Friday, November 25, 2011

A Twitter Debate about Health Care reform

I had an interesting experience after  I used Twitter to note and lament the resignation of CMS Director Dr. Donald Berwick.  Craig Casey, an insurance agent in San Diego, sent several "tweets"disparaging Dr. Berwick and taking issue with"Obamacare". It is impossible for me to tweet an adequate reply to Craig, so I am using this column to reply point by point:
20+ million more on Medicaid equals Dr. shortage in / or rationing. you have elderly relatives Dave? 
This statement assumes that these folks were not receiving care before, and that suddenly they will now show up! The reality is, however, that they have been  seen for expensive and uncoordinated care in emergency rooms, and for complications due to no consistent primary care access. Obamacare will shift that to early primary care, and yes, we will need more folks to provide that care as things change.
Quoting his own comments about  , he committed political suicide, no assassination. Good bye Obamacareite. Actually, Dr. Berwick has been a tireless advocate of safety in health care as head of the Institute for Health Care Improvement, and he has always focused on the patient and how we need to work together to achieve better outcomes of care. This work takes study and organization, which has caused him to step on a few toes in the insurance industry and elsewhere. This has lead to pressure by republicans in Congress to make his confirmation impossible. He should be proud of who his enemies are. Organized medicine has supported him completely.
The cost curve was bent upwards, health  rates have jumped 20% since  was passed UNaffordable care act. This is just not true. Insurance rates have been going up at an astronomical rate for years. The Employer Health Benefits Survey by the Kaiser Family Foundation, which specializes in health care issues, found that health insurance premiums have jumped by 9 percent in 2011. Drew Altman, president and CEO of Kaiser, said that the premium increase was not because of Obamacare but that the Obamacare law accounted for 1 to 2 percentage points. He noted, “It reflects the costs of covering young adults up to 26 years of age under their parents’ policies" and also "the costs of providing prevention benefits without cost-sharing". We can actually expect cost savings later from these measures!
Not when their reimbursement rates are being cut by the false promises of coverage via . This makes no sense to me. There is a problem at present due to the fact that Medicare rates are due to decrease 27%, because of the flawed update formula from years past, but that has nothing to do with Obamacare.
Since you And Berwick brought it up, MedPAC, IPAB, & CER.  equals . disprove it then. This is nutty talk. The reality is that we ration care now, and always have, by ability to pay. Even people with insurance are now often having trouble affording care. If we don't start paying for health care based on quality instead of volume, and work together to organize and provide services that we all need for a healthy and productive society, more of us will be priced out of needed care ever year. That is not an outcome that we can afford.

Wednesday, November 23, 2011

Dr. Donald Berwick Resigns as Head of CMS

Donald Berwick, MD, a tireless advocate for patient safety in health care, has decided to resign his post as administrator of the Centers for Medicare and Medicaid Services (CMS), effective December 2. I am very sorry to see him go.

Dr. Berwick will have served only 17 months in the post. President Obama nominated Dr. Berwick, who was head of the Institute for Healthcare Improvement, for the CMS post in April 2010, a move that was hailed by diverse groups such as the American College of Physicians, the American Academy of Family Physicians, AARP, Walmart, and Consumers Union. Inspite ofthis broad based support, President Obama found that GOP opponents were blocking his Senate confirmation, as part of their all out strategy to stop health care reform. This caused the president to install Dr. Berwick as CMS administrator through a "pocket" appointment while the Senate was in recess, a special appointment that is set to expire by law at the end of 2011. Dr. Berwick was renominated in January 2011, but he still faced implacable opposition from Senate Republicans. His resignation, therefore, comes as no surprise.

According to news reports,  Dr. Berwick told the staff of the Department of Health and Human Services in an email, that he had "bittersweet emotions", and that although their work was challenging and incomplete, that "we are now well on our way to achieving a whole new level of security and quality for healthcare in America."

Amen. I hope so. Thank you, Dr. Berwick, for your leadership.