Social Media Is No longer Just Social

 

Mission creep  is the descriptive term which explains how a previously focused goal becomes another things .

For those who use social media in healthcare regularly this apparent.. The internet began as a ‘sideshow’ and within five to ten years it became a necessity. If you are not using social media you would not be aware of the advantages and power of the social media sphere.

   

HOW TO Sell Social Media to Cynics, Skeptics & Luddites

For example: (personal uses)

1. Twitter , along with use of hashtags provides the opportunity to direct traffic to your web site, blog, and/or even Google Drive or Live drive.  GDrive provides sharing to anyone who has the link to that document (or folder).

2. Information source: Many physicians and others regularly tweet from meetings and symposia using a meeting hashtag.  Specific hashtags can be found on Symplur, a site devoted to medical hashtags with some specificity.  It’s not just for social contact at the meeting, (ie, “meet me at Starbuck’s afterward”). Tweets can be linked with photos and/or graphic using a smartphone or tablet with Flickr, yFrog, and other photo sharing sites. (most are free with limited storage capacity) Videos can be uploaded to YouTube and linked to Twitter announcements.  Imagination leads one to many other outbound messages. The 2012 Top Ten Photo Sharing Sites.

3. Search on twitter using hashtags is a primitive form of search, limited only by your knowledge of which hashtags are useful in the area you are interested in. Unfortunately at this time hashtags seem to appear by popular  acclaim and usage. There is as yet no nomenclature that is officially blessed by the twitter community.

4. Facebook and Google can be used as well, offering more than 140 characters. (I preface this with the fact that there are several url shorteners, as well as text abbreviation services which truncate tweets longer than 140 characters, providing a link within your tweet.  Linkedin is well known among professionals. It offers much to professionals. This sleeper network has become more popular and is now more integrated with other social media sites.  Although Linkedin recently prevented twitter feeds to their site, the reverse is not true, allowing a Linkedin  user to simultaneously tweet.

5. Many applications have been developed which offer simultaneous social media messages across multiple applications. Tweetdeck allows a single tweet to also be placed Facebook, and Linked in.  A  post on a Google stream can be shared on Twitter, or  Facebook. Google is closely linked with YouTube, and can be used for live video and Google on Air Hangouts. Buffer app creates the ability to send your tweets repeatedly during a 24 hour period (at times when most users are active). Inserting a hashtag improves the chance that your recipients get the message(s).

6. Analytics, BuddyMedia,  Social Media Examiner,  SocialBro,  Sprout Social (free trial), Google Analytics,  Twitter Analytics are available to measure your impact, followers, networking, influence and the times your tweets are most read.  It is possible to schedule your tweets at those times. MentionMapp is one of the coolest maps of  the twitter universe. Type in your “twitter handle” and presto you have a map of your own twitter galaxy. For those of you proficient in spreadsheets and APIs there are a host of free Macros and apps.

7 Facebook uses “friends” or ‘likes’. Google Plus for Business as well as Personal Google Plus  uses “circles”. Twitter uses “followers” to organize your audience.  There are some nuances, which go beyond the limits of my blog.

8. Blogs and web sites provide insider information about health and facilities as well as providing meeting schedules, agendas, and speaker lists.

  Microsoft has already said that Windows 8 tablets, irrespective of their x86 or ARM underpinnings, are PCs.

9. Web 2.0 and Health 2.0 may be ending to be replaced by Mobile    Studies and surveys indicate that mobile applications in health care will multiply exponentially in 2012.  They also reveal a relative decrease in laptop, and desktop computers as compared to sales of tablet pc and smartphones. Almost everyone will use their mobile device much like a pc, giving facebook, twitter and google plus an advantage with applications designed especially for mobile, and consumers carry them wherever they are, waiting for your message.   And yes all of this is coming to an EMR for your examining room. Just like your progress notes used to be.

  

After all isn’t this what separated the MDs from the RNs and others? (Illegibility) And this is probably why CPT codes and ICDs evolved.

