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Sunday, August 31, 2014

Health Care Reform Articles - August 31, 2014


Editor's Note:

I have embarked on an experiment and have created by own website at www.philcaper.net. It contains links to my regular Bangor Daily News columns and to other articles I have written, as well as a link to a radio interview (about 30 minutes long) I did recently during a visit to Seattle and to the Maine AllCare website.

 In addition, I have devoted a page in the website to articles by others I think are especially important or well written (often both).

It is a work in progress, and other material will be added and some deleted as time goes on.

If you'd like, let me know what you think of it and please forward any suggestions you may have for improving it and making it more useful to me at pcpcaper21@gmail.com.

- SPC


A Visit with a Neighbor
By Richard Dillihunt, MD

 For decades, I have admired the Canadian health care system, first while at a remote Northern Quebec fishing camp. There, impromptu sick call was held for the Cree, local aboriginal people with rights to this remote land. Members of this tribe had various complaints that we treated with our medical chest. Despite the difference in language in the elderly, the shyness barriers were easily overcome. They seemed completely confident in our medical abilities.
We felt privileged as caregivers to be given such confidence and warm doctor-patient relationships came forth. Over the years we saw burns from campfire mishaps, an acute gallbladder, and a mangled hand injured beyond our medical capabilities. We made radio calls to regional flying services, and patients were fetched and flown to various medical centers. There were no lawyers or insurance companies involved. The only physical evidence of health care coverage was a small card that each patient guarded carefully. This card admitted them to their national health care system. It provided quality medical care covering all 35 million Canadians scattered across the second largest nation on earth.
The patient with the injured hand was emblematic of this system. A radio call summoned a floatplane, and the patient was loaded and lugged across and down the 150 km of the Peribonka River to the medical center in Chicoutimi. After treatment, he was returned by air. That little card had covered all medical care and transportation. Imagine what such a journey would cost us!
This system of universal health care came into being in 1946. It is attributed to a Canadian native son, Tommy Douglas. As premier of Saskatchewan, he established a universal single payer health care for all of Canada. After his death he was voted “Greatest Canadian” by the Canadian Broadcast Corporation viewers.
Although medical service for the Cree and Inuit have been difficult for the Canadian government to perfect, they have enjoyed great success. Given the vast territory, the nation does well to spread its resources over ten million square km, much of it being a harsh environment.
The Canadian system deserves careful scrutiny by every American who has concerns regarding our badly broken health care system. Inspection of how the Canadians have successfully developed their universal single payer form of health care uncovers features that the US needs to seriously consider. Just recently Danielle Martin, a brilliant young Canadian physician, called attention to the superior provisions of Canada’s public system in her testimony before Sen. Bernie Sanders’ committee in Washington. She showed that the Canadian system is based on need, not on the ability to pay. Her interaction with Sen. Burr (R-NC) went viral, generating over 700,000 views on YouTube across North America. Many major media outlets focused on her evidence-based, intelligent, and energetic defense of Canadian Medicare.
Canadians take great pride in their medicare-for-all system. They know that Canada’s life expectancy rates and maternal and infant mortality figures are superior to America’s, and their quality of care is equal to ours. They are aware that, traditionally, wait times have been a source of intense criticism of their system. They understand that this is largely overblown by stateside special interest groups whose propaganda has brainwashed America about horrendous waiting times for referrals and elective surgery. The facts show differently. Canada has addressed wait time issues with a Wait Time Alliance. Through this alliance there has been much improvement, and changes have been uncovered to correct this problem.
Two nations have developed, through different pathways, health care systems which are clinically similar and among the world’s best. When compared, Canada has taken the high ground, selecting a route featuring social justice and equality with a strong nationalism. Canadians are caring for one another. America’s profit- driven hard-nosed traditions and business practices have permeated the ways and means of the USA’s health care.
Lacking checks and balances, our system costs nearly twice that of Canada’s per capita, $8233 vs $4445 yearly. This accounts for 17.6% of America’s GDP while Canada’s health care expenditure is 11.4% of her GDP according to 2012 statistics. The most stunning statistic of all is this. Even with the ACA finally deployed, there are over 30 million uninsured American citizens, approximately equal to the entire population of Canada where everyone is covered by Medicare, and a simple little card replaces by comparison a vast array of paperwork that chokes our system.
The Canadian system is remarkably popular in America. Maine must pay attention to this surge. Because of our unique geographical location, we are surrounded by Canadian relatives, friends, and neighbors. Canada can provide us with more than frigid winds. We need to lead the way in acknowledging a very attractive Canadian healthcare system.
http://www.mainemed.com/sites/default/files/content/JulAugSep2014_FINAL.pdf



