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Thursday, April 16, 2015

Health Care Reform Articles - April 16, 2015

Maine’s delayed kidney donation shows disgrace of U.S. health care

By Dr. Philip Caper, Special to the BDN
Posted April 16, 2015, at 11:18 a.m.
Getting health care in the U.S. often seems first and foremost to be about money. Our first encounter when seeking health care always seems to be with the billing department, not a caregiver. The problem often is about too little money.
But the latest health care media kerfuffle in Maine is about too much money. It centers around the efforts of a local woman needing a kidney transplant to find a donor. She posted a note on her car’s window asking for somebody to volunteer. A man did volunteer and turned out to be a good match for the patient.
That was the easy part.
Because the U.S. has not created a system to routinely pay the costs of health care, including organ donation, a friend of the donor set up a crowdsourcing fund to cover some of the medical costs, lost income and other expenses he would incur, estimated to be around $6,000.
To everybody’s astonishment, donations came flooding in and soon amounted to about $50,000. Great news and a great success story.
Not so fast. The size of the fund triggered concern on the part of Maine Medical Center, where the transplant was scheduled to be performed, that the donor would be perceived to be selling his kidney. That turns out to be a violation of federal law. Accordingly, the hospital put the transplant on hold, pending resolution of the legal question.
This is just one more example of the ways in which the dysfunctional way we finance health care actually interferes with the provision of care instead of facilitating it. That is true not only for individual cases, but there is evidence the daunting prospect of unpaid bills in the U.S. is deterring potential organ donors to boot.
In many other wealthy democracies that, unlike the U.S., have well-designed health care systems, the donor’s and the recipient’s medical costs and ancillary expenses would be covered, no questions asked. No crowdsourcing, bean suppers or cookie jars in the general store are needed.
“How can they afford to do that?” we might well ask.
The answer is pretty straightforward. Instead of wasting billions of dollars on unnecessary administrative costs related solely to dealing with multiple insurance companies, they have eliminated those costs by simplifying their health care financing into a single system. Savings in the U.S. from eliminating such administrative waste are credibly estimated to reach $190 billion.
By doing that, they free up resources to devote to actual health care and other pressing public needs such as infrastructure, education and public safety. As a result, they are able to cover everybody; get better results than ours; have systems that are simpler and more popular with their public, politicians and doctors; and spend, on average, about half of what we do. If we had such a system, where money is not the dominant issue in determining whether appropriate care is provided, we could join them.
Unfortunately, the top management in many of our nation’s largest medical centers, where much of the care is provided and much of the money is spent, are well known to be hostile to a simplified, single, nonprofit payment system. Instead, they seem to be preoccupied with increasing their “market share” and boosting their bottom line rather than embracing the most efficient system for providing quality care for everybody.
I would love to be proven wrong and see more influential health care leaders advocating for such a transformation. But there is no evidence this will happen anytime soon. It seems that the barriers to reform of our health care system — apathy, fear and anger, ignorance and greed — are alive and well in our medical-industrial complex.
The fundamental problem is that we still treat health care as a privilege instead a right and spend inordinate amounts of money to make sure nobody who doesn’t “deserve” it has to grovel to get it. In the meantime, this patient’s kidneys continue to fail, her transplant continues to be on hold and the patient and donor continue to be subjected to unnecessary anxiety and delay.
This a disgrace. It’s an entirely unnecessary evil. Americans deserve better than this. We all need to push harder for more fundamental reform.
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.


