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Saturday, December 19, 2015

Health Care Reform Articles - December 19, 2015

Few Uninsured Know Date of Pending Deadline for Obtaining Marketplace Coverage; Many Say They Will Get Coverage Soon, Though Cost is a Concern

Most Democrats Like Medicare-for-All, But Very Few Say the Issue Will Drive Their Votes in the 2016 Elections

Similar to Last Month, More Hold Unfavorable Views of the ACA than Favorable Ones

Few Uninsured Know Date of Pending Deadline for Obtaining Marketplace Coverage; Many Say They Will Get Coverage Soon, Though Cost is a Concern

Most Democrats Like Medicare-for-All, But Very Few Say the Issue Will Drive Their Votes in the 2016 Elections

Similar to Last Month, More Hold Unfavorable Views of the ACA than Favorable Ones

The Affordable Care Act’s third open enrollment period will end on Jan. 31, but the latest Kaiser Health Tracking Poll finds that only a small share of people without health insurance realize it.
Just 7 percent of the uninsured correctly identify January as the deadline to enroll; another 20 percent say the deadline is at the end of 2015, while everyone else either says they don’t know, gives another date or says the deadline has already passed.
People without health insurance remain a key outreach target for the government, outreach groups, and insurers, and the poll finds one in five (20%) report that over the past six months they have personally been contacted by someone about signing up for coverage.
The majority (65%) of the uninsured think they are personally required to have health insurance, though about a quarter (27%) say they don’t think the requirement applies to them personally. (Some in fact may be exempt under specific provisions of the law.)
When asked why they have not personally purchased health insurance this year, nearly half of the uninsured (46%) say they have tried to get coverage but that it was too expensive. Relatively few cite other reasons, including 9 percent who say they’d rather pay a fine than pay for insurance.
Most of the uninsured (55%) say they plan to get health insurance in the next few months. Some may in fact be in the midst of a brief period without insurance; however, a majority (55%) say that they have been uninsured for at least two years.
Recently Democratic presidential candidates Hillary Clinton and Bernie Sanders debated the idea of “Medicare-for-all,” which involves creating a national health plan in which all Americans would get their insurance through an expanded version of the Medicare program. A large majority of Democrats (81%) support the idea of Medicare-for-all, as do most independents (60%), while most Republicans (63%) oppose the idea. The poll did not ask about details or tradeoffs.
At the same time, few Democrats say the issue will be the driving force behind their vote: just 5 percent of Democrats say that it will be the single most important factor in their presidential vote. A third of Democrats (34%) say it will be very important, but not the most important factor, while others say it will be one of many factors they will consider (36%) or that it won’t matter at all (5%). Future polls may explore the issue in greater depth.
As the U.S. Senate voted to repeal the Affordable Care Act (ACA) earlier this month, more of the public views the health care law unfavorably (46%) than favorably (40%), statistically unchanged from last month when a gap reopened between unfavorable and favorable views. The public also remains divided over what Congress should do next with the law, with just over a third (35%) supporting repeal and others favoring scaling back the law (14%), implementing it as is (18%) or expanding what the law does (22%).


Kaiser Permanente Plans to Open a Medical School

By ABBY GOODNOUGH

WASHINGTON — Kaiser Permanente, the health system based in California that combines a nonprofit insurance plan with its own hospitals and clinics, announced Thursday that it would open its own medical school in the state in 2019. 
The system’s leaders said their central goal was to teach Kaiser’s model of integrated care to a new generation of doctors who will be under pressure to improve health outcomes and control costs by working in teams and using technology. 
“Health care is evolving at a very, very rapid pace in our country and we have a model of care that’s increasingly being looked to as an answer,” said Dr. Edward M. Ellison, executive medical director for the Southern California Permanente Medical Group, who is helping to oversee the medical school’s creation. 
Kaiser already trains about 600 medical residents in its own program, and several thousand more complete a portion of their training in it each year. But its medical school, planned for Southern California, would be one of the first run by an integrated health system without an academic partner, said Dr. George E. Thibault, president of the Josiah Macy Jr. Foundation, which encourages innovation in medical schools. 
“If health care is increasingly going to take place in integrated systems,” Dr. Thibault said, “a large part of the medical education experience should be what it’s like to work in a system like that: the efficiencies and the processes and the ways in which patient care is benefited.”
Dr. Thibault added that while Kaiser would not be the only integrated health system involved in medical education, it is “larger than any of them, has greater reach than any of them, greater resources.” 