New Novartis Drug Shows Striking Efficacy in Treating Heart Failure

By 
An experimental drug has shown a striking efficacy in prolonging the lives of people with heart failure and could replace what has been the bedrock treatment for more than 20 years, researchers said Saturday.
The drug, which is being developed by the Swiss company Novartis, reduced both the risk of dying from cardiovascular causes and the risk of being hospitalized for worsening heart failure by about 20 percent in a large clinical trial.
“I think that when physicians see these data, they will find it compelling, and what we will see is a paradigm shift,” said Dr. Milton Packer, a professor of clinical sciences at the University of Texas Southwestern Medical Center in Dallas and one of the two principal investigators in the study.
The results are being presented at the European Society of Cardiology congress in Barcelona, Spain this weekend and were published Saturday by The New England Journal of Medicine.
Heart failure is a disease in which the heart cannot pump enough blood to the body’s organs, resulting in shortness of breath, fatigue and retention of fluids. It can be caused by a heart attack, uncontrolled hypertension or other problems.
Some five million to six million Americans, and an estimated 26 million people globally, have heart failure, and it is the leading cause of hospitalization in the United States and Europe, according to a recent paper in the Journal of the American College of Cardiology. Many patients die within a few years of diagnosis.
Some doctors not involved in the study agreed the results were compelling.

Donald Berwick pushes single payer health plan

By David Scharfenberg

  | GLOBE STAFF   AUGUST 30, 2014
Democratic gubernatorial candidate Donald Berwick has laid out some ambitious goals, among them ending chronic homelessness and eliminating childhood poverty. But his most sweeping proposal — arguably the most sweeping proposal of the political season — is moving Massachusetts to a single-payer or “Medicare for all” health care system.
Eight years after the state became the first in the country to establish near-universal coverage, Berwick is reaching for an even bigger prize sought by liberals: shifting from privately financed care to a system funded by the government.
The candidate says replacing a welter of insurance companies with a single public payer would simplify a complex system and save hundreds of millions of dollars in administrative costs that could be redirected to other needs: job creation, education, and infrastructure.
“The opportunity is vast,” said Berwick, who ran Medicare and Medicaid for the Obama Administration for 1½ years.
But observers say the hurdles to single-payer health care are many. For one thing, it would require a tax increase. For another, it can be a complex idea that is difficult to explain in campaign soundbites. That may explain, in part, the candidate’s poor standing in the polls with just over a week to go until the Sept. 9 Democratic gubernatorial primary.
It’s also unclear that state legislators or the public have the appetite for another major health care overhaul. And powerful interests, including the insurance industry, are arrayed against a single-payer system that would sharply curtail their business.

Surgical error at Tufts prompts widespread changes

By Liz Kowalczyk

  | GLOBE STAFF   AUGUST 31, 2014
Caroline Carcerano arrived at Tufts Medical Center hoping that a brief procedure would relieve lingering symptoms from a back injury. In the operating room, the neurosurgeon requested a special dye to test the location of tubing that had been threaded into her spine. But the pharmacy didn’t have it and provided a different one.
The surgeon checked the label, hospital executives said, and then injected it, twice.
After Carcerano awoke with severe pain and seizures, caregivers zeroed in on the substitute dye, whose label clearly warned against use inside the spine, according to a report from regulators who investigated the error.
“A mistake was made,” the neurosurgeon, Dr. Steven Hwang, immediately told Carcerano’s two sons as they watched over their 74-year-old mother. “We gave her the wrong dye.’’
Carcerano died the following day last November, unleashing hospital and government inquiries that have led to widespread safety improvements in Tufts operating rooms this year and may highlight medical errors involving “cognitive bias” — an area of growing interest among researchers. The label on the dye read “not for intrathecal use,’’ meaning it should never be injected into the spine. But hospital executives said Hwang did not notice that warning, and instead saw what he anticipated the label would say — the name of a dye intended for injection into the spine.

Coverage for End-of-Life Talks Gaining Ground

By 

DUNDEE, N.Y. — Five years after it exploded into a political conflagration over “death panels,” the issue of paying doctors to talk to patients about end-of-life care is making a comeback, and such sessions may be covered for the 50 million Americans on Medicare as early as next year.
Bypassing the political process, private insurers have begun reimbursing doctors for these “advance care planning” conversations as interest in them rises along with the number of aging Americans. People are living longer with illnesses, and many want more input into how they will spend their final days, including whether they want to die at home or in the hospital, and whether they want full-fledged life-sustaining treatment, just pain relief or something in between. Some states, including Colorado and Oregon, recently began covering the sessions for Medicaid patients.
But far more significant, Medicare may begin covering end-of-life discussions next year if it approves a recent request from the American Medical Association, the country’s largest association of physicians and medical students. One of the A.M.A.’s roles is to create billing codes for medical services, codes used by doctors, hospitals and insurers. It recently created codes for end-of-life conversations and submitted them to Medicare.
The Centers for Medicare and Medicaid Services, which runs Medicare, would not discuss whether it will agree to cover end-of-life discussions; its decision is expected this fall. But the agency often adopts A.M.A. recommendations, which are developed in meetings attended by its representatives. And the political environment is less toxic than it was when the “death panel” label was coined; although there are still opponents, there are more proponents, including Republican politicians.

