Archive for the ‘Health Reform’ Category

October 2, 2009

Congress: Listen to the Academic Health Center Leaders on Health Reform

I heard today that congressional staffers are “punch drunk” from logging in so many hours working on health reform.  I am not comforted by that thought given they are trying to  write one of the most significant pieces of legislation in decades.  I am  wary of the urgent rush to produce something—good or bad—to show that Congress is not twiddling its thumbs.  Does the Congress really have all the facts?  Or are they also developing legislation based on minimal or biased information, evidence, experience, or truth?

 I would point to an opinion piece in the LA Times by Dr. Philip Pizzo, dean of the school of medicine of Stanford University and chairman of the board of the Association of Academic Health Centers, where he wrote, “Undertaking such an important shift in how we deliver healthcare requires a robust national debate.” With the members of Congress getting ready to say yea or nay on health reform,  we still have not had sufficient debate from all sides.  The nation has heard too much from those leaders who, as Dr. Pizzo says, “choose to rely on fear instead of facts to make their case.”

 Before the votes get counted, we need to hear from the patients who really use and have experience with the health care system as it exists today.  We need to hear more from the leaders of the nation’s academic health centers–some of the most experienced experts on health care in the nation.  Most are physicians who not only have practiced medicine for decades but also have had distinguished careers in academe (and sometimes government).  Most of all, they know what it means to lead and operate an institution, without which our communities–and the health system–cannot function. 

These leaders, who also include nonphysicians, can tell us about patient care, the impact of health on communities, the health and economic consequences of  having no insurance,  and the problems with the current reimbursement system.  They can tell us what it is like to run health professions schools–from medicine to allied health,   major departments at a children’s or other teaching hospital, or an entire teaching hospital or  health system–and what facilitates or impedes care delivery.  

Academic health center leaders are the people at ground zero, making sure that the nation can provide health professions education, biomedical research, and patient care.  They are sustaining the infrastructure that may determine the nation’s future.  Congress should be listening to these voices of experience and reason.

Academic health center leaders know what it takes to provide patient care and sustain a health system in challenging economic times. They not only know the problems but also how to resolve them.  Academic health center  leaders for example, will tell the Congress why we need to establish a permanent workforce planning entity or board so we can resolve primary care shortages and rural health problems–and  ensure the nation has a health workforce for the future.  

Congressional staffers—stop running on empty and get MORE input, advice, and recommendations from the academic health center community.

September 30, 2009

Baucus Tells America: No Public Option, Horatio Alger is Role Model

Long live Horatio Alger, the Congress said yesterday.  The Senate Finance Committee, by its vote against a public option in health reform legislation,  told the American people  that  if you can’t be Horatio Alger–if you can’t suffer and persevere and make it on your own when it comes to health care– tough luck.  Senate Finance Committee Chairman Max Baucus lives too much on the frontier.  He  obviously still believes in the Horatio Alger myth–that is,  that America can be sustained by  rugged individuals who, like the boys glorified by the 19th century dime-store novelist  Horatio Alger,  can go from rags to riches on their own solely by hard work and clean living. 

Without a public option, Baucus is saying that if you get sick, don’t have a job, lost your job, can’t pay your bills, get insurance coverage, figure out the insurance system, there must be something  wrong with you.  You’re not living right. You didn’t follow the Alger rules. The government will not help you.

 Shame on Senator Max Baucus. Shame on the Finance Committee. Shame on President Obama for letting the Congress act on its own on health care.  Shame on  America for not protesting in favor of a public option.

 This is the 21st Century.  Horatio Alger is not the role model we should be admiring. Did Horatio get an inherited form of cancer? Did Horatio lose his job because thieves on Wall Street were “too big to fail?”  There are forces at work beyond the control of any one person.  No one can make it on his  own these days—and no one should be blamed for that.

Horatio Alger  can no more protect his health in the modern world than he can provide for his own defense with a musket in the corner of his room in the boarding house!

 The government should protect its people with a health care program just as Horatio Alger –in the end– was saved from poverty with the help of a wealthy benefactor.