Martin Shkreli’s Arrest Gives Drug Makers Cover

By 


During his three months as a household name, Martin Shkreli has been a walking, talking (incessantly) personification of one of the pharmaceutical industry’s worst nightmares — the greedy drug company executive.
So his arrest Thursday on securities fraud charges might bring some private cheer to pharmaceutical company executives, who blame him for setting off a public uproar over drug prices.
In fact, in some ways, Mr. Shkreli, chief executive of Turing Pharmaceuticals, has taken the heat off other drug companies.
Most drug companies do not increase prices fiftyfold overnight, as Mr. Shkreli did.
But they often increase prices 10 percent or more a year, far faster than inflation. And those 10 percent increases — on drugs for common diseases like diabetes, high cholesterol and cancer — have a far bigger impact on health care spending than the 5,000 percent increase on Turing’s drug, Daraprim, which might be used by about 2,000 people a year facing possible brain damage from a parasitic infection called toxoplasmosis.
“Because he played the part so well of the evil Wall Street hedge fund guy, Martin really drew attention away from the more serious issues with much bigger dollar impacts,” said John Rother, chief executive of the National Coalition on Health Care, a Washington organization concerned with drug prices. Its members include medical societies, insurers, consumer groups and labor unions.
The arrest and indictment will buttress the efforts of more established pharmaceutical companies to distance themselves from the upstart Mr. Shkreli. They have been arguing that most companies do research to invent innovative new drugs, not merely acquire the rights to old ones and raise their prices.
“He is not us,” Kenneth C. Frazier, chief executive of Merck and chairman of the pharmaceutical industry’s main trade group, said this month at the Forbes Healthcare Summit this month. Now, pharmaceutical executives can look at the federal indictment and say that Mr. Shkreli is an aberration, a rotten apple.

Iowa’s radical privatization of Medicaid is already struggling
by Dana Milbank
On Jan. 1, 31 days before Iowa caucus-goers cast the first votes of the 2016 presidential race, the state will gain another national distinction, but of a dubious variety: It plans to launch the most sweeping and radical privatization of Medicaidever attempted. 
In an extraordinary social policy experiment, Iowa’s Gov. Terry Branstad (R) is kicking about 560,000 of the state’s poorest residents out of the traditional Medicaid health-care program for the poor and forcing virtually all of them to sign up with private insurers. The trend toward managed care for Medicaid has been underway for decades and some 39 states do it to some extent. But experts inside and outside government say no state has tried to make such a wholesale change so quickly — in Iowa’s case, launching the program fewer than 90 days after signing contracts with private health-care companies.
Iowa is conducting an extreme test of a familiar premise of free-market conservatism: that the private sector is more efficient at management and service delivery than government. But the results so far should give pause to those who automatically make such assumptions. The transition of Iowa’s $4.2 billion Medicaid program has made the rollout of HealthCare.gov look orderly.
An Iowa administrative law judge late last month recommended that Iowa throw outthe contract it awarded to WellCare, one of the four companies hired to manage the new program, noting that the company failed to disclose details of its “integrity agreement” with the federal government after the 2014 convictions of three former executives involving the misuse of Medicaid money. In addition, WellCare had paid$138 million to resolve claims that it overbilled Medicare and Medicaid, and the firm had also hired two former Iowa legislators, who improperly communicated with the Branstad administration during the bidding process. 

The Des Moines Register has reported that the four companies selected to operate the Iowa program have had more than 1,500 regulatory sanctions combined and have paid $10.2 million in fines over the past five years. These involved canceled appointments, privacy breaches, untimely processing and failure to obtain informed consent. 

The Iowa rollout has been hampered by delays, and some beneficiaries of the program are only now getting their enrollment packets, though the deadline for signing up is Dec. 17. Health-care providers complain that they are being forced to sign incomplete contracts or face a penalty, and they complain that some contracts don’t cover services that had been covered under the existing Medicaid program.

Branstad’s administration has answered critics by saying the new program will save $51 million in its first six months. But he has been unable to come up with documentation to justify the cost savings for Iowa, which already has a low-cost Medicaid system.