If you are not using social media for some vague reason such  as stereotyping, you are cheating yourself out of an efficient and powerful medium. The caveat is ‘learn how to use it”

Mayo Clinic even offers a Residency in Health Care Social Media .

Social Media Toolkit from Doctors 2.0  2012 Meeting

Let’s talk about the Internet & Social Media in Healthcare – Kathi Apostolidis

“Come on, Dad, get with it”  (a favorite lecture from my kids).

 

LiveJournal Tags: google,twitter,linkedin,analytics,#hcsm,mayo clinic,social media,heathcare,hashtags,yFrog,skydrive,google drive,flikr,photobucket mobile app,web 2.0

Doctors 4 Patient Care on The Health Train Express

 

TESTIMONY BEFORE CONGRESS  Doctors 4 Patient Care

Tomorrow, July 10th Doctors 4 Patient Care will give testimony in Congress regarding the impact of the Patient Protection Affordability Care Act. Never before has a Law had such an oxymoron for a title. The law is not about patients, not about protection, not about care. It however is an  act….an imaginary folly created by who knows.

Included in today’s post is the link to testimony of the participants.  Erick Novak MD states the issues simply, and without useless rhetoric.   Most of what you read here is read by you the “choir”.  It’s meant for our patients and governmental officials to read.

Please forward this to all your contacts

I urge you to respond with a ‘ROAR’

 

Technorati Tags: ppaca,patient care and affordability act,congress,docs4patientcare

This Week on Health Train Express

Mark your calendars; set your iPhones - Artificial Intelligence in Healthcare this Friday on Voice of the Doctor http://bit.ly/MMr0y9
What’s In Your Record? Contest on Challenge.gov http://bit.ly/NDjO4n
How does Your EHR Calculate Meaningful Use Measures? http://bit.ly/PBAJZk

Mayo Clinic Offers Two Day Program on Social Media in Healthcare http://bit.ly/Pvatje

Latest on MGMA Conference in October in San Antonio http://bit.ly/M4dZLa
Our Health IT Business News Wrap-up for week ending July 6, 2012 http://bit.ly/MOORgF
Listen to HealthcareNOWradio.com  http://www.hitechanswers.net/
Latest post on ONC Health T Buzz: National Priorities for Research on the Use of Health IT http://bit.ly/ND6ayp
Live Webcast Thursday from NeHC: Beacon Communities and EHR Vendors Working Together to Accelerate Interoperability and Exchange http://bit.ly/OU2auC
Missed these recent great articles?
OIG Study Shows EHR Use in Medicare Physicians http://bit.ly/LCVpQe
Protocol for HIPAA Audits Released http://bit.ly/MGxdf7
American Medical Association Takes Up ICD-11 Cause http://bit.ly/OhSkET
A classic post from the archives:
Confessions of an EHR Project Manager http://bit.ly/ndJTlY
Miss tuning in weekly to MU Live!? Don't worry -- we'll be back starting August 14, gearing up for the release of all those final rules. Sign up here to be notified of upcoming guests and topics http://bit.ly/odbatZ

 

And who doesn't like free white papers?
2012 HIPAA Audits: Will the Past Predict the Future...Preparing for HIPAA Security Rule Again...Do EHRs Increase Liability and others. Get them all here: http://www.hitechanswers.net/free-downloads/

All this and more from Hitech Answers
Carol Flagg
Group Manager
www.hitechanswers.net
www.healthcareNOWradio.com

Technorati Tags: mayo clinic,artificial intelligence,social media in healthcare,hipaa,ehr adoption,ama,beacon communities,health it,mgma,onc

Social Media Nihilist…are you one of them?

Social Media Nihilist…are you one of them?

Social Media Nihilist…are you one of them?

 

The term Nihilist encompasses a broad array of issues. I am not one to write dispassionately about the impact and/or importance of social media in healthcare.

Others do not agree. In the interest of fairness many MDs are downright negative about social media.

Some would call it a waste of time and perhaps even dangerous.   HappyMD sees it as adding another theme hastening  “burnout” for MDs who use or anticipate using social media in medicine.

