Below, a guest-post by Nortin M. Hadler, M.D., Professor of Medicine and Microbiology/Immunology at UNC Chapel Hill’s School of Medicine.Dr. Hadler is also an Attending Rheumatologist at UNC Hospitals, and author of The Last Well Person: How to stay well despite the health care system,  Worried Sick, A prescription for health in an overtreated America and Stabbed in the Back, Confronting back pain in an overtreated society.

I don’t buy lottery tickets. True, someone will win, and likely a mind boggling windfall. That someone may be one in a million, but someone will win. It is so unlikely to be that someone, maybe there’s a magical force at play, maybe a gambler’s gryphon or a good fairy. Many reasonable Americans must believe in the gambler’s gryphon. Some have premonitions, a sense that the gryphon will fend for them in the deepest reaches of improbability where the power ball hides. None of this is irrational behavior. All understand the probabilities and many get a kick out of the possibilities.

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The Mayo Clinic now has two family medicine clinics in Arizona. Beginning January 1, primary physicians at one of those clinics will no longer see Medicare patients unless they are able and willing to pay an annual $250 administrative fee, plus $175 to $400 per visit . They will also have to agree to“an appropriate number of visits each year, including physicals.

 The total annual costs for the physical and three office visits would be about $1500, according to  the letter that Mayo sent  to the 3,000 patients who receive care at the clinic. The letter also informs those patients that they will not be able to transfer their primary care to another Mayo facility.

Michael Yardley, chairman of public affairs of the Mayo Clinic in Arizona, said the changes are necessary because Medicare’s reimbursement rates for primary care are so low.  "It has been difficult for us to be able to sustain our own medical practice in a way to provide the best care to patients and for us," he told a local news outlet, youwestvalley.com.  “For some the $1500 annual fee- will be cost-prohibitive, and that’s why it’s so painful," Yardley acknowledged. "We have a list of physicians for them that are accepting new Medicare patients. We have done homework in that area, and we have customer service representatives for folks who we are encouraging them to talk to about it."

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There is now some talk of finding a compromise to the public option debate by including the public option in health reform legislation—and then letting individual states “opt out” leaving their citizens without the opportunity to sign up for a less expensive public plan modeled on Medicare, and letting private insurers set the market rules in those states. 

(Not long ago, the Washington Post reported that private insurers are already figuring out ways to “shun the sick,” despite health care reform. While they won’t be able to deny care because of pre-existing conditions, they can make their plans less attractive to cancer patients by including fewer oncologists in their networks.)

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Below, a guest-post by HealthBeat reader Frederick L. Moolten, M.D. Professor of Medicine at the University of Pittsburgh Medical Center, he has devoted several decades of his career to cancer research, supported by the NIH and the VA.

We love wars.  Ever since our nation was forged in the heat of the American Revolution, we have celebrated victories in some (World War II – the “good war”), lamented the agony of others (the Civil War), and debated the merits of more recent ones, including Iraq and now Afghanistan.  Our combativeness extends into the realm of metaphor—hence the War On Drugs, the War On Poverty, and the War On Terror (only part metaphorical).  None of these has yet outlasted the War On Cancer, which we have been fighting for more than a century. Why have we not yet won?

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October is National Breast Cancer Awareness Month and the sea of pink has reached tidal-wave proportions. Every conceivable product from yogurt to running shoes to breakfast cereal now sports the ubiquitous pink ribbon. This month some NFL players will wear pink cleats, still more will don helmets festooned with pink ribbons, and legions of supporters are participating in walks, runs and bike rides to raise money for breast cancer causes. The collective spirit has been awakened; the American public wants progress on breast cancer!

But besides being a great marketing tool for selling “things,” what, ultimately, is the purpose of National Breast Cancer Awareness Month? The concept was introduced in 1985 by AstraZeneca, the giant international pharmaceutical company that makes the breast cancer drugs tamoxifen and Arimidex. The company’s aim was to promote regular mammograms as the most effective weapon in fighting breast cancer. It has since enlisted the support of such venerable groups as the American Cancer Society, the American College of Radiology, the National Cancer Institute and the Center for Disease Control, among others in this campaign.

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Over at the Hasting Center’s new “Values and Health Reform Connection,” blog Joanne Kenen’s candid post, “Honest Debate, and Candid Solutions” caught my eye. I recommend it to HealthBeat readers.  (Kenen writes The  New America Foundation’s “New Health Dialogue Blog.") Below, an excerpt:

“Liberty. Justice, Responsibility, Solidarity.