September 17, 2009

Insurers Celebrate Baucus Health Reform Proposal

Wake up America!  Now you can learn who controls the U.S. health care system. Read the provisions of the  new health reform proposal by Senator Max Baucus (D-Mont.) and you will understand why for months there has been a smear campaign against the U.S. government promoting the myth that the federal government will control access to and dictate  choice within the health care system. While America was diverted in a riotous way from a rational approach to health care reform, the insurers were busy making hay with Senator Baucus to ensure that they maintained their stranglehold on the health care sector, the American taxpayer–and, of course, the U.S. Congress.  

With the Baucus proposal, we can truly say that  the federal government does not control health care but the insurance industry does? When and how often you see a doctor–and whether or not you get the necessary lab tests you need–and even which provider you see—are all determined–and will continue to be determined– by the insurers. 

Yesterday, I heard about a patient who was on the verge of a heart attack.  He saw his cardiologist who determined he needed a nuclear stress test immediately.  Did I say immediately?  According to  a top cardiologist he did?  According to his insurer, he had to wait two weeks for the test. Was this the government intruding in health care?  No, way. 

The government is not in your doctor’s office–but the health insurers are.   And now they will be in every house in America–like roaches, they are taking over.  Break out the Combat.

 Insurers broke out the champagne last night, knowing they succeeded in getting Senator Baucus  to allow them to make a killing with provisions for  U.S.  families to pay 13% of their income for healthcare coverage or pay a fine. A family of four with annual income of $65,000 would be asked to spend $8,450 on health insurance premiums before receiving any federal subsidy.  

 Certainly, Senator Baucus has been receiving too much  money from health insurance lobbyists to be in touch with the reality of the average American who cannot pay out 13% of their income on health insurance premiums.  The insurers are already raising premiums to cushion any blow that would come from doing away with non-payment for preexisting conditions.  After all, who is there to stop–or regulate– them?  The government?  With leaders like Baucus, I doubt it.

Where’s the reform?  Where’s the coverage?  Where’s the safety net? Where are the promises of President Obama?  The rising stock prices tell us who is benefiting from reform.  Perhaps Wall Street is also telling us that we learned nothing from the scandals of last year.  If the profits are only benefiting some big companies, something is very wrong.  It is time for Senator Baucus to recuse himself from the debate given that the first reaction to his health reform bill was mild pandemonium on Wall Street.

September 10, 2009

The Time for Games Has Passed, Says Obama on Health Reform

The President  brought new energy and enthusiasm  to Congress last night as he tried to reignite action on health care reform.  Overcoming my anger at a joint session of Congress during a  BIG GAME –a quarterfinal match at the U.S. Open with 1 of only 2 Americans left in the tournament — the speech showed the President taking a firmer stand on reform, attacking the false claims on reform options, and talking of “my plan.”

Obama exhorted Americans to believe in their power—and the power of government—to do good.  He called on Americans to address health care as a moral issue, emphasizing that social justice and the character of the nation are at stake.

That said, what did we learn?  The President said that if we do nothing to slow the costs of Medicare and Medicaid, they will eat up the entire budget.  On the other hand, Obama made of point of saying that if you’re enrolled in Medicare, Medicaid, or the VA, or have employer based health insurance, nothing will change. Does that mean that the government will not cut Medicare and Medicaid payments? 

 The President’s plan will provide more security and stability to those who have insurance, provide insurance to those who do not, and slow the growth of health care costs.  His plan is to “make insurance work better for you.”  Will the insurers just pay for less (especially since they will have to cover pre-existing conditions)? How much will insurers change their pricing with academic health centers?

For those individuals without insurance, they will be required to get insurance (like auto insurance, said the President). The interesting thing is that some states do not make motorists show proof of insurance on routine traffic stops. Insurance is required, but only in the event of an accident. While fines can run to $5000, most are in the $500 range and only a few states impound your car—or send you to jail.  How will the government enforce the mandate?

As for the new insurance exchanges to be established, “customers will have leverage with the insurers,” said the President, who added that he will hold insurers accountable. The President did not say how that would happen.  I hope you’re right, Mr. President, but it sounded a bit like Shangri-la.  

