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7 social media mistakes made in health care @Medici_Manager @kevinmd

If you’re a health care professional, chances are you know a bit about social media, possibly feel compelled to use it sometimes and you might actually be participating in the Facebook/Twitter/LinkedIn/blog revolution.

But there can be real problems in using social media in the health care context. Whether you are in private practice or work for a group of large hospital network, social media mistakes can be costly in terms of misrepresenting your specialty, breaching patient confidentiality, or limiting your business growth. Do you make the following mistakes when using social media?

1.  Avoidance.  Most health care professionals wish social media didn’t exist.  They see it as confusing and a distraction.  The questions about how, when and why social media is important and useful give them indigestion and some go to great lengths to tell others to” just say no”  to all thing social media. The problem with this is social media exists for millions of people (500 million on Facebook alone) and to ignore all things social media is to ignore your patients’ needs and a wide-range of new business development opportunities.

If you’re reading this, you probably aren’t a total avoider, but reading and engaging are two very different things.  Social media is here to stay. Your clients and patients probably use it more than you can even imagine. If you hear colleagues “pooh-pooh”ing social media, correct them quickly.  It’s here, it’s real, it’s a force to be reckoned with and made your own.

2. Fear. After avoidance, many health care professionals move to the stage of reluctant acceptance, but aren’t happy about it.  They are ignorant of why social media is important or how to effectively leverage it to help their patients and grow their practice.Ignorance plus anxiety = fear and we’ve got a lot of fear in health care about social media.   But the fear seems silly from some of the most educated and intelligent people on the planet. I mean, we are not born to do heart or brain surgery (and I sure as hell fear the idea of me doing any kind of surgery), support someone through a suicidal crisis or diagnose schizophrenia. We had to learn how to do these things over time. So too social media.  The sky is not falling. You can learn how to do social media well and effectively. Learning is kinda your thing.

It does take courage to try something new and work at it until we see a positive return.  Will you be a courageous health care provider and learn, experiment and grow via social media?

3. Sloth. Doing social media well is work. Not save-a-life work or Alaskan salmon fishing work, but it requires time, thought and energy.  I hear many health care professionals bemoan the fact that “social media is hard work,” and then vent on and on about the unfairness of health care reform, patients not valuing them, the jerks over at health care insurance companies 1,2 and 3.

It’s important to remember that we all have the same number of hours in a day. Someone who spends an hour writing and talking about negative stuff has wasted 60 minutes of their life.  Another person who uses that time to connect with people is doing a service and building their future. Use your time wisely, work to achieve positive goals. How are you currently using your time?

4. Narcissism. Many health care professionals see Twitter as the place where people talk about their life and what they had for lunch. One of my colleagues has this as his email signature: “Follow me on Twitter: I’ll tell you how I feel.”  Ugh. Narcissistic.  Why? First, he doesn’t get it, second, instead of trying to learn more and understand, he mocks it and looks foolish.  (As an aside if you don’t understand a technology, it is best to say nothing, rather than look stupid in front of colleagues who do understand … just saying.)

Despite how it may seem, social media is not about you. No one reading your wall or tweets really cares about how you feel.  Social media is about making connections, helping others with useful information, sharing ideas and building business opportunities.  If you’re not into doing the above things, by all means avoid social media. But if you want to touch lives and grow professionally, social media is a neat way to jump start the process.

5. Selfishness. Social media is about giving. Giving great content, information, tips that people can use to live a better, healthier life. Sharing articles and info from other sources that you know will help your readers.  The more you give, the more people follow you and when you make an offer to sell a service or product, your followers are so impressed with your quality as a person and a professional, they can’t wait to pay to get more support and help from you.

Social media is not advertising, nor is it your personal water cooler.  Selfish use of social media includes only broadcasting your articles and blog posts, using Twitter as an advertisement stream rather than an opportunity for connection. If you stream only includes your posts about your business and you, take note.  The most powerful use of Twitter is when you use the retweet (RT) and the @ reply.  The people who are leveraging Twitter to the max say that they retweet and reply 90% of the time, with only 10% of their tweets about their own stuff.  Share, converse, introduce people to one another .. you’ll get so much more out of the social media experience.  How do you give on social media?

