How To Solve Most of our Budget Problems and Improve Our Medical Care

Over the last 10 years, average wages in the United States have increased 38%, while the cost of health care has risen 131%. If other costs during my lifetime increased at the same rate, a dozen eggs would now cost $38, and a gallon of milk would be $48. Why this difference? What can we do about it? What should we do about it? That is what we should be talking about every day.

To listen to the superficial analysis of our politicians and talking heads on TV, we face a stark choice: we must either go bankrupt as a nation, or cut back on the benefits of programs like Social Security and Medicare that people have paid into for years. Are these really our only two choices?

The answer is, we do have a better way! As a family physician with over 35 years of experience, I can testify to that fact that I see copious waste in our medical care system occur every day. Every doctor can tell you the same thing, and many others have documented this waste as well. In fact, the Institute of Medicine has published information that reveals a total of $765 Billion dollars of waste in 2009. If we can solve this problem, our budget concerns go away.

So, where is this waste, exactly? Well, $190 Billion comes from wasteful administration - all of the forms and complex rules we deal with every day, that are different from plan to plan. $130 Billion comes from poor efficiency - the lack of coordination that results in tests being repeated, and one part of our system not talking well with the other. Unnecessary care cost $210 Billion dollars in 2009. These are the tests you didn't need, and the care that didn't really address what would solve the problem. Missed opportunities to prevent illness cost an additional $55 Billion dollars - flu shots,  immunizations and good primary care that was never given. Fraud was also a factor, accounting for $75 Billion in waste. Criminals need to be prosecuted and locked up.

What would a different system look like? To me, the answer is simple. It would be a system built around the actual needs of patients, that gives every person a primary care medical home to provide most of their care, and coordinate with other care givers when they are needed. Payments would be partially based on the quality of care outcomes and satisfaction of those we serve. 

If we make this choice, we will not only solve our budget problem, we will also lay the foundation for a healthy and productive population for years to come. Let's have that discussion!

What did Mitt Romney learn about health care on his trip?

 Republican presidential candidate Mitt Romney has just returned from traveling abroad, where he said he wanted to learn and listen. In Israel, he commented that Israel was a “pretty healthy nation” that spends far less on health care than the United States does. 

“Our health care costs are completely out of control,” he said. “Do you realize what health care spending is as a percentage of the [gross domestic product] in Israel? Eight percent. You spend 8 percent of GDP on health care. . . . We spend 18 percent of our GDP on health care. Ten percentage points more.”

 Did he learn something new about health care, or just drift off of his message again? He visited three countries:

United Kingdom:
Health care costs as a percentage of GDP: 9.6%
Life expectancy at birth, both sexes: 80.6 years
Infant mortality, per 1,000 live births: 4.2

Israel:
Health care costs as a percentage of GDP: 7.9%
Life expectancy at birth, both sexes: 81.7 years
Infant mortality, per 1,000 live births: 3.7

Poland:
Health care costs as a percentage of GDP: 7.0%
Life expectancy at birth, both sexes: 76.3 years
Infant mortality, per 1,000 live births: 5.0

He returns to the United States:
Health care costs as a percentage of GDP: 17.6 percent
Life expectancy at birth, both sexes: 78.7 years
Infant mortality, per 1,000 live births: 6.1

What do you think Mitt will conclude after comparing these numbers?  How about you?

What do you have wrong about Obamacare?

Obamacare has been confirmed as the law of the land, and the common belief that it was unconstitutional has been shown to be incorrect. 

The Affordable Care Act will affect all of us, so what other common beliefs that people have about  this law are also wrong? The following is a list of common misperceptions that I have observed.

Common belief: Obamacare is a government takeover of health care. 

ACTUALLY: The Affordable Care Act has no government plan. It preserves private plans and strengthens the private insurance market, making it easy to shop for a plan you like, while protecting people and their health. 

Common belief:  the law is just about insurance and not about cost. 

ACTUALLY: the law promotes new models, innovations, and research to start improving care while decreasing costs. Here in Whatcom County, the Whatcom Alliance for Healthcare Advancement (WAHA) has received one of these grants!

Common belief:  the law is just about insurance and not about health. 

ACTUALLY: the law creates a national Prevention Fund, and invests in training for doctors, nurses, and other needed health professionals 

Common belief:  the law is hurts small businesses. 

ACTUALLY: the law will help most small businesses a lot! Companies with less than than 50 employees get tax credits for up to 35% of employee health insurance 

premiums. Beginning in 2014,  tax credits rise up to 50% of insurance premiums. 

