That Republicans don’t support health care reform.
Opponents of health care reform have been touting the results of yesterday’s primary in Missouri as if it were a national referendum on “the will of the people.” After all, more than 70 percent of voters who came out for the primary cast ballots in favor of Proposition C, a measure that would allow state residents to opt out of mandatory health insurance.
In “Bad Medicine” the Cato Institute white paper exploring “The Real Costs and Consequences of the New Health Care Law,” Cato senior fellow Michael Tanner declares the individual mandate "perhaps the single most important piece of health care legislation.” By insisting that citizens have insurance –or pay a penalty– Congress has taken an “unprecedented” step, says Tanner. Like many who object to the mandate, he argues that “The government has never required people to buy any good or service as a condition of lawful residence.”
In fact, that isn’t quite true.
But before getting to what the federal government has or hasn’t required of its citizens in the past, let me say that I agree with Tanner on his first point: the individual mandate is the lynchpin at the center of the Accountable Care Act (ACA).
Summary: As regular readers know, not long ago Cato Institute senior fellow Michael Tanner published a 52-page critique of the new health care legislation titled Bad Medicine, and I decided to write a series of posts, rebutting Tanner’s arguments about the Real Costs and Consequences of the Law. In my first post, I took on Tanner’s assertion that “ObamaCare remains deeply unpopular,” with the majority of Americans supporting repeal.
Tanner’s colleague, Michael Cannon replied to my post, and I responded to his reply, Since then, Cannon has written another post titled “ObamaCare Still Unpopular: Round Two of My Exchange with Maggie Mahar.” Once again, he focuses on what the polls say about the public’s appetite for repeal.
Summary: In the August 2 issue of the New Yorker, Boston surgeon Atul Gawande writes about the ambiguities that plague end-of-life care. With the candor that makes his writing both so credible and so moving, he acknowledges that, as a physician, he too has great difficulty “letting go” of a dying patient.
Ultimately, Gawande suggests, the problem with the way we deal with death today is that we have forgotten the art of dying. Palliative and hospice care can help us recover a lost art, he adds, though not quite in the way most of us expect. The goal is not to cut costs and curtail suffering by shortening the process of dying. In fact research shows that those who receive hospice or palliative care often live longer than other patients.
The aim of hospice and palliative care is to help patients “have the fullest possible lives,” during their final weeks or months, Gawande explains. “That means focusing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter.”
Summary: Once again, Health Wonk Review offers a round-up of many of the most intriguing and informative health care posts that appeared during the preceding two weeks. Julie Ferguson, of Workers Comp Insider, http://www.workerscompinsider.com hosts the most recent edition. She begins with an eloquent riff on the “dog days of summer,” July 24-August 24, a span ancient Romans described as an evil time, “when the seas boiled, wine turned sour, dogs grew mad, and all creatures became languid, causing to man burning fevers, hysterics, and phrensies.” Ferguson suggests that the description captures not only this summer’s heat, but the ongoing debate over health care reform.
She then goes on to do a splendid job of highlighting rich, thought-provoking posts that bloggers have managed to pen recently, despite the maddening heat. Below, I offer just a short summary of some of these pieces, along with my commentary. To read the posts in full, go to Ferguson’s Health Wonk Review http://www.workerscompinsider.com/2010/07/-like-much-of-t.html where you will find links to each post.
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On Managed Care Matters, Joe Paduda congratulates "Several large health insurers [that] have decided it's time to get serious about managing costs. They're introducing plans with limited provider networks and either no coverage for out of network providers or high deductibles and co-insurance/co-pays. The plans, introduced by United Healthcare, Aetna, Wellpoint and others, are currently only available in a few markets as the health plans test market receptivity."
As regular Health Beat readers know, over the past three years, Naomi Freundlich, and I have written about the risks as well as the benefits of mammograms more than once on this blog. Nevertheless, I want to call attention to an outstanding New York Times story by Stephanie Saul that appeared on the front page of the Times Wednesday, July 19, taking an in-depth look at what can only be called a medical tragedy.
Saul tells the tale of women who lost all or part of a breast, and in many cases suffered through radiation, for absolutely no reason. This could happen to anyone. One of these women was a nurse.
Summary: Not long ago the Medicare Payment Advisory Commission (MedPac) came out with a data book on Medicare spending. The information is condensed into tables and charts. As I looked at the charts, I found some surprises. Below, myths and facts about:
The Cato Institute’s Michael Cannon has replied to Part 1 of my response to Cato’s report on the Patient Protection and Affordable Care Act (ACA) .You’ll find his reply here. Unfortunately, the Cato Institute website doesn’t have a space for comments, so I decided to respond here, on HealthBeat.