Most importantly, the President will end fraud and abuse in Medicare.  While a worthy goal, it raises concern for academic health centers. The government does little now to evaluate providers (many fraudulent) who apply for a Medicare provider ID and run off with millions of dollars in payments for services never rendered.  So where is there money to be found?  The government is able to collect money by establishing Recovery Audit Contractors and other vehicles to search for supposed billing errors by academic health centers.  Is this the “fraud” the President is talking about?  Will we see some RAC clones established or a new wave of billing regulations? 

The President said the details of the plan are yet to be worked out.  The coming days will show the true impact of the speech and whether we see any change in attitude or action on Capitol Hill.

September 8, 2009

Baucus to Uninsured: Pay Up or Face Fines

According to reports about  Sen. Max Baucus’ latest plan for health reform, fines would be imposed on those individuals and families who do not buy health insurance–$950 for individuals and up to $3800 for families.  Senator Baucus, what kind of reform is this?   Talk about wasting resources.  How will the plan be monitored and enforced?  Maybe the U.S. Department of Homeland Security and the Transportation Security Administration can add insurance surveillance  to their duties.  As you are screened at airports, you have to show your insurance card.  Will Senator Baucus create the insurance police or just ask the OIG to create a new department?  Will neighbors be asked to report on neighbors and become insurance spies with some incentive program for reporting?  What happens  if you pay the fine and still don’t buy insurance?  Will you just pass GO and head directly to jail?

I can’t understand such a proposal.   Is Baucus worried about not throwing enough business to his backers–the insurance companies?  Reform should be so good that everyone wants “in.”   Something tells me that Baucus is not offering much if he has to fine the non-participants.   Sounds like our current system where people, mostly for financial reasons, do not buy insurance.   Today, many people say, “OK, I’ll pay the medical bills for my post-college age kid because health insurance premiums are either too high or don’t provide decent coverage.”

In Baucus’ plan, we see he penalizes the victim–adding insult to injury to those people who cannot afford insurance–even with a government subsidy, which will amount to peanuts.  So we make the non-insured pay a fine–and then what?   Do they still go the emergency room of an academic health center hospital to get care?  Will Senator Baucus pay for that?

September 3, 2009

Obama Trying to Salvage Match Point in U.S. Health Reform Open

What should have been a “love game,” with Obama easily cruising to victory in the U.S. Health Open, has now turned  into a grueling last set, last game battle, with the President having to save match point.  The President will address a joint session of Congress next Wednesday night to add specifics to his vision of health reform, according to media reports.   If conversations with White House health advisors are any indication, it is difficult to discern anything new in the messaging.  If the President tells the nation we need more primary care, health IT, and research to find out what treatments work and don’t work, America will not be enthused.

 America wants to know what systemic changes the President wants in a health reform bill. Will he stand for a strong public option?  Will he provide the roadmap and transition time for changing the current health insurance industry? Will he ensure that the health workforce is a priority and address workforce issues now—not later?  Will he go beyond primary care—and provide a new vision for how to deliver primary and specialty care to all segments of society or will he be satisfied with a 19th century view of the primary care doc going off alone to the rural regions of the country to solve the workforce crisis? 

Will the President explain to the nation that whatever happens in the delivery of services will ultimately affect  the nation’s research enterprise because of the unique  role that academic health centers play in the nation’s health system?  Will he explain how health reform must take account of how the clinical monies help to support the nation’s biomedical research through these institutions?  If the answers to these questions are what is meant  when the White House says  “specifics,” then America will listen.  If not,  the  President will be forced to make a quick exit from Center Court.

August 27, 2009

Kennedy Believed in Government and the People

Senator Edward Kennedy came from wealth and privilege but believed in the obligation to serve the public—to give back to society and make it better.  He will be remembered as the champion for the little guys–the people without a voice. But he spoke and acted for all Americans.  He raised our consciousness. He channeled our outrage against injustice into solutions to help people live better lives. He reminded us of duty.  He showed us the positive role that government can and must play in the lives of all Americans. He believed in equality and fought and won battles for social justice, health care, higher education, and labor.   That was Edward Kennedy.   There is talk of naming the health reform bill for him.  He would not want the honor without substance—without health care legislated as a right for all.  To remember one of the greats of history with a health care bill that does not live up to the ideals he fought for more than 50 years would be shameful.  Kennedy wanted what was right for the little guy—not the rich, powerful, or corporate interests.

