After Obama, Some Health Reforms May Prove Lasting
A transformation of the delivery of health care may be an enduring legacy for the president, even as Republicans plan to repeal the Affordable Care Act.
by Abby Goodnough and Robert Pear
FISHERS, Ind. — Fragments of bone and cartilage arced across the operating room as Dr. R. Michael Meneghini drilled into the knee of his first patient at a hospital here at dawn. Within an hour, the 66-year-old woman had a replacement joint made of titanium and cobalt chrome, and she was sent home the next day.
But the Obama administration was watching over her caregivers’ shoulders. If, over three months, her medical costs exceeded a target amount set by President Obama’s health regulators in Washington, Dr. Meneghini’s employer, Indiana University Health, stood to lose money.
Such efforts to squeeze spending out of the nation’s health system may well remain as Mr. Obama exits the West Wing and Donald J. Trump takes his seat in the Oval Office. The Affordable Care Act is in extreme peril, and Mr. Obama will meet with congressional Democrats at the Capitol on Wednesday to try to devise a strategy that can stave off the quick-strike repeal of the health law that Republicans plan for the opening months of the Trump administration.
But the transformation of American health care that has occurred over the last eight years — touching every aspect of the system, down to a knee replacement in the nation’s heartland — has a momentum that could prove impossible to stop.
Expanding insurance coverage to more than 20 million Americans is among Mr. Obama’s proudest accomplishments, but the changes he has pushed go deeper. They have had an impact on every level of care — from what happens during checkups and surgery to how doctors and hospitals are paid, how their results are measured and how they work together.
FISHERS, Ind. — Fragments of bone and cartilage arced across the operating room as Dr. R. Michael Meneghini drilled into the knee of his first patient at a hospital here at dawn. Within an hour, the 66-year-old woman had a replacement joint made of titanium and cobalt chrome, and she was sent home the next day.
But the Obama administration was watching over her caregivers’ shoulders. If, over three months, her medical costs exceeded a target amount set by President Obama’s health regulators in Washington, Dr. Meneghini’s employer, Indiana University Health, stood to lose money.
Such efforts to squeeze spending out of the nation’s health system may well remain as Mr. Obama exits the West Wing and Donald J. Trump takes his seat in the Oval Office. The Affordable Care Act is in extreme peril, and Mr. Obama will meet with congressional Democrats at the Capitol on Wednesday to try to devise a strategy that can stave off the quick-strike repeal of the health law that Republicans plan for the opening months of the Trump administration.
But the transformation of American health care that has occurred over the last eight years — touching every aspect of the system, down to a knee replacement in the nation’s heartland — has a momentum that could prove impossible to stop.
Expanding insurance coverage to more than 20 million Americans is among Mr. Obama’s proudest accomplishments, but the changes he has pushed go deeper. They have had an impact on every level of care — from what happens during checkups and surgery to how doctors and hospitals are paid, how their results are measured and how they work together.
Related Coverage
“From the moment I first set foot in the Oval Office in February 2009, the president told me that the law can’t be just about covering the uninsured, but that it also has to be about changing the way care is delivered,” said Nancy-Ann DeParle, who as a White House aide helped lead the effort to pass and carry out the health law. His message, she said: “I don’t want to cover everyone and just put them in the same creaky old delivery system.”
Changes in the delivery system already affect far more people than the law’s higher-profile coverage gains. To visit IU Health, the largest health care provider in Indiana, with 15 hospitals and 8,700 doctors, is to see those changes up close. Its leaders have started moving away from fee-for-service medicine, where every procedure, examination and prescription fetches a price. The emphasis now is on preventive care, on taking responsibility for the health of patients not only in the hospital, but also in the community.
Social work has become a larger part of the medical mission. Collaboration between doctors is becoming a necessity.
“I don’t know who could be against it: higher quality and lower cost,” said Ryan C. Kitchell, an executive vice president and the chief administrative officer of IU Health.
And unlike Mr. Obama’s insurance coverage expansions, these changes are not in jeopardy, said Dennis M. Murphy, IU Health’s president and chief executive.
“We’ve got to create more value in health care,” Mr. Murphy said in an interview after Mr. Trump’s election. “That principle, I think, survives.”
During Mr. Obama’s tenure, big systems like IU Health have gobbled up smaller hospitals and physician groups as the industry has consolidated, partly in response to incentives in the Affordable Care Act. Most doctors across the United States are using electronic medical records, installed in many cases with federal money provided by the economic stimulus law of 2009. The federal government and private insurers are rewarding health care providers that work together to coordinate care and avoid unnecessary expenses.
Doctors and hospitals here are obsessed with metrics, not least because under the health law, they may be rewarded or penalized based on their performance. They tally the number of medication errors, the number of patients injured in falls and the number who develop infections after certain types of surgery.
Expanding coverage is seen not as a political issue, but as a clinical and financial imperative. IU Health has more than 150 “navigators” who work with patients to help them get insurance, often through a Medicaid expansion authorized and funded by the health law and engineered here by Gov. Mike Pence, the vice president-elect.
“I’ve been a registered Republican my whole life, but I support the Affordable Care Act,” said Dr. Gregory C. Kiray, co-chief of primary care for IU Health Physicians, “because it allows patients to be taken care of.”
To better understand how Mr. Obama has changed health care, two reporters from The New York Times spent a week shadowing and talking to doctors, patients, executives and others at IU Health, a system that demonstrates the breadth of changes catalyzed by the Affordable Care Act.
To many IU Health employees, the pace of change can be bewildering, the new directives too numerous or burdensome.
“People feel like they are swimming in an ocean, drowning,” said Dr. Meneghini, an orthopedic surgeon at IU Health’s Saxony Hospital here in Fishers, a suburb of Indianapolis.
But the medical profession increasingly understands that painful as it is, the revolution is necessary and unstoppable.
“The national economy cannot sustain health care being as big a share of the gross domestic product as it is,” Mr. Murphy said, uttering what once amounted to heresy for a health care provider.
“From the moment I first set foot in the Oval Office in February 2009, the president told me that the law can’t be just about covering the uninsured, but that it also has to be about changing the way care is delivered,” said Nancy-Ann DeParle, who as a White House aide helped lead the effort to pass and carry out the health law. His message, she said: “I don’t want to cover everyone and just put them in the same creaky old delivery system.”
Changes in the delivery system already affect far more people than the law’s higher-profile coverage gains. To visit IU Health, the largest health care provider in Indiana, with 15 hospitals and 8,700 doctors, is to see those changes up close. Its leaders have started moving away from fee-for-service medicine, where every procedure, examination and prescription fetches a price. The emphasis now is on preventive care, on taking responsibility for the health of patients not only in the hospital, but also in the community.
