Link to O'Reilly on public option

Doctors and Nurses, Strange Bedfellows?

Imagine having to pay out hundreds of thousands of dollars that you hadn't expected you'd owe. Now, imagine that you're only one step away from owing that money. While they may not know it, that is exactly how far away from the deep debt that healthcare costs can accrue many Americans are. One step, one diagnosis, is all it takes.

From diagnosis to treatment to unforeseen, but not uncommon complications, the cost of being ill in America is no longer paid in suffering alone. There is a dollar amount attached to all of this that is enough to plummet the vast majority of us into financial ruin.

Earlier this week, physicianvoice posted about the possibility of the 'public option' being administered through the state medical society, either independently or in conjunction with others. As we look forward to the delivery of not just a 'public option,' but healthcare in general, it is important for physicians to ask ourselves just which groups we would be well-placed to work in conjunction with.

When approaching patient care and thinking of the healthcare teams around us in our offices and hospitals, one comes forth rather readily, the nurses. In policy, however, we sometimes find ourselves working at opposite ends from our trusted ally in clinical practice. But does this have to be the case?

As the healthcare debate rages on, maintaining a patient-centered approach provides high common ground for physicians and nurses to work together. Just as both groups work in tandem in the healthcare setting, so too may we work together in the healthcare reform forum, particularly, where the benefits of creating a role for providers in administration of a 'public option' are concerned.

Just as, now is the time for dissenting physicians to come together, now, may also be the time for physicians to take that first step in reaching out to nurses to seek alliance where we agree, and settle differences where we do not.

It is important to recognize that nurses have had tremendous success in shaping their public image as well as lobbying. In fact, in 2006, nursing was the only field in the health services sector that saw an increase in government funding.

It is also important to recognize that when it comes to healthcare delivery, physicians and nurses share the front line perspective. We know firsthand that many of our patients, and us, are just one diagnosis away from not only medical, but also financial catastrophe.

Options to Consider In A "Public Option"

While the details of the "public option" remain to be seen, critics are already quick to point to the likelihood that such an entity would merely build upon a faulty program and result in a disservice to beneficiaries and providers alike.

It is important to note, however, that there is nothing mandating that the federal government, while certainly providing the initial funding, needs or should be the body administering this option.

There is potential benefit, for both patients and providers, in having decisions regarding coverage and reimbursement be physician driven.

Given that insurance is regulated on a state level, state medical societies, whether working independently or in conjunction with other entities (such as government representatives and even plan beneficiaries) may be a logical option to fill this role.

Retail Health Clinics Lobby for Place in Heath Reform

Retail health clinics are adding treatments for chronic diseases as part of their efforts to halt losses at the clinics.

The chains are also lobbying for more insurance coverage, and angling for a place in pending health-care reform legislation, while trying to temper calls for regulations.

Nurse Practitioners and Physician Assistants, who typically staff the clinics, "are very important parts of health-care teams," said Dr. Ted Epperly, president of the American Academy of Family Physicians.

But "for them to create retail health clinics and take care of the community as if they were family physicians, that's not their skill set."

Golden (not silver) Bullets?

'Now, I don't believe malpractice reform is a silver bullet, but I've talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. So -- so -- so I'm proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. I know...

... I know that the Bush administration considered authorizing demonstration projects in individual states to test these ideas. I think it's a good idea, and I'm directing my secretary of health and human services to move forward on this initiative today.'

President Obama

your administrators thank maria basile md for this link to Bush initiatives

Goldhill - Way Forward to Financing Health Care

In The Atlantic, David Goldhill offers a solution to reform the way health care is paid for. The article is lengthy, perhaps flawed in some of the specifics (particularly the attempts to apply standard economic models to health care and in overstating the death rates due to medical error) - but at the end of the day offers a tractable and thoughtful remedy.

He proposes a move away from comprehensive health insurance as the single model for financing care. In addition, he includes indigent care and long term care in his plan.

He instead would make use of different sorts of financing for different elements of care—

• routine care funded largely out of our incomes;
• major, predictable expenses (including much end-of-life care) funded by savings and credit; and
• massive, unpredictable expenses funded by (catastrophic) insurance.

Under Goldhill's plan, every American would maintain an HSA, and contribute a minimum percentage of post-tax income, subject to a floor and a cap. All noncatastrophic care should eventually be funded out of (these) HSAs.

For care that falls through the cracks—major expenses (an appendectomy, sports injury, or birth) that might exceed the current balance of someone’s HSA but are not considered catastrophic - These should be funded the same way we pay for most expensive purchases that confer long-term benefits: with credit. Americans should be able to borrow against their future contributions to their HSA to cover major health needs.

Medicare & the 'Public Option' - Physician Perspectives

A physician writes: "a public option (nationally or at the NYS level) is a necessary and desirable alternative to private health insurance."

Further, he reflects upon his own experience: "As a newly eligible Medicare user it is clear that the private Advantage options are both expensive for medicare and a rip off for the consumer.

The only issue that I have about Medicare ... is that after paying a fortune in Medicare taxes over 30 years and after (also) building an adequate retirement plan, I find that my Medicare premium is based on my 2007 income (including tax free bonds). For A and B it comes to over $300 a month and if I choose to not play, I will be surcharged 10% FOR EVERY YEAR that I wait."

sk

Med Students Presage Pharm Fraud

the harvard policy, predicated in response to the med students distaste for pharm intruding upon academia, shares space in today's paper with the news of pfizer's $2.3 billion settlement for health fraud.

pharm's settlements exceed those of the health plans, yet the administration (and your blog administrator) vilifies the insurers. certainly, the med student's rejection of pharm's behavior presaged news of their even more egregious conduct.

as healthcare stakeholders go, we doctors are saints - but, especially in the era of health care reform, we should be careful with whom we 'partner'.

Deficit Distortions

This graph appeared in the print edition of the Sunday NYTimes. Analysis of the graph reveals a dip in revenue that exactly coincides (time wise) with a spike in spending.

Its creators employ a clever distortion relating to the current deficit situation. They put the 'entitlement spending' at the top of the graph, in order to illustrate that the magnitude of entitlement spending happens to correspond in magnitude to the deficit. This suggests that in order to eliminate the deficit, one should focus on Social Security, Medicare and Medicaid.

The truth is, it is the spike in the graph of 'other spending' around 2007-08 which pushes the Social Security, Medicare and Medicaid lines up, correspondingly, over the revenue line. Inverting the graph, (placing Health & Social Security spending at the bottom), would be far less disingenuous.

While the deficit could surely be offset by the elimination of Social Security, Medicare and Medicaid spending - it is wrong to conclude that such spending is the actual cause of the deficit.

In pondering health care reform, consideration of deficits should be directed to their cause, not merely at an easy target.