I personally disagree with him, although if you see social media as just another burden, or  more bureaucracy, don’t do it….it’s meant to be fun!  Some practices ‘outsource’ their blogging and/or social media. It’s not expensive and can be done with free lance writers available at eLance.com, and you will find them on Facebook, Twitter or G+.

Dike Drummond MD is an  expert on counseling physicians on burnout, he provides a needed and urgent service to you. MDs are not immune to drug dependency, alcoholism, depression, acting out behavior, nor the  ever mounting aspects of frustrations with daily life, at home, at the hospital and in the office.  In today’s disruptive health reform, many are not the masters of their own office or space, a once prominent feature of solo or small group practice where you have the ultimate control of your destiny, finances, and choices. Many occupational psychology surveys reveal how these changes have led to more dissatisfaction at work.

Young Guns in Medicine

 

Are you one of these “Young Guns” ?

I am watching a Facebook Live Video meeting with Paul Ryan, Eric Kantor and, Kevin McCarthy designated as ‘The Young Guns” of the U.S. Congress. They are, as quoted by Facebook as politically and technologically savvy.

Surely we must have “Young Guns in Healthcare”.

 

Who are ‘they"?’  Can we define young guns in all areas of healthcare? Are they defined by specialty, mode of practice, such as group practice, proponents of health reform, public health policy, or health reform?  Can they be found in blogs, or social media?

Young guns seem to define their role as ‘initiators of change’.

Are our ‘Young Guns” the initiators of health reform, health information technology, innovative  uses of mobile health, remote monitoring, telehealth.  Would it be the top 10 MDs  Twitter, Google +, or Facebook?  Are they in Government, or Clinical Medicine?

Are Young Guns selected from their reputations in the private sector, then selected for positions at HHS, NIH, FDA or other Health Related sites.  Are they the creators and innovators of our health system.  Who designates the “Young Guns”?

Senator Paul Ryan correctly identifies the impact of social media to allow instantaneous connections which may be global on topics of interest. Government-government: Business to business: Business to consumer: people to people:

Social Media is a two way medium, it allows a direct two way connection with government.

Government should learn from social media as an efficient and almost instantaneous method for change. Are committees out?

Social media allow you and me to converse and render our  research, comments and opinion to potentially millions of social media users, blog readers, government officials.

 

Technorati Tags: young guns,eric kantor,paul ryan,social media,hhs,nih,fda,telehealth,remote monitoring,policy,blogs

Expert Opinions on PPACA

 

The CATO Institute reported on June 25, 2012,

Even if the Affordable Care Act survives its first Supreme Court test — the lawsuits won't end. Citizens have already filed challenges to what critics call the law's "death panel" and its impact on privacy rights, religious liberty and physician-owned hospitals. Still another potential lawsuit poses as great a threat to the law as the case now before the high court.

Under the guise of implementing the law, the Internal Revenue Service has announced it will impose a tax of up to $3,000 per worker on employers whom Congress has not authorized a tax. To make things more interesting: If the IRS doesn't impose that unauthorized tax, the whole law could collapse. 

The Act's "employer mandate" taxes employers up to $3,000 per employee if they fail to offer required health benefits. But that tax kicks in only if their employees receive tax credits or subsidies to purchase a health plan through a state-run insurance "exchange."

The IRS doesn't have a leg to stand on here.

This 2,000-page law is complex. But in one respect the statute is clear: Credits are available only in states that create an exchange themselves. The federal government might create exchanges in states that decline, but it cannot offer credits through its own exchanges. And where there can be no credits, there is nothing to trigger that $3,000 tax.

States are so reluctant to create exchanges that Secretary of Health and Human Services Kathleen Sebelius estimates she might have to operate them for 15 to 30 states. Even if she manages that feat, the law will still collapse without the employer mandate and tax credit.

The IRS doesn't have a leg to stand on here.  This may now be a moot argument since the SCOTUS ruled the ‘penalty’ is really a tax. Congress under pressure could vote to amend the PPACA to prohibit this being a  tax, athough the law mandates that the IRS would administer the penalty (tax)

This is only the first barrage fired across the bow of PPACA.