Social work has become a larger part of the medical mission. Collaboration between doctors is becoming a necessity.
“I don’t know who could be against it: higher quality and lower cost,” said Ryan C. Kitchell, an executive vice president and the chief administrative officer of IU Health.
And unlike Mr. Obama’s insurance coverage expansions, these changes are not in jeopardy, said Dennis M. Murphy, IU Health’s president and chief executive.
“We’ve got to create more value in health care,” Mr. Murphy said in an interview after Mr. Trump’s election. “That principle, I think, survives.”
During Mr. Obama’s tenure, big systems like IU Health have gobbled up smaller hospitals and physician groups as the industry has consolidated, partly in response to incentives in the Affordable Care Act. Most doctors across the United States are using electronic medical records, installed in many cases with federal money provided by the economic stimulus law of 2009. The federal government and private insurers are rewarding health care providers that work together to coordinate care and avoid unnecessary expenses.
Doctors and hospitals here are obsessed with metrics, not least because under the health law, they may be rewarded or penalized based on their performance. They tally the number of medication errors, the number of patients injured in falls and the number who develop infections after certain types of surgery.
Expanding coverage is seen not as a political issue, but as a clinical and financial imperative. IU Health has more than 150 “navigators” who work with patients to help them get insurance, often through a Medicaid expansion authorized and funded by the health law and engineered here by Gov. Mike Pence, the vice president-elect.
“I’ve been a registered Republican my whole life, but I support the Affordable Care Act,” said Dr. Gregory C. Kiray, co-chief of primary care for IU Health Physicians, “because it allows patients to be taken care of.”
To better understand how Mr. Obama has changed health care, two reporters from The New York Times spent a week shadowing and talking to doctors, patients, executives and others at IU Health, a system that demonstrates the breadth of changes catalyzed by the Affordable Care Act.
To many IU Health employees, the pace of change can be bewildering, the new directives too numerous or burdensome.
“People feel like they are swimming in an ocean, drowning,” said Dr. Meneghini, an orthopedic surgeon at IU Health’s Saxony Hospital here in Fishers, a suburb of Indianapolis.
But the medical profession increasingly understands that painful as it is, the revolution is necessary and unstoppable.
“The national economy cannot sustain health care being as big a share of the gross domestic product as it is,” Mr. Murphy said, uttering what once amounted to heresy for a health care provider.
‘Be Thoughtfully Aggressive’
Fury over the Affordable Care Act helped jump-start the Tea Party movement and sweep Republicans into control of the House of Representatives in 2010 and the Senate in 2014. It ensured gridlock that stifled many of Mr. Obama’s greatest legislative ambitions for six of his eight years in office, and it may well have played a role in the election of Mr. Trump, who attacked the law throughout his campaign.
Yet to Mr. Obama, the law remains one of his greatest achievements, said Denis McDonough, the White House chief of staff. It also has been his constant concern.
“This attention to cost and concern about cost, and even the emotional concern about cost, comes up all the time,” Mr. McDonough said.
The Affordable Care Act gave the government sweeping authority to test new models of care, and the administration has aggressively used that power to try different ways of paying for cancer care, heart surgery, primary care and other services covered by Medicare and Medicaid.
Sylvia Mathews Burwell, who has been the secretary of health and human services since 2014, said she met with Mr. Obama early in her tenure to describe a series of payment and delivery reforms. He was so supportive, she said, that she and her team decided to undertake even more changes.
The size and speed of some of those initiatives have provoked criticism from Republicans, including Representative Tom Price of Georgia, picked by Mr. Trump to be the health and human services secretary. They say the efforts threaten the quality of care and exceed the authority of the agency overseeing Medicare by requiring doctors and hospitals to participate.
More than 170 House Republicans signed a recent letter of which Mr. Price was an author, urging the administration to “stop experimenting with Americans’ health.”
But moving aggressively to change how medical care is delivered and paid for has been important to Mr. Obama. In 2015, his administration set a goal for half of all Medicare payments to be tied to the quality, instead of the quantity, of care that doctors and hospitals provide by 2018. Mr. Obama believes that basing pay on whether a doctor visit or a medical procedure helps a patient, rather than on how much care the patient receives, will result in better care.
“What he said was, ‘Be thoughtfully aggressive,’” Ms. Burwell said.
At Patients’ Service and Mercy
“I started drinking soda again,” confessed Willie Johnson, a 52-year-old patient with uncontrolled diabetes and high blood pressure.
“How much?” Dr. Michael E. Busha, a primary care physician at IU Health in Indianapolis, asked quietly as he updated Mr. Johnson’s electronic record.
“Quite a bit.”
For Dr. Busha, that mattered.
He helps lead the IU system’s effort to measure how well doctors do at keeping patients healthy. And even this champion of “quality measures” — vital to the Obama administration’s goal of paying doctors based on outcomes, not the amount of care — has found that it is not always easy to meet them.
If enough of his patients fall below the standards set by IU Health, Dr. Busha could lose some of his income. The average salary for the system’s primary care doctors is $236,000. Of that, $50,000 is tied to meeting benchmarks for quality, access (whether a doctor agrees to see patients on weekends and at night, for example) and other performance measures.
Mr. Johnson, who registers patients when they arrive for neurology appointments at IU Health Methodist Hospital in Indianapolis, was not helping. He also had stopped taking his cholesterol medicine because it left a bad taste in his mouth. And he was using neither the gym membership that IU Health helps pay for nor his sleep apnea machine. “I never could get adjusted to it,” he told the doctor.
Like other primary care doctors at IU Health, Dr. Busha is part of a team that includes a pharmacist, a social worker and a “care manager.” Such teams, encouraged by the health law, focus on patients like Mr. Johnson who are not meeting IU Health’s quality measures, and who are disproportionately likely to end up in the emergency room or be hospitalized.
“The whole paradigm now is to identify your high-risk people and provide more resources to them, provide better care to them, keep them out of the hospital,” said Dr. Kiray, the primary care co-chief.
Partly because of these efforts, IU Health’s two adult hospitals in downtown Indianapolis are already seeing 12 percent fewer inpatients than they were in 2013. The system is merging the two hospitals into a $1 billion medical center focused heavily on outpatient care.
President Obama would be proud. Administration officials have continually emphasized the importance of primary care and the “social determinants” of health. They have offered grants to health care providers to identify Medicaid and Medicare patients with unmet social needs: inadequate food supplies, unpaid rent or utility bills and experience with violence at home, for example.
