Those of you who have read my two previous posts realize how fortunate we are to have Dr.Tom Coburn as a U.S. Senator. He uniquely represents physicians (as advocates of the patient). and is highly articulate, and well informed. His comments on the previous posts were from the Health, Education, Labor, and Pensions Committe during their discussions on SR 325.
WHICH HEALTH CARE PLAN IS BETTER??
The Patients Choice Act S 1099 or:
The Democratic House Bill HR 3200
I was just responding to a thread between several of my former classmates from GWU Med School. After composing it and reading it I realized my thoughts probably reflect those of you who read my blog.
Dear Gary,
I thank you for your letter to Al. Your continued leadership is a blessing. Jim Rowsey On Aug 8, 2009, at 7:52 AM, Gary Levin wrote:
> Dear Al,
>
> Sorry my response was so abbreviated. I was thinking a great deal
> about what you said about opposition vs. leadership.
>
> As you and I know this is a very complex "industry'. Each segment
> responds to market pressures in it's own way.
>
> I agree that physicians must be leaders, as we have always attempted
> to do so as patient advocates...
>
> Frankly my feeling (and many others) is that our advocacy for patients
> and our desire to 'comply' and not rock the boat has led many segments
> to take advantage and use their own advantages to obtain what they
> desired.
>
> Now we are being asked to agree with an overall sweeping change to
> further accommodate and endorse what we already know does not work.
> Some of these changes started as far back as 1971 when the HMO act
> began a series of events that had many unintended consequences such as
> the failures of many practices, unethical marketing practices, the
> construction of many evanescent organizations which controlled
> physician referrals, closed out markets to new entrants (ie, new
> physicians). And some of these have led to the shortage of primary
> care physicians.
>
> Our present system gives more credentialing clout to insurance
> companies than state medical boards, The only group of people that
> have consistently been asked to do more for less while our overhead
> has soared is physicians and hospitals. It is close to a miracle we
> have survived. Many of us went bankrupt in the late 1980s here in
> California. Medicaid is an unfunded mandate, and actually Medicare is
> as well.
>
> The devil is in the details. I doubt if any legislator is capable of
> analyzing the impact of this gargantuan bill. Our leadership should
> consist of careful advice in regard to the known impact and the
> unintended consequences of each portion of this 'global HR 3200.
>
> I am not opposed to change, however slick slogans and the 'crisis
> mentality'
> of our present administration is disingenuous. Doctors have been
> talking crisis for the past 20 or more years.
>
> Change can be made. The first is that the insurance industry must
> stop cherry picking and have a level playing risk pool. Health
> insurance should not be an employer responsibility. That is obvious
> by the many who lose their coverage for no good reason other than they
> lost their job and COBRA rates are punitive. If someone in their mid
> 40-50s becomes ill and loses their coverage, it is neigh well
> impossible for them to regain coverage due to exclusions wavers and
> predatory premiums. These changes are do- able.
>
> Reimbursing primary care doctors equitably would swell the ranks of
> primary care. Even though I have been an ophthalmologist the majority
> of my career, I miss many aspects of general medicine. Primary care
> physician spend a lot of time triaging to specialists. They are not
> reimbursed for this cognitive skill.
>
> I know that most physicians have tried to be calm, reasonable, and
> also have compromised a great deal (under the economic threat of
> worse)....
>
> Perhaps the younger physicians will not know better.
>
> Americans will lose their freedoms if medicine goes the way Obama
> wants it to. We are a deeply divided nation. I don't think we need to
> look at other countries for a 'better solution'...we have it in our
> power to develop a beter system right here, and now.
>
> The argument that if we don't do it now, it will not be done, and our
> economy, the country and the world will go away. Balderdash!!! The
> taxpayers were forced to bail out the financial world, why should they
> be asked to continue throwing money down the toilet. (there is no end
> to medical expenses, Who wants to let their parents, brothers, etc
> die?
> Especially if mandated by a huge unfeeling government or insurance
> entity.
>
> For many years children, brothers and sisters made those decisions
> based upon their family's needs and desires.
>
> We now have to get authorizations, certifications, approvals to have a
> bowel movement. How much money does all of that cost? A doctor can no
> longer express his anger or discontent at the hospital without being
> sent to 'anger management' I doubt if there is a group of
> professionals who have been taught more about imperturbability and
> equanimitiy than physicians.
A word from Senator Coburn D Oklahoma, physician.
>
>
My next post will contain Part II>
> It's great that our class is still so active in these matters.
>
> My best to you , old friend...I hope your health maintains..
>
> Gary Levin
>
THANK YOU TOM COBURN
Part I is on my previous blog post.
Matt Holt, last week proposed these two basic rules to guide us in health care reform:
Rule 1 A health care reform bill needs to guarantee that no one should find themselves unable to get care simply because they cannot afford it. Neither should anyone find themselves financially compromised (or worse) because they have received care.
Rule 2 A health care reform bill needs to limit the amount of GDP that is going to health care to its current level, with an overall aim of reducing the share of health care going to GDP.
This week Uwe Reinhardt expands a bit:
Writing in his blog in the NY Times, Uwe Reinhardt sets out three overarching goals of health reform
1. Financial barriers should not stand between Americans and preventive or acute health care that they sincerely believe will address concerns over a troubling medical condition, in a timely manner, before that condition grows into a critically serious illness.
2. Having received needed health care, no American family should be so financially devastated by medical bills that it cannot meet routine daily living expenses — for example, make utility or mortgage payments on time or finance the education of the family’s children.
3. The future growth in national health spending should be constrained to fall significantly below currently projected spending growth, which has the United States devoting about 40 percent of its G.D.P. to health care by mid-century.
All other goals are subordinate to these three overarching goals, as are the means to reach them.