Lost completely in this current round are the underrepresented uninsured, unemployed, and disabled Americans.

The law is desperately flawed, built by persons who do not, did not, nor ever will understandthe physician patient interface, the byzantine multilayered approaches to payments, and the new calling to laminate the system with another stratum of sediment.

Unauthorized Tax

To prevent that from happening, on May 18 the IRS finalized a rule making credits available through federal exchanges, contrary to the express language of the statute.

Because those credits trigger penalties against employers, the IRS is literally taxing employers and spending billions without congressional authorization. Estimates by the Urban Institute indicate that had this rule been in effect in 2011, it would have cost at least $14.3 billion for HHS to run exchanges for 30 states. About 75% of that is new federal spending; the remainder is forgone tax revenue.

The IRS doesn't have a leg to stand on here. It has not cited any express statutory authority for its decision, because there is none. The language limiting tax credits to state-established exchanges is clear and consistent with the rest of the statute. The law's chief sponsor, Senate Finance Committee chairman Max Baucus (D-Mont.), is on record explaining creation of an exchange is among the conditions states must satisfy before credits become available. Indeed, all previous drafts of the law also withheld credits from states to push them to cooperate.

Employers can sue

Under the Congressional Review Act, Congress has 60 days from the date of issue to block the rule. Reps. Scott DesJarlais, R-Tenn., and Phil Roe, R-Tenn., have introduced a resolution. It may receive a cold reception from President Obama, but "taxation without representation" is a difficult position to defend. If that approach fails, states that have refused to establish a health insurance exchange, and large employers the IRS will hit with this unauthorized tax, could challenge the rule in court.

The authors of the Affordable Care Act wrongly assumed states would be eager to implement it. If saving the law from that miscalculation requires letting the IRS tax Americans without authorization, then it is s not worth saving.

Technorati Tags: irs,ppaca,scotus,taxation,congressional review act,cato

The Treacle of Social Media

 

Well, there it is… The Higgs Boson particle…It took 50 years to prove it is there. We cannot see it, we can prove it’s there using highly sophisticated physics. What is it? It’s the ‘glue’ that exists throughout the universe which allows matter to exist. Without it all there would be is pure energy flying around at the speed of light. There would be no stars, no planets, no life (as we know it). Without it would  beings of pure energy, much like some of the creatures we read about in science fiction or Star Trek’ s ‘Q’ who materialized or the other malevolent energy fields the Enterprise would encounter on their journey to ‘where no one had gone before’.

Happy Independence Day everyone 1776-2012. 236 years have passed. The U.S.A. is still a relatively young nation, our national identified thus far by exceptionalism in private investment and entrepreneurial enthusiasm.  We have always striven for excellence based upon individual effort coupled with team work.

Social media is a form of teamwork….Competition abounds in the social media sphere between Facebook, Twitter, Google plus, and many other social platforms.  How many platforms can you name  ?

Social media’s treacle is the very essence of humanity, the need for social interaction, the glue of what makes us human, along with primates and an inborn need to communicate and have sensory input from outside each of our beings.

 

Technorati Tags: social media,boson particle,higgs,treacle

#mHealth is Here, Now along with #hcsm

 

 

Top Paid Medical Apps for iPhones (from the iTunes store)

 

 

1. Pill Identifier ($0.99)

Developer: Drugs.com

Pill Identifier allows you to identify more than 10,000 different over-the-counter and prescription pills based on their appearance. Search by imprint, size, shape or color.

2. Pregnancy ++ ($2.99)

Developer: Health & Parenting Ltd.

Pregnancy ++ tracks the course of your pregnancy, including your weight, diet and exercise. It also includes HD fetal pictures, a kick counter and a contraction counter.

3. Baby Connect (Activity Logger) ($4.99)

Developer: Seacloud Software

Baby Connect tracks your baby’s everyday activities (including feeding, sleep, growth, health and vaccines) and creates graphical reports and trending charts. The information can be shared between parents, nannies and other child care providers.