But with some patients, only so much can be done: Mr. Johnson’s care manager had stopped working with him after deciding he was not ready to make changes.
“Are we ready to try it again?” Dr. Busha asked him.
Mr. Johnson agreed to let the care manager contact him, and to return for a follow-up visit in two months.
Such efforts, said Mr. Murphy, the system’s chief executive, will remain “highly relevant” even if the Affordable Care Act is repealed.
The push toward a “risk-based” model over traditional fee-for-service medicine has spread beyond Medicare and Medicaid to private insurers. And the Obama administration has been testing new ways to save money on all sorts of medical care. Some of the experiments, overseen by an office created under the Affordable Care Act, have shown promise. But evaluating results is difficult.
“It may be good in theory,” Dr. John M. Thomas, a primary care physician at an IU Health practice in Lafayette, said of Dr. Busha’s system of quality measurements. “But there are a lot of flaws.”
For example, he explained, rather than risk being paid less because some patients have uncontrolled diabetes, doctors could tell those patients, “I’m sorry, you’re not in compliance with your medications, and I don’t want to be your physician.”
Dr. Busha said he was used to hearing such arguments.
“I have that conversation on a weekly basis,” he said. “You know: ‘What if my patients don’t believe in immunizations? Why am I held accountable for that?’”
He added, “We kind of tell them, ‘It’s your job to convince them.’”
Suddenly, Cost Counts
Warning: graphic content. Dr. R. Michael Meneghini, an orthopedic surgeon at IU Health Saxony Hospital, performing a medial unicompartmental knee arthroplasty (also known as a partial knee replacement).
By JONAH M. KESSEL on January 2, 2017. Photo by Ilana Panich-Linsman for The New York Times.
When IU Health discovered that a knee surgeon was using “bone cement” costing $300 a patient while another achieved the same results for $84, the first doctor was promptly informed. He switched.
IU Health now posts a color-coded “value tracker” in operating rooms that gives a green light to lower-cost surgical products, a red light to high-cost items and a yellow light to those in between.
“A huge cultural shift,” Dr. Anthony T. Sorkin, the medical director of orthopedics, said of the changes in his department — for the surgeons and the patients.
The IU Health system performed 3,900 hip- and knee-replacement operations in the year that ended on June 30. But it is not enough for doctors just to replace a knee or a hip. They are under pressure, from Medicare and private insurers, to manage and coordinate care for their patients before and after surgery. And, they say, payment for their services is continually being squeezed.
Doctors have three main ways to cut costs: improve the condition of patients before surgery, look for savings in every item used in the operating room (gloves, gowns, syringes, surgical tools, sutures, sponges and the implant itself), and send patients to nursing homes that strive to shorten the length of stay.
“I’ve been an orthopedic surgeon for 18 years,” Dr. Sorkin said. “For many of those years, I never once considered the cost for nursing homes.”
Why such attention to cost? In 67 geographic areas, including Indianapolis, Medicare now sets a target price for joint-replacement procedures. That target covers not only doctor services and hospital care but also 90 days of follow-up services like physical therapy, home health care and nursing-home stays. Hospitals are at risk: Medicare can pay bonuses or impose penalties, depending on whether spending targets and quality standards set by the government are met.
“We worry about 90 days of care, 90 days of Medicare spending, not just the brief time a patient spends in the hospital,” Dr. Sorkin said.
The joint-replacement program was one of the main targets of the letter that Mr. Price and other Republicans wrote to the Obama administration in September, complaining that such programs should be tested on a “voluntary, limited-scale basis” with no requirement for doctors to participate.
But in Indianapolis, the results have been promising. By working closely with nursing homes, IU Health halved the length of stay for patients recuperating from surgery, to an average of 12 days from 24 days in early 2016.
Doctors and nurses understand the need for change, but some still have concerns.
“These reforms are all intended to slow down the consumption of health care resources in the United States,” said Dr. Meneghini, who is the director of joint-replacement at Saxony Hospital here in Fishers. “We are careening at a rapid rate to a two-tier system. The public who can’t afford it goes to a public hospital and gets free health care. Those who have money get to pay for really nice care.”
A Mind Unchanged
Justin Kloski learned that he qualified for Medicaid under the worst of circumstances. The student and part-time lawn-company worker had lost 20 pounds, could not shake a nagging cough and was sleeping 14 hours a day when he decided to visit a clinic in Muncie, Ind., that provides free care for the poor and uninsured. A clinic employee invited Mr. Kloski, now 28, to apply for Medicaid.
A few days later, he took his new coverage to the emergency room at IU Health Ball Memorial Hospital in Muncie. A CT scan found a 15-centimeter tumor in his chest, so big it was pressing on his windpipe. In May 2015, he learned he had Hodgkin’s lymphoma, a form of cancer that is curable if caught early.
The Affordable Care Act, and Governor Pence’s decision to go against many other Republican governors and expand Medicaid under the law, may well have saved Mr. Kloski’s life.
He is among more than 400,000 Indiana residents — many of them previously uninsured — who have enrolled in Medicaid since Mr. Pence expanded it in 2015, the 10th Republican governor to do so. Under the terms of the health law, anyone with income up to 138 percent of the poverty level, or approximately $16,500 a year for an individual, now qualifies in states that opt to expand the program.
IU Health says it receives more Medicaid payments than any other health care provider in the state. Since the expansion began, the percentage of patients with Medicaid has grown to 23.2 from 20.7.
At the same time, the percentage of IU Health patients who are uninsured has fallen to 2.2 from 5.
In 2015 alone, the health system enrolled 14,000 people in Medicaid or private coverage, sometimes even signing up patients as they lay in hospital beds.
“We went all in because it’s a pretty big deal to us,” said Jonathan W. Vanator, IU Health’s vice president for revenue cycle services.
In the first nine months of last year, IU Health officials said, the amount of bad debt owed by patients and referred to collection agencies totaled $233 million, a 23 percent reduction from the comparable period in 2015, thanks largely to Mr. Obama’s health law.
But, the officials added, these gains have been largely offset by cuts in Medicare reimbursements and other federal funds under a law that has given and taken away.
Mr. Murphy is among many hospital executives now anxious about the possibility of seeing a bump in uninsured patients if the health law is repealed, while not getting back the federal funds they gave up under the health law. “I do think it would be problematic if part of the deal was changed and not the whole deal,” he said.