How do we get from here to there?
Another word for SERMO. Dan Palestrant (founder of Sermo) was on MSNBC.com for another ‘debate’ with “established’ organized medicine. This time it was with the head (/Dr. William Struck ) of the Bassett Hospital in Cooperstown, New York. The argument again was about ‘salarizing’ physicians as a means of cost containment.
Viewers of this ‘sound byte’ need to know about Bassett Hospital.. Bassett Hospital operates in a rural area of Northern New York. It is a pristine small community with a fairly large drawing area of a lightly populated region. Solo private practice in that communitiy would be untenable economically. Bassett Hospital also is affiliated with Columbia University School of Medicine, and has multiple training programs for residents from Albany Medical Center (over 100 miles distant) and also from Columbia University in New York City, over 200 miles distant.
This is a unique population of physicians and their practice setting. The presence of residents in training (who are salaried at a much lower level than attendings) shifts a great deal of work load, night call and physician administration, such as record keeping to junior physicians who are not yet qualified to practice independently..
Attending physician work load in this setting is diminished when compared to other settings. The lowered physician income does not decrease overall costs, and any benefit is shifted to the administrative staff, capital expenditures, and operating budgets. Physician income is a very small component of their budget. (so is income for physicians not in integrated health care systems.)
When asked, the CEO of Bassett hospital dodged the question from about how much savings there were by salarizing their physicians. I suspect this was because he either did not know, or would not admit there are “NO SAVINGS” overall.
Dr Struck contends that salarizing physicians removes the added administrative tasks from physicians and allow them to focus on their patient care. This begs the question and denies the culpability of the insurance industry and regulatory affairs that has imposed these tasks upon the physician. It puts the horse before the cart and attempts to make physicians responsible to reduce the cost of this burden imposed by insurance and government payors.
Dr. Palestrant and Sermo join other real physician advocates in their proactive and aggressive education program for the general public.
As some of us prepare for the long awaited "August" vacation, remember that your elected congressman, senators are also spending time in their congressional districts. Keep them busy at this critical time and voice your opinions on health reform.
Things are reaching a critical mass, and this now has national attention, with everyone weighing in...Make our voices heard, fellow physicians and health care workers.
It is apparent that some beginning of health reform will take place. Most opinions revolve around increasing availability of primary care, levelling reimbursements between primary care (family practice for you other dinosaurs) and specialty care.
Rather than over all revolution it seems that the insurance companies should be the focus of initial changes in regard to cherry picking,
increasing risk pools and universal coverage via market economics, not government intervention. Government should act to enable this to occur via present structures rather than inventing new government bureaucracy and restrictive regulations.
It seems the critical mass has boiled down to "
THE BAUCUS SIX".
Health reform created a weird calculus of outcomes, decision makers and political intrigue
Update | 2:11 p.m. List of states has been corrected.
My colleagues David Herszenhorn and Robert Pear had an article on Tuesday on the Baucus Six — the group of six senators tasked by their parties to hammer out a new health care package to be considered by the Senate Finance Committee (and then, presumably, the full Senate).
The senators are from Maine, Iowa, Montana, North Dakota, New Mexico and Wyoming. A colleague noted that it’s a somewhat odd group to be asked to design a new health care system, given their constituents.
Whom, exactly, do these senators represent?
They come from some of the country’s least populous states, with no true urban centers to speak of. None of their home states contains even one of the 20 biggest cities in the country. Forget that: Of the country’s 100 biggest cities, just one is in these states (#34, Albuquerque, N.M.).
These states represent less than 3 percent of the country’s population, and hold only 2 percent of the nation’s uninsured, according to Census Bureau estimates.
It makes sense to give the residents of Montana and Wyoming a strong say in the future of health care reform, which will likely affect residents of every state. But shouldn’t someone representing a state with a few big complicated cities also have an official seat at that table, which is trying to determine a compromise that works for (almost) everyone? The way health care functions varies greatly from region to region, in terms of things like patient needs, delivery systems and resources. A more metropolitan state with a few rich, research-oriented medical facilities will operate differently, with regard to everything from expenses to treatment options to patients, from a rural state with fewer resources.
There would be a similarly problematic imbalance if the senators asked to design a template for the future of American health care were all from California, New York, New Jersey and Florida, and excluded all the Iowans and North Dakotans from the table. The plan that resulted from some Bizarro-World, urban-state-only cabal would have altogether different blind spots, of course.
This problem transcends the issue of health care reform; there are surely many occasions when the actual representativeness of our “representative democracy” seems in doubt.
But in this case — where the richer, more populous states will likely disproportionately contribute the federal taxes used for any additional government involvement in health care — it seems especially curious, not to mention impolitic, to exclude a California or a New York from the current discussions.
The Baucus Conference Room:
Last week, there were chippers — chocolate-covered potato chips — described on a sign as “North Dakota Diet Food.” More often, there are Doritos, pretzels, Oreo cookies and beef jerky: fuel to get through hours of talks on topics like the actuarial values of private insurance plans or the cost-sharing provisions of Medicare.
The fate of the health care overhaul largely rests on the shoulders of six senators who since June 17 have gathered — often twice a day, and for many hours at a stretch — in a conference room with burnt sienna walls, in the office of the Senate Finance Committee chairman, Max Baucus, Democrat of Montana.
President Obama and Congressional leaders agree that if a bipartisan deal can be forged on health care, it will emerge from this conference room, with a huge map of Montana on one wall and photos of Mike Mansfield, the Montanan who was the longest-serving Senate majority leader, on the other.
The battle over health care is all but paralyzed as everyone awaits the outcome of their talks.
We talk a lot about fixing healthcare, but none of it matters if the people delivering care cannot survive the system themselves. More than ...
