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Saturday, January 4, 2014

Health Care Reform Articles - January 4, 2014

Can the VHA Be a Model for Integrative Healthcare?
11/14/2013
Interview by Karolyn A. Gazella
Gaining Perspective From Tracy Gaudet, MD
Tracy Gaudet, MD, spoke to a capacity crowd of 300+ attendees of the recent International Congress for Clinicians in Complementary & Integrative Medicine held in Chicago. Gaudet, who joined the Department of Veterans Affairs in 2011 as their director of the Veterans Health Administration (VHA) Office of Patient Centered Care and Cultural Transformation, kicked off the conference with a lively keynote about how the VHA is attempting to transform healthcare by utilizing an integrative, holistic approach.

In her role leading this newly created office within the VHA, Gaudet will help the VHA transition from a physician-centered model of care to one that focuses on personalized, proactive, patient-centered care. “This is an opportunity unparalleled in the history of medicine, and a radical departure from the VHA’s current approach,” Gaudet explained.

Before joining the VHA, Gaudet was the executive director of Duke Integrative Medicine and is recognized for leading that center to the forefront of the field. She is also the founding executive director of the University of Arizona Program in Integrative Medicine where she was instrumental in designing the country’s first comprehensive curriculum in integrative medicine.

“Our present healthcare system is not designed to fix the problems we face,” Gaudet told the audience. “We have to completely rebuild the system.”

Gaudet explained that the VHA can act as a “living laboratory” to help demonstrate efficacy of changes that could positively impact healthcare nationwide. The VHA can potentially act as a model for integrative care throughout the United States, she said, but for that to happen, a “massive change in philosophy and structure is required.”
http://www.naturalmedicinejournal.com/article_content.asp?edition=1&section=6&article=475

Access to Abortion Falling as States Pass Restrictions


By 

A three-year surge in anti-abortion measures in more than half the states has altered the landscape for abortion access, with supporters and opponents agreeing that the new restrictions are shutting some clinics, threatening others and making it far more difficult in many regions to obtain the procedure.
Advocates for both sides are preparing for new political campaigns and court battles that could redefine the constitutional limits for curbing the right to abortion set by the 1973 Roe v. Wade decision and later modifications by the Supreme Court.
On Monday, in a clash that is likely to reach the Supreme Court, a federal appeals court in New Orleans will hear arguments on a Texas requirement that abortion doctors have admitting privileges at local hospitals — a measure that caused one-third of the state’s abortion clinics to close, at least temporarily.
Advocates for abortion rights, taking heart from recent signs in Virginia and New Mexico that proposals for strong or intrusive controls may alienate voters, hope to help unseat some Republican governors this year as well as shore up the Democratic majority in the United States Senate.
Anti-abortion groups aim to consolidate their position in dozens of states and to push the Senate to support a proposal adopted by the Republican-controlled House for a nationwide ban on most abortions at 20 weeks after conception.
“I think we are at a potential turning point: Either access to abortion will be dramatically restricted in the coming year or perhaps the pushback will begin,” said Suzanne Goldberg, director of the Center for Gender and Sexuality Law at Columbia University.
The anti-abortion groups, for their part, feel emboldened by new tactics that they say have wide public appeal even as they push the edges of Supreme Court guidelines, including costly clinic regulations and bans on late abortions.
“I’m very encouraged,” said Carol Tobias, president of National Right to Life. “We’ve been gaining ground in recent years with laws that are a stronger challenge to Roe.”
“I think it is more difficult to get an abortion in the country today,” she said.

Justices Are Asked to Reject Nuns’ Challenge to Health Law


By 

WASHINGTON — The Obama administration urged the Supreme Court on Friday to reject a lawsuit filed by the Little Sisters of the Poor, an order of Roman Catholic nuns challenging requirements for many employers to provide health insurance coverage for birth control or face penalties under the new health care law.
The Justice Department said the requirements did not impose a “substantial burden” on the nuns’ exercise of religion because they could “opt out” of the obligation by certifying that they had religious objections to such coverage.
The Little Sisters “need only self-certify that they are nonprofit organizations that hold themselves out as religious and have religious objections to providing coverage for contraceptive services,” the administration said in a brief filed with the Supreme Court by the solicitor general, Donald B. Verrilli Jr.
In addition, he said, the nuns would need to send a copy of the certification to an entity that administers their health plan, Christian Brothers Services.
On Tuesday night, hours before the contraceptive coverage requirements were to take effect, Justice Sonia Sotomayor of the Supreme Court temporarily blocked the Obama administration from enforcing them with respect to the nuns and certain other religious groups. The Little Sisters of the Poor operate nursing homes for poor people in the United States and around the world.
In its filing with the court on Friday, the administration said the nuns “have no legal basis to challenge the self-certification requirement or to complain that it involves them in the process of providing contraceptive coverage.”
If the nuns sign the certification required by federal rules, the administration said, neither they nor their health plan nor the entity that manages their health plan will be under any legal obligation to provide coverage of birth control.
“With the stroke of their own pen,” Mr. Verrilli said, the nuns “can secure for themselves the relief they seek from this court.” Accordingly, he said, the court should lift the stay imposed by Justice Sotomayor.
The nuns disagreed.

