How ACA fuels corporatization of American health care
Posted Nov. 20, 2014, at 11:01 a.m.
A new Harvard study has found that Americans’ trust in the medical profession has dropped dramatically in recent years and lags behind that in many other wealthy countries. At the same time, doctors are becoming increasingly unhappy with our profession. In his new memoir, “ Doctored,” Dr. Sandeep Jauhar eloquently explains why: More and more doctors are coming to view our profession as just another job.
We now have a situation where patients are losing confidence in their doctors, while doctors are losing confidence in our ability to do the right thing for our patients. We have a health care system becoming more hostile to doctors and patients and more friendly to health care corporations.
These trends are collateral damage caused by another trend: our increasingly corporatized, commodified and commercialized U.S. health care “industry” that is being put into hyper drive by the Affordable Care Act. The ACA is accelerating an ongoing wave of hospital consolidations and acquisition of doctors’ practices by large corporations, such as Eastern Maine Healthcare Systems and MaineHealth.
As we continue down this road, doctors see our clinical autonomy disappearing as more and more of us become corporate employees subject to pressure to meet corporate financial goals that often differ from what is best for our patients. Patients sense that pressure as they are rushed through exams and are subject to more tests and procedures, some of them of questionable clinical value. They can almost hear the cash registers ringing as they move through their doctors’ offices, as more wealth is transferred from patients to those selling health care goods and services.
Why is American medicine, once the crown jewel of American professionalism and a proud and respected calling, becoming just another commercial enterprise? In his 2010 book “ Hijacked,” Dr. John Geyman, chairman emeritus of the department of family practice at the University of Washington, explains how during the year-long Congressional debate leading up to enactment of the ACA, the interests of the public, including doctors and patients, were subverted to those of large health care corporations.
The highjacking of health care reform is paying off handsomely. Robert Pear of the New York Times recently described how the federal government and the commercial health insurance industry have morphed into one big fan club for the ACA. He quotes the libertarian Cato Institute’s Michael Cannon explaining that since the ACA’s enactment, “Insurers and the government have developed a symbiotic relationship, nurtured by tens of billions of dollars that flow from the federal Treasury to insurers each year.”
Pear goes on to report that, “Since Mr. Obama signed the law, share prices for four of the major insurance companies — Aetna, Cigna, Humana and UnitedHealth — have more than doubled, while the Standard & Poor’s 500-stock index has increased about 70 percent.”
Pharmaceutical companies also have done very well. The ACA contains no authority for the government to negotiate pharmaceutical prices but continues the federal prohibition on the importation by U.S. residents of lower priced prescription drugs from many foreign countries.
This situation won’t change anytime soon. Congress is gridlocked. What is widely recognized as a drafting error in the ACA — which, in saner times, could have been fixed quickly without attracting much attention — is now headed to the Supreme Court.
Of course, health care is just one of many examples in which the welfare of corporations has been put ahead of the interests of the public, but it may be the poster child. Health care is now more than a sixth of our economy, and human lives and dollars are at stake.
Corporate stranglehold of our public policy traces back to the increasingly corrupt way our political campaigns are financed. The recent midterm elections were a stark reminder of that, setting record levels for corporate spending, even on local races, and saturating voters with negative, intrusive and often obnoxious messages.
What’s at stake is the future of health care and many other issues that will determine what kind of a country our children will live in. That future depends on how active and informed the public is willing to become in electing public officials who place the welfare of their constituents ahead of the wishes of their corporate contributors.
The results of the recent elections are not encouraging. But what’s becoming clearer is that our struggle is not between Democrats and Republicans, liberals and conservatives, or occupiers and tea partiers. It is between real American people and corporations.
I, for one, intend to continue pointing that out. That’s where our attention should be focused.
Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com or through his website at philcaper.net.
The next step for Partners HealthCare
FROM A business perspective, Partners needs a new face, a new voice, and most of all, a new attitude.
That’s why Kate Walsh’s name comes up as a potential candidate to succeed Gary Gottlieb, Partners’s outgoing CEO. Walsh, the current president and CEO of Boston Medical Center, is known as a fearless and independent leader who is passionately committed to BMC’s mission — serving the city’s most needy.
Choosing someone like that to head the state’s largest health care network would send a powerful message about Partners’s reconfigured priorities.
It would also be precedent-setting. The Partners’s CEO job has always been held by a male physician — and Walsh is neither. This break with tradition could be just what the doctor ordered.
The institution is at a pivot point, as it awaits approval of an agreement with the state attorney general that would limit future price increases while allowing it to add South Shore Hospital and the Hallmark Health hospitals in Melrose and Medford to its network. The grueling process has not been good for the Partners brand.
Instead of focusing on the undisputed excellence of medical care and research at Partners hospitals, ongoing headlines suggest a power grab by arrogant bullies who want to dominate a market. That kind of aggressiveness plays well on Wall Street, but feels unseemly in what used to be the genteel world of nonprofit health care. Whether or not a judge gives the go-ahead, Partners has some serious image-rebuilding ahead.
Of course, the current Partners management team doesn’t see it that way; in their view, rival hospitals who are challenging their merger plans are the bullies. But this time, Partners is losing the PR battle.
The network was created 20 years ago when Brigham and Women’s and Massachusetts General Hospital joined forces. It now includes McLean Hospital, Spaulding Rehabilitation Hospital, a network of affiliated physicians, and a chain of community hospitals. Over the years, the growing market share stirred competitor grumbling, and the state and Justice Department spent several years investigating Partners for possible anti-trust violations. Then came last summer’s agreement with the AG. In response, rivals formed a coalition to challenge Partners and won backing from the state’s Health Policy Commission, which questioned the ability of the agreement to hold the line on costs.