Mr. Pence expanded Medicaid only after the Obama administration agreed to let Indiana do it in its own way: Instead of getting virtually free coverage, as Medicaid recipients in many other states do, people enrolled in Indiana’s expansion pay up to 5 percent of their income toward it. Mr. Trump appears interested in promoting Indiana’s “personal responsibility” model: He has picked its chief architect, Seema Verma, to run the Centers for Medicare and Medicaid Services.
Since Mr. Kloski had no income when he enrolled, he paid $1 a month; he has since been classified as “medically frail” and does not have to pay anything.
Medicaid has paid for virtually all of his cancer care, including a one-week hospitalization after the diagnosis, months of chemotherapy, and frequent scans and blood tests.
But Mr. Kloski and his mother, Renee Epperson, are still not fans of the health law over all. They believed that it required that Mr. Kloski be dropped, when he turned 26, from the health plan his mother has through her job at Target — not understanding that it was the law that kept him on the plan until he was 26.
Mr. Kloski paid a penalty for going uninsured in 2014 rather than even explore whether he might qualify for a subsidy and find an affordable private plan through the marketplaces.
“There were so many horror stories about how expensive it was going to be,” Ms. Epperson, 47, recalled. “Justin said, ‘I’m not even going to try it, Mom.’”
And until they were interviewed for this article, the mother and son did not know that the law was responsible for the expansion of Medicaid that Mr. Kloski benefited from. Neither voted in last year’s presidential election; Ms. Epperson said that she disliked both candidates, and that even though Hillary Clinton supported the Affordable Care Act, she found Mrs. Clinton’s positions unacceptable on too many other issues, like abortion rights, to support her.
Still, she said, she ardently hopes that Mr. Trump and the Republican Congress will continue allowing low-income adults like her son to qualify for Medicaid.
“Oh my God, yes,” she said. “Absolutely.”
As for Mr. Murphy, IU Health’s chief executive, he said that while he did not want to think too much about changes that were still hypothetical, the prospect of losing the Medicaid expansion made him anxious.
“I worry about lots of things,” he said. “That list is probably 50 long, and this is definitely on that list.”
To Stop Trump, Democrats Can Learn From the Tea Party
by Ezra Levin, Leah Greenberg, and Angel Padilla - NYT
Today is the first day of the 115th United States Congress. In less than three weeks, this Congress will join with President-elect Donald J. Trump to claim a mandate they do not have for policies that most Americans do not support. Together, they will seek to enact a bigoted and anti-democratic agenda, threatening our values and endangering us all.
But Americans have the power to resist this dangerous turn. We know because we’ve seen it before.
We served as congressional staff members during the early years of the Obama administration. It was an exhilarating time to be a progressive in Washington: An inspirational new president was taking office, accompanied by a majority in the House and a supermajority in the Senate. But by February 2009, something had begun to change. Small protests calling themselves “tea parties” were popping up all over the country. In April, their Tax Day demonstrations dominated the news.
In August, routine hometown events got unexpectedly rough for members of Congress. At a neighborhood event at Randalls, a grocery store in Austin, Tex., Congressman Lloyd Doggett came face to face with a group of “tea party patriots,” carrying signs that said “No Socialized Health Care.” In Austin — and in congressional districts across the country — the tea partyers chanted what became their battle cry: “Just say no!”
Their tactics weren’t fancy: They just showed up on their own home turf, and they just said no.
Here’s the crazy thing: It worked.
The Tea Party’s ideas were wrong, and their often racist rhetoric and physical threats were unacceptable. But they understood how to wield political power and made two critical strategic decisions. First, they organized locally, focusing on their own members of Congress. Second, they played defense, sticking together to aggressively resist anything with President Obama’s support. With this playbook, they rattled our elected officials, targeting Democrats and Republicans alike.
Politics is the art of the possible, and the Tea Party changed what was possible. They waged a relentless campaign to force Republicans away from compromise and tank Democratic legislative priorities like immigration reform and campaign finance transparency. Their members ensured that legislation that did pass, like the Affordable Care Act, was unpopular from the start. They hijacked the national narrative and created the impression of broad discontent with President Obama.
And they organized for the 2010 election, targeting Republicans in the primaries and Democrats in the general election. After the November 2010 elections, the Democratic majority in the House and supermajority in the Senate were gone. With them went all hope for bold progressive reform under President Obama.
The Tea Party’s success was a disaster for President Obama’s agenda and for our country, but that success should give us hope today. It proved the power that local, defensive organizing can have.
With this in mind, we coordinated a group of former congressional staffers and advocates to develop “Indivisible: A Practical Guide for Resisting the Trump Agenda.” It takes a few pages from the Tea Party playbook, focusing on its strategic choices and tactics, while dispensing with its viciousness. It’s the Tea Party inverted: locally driven advocacy built on inclusion, fairness and respect. It’s playing defense, not to obstruct, but to protect.
The guide is informed by a simple principle: Federal policy change in the next four years doesn’t depend on Mr. Trump but on whether our representatives support or oppose him. And through local pressure, we have the power to shape what they consider possible.
This kind of local advocacy can make nearly any member of Congress think a lot harder about his re-election chances. It can ensure that the 10 Senate Democrats up next year in Trump-won states recognize that their best hope for survival lies in bold action to defend democracy rather than cutting deals with a petty tyrant.
It can also weaken the grip of the Senate majority leader, Mitch McConnell, on his slim two-vote majority when he tries to empower Mr. Trump. It can drive home for Chuck Schumer, the Senate minority leader, that his constituents won’t accept deals with a would-be dictator. And it can complement the efforts of organizers as they mobilize to support those most threatened by Mr. Trump’s agenda.
If anything, this model has greater potential now than it did for the Tea Party in 2009. Unlike President Obama, President-elect Trump has no mandate, a slim congressional majority and a slew of brewing scandals. Our incoming president is a weak president, and he can be beat.
But this fight won’t be won by politicos in Washington, D.C. It will be won by groups in Fort Collins, Colo., Hershey, Pa., Houston and Atlanta who were organizing for justice long before a handful of former congressional staffers wrote some guide. It will be won by groups in Tucson, Madison, Wis., and St. Louis who started organizing resistance in just the last few weeks. It will be won by you, and it starts today.
Gather your friends over Martin Luther King weekend. Join an existing local group or start your own. Find your members of Congress and start following their work. Show up at their local offices and let them know you’re watching. Remind them that they represent you, not Donald Trump. Together, we can resist.
http://www.nytimes.com/2017/01/02/opinion/to-stop-trump-democrats-can-learn-from-the-tea-party.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-right-region®ion=opinion-c-col-right-region&WT.nav=opinion-c-col-right-region&_r=0
The Republican New Year’s Resolution: Destroy Medicare
by Nancy Altman - Huffington Post
New Year’s is a time for resolutions. Consistent with this tradition, powerful Republicans have made clear that they are resolving, in the New Year, to dismantle Medicare, ending it as we know it.