Doctors are shifting their business models
by Lisa Zamosky
With insurance companies often paying doctors less for their services and with paperwork increasing, Dr. Gregory Yu was putting in longer workdays to squeeze in more patients.
He figured there had to be a better way. So a few years ago he shifted a portion of his practice to a concierge model in which patients pay a monthly fee of $150 in exchange for more of his time — both in and out of the office.
"It was more for my own personal longevity," said the La Cañada Flintridge internist, explaining why he made the switch. "If I have to see patient after patient after patient, and I'm not really feeling the satisfaction of doing the best job that I possibly could for people, I was afraid I might burn out."
Being a doctor in private practice today is more complicated than it used to be, with growing financial pressures, more government regulation, greater oversight by insurers, rapid developments in medicine and pressure to keep up with technology.
"Practices are being asked to do more with less," says Dr. Susan Turney, chief executive of the Medical Group Management Assn., which represents professionals running medical practices.
In response, doctors say they are increasingly looking for new ways to practice medicine so they can spend more time with patients and less time on paperwork — while maximizing their incomes.
Many are giving up on independent practice to become employees of larger healthcare systems, Turney says.
In fact, a national survey of 13,500 doctors by the Physicians Foundation, a nonprofit organization representing the interests of physicians, shows that in 2000 more than half were practicing independently. But by 2013, that share had shrunk to a third.
In some cases, those wanting to remain independent are switching to alternate models, such as the concierge-style practice that Yu adopted. For consumers, that can mean changes in the way they get their medical care and how they pay for it.
Experts outline a few common ways doctors are shifting the way they do business and how they're likely to affect your care and your wallet.
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Friday, August 29, 2014

Health Care Reform Articles - August 29, 2014


TUESDAY, AUGUST 26, 2014
The Study You’ll Never Hear About
According to a new Commonwealth Fund
sponsored study published in Health Affairs,
“Small Primary Care Physician Practices Have
Low Rates Of Preventable Hospital
Admissions”. The study of over one thousand
practices of various sizes and ownerships,
conducted by some of the most respected names
in health care, found that the smallest
independent primary care practices, that are
physician owned, provide better care at lower
overall cost. Considering the current, and rather belligerent, advocacy and policy efforts to eradicate small independent medical practice, and the massive move of physicians from private practice to hospital employment in the name of efficiency, quality, value and economies of scale, this study should have created quite the furor. It has not, and chances are excellent that it never will.
The study, consisting of 1045 practices and 284,000 patients, is a combination of survey responses regarding practice characteristics, and Medicare claims data used to calculate rates of ambulatory care-sensitive admissions (ACSA). As the title implies, Lawrence Casalino and colleagues found that practices with one or two physicians had 30% lower rates of these presumably preventable admissions. But this was by no means the only finding, because in general, physician owned practices, as opposed to hospital owned practices, regardless of size, had lower ACSA rates. Furthermore, the study also found that all sorts of innovative practice models foisted on physicians nowadays have marginal and sometimes negative effects on ACSA rates: “Neither the patient-centered medical home score, nor pay-for-performance incentives, nor the acceptance of risk for the cost of hospital care for the practice’s patients was significantly associated with the ambulatory care–sensitive admission rate ... . Practices exposed to public reporting had somewhat higher rates.”
http://content.healthaffairs.org/content/early/2014/08/08/hlthaff.2014.0434.full.html 

Expansion of Mental Health Care Hits Obstacles

by Abby Goodenough
LOUISVILLE, Ky. — Terri Hall’s anxiety was back, making her hands shake as she tried to light a cigarette on the stoop of her faded apartment building. She had no appetite, and her mind galloped as she grasped for an answer to her latest setback.
In January, almost immediately after she got Medicaid coverage through the Affordable Care Act, she had called a community mental health agency seeking help for the depression and anxiety that had so often consumed her.
Now she was getting therapy for the first time, and it was helping, no question. She just wished she could go more often. The agency, Seven Counties Services, has been deluged with new Medicaid recipients, and Ms. Hall has had to wait up to seven weeks between appointments with her therapist, Erin Riedel, whose caseload has more than doubled.
“She’s just awesome,” Ms. Hall said. “But she’s busy, very busy.”
The Affordable Care Act has paved the way for a vast expansion of mental health coverage in America, providing access for millions of people who were previously uninsured or whose policies did not include such coverage before. Under the law, mental health treatment is an “essential” benefit that must be covered by Medicaid and every private plan sold through the new online insurance marketplaces.
The need is widely viewed as great: Nearly one in five Americans has a diagnosable mental illness, according to the Department of Health and Human Services, but most get no treatment. If the law’s goal is met, advocates say, it will reduce not only personal suffering but also exorbitant economic costs, like the higher rate of general health problems among those with mental illnesses, and their lost productivity.
Kentucky has been trying to overhaul its mental health system, partly by allowing private psychologists and social workers to accept Medicaid patients for the first time. The change is crucial, state officials say, because 85 percent of the 521,000 Kentuckians who got coverage through the state’s new insurance exchange this year were poor enough to enroll in Medicaid. Previously, only psychologists and social workers at community health centers like Seven Counties, which are quasi-governmental agencies, could provide outpatient therapy to Medicaid recipients here. Now, more than 1,000 private mental health providers statewide have signed up to treat Medicaid enrollees, according to the state.
http://www.nytimes.com/2014/08/28/us/expansion-of-mental-health-care-hits-obstacles.html?smid=nytcore-ipad-share&smprod=nytcore-ipad&_r=0