First, let say that Cannon’s reply is both civil and gracious. Thank you, Michael Cannon. I’m hoping that this debate will move forward as I continue to write about the rest of the Institute’s recent white paper, “Bad Medicine: A Guide to the Real Costs and Consequences of the New Health Care Law.” This seems to me a good opportunity to have an intelligent, rational dialogue about reform, comparing facts, while laying out two very different points of view, calmly and clearly.
This week, the Cato Institute released a 52-page report on health care reform titled: Bad Medicine: A Guide to the Real Costs and Consequences of the New Health Care Law.
The tract was written by Michael Tanner, a senior fellow at the Institute, and it rests on the thesis that the Patient Protection and Affordable Care Act (ACA) is both Unaffordable and Unfair. Inevitably, Tanner’s claims about affordability are shaky; in truth no one can project how much reform will cost over ten years—and how much it will save. There are too many variables involved. Nevertheless, Tanner seems sure: the legislation will add to the deficit, he asserts, and force insurance premiums higher. Moreover, he stamps the legislation “unjust”: it would turn private insurance companies into regulated “public utilities,” forcing them to insure sick people, while “redistributing income” from families earning “over $348,000” to families earning “$18,000 to $55,000.” Ultimately, he argues, reform represents yet another step toward transforming the U.S. into a “Nanny State.”
Today the Department of Health and Human Services announced what criteria doctors and hospitals will be required to meet if they want to receive payments to help buy the Health IT needed to computerize patients’ medical records. Under the HiTech Act’s incentive program, Medicare and Medicaid will be giving out some $27 billion over the next ten years. The program begins next year. A doctor can receive up to $44,000 under Medicare and $63,750 under Medicaid, while a hospital can receive millions of dollars, depending on its size. (Starting in 2015, hospitals and doctors will be subject to financial penalties under Medicare if they are not using electronic health records.)
The rules boil down to this: providers who want to be eligible for incentive payments will have to show that they are making “meaningful use” of electronic health records (EHRs)—i.e., that they’re not just using them to expedite billing , but that they’re using EHRs to improve patient care.
For example, under the final rules doctors will be expected to transmit more than 40% of their prescriptions electronically, hospitals must be able provide more than 50% of patients who are discharged with an electronic copy of discharge instructions if they request it, and providers must produce an electronic copy of a patient’s medical record within three business days to more than 50% of patients who request it. Click here for a summary of all of the rules.
Regina Holliday appeared at today’s announcement to stress just how important patient access to a medical record can be. Below, she tells the tale of what happened to her husband, Fred, after he was diagnosed with Renal Cell Carcinoma and hospitalized.
What is striking about her story is that Holliday is not complaining that the hospital didn’t “save” her husband. She is objecting to how little information she and her husband received: “the terror of not being told what was going on.” In other words, this is less about what treatment he did or didn’t receive than it is about how he was treated. Holliday is calling for “patient-centered care” that includes the patient in the decision-making loop, giving him the information he needs to make an informed choice.
This piece originally appeared on Regina Holliday’s Medical Advocacy Blog in October of 2009 where it was titled "Thoughts on Medicine and Social Media." Many thanks to THCB’s Matthew Holt who cross-posted Regina’s story in October, and wrote about her appearance at today’s "meaingful use" announcement. Holt describes her as “the poster child for why access to health data matters to ordinary people," adding: “we need to get her from the world of webinars, Health 2.0 Conferences and HHS announcements onto Oprah and the 6 O’Clock News right now.”
I agree, which is why I’m posting her story here on HealthBeat. (It's not Oprah, to be sure, but unlike the 6 O'Clock News, at least I can give her more than a soundbite.)
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Thoughts on Medicine and Social Media
On March 27 my husband, Fred Holliday, was diagnosed with probable Renal Cell Carcinoma (RCC) . Within one day, I became an e-patient, a caregiver and a medical advocate. I would use the internet for both research and patient/family support. To help my husband receive the best care, I surfed the internet at night; researching his cancer using Google, reading the Wikipedia entry on RCC with all of its links, and finding personal cancer stories. Facebook became the information source on Fred’s medical status. I would take a few minutes each night to post to the 100 plus people following Fred’s care. Within days of diagnosis, two of my friends had set up a "Lots of Helping Hands" account. This online network, which rapidly grew to 150 volunteers, would fundraise and provide meals, babysitting and groceries. This pool of helpers was immensely diverse. Before sites such as Lots of Helping Hands, orchestration of a volunteer effort this complex would not have been possible.