6. Unethical shenanigans. Social media can be used unethically. The problem is,most health care professionals don’t realize when they are being unethical online.  So let’s try to make this simple. It is unethical to breach your clients’ confidentiality online.  Do not, under any circumstances mention your clients’ experiences or demographics in your social media space.

Another unethical move is to tell your clients how to use social media vis-a-vis your professional relationship. Why? By doing this you are misusing your position of power in the treatment dynamic.

Let’s talk about this for a bit.

Some mental health professionals want to develop social media policies and often these policies say things like, “I have a Twitter account, but if I find you’re following me I’ll remove you,” or “I’m on Facebook, but you can’t friend me because it could be a breach of confidentiality.”

At first glance these statements seem ok, until you think about what the professional is saying here.  Essentially she’s saying “I have a social media life and you can’t participate. I will tell you how to engage in social media.”  The problem is, social media is free and open access. When you have an open Twitter account you imply that anyone who wants to can follow you.  Otherwise, you can make the account private.  So while you can prevent your clients from calling you at home or knowing where you live, you really can’t tell them what to do in social media if you have public accounts.  Well, you can try to tell them what to do but how does that impact your relationship and how do you enforce it?

The attraction of social media is it puts all of us on an equal playing field. There is no cost to entry. If I want to follow Lance Armstrong, President Obama, or musician John Mayer, I can.  When we try to tell our clients what to do in the social media space we are abusing our power. If you’re not comfortable with the openness of this, privatize your accounts or simply don’t participate.

One more unethical trap: Googling clients.  Awhile ago this was a topic of discussion in mental health circles.  Some argued that, in cases of emergency, it’s acceptable to Google a client to get more information. I disagree.  It’s a violation of privacy and opens you up to a pandora’s box of legal liabilities.

7.  Lack of imagination. This may be the worse sin of all.  I’ve realized over the last few months just how powerful social media can be to influence people’s ideas, change behavior and educate large groups of people.  We in health care get so stuck on the first 6 sins in this list that we don’t consider all of the positive possibilities. We stop at simplistic uses, put up barriers by citing HIPAA,  wait for someone more official than we are to give us permission, and essentially stop growth for ourselves and our clients. It’s frustrating.

What if we saw social media as a problem solver? What if we devised ways to use it to educate, inform, treat and improve lives?  What if we become open to the possibilities and then grapple with the confidentiality and access issues?  In health care we tend to put the cart before the horse. We think, “How can this all go wrong?” before we imagine how the world will look if it all goes right.

We can send humans into space for months at a time, do all our banking securely online and video chat with people on the other side of the world. I think we can find a way to make the technology of social media work for health care. Don’t you?

Susan Giurleo is a psychologist who blogs at the BizSaavy Therapist.


Predicting the next 4 years of health reform @Medici_Manager @kevinMD

 | POLICY | DECEMBER 21, 2012

Predicting the next 4 years of health reform

Although members of the Obama team are now celebrating their election victory, the next four years will not be smooth sailing. Ignoring the campaign rhetoric, there is still much more work to be done in order to reshape our health care system; the effect on academic medical centers and teaching hospitals will be significant.

The political conscience is still being driven by the fear of the fiscal cliff, which dominates most Washington conversations. Both political parties agree that health care is a significant contributor to our present and future deficit and that we have to figure out how to deliver more care at a lower cost. But, they argue about what to call it, who gets credit, and whether the solution is bigger government involvement or a dominant private market?The potential cuts to NIH funding and graduate medical education support do not go away with another four Obama years. We anticipate that the president will reform the tax code and transform how we deliver health care. The latter will be his lasting legacy.

However, in all this chaos, there are opportunities. While we no longer hope for a bipartisan middle ground on health care — and rancor will certainly escalate if President Obama is reelected — to many people, the Affordable Care Act is starting to look like a tangible business opportunity. Every insurer is looking at the 30 million uninsured people who will receive coverage through a mix of subsidized private insurance for middle-class households and expanded Medicaid for low-income people. These new markets could be worth $50 billion to $60 billion in premiums in 2014, and as much as $230 billion annually within seven years. The structure and implementation of these programs present specific challenges for AMCs.


Academic medical centers currently deliver 28 percent of inpatient care for Medicaid recipients and 40 percent of uninsured care in the United States — in only 6 percent of the acute care facilities. We have the Medicaid specialty care market cornered — because no one else will accept these patients. The expansion of Medicaid will create stress in our historical access points: emergency rooms and primary care offices. We will be overwhelmed if we do not dramatically reengineer where we deliver care and rethink who should deliver care for what conditions. We will experience costs that quickly spiral out of control if we just expand our current system.