Speaker of the House Paul Ryan has said that destroying Medicare is part of the Republican plan to repeal Obamacare, another Republican resolution for 2017. And Representative Tom Price, powerful chairman of the House Budget Committee, Ryan ally, and likely next Secretary of Health and Human Services, has explained that the Republicans will enact Medicare legislation in the first six to eight months of 2017, since it is probably too big a task to include it in the planned January repeal of Obamacare.
These Republicans are people who carry through on their New Year’s resolutions. In discussing the goal of destroying Medicare in the New Year, Ryan explained, “With a unified Republican government, we can actually get things done.”
These Republicans never say, straightforwardly, that their plan is the repeal and replacement of Medicare. Because of Medicare’s overwhelming popularity, Republicans hide their true intentions behind euphemisms about “saving” it. But no one should be fooled. Their idea of saving Medicare is to destroy it, just as, during the Vietnam war, a U.S. military officer explained, “It became necessary to destroy the town to save it.”
The truth is that Medicare doesn’t need saving. There is no question that, as the wealthiest nation in the world at the wealthiest moment in our history, the United States can afford not just today’s Medicare, but a greatly expanded Medicare. In 1965, when Medicare was enacted, the nation’s Gross Domestic Product was, in real terms, a quarter of what it is today ($4.1 trillion in 1965 versus $16.7 trillion today.) Moreover, Medicare covers the most expensive part of the population – seniors and people with disabilities. Covering the rest of us is easier and cheaper.
Indeed, other industrialized countries spend a small fraction of what the United States spends on health care with better outcomes, despite older populations. Japan, for example, has a much older population than we do, and theirs is aging more rapidly than ours. In 2010, seniors represented 23 percent of the Japanese population, but just 13 percent of the U.S. population. In 2050, American seniors will compose just under 21 percent of the population ― less than Japan’s percentage of seniors today! Yet, the United States today spends three times more per capita than Japan on health care. Despite the additional spending, our health outcomes are worse. Indeed, Japan’s average life expectancy is more than four years longer than that of Americans!
The Republican plan to destroy Medicare will make American costs and health outcomes worse. Despite Medicare covering the most expensive part of the population, it is much more efficient than the rest of the American health care system. Japan and other industrialized countries have what amounts to Medicare for all. No other nation has the crazy patchwork system we have, which includes employer-sponsored private insurance, means-tested insurance, and individual private insurance, in addition to government-run Medicare.
Ryan proposes to make the patchwork system even more of a hodgepodge, with less coverage and higher costs. He wants to end Medicare as we know it and, instead, simply give seniors and people with disabilities fixed cash stipends to fend for themselves, unprotected, on the private market. But before the enactment of Medicare, many seniors and people with disabilities couldn’t get health insurance at any price. And those that managed to find an insurance company willing to cover them paid much higher prices than other Americans.
So why do the Republicans want to destroy Medicare and make our health care system less efficient and more expensive, with less coverage and poorer outcomes? Ideology, pure and simple. Republicans believe that the private sector is always superior to the government. But there are some things the government does better than the private sector. And Medicare is one of them.
Insurance is most inexpensive when everyone is covered under the same plan as the result of mandatory coverage. Only the federal government has the power and the ability to cover everyone, spreading the risk and responsibility as broadly as possible. Indeed, we should be expanding Medicare, not destroying it.
But, driven by ideology, Ryan and his fellow Republicans want to end Medicare as we know it. Ryan proposes to raise the initial age of eligibility for Medicare from its current age 65 to age 67, and to simply give everyone now under the age of 55 cash to buy insurance on their own, eliminating the efficiency of a single, large risk pool.
While those now on Medicare may think that they will be spared, they are wrong. Republicans always say, about their efforts to end Social Security and Medicare, that those aged 55 and over will not be affected, because those politicians recognize that seniors are most concerned about the programs and they vote. This assurance, of course, is insulting, because it assumes seniors are only concerned about themselves and not their children and grandchildren.
Moreover, the blatant assurance is not even true. Many Republican Social Security proposals cut current beneficiaries’ cost of living proposals. And, in the case of Medicare, the impact on current beneficiaries is likely to be even more substantial. If Ryan and his fellow Republicans have their way, Medicare will become increasingly expensive per enrollee, covering an aging and shrinking group, with high medical costs. As the group shrinks, they will have less and less political clout. Everyone not on traditional Medicare, will, by that time, be forced to fend for themselves with private insurance companies. It is extremely foreseeable that at some point, someone will propose treating this very old, small, and expensive population like everyone else. And then their Medicare will be gone, as well.
If we want a health care system in this country that provides everyone with access to the best medical care possible at the lowest possible cost, the way to achieve that is not to end Medicare, but to expand it. That, indeed, was the idea of the program’s founders. They saw Medicare as simply a first step, to be followed soon after by expanding it to include all children, and then more and more of the population, until the United States had Medicare for All.
We should follow that wise plan. As a next step, we should lower the initial age of Medicare eligibility, when people can first claim Social Security retirement benefits, from age 65 to 62. We certainly should not raise the age to 67 and then end the program as we know it, as the Republicans resolve to do. Unfortunately, they are now in control of all branches of government, and so have the political power to do what they want.
To stop them, I urge everyone who is old or hopes to be old someday to make your own Medicare resolution for 2017. Tell your elected leaders: Hands off Medicare except to expand it. And ask your friends to join you. Mobilize and make your voices heard. Then, as a resolution for 2018, we can all resolve to elect leaders who listen to us and have the good sense to expand, not destroy, Medicare.
Nancy Altman is founding co-director of Social Security Works.
The Parliamentary Tactic That Could Obliterate Obamacare
by Robert Pear - NYT
WASHINGTON — Republicans hope to repeal major parts of the Affordable Care Act using an expedited procedure known as budget reconciliation.
The process is sometimes called arcane, but it has been used often in the past 35 years to write some of the nation’s most important laws. “Reconciliation is probably the most potent budget enforcement tool available to Congress for a large portion of the budget,” the Congressional Research Service, a nonpartisan arm of Congress, has said.
Here is a primer.
Q. What is the budget reconciliation process?
A. It is a way for Congress to speed action on legislation that changes taxes or spending, especially spending for entitlement programs like Medicare and Medicaid. Although conceived primarily as a way to reduce federal budget deficits, it has also been used to cut taxes and to create programs that increase spending — changes that can raise deficits.