Has Obamacare Turned Voters Against Sharing the Wealth?


by Thomas Edsall - NYT

With the advent of the Affordable Care Act, the share of Americans convinced that health care is a right shrank from a majority to a minority.
This shift in public opinion is a major victory for the Republican Party. It is part of a larger trend: a steady decline in support for redistributive government policies. Emmanuel Saez, an economics professor at Berkeley and one of the nation’s premier experts on inequality, is a co-author of a study that confirms this trend, which has been developing over the last four decades. A separate study, “The Structure of Inequality and Americans’ Attitudes Toward Redistribution,” found that as inequality increases, so does ideological conservatism in the electorate.
The erosion of the belief in health care as a government-protected right is perhaps the most dramatic reflection of these trends. In 2006, by a margin of more than two to one, 69-28, those surveyed by Gallup said that the federal government should guarantee health care coverage for all citizens of the United States. By late 2014, however, Gallup found that this percentage had fallen 24 points to 45 percent, while the percentage of respondents who said health care is not a federal responsibility nearly doubled to 52 percent.
Robert Blendon, a professor of health policy and political analysis at Harvard’s School of Public Health, wrote in an email that the character of the debate over health care began to change during the 2008 campaign. Before that, according to Blendon, the major issue was the moral principle of providing care for the poor. In the context of the presidential campaign, however, the public focus shifted:
Critics started raising concerns about the cost of these plans — higher taxes and premiums for those with coverage, more government interference in physician choices, and of course the potential of abortion coverage. People with coverage [83.7 percent of the population in 2010] became concerned about the implications for middle income people with these universal plans.
The altered public mood is especially relevant because the Supreme Court is expected to issue a ruling later this year in King v. Burwell, a case that challenges the legality of the Affordable Care Act. 
If the court rules against the A.C.A., public and private health care delivery would be disrupted, to put it mildly. Congressional Republicans are already working on replacement proposals that would, among other things, limit coverage for the poor.

Senate Approves a Bill on Changes to Medicare

By 

WASHINGTON — The Senate on Tuesday overwhelmingly approved sweeping changes in the way Medicare pays doctors, clearing the bill for President Obama and resolving an issue that has bedeviled Congress and the Medicare program for more than a decade.
The 92-to-8 vote in the Senate, following passage in the House last month by a vote of 392 to 37, was a major success for Republicans, who devised a solution to a complex policy problem that had frustrated lawmakers of both parties. Mr. Obama has endorsed the bill, saying it “could help slow health care cost growth.”
The bill, drafted in the House in negotiations between Speaker John A. Boehner and Representative Nancy Pelosi, the Democratic leader, also extends the Children’s Health Insurance Program for two years, through 2017.
Without action by Congress, doctors would have faced a 21 percent cut in Medicare fees on Wednesday or Thursday. Senate leaders cleared the way for final passage by allowing votes on several amendments sought by liberal Democrats and conservative Republicans.
Medicare spent $70 billion last year under the fee schedule used to pay doctors and some other health care professionals. That accounts for about 12 percent of all Medicare spending. Ninety-eight percent of people enrolled in the traditional fee-for-service Medicare program receive at least one physician service during the year.
The legislation moves Medicare in a direction espoused by Mr. Obama and many health policy experts, toward payment based on the quality and value of care, rather than just the volume of services. Organized medicine now accepts that change in principle, and the American Medical Association lobbied strongly for the bill, demanding that Congress “fix Medicare now.”