Obama’s re-election removes the indecision about whether to opt in or opt out for many state governors. Most insurers are betting on the fact that dual eligibles (patients who are disabled or poor enough to qualify for both Medicaid and Medicare) will be moved into the managed Medicaid plans. This will require active care management, better EHRs, geomapping of resource utilization, and a greater understanding of the impact of social determinants of health on this population. It will be interesting to see if the role of the insurer really expands to manage the outcome instead of just the cost.

Health exchanges

The implementation of the exchanges poses challenges for states, because they are supposed to be self-sustaining by 2015. Their ability to achieve this comes down to demographics and the size of their insured pool. Small high-risk pools will need to be intensively managed (like the District of Columbia), in contrast to larger populations that can be more loosely managed as they develop state-wide infrastructure. For academic medicine, the exchanges will present specific challenges. Our services could be subject to higher deductibles, copays and even co-insurance if the exchanges choose to tier providers according to cost. As a result, our care could be inaccessible to many patients without means.

There has also been very little discussion about how to transition graduate medical education support into the exchange market. Currently Medicare, Medicaid, and other insurers support the educational mission through explicit or implicit support. Supporting the training of the health care workforce has been considered a public good that increases access and quality for patients. Medicare Advantage programs use a “carve out” to preserve this support, but this option has not yet been part of the exchange discussions.

Physician shortages

The Center for Workforce Studies at the AAMC estimates that the nation will face significant physician shortages by 2020. As the newly insured begin to seek care in 2014, and as we anticipate these shortages, one must wonder who will care for these patients? By 2017, the number of physician retirees will be close to the number of new medical school graduates. While medical schools as a whole have been expanding the number of students they admit, there may not be enough residency positions to accommodate them. The Obama team can ignore the growing physician shortage — but at their peril. Unfortunately, we also continue to debate within specialty societies about who should provide the services, rather than talking about how we can deliver care as a team more efficiently. Use of interprofessional teams holds great promise for improving the efficiency of the physician workforce, and we anticipate that the administration will continue to support innovative reforms in health care delivery.

The election outcome is good news … with caution. Health care reform will continue to move forward, imperfect as it may be. I have great hopes for bipartisan solutions, but I won’t hold my breath. The really hard work is not over; it has just begun.

Joanne Conroy is Chief Health Care Officer at the Association of American Medical Colleges.  She blogs at Wing of Zock and can be reached on Twitter@joanneconroymd.


How Obamacare will create a new normal for medicine @Medici_Manager @kevinmd

 | POLICY | DECEMBER 7, 2012

The 2012 Presidential election is over. Obamacare is the law of the land and is certain to remain so.  There was tremendous uncertainty not knowing whether the law would be repealed, revised or remain.  Many of us opposed the bill, and there certainly are negatives.  Like it or not, it is time to “get over it,” and not a second later than now.  The new-found certainty offers an opportunity to reassess and adapt to the coming changes.

In addition to Obamacare, other pillars of our “new normal” include patient satisfaction surveys, threats of reimbursement cuts, increasing pressure from administrators obsessing over “metrics,” more time drained by cumbersome electronic health records, resentment from patients who blame us for the failings of the healthcare system, as well as a steady stream of frivolous lawsuits with no end in sight.  It’s time to adapt to our “new normal.”

Comparing and contrasting with other industries

In this modern age of Medicine, these factors have been piled on top of the traditional responsibilities of physicians such as life and death, health and wellness, and paradoxically have seemed to rise above them in importance like unstoppable flood waters drowning the ghosts of Hippocrates, Osler and Marcus Welby M.D.  This contributes to poor morale among physicians and understandably so.  Other industries have had to deal with the same concepts for decades, however.  The service industries are bound by “patient satisfaction” measures and always have been.  Businessmen also have to guard against lawsuits. They expect them and manage the risk and accept it as a norm. I doubt they perceive a lawsuit where they did nothing wrong, as life altering like so many physicians do.  Companies often times have decreases in sales just as our reimbursements may drop and constantly have to adapt.  Just about everyone else in the “real world” has to deal with a “boss” of some variety and a necessary part of their job is to keep that person or entity happy, regardless of whether they like them personally or not.  So why do we find it so difficult to deal with such factors?

