(We Should Not Scoff at the Medicare Pilot Programs in Reform Legislation)

I urge everyone to read this story by David Leonhardt in this Sunday’s (November 8) New York Times.  (Thanks to HealthBeat reader Lisa Lindel for spotting it. )
Leonhardt
profiles Intermountain Healthcare, a network of hospitals and clinics
in Utah and Idaho that President Obama and others have described as a
model for health reform.

Leonhardt concludes:

“If
you simply looked at Intermountain’s overall results — the good
outcomes and low costs — you might be tempted to dismiss them as a
product of the environment. Utah has the youngest population of
any state, as well one of the lowest rates of alcohol and tobacco use.
More than half of the state’s residents are Mormons. This homogeneity
creates a noticeable sense of community, even a sense of mission, among
many Intermountain doctors and nurses.

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Over at the New America Foundation, blogger Joanne Kenen elaborates on how the House and Senate Finance bills can lead to providing better end-of-life care.  As As Kenen points out, these proposals are all about giving people choices—including the parents of children who are seriously ill. Finally, these proposals would reduce health care costs by making sure that people who don’t want to die in an ICU don’t wind up there by default.

“After all the sound and fury of last August, we're pleasantly surprised that the right hasn't risen again with all sorts of horror stories about the resurrection, so to speak, of the "death panels." Maybe because all that fear-mongering was finally discredited. Maybe we are finally getting just a little bit smarter.
The inevitable focus on the politics of health reform, and the disproportionate amount of attention paid to the public plan, sometimes obscures the many ways that the House and the Senate health plans are ambitious. Not perfect. Ambitious. I've heard experts, people I like and respect, say the legislation does "nothing" to advance the cause of quality of end of life care in America. They are wrong. The House and Senate bill each contain measures that would advance that cause — not fix it completely, far from it, but they will take us important steps in the right direction. It's too soon to know which of these measures – if any — will survive a final melding of House and Senate legislation. But let's look at them here because, except for the end of life consults which got way too much of the wrong kind of attention, they haven't gotten adequate attention. In an accompanying guest post. Dr. Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center in New Hampshire, talks about what these changes can mean for his patients and their families.

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Many reformers have been uncertain as
to whether they could rely on the Association of Retired Persons (AARP)
to support progressive health care reform.  After all, AARP has close ties to the insurance industry.

But
this evening, the Associated Press (AP) reported that “In a coup for
House Democrats, AARP will endorse sweeping health care overhaul
legislation headed for a history-making floor vote

“An
announcement from the 40-million member group is expected Thursday
[tomorrow], said officials with knowledge of the group's decision. They
spoke on condition of anonymity because the endorsement is not official
yet.

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Conservatives have argued that abortion has no place in a health care bill—I couldn’t agree more (although for completely different reasons…). In fact, I think individual insurers should be the ones to decide whether or not it makes sense for them to offer the benefit to women. We are wasting far too much time and political capital on an issue that has little to do with the overall goals of reform.

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What Has Been Accomplished; What Still Must Be Done

These days, many progressives are expressing deep disappointment with the health reform legislation now moving through Congress. Some suggest that some legislators made deals with lobbyists and let them write the bills. Others complain that both the subsidies and the penalties are too low. Still others don’t like the fact that states can “opt out” of the public insurance option, and decide not to offer Medicare E. Finally, many ask: “Why can’t everyone sign on for the public plan in 2013? Why do we have to wait until 2013? Why can’t they roll out universal coverage next year?”

Normally, I would be among the first to critique the bills. By temperament and training, I’m both a skeptic and a critic.

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Non-profit hospitals have been spending, hand-over-fist, on new construction and new wings, adding rooms that most communities don’t need, while investing in the same multi-million dollar medical equipment that five hospitals in a three-mile radius already have. On HealthBeat, I’ve been writing about the investments in hotel-like amenities for more than two years.

Hospitals were borrowing in order to build – interest rates were low; money was available—why not?  Inevitably, the recession would bring an end to all of that. I have predicted that many hospitals would find themselves running out of money in the middle of projects. Other are now saddled with debt, and struggling to hold onto market share.  

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Joe Lieberman is no Olympia Snowe (R-ME). Many progressives admired Olympia Snowe’s stance (even if they disagreed with her). By contrast Lieberman’s  announcement that he may join the Republicans in a filibuster that aims to block letting the health care reform bill come to the Senate floor is merely vintage Lieberman. He’s an opportunist. I knew him many years ago, back in Connecticut, when a reform candidate was challenging the Democratic machine. Lieberman wavered on the sidelines, waiting to see who was going to win. He didn’t want to risk picking a losing team.

Today, as Lincoln Mitchell points out on Huffington Post: “By wavering between the two parties while never fully abandoning the Democratic Party, Lieberman has made himself far more important than he should be. If he were to formally switch parties, he would suddenly be of little interest to the Republicans as he would be just another member of the minority who would probably be suspect because his right wing credentials would not be strong enough for the Limbaugh-Palin wing of the party.”

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Very likely you have heard that only a “tiny group” of Americans will be eligible for the public plan. But if you read the House bill approved by three House committees (HR 3200) carefully, (this is the proposal that provides the most detail on the public option) it appears that 20 percent to 25 percent of all Americans would be eligible to sign up for the public plan in 2013. In the years that follow, the Exchange will be open to all Americans.
 
The notion that only “10 percent of the population” will be eligible to enter the Insurance Exchange and choose between private sector insurance and Medicare for Everyone is fast becoming an urban myth. Some commentators are using the number to minimize the importance of the public plan.

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As debate over the cost of health reform intensifies, it is worth repeating that significant savings will result from making fundamental changes in the way health care is delivered. Here at Healthbeat, we have written extensively about how cutting the waste and over-treatment out of the current health care system will not only reduce the cost of care, but also lead to better outcomes for patients. But there is nothing like a real-life experience to drive this message home.

Recently, my neighbor called and asked if I would walk with her to her internist’s office just two blocks away. Mary is 80 years old and had been feeling dizzy and unsteady on her feet for over a week. Since she has hypertension, she wanted the doctor to check her blood pressure to make sure it wasn’t contributing to her symptoms.

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Below, an excellent Op-ed by Kevin M.D. in “U.S.A Today.” It looks at malpractice from the patient’s perspective. Read the whole piece—the final section explores what we might learn from other countries. Before commenting, be sure to take a look at the NEJM article (see link below).

Any malpractice reforms should put patients first

By Kevin Pho

Whenever the issue of medical malpractice comes up, my fellow physicians and I agree that changes are necessary. Where we disagree is on how to fix the problem. So we all took note when President Obama acknowledged that  medical malpractice reform must be considered. In fact, he proposed pilot projects to study how to improve patient safety and change the way we compensate injured patients.

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