4. Instant ECG: An Electrocardiogram Rhythms Interpretation Guide ($0.99)

Developer: iAnesthesia LLC

Instant ECG is an app for health care professionals, which teaches the basics of reading electrocardiograms (ECG). The app offers video demonstrations of 30 different arrhythmias to teach and then test a provider’s ability to diagnose irregularities.

5. MedCalc (medical calculator) ($0.99)

Developer: Mathias Tschopp and Pascal Pfiffner

MedCalc gives health care professionals access to more than 200 different diagnostic formulas, scores, scales and classifications that help measure a person’s health.

6. Pill Reminder by Drugs.com ($0.99)

Developer: Drugs.com

The Pill Reminder App keeps track of all of your medications, vitamins and supplements. Set up reminders to take your meds or refill a prescription, and check for drug interactions, dosage information and possible side effects.

7. Anatomy 3D: Organs ($1.99)

Developer: Real Bodywork

Anatomy 3D: Organs teaches users about structure and function of internal organs using 3D models, videos, audio lectures, diagrams, quizzes and a glossary.

8. Diagnosaurus DDx ($1.99)

Developer: Unbound Medicine, Inc.

Diagnosaurus DDX helps health care providers accurately diagnose patients quickly at the bedside. Providers can search over 1,000 differential diagnoses by organ system, symptom and disease, and use a special feature to consider alternative diagnoses when multiple conditions are possible.

9. Everyday First Aid ($0.99)

Developer: Portable Monster LLC

Everyday First Aid offers users information on how to handle an emergency. The medical information is based on guidelines from the American Red Cross and other health organization, and tells you how to handle situations including choking, wound cleaning, jellyfish stings, tick bites and heart attacks with illustrated training guides.

10. Drugs & Bugs ($5.99)

Developer: Haymarket Media

Drugs & Bugs is an app for medical students and health care professionals who care for patients with infectious diseases. It provides information on more than 100 antibiotics and nearly 200 bacterial pathogens, and allows providers to compare the effectiveness of various drugs.

 

Technorati Tags: iOS,apple,medical apps,#mhealth

Hangout Therapy for Immobilized and Challenged Patients

Virtual Photo Walk Tour, Capture Image of Toronto Canada, courtesy VFW.

Today’s Health Train Express delivers us to a wide variety of global tourist interests. The power of technology is readily harnessed with new, innovative and affordable consumer devices.

 

I have been privileged to work with many talented individuals, our cofounders, Bruce Garber (in Boston, MA), our announcer, video producer, and John Butterill  Ontario Canada) CEO of Virtual Photo Walks.

VPWs are routinely broadcast, as scheduled events.

In today’s VPW we had several patients challenged with advanced neurologic diseases, multiple sclerosis which render them non ambulatory.

The technology necessary for this is a simple webcam, laptop with broadband internet and even works well with smartphone or tablet pc’s running on a cell network for the VPW.  The broadcast locations were all transmitted using either an Android device or an iPhone using 4G cell connectivity.

I have included several previously archived events. The live events can be viewed via a ‘Google Hangout on Air’  (HOA).

KOMU TV news Anchor Sarah Hill is a journalism professor at the University of Missouri and is a pioneer Google Hangout person, championing it’s use in health, charitable fund raising, news gathering and in education.

Follow her narration of our next virtual photo walk.

 

 

Australian Beach

 

Japanese Cherry Blossoms

 

GooglePlex

 

Virtual Photowalk in Singapore

For future events go to www.virtualphotowalks.com . Also please visit our YouTube Channel at  Virtual Photo Walk for the archives.

Virtual Photowalks invites requests for specific patients to be scheduled. Photowalks are global in nature and we have resources on all continents (we are working on Antarctica)

 

Technorati Tags: google,google plus hangout,googleplex,virtual photowalk,komu tv,sarah hill,john butterill,bruce garber,health train express,disabled

Something This Way Wicked Cometh.

 

The New Yorker this morning has an article by Atul Gwande MD with that ominous title.

Pumping up the rhetoric seems to have been the present outcome of the Supreme Court Decision about the Patient Protection and Affordability Care Act.