Common belief:  the law just  increases premiums and costs for families. 

ACTUALLY: health premiums were skyrocketing before the law, and this is a major reason for the law! Insurance companies will now have to explain why they are raising rates, and the reasons will be published on a publicly available website. If insurance companies don’t spend most of your premium dollars on health care, they are now required to send you a rebate at the end of the year. 

Common belief:  the law hurts Medicare and seniors. 

ACTUALLY: the law saves 600 million dollars by reducing extra payments to insurance companies, and strengthens Medicare to help seniors  afford prescription drugs, get annual checkups with no co-pays and to make Medicare work better for seniors and doctors. 

Common belief:  We can’t afford Obamacare

ACTUALLY: the law's expense replaces costs we already pay that have been going through the roof for years, and we can’t afford not to have it. The law extends coverage, promotes access to the right care, in the right place, and at the right time. This is one way the Affordable Care Act was designed to save money by keeping people healthier. 

Common belief:  The law is too complicated to understand.

ACTUALLY:  The basic facts are simple. 32 million more American citizens will be insured. There will be help for those who cannot afford coverage. Most insurance company abuses will end. We will start building a system that improves quality and controls cost for all of us.

If you want to be informed, ignore most of what you hear and visit HealthCare.gov which is an easy to use site that explains the law and how it is being rolled out. 

What do money, Winston Churchill, Obamacare and an informed public have in common?

It was Winston Churchill who noted that "The best argument against Democracy is a 5 minute conversation with the average voter". As we await the Supreme Court decision, recent events are once again proving the truth of his assertion. 


It has now been two years since this landmark legislation,  and a recent Kaiser Foundation poll shows that fewer people today know what is actually in the bill than did when it was passed! This lack of knowledge parallels the decreasing public support for the bill. What is responsible for people dumbing down? A just released New York Times article documents that opinion about the Affordable Care Act is related to the money spent on advertising by its wealthy special interest group opponents.  Consider this:  opponents of the legislation have outspent those in favor by a more than 2:1 ratio since the law was passed, and more than 3:1 in the last year. The same study notes that since July 2011 there have been 164 different attack ads produced, and only 16 in favor.


It seems clear that wild spending by monied interests can sway public opinion on this and many other matters. Can it do the same with the Supreme Court? Stay tuned.

The Affordable Care Act in Washington State - Why we need it more than ever

Over 1 million Washingtonians have no health insurance, and unfortunately, Obamacare is their only realistic hope for getting coverage. Millions more will see real benefit from important consumer protections built into the law. That is the conclusion of an important new report just released by Mike Kreidler, the Washington state Insurance Commissioner.

As the graph above shows, the lower your income, the less likely you are to have health insurance. People without insurance in Washington State are usually working, but simply earn too little to afford the medical coverage they need, even when working full time. Their employment is the gateway to their poverty, instead of a way to earn their way out. That is why medical coverage must eventually be decoupled from employment status.

Read the report itself for a county by county breakdown of what we will lose if the Affordable Care Act goes away.

What’s at stake: The Affordable Care Act in Washington state: A county‐by‐county analysis

When adequate health care was an inconceivable notion - How Our History Contributes to our Troubles Today

Why is it that we have such a contentious argument about providing an equitable system of medical care to the citizens of our country? We have already talked about the fact that our employer system of paying for insurance causes unique difficulties, but I believe that there is another, core reason for our troubles. When the founders crafted our Declaration of Independence and United States Constitution, there was no such thing as effective medical care. The average age of death at the time of our founding was in the early 40s, and there was little difference between the rich and poor. Indeed, those who could afford medical care in those days were often treated barbarically, and a good case can be made that the net effect of such care was deleterious and not helpful. The Father of Our Country, George Washington himself, died at home in his bed in Mt. Vernon from the complications of a strep throat. In other words, the same people who proclaimed  "that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness " would never have thought of the fact that access to life saving medical care might be a right that would follow from this assertion. 


Today, we understand that in order to enjoy our constitutional rights and fully participate in a democratic society, we need and deserve access to basic health care services. It seems ironic to me that our effort to ensure that our citizens are healthy and able to strive for their rights of  "Life, Liberty and the Pursuit of Happiness" will be judged on the basis of a document that has its origin in a time where adequate health care was an inconceivable notion. The Supreme Court will be thinking about interstate commerce, the rights of the states and the federal governments ability to regulate. They will have no guidance from our Constitution on why the inadequate access of millions of citizens to modern health care serves as a denial of their most basic, "unalienable rights". 