Loving and Hating Obamacare With One Muddled Mind

E.J. Dionne has a nice column pointing out that while “Obamacare” remains unpopular, most of the provisions are well-liked, and thus Democrats should run on the issue. As regular readers know, I certainly agree that the individual components of reform are far more popular than reform overall. However, the column's headline -- “Obamacare has growing support, even if its name does not” -- isn't really buttressed by the article. Actually, support for key provisions of the law, including coverage of pre-existing conditions, health-insurance exchanges offering subsidies to middle-income policy holders and Obamacare's Medicaid expansion, have always polled well.
Moreover caution is always in order with issue polling. When these kinds of polls show public opinion fractured, it’s tempting to believe that one side or the other represents voters' “true” support. That’s the wrong way to interpret such polls. Yes, the ACA polls badly while most of its components poll well. But that doesn’t mean that the ACA is genuinely unpopular (as most opponents suggest) or that it’s genuinely popular (as most supporters contend). There is no underlying truth to be excavated from the results; the best we can do is say that public opinion is inconsistent.
Well, that’s the best we observers can do. Campaign operatives, in contrast, can counsel their candidates to stress whatever is popular. What those operatives shouldn't do is to fall for their own spin, or let their candidates fall for it. That applies both to Republican consultants encouraging candidates to bash Obamacare, and Democratic consultants urging candidates to highlight the law's most popular provisions.

What Doctors Can’t Do

By 
 
Mary White makes house calls. She’s a senior community health worker in Philadelphia in the IMPaCT program at the Penn Center for Community Health Workers. She has 25 of the University of Pennsylvania Health System’s toughest patients. It’s her job to help them set health goals and, step by step, carry them out.
One of her patients is Grover Wilson, an engaging man of 56 who weighs 515 pounds. Wilson had long been athletic and sociable, the organizer of a long-running community volleyball game. But depression and an injury led him to gain weight. Now he lives in a tiny basement apartment packed floor to ceiling with boxes of his possessions, and is trapped and isolated by his weight.
White has been visiting Wilson for three months. He’s lost 15 pounds during that time, with the help of a group class at the Penn Center and her visits. “How are you doing on your goal to cut down on sugary drinks?” she asks. What about your snacks? “I’ve finished all my hummus and pretzels,” he says. “I’m going to get some baby carrots, and more hummus, and pita chips.”
“That’s good, that’s good,” White says. “They’re having a sale on hummus.”
They talk about his exercise goal: walking up and down his hallway. “As usual, I’m not doing a great job on my own,” he said. “It’s very easy when you’re alone and obese and have sleep apnea and other problems to say, ‘I just want to give up.’ Depression comes and goes. But today’s a good day.” He means because White is visiting.
http://opinionator.blogs.nytimes.com/2014/08/28/what-doctors-cant-do/?_php=true&_type=blogs&_php=true&_type=blogs&emc=edit_tnt_20140828&nlid=1311158&tntemail0=y&_r=1&

Pennsylvania to Purchase Private Care for Its Poor

By 
WASHINGTON — Pennsylvania will become the 27th state to expandMedicaid under the Affordable Care Act, the Obama administration announced Thursday, using federal funds to buy private health insurance for about 500,000 low-income residents starting next year.
Gov. Tom Corbett, a Republican, had proposed the plan as an alternative to expanding traditional Medicaid under the health care law, which he opposes. Now that federal officials have signed off, Pennsylvania will join Arkansas and Iowa in using Medicaid funds to buy private coverage for the poor.
The Republican governor of Indiana, Mike Pence, has proposed a similar plan but has not yet received approval from the Obama administration. The so-called private option has increasingly appealed to some conservatives as a free-market alternative to traditional Medicaid, a government-run program that critics say has out-of-control costs.
Pennsylvania’s plan includes requirements for the Medicaid expansion population that go beyond the traditional program. For example, people with annual incomes above the poverty level — $11,670 for an individual — will have to pay premiums equaling up to 2 percent of their household income starting in 2016.

How to Complain to Medicare

by Paula Span
How Medicare handles complaints and appeals is no trivial matter — the Centers for Medicare and Medicaid Services says it reviews more than 100,000 of them a year. Beneficiaries file roughly 16,000 annually related to hospital care (mostly contesting discharges) and 18,000 about nursing homes, home health services and hospice programs. And 30,000 other complaints and appeals concern Medicare Advantage programs.
On Aug. 1, Medicare made what should be a simple change in this process: There are new toll-free phone numbers to call. You may have already received the new numbers on the forms a hospital or nursing home provided about your rights. But if a health care provider hasn’t yet caught up with the change, you may not have.
And if you’re looking on the Medicare.gov website for phone numbers, I wish you luck. I went rummaging through the site several times without finding them, and so did the folks at the United Hospital Fund, until they finally located the proper tool.
The new phone numbers, which I’ll pass along in a minute, reflect a larger change. Each state has a quality improvement organization, aQ.I.O., which until now worked with providers on issues like reducing hospital readmissions or preventing infections, and reviewed beneficiaries’ complaints and expedited appeals.
Some beneficiaries and other critics, including the Institute of Medicine, saw potential conflicts of interests: Could the organization that advised providers also fairly review complaints against them? They recommended separating those functions.