Are we special?

Are we different?

In a word, “No.”  Not anymore.  It’s time to accept that fact and move on.  We are now cogs, replaceable de facto employees of a massive business-medico-legal-political machine; nothing more.  All indications are that it will remain this way.  Much can be learned from such other industries that have had to adapt to the stark realities ahead of us.  I think for the profession of Medicine to reinvigorate itself, and for us to truly value what we do have again, we must properly manage expectations.

What government will (or will not) do

Though we might each individually be very replaceable, the reality is that we still have extremely high paying jobs in a profession that is relatively recession proof with greatly increasing demand for our services. There are some other positives and ironic realities that I think many physicians are glaringly overlooking.  One is that Obamacare proposes to commit about 1 trillion more dollars towards healthcare over the next 10 years, with tens of millions newly insured.  Necessarily, demand for our services will go up, way up.  And the best (or worst) news is that despite all the talk about “severe rationing” and “draconian reimbursement cuts” there’s good reason to believe that talk is a big load of … nonsense.  That’s right; they’re not going to cut a damn thing.  How can I be so sure?

There has been essentially no real political will, whatsoever, by either political party to make any significant cuts from the federal budget, ever.  Even the most “harsh” and “cruelest” proposals only call for a decrease in the rate-of-increase, of overall spending.  There never has been any, and there’s no reason to predict there ever will be, any policy other than kicking the can down the road until after the next election, and the next one and the next one. The voters have spoken and they want to spend an extra $1,000,000,000,000 on healthcare.  Santa Claus is in fact coming to town! That may be terrible for the country, but it may well be very good for doctors; that is the smart ones.  There may be more hoops to jump through, more requirements and regulations, as well as creative strategies needed to get a “piece of the pie,” but demand for doctors’ services will necessarily increase, and tremendously so.  Also, despite much posturing, tough talk and threats of showdowns year after year, the SGR-fix has always been passed and the budget debt ceiling has always been raised.  Medicare expenditures will necessarily continue to go up, and up, and up. More patients will be insured wanting our services. The elderly baby-boom population will be sick and growing older and need us desperately.

I was told a story by a retired physician about his long deceased cardiologist father who practiced before Medicare was instituted.  He tells of his father who was a very compassionate physician, but a staunch free-market conservative who like many physicians at the time vehemently opposed the proposed Medicare system.  His father would say that physicians provided charity care for free to the disabled and elderly all the time and that Medicare was just a Trojan-Horse for socialists who wanted to take over the American healthcare system.  He may or may not have been correct, but ultimately to his dismay, Medicare passed and became law.  All of a sudden and very unexpectedly, his salary … doubled.  He never complained about Medicare again.

The point of this anecdote is not to suggest that physicians’ salaries will double as a result of Obamacare.  They will not.  However, it is to suggest that despite the 2000 pages of regulations and requirements in the cloud of Obamacare that hangs over our heads, there will be an unexpected silver lining, somewhere.  I think we can simultaneously work vigorously to reform our profession, yet shed the “culture of victimhood” that has grown like mold upon physician attitudes and search for positive opportunities.

Some physicians will “opt-in”

Such new opportunities will not be the same as in the dead era of Osler, Hippocrates and Marcus Welby M.D.  Also, I cannot say that chugging along with the same old strategy, expectations, and disappointments of a bygone Golden Age will be a winning plan, either.  It may involve simply being content as a cog in a large machine or “system.”  It may involve thriving in the role of “corporate soldier,” learning how to “play the game” while finding ways to save costs, increasing efficiency for your group or other groups and “promoting” your hospital.  Others may move into the government side of healthcare and find opportunities in healthcare policy planning and consulting.  Clearly, knowing “the medicine” isn’t enough anymore and in fact, seems the least important of that which is expected of us.

Other physicians will “opt-out”

Greater numbers of physicians will find opportunity in opting-out of the system by making their practices cash only, concierge, or declining to participate in Medicare and a more dominant Medicaid system.  Another option may be for more Emergency Physicians and surgeons to exploit technicalities in Obamacare and States with liberal certificate of need laws and open their own centers that offer services for a flat fee outside of traditional government or private insurances.  As more insurance plans require deductibles in the thousands of dollars and refuse to pay for certain services entirely, such centers may gain more traction where they are feasible.