In the Senate, a reconciliation bill can ordinarily be passed with a simple majority. For other bills, a 60-vote majority is often needed to limit debate and move to a final vote.
Q. Why is it called reconciliation?
A. The term originated in the Congressional Budget and Impoundment Control Act of 1974, which was intended to give Congress more control over the budget process by allowing lawmakers to set overall levels of spending and revenue.
The process begins with a budget blueprint, a resolution that guides Congress but is not presented to the president for a signature or veto. It recommends federal revenue, deficit, debt and spending levels in areas like defense, energy, education and health care.
The resolution may direct one or more committees to develop legislation to achieve specified budgetary results. By adopting these proposals, Congress can change existing laws so that actual revenue and spending are brought into line with — reconciled with — policies in the budget resolution.
Q. How has reconciliation been used?
A. Since 1980, Congress has completed action on 24 budget reconciliation bills. Twenty became law. Four were vetoed.
The Omnibus Budget Reconciliation Act of 1981 was a vehicle for much of the “Reagan revolution.” It squeezed savings out of Social Security, Medicare, Medicaid, food stamps, the school lunch program, farm subsidies, student loans, welfare and jobless benefits, among many other programs.
In 1996, Congress reversed six decades of social welfare policy, eliminating the individual entitlement to cash assistance for the nation’s poorest children and giving each state a lump sum of federal money with vast discretion over its use. Those changes were made in a reconciliation bill, pushed by Republicans but signed by President Bill Clinton.
Congress reduced deficits with another reconciliation bill, the Balanced Budget Act of 1997. That law also created the Children’s Health Insurance Program, primarily for uninsured children in low-income families. On the same day in 1997, Mr. Clinton signed a separate reconciliation bill that cut taxes.
The Bush tax cuts were adopted in reconciliation bills signed by President George W. Bush in 2001 and 2003.
On several occasions, Congress has increased assistance to low-income working families by increasing the earned-income tax credit in reconciliation bills.
Congress also made changes to the Affordable Care Act in a reconciliation bill passed immediately after President Obama signed the health care overhaul in 2010. Later, when Republicans controlled both houses of Congress, they passed a reconciliation bill to eviscerate the Affordable Care Act, but Mr. Obama vetoed the bill in January 2016.
Republicans say that measure will provide a template or starting point for their efforts to undo the health care law this year, with support from President-elect Donald J. Trump, who calls the law “an absolute disaster.”
Q. How does the reconciliation process work in the Senate?
A. In the House, leaders of the majority party can usually control what happens if their members stick together. In the Senate, by contrast, one member or a handful of senators can often derail the leaders’ plans. The reconciliation process enhances the power of the majority party and its leaders. Senate debate on a reconciliation bill is normally limited to 20 hours, so it cannot be filibustered on the Senate floor.
The Senate has a special rule to prevent abuse of the budget reconciliation process. The rule, named for former Senator Robert C. Byrd, Democrat of West Virginia, generally bars use of the procedure to consider legislation that has no effect on spending, taxes and deficits. The Senate parliamentarian normally decides whether particular provisions violate the Byrd rule, but the Senate can waive the rule with a 60-vote majority.
Q. What does this mean for the Affordable Care Act?
A. Republicans hope to use the fast-track procedure of budget reconciliation to repeal or nullify provisions of the law that affect spending and taxes. They could, for example, eliminate penalties imposed on people who go without insurance and on larger employers who do not offer coverage to employees.
They could use a reconciliation bill to eliminate tens of billions of dollars provided each year to states that have expanded eligibility for Medicaid. And they could use it to repeal subsidies for private health insurance coverage obtained through the public marketplaces known as exchanges.
Republicans could also repeal a number of taxes and fees imposed on certain high-income people and on health insurers and manufacturers of brand-name prescription drugs and medical devices: tax increases that help offset the cost of the insurance coverage expansions.
Those provisions were all rolled back in the reconciliation bill Mr. Obama vetoed last January. That bill did not touch insurance market standards established in the Affordable Care Act, which do not directly cost the government money or raise taxes. The standards stipulate, for example, that insurers cannot deny coverage or charge higher premiums because of a person’s pre-existing conditions. Insurers must allow parents to keep children on their policies until the age of 26, and they cannot charge women higher rates than men, as they often did in the past.
Such provisions are politically popular, but it is not clear how they could remain in force without the coverage expansions that help insurers afford such regulations. Without an effective requirement for people to carry insurance, and without subsidies, supporters of the health law say many healthy people would go without coverage, knowing they could obtain it if they became ill and needed it.
Democrats say they will fight to preserve the law after Mr. Obama leaves office. Recent history shows that lobbying and public pressure can sometimes make a difference, altering the votes of individual lawmakers and changing the contents of a reconciliation bill.
Obama huddles with Democrats on protecting his signature health care law
by Juliet Eilperin and Amy Goldstein - Washington Post
President Obama was meeting behind closed doors Wednesday morning with congressional Democrats to map out a strategy to defend the Affordable Care Act and other health-care policies — the very day Republicans are beginning debate on how to get rid of the sweeping 2010 health-care law.
Obama’s rare visit to Capitol Hill, less than three weeks before Donald Trump assumes the presidency, is part of his administration’s final push to hold onto its achievements before handing over the reins of power in Washington. Next week, Obama will deliver his farewell address in his adopted hometown of Chicago.
The president arrived at the Capitol at about 9:20 a.m. Accompanied by Senate Democratic leader Charles E. Schumer (N.Y.), House Minority Leader Nancy Pelosi (D-Calif.) and Rep. Frederica S. Wilson (D-Fla.), Obama took no questions from reporters.
Even as the president huddled with members of his party, the administration-in-waiting was staking out its own turf on the Hill. Vice President-elect Mike Pence was talking to House Republicans about health care at the same time elsewhere in the Capitol.
Trump took to Twitter on Wednesday morning to urge Republicans to “be careful in that the Dems own the failed ObamaCare disaster.” In a dig at Senate Minority Leader Charles E. Schumer (D-N.Y.) and his allies, Trump added: “Don’t let the Schumer clowns out of this Web.”
Post reporter Amy Goldstein walks us through what changes health care will face under a Trump presidency. President-elect Donald Trump campaigned on his promise to repeal and replace the Affordable Care Act. (The Washington Post)
Less than half an hour after Trump’s social media messages, Schumer tweeted: “Republicans should stop clowning around with America’s health care. Don’t #MakeAmericaSickAgain.”
Speaking to reporters Tuesday, White House press secretary Josh Earnest said that “the president is deeply concerned about the impact” of Republicans’ “stated objective” to repeal and replace the signature health-care law, which has extended insurance to more than 20 million Americans.