Last month, Gottlieb, a psychiatrist with an MBA from the University of Pennsylvania’s Wharton School, announced he was leaving the CEO’s post as of July 1. Likely successors — all doctors — are said to include Peter Slavin, president of Mass. General; David Torchiana, head of the Mass. General doctors group; and Betsy Nabel, president of Brigham and Women’s.
If LePage wants Medicaid case before Supreme Court, he needs a credible case
BDN Editorial Board
Gov. Paul LePage thinks his administration’s bid to trim Maine’s Medicaid rolls even more than it already has is destined to be settled by the nine justices of the U.S. Supreme Court. But he’s mistaken in thinking his administration is raising a compelling legal challenge to a federal law.
“I thought from the first time this would end up on [Chief Justice John] Roberts’ lap,” LePage told the Maine Public Broadcasting Network on Tuesday, the day after a three-judge panel from the 1st Circuit Court of Appeals unanimously ruled against his administration’s efforts to eliminate Medicaid coverage for about 6,000 low-income 19- and 20-year-olds. “This has to be decided at the Supreme Court, and we are just going through the process.”
But the odds of the Supreme Court hearing this case are stacked against LePage.
To start, the court receives about 10,000 petitions each year from parties seeking oral arguments before the court. The justices typically accept 75-80, according to the court’s website. That’s less than 1 percent.
Then, there needs to be a compelling reason for the court to hear the case. The Supreme Court often selects cases that could have national significance or that would allow the court to resolve conflicting legal decisions issued by the country’s 12 Circuit courts.
LePage’s case doesn’t meet those criteria. For one, there’s basically no conflict to settle. Other than the administration and its lawyers, there appear to be few with any legal credentials who believe LePage’s case passes legal muster. Even among Republican governors resisting Obamacare’s Medicaid expansion, LePage is the only one arguing that a provision of the federal law known as “maintenance of effort,” which requires states to maintain existing coverage levels for children until 2019, is invalid.
Maine people, legislators far less divided than some apparently believe
Alice Knapp
I take issue with the newspaper’s editorial claims that we are a sharply divided state, and with its pessimistic predictions for the coming legislative session.
I believe the majority of Maine people are much less divided than the pundit class would have us think. Among other things, we all want a healthy environment in which to live, quality schools for our children, economic opportunity for all our citizens, access to affordable health care, and government that serves the public interest.
As the Green Independent candidate for Senate District 23 this year, I was struck by incumbent legislators’ repeated insistence that the Maine Legislature is a far less divisive place than the media portray. This message is consistent with my impression of the candidates I met on the campaign trail, who all struck me as fundamentally decent and reasonable people sincerely concerned with the welfare of Maine and its people.
Happily, this also describes the vast majority of Maine people I have had the good fortune to meet in the 30 years I have been privileged to call Maine home.
Unfortunately, this good will and willingness to find common ground is routinely sabotaged by highly partisan political campaigns and their special interest backers, which once again this year flooded Maine with campaign spending, much of it originating out of state. Spending records were broken again this year, most of it benefiting even “clean election” Democrats under a loophole that significantly undercuts the purpose of publicly funded campaigns.
I can’t be the only person who can think of better uses for the millions of dollars spent cluttering our mailboxes, phone lines and airwaves with largely vacuous, alarmist and repetitive content.
One ad that stood out for me as representing everything that is wrong with politics these days was the appalling, pre-election, full page ad run by the NextGen Climate Action Committee in a number of Sunday papers proclaiming that “Paul LePage is an embarrassment” and “if you want LePage to take a hike, you gotta vote for Mike.”
While I am no LePage fan, having found him far too quick to dismiss pertinent facts that don’t neatly fit within his ideology (a recipe for bad policy), I have not found the Democrats immune from this defect, and LePage does raise some legitimate issues.
However, I was deeply offended by the incivility of the ad’s inherent disrespect for the many fine men and women of this state who happen to be LePage supporters. I shudder for the future of this state if any significant percentage of Democratic voters truly think that the 48 percent of Maine people who voted for LePage are buffoons, in which case those so afflicted would do well to engage in a bit of self-reflection and community involvement.
Turning to the newspaper’s prognostications, I am not prepared to write off any possibility of a MaineCare expansion in the coming year. Roger Katz was re-elected overwhelmingly, and I hope he has the good sense to reintroduce his eminently reasonable proposal that Maine take the money for the MaineCare expansion for only so long as the federal government is prepared to fund it at 100 percent.
I am no great fan of the Affordable Care Act as it perpetuates and strengthens our unconscionably expensive, administratively irrational and grossly unfair health care system, but there is no good reason not to accept the 100 percent federal funding offered. As many people already have pointed out, those funds would dramatically reduce the fiscal strain of uncompensated hospital care and would pump millions of badly needed dollars into our wage economy.
Expansion also, at least for a spell, would provide people with access to the health care many desperately need. The governor already has demonstrated his willingness to terminate people from MaineCare eligibility, and any administrative expense required to manage the expansion is a drop in the bucket compared to the financial benefits expansion would bring to Maine’s economy and the hospitals for which LePage professed such concern during his first term.
For best health care network Doctors Electronic Medical Office, Health care services
ReplyDelete