Gen. Colin Powell calls for universal health care in the U.S.
Former Secretary of State and longtime Republican Colin Powell is calling for a universal health care solution in the U.S.
“We are a wealthy enough country with the capacity to make sure that every one of our fellow citizens has access to quality health care,” he said Thursday at a Seattle fundraiser for prostate cancer. “(Let’s show) the rest of the world what our democratic system is all about and how we take care of all of our citizens."
The retired four-star general, a prostate cancer survivor, spoke at the Prostate Cancer Survivors Celebration Breakfast, organized by UW Medicine and the Fred Hutchinson Cancer Research Center.
Powell took the opportunity to share some of his own experiences and to publicly call for a health care solution similar to those in Canada, Japan and other countries that have a universal, single-payer system.
In the case of his own cancer diagnosis, he recovered, thanks to what he described as universal health care offered through the U.S. military.
“I am not an expert in health care, or Obamacare, or the Affordable Care Act, or however you choose to describe it, but I do know this: I have benefited from that kind of universal health care in my 55 years of public life,” Powell said. “And I don’t see why we can’t do what Europe is doing, what Canada is doing, what Korea is doing, what all these other places are doing.”
The long, lurid tradition of public health propaganda
How the scare tactics of the past shape the Affordable Care Act debate today
By Kevin Hartnett
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DECEMBER 08, 2013
THE AFFORDABLE CARE ACT has prompted a Supreme Court case, polarized Congress, and defined a national election. It has also inspired a secondary battle: a propaganda war. Though propaganda might seem like a heavy weapon to deploy on an already-passed health care law, public health has been the site of intense propaganda wars for more than a century—sometimes with lurid, dramatic imagery that makes the tussle over the ACA look tame. A new book, “Propaganda: Power and Persuasion,” shows how postwar governments put new propaganda tools to work in the sphere of public health, and gave propaganda a reputation that continues to affect our battle over the ACA today.
Enhanced Medical Care for an Annual Fee
By GINIA BELLAFANTE
On a recent morning, Edward S. Goldberg, an unusually affable internist who bears the look of a scholarly Robert De Niro, sat in his office on the Upper East Side and described the realities of practicing general medicine in the Manhattan of the 21st century. Dr. Goldberg, who also retains a specialty in gastroenterology, opened his practice in 1993 and accepted insurance for the first 16 years. By 2008 his reimbursements for office visits had been, in some cases, reduced to a tenth of what they were in the previous decade, he said. Colonoscopies, which had once rendered him $1,800 per procedure, were now bringing in $350.
Because there has been so much excess in the system, and because American doctors are among the highest paid in the developed world, their complaints about diminishing returns — a strain of grievance that has intensified around the Affordable Care Act — are hardly immediate triggers of our collective sympathy. Median compensation for practitioners of internal medicine was about $210,000 last year.
And yet Dr. Goldberg’s experience illustrates the difficulties primary-care physicians often face in a city where staffing and real estate costs vastly outpace those in the rest of the country. By the time Dr. Goldberg stopped taking insurance in 2009 he had become unable to deliver the level of patient service he aspired to and couldn’t afford to maintain his practice as it stood, he told me.
“I really had nothing left to lose,” he said.
The health care market in New York is sufficiently unusual that members of the affluent classes routinely question the merits of doctors who do take insurance. How could the doctor satisfied to receive a $20 co-pay also be the doctor skilled enough to know that your palm’s itch is really the early sign of something rare and disfiguring? This psychology, along with the cost-cutting strategies pursued by insurance companies over the years, have driven the field of concierge medicine — typically, boutique general practices that charge premiums for enhanced attention. Five years ago there were 28 concierge doctors in the New York metropolitan area, according to the groupConcierge Medicine Today, which studies the field. Today there are 124.
In recent years, some of Dr. Goldberg’s patients have made unusual requests that he has obliged. In one instance, when a patient didn’t want to be seen having a colonoscopy, Dr. Goldberg closed his office for four hours to grant her more privacy. Another requested allergy shots at home and another his accompaniment to a stressful M.R.I. where Dr. Goldberg held the patient’s toe to supply comfort.
Obamacare Turns a Corner?
By ROSS DOUTHAT
THIS was the week when liberals decided that it was safe to feel optimistic about Obamacare again.