August 25, 2009

Health Reform Hysteria

The emotional and sometimes angry discourse seen at some health care reform town hall meetings reflects a disturbing combination of politics, fear, and misunderstanding.   On one hand, there are the deep divisions within our country concerning the role of government.  On the other, there is fear that something as intensely personal as health care might be made “less personal” and more bureaucratic.  And lastly, there is confusion as to how our current health system actually works.   So far, this combination is proving to be an important obstacle to health reform and perhaps lethal to a bipartisan effort.

Given the huge part of the economy represented by the health care sector, the interplay of economics and health reform is intense on many levels.  Yet,  I think many of these reactions speak to another aspect of the debate:  the basic issue as to whether health care is perceived as a social entitlement that is part of citizenship or as a commodity that can be purchased if desired.  There is a deeply reflexive reaction to what are perceived as handouts, and a strongly held sense of one’s just rewards for hard work.  Against this backdrop, it is not that surprising that the U.S. is alone amongst highly developed nations in not having a system of universal health care.   I would like to see the health reform debate focus more on the meaning of health care to American society and less on the paranoia of change.

August 20, 2009

Health care and jobs

The pressures to cut health care costs are enormous, but these cuts can also be a double-edged sword.  Certainly, no one would argue against cutting fraud and overuse.  But at a time when job creation is so important, the health sector is and will be a key player.  These jobs are not just for a broad variety of health care providers, but also for a large range of administrative and management positions.  A recent article points this out by focusing on individuals who cross over from other economic sectors to work in health care.  As health care exceeds one-sixth of the economy and one out of every ten jobs, it becomes increasingly difficult to disentangle needed job growth from excessive health care spending in terms of driving the economy.  This is especially true if there is some kind of health reform that increases access to a substantial number of persons who are currently either uninsured or underinsured.  As we have pointed out in our report, Out of  Order, Out of Time: The State of the Nation’s Health Workforce, we need to gain a more in-depth understanding of the kinds and numbers of health providers that are needed to take care of patients now and in the future.   Perhaps by engaging in this discussion we can address the complex issues around “right-sizing” health care.

August 18, 2009

A Real Health Reform Issue to Address: Medicare’s Clinical Trial Policy

Let’s get some real issues on the table in the health reform debate—like Medicare’s clinical trial policy.  The Medicare program is not only the key to current and future health care delivery in this nation but also the most critical link to all clinical research occurring throughout the nation. 

Good science—and new cures and treatments for a host of diseases and illnesses–require that Medicare beneficiaries participate in clinical trials.  That was the vision and purpose of the clinical trial policy, laid out in an executive memorandum signed by President Clinton in 2000.  The goal was to provide increased access for Medicare beneficiaries to clinical trials—and that is not happening. During the Bush Administration, the policy was not fulfilling its intent and, in fact, was quite dismantled, creating a situation that discouraged participation of seniors in trials.

It’s not only seniors. The President had better check his health plan because many of the government plans do not cover clinical trials—as they should. 

Health and Human Services Secretary Sebelius should be spending more time addressing this issue.  She can provide the leadership to reform Medicare’s clinical trial policy, which currently:

  • Compromises the quality and credibility of many research studies by discouraging enrollment of elderly patients
  • Limits coverage for the elderly to potentially life-saving therapies and treatments
  • Undermines the financial viability of the nation’s academic health centers where the majority of clinical trials take place
  • Increases the likelihood of an adverse impact on the nation’s economy and job market as clinical trials continue to move overseas.

The Association of Academic Health Centers (AAHC) has been at the forefront in calling for reform of the policy.  One of AAHC’s most important recommendations is for the HHS Secretary to establish the position of research coordinator at the Centers for Medicare & Medicaid Services (CMS) to oversee clinical research coverage policy.  This position would ensure that an expert with knowledge of clinical research and trials processes and operations is providing needed leadership and making the issue a national priority.

President Obama and Secretary Sebelius need to signal that they recognize the significance of Medicare’s clinical trial policy.  Appointing a permanent administrator for CMS would also be a good start.  If the Administration can’t address clinical  trial policy, there are  many on Capitol Hill who will check their health plans, suddenly wake up and take notice, and address Medicare’s clinical trial policy so they can claim some real progress on health care reform.