MaineHealth acquires Farmington hospital network

By Jackie Farwell, BDN Staff
Posted Aug. 28, 2014, at 6:03 p.m.
Franklin Community Health Network has become the 13th member of the state’s largest hospital system, following a state approval issued Wednesday.
The independent health network, parent to the 65-bed Franklin Memorial Hospital in Farmington, will join Portland-based MaineHealth effective Oct. 1, both organizations announced Thursday.
MaineHealth, the parent organization to Maine Medical Center and a dozen other health care entities, plans to invest at least $2.25 million into FCHN, according to documents filed with the state’s certificate of need unit, which regulates the expansion of health care facilities in Maine. Over the next four years, the money will fund implementation of an outpatient electronic medical records system also adopted by MaineHealth.
The certificate of need unit recommended approval of the deal, which Maine Department of Health and Human Services Commissioner Mary Mayhew granted Wednesday. She noted several conditions, including the organization’s report on the success of their efforts to improve health in the community. They also must report to the state on referral patterns, which will reflect where patients in FCHN’s service area seek care after the deal.
Neighboring Central Maine Healthcare, based in Lewiston, expressed concern to state regulators about where local doctors will refer patients following the acquisition.
The Franklin health network will pay MaineHealth an annual membership fee of $375,000. Those dues are expected to be offset by savings in lab services, insurance premiums and legal fees FCHN will realize by joining the system, according to the documents.
FCHN reported an operating loss of $7.6 million in fiscal year 2013. MaineHealth expects the network’s operating costs to drop by about $523,000 within three years of becoming a member.
“Our health system has enjoyed a long-standing clinical collaboration with Franklin and its providers,” MaineHealth President Bill Caron said in a news release. “Welcoming Franklin Community Health Network as a member of the MaineHealth family is a natural next step, and we look forward to working together to care for the greater Franklin County community.”

Expanding Medicaid is good for the economy, health of Maine

By Sara Gagne-Holmes, Special to the BDN
Posted Aug. 28, 2014, at 2:52 p.m.
For many working families in Maine, a job isn’t enough to make ends meet. Between paying for rent, putting food on the table and meeting everyday expenses, there’s no money left for health insurance.
As we celebrate Labor Day, it’s a good time to reconsider a critical opportunity Maine has to improve the lives of nearly 70,000 people, including 3,000 veterans. Through the Affordable Care Act, Maine could provide access to affordable, high quality health care.
Expansion of Medicaid, called MaineCare here, would realize an incredible return on the investment by boosting our state’s economy, creating jobs and lowering health insurance costs for everyone, including those with private health insurance.
Unfortunately, Gov. Paul LePage has rejected this common-sense idea – vetoing bipartisan efforts to expand access five times – even though Republican and Democratic governors around the country have realized this opportunity is too good to pass up.
Maine, unlike the rest of New England, is missing a major opportunity for new economic growth, and thousands of Maine families are being put, unnecessarily, at risk of tragic health outcomes and bankruptcy caused by medical bills.
The facts are indisputable.
Hospitals are being hurt by refusing to expand Medicaid. As a new report by the Robert Wood Johnson Foundation found, hospitals in expansion states are seeing declines in charity care — free medical services provided to income eligible individuals by nonprofit hospitals pursuant to state law. Reductions in charity care help to reduce cost shifting onto other policyholders and protect jobs.
The same report found Maine hospitals will lose out on nearly $900 million in state and federal Medicaid reimbursement over 10 years if Maine doesn’t expand Medicaid.
But the economic impact goes much further.
Over the next 10 years, Maine would receive $3.1 billion in federal Medicaid funding if Maine expanded Medicaid. This funding and the economic activity it would generate is likely to result in 3,100 new or retained jobs in the health care sector and the rest of our communities.
In states that have expanded Medicaid, the rate of people without insurance has declined by 38 percent, compared to just 9 percent in nonexpansion states.
It’s not too late to change course.

LePage tells newspapers to drop dead as another GOP governor pursues people’s health

What a contrast: As Gov. LePage said it’s a plague that newspapers are “still alive,” another Republican governor is pursuing a policy that will save lives and improve health.
In deep red Wyoming, Republican Gov. Matt Mead has started negotiating with federal officials on expanding Medicaid. Like Maine, the state hospital association supports an expansion, which would reduce uncompensated care and make preventive care more available, reducing overall costs and human suffering.
LePage made his comments on a day when his electoral opponents were talking about policies to help Maine people. Eliot Cutler sketched out proposals on welfare reform. Mike Michaud put out a detailed plan, comprehensive plan to support Maine agriculture and make Maine New England’s food basket.
As LePage’s challengers and Wyoming look to solutions, LePage continues his intense rhetoric
Gov. LePage has again made it clear that he really doesn’t like Maine newspapers.