Doctors See Benefits and Risks in Medicare Changes

By  and 

Dr. Robert Wergin, president of the American Academy of Family Physicians, made little effort to contain his glee Wednesday over the news that Congress had voted to end a reviled payment system for doctors, simultaneously averting a 21 percent physician pay cut and overhauling the way Medicare will pay doctors in the future.
“I just can’t be more positive about it,” said Dr. Wergin, who is a family doctor in rural southeast Nebraska. “The one word is yahoo.”
Then he added: “Now, what next?”
President Obama has signaled that he will sign the bill, resolving an issue that frustrated lawmakers in both parties for more than a decade because it repeatedly required Congress to step in to avert cuts to doctor fees. Doctors and health policy experts have begun to take stock of the practical implications of the legislation, which seeks to move away from paying doctors solely on the volume of their services and toward reimbursing them based on the quality and value of the care they provide. Many said the legislation was short on details about how such quality will be measured, and others expressed apprehension about whether the system will be fair.
“It’s very important legislation in that it aims to support better care and lower costs, but there are a whole lot of details that still need to be filled in,” said Dr. Mark McClellan, a senior fellow at the Brookings Institution and a Medicare administrator in the George W. Bush administration.
Under the new legislation, Medicare will increase the amount it reimburses doctors by 0.5 percent for the next five years. Doctors will earn a 5 percent bonus if they participate in newer payment models that seek to better coordinate care. One example is the so-called medical home, in which a medical team coordinates a patient’s care. They could also work in groups, called accountable care organizations, that receive a set fee to take care of a patient while still meeting quality standards.
“It’s a very big boost to these models,” said Paul B. Ginsburg, a health economist at the University of Southern California, although he and others noted that how these payment models will be defined is still not clear.
Mr. Ginsburg and others expressed more skepticism about another component of the legislation: one that, beginning in 2019, would pay doctors based on how they perform on quality and other measures. Ultimately, the Department of Health and Human Services will decide those standards.


In Race for Medicare Dollars, Nursing Home Care May Lag

By 

Promises of “decadent” hot baths on demand, putting greens and gurgling waterfalls to calm the mind: These luxurious touches rarely conjure images of a stay in a nursing home.
But in a cutthroat race for Medicare dollars, nursing homes are turning to amenities like those to lure patients who are leaving a hospital and need short-term rehabilitation after an injury or illness, rather than long-term care at the end of life.
Even as nursing homes are busily investing in luxury living quarters, however, the quality of care is strikingly uneven. And it is clear that many of the homes are not up to the challenge of providing the intensive medical care that rehabilitation requires. Many are often short on nurses and aides and do not have doctors on staff.
A report released in 2014 by the Department of Health and Human Services’ Office of the Inspector General found that 22 percent of Medicare patients who stayed in a nursing facility for 35 days or less experienced harm as a result of their medical care. An additional 11 percent suffered temporary injury. The report estimated that Medicare spent $2.8 billion on hospital treatment in 2011 because of harm experienced in nursing facilities.
“These nursing homes were not built for this purpose,” said Dr. Arif Nazir, an associate professor of clinical medicine at Indiana University who studies geriatrics. He said many patients leave hospitals with acute medical needs, before infections have been fully treated, or as they adjust to new medications.
“These patients are leaving the hospital half-cooked, and believe me, the latter part of the cooking is the hardest part,” he said.
Competition for these patients has become intense because Medicare, the health insurance program for older adults, pays 84 percent more for short-term patients than nursing homes typically get from Medicaid, the health insurance program for the poor, for long-term residents.
At the same time, hospitals are trying to cut costs by pushing some patients out early — like those who have had hip replacement or heart surgery. Not quite ready to go home, they need continuing care somewhere. And for older adults, Medicare usually pays the bill.

Four largest states have sharp disparities in access to healthcare
The national divide over the Affordable Care Act is beginning to affect Americans' access to medical care and perhaps even their ability to pay medical bills, a new study of the country's four largest states suggests.
Residents of Florida and Texas, which have resisted expanding insurance coverage through the health law, reported more problems getting needed care than residents of California and New York, which both guarantee coverage to their residents.
Floridians and Texans were also significantly more likely to struggle with medical bills and to report that they had medical debt, according to the study from the Commonwealth Fund, a New York foundation that studies health systems domestically and around the world.
"Health policy decisions made by state leaders matter," the study's authors conclude, warning: "Coverage gaps are leaving millions uninsured and without access to affordable coverage."
The new research adds to growing evidence that the 2010 health law may be widening geographic health disparities in the United States, an increase driven in large part by state decisions about whether to open their government Medicaid programs to poor adults.
Some states have expanded Medicaid with federal aid made available by the law; other states — all led by either Republican governors or legislatures, or both — have turned down the assistance, citing concerns about Medicaid's effectiveness and cost.
National surveys have already shown that has dramatically affected rates of coverage.

