Category Archives: Health Reform

The Supreme Court’s decision buys time: More Americans will have a chance to learn what reform means

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Now, the power to make a decision about health reform is back where it should be – in the hands of the American people. In November, they will vote.

Ironically, the Supreme Court challenge may have put them in a better position to vote in their own self interest.

When the case went to the Court, a dreary policy debate turned into a contest that piqued our interest. Americans like spectator sports: Who will win? Who will lose?

Thanks to the publicity, some learned that the Affordable Care Act’s mandate will apply only to Americans who don’t have employer-based insurance, Medicaid or Medicare. And while that relatively small group will be subject to a penalty if they don’t buy insurance, they also will be eligible for a subsidy if they do.

Since the Court announced its controversial decison, some media coverage has delved a little deeper into the details of reform.

For example, last week, the Christian Science Monitor offered a quick lesson in “How the Supreme Court Ruling Affects Families.” Consider a “family of four, headed by a 45-year-old, with an income of $60,000″ purchasing their own insurance. In 2014, they “would reap a tax subsidy of $9,308.”

If they didn’t buy insurance, in 2014 they would pay a penalty of $285. Suddenly, health reform doesn’t sound so scary.

I published this post on HealthInsurance.org a few hours ago.  To read the rest of the post, click here

Self-fulfilling Media Narratives: How One Man Wound Up Deciding the Fate of Healthcare Reform

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Personally, I am delighted that Chief Justice Roberts voted to uphold the Affordable Care Act (ACA)   But, I am troubled that the fate of U.S. healthcare turned on one man’s opinion. This is not how things are supposed to work in a democracy.

Healthcare represents 16% of our economy. It touches all of our lives. If we don’t like the laws our elected representatives pass, we can vote them out of office.  The Supreme Court, on the other hand, doesn’t have to worry whether its decisions reflect the will of the people. The Justices are appointed for life.  This is why they are not charged with setting public policy.

                        The Media Shapes Our Expectations 

As I suggested when oral arguments began back in March,  a “media narrative” drove the case to the Court– a fiction that caught on, in the press, on television, and in the blogosphere, where it began to take on a reality of its own. A handful of “state attorneys general and governors” saw “a political opportunity” and floated the idea that the law might be unconstitutional.  The media picked up the story, repeated the heated rhetoric, and “fanned the flames … Before long, what constitutional experts thought was a non-story became a Supreme Court case.”

These media narratives are based on what “that those in power and in the media have concluded is likely to happen,” says Lyle Denniston, known by some as the “Dean” of Supreme Court reporters.  Writing on “Scotusblog.com,” he observes: “One ‘narrative’ about the health care law began building up in Washington, and perhaps beyond, right after the Supreme Court held its hearings in late March.  The mandate, it was said, was going to be struck down, the government’s lawyer had blown it, and the President was going to be deeply wounded politically over the loss of his treasured domestic initiative.”  Some media outlets were so persuaded by their own myth-making that initially, they reported that the Court had ruled against reform!

Denniston explains that once the story goes viral, the conventional wisdom is then repeated, over and over, until “often, it seems, such ‘narratives’ become self-fulfilling.”

He then points to a “currently prevailing ‘narrative’ that most of the country is stubbornly committed to the Tea Party’s wish to limit the power of the federal government.”   The facts contradict the  fiction: Tea Party Candidates have been “losing  steam” in recent elections   In April, a WashingtonPost/ABC poll revealed that support for the Tea Party among young adults had plunged to 31%– down from 52% in the fall 2011. Half of those polled said that the more they heard about the Tea Party, the less they liked it.

I wrote this post for null.com, where it appeared earliler today, To Read the Rest of the Post, go to https://www.null.com/blog/2012/07/12/self-fulfilling-media-narratives/

 

How to Avoid Avoidable Care–by George Lundberg

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Below, a  guest-post by Dr. George Lundberg, Editor-at-Large of MedPageToday; Editor in Chief of Collabrx; President and Board Chair of the Lundberg Institute.  (Full disclosure: I am a member of the Lundberg Institute’s Board)

What Lundberg says is not meant to be news.  Today, physicians tend to agree that many of the tests that patients undergo are unnecessary. Three years ago, one hospitalist shared a story on HealthBeat, describing how he warned his residents about over-testing.  His hospital may not have been happy about his disclosure: tests boost revenues.

But in some cases, we have solid medical evidence showing that for certain patients, these tests do more harm than good– though vested interests may try to bury that evidence. (See Dr. Hoffman’s post below.)

Yet doctors continue to order the tests– why?  

George Lundberg brings a unique perspective to this problem. Drawing on his wealth of experience, both as a practitioner and as a teacher, he puts it in a historical context.  For 40 years, he has asked physicians why they perform so many tests. The frankness of their responses is matched only by Lundberg’s own candor as he diagnoses the excesses in our medical system . 

How to Avoid Avoidable Care 

George Lundberg

Why do physicians order laboratory tests?  The traditional reasons are: diagnosis 37%, monitoring 33%, screening 32%, previous abnormal result 12%, prognosis 7%, education 2%, and medicolegal 1%.