Reaction swift to Oregon Medicaid study showing more ER use

Affordable Care Act, health policy, hospitals
By 
Critics of expanding Medicaid under the Affordable Care Act are jumping on a new study released Thursday that undermines a chief argument for boosting the rolls of the government health insurance program for the poor.
The study, published in the journal Science, found that newly insured Medicaid recipients visited emergency departments significantly more than the uninsured. Some experts and supporters of Medicaid expansion expected just the opposite, that insuring more people would reduce costly ER visits as enrollees took advantage of more appropriate and affordable primary care services. With regular checkups and access to preventive care, new Medicaid recipients would head off urgent health crises and skip the ER for more routine problems in favor of their doctor’s office, the thinking went. That would make recipients healthier and also save Medicaid money.
But the new study suggests that signing people up for Medicaid leads them to use both more primary care and more emergency room treatment.
The study, which looked at 25,000 Medicaid participants in Oregon in 2008, found those who benefitted from expanded coverage increased their visits by a sizeable 40 percent over 18 months. The visits encompassed a range of health issues, including problems best treated by a primary care doctor. That’s precisely what policymakers want to avoid as they work to insure more people — expensive emergency visits that aren’t for, well, real emergencies.
The study is the third in a series of papers about Oregon’s Medicaid expansion. Researchers zeroed in on Oregon because it expanded Medicaid through a lottery system, allowing them to easily compare the effects of having health insurance using a randomized group.

Shouldn’t it be expected that people will do what they know?

Today’s outrage by Republicans and others that want nothing less than the repeal of the Affordable Care Act (ACA aka ObamaCare) is a new study by Amy Finkelstein of Harvard.
Finkelstein’s study shows a marked increase in emergency room visits by those newly receiving health insurance via Medicaid expansion in Oregon. From this report on the study, which is published in the journal Science:
“When you cover the uninsured, emergency room use goes up by a large magnitude,” says Amy Finkelstein, the Ford Professor of Economics at MIT and a principal investigator of the study, along with Katherine Baicker, a professor at the Harvard School of Public Health.
The study, which is being published today in the journal Science, also documents that having Medicaid consistently increases visits to the emergency room across a range of demographic groups, types of visits, and medical conditions, including types of conditions that may be most readily treatable in primary-care situations.
“In no case were we able to find any subpopulations, or type of conditions, for which Medicaid caused a significant decrease in emergency department use,” Finkelstein adds. “Although one always needs to be careful generalizing to other settings, these results suggest that other Medicaid expansions are unlikely to decrease emergency room use.”
But let’s think about this for second. Let’s assume that for many, if not most, of those in the Medicaid expansion program, this may be the first time in their lives that they have had health insurance coverage. It is very unlikely that these people have ever had a primary care provider, and that the only experience with the health care system they have had is via an emergency room.

The Myth of Health Care's Free Market

By David Cay Johnston
Newsweek, January 3, 2014
Has it ever occurred to you to negotiate with the pilot of the plane you just boarded about her pay?
Assuming the pilot was willing to take bids for her services, would you have any idea of how to evaluate the worth of that particular pilot compared to anyone else who might be at the controls? How long would it delay the flight while you and other passengers haggled over that fee?
And what of the risks in having a pilot focused on whether she negotiated good deals with her passengers, rather than getting everyone safely to their destination?
While haggling with pilots is absurd, the idea that individual Americans should negotiate the prices each pays for health care is getting a lot of serious discussion right now. The reason is the Affordable Care Act, a.k.a. Obamacare, which critics are desperate to find some way to stop.
For weeks, politicians and writers in the opinion pages of The Wall Street Journal and other critical outlets have declared Obamacare a failure with plenty of victims. Those are silly assertions because the law only took effect this week, on the first day of 2014.
These critics are all outrage with no detailed alternatives, except the mantra that competition will magically bring down health-care costs. The libertarians at the Cato Institute argue "we need market competition more than ever. Not the mealymouthed substitutes bandied about by most health policy wonks. We need something that none of us has ever seen - real competition in a free health-care market."
No. We need something easier, simpler, and already proven to cut costs.
For starters, markets can push prices up as well as down. The electricity market rules, initially written by Enron (at the urging of former Vice President Dick Cheney, who was pals with the company's late founder), can raise prices to 90 percent of what an unfettered monopolist could charge, as I showed in my book Free Lunch, citing research by Professor Sarosh Talukdar of Carnegie-Mellon University that no one has challenged.
Then there's the knowledge component of markets. When one side knows and the other side is ignorant, you get price-gouging. Under current policies, prices for medical services are generally confidential. You could call hospitals and your health insurer to ask the cost of a standard medical procedure, say cataract or gall-bladder surgery. I tried that, and was told at every turn that prices were proprietary information - none of my business, until I got a bill.
More than four decades ago the Supreme Court defined a fair market as the "price at which the property would change hands between a willing buyer and a willing seller, neither being under any compulsion to buy or to sell and both having reasonable knowledge of relevant facts." How many of us have "reasonable knowledge" of medical procedures, costs, or even the difference between a neurologist and a nephrologist?
Is an accident victim writhing in pain, life's blood flowing out of his body, free of compulsion?
And how many of us know the assortment of facts needed to price an MRI, an angiogram or just a dozen stitches? Or, for that matter, whether any of those procedures is the best alternative, or even necessary?
http://www.pnhp.org/print/news/2014/january/the-myth-of-health-cares-free-market




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