Doctor’s prognosis: American-style health care a nightmare

By Inge De Becker, M.D.
The Chronicle Herald (Halifax, Nova Scotia), Aug. 26, 2014
As a Canadian physician who now lives south of the 49th parallel, I’m alarmed that Canada’s publicly financed national health-care system is once again under attack
Nine years ago, we witnessed Dr. Jacques Chaoulli’s legal attack on medicare in Quebec. Then we saw the Harper government’s failure to renegotiate a new Canada Health Accord this past March. And now Dr. Brian Day, owner of the for-profit Cambie Surgery Centre in Vancouver, is unleashing his drive to “profitize” health care in British Columbia.
On Sept. 8, a trial to hear a constitutional challenge to B.C.’s health system that Dr. Day launched in 2008 will begin in Vancouver. Day wants to strike down provincial legislation that limits private payments for medically needed services by claiming that these laws violate the Canadian Charter of Rights and Freedoms.
Should he win, the door will open for an American-style health-care system (consistently ranked lowest in performance among wealthy nations — and the most expensive) with its profit-driven insurance companies, bloated administrative costs, and inequitable access.
Let me tell you about my experience with the U.S. health-care system. I am a pediatric ophthalmologist by training and, like all of us, I am occasionally also a patient. In 2008, for personal reasons — not for a better job — I chose to move across the border from my home in Nova Scotia to Minnesota.
I knew that the health-care system in both countries would be different. But I did not grasp what that meant until I lived the difference.
My learning curve as a patient in the U.S. was brutal: even as a “well-insured” patient, I suddenly was dealing with pre-authorizations, in-network/out-of-network issues, co-pays, co-insurance, deductibles, health savings accounts, and EOBs (Explanation of Benefits) which look like bills but aren’t.
The accounting department of my HMO (Health Maintenance Organization) overbilled me by thousands of dollars. I stalled with the payment.
On a bright Saturday morning, I received an intimidating call from a collection agency for unpaid medical bills. Never mind how that affected my credit rating.
In Canada, I paid taxes, had a Nova Scotia health card that guaranteed access to medically needed care anywhere in the country, used the health-care system if I needed it, got to choose my doctor, and did not have to worry about bills. With private insurance in the U.S., I learned not to take the Canadian experience for granted anymore.
In Canada, I benefited from superb oncology care. In Canada, my son was in a catastrophic car crash. He spent seven days in a state-of-the-art neuro-intensive care unit. Not one bill, not one phone call to or from an insurance company disrupted emotionally charged times.
My learning curve as a physician practising in the U.S. was equally unpleasant. For the first time in my professional life, I had to deal with the intrusion of third parties — health insurance companies — between the patient and me.
I had to keep in mind that a patient’s insurance may not cover the tests and treatments needed, that common procedures needed to be pre-authorized by an insurance clerk, that certain things needed to be done before the insurance ran out, or that some treatments had to be delayed to the next “benefit year.”



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Wednesday, August 27, 2014

Health Care Reform Articles - August 27, 2014


Leader of Connecticut’s Health Marketplace Is Named to Run Federal Program
By ABBY GOODNOUGH AUG. 26, 2014
WASHINGTON  —  The  Obama  administration  on  Tuesday  named  Kevin  J. Counihan,  who  ran  Connecticut’s  successful  health  insurance  marketplace, as  the  chief  executive  of  the  federal  marketplace  serving  consumers  in  36 states.
Mr.  Counihan  will  start  on  Sept.  8,  a  little  more  than  two  months  before the  next  sign-­up  period  for  health  insurance  begins  on  Nov.  15.  Sylvia Mathews  Burwell,  the  secretary  of  Health  and  Human  Services,  hired  Mr. Counihan  for  the  new  position  of  chief  executive  as  part  of  an  effort  to improve  management  of  the  federal  marketplace  and  to  avoid  the technological  failures  that  paralyzed  its  website,  HealthCare.gov,  last  fall.
Ms.  Burwell  said  Mr.  Counihan  would  be  “a  clear,  single  point  of  contact for  streamlined  decision-­making.”
Although  he  comes  to  the  federal  marketplace  with  a  record  of  success —  enrollment  in  health  plans  exceeded  expectations  in  Connecticut  under his  watch,  and  the  state’s  online  marketplace  ran  relatively  smoothly  —  Mr. Counihan  now  faces  a  far  bigger  challenge.  He  will  be  under  pressure  to  get millions  more  Americans  signed  up  for  insurance  during  the  three-­month enrollment  period,  even  as  millions  who  already  bought  plans  through  the online  marketplaces  will  need  to  renew  them  or  switch  to  new  coverage. 
http://www.nytimes.com/2014/08/27/us/politics/Kevin-J-Counihan-chief-executive-health-marketplace.html?hpw&rref=health&action=click&pgtype=Homepage&version=HpHedThumbWell&module=well-region&region=bottom-well&WT.nav=bottom-well