Not, mind you, because the website’s flaws have all been wiped away, or because the pace of enrollment is where the White House wanted it to be, or because the political backlash over plan cancellations has disappeared. The site may be better, the enrollment pace higher, the backlash no longer front-page news — but the law’s rollout is by any reasonable definition still a dreadful mess.
But a worst-case scenario, in which the website remained unusable well into the new year, seems to have been averted, and with it the danger that insurers or Congressional Democrats would begin to bail on Obamacare entirely.
And liberals have apparently decided that just getting things moving in the right direction makes all the difference. Sure, problems persist, crucial errors remain, and confusion probably looms for some customers and insurers in January, when policies are supposed to take effect. But errors can be fixed, money sluiced around, more temporary changes made. The important thing is there will be no immediate political unraveling ... which means that enrollment will keep rising ... which means that by 2016, Obamacare will be a locked-in, impossible-to-repeal feature of the American landscape.
This holds true, liberals have begun telling themselves, even if the law’s disruptions cost Democrats dearly in the 2014 midterms. Because a working website will give the White House “three full years to create millions, and perhaps tens of millions, of winners who are getting insurance or protection,” The Washington Post’s Ezra Klein wrote last week, Democrats can “lose on the politics in the midterm election even as they win on the policy in the long term.”
The entrenchment hypothesis is plausible. But it elides one crucial problem: the extent to which the successful implementation of Obamacare actually depends on the law’s political standing.
That’s because the law can work only if people who don’t necessarily benefit immediately from its provisions decide to participate anyway. If they respond to higher premiums by either staying out or dropping out, then Obamacare will be permanently unstable: the dollar figures, both for insurers and the government, simply won’t add up.
The participation of the young and healthy is supposed to be required, of course, by the individual mandate. But the mandate’s penalty is relatively modest and its enforcement mechanisms relatively weak, which means its power ultimately depends more on civic duty than on immediate self-interest.
Think the E.R. Is Expensive? Look at How Much It Costs to Get There
By ELISABETH ROSENTHAL
Kira Milas has no idea who called 911, summoning an ambulance filled with emergency medical technicians. Ms. Milas, 23, was working as a swim instructor for the summer and had swum into the side of the pool, breaking three teeth.
Shaken, she accepted the ambulance ride to Scripps Memorial Hospital in La Jolla, Calif. The paramedics applied a neck brace as a precaution.
A week later she received a bill for the 15-minute trip: $1,772.42. Though her employer’s workers’ compensation will cover the bill, she still was stunned at the charge. “We only drove nine miles and it was a non-life-threatening injury,” she said in a phone interview. “I needed absolutely no emergency treatment.”
Thirty years ago ambulance rides were generally provided free of charge, underwritten by taxpayers as a municipal service or provided by volunteers. Today, like the rest of the health care system in the United States, most ambulance services operate as businesses and contribute to America’s escalating medical bills. Often, they are a high-cost prequel to expensive emergency room visits.
Although ambulances are often requested by a bystander or summoned by 911 dispatchers, they are almost always billed to the patient involved. And the charges, as well as insurance coverage, range widely, from zero to tens of thousands of dollars.
“There are a significant numbers of patients who have no coverage for this, and the number of self-pay patients has climbed” since the recession, said Jay Fitch, president of Fitch and Associates, the largest emergency medical services consulting firm in the United States.
What is more, since ambulances companies typically collect only 30 to 40 percent of the amount they bill, they often try to charge more for patients with insurance and those who can pay, Mr. Fitch said.
Part of the inconsistency in pricing stems from the fact that ambulance services are variously run by fire departments, hospitals, private companies and volunteer groups. Some services are included in insurance networks, others not.
“There’s a saying that if you’ve seen one emergency medical system, you’ve seen one emergency medical system — no two are alike,” said Dr. Robert E. O’Connor, a vice president of the American College of Emergency Medicine and chairman of the department at the University of Virginia. Charges and payments, he said, “are all over the place.” Fire departments, which don’t charge for driving to fire alarms, do charge for ambulance runs.
In such a fragmented system, it is hard to know how much high-priced ambulance transport contributes nationally to America’s $2.7 trillion health care bill. And total out-of-pocket expenditures by individuals are hard to tally.
No, There Won’t Be a Doctor Shortage
By SCOTT GOTTLIEB and EZEKIEL J. EMANUEL
IN just over a decade the United States will need 130,000 more doctors than medical schools are producing. So says the Association of American Medical Colleges, which warns of a doctor shortage that will drive up wait times, shorten office visits and make it harder for Americans to access the care they need.