Here comes the list of the present ‘winners’ and ‘losers’

THE MORNING AFTER

It's the bitter pill 24 hours after the supreme court decision(s) on PPACA.

The decision leaves a trail of winners and losers, from Main Street, USA, to the very steps of the Supreme Court. For some, it's a mixed bag. Here's a look:

WINNERS

Casey Quinlan, a 59-year-old breast cancer survivor who lives near Richmond, Va., and millions of other uninsured people. Starting in October 2013, the uninsured will be able to sign up for taxpayer subsidized coverage either through private insurance plans or the Medicaid health care program. Coverage commences on Jan. 1, 2014. The law eventually is expected to provide health insurance to about 30 million of the estimated 50 million uninsured Americans. Insurers will not be able to turn away people with a history or medical problems, or charge them more.

Hospitals. Their stock zoomed Thursday after the Supreme Court ruling guaranteed them millions more paying customers. Some analysts expect the law to reduce uncompensated care losses borne by hospitals by about half. Currently about one-fourth of the care provided by hospitals is never paid for, either because debts can't be collected or the patient is uninsured.

Stocks of big laboratories also rose.

insurance companies had a see-saw day, down sharply at first but recovering some lost ground. They'll get millions of new customers also, but they face new federal regulation and taxes they fear will drive up costs.

Family practice doctors. The law provides a pay boost for those treating Medicare patients, and takes other steps that could make general practitioners the new gatekeepers of a more efficient health care system.

Democrats. President Barack Obama and former House Speaker Nancy Pelosi devoted a vast amount of his first term to passing a health care law that has divided the nation.

Solicitor General Donald Verrilli Jr. Obama's top Supreme Court lawyer was maligned for his performance in both the health care and Arizona immigration cases.

Chief Justice John Roberts - The darling of conservatives, Roberts finds himself in the unusual position of being praised by the left and criticized by the right following the health care ruling,

LOSERS

The National Federation of Independent Business. The law imposes fines on employers that do not offer coverage, but companies with fewer than 50 workers are exempt,

Republicans. From presidential candidate Mitt Romney, to congressional leaders like House Speaker John Boehner, R-Ohio, and Senate Minority Leader Mitch McConnell, R-Ky., it will get harder for Republicans to argue that the law should be wiped from the books. However, Republicans could regain the upper hand by targeting unpopular provisions for repeal, like tax increases on industry, cost controls and cuts to service providers.

States that didn't prepare. About half the states now find themselves in the position of the little piggy that built his house out of straw. Many Republican-led states held back on carrying out the law's plan to set up new insurance markets, confident the Supreme Court would toss out the whole thing.

Justice Antonin Scalia. He sat glumly and silently as other justices read their takes on the health care law. Scalia was more vocal than any justice in his distaste for the law

 

Technorati Tags: scotus,ppaca,supreme court,republicans,democrats,obama,romney

Supreme Court Decision on PPACA

 

First-person Impressions from Today's Supreme Court Decision on Healthcare

My friend and colleague +Ann Waldo (an attorney with whom I've worked on some healthcare privacy issues) was able to attend today's Supreme Court decision.  She shared some first-person impressions via email, and gave me permission to share them more widely here.  Ann wrote:
"Family and friends,  here’s a summary of my take on the Supreme Court decision that Doug and I were privileged to attend in person today.  I’m still pinching myself that we got to be there.  I sat up front in the Supreme Court Bar section, approximately four feet from retired Justice John Paul Stevens and about 10 feet from the Justices.  The day was full of formality – the Deputy Clerk was wearing a morning suit with tails!  What a pleasure to be there.
I do realize, of course, that not all of us view the underlying law the same way, and I’m not trying to open a political debate.  Just sharing with you my impressions of being present on this historic occasion

“First of all, it really was breathtaking just to be there on such an historic day.
The mood in the courtroom was silent but extremely suspenseful.  Chief Justice Roberts started out by saying in very strong language that the Commerce Clause does NOT permit Congress to compel citizens to buy something they don't want to buy, whether insurance or broccoli.  He said the Constitution allows the regulation of commerce, but not the compulsion of commerce.  He went on for about 10 minutes about how the framers of the Constitution would have understood this in a common sense way – the government simply cannot compel people to buy an unwanted product.
I was sitting (in the second row, unbelievably!) along with the Solicitor General’s lawyers, and they all seemed to stop breathing.  Roberts continued, saying that allowing the mandate as an exercise of regulating commerce would be a vast government overreach, and would fundamentally change the relationship between government and individuals.