Maine Voices: DHHS action threatens health insurance advocacy group

BY KAREN VACHON AND PATTY HYMANSON
People who want to change their health insurance plans or enroll for the first time for a Jan. 1 start date must do so before Dec. 15.
For some, this is an easy process: They like their current plan and their income will be the same in 2016 – they can opt for the passive re-enrollment. They need not do anything.
But for others, it’s a significant challenge. Changes in income, family status and employment can all make signing up for insurance complicated. Mainers are scrambling for help, and a valuable resource has had its funding cut in half.
Consumers for Affordable Health Care is Maine’s go-to advocacy group for handling complicated matters around consumer access to affordable health care. We’re a licensed health insurance agent and a doctor, and CAHC is a go-to resource when clients and patients have problems navigating the health coverage system.
CAHC has been there to assist consumers, navigators, assisters, insurance agents, brokers and health professionals since the rollout of the Affordable Care Act’s health insurance marketplace in 2014. For more than a decade, it has been Maine’s advocacy resource for consumers who need help navigating the health care system.
It has been pivotal for consumers, agents and health professionals alike.
CAHC also assists low-income Mainers in determining eligibility for MaineCare, Maine’s Medicaid program. The nonprofit raises money privately; thanks to a contract that CAHC had with the Department of Health and Human Services starting in 2006, those private funds are matched with federal dollars, essentially doubling the financial resources available to provide badly needed assistance to Mainers.
In June, the DHHS abruptly ended its contract with CAHC without explanation. This couldn’t have happened at a worse time. In the third enrollment season for Healthcare.gov, Mainers need help now more than ever.
Although Healthcare.gov is working much more smoothly than it did in its first year, Mainers looking for affordable health coverage are still facing many challenges as they navigate our health coverage system.
For example, many Mainers who work seasonally, are self-employed or have fluctuating income struggle to estimate their income correctly, and may have to send additional paperwork to the marketplace.
Some may find that members of their family qualify for MaineCare, and will need to apply to the DHHS to get health coverage. In some cases, applicants whose incomes are close to MaineCare levels may have to apply to MaineCare and get a denial before they can move on in their marketplace application.
And here’s where the problem comes in. We often hear from clients and patients who have waited weeks or even months to get a response from the DHHS. Families who call the agency get recorded messages stating that because of heavy call volume, the DHHS cannot take their call today; call back tomorrow. Tomorrow comes and they receive the same message.

Even in Basic Health Decisions, You Can’t Screen Out Politics

by Aaron Carroll

Like it or not, someone other than your doctor is in the business of recommending your medical treatments.
That job falls to a little-known group called the U.S. Preventive Services Task Force.It has been the subject of increasing controversy, not because it guides decisions, but because some of its recommendations have shifted from encouraging expensive and expansive screening to discouraging its overuse. As with many things in medicine, it’s much more popular to do stuff than to tell people “no.”
Created in 1984 by Congress, the task force makes recommendations about clinical services, like screening for common diseases, that are essential elements of preventive care. The panel of volunteers is appointed by a federal government agency and is composed of experts in a wide field of primary care and preventive medicine, including pediatrics, family medicine and internal medicine, as well as obstetrics and gynecology, nursing and behavioral health.
Their job is to come up with the evidence that justifies one service and not another, whether the problem involves children’s cavities or cancer. What they decide makes a difference in whether doctors routinely think to order a prostate test, a mammogram or a screen for autism.
The panel makes a recommendation and issues a specific letter grade to a service or procedure. An “A” means that the task force recommends that all clinicians offer or provide a service, like screening, because there is a high certainty of a substantial net benefit. A “B” also means that all clinicians should offer or provide a service, but that there is only a high certainty of a moderate net benefit.
A “C” level recommendation tells doctors that a service should not be universally offered. Instead, it should be left to the individual patient and clinician to decide. A “D” recommendation signals that a service should not be used because there is at least a moderate certainty of no net benefits or that harms outweigh benefits.
The Affordable Care Act, in an effort to encourage the use of evidence-based, beneficial preventive services, mandates that all recommendations with an “A” or “B” rating be covered by insurance with no out-of-pocket payments. In other words, the services have to be completely free, regardless of the type or level of insurance coverage.