“These are some of the American Values highlighted in the Hastings Center’s report on Connecting American Values with Health Reform.

“Watching health reform unfold here in Washington, however, that ‘Connection’ is painfully elusive.  The debate is not a careful calibration of competing rights, values and obligations. It’s a political moshpit. Instead of values, we have vitriol.

“Outside of Washington, even extremely astute people ask me why we can’t fix a health care system that is inefficient, inequitable and downright inexplicable.

“I patiently explain that this fight is not purely about policy (or values). Health policy becomes a gritty proxy for politics.

“Values, or at least ideology – particularly about the size and reach of government – play a role in politics. But an awful lot of what passes for policy debate is trench warfare before the next election.  Look at the list of amendments proposed for any of the major bills – and ask yourself how many are meant to improve the health and well-being of the American people and the American economy, and how many are meant to score points, woo donors, placate interest groups and create a C-Span moment.” [my emphasis]

To read the rest of Kenen’s essay, click here.

The Hastings Center, a nonpartisan bioethics research institute, recently asked me to write an essay to help launch their new group blog, The Values and Health Reform Connection. The website focuses on American values, and why they matter to health care reform.  Here is the link to the blog. 

Below, an excerpt from the piece that I wrote:

“While many speak of health care as an individual ‘right,’ I prefer to think of universal coverage as something that we, as a civilized nation, desire for all members of our society because we recognize each other as equally human, vulnerable, and in need of care.

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When I reported on the waste in Medicare Advantage plans not long ago, HealthBeat reader Don Grunt pointed out that not all MA plans are alike. He wrote: “I'm a Medicare Advantage product manager in Oregon where 45% of beneficiaries sign up for MA plans (highest in the country) because we offer good plans and the competitive market keeps us honest.  So I don't work in Miami or any of the wild west of MA plans.”

Oregon is one of those states that belongs to what I like to call “Canada South” (a region that includes part of the Northwest as well as the northern tip of New England–Vermont, New Hampshire and Maine). These are states where medicine seems less “money-driven,” and by and large, patients get better value for their health care dollars. In many of these states, care is more collaborative. It struck me that Don Grunt, who knows the MA system from the inside, was probably right.

I kept his remarks in mind when I wrote a piece for the Washington Post’s “HealthCare Rx” last week. (I am part of the “HealthCare Rx” standing panel, a group that spans a spectrum of opinion, ranging from Ezra Klein to Newt Gingrich. Each week, Rachel Saslow, the Rx editor, poses a question.  Last week’s query: “The Senate Finance Committee is debating a bill that would trim $113 billion from the privately-run Medicare Advantage plans over the next decade, a move that proponents say will bring its funding in line with traditional Medicare coverage. Do you think such a move will hurt beneficiaries?”

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Over at TNR, special correspondent Thomas B. Edsall raises
provocative questions about the coalition of wealthy and poor that
elected Obama.  Will they stand together?  Below, excerpts from his
post, and my comments:

“The health care debate has exposed the
ideological tension in Barack Obama’s political coalition between
moderates and liberals. But it has also offered hints of how another,
less obvious divide built into the Democratic majority could wreak
havoc on the administration during the years to come.

“In 2008, the Democratic Party blossomed into a successful alliance
of the upscale and the downscale–wealthy and needy marching hand in
hand, sharing animosity to George W. Bush and the war in Iraq. The
extent to which Democrats are relying on the far extremes of the income
spectrum is striking. Democrats have generally performed well among
low-income voters in the past, but now, the phenomenon has become more
pronounced. Voters from households making less than $30,000 backed
Obama by 31 points last November. That margin was 13 points higher than
Jimmy Carter’s advantage over Gerald Ford with poor voters in 1976–and
21 points better than Walter Mondale’s advantage among the same
demographic in 1984.

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We knew that the Senate Finance Committee would reject the public sector option. Now they have done just that.

This is not news. Nor is this a “fatal blow” for progressives.

Will the public option survive a vote on the Senate floor?  Probably not—though it could happen. But this still does not mean that the public option is dead.

We know that the bill that emerges from the House will contain a MedicareE (for Everyone) alternative. The House bill and the Senate bill will then go to conference. This is the moment that matters. As a respected HealthBeat reader who knows Washington well recently told me, “Everything else is foreplay.” Much of what we are reading now is posturing–by some politicians ( Charles Schumer deserves an Emmy), by some pundits and by unnamed sources who want reporters to think that they know more than they actually know.

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