In  order to confirm these data, I began to ask the same question of many groups of clinical and laboratory workers over three continents in the 1970s, ‘80s and ‘90s during  Socratic teaching sessions on how to use the clinical laboratory correctly. And I began to get very different answers.  

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Urologists Threaten the Autonomy of the U.S. Preventive Services Task Force

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Over at HealthNewsReview.org  Gary Schwitzer has published a disturbing piece that looks at American Urological Association support for a bll that would make “significant changes to the U.S. Preventive Services Task Force.”

The guest post is written by Dr.Richard Hoffman, who is both one of HealthNewsReivew’s reviewers, and an editor at the Informed Medical Decisions Foundation,  a group that promotes “shared decision making.”   The Foundation, which was co-founded by Dr.Jack Wennber, the father of the Dartmouth Reserach,uses medical evidence to produce outstanding videos, pamphlets and web-based programs that help patients understand the potential risks and benefits of  elective surgeries and tests..  (I have written about “shared decision making” in past posts ). 

Below, an excerpt from Hoffman’s piece:

“Last week, the Supreme Court largely upheld the Affordable Care Act. Two weeks ago, legislation (H.R. 5998) was introduced that threatens the autonomy of the U.S. Preventive Services Task Force.

“The legislation proposes to mandate a more transparent process for guideline development, a greater role for specialists and advocacy groups, and eliminating the Department of Health and Human Services’ secretarial discretion to withhold Medicare funding for interventions that lack convincing evidence for benefit.  The legislation, which comes on the heels of the Task Force’s controversial D rating against prostate cancer screening, is strongly supported by several prominent urological associations. 

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What Will the Supreme Court’s Decision Mean for the November Election?

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Thursday, when Chief Justice Roberts explained that the Affordable Care Act (ACA) is constitutional because the “penalty” that some Americans will have to pay is, for all practical purposes, a “tax,” you could hear tea cups shattering from Billings to Boca Raton. In conservative and libertarian circles, the initial reaction was shock, but it didn’t take long for President Obama’s opponents to rally.

The word “tax” might as well have been a pistol shot at a horse race. In the blink of an eye, Obama’s opponents were off and running, megaphones in hand, blasting the president for lying to the American people while hiking taxes under the guise of healthcare reform. Presidential candidate Mitt Romney’s campaign then began providing regular Twitter updates on the campaign contributions it was raking in following the decision. Friday, it announced that it had collected $5.5 million.

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Today, the Supremes sang.

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Today, the Supremes sang.

To the surprise of many, they upheld the individual mandate requiring that most Americans buy insurance–or face a modest penalty. The vote was 5-4 with Chief Justice Roberts joining the majority.  The court overturned just one small part of the legislation. Under the Affordable Care Act, the federal government is offering states funding to expand their Medicaid programs. Washington had threatened to withhold all Medicaid funding if a state refused to participate in the expansion. The Court ruled that the federal government cannot penalize the states in that way.

I was not entirely surprised by the Court’s decision. Indeed,  on March 26, the day that the Supreme Court began to hear oral arguments, I wrote:

“For months, the media has been feasting on the story, calling it “The Case That Could Change Health Care Forever.”

“Yesterday, the Baltimore Sun declared that ‘The most important six hours of recent American history will start to unfold on Monday.’

“No question, the story is sizzling. And I hate to be a wet blanket. But let me suggest that the hullaballoo is totally unwarranted.

Why the law won’t be overturned

“I cannot believe for a minute that this Court wants to go down in history as the Gang of Nine that quashed the most important piece of legislation that Congress has passed in 47 years. If it did, we could find ourselves on the brink of a constitutional crisis. It is simply not up to the Supreme Court to rewrite legislation passed by Congress.”

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What if the Court rules that insurers don’t have to cover people suffering from pre-existing conditions?

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The following post originally appeared on the null.com blog.

In March, Ethan Fidler, a 10-year-old from England who had just had a tumor removed from his brain flew to Florida where doctors at the University of Florida used proton therapy to blast lingering cancer cells. (While proton therapy is widely available in Western Europe, the UK government has only recently approved funding the technology. Ethan couldn’t wait.)

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If the Individual Mandate is Struck Down, What’s Next?

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The following post originally appeared on the null.com blog.

In Sunday’s edition of the New York Times, blogger Maggie Mahar responded briefly to the question, “What would the future hold if the Supreme Court strikes down the most controversial part of the health care law, the individual mandate?” We asked Mahar to elaborate on the question in this post.

Betting the individual mandate will be upheld

Ezekiel Emanuel says he has been betting on how the Supreme Court will decide the case challenging the constitutionality of the Patient Protection and Affordable Care Act (PPACA).

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Health Wonk Review: ‘Voices from the Blogosphere’

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The following post originally appeared on the null.com blog.

This week, Maggie Mahar edits the Health Wonk Review, a biweekly compendium of the best of the health policy blogs.

Voices from the Blogosphere, May 21-June 6

I’ve decided to let the “Voices” of healthcare bloggers become the theme of this edition of Health Wonk Review. Some are passionate; others are dispassionate; some are disarmingly candid; others are angry.

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