Why The Affordable Care Act Isn't 'Here To Stay'­­­­--In One Picture


Here is one picture that tells you just about everything you need to know to understand where Obamacare stands–politically and financially.
In the wake of the Supreme Court decision President Obama said, “the Affordable Care Act is here to stay.”
Will it be repealed and replaced by Republicans? I doubt it because it is so unlikely that Republicans will score the electoral trifecta Democrats did in 2008 by winning the White House, the House of Representatives, and having a filibuster proof 60 votes in the U.S. Senate and therefore have the power for a complete repeal and replace.
But does that mean Obamacare is “here to stay” as it is? It clearly is not.
Why not?
Here is the answer in just one picture:
Why is Obamacare still so unpopular? Why aren’t the working class and middle-class signing up for it? Why is the Obamacare population sicker and causing so many big rate increases a year earlier than expected? Is Obamacare financially sustainable in its present form? Is it politically sustainable as it is?
Why is Obamacare still so unpopular?
The most recent Real Clear Politics average of recent Obamacare approval finds 43.6% favoring the law and 51.4% opposing it.
Why have so many more opposed Obamacare than approved it since its inception?
Just look at the picture.
For those eligible for Obamacare, an impressive 76% of those earning between 100% and 150% of the federal poverty level have signed up. [Note: the eligible up to 400% of the federal poverty level includes only those eligible for Obamacare's insurance subsidies and does not include those in or eligible for employer-based plans.]
But after that income level the percentage of those eligible who have signed up drops like a rock.


The Experts Were Wrong About the Best
Places for Better and Cheaper Health Care

By  and  

These maps look nothing alike. Their big differences are forcing health experts to rethink what they know about health costs in Portland, Me.and across the country.

Medicare spending per capita
A lot of what we know about health care costs comes from Medicare data.
Private insurance spending per capita
But a new study suggests that places spending less on Medicare do not necessarily spend less on health care over all.
GRAND JUNCTION, Colo. — As part of his push for the Affordable Care Act in 2009, President Obama came to Central High School to laud this community as a model of better, cheaper health care. “You’re getting better results while wasting less money,” he told the crowd. His visit had come amid similar praise from television broadcasts, a documentary film and a much-read New Yorker article.
All of the attention stemmed from academic work showing that Grand Junction spent far less money on Medicare treatments – with no apparent detriment to people’s health. The lesson seemed obvious: If the rest of the country became more like Grand Junction, this nation’s notoriously high medical costs would fall.
But a new study casts doubt on that simple message.
The research looked not only at Medicare but also at a huge, new database drawn from private-insurance plans – the sorts used by most Americans for health care. And it shows that places that spend less on Medicare do not necessarily spend less on health care over all. Grand Junction, as it happens, is one of the most expensive health-care markets in the country for the privately insured – despite its unusually low spending on Medicare.
Health-care researchers who have seen the new findings say they are likely to force a rethinking of some conventional wisdom about health care. In particular, they cast doubt on the wisdom of encouraging mergers among hospitals, as parts of the 2010 health care law did.
Larger, integrated hospital systems – like those in Grand Junction – can often spend less money in Medicare, by avoiding duplicative treatments. But those systems also tend to set higher prices in private markets, because they face relatively little local competition.
“Price has been ignored in public policy,” said Dr. Robert Berenson, a fellow at the Urban Institute, who was unconnected with the research. Dr. Berenson is a former vice chairman of the Medicare Payment Advisory Commision, which recommends policies to Congress. “That has been counterproductive.”

A prescription for health reform

By Ben Carson   

I HAVE SPENT nearly my entire adult life within the American health care system as a physician, a neurosurgeon, and the chief of pediatric neurosurgery at Johns Hopkins Hospital. I have learned that the needs of each patient are unique. Any broad government mandate, however well-intended, can cause a cascade of effects that reduce the quality of care patients receive. Obamacare has proven to be no exception to this rule.
Since the implementation of Obamacare, Americans have seen health care premiums skyrocket, choices diminish, and quality of care reduced. Medicare and Medicaid enrollees have been relegated to a two-tiered health system in which doctors are harder to find and waiting periods grow longer each year.
My health care plan will establish Health Empowerment Accounts, or HEAs — a new and expanded version of Health Savings Accounts — that will be available to anyone with a valid Social Security number. These accounts will be owned specifically by the individual and not by the government or large corporations. The accounts will also remain with the owner through job changes or state-to-state relocation. HEAs will be created for every child at birth and are freely transferable from one family member to another. This system will enable Americans to build their own health accounts and grow them through a lifetime.