Covered California officials, insurance chief clash over Prop. 45

by Chad Ternune

California's Obamacare exchange and the state insurance commissioner are on a collision course over Proposition 45, a popular ballot measure aimed at reining in health insurance rates.
Covered California officials lashed out at the statewide ballot initiative this week and warned that it could be disastrous to the state's implementation of the federal healthcare law.
In November, voters will decide whether to give Insurance Commissioner Dave Jones veto power over rate increases for about 6 million Californians who have individual and small-business policies. Without this authority, Jones says, consumers will keep being subjected to excessive rate hikes and Obamacare won't be affordable.
Until now, the state-run exchange had largely avoided a public clash over Proposition 45 with Jones, a Democrat who supports the health law. That restraint disappeared at an exchange board meeting Thursday, and officials there will take up a vote next month to formally oppose it.
These moves thrust Covered California into the middle of what's expected to be a highly contentious and costly campaign.
Anthem Blue Cross, Kaiser Permanente and other companies have already contributed more than $37 million to defeat the measure. Insurers argue that the initiative is unnecessary because the Affordable Care Act already imposes new rules to protect consumers.
The ballot fight starts with broad support for Proposition 45. A Field Poll released this week found 69% of California voters favored the proposition. That support may wane once ads attacking the measure ramp up.

Obamacare chief in California gets $53,000 bonus

By Chad Terhune
California's health insurance exchange awarded its executive director a one-time bonus of $53,000 after the state enrolled 1.2 million people in Obamacare coverage.
Covered California's board chairwoman, Diana Dooley, said Peter Lee had not received a raise in three years, so the exchange granted the executive director a 20% incentive award based on his annual salary of $262,644.
Lee, a former healthcare official in the Obama administration, was instrumental in building California's state-run marketplace.
Consumer advocates credited him with securing lower-than-expected rates from health insurers in his first two years on the job, and with surpassing the state's enrollment goals.
California accounted for about 15% of the overall U.S. enrollment of 8 million people in individual policies under the Affordable Care Act.
The state also avoided many of the online glitches that plagued the federal exchange at Healthcare.gov and other state sites.
Several state exchange directors didn't survive the rollout of Obamacare this year. Officials in Oregon, Minnesota and Maryland all resigned as troubles mounted.
Lee hasn't been immune to criticism. On Thursday, after his bonus was announced at a meeting of the exchange's board, two state lawmakers faulted him for low enrollment among African Americans.

Beware siren song of private-payer care

In the U.S., the doctor is in, but maybe financially unavailable

By Jessica Schorr Saxe, M.D.
Vancouver Sun, Aug. 25, 2014
The middle-aged woman came to my family medicine practice for a routine visit to check her high blood pressure. It was the highest I’ve ever seen in the office: 280/180. I told her to go to the emergency department for probable admission to the hospital.
Her eyes crinkled, and tears fell silently. I thought she was crying because I had frightened her about the urgency of her condition. I was wrong.
“I can’t go to the hospital,” she said, “I can’t afford it.”
I have practised for more than 30 years in a health centre that cares for low-income patients in Charlotte, N.C. As is typical in the United States, our patients rely on a hodgepodge of funding sources. Almost all patients face some financial barriers to care.
A few have private insurance (increasingly with high co-pays and deductibles), many have Medicare (for the elderly) or Medicaid (for some of the poorest of the poor), and many are uninsured. Of the uninsured, some are “self-pay” and some qualify for sliding-scale charges pegged to their income.
While my patient with extreme hypertension is deeply etched into my mind, I could tell you many similar stories.
The typical new patients in my practice have not had health care for months or years. In many cases, they once had employer-based insurance and access to private doctors, then lost their job and thus their coverage and their physicians. Some cry when they talk about the interruption of these long-term relationships with their doctors.
One such patient had been hospitalized with severe congestive heart failure and had lost his full-time job because of his illness. Although he continued to work part-time, he was uninsured and could no longer see his usual doctor.
It took months for him to see me. When he did, I promptly sent him to a cardiologist who prescribed open-heart surgery. He received it, but he could have died waiting for care, as thousands of Americans do every year.
The constant churning of patients in and out of coverage, or in and out of private insurance plans (each with a restrictive network of providers), is cumbersome and costly. Such transitions require patients to seek out new doctors who request and scrutinize old records and sometimes order tests, not realizing they have already been done.
The U.S. system creates other challenges to providing good care. Some patients miss appointments simply because they don’t have enough money for their insurance co-pays.
I approach each patient with an algorithm. This patient has Blue Cross/Blue Shield and has these options, this one has Medicare and another set of options for referrals and medications, this patient is on sliding scale and another set: oops, no options here for certain services. It is even more complicated, because the options change.
Unlike many other places in the U.S., we are fortunate at my health centre to have many services for the uninsured, but there are still many gaps. Elective orthopedic surgery, for example, is not even an option.
I have a patient with a painful hand condition and several patients who need knee or hip replacements. Many of them would be able to work if they could afford the recommended surgery, but instead they live in pain and poverty.
I know some people in Canada decry excessive waiting times for elective procedures. The waiting times for patients on the U.S. side are sometimes infinite or until they reach the age of 65 (decades away for some), when they finally receive our Medicare.
Medical care in the United States costs twice as much per capita as in Canada, yet we have tens of millions who are uninsured, two million people a year who are victims of medical bankruptcy, and some of the worst health statistics in the developed world.
http://www.pnhp.org/print/news/2014/august/beware-siren-song-of-private-payer-care