So – it really looked like the mandate was dead as a doornail, and my mind was racing ahead to the next logical question - the severability question – i.e., how much of the law would instantly evaporate.  I, like most in the room, was listening hard for clues as to how much of the law would disappear (contemplating the massive changes to contracts, payment arrangements, delivery systems, ACOs, performance measures, children’s health, keeping kids under 26 on their parents’ insurance, etc.)

But then the Chief Justice suddenly switched gears.  He said that if a law is unsustainable under one constitutional theory, but supportable under another theory, then it must be upheld.  He then analytically worked his way to a firm conclusion that the mandate is a tax.  Even though Congress didn’t call it a tax, it is administered by the IRS, it is collected on 1040s, it is based on income and dependents, and it raises revenue – it’s a  tax.  And, of course, Congress has almost plenary power to enact taxes.  (I’ve been saying for months that I wish the Democrats had just called it a tax, for then all these lawsuits would have been dismissed summarily.)
The bottom line – a person can choose to decline to buy insurance and pay the tax without breaking any law.  Thus, it’s not a real mandate; it’s a tax.  Thus, it’s Constitutional.

Roberts did a brilliant job of threading the needle. In my opinion, he showed real leadership by following the law, not politics or his personal views.  (He even implied he didn’t favor the law.) And by unexpectedly voting with the liberals, he helped undermine the growing perception of the Court’s own partisanship.  There’s no question that he elevated his own historical position as a powerful Chief Justice.

He also threaded the needle on the Medicaid expansion.  Although he ruled that while the Medicaid expansion as written was overbroad and coercive (which was the first time in history that the federal spending power has been ruled to be so heavy-headed as to be unconstitutionally coercive on the states), he found a way to avoid knocking millions of poor people out of newly eligible care by making the Medicaid expansion essentially optional at the state level.
Justice Kennedy delivered a blistering dissent.  People have been saying he was a swing vote and might vote to uphold the mandate, but no way, that was far from true.  He was adamant about how the mandate exceeded the government’s powers, and he didn’t buy the argument that it was really a tax.  Powerful, articulate positions.

Justice Ginsburg delivered a strong dissent to the majority decision that the mandate violated the Commerce Clause.  She said that not buying health insurance is not remotely like not buying vegetables, because individuals who don’t buy insurance and get sick impose substantial costs on taxpayers and other people who pay for insurance, and that slippery slope arguments are absurd. “

A big day, an amazing decision.  We’ll all have to stay tuned for reactions and next steps. The political battle lines are certainly being hardened already.
P.S. In case you’re not  clear on what the contents of this extremely complicated law are, here’s a small summary.  There’s a lot more too, much of which has to do with overhauling how we improve quality and save money by paying hospitals and clinicians for the quality of their results, rather than the expensive, terribly expensive status quo method of paying for each service ordered. 

But here’s a quick summary of some of the major effects on individuals:

* Insurance companies no longer have unchecked power to cancel your policy, deny you coverage, or charge women more than men.
* Soon, no American will ever again be denied care or charged more due to a pre-existing condition, like cancer or even asthma.
* Preventive care will still be covered free of charge by insurance companies--including mammograms for women and wellness visits for seniors.
* By August, millions of Americans will receive a rebate because their insurance company spent too much of their premium on administrative costs or CEO bonuses.
* 5.3 million seniors will continue to save $600 a year on their prescription drugs.
* Efforts to strengthen and protect Medicare by cracking down on waste, fraud, and abuse will remain in place.
* 6.6 million young adults will still be able to stay on their family's plan until they're 26."l