Maine must protect its older residents, not cut their prescription drug coverage

by Lori Parham - AARP

In a year when Maine is not facing a budget crisis — and with clear bipartisan support for policies that support building an age-friendly Maine — it is troubling that programs that help people stay safely at home are in jeopardy. Maine should lead in taking care of its oldest and poorest residents.
We are halfway through the legislative session, and many of Maine’s seniors are wondering whether they will be able to afford their health care costs and much-needed prescription drugs. While it is understandable that balancing a state budget presents unique challenges, there is an element in the current budget proposal that is of particular concern to seniors and disabled Mainers on low or fixed incomes. These Mainers are grappling, as they do each year, with the challenge of simply getting by from one month to another. Faced with often crushing everyday costs of buying food, heating their homes and other living expenses, some are in great despair. For them, the proposed cuts to the Medicare Savings Program and the Drugs for the Elderly Program will be nothing short of devastating. Sadly, many of our leaders do not understand the depth of the impact.
The Medicare Savings Program, or MSP, covers Medicare Part B premiums that pay for doctor visits, preventive care, ambulance services and outpatient care. It also covers Medicare Part D prescription drug costs and co-payments. Under the current proposal, tens of thousands of seniors will be cut from the program. Depending on their circumstances, these at-risk Mainers will lose some or all coverage for these services.

Keep Patients Healthy, and Doctors Sane

By CAROL W. CASSELLA

BAINBRIDGE ISLAND, Wash. — I OPENED the curtain and found my patient stretched out flat on the recliner, one arm thrown across his eyes. Worried, I reached for his pulse, but then I heard a soft snore. He was sound asleep, before I’d given him any anesthesia. I felt far less relaxed than he seemed to about his upcoming surgery.
Thanks to the Affordable Care Act, this man had health insurance for the first time in over a decade, and his diabetes, hypertension, clogged blood vessels and early emphysema — the death threats silently stalking him for years — had finally been identified and treatment had been started. Already an ophthalmologist had discovered that he would most likely go blind without surgery, and every day he delayed put his vision at risk.
But you don’t undo 10 years of neglected health in six months. I needed time to untangle his newly accumulated tests and labs, talk to him about his symptoms, and make my best guess about whether he was stable enough for surgery. When I finished examining him, we were 20 minutes behind schedule, with a long row of waiting patients.
I recently treated a man with a painful hernia who had passed out two weeks earlier because his blood sugar was seven times the normal level, and an elderly man whose untreated thyroid disease made his eyes bulge and skew — a problem I last saw when I volunteered at a charity clinic in rural Thailand. Every month, more of my patients are new to the medical system because, at last, they have health insurance and can see a doctor about long-neglected symptoms.
Obamacare has ripped the invisibility cloak off millions of people who ignored signs of deteriorating health until the consequences were irreversible. But, in case you haven’t been listening to talk radio, Obamacare is not perfect. Small communities such as mine must cope with thousands of patients who need specialty care at Medicaid and Medicare reimbursement rates. Many doctors are straining to treat urgent and expensive problems while paying rising office overhead — higher in part because meeting new regulations demands more software and staff time. As a consequence, some now cap the number of Medicaid patients they accept in their practice.
Similarly, an empty operating room costs about a thousand dollars per hour, and everyone from the surgeons to the cleaning crew is under pressure to keep it occupied. When I evaluate a sick diabetic patient for 30 minutes instead of 10, we all lose money, regardless of how well or poorly the patient does. As we push more sick patients through an already crowded schedule, I feel increasingly penalized by a system that values how many patients I care for rather than how well I care for them.