As Health Care Act Insurance Deadline Nears, ‘Unprecedented Demand’

By 


WASHINGTON — Milwaukee, Detroit and Philadelphia have done the best among 20 cities competing to sign up people for health insurance under the Affordable Care Act, while Dallas, Denver and Las Vegas are lagging, the White House said Monday ahead of Tuesday’s deadline to enroll for coverage that takes effect on Jan. 1.
A surge of callers temporarily overwhelmed the government’s capacity to enroll consumers on Monday, prompting officials to record telephone numbers so they could return calls later to arrange for coverage.
Federal officials said that people stuck waiting would be given a brief special enrollment period so they could complete their applications and select health plans after Dec. 15, but still get coverage in January.
“We are seeing unprecedented demand,” said Lori Lodes, a spokeswoman for the Department of Health and Human Services, which runs the federal insurance marketplace.
But successes do vary. In early November, President Obama challenged 20 communities around the country to compete with one another in signing up people who were uninsured. The places were chosen because they had large numbers of uninsured residents or because people lacking coverage accounted for a large share of the population.
A scoreboard prepared by the White House says that Milwaukee — with a Democratic mayor who strongly supports the health law — has made the most progress, followed by Detroit, Philadelphia, Chicago, Charlotte, N.C., and Atlanta. Oakland, Calif., Nashville, Tampa, Fla., and Salt Lake City were also in the top 10.
Dallas, Denver, Las Vegas, New Orleans, Phoenix and Great Falls, Mont., did less well, but are “still in the game,” the Obama administration said Monday.
Not everyone is on board. A news release on Nov. 6 from the Obama administration said that Mayor Michael J. Winters of Great Falls had “embraced the Healthy Communities Challenge.”
http://www.nytimes.com/2015/12/15/us/politics/as-health-care-act-insurance-deadline-nears-unprecedented-demand.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region&region=top-news&WT.nav=top-news

A Prescription for Confusion: When to Take All Those Pills

by Paula Span
“Imagine that your doctor has prescribed you these medications,” the researchers told the older adults, aged 55 to 74, who were participating in an experiment at several Chicago health centers.
“Please show me when you would take these medicines over the course of one day.” After reading the instructions on seven pill bottles, the participants were asked to distribute them in a medication box with 24 slots, one for each hour of the day.
Ideally, the seven meds could have been grouped into just four dosings per day. But only 15 percent of the 464 subjects grasped that possibility. Most commonly, they decided they needed to take pills six times a day; one-third organized the pills into seven daily doses.
Two of the drugs carried identical instructions, but a third of participants didn’t realize that they could be taken together. Almost 80 percent didn’t understand that they could take two drugs together if one label read “every 12 hours” and the other “twice daily” — even though, in this context, they meant the same thing.
“We learn over and over again how challenging it is to maintain a drug regimen,” said Michael Wolf, an epidemiologist at the Feinberg School of Medicine at Northwestern University, who led the experiment.
Medication adherence, a widespread public health concern, is a particular problem for older people. They take many more drugs than younger patients do — seven prescriptions is hardly unusual. Yet studies have repeatedly demonstrated that “the more times a day you have to take a medication, the lower your adherence,” Dr. Wolf said.
When patients can’t come up with a workable plan, or can’t stick to a plan, unhappy consequences can follow.
Drug A seems ineffective, leading a physician to add Drug B, when the real problem is that the patient simply misunderstood the dosage and wasn’t taking enough A. Or an older patient simply throws up his hands over a complex regimen and remains unmedicated or undermedicated, risking serious illness.
“I see this stuff every day in my clinical practice,” said Dr. William Hall, a geriatrician who directs the Center for Lifetime Wellness at the University of Rochester in New York. “There’s tremendous possibility for confusion.”
Let’s acknowledge that some of the reasons that older adults get their drugs wrong are tough to fix.


