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"

3 Principles that can bring us together for meaningful healthcare reform

The usual discussion about health care reform often resembles a food fight in middle school. Insults pass for argument, and facts get ignored or selectively presented only when they bolster one's opinion. What would it look like if we talked about what we all truly care about. Could we have a different discussion?

When I have discussed this issue with others in my community, there are 3 important principles that seem to ring true with most of us.

First, we need to invest  in "us" and the future we want to build. If we envision America as a successful land of opportunity, it means that we need a healthy workforce, able to compete and healthy students able to learn new skills. Our investment now in an equitable system that allows that to happen is simply a requirement needed to  make it so! This future will not happen by accident, and our failure to act now will doom our next generation to a future much different than we would like for them.

Secondly, we must end waste! It makes no sense to spend money on treatments that do not heal, or on complicated paper work that drives up costs. Fraud must be eliminated. Research on how to improve care must be supported, and the public should see the benefits!

Finally,  we need to end cost shifting, and share the burden fairly. Medical pricing today makes no sense. The cash paying person is charged the most. Hospitals overcharge for some things to pay for what is not covered. Some people get a tax break on insurance and some do not. A healthy society needs every one to be covered, and the cost must be affordable for all, or our society will remain broken and care will remain out of reach for many.

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 #Healthcare #rationing, 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 #insurance rates have jumped 20% since #Obamacare 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 #Obamacare. 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. #Rationing equals #deathpanels. 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.

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.

How to not save money while providing healthcare!

As of October 1st, the State of Washington has decided to "save money" on Medicaid (DSHS) medical care payments, by allowing maximum of three “non-emergency” visits to emergency departments each year.   They have drawn up a list of more than 700 diagnoses as “non-emergent” that include such surprising symptoms as chest pain, abdominal pain, miscarriage and breathing problems, and the decision affects all Medicaid patients, including children. 

Now all of us want to save money on rising health care costs, and if some is wasted in the emergency department, it makes good sense to try and reduce the waste, but this plan is ridiculous! People who go to the emergency department often do so because they have no regular physician or other alternative and they do not know where else to go. The "savings" the state thinks they will get will actually be a cost to the hospital who is not paid, and that will simply drive up costs for the rest of us. Limiting access to people in pain, having trouble breathing or having a miscarriage, without providing an alternative, is dangerous, unethical and wrong.

The Washington State state chapter of the American College of Emergency Physicians (WA-ACEP) has filed suit to void this action by our state Health Care Authority. Their action follows an unsatisfactory effort to work with the Health Care Authority before filing suit. 

Any effort to save money in medical care must also address patient safety, effectiveness, timeliness, efficiency, equity and the needs of the patient. This action by the State of Washington fails on all levels!