Democrats are “interested in looking out for working people in this country,” Earnest said, adding that “the president’s message will be to encourage them in that fight and to offer his own insight about the most effective way to engage in that fight.”
The first bill Republicans introduced in the new Senate that began on Tuesday was budget legislation with instructions for House and Senate committees to begin repealing the Affordable Care Act. The bare-bones spending outline gives members of four committees — Ways and Means and Energy and Commerce in the House; and Finance and Health, Education, Labor and Pensions in the Senate — until Jan. 27 to produce bills that each would save $1 billion over a decade by slashing elements of the heath-care law.
“Americans face skyrocketing premiums and soaring deductibles,” Senate Budget Committee Chairman Mike Enzi (R-Wyo.) said in a statement. “Today, we take the first steps to repair the nation’s broken health-care system, removing Washington from the equation and putting control back where it belongs: with patients, their families and their doctors.”
Senate rules allow budget resolutions to pass by a simple majority — a maneuver that guarantees that the chamber’s Democratic minority will not have enough votes for a filibuster to block the eventual repeal bill. Only changes related to taxes, spending or the long-term federal budget are eligible for the simple-majority treatment, however, restricting the extent to which Republicans can rescind the law.
Other parts of the law, such as the structure of the insurance marketplaces, would likely require a veto-proof margin of 60 votes in the Senate, a trickier task because the new Senate contains 52 Republicans.
Since its passage by Congress in the spring of 2010 — entirely with Democratic votes — the ACA has spurred the most significant changes to U.S. health policy since the creation of Medicare and Medicaid during the Great Society legislation of the 1960s. It also has faced sustained opposition by its Republican foes, leading to two Supreme Court cases and a lawsuit over cost-sharing subsidies that is now before the U.S. Court of Appeals for the District of Columbia Circuit. The arrival of a GOP president sharing their antipathy for the law now gives congressional Republicans their long-awaited chance to demolish it.
The ACA is best known for having expanded insurance coverage, starting in 2014, in two ways: new marketplaces selling private health plans to Americans who do not have access to affordable health benefits through a job, and an expansion of Medicaid in about three-fifths of the states. The marketplaces got off to a shaky start because of computer dysfunction with HealthCare.gov, the federal enrollment website.
Three years later, the U.S. Census survey reported that the nation’s uninsured rate had declined to 9.1 percent, with most of a recent decrease coming from people who bought insurance on their own and more who had joined Medicaid.
The law has aspects that reach deep into the health-care system. It has eliminated the ability of health insurers to place yearly or lifetime limits on consumers’ coverage and deny insurance on the basis of preexisting medical conditions. It has led to more preventive care for older Americans through Medicare. It has created an “innovation center” within the Department of Health and Human Services that has been trying to slow health-care expenditures, in part by nudging doctors and hospitals away from fee-for-service medicine and toward payment methods with incentives to lower costs while emphasizing quality. And it has led HHS to define a set of benefits that must be included by all health plans sold on the ACA marketplaces.
Democrats planned to discuss both “message and strategy” for blocking not just a rollback of the law but also changes to Medicaid and Medicare that Republicans have in mind, according to senior Senate Democratic aides.
Earnest suggested Democrats could pressure some Republicans into preserving large parts of the law because “the one thing that has proved to be true is that the more the people understand what’s included in the Affordable Care Act and how they benefit from it, the more popular the program is, and the harder it is for Republicans to have political support for tearing it down.”
The president’s appearance on the Hill is part of a broader effort by his administration to use its final weeks in power to defend a central element of Obama’s domestic legacy.
On Jan. 9, HHS Secretary Sylvia Mathews Burwell is scheduled to deliver her first speech at the National Press Club, according to an administration official who spoke on condition of anonymity about the not-yet-announced event. The official said that Burwell will appear with a few Americans who have benefited from the ACA in various ways and who would be harmed if it were dismantled.
Meanwhile, HHS officials have been trying to use to their messaging advantage about the fact that the change in administrations will take place while the fourth year’s enrollment period for ACA health plans is still underway. In recent weeks, HHS has been releasing HealthCare.gov enrollment figures, pointing out that the number of people signing up for 2017 coverage in the 39 states relying on the federal exchange website is running ahead of last year.
In advance of Wednesday’s action on Capitol Hill, major groups that have supported the ACA issued warnings about the effects of its repeal.
Debra L. Ness, president of the National Partnership for Women & Families, said in a statement that repealing the law would reverse what amounts to “the greatest advance for women’s health in a generation; among other provisions, it provides access to affordable birth control and coverage for maternity services, and it ends the practice of charging women higher premiums simply because of their gender.”
Republicans — including Pence, a longtime abortion opponent — have vowed to cut off all funding for Planned Parenthood now that there is a president willing to enact such a ban. Barring Medicaid from reimbursing Planned Parenthood for providing services for poor women, Ness said, prevents these “low-income patients from accessing essential health care and would have a devastating impact on public health.”
Meanwhile, the American Medical Association, the nation’s largest physicians’ lobby, dispatched a letter to House and Senate leaders in both parties that contains a more nuanced expression of its goals. The letter, from AMA chief executive James L. Madara, says that the organization backed the law because “it was a significant improvement on the status quo at that time” and urged lawmakers to hold off on any repeal until they have decided upon their own health-policy ideas.
“Before any action is taken through reconciliation or other means that would potentially alter coverage, policymakers should lay out for the American people, in reasonable detail, what will replace current policies,” it said.
But the letter adds, “We also recognize that the ACA is imperfect and there a number of issues that need to be addressed. As such, we welcome proposals, consistent with the policies of our House of Delegates, to make coverage more affordable, provide greater choice, and increase the number of those insured.”
The new drive to unwind the health-care law will take time. Senate leaders must also allow Democrats to offer a nearly unlimited number of amendments before a final budget vote. Democrats plan to use the process, known as a “vote-a-rama,” to offer a long string of potentially toxic amendments that could make it difficult for Republicans to vote for the final legislation, Democratic leadership aides said.
Obama’s enduring legacy: The concept of universal coverage
by Doyle McManus - LA Times
President Obama has embarked on his final campaign, this one aimed at making sure we miss him once he’s gone.
He’s giving a speech in Chicago next week to talk about his legacy. “I couldn’t be prouder of the work that we’ve done,” he said in a recent preview. “I can say without equivocation that the country is a lot better off: the economy is stronger, the federal government works better, and our standing in the world is higher.”