Single payer momentum builds with PNHP

By Dave Dvorak, M.D., M.P.H.
MetroDoctors: The Journal of the Twin Cities Medical Society, November/December 2015
The 23-year-old young man sitting before me in the emergency department looked ill. Febrile to 101 degrees, he held out his swollen right forearm, revealing a painful abscess the size of a golf ball on its undersurface. A large patch of warmth and redness tracked aggressively beyond his elbow to his upper arm. His symptoms had been progressing for nearly a week. 
I noticed several puncture marks on the tense skin surface overlying the abscess.
   
“That’s where I tried to lance it with a needle to get the pus out,” he admitted sheepishly. “It didn’t work.” The reason he waited for days to seek care, remaining at home as his symptoms progressed: a $3,000 deductible required by his insurance plan. “I just don’t have that kind of money,” he explained.
I suspect most Minnesota physicians have their own stories of patients delaying or forgoing medical care due to unaffordability. A May 2015 Commonwealth Fund study found that 44 percent of privately insured adults don’t get needed care when they’re sick, due to high cost-sharing required by private insurance plans.[1] 
Physicians for a National Health Program (PNHP) is a physician organization that finds such a situation untenable. It believes that a civilized country as wealthy as the United States should be able to find a way to guarantee quality health care for its citizens. It argues that the fragmentation and patchwork inefficiencies of the US health care system have led to decades of skyrocketing costs and corporate profiteering at the expense of patients, who continue to struggle with access and unaffordable health care bills. 
With over 20,000 members nationally and state chapters across the country (including here in Minnesota), PNHP advocates for a fundamental change in the way we pay for health care. Known as single payer reform, it would create a unified, publicly financed system – while keeping the delivery of health care largely private, as it is now. Such reform, PNHP maintains, would soundly achieve the efficiencies necessary to provide affordable and equitable health coverage for all Americans.
The problem, as PNHP sees it, certainly isn’t a lack of national spending on health care – at 17% of our GDP, the US spends twice as much per capita as other industrialized countries.[2] Rather, it’s how we spend our health care dollars. The organization cites a New England Journal of Medicine study showing that a staggering 31% of US health care spending goes to administrative overhead rather than to actual health care.[3] 
In large part, this tremendous inefficiency is rooted in our multi-payer system, with hundreds of profit-driven private insurance companies duplicating the services of one other. As businesses motivated by profit, private insurance companies naturally have incentive to deny or create barriers to coverage, all the while diverting policyholder premiums to advertising, marketing, underwriting, lobbying, exorbitant executive salaries and investor profits – administrative functions wholly unrelated to patient care. 
Meanwhile, physicians grapple with the wasted time and frustrations of practicing in a complicated maze of insurance plans, in which every patient has differing coverage. This necessitates significant billing staff labor and huge hospital billing departments. An increasing share of the physician workday is spent seeking prior authorization from insurance companies in order to treat their patients appropriately. A 2011 Health Affairs study found that interaction with private insurance companies costs the average US physician nearly $83,000 per year.[4]
While the reforms of the Affordable Care Act (ACA) have enabled millions of previously uninsured Americans to obtain coverage, such coverage increasingly is proving to be sorely lacking. Ultra-high deductibles – as high as $7,500 – required to be paid before insurance kicks in make patients reluctant to seek needed care, and vulnerable to financial ruin when they do. A July 2015 Minneapolis Star Tribune article portrays the aggressive manner in which the state’s major hospital systems are pursuing patients for unpaid deductibles through debt collectors and lawsuits.[5] Not surprisingly, unaffordable health bills are the leading cause of bankruptcy for American families, accounting for 62% of US bankruptcies.[6] 