Study: Maine Could Save $26 Million by Expanding Medicaid 

By  
The state of Maine could save $26 million dollars in 2016 if it expanded Medicaid, according to a new study.
A New York-based consulting firm based its findings on the experiences of eight states that already expanded Medicaid under the Obama health care law. Proponents of increased health care coverage hope the study will reignite the expansion conversation in the state, but members of the LePage administration say the issue has already been settled.
The Maine Health Access Foundation commissioned the report, which examines the effect of Medicaid expansion on the state's budget for 2016. President and CEO Wendy Wolf says the most compelling finding is that Maine can afford to provide health coverage to people who can't afford it on their own.
"And we can do so in a way that brings additional revenue into the state, and provides additional revenue in the state budget," she says.
Researchers with consulting firm Manatt Health Solutions looked at publicly available data on Maine's health care costs, and compared that to data from eight states that expanded Medicaid in 2014.
"There are two big buckets of savings," says Deborah Bachrach, one of the report's authors. She says Maine currently covers about 40 percent of the health costs for disabled, pregnant and medically needy individuals. Under expansion, the federal government would pick up 100 percent of the tab. Maine also provides mental health and substance abuse treatment for the uninsured. But many of those individuals would gain insurance coverage under federal dollars if the state expanded Medicaid.
"For example, we looked at a budget of just over $40 million, and we estimated that perhaps as much as 50 percent could be withdrawn because the individuals that are relying on this service would have health insurance — they would have MaineCare," she says.
The Manatt study also found it would cost the state about $17 million to implement and manage Medcaid expansion, though that's offset by an estimated $43 million in savings and extra revenue. But Department of Health and Human Services Commissioner Mary Mayhew isn't swayed by the results.
"We don't need to study what we've already experienced," she says. "That when you expand a program as Maine did, many, many more enroll than are ever estimated, and the costs are far greater. And that is certainly what Maine has been digging out of for more than a decade."


Focus on Healthcare for ALL Mainers at the UUC of Ellsworth

By Robin Lovrien
Posted April 14, 2015, at 11:33 a.m.
Saturday, April 25, 2015 7 p.m. to 9:30 p.m.
Sunday, April 26, 2015 10 a.m. to 1:30 p.m.
Location: Unitarian Universalist Church of Ellsworth, 121 Bucksport Rd, Ellsworth, Maine
For more information: 207-598-0468; uuellsworth.org
Assuring that ALL have healthcare is one of the most straightforward ways for Mainers to take care of each other. On the weekend of April 25-26, the Unitarian Universalist Church of Ellsworth, in conjunction with Maine Allcare and the Southern Maine Workers’ Center, will sponsor three events which focus on the need for universal health care in Maine.
The Healthcare Movie, detailing the birth and development of the Canadian universal healthcare system and contrasting that with the US approach to healtcare, will be shown on Saturday, April 25 at 7 Pm at the UUC Church in Ellsworth. Dr. Phil Caper, of the Maine Allcare Board, will introduce the film and then lead a discussion about it after the film. Narrated by actor Kiefer Sutherland, whose grandfather is considered the “father” of Canadian healthcare, the film provides a stunning message about the disadvantages of our insurance-based healthcare system. There will be refreshments at this event as well.
Furthering support for Maine Allcare’s “Healthcare is a Human Right” campaign for universal healthcare for all Mainers, on Sunday, April 26 at 10:20 AM a group from Maine Allcare and the Allen Avenue Unitarian-Universalist Church of Portland will present a worship service entitled,”Who Will Live and Who Will Die?” This service will feature personal stories of those who have been ill-served by their current healthcare as well as those who have been well served in other countries.
Following the service on Sunday, a team from The Southern Maine Worker’s Center will provide detailed information about how single-payer healthcare works. They will also provide training in use of a survey designed to gather personal healthcare stories of Mainers. These stories help people realize the need for a more humane healthcare system and provide data for the campaign to illustrate how the current system is not working.
All these events are free; all take place at the UU Church of Ellsworth, 121 Bucksport Road, Ellsworth. The public is warmly invited to all events. For more information, call event coordinator, Robin Lovrien at 207-598-0468.
This post was contributed by a community member.



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