Is it time to end employer sponsored medical insurance?

It has been more than a little hard to follow the politics of the healthcare reform "debate" over the last few years. Sponsors of reform have been treated to accusations of death panels, the President has been portrayed as a Nazi and republicans have uncharacteristically complained that money saving measures were an attempt by President Obama to "gut Medicare". Now, the strangest twist of all may be the new proposal from Sen. Roy Blunt (R) Missouri. Simply stated, the "Blunt Amendment" would allow employers who provide insurance coverage and insurance companies themselves to refuse coverage of any health care service required under the new health care law if they feel it violates their “religious beliefs or moral convictions.”  Wow. 
Unfortunately, this phenomenon is uniquely American. 
Coverage of contraception services, for example, has been a settled issue in the majority of our states, supported by both democrats and republican legislators for almost 40 years. Other countries, even predominantly Roman Catholic nations such as Spain and Italy, also provide contraception coverage, and they do not have the conservatively devout trying to end the coverage! The difference is that our way of doing things revolves around the unique way that medical insurance is sponsored in the United States, and that is our reliance on employers to sponsor private insurance options for their employers. 
As I witness this debate, I can't escape the feeling that the only way to end this kind of messy politics may well be to end our dependance the private insurance system itself. We can't have it both ways. If private employers and plans can pick and choose conditions and services to pay for, then the rights of those covered to follow their own conscience and make their own choice is impossible. Diseases felt to be due to an unhealthy lifestyle, for example, might join contraception as prohibited items to cover. The result would be chaos and anything but a just and equitable situation.
It would be ironic in the extreme if the immoderate rhetoric used by the extreme right to oppose efforts to improve our system actually led us to a true national health insurance system such as Medicare for all. President Obama's efforts to compromise on this issue for the passage of the Affordable Care Act may still lead us to a government plan. 

Washington State Medical Association (WSMA) supports the Washington State Health Benefits Exchange

The Washington State Medical Association (WSMA) has announced support for the Governor’s requested legislation on the Washington State Health Benefits Exchange (SB 6178/HB 2319), authorized by the Affordable Care Act. WSMA testimony before the Senate Health & Long-Term Care Committee and the House Health Care and Wellness Committee made the following points:
 
·         The WSMA supports an Exchange that promotes the purchase of health insurance, ensures administrative simplification, ensures patients have access to local providers, provides coverage for key benefits and promotes the viability of physicians and their medical practices.
·         Qualified Health Plans - Any decisions to expand Qualified Health Plan standards should be analyzed carefully with mindfulness towards barriers that can limit access to affordable health coverage.
·         Market Rules - The exchange must be stable and sustainable. Market rules imposed should keep an eye on affordability for patients and the viability of medical practices.
·         Powers of the Exchange Board and the Office of Insurance Commissioner (OIC) - In regulating the Exchange, the Board must be responsive to the interests and needs of Washington’s physicians and consumers. Policies that drive payment rates down to Medicaid levels will jeopardize access to care.
·         Washington High Risk Insurance Pool - WSMA supports operation of the WSHIP for patients who are most vulnerable. Consideration should be given towards keeping it open past January 1, 2014.
 
In my view, this common sense input is important advice to heed that will make our Washington State Health Benefits Exchange strong, sustainable and useful.

Announcement from Larry Thompson, Director of the Whatcom Alliance for Health Care Access

A momentous accomplishment for our community that will go a log way to assist in our work to build a safe, efficient and effective Accountable Care Organization for Whatcom County.

"I am pleased to announce that the Center for Medicare Services (CMS) has recommended the Whatcom Alliance for Health Care Access (WAHA) for award of funds under the Care Transitions program (Project Impact). There are conditions on this award which have not yet been shared with us. We are scheduled to review these conditions by phone with CMS on January 17.

This is a multi-year award which carries with it up to $5.7 million to reimburse us for the cost of assisting patients to make safe transitions between care settings.

As you can appreciate, this is one key piece of several funding awards we must secure to fully implement the vision called for in our Phase I ACO work. On the other hand, the scale of the award relative to the current WAHA budget will present us all with stewardship and management challenges.

I would like to take this opportunity to thank our many community partners in this venture without whom this effort is merely a shell. As well, please join me in thanking our staff, especially Elya Moore, whose hard work and inspiration led to this success.

Larry Thompson"