Why the profit-driven market model doesn’t work in health care

By Jessica Schorr Saxe, M.D.
The Charlotte (N.C.) Observer, Dec. 17, 2015
“Is medicine a business or is that an oxymoron?” asked the moderator of panel members convened by Leadership Charlotte recently.
When I started my medical career, we reflected on the nature of medicine – namely, whether it was an art or a science. No one talked about the business of medicine.
Healing medicine has been practiced for over 2000 years, and scientific medicine for more than 100. The perception of medicine as a business is relatively new.
We now view medical care as a commodity, much as we view buying shoes. Though the market model is pervasive, it does not apply to everything. Some services remain public goods such as police protection, fire protection, and education. I posed this question to our audience: Why do we view health care as different from education, to which most of us believe all children are entitled?
Applying the market model to medical care is a poor fit. Many factors interfere with choice, on which market models rely, in health care. When patients have decisions to make about medical care, they are often scared, vulnerable – and sick. If your doctor tells you you need an MRI because you might have a brain tumor, you are unlikely to do extensive research to see which is the cheapest or most accurate – or if an MRI is actually indicated. And, if you research a medical intervention, you are likely to find cost information opaque – and reliable quality measures even more elusive.
A for-profit system creates perverse incentives. Insurance companies make money for investors when they provide less care. For-profit medical institutions have troubling outcomes. Investor-owned hospitals are more expensive. Death rates are higher in for-profit hospitals and dialysis units.
Drug companies make more profits when they sell newer drugs, still patent-protected. This leads to promotion of new drugs as safe, such as rofecoxib (Vioxx), an anti-inflammatory. After being widely prescribed, it was linked to thousands of deaths.
This incentive to promote new drugs obscures the fact that it is generally better to take an old drug rather than the glittery new drug being promoted.
Also obscured is the fact that often non-drug treatments are superior. For instance, exercise is often as effective a treatment for depression as antidepressant medications.
Your neighbor’s health care has different implications for you than most things that we view as commodities. While we are unaffected by which shoes our neighbors buy, their health and health care affect us. For example, we are better off if the sick server at our local restaurant can see a doctor and have the flu or tuberculosis diagnosed and treated.
One of the biggest casualties of the marketization of medicine has been the doctor-patient relationship. When I started my practice, the patient and I were the only ones in the exam room. Now, the room also contains an insurance company, an administrator and a coding specialist. Though invisible, they all have something to say about what the doctor does.
Is the “business of medicine” its future or a blip in a distinguished history that spans centuries?
Do the words of our exemplars still inspire us? If so, let Sir William Osler, father of modern medicine, have the last word: “We are in the profession as a calling, not as a business. ... Once you get down to a purely business level, your influence is gone and the true light of your life is dimmed.”
Jessica Schorr Saxe is a Charlotte family physician and the chair of Health Care Justice – NC. Contact her at: HCJusticeNC@gmail.com.


Coloradans Will Put Single-Payer Health Care To A Vote

by John Daly - NPR

Dr. Irene Aguilar, a Democrat and Colorado state senator from Denver County, is also a medical internist and advocate of universal health care. She led this Denver rally in favor of the 2016 ballot measure.
John Daley/Colorado Public Radio
On a brisk morning in Denver recently, an ambulance pulled up in front of a downtown office tower. "I think the patient is going to make it," Dr. Irene Aguilarsaid as a team rolled out the gurney.
This wasn't a medical emergency, but rather a bit of political theater. The gurney held several big boxes of signed petitions to be delivered to Colorado's Secretary of State's office. The group ColoradoCareYES gathered enough signatures — more than 100,000 — to put a single-payer health system on the ballot next fall.
Under the plan, Coloradans would still pick their own providers of health care, but the new system would pick up all the bills. There would be no deductibles and fewer and smaller copays.
"Our current system gouges us financially," says Ken Connell, a volunteer with ColoradoCareYES. "Too many don't have access until they're too far along the sick path."
Connell says he's been advocating for changes to the U.S. system of health care insurance for more than a decade — ever since his 33-year-old son took his own life. Connell says better access to mental health care could have made a difference for his son.
"We could not get him care," Connell says. "It's a human right. We should be taking care of each other, as long as we can, and we certainly have the resources in this country."
Aguilar, the doctor who accompanied the box-filled gurney, is also a Colorado state senator and a Democrat. She led the rally at Denver's Civic Center the day the signatures were delivered.
"This is not going to be an easy fight," Aguilar says. Obamacare has been a good start, she says. It has sliced Colorado's uninsured rate in half. But many people are still uninsured, and others struggle to pay their premiums and out-of-pocket costs.
The idea behind ColoradoCare, Aguilar says, is "to have everybody paying in but everybody having access to health care that will keep them healthy, keep them working, keep them contributing to our society."



The ACA Excise Tax Targets Where You Live and Other Factors More than Benefit Levels


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