The road to Obamacare has seen its share of speed bumps, as well as big potholes. But a physician shortage is unlikely to be one of its roadblocks.
Shortage forecasters point to two major factors. One is an aging population. The proportion of Americans who are 65 and older will increase to 19 percent in 2030 from 12.9 percent today, according to federal projections. Second, Obamacare will insure 30 million more Americans by the end of the decade, dramatically increasing demand for physicians. Extrapolating forward from today’s 2.4 physicians per 1,000 Americans would mean we will need at least 90,000 more physicians by 2020, or so the reasoning goes.
Regardless of your political views, there are good reasons to be skeptical of these predictions. Take Massachusetts, where Obamacare-style reforms were implemented beginning in 2006, adding nearly 400,000 people to the insurance rolls. Appointment wait times for family physicians, internists, pediatricians, obstetricians and gynecologists, and even specialists like cardiologists, have bounced around since but have not appreciably increased overall, according to a Massachusetts Medical Society survey. Massachusetts’s experience may differ from other areas, particularly rural regions, but the results of reform there suggest shortage fears are exaggerated.
The population is indeed aging fast, but the methods of treating illness in old age are also changing quickly. Today, more patients can be cared for in subacute settings rather than in hospitals. And new technologies are turning the treatment of many medical conditions into less resource-intensive endeavors, requiring fewer doctors to manage each episode of illness.
Innovations, such as sensors that enable remote monitoring of disease and more timely interventions, can help pre-empt the need for inpatient treatment. Drugs and devices can also obviate the need for more costly treatments. Minimally invasive procedures, like laparoscopic surgeries, can be done more quickly with faster recovery times and fewer physicians. An average patient stay in the hospital is about two days or less following a stent but about seven days following a coronary bypass operation. Research on radiation treatments for breast cancer suggests that 15 treatments can be just as effective as the traditional 30 treatments. Likewise, one larger dose of radiation can be as good at relieving pain from bone metastases as five to 10 separate, smaller treatments. There’s every reason to expect the pace of these timesaving medical innovations to continue.
MAN CHARGED WITH CREATING SINGLE-PAYER FINANCE SYSTEM FACES CHALLENGE
Finding a way to pay for a health care system that doesn’t yet exist is a daunting task.
And as Vermont marches toward single-payer health care by 2017, that task largely falls to Michael Costa, the state’s deputy director of health care reform. Speaking to an audience of tax and insurance professionals Friday at the 41st annual Vermont Tax Seminar in Burlington, Costa mapped out his plan for getting there.
Preliminary studies peg the cost at $1.6 billion of public money, though Costa describes that less as a bull’s-eye and more as an approximate range. That large sum is not new spending, he says, but a rearrangement of costs that people already pay on the private market.
Getting that message across, Costa says, is supremely difficult considering the opacity of the current employer-based health insurance system.
TIMELINE
In early 2014, Costa will offer several financing structures for the Legislature to consider. Lawmakers will then spend the session crunching numbers to assess the relative impact of each option on Vermont residents, businesses and government.
Meanwhile, all stakeholders will be talking a lot about the benefits assumptions built into the alternatives. For example, will it cover dental care? At what rate will the system reimburse doctors? Will the state hire a private insurance carrier for the job, or take on the task itself?
With feedback from the Legislature, Costa and his team will go back to the drawing board. In spring 2015, the administration will propose a single financing plan to the Legislature, along with some alternative benefits packages.
An effective eye drug is available for $50. But many doctors choose a $2,000 alternative.
By Peter Whoriskey and Dan Keating, Published: December 7
The two drugs have been declared equivalently miraculous. Tested side by side in six major trials, both prevent blindness in a common old-age affliction. Biologically, they are cousins. They’re even made by the same company.
But one holds a clear price advantage.
Avastin costs about $50 per injection.
Lucentis costs about $2,000 per injection.
Doctors choose the more expensive drug more than half a million times every year, a choice that costs the Medicare program, the largest single customer, an extra $1 billion or more annually.
Spending that much may make little sense for a country burdened by ever-
rising health bills, but as is often the case in American health care, there is a certain economic logic: Doctors and drugmakers profit when more-costly treatments are adopted.
rising health bills, but as is often the case in American health care, there is a certain economic logic: Doctors and drugmakers profit when more-costly treatments are adopted.