Oregon: State Sues Over Health Website

by Reuters

The state sued Oracle America Inc. and six of its top executives on Friday, accusing the software giant of fraud for failing to deliver a working website for the Affordable Care Act program. The lawsuit, filed in Marion County Circuit Court, claims that fraud, lying and “a pattern of racketeering” by Oracle cost the state and its Cover Oregon program hundreds of millions of dollars. Oregon paid Oracle about $240.3 million for a system that never worked, the suit said. Oracle issued a statement saying that the suit “is a desperate attempt to deflect blame from Cover Oregon and the governor for their failures to manage a complex I.T. project.” It added, “The complaint is a fictional account of the Oregon health care project.” The company said it expected to prevail in both the state court lawsuit and in a breach of contract suit it filed against Cover Oregon two weeks ago in federal court.

Part D Gains May Be Eroding

by Paula Span

In 2003, when President George W. Bush signed the major Medicare expansion that would establish prescription drug coverage, he called it “a promise, a solemn promise, to America’s seniors.”
Medicare Part D, which took effect in 2006, initially made plenty of people angry. Some Congressional Democrats had argued that it would “privatize Medicare” by relying on insurance companies, while a number of Republicans insisted that the nation couldn’t afford the new program. Ordinary older adults learned to fear falling into the infamous “doughnut hole” coverage gap.
But in its first few years, national data shows, Part D did help elderly Medicare beneficiaries make modest progress. Out-of-pocket costs decreased. Better able to afford their medications, seniors were less likely to stop taking them for financial reasons. And they were less likely to do without other basic needs — like food and heat — in order to pay for drugs.
“I expected that to keep going,” said Jeanne Madden, a health policy analyst at Harvard Medical School. Instead, as she and a team researchers from Harvard and the University of Massachusetts report in the most recent issue of Health Affairs, those downward trends took a U-turn in 2009. “Things improved after Part D, continued to improve for a few years, and then reversed,” she said in an interview.

Obamacare has growing support, even if its name does not

by E.J. Dionne, Jr. 

The Affordable Care Act was supposed to be a slam-dunk issue for Republicans in this fall’s elections. Karl Rove told us so in April, writing that “Obamacare is and will remain a political problem for Democrats.”
So how’s that Obamacare thing working out for the GOP?
The most significant bit of election news last week was the decision of Sen. Mark Pryor, the embattled Arkansas Democrat, to run an ad touting his vote for the health care law as a positive for the people of his increasingly Republican state.
Pryor’s ad is so soft and personal that it’s almost apolitical. After his dad, the popular former senator David Pryor, tells of his son’s bout with cancer, he notes that “Mark’s insurance company didn’t want to pay for the treatment that ultimately saved his life.” The picture has widened to show Mark Pryor sitting next to his father. “No one should be fighting an insurance company while you’re fighting for your life,” he says. “That’s why I helped pass a law that prevents insurance companies from canceling your policy if you get sick, or deny coverage for preexisting conditions.”
Who knew a law that critics claim is so dreadful could provide such powerful reassurance to Americans who are ill?
Democrats have never fully recovered from the Obama administration’s lousy sales job for (and botched rollout of) what is, legitimately, its proudest domestic achievement. That’s one reason Pryor doesn’t use the word “Obamacare” in describing what he voted for. Another is that, in many of the states with contested Senate races this year, most definitely including Arkansas, President Obama himself is so unpopular that if you attached his name to Social Security, one of the most popular programs in American history would probably drop 20 points in the polls.

No Link Found for Deaths and Veterans’ Care Delays

by Richard A. Oppel, Jr.

An investigation by the watchdog office for the Department of Veterans Affairs has been unable to substantiate allegations that 40 veterans may have died because of delays in care at the veterans medical center in Phoenix, according to a letter from the new secretary of Veterans Affairs.
The allegations of deaths created a national scandal that eventually led to the ouster of the previous secretary of Veterans Affairs, Eric Shinseki.
Outrage over the manipulation of waiting list data in Phoenix and other veterans medical centers also led to passage by Congress of a $15 billion plan to improve access to medical providers. The director of the Phoenix hospital, Sharon Helman, has been placed on leave and the department has begun the process of firing her.
A report by the department’s office of inspector general is expected to be released this week that will describe findings from its investigation into Phoenix. Officials from the inspector general’s office have declined to comment on what the report will say.
However, a letter sent from the new Veterans Affairs secretary, Robert A. McDonald, to the inspector general responding to the report’s findings states that the investigation was unable to prove a link between the deaths of 40 veterans and delays in care.


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