All of the above are well intentioned and meaningful. However there remains much to decide as the law proscribes a rigid administrative bureaucratic structure that will increase costs dramatically with formation of accountable care organizations, a nationwide health information network (which is still largely inoperative and only in the planning stages. In addition to the ACOs and the NHIN a new paradigm for reimbursement must be designed, converting from a procedural base to one of  excellence of outcomes. And there is still uncertainty how and what measures will be utilized

 

Technorati Tags: scotus,ppaca,john roberts,justice kennedy,justice ginsbert,justice scalia,healthreform,individual mandate,irs,tax

Governor Brown Loves the Children !

 

SACRAMENTO -- Advocates on Monday made a last ditch effort to persuade Gov. Jerry Brown and Democratic leaders to back down from a plan to eliminate Healthy Families, the medical insurance program that serves children from low-income working families.

Axing the program to save tens of millions of dollars is a key provision in the budget that Brown and Democrats worked out last week as part of an agreement that spared more painful cuts to safety net programs for the poor. More than 900,000 children would be required to change to the Medi-Cal system over the next year and a half, forcing them to find new doctors in what critics say is an already overwhelmed system.  (and the medi-cal system is fee for service with even fewer doctors)

"Medi-Cal already faces serious challenges in providing access for 3.5 million kids served by it today, and it's straining to serve them well," said Wendy Lazarus, founder and co-president of The Children's Partnership, which outlined demands in a letter co-signed by 64 groups.

"But by putting added pressure on a very fragile Medi-Cal system now, the plan will endanger access to care for as many as 4.5 million kids."

Healthy Families provides medical, dental and vision care for children who don't have insurance but who do not qualify for Medi-Cal. A family of four can make up to $30,000 and qualify for Medi-Cal, while a family of four can qualify for Healthy Families with an income of up to $56,000.

Democrats on Monday began taking up 21 trailer bills that will enact

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various aspects of the budget, including one specifically on Healthy Families. They will work through the bills in committee before taking a vote on Wednesday. That is the last day Brown can take action on the budget: He can either veto it, veto parts of it, sign it, or take no action, which would automatically enact it into law.

Only a majority of votes are needed for each bill in both houses, so Democrats, who have wide majorities in each house, could spare a handful of no votes. If enough rise up against it, the budget deal would collapse with the end of the fiscal year looming. That doesn't look likely, however, as advocates can count only two Democratic lawmakers opposed to the dissolution of Healthy Families. They need a minimum of seven to block it in the Senate and 12 in the Assembly.

Sen. Leland Yee, D-San Francisco, is one who opposes the dissolution, along with Assemblyman Richard Pan, D-Sacramento. Yee said if he can't persuade colleagues to support abandoning the plan to eliminate Healthy Families, he wants a strong assurance that children moving to Medi-Cal won't lose coverage.

"It's incumbent on all of us to do what we can to change the governor's mind," Yee said. But short of that, he wants to "ensure children in Healthy Families are not going to be left holding the bag."

One of the biggest concerns is that doctors who receive Healthy Families patients do not accept Medi-Cal patients. Doctors and health providers receive a higher reimbursement rate from Healthy Families than from Medi-Cal.

By dissolving Health Families, the savings would net $13 million for the rest of this year, and another $54 million next year and $78 million the following year. But the state stands to lose millions of dollars in federal matching funds that will be cut off once Healthy Families is dissolved, critics said. And it will likely forfeit $200 million for each of the next two years that it would have gotten through an industry-paid managed care organization tax, which helps fund Healthy Families.

The tax is set to expire at the end of the month, and extending it would require a two-thirds vote, and Republicans, who have criticized the move to shutter Healthy Families, are unlikely to vote for it.

"This has the potential to make our budget worse, not better," said Anthony Wright, director of Health Access California. "In order to get a little savings now, we're potentially blowing a bigger hole in the budget in the future, one that will reverberate onto kids' programs and kids' services."

Contact Steven Harmon at 916-441-2101. Follow him at Twitter.com/ssharmon