Genentech, a division of the Roche Group, makes both products but reaps far more profit when it sells the more expensive drug. Although Lucentis is about 40 times as expensive as Avastin to buy, the cost of producing the two drugs is similar, according to scientists familiar with the drugs and the industry.
Doctors, meanwhile, may benefit when they choose the more expensive drug. Under Medicare repayment rules for drugs given by physicians, they are reimbursed for the average price of the drug plus 6 percent. That means a drug with a higher price may be easier to sell to doctors than a cheaper one. In addition, Genentech offers rebates to doctors who use large volumes of the more expensive drug.
“Genentech continues to maintain that Lucentis is the most appropriate medicine,” the company said in a statement, adding that it costs “significantly” more to make and is tailored for use in the eye. The drug “has made an immense impact.”
Many ophthalmologists, however, are skeptical that it provides any added value over the cheaper alternative.
Health care: Dirigo led the way – lessons will follow
With Maine’s decade-long attempt at reform ending and Obamacare starting, comparisons are inevitable.
WASHINGTON — Like millions of Americans, Nick Rosolino was thrust into the insurance-shopping maze this fall after learning his family’s health coverage will terminate Dec. 31.
But it was a policy decision made by the state of Maine – not Obamacare, the controversial new federal health care law – that precipitated the cancellation notices sent to Rosolino and thousands of other Mainers enrolled in the state’s Dirigo Choice insurance program.
Jan. 1 marks the launch of health insurance under Obamacare but also the end of coverage under the Dirigo Health Agency, Maine’s ambitious 10-year attempt at health care reform. Republican Gov. Paul LePage, a vocal Dirigo critic, dismantled his predecessor’s handiwork by eliminating its funding.
To supporters, Dirigo insured more than 40,000 Mainers and helped blaze the trail for President Obama’s landmark health reform initiative, the Affordable Care Act. Critics, meanwhile, contend Obamacare repeats many of the design and policy flaws that handicapped Dirigo.
The Obamacare mess
By Dr. Erik Steele,
Posted Dec. 05, 2013, at 4:09 p.m.
Many of us who have cared for critically ill patients recognize the point America is at in its health care reform journey; it is the same place critical care teams often end up about two weeks into the care of someone who is critically ill and not improving. Initial optimism about the patient’s prospects has been eroded by the failure of our efforts to turn the patient around quickly, by the overwhelming multiplicity and complexity of the patient’s problems, and by new complications that seem to emerge more quickly than existing problems can be fixed. Some team members are emotionally exhausted, and all are saddened by the possibility that the effort to save a fellow human being, into which we have poured heart and soul, might be for naught. The chorus of voices suggesting that it’s time to let this patient die starts to grow.
In the care of critically ill patients, when that time comes, some team members must resist the infectious fatigue, pessimism and sadness that may lead others to prematurely conclude the patient cannot be saved. That’s where we are with health care reform and the Patient Protection and Affordable Care Act — at the hardest part of the work, when giving up seems easier than fighting on, and some of us have to stand up and say stick to it, we can do this.
So we need to tell our leaders in Washington that we know it’s difficult, messy and painful, but failure to reform the American health care system is not an option. Giving up now when the going has gotten tough, and the tough want to head for the hills, is not an option either. Education, defense, transportation and other parts of the American infrastructure that are all underfunded because we spend too much on health care are counting on us. Our children, our economy, 50 million uninsured Americans, and 26,000 Americans who will die next year because of lack of insurance, are all counting on us.
We all need to understand that the other options for fixing that health care system are messy and difficult, too; if they were not, we would have fixed the system long ago. So failure because Americans hope a simple solution is just down the yellow brick road, they are anxious about reform, the polls about voter support of reform don’t look good, or new problems with the Patient Protection and Affordability Act seem to arise at a much greater rate than current problems get fixed, are no excuse for quitting now.
In fact, they are reasons for doubling down and for renewing efforts to fix problems in the Affordable Care Act. Reform will get more difficult the longer we put it off, options will be fewer, and time to fix the system before national financial disaster will be shorter. If we wait, crisis will guide policy-making. Then the willingness of our leaders to tackle all of that will be less, because if current reform efforts fail, few politicians in their right minds will tackle the issue again for a generation
Obamacare advisory panel steers clear of advocating for Medicaid expansion
By Christopher Cousins, BDN Staff
Posted Dec. 02, 2013, at 4:47 p.m.