It’s not unusual for presidents to give a farewell address; the practice began, after all, with George Washington. Obama has a more practical reason: He’s handing the keys to a successor and a party that have promised to dismantle everything he’s done, brick by brick.
Donald Trump’s Republicans have vowed to repeal Obama’s healthcare law, abolish his financial reform law, and undo his executive orders on immigration and clean energy. As Edward Luce of the Financial Times wrote: “It will be as if Mr. Obama was never here.”
But their No. 1 target, Obamacare, may be safer than it seems.
The reason is simple but underappreciated: Because of Obamacare, Republicans have inherited an obligation to ensure access to affordable health insurance for every American — a duty the federal government didn’t have before. They could disavow the burden — but they haven’t. Indeed, Trump has embraced it.
During his campaign, the president-elect promised to enact “a beautiful new plan [for] much better healthcare at a much lower cost.”
After the election, he repeated the pledge, saying: “Everybody’s got to be covered.”
In the short run, that means Obamacare has to continue operating until a new plan is ready. Indeed, Democrats have already been taunting Republicans with what some call the Pottery Barn rule: “You break it, you own it.”
“We’re talking about a three-year transition,” Sen. John Cornyn (R-Texas) said. “People are being understandably cautious to make sure nobody’s dropped through the cracks.”
Next week, the Senate is expected to vote on what its leaders have called the “Obamacare repeal resolution,” but it won’t actually repeal the law; it will merely be a promise to repeal it later.
After that, Republicans in the Senate and House will get to work on a new plan, drawing on conservative proposals drafted well before the election. The irony is that the drafts most likely to succeed share some basic features with Obamacare.
They agree on the basic goal of universal coverage — or, at least, universal access to affordable insurance. They agree on subsidies to make it possible for low- and middle-income families to afford insurance — in most cases, in the form of tax credits (“refundable” credits, so they would go even to people who don’t pay taxes). Some Republican plans would even keep the state insurance exchanges that Obamacare set up — and in at least one case, the federal healthcare.gov exchange as well.
Naturally, there are big differences too, all of which make the GOP proposals less generous and less universal in coverage than Obamacare.
Most of the Republican alternatives would push many people into bare-bones catastrophic insurance policies, with less coverage than Obamacare offers. (They would pay less, but get less.) They would cover fewer people too — at least 4 million fewer, according to one forecast. And there’s a controversial divergence on guaranteed coverage for people with preexisting conditions: The GOP plans provide it only for users who have maintained “continuous coverage” for some period of time.
James Capretta, a conservative health policy expert at the American Enterprise Institute, believes the political imperative will be for the GOP to deliver something credible on its promises.
“They’re halfway to where they need to go,” he told me. “They need to make sure everybody in the country can get health insurance if they want it…. And that the prices are right — that this looks to most Americans like a reasonable way to get health insurance.”
“Voters and history will judge them to have failed if the end result is millions of people becoming uninsured again,” he said.
If Republicans can’t do it on their own, they might even have to try an unusual Plan B: bipartisan compromise.
Either way, the basic premise that the federal government has an obligation to make affordable, comprehensive health insurance available to everyone, with near-universal coverage, appears as if it’s going to stick.
The result won’t be the plan Obama wanted — but in the long run, he’ll still deserve credit from history.
The Health Data Conundrum
by Kathryn Haun and Eric J. Topol - NYT
THERE’S quite a paradox when it comes to our health data. Most of us still cannot readily look at it, but there’s been an epidemic of cybercriminals and thieves hacking and stealing this most personal information.
Last year hundreds of breaches involving millions of health records were reported to the Department of Health and Human Services — with the hackings of the health insurers Anthem and Premera Blue Cross alone affecting some 90 million Americans. At least 10 hospitals and health care systems have had their patient data and information systems literally held for ransom. This month, the national medical lab Quest Diagnostics reported that information on 34,000 patients had been stolen. And these breaches are just the ones that have been disclosed.
Why is our private health information being stolen and trafficked by cybercriminals? For one, these records include information that makes them more valuable to hackers than almost any other type of data. Thieves can use this information to order medical equipment and drugs to resell and to fraudulently bill insurance companies, the costs of which are passed along to consumers.
Second, while our personal medical data is so precious and valuable to us, it’s an exceptionally easy target for criminals. The health care industry’s focus has been on patient care rather than cybersecurity, and federal regulations intended to protect financial data do not apply to health care records. It is common for millions of patients’ health records to be stored together in huge central databases that, once breached, yield a trove of information.
It has become increasingly difficult to combat this problem using traditional methods of enforcement and deterrence. Even assuming the wrongdoers are identified, there are often jurisdictional hurdles because the thieves aren’t in the United States or in countries that will easily extradite them. Moreover, companies that are hacked are restrained in their desire for the criminals to be prosecuted because that means their own embarrassing breach will be in the news that much longer. In April 2014, the F.B.I. issued an alert that these sorts of attacks would only increase as providers moved from paper to electronic records.
A recent theft involving Anthem is a perfect illustration. Tens of millions of patient records were compromised, all were stored in a centralized database, none were encrypted, and no one has been caught. Anthem’s response was to send out letters to victims offering free credit monitoring. But credit monitoring isn’t an antidote for a breach of medical records. What good does a form letter do for someone whose most private data has just been stolen?
What’s the solution? For starters, disaggregation, meaning that medical data should be stored in individual or family units rather than in centralized databases. Such a regime would return the data to the person who should own it in the first place: the patient. Each individual or family would have medical data in a personal cloud or a digital wallet. Patients could then share their data how they choose: with family members, with researchers, with other doctors for a second opinion.
We cannot leave it to the health record software companies — the Cerners, Epics and Allscripts of the world — to bring about the needed changes. Their business is to sell proprietary information software to health systems to create large centralized databases for such things as insurance reimbursements and patient care. Their success has relied on an old, paternalistic model in medicine in which the data is generated and owned by doctors and hospitals.
Yes, giving consumers control of their own medical data would revolutionize who owns medical data and how it is used. Concerns about researchers losing access to this amassed data are overstated. Patients have shown an overwhelming willingness to share their information for altruistic reasons (which far exceeds the track record of doctors and health systems when it comes to sharing data).
The private and academic sectors are hard at work on a technology solution: one that is tamper-proof, ensures confidentiality and makes sharing medical data easy. One approach, known as a blockchain, is an encrypted data platform that would give patients digital wallets containing all their medical data, continually updated, that they can share at will.
We need to move on from the days of health systems storing and owning all our health data. Patients should be the owners of their own medical data. It’s an entitlement and civil right that should be recognized.
No comments:
Post a Comment