AUGUSTA, Maine — A committee charged with overseeing the implementation of the federal Affordable Care Act in Maine shied away Monday from pushing the Legislature and Gov. Paul LePage on the controversial issue of expanding Medicaid eligibility in Maine even though the majority of its members favor it.
Though all but one member of the Maine Health Exchange Advisory Committee — Rep. Michael McClellan, R-Raymond — said Monday that they favor the federal government’s offer to pay 100 percent of the cost of the first three years of Medicaid expansion, recommendations that will be finalized next week won’t likely include it.
Gordon Smith, executive vice president of the Maine Medical Association, said he feared stepping into the debate over Medicaid expansion, which failed in the Legislature earlier this year due to the opposition of LePage and most Republican lawmakers, would overshadow the committee’s other work.
“If we get into that issue that will be fully debated by others, it really detracts from the rest of our work,” said Smith to the rest of the committee on Monday afternoon. “We would really be going into a deep black hole that we would never get out of.”
The committee, which is made up of legislators, health care advocates and officials and members of the general public, agreed in concept that solutions should be sought for the ranks of Mainers who don’t have health insurance. Some on the committee appeared to be positioning themselves to wage the Medicaid expansion in the future.
While supporters of the expansion have focused on its benefits to people who aren’t currently insured and the federal government’s promise to pay for 100 percent of the expansion for three years before gradually reducing to 90 percent funding, opponents argue that costs will eventually balloon out of control no matter what the feds promise.
Rep. Sharon Treat, D-Hallowell, who co-chairs the committee, joined other members in pushing for more data from the federal Center for Medicaid and Medicare Services, the Maine Department of Health and Human Services and the Maine Bureau of Insurance. Specifically, she and others want to know who is applying for health insurance subsidies under the new federal health care law, who is being denied and what those people do after being denied.
Though there is little hard data, Treat said the committee is hearing anecdotally that about half of the Mainers who are applying for insurance at www.healthcare.gov are falling into the so-called “coverage gap,” which means they earn too much money to qualify for Medicaid and not enough to afford a private insurance policy even with subsidies from the federal government.
By Scott Thistle, Sun Journal
Posted Dec. 02, 2013, at 7:25 p.m.
AUGUSTA, Maine — The first portion of a five-part study on Maine’s welfare system that had a target due date of Dec. 1 has not been submitted to the state’s Department of Health and Human Services, a department spokesman said Monday.
The Alexander Group, the consulting company awarded a nearly $1 million no-bid contract for the study, did not meet the first target date on a $108,000 portion of the study meant to examine the feasibility of expanding Medicaid in Maine, according to John Martins, a spokesman for DHHS. He would not say when the department expected the report.
Gary Alexander, the consulting firm’s top executive, previously served as secretary of public welfare for Pennsylvania and held a similar post as secretary of Health and Human Services in Rhode Island. Democrats in those states criticized him for basing welfare reform measures on conservative ideology, and Maine Democrats have questioned the necessity of the study and the process Republican Gov. Paul LePage used to award the contract.
Martins said the company would not be fully paid for the report until it is delivered. Under its contract with the state, the Alexander Group is due to be paid on a monthly basis and should have received three $61,680 payments — one each in September, October and November.
The terms of the contract also allow the state to withhold $70,000 of the price of the first portion of the report until it is delivered. The final part of the study is due in May 2014, which is after the legislative session is scheduled to end.
Meanwhile, Martins in an email also noted that the report may be reviewed internally by department officials before it is released to lawmakers and the public.
The $925,000 contract for the study, inked in September, was first made public in late November. Some Democratic state lawmakers on the Legislature’s Health and Human Services Committee have voiced concerns about the objectivity of the company involved.
The contract in Maine was offered exclusively to Alexander’s firm because, according to Martins, it was “uniquely qualified” to perform the work.
Some Republicans have praised the department’s decision to hire the company to review Maine’s welfare system.
The company and Alexander, however, have a controversial record, and in November Pennsylvania Auditor General Eugene DePasquale released a report alleging that “long-term mismanagement” cost the state $7 million. Some of that occurred during Alexander’s tenure at the helm of the Department of Public Welfare.
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