Others may “opt-out” more insidiously.  The new generation of physicians may very well evolve into protocol-following, brown-nosing, corporate mantra-spewing clock-punchers, indistinguishable from other “providers” all while refusing to make the tremendous sacrifices of doctors past, such as incredibly long hours, over-burdensome call schedules with great sacrifice to marriage, family, and personal well-being.  Maybe that’s okay, and maybe that’s what our new Overlords of Healthcare want and will reward.

More primary care physicians and other specialties likely will take the “9-5, no call” route and leave the after-hours hassles to the ED and hospitalists.  More medical students may pick careers in cosmetics over critical care.  More Emergency Physicians may leave high-stress clinical shift work in the Emergency Department for Administration, group management, Hospice and Palliative care fellowships, Urgent Care ownership or anything else seen as less stressful.  More surgeons and specialists may opt out of emergency call for a less stressful life and a focus on elective cases with higher reimbursement to liability ratios.  I see more Anesthesiologist moving to “lifestyle” positions at ASCs doing elective cases, or pain procedures with little or no call.  Many physicians will consider early retirement.

The silver lining

The pioneers of Medicine did not have to worry about our “new normal” of Obamacare and all of its 2000 pages of regulations and requirements.  They didn’t have to worry about $300,000 of medical school debt, mega-million dollar frivolous lawsuits or being fired over patient satisfaction surveys based on complaints that may or may not even be valid.  But they also didn’t have our modern-day luxuries, salaries, exploding technologies, or a nation of patients soon to be more widely insured and in demand of our services than ever.  There is much worth fighting to reform, yet even more worth fighting to preserve.  All things considered, we are tremendously better off.

Be sure, Obamacare will change modern medicine, and it will change it mightily.  Also be sure, that with us or without us, and whether we look forward to seize new opportunities or look back upon shattered expectations, the profession of Medicine will be alive and well, and thriving more than ever before.

“BirdStrike” is an emergency physician who blogs at WhiteCoat’s Call Room at Emergency Physicians Monthly.


Brandeis professor traces efforts to reshape health care @Medici_Manager @DonaldsonLiam


When President Nixon wanted to overhaul the health care system to provide universal coverage, his administration turned to Stuart Altman.

Ten years later, when Congress created a commission to improve the Medicare payment system, Altman led the effort. And, in the early ’90s, when newly elected Bill Clinton assembled a team to guide his health care policies, Altman was among the first chosen.

There may be no single person with a longer or deeper history in the health care overhaul efforts of the past 40 years than Altman, a professor of national health policy at Brandeis University in Waltham. He has advised five presidents, both Democratic and Republican; authored countless articles about health policy; and served on a variety of task forces aimed at fixing health care on both the national and state levels.

These four decades as policy maker, adviser, and scholar play a central role in Altman’s new book, “Power, Politics, and Universal Health Care,’’ which traces 100 years of debate and confrontation over one of the nation’s most intractable issues. With President Obama’s health care overhaul under attack from Republicans – and certain to be a defining issue in the November election – Altman and his coauthor, former Brandeis fellow David Shactman, show that today’s controversies have roots in the political and philosophical battles that raged a century ago.

In 1915, for example, the American Association for Labor Legislation, a workers advocacy group, proposed that the US government provide health insurance for low-income workers and their families, similar to programs adopted in Germany and England. Special interests, including the insurance industry and American Medical Association, lined up against the plan. Conservatives, raising alarms about government intervention into the private sector, joined the opposition.

“Opponents claimed that national health insurance was a tool of socialists and communists – rhetoric that still reverberates today in the halls of Congress,’’ Altman and Shactman wrote.

Altman first became involved in health care reform in the early 1970s. He earned his doctorate in economics at the University of California, Los Angeles, where he wrote his dissertation on unemployed married women, then went to teach at Brown University. Former colleagues, working at the US Department of Health, Education, and Welfare during Lyndon B. Johnson’s administration, recruited him to study the supply of registered nurses in the workforce.

When Nixon was elected president, Altman stuck around. Although a Republican, Nixon was eager to propose a universal health care plan to compete with more far-reaching alternatives pushed by liberals such as Massachusetts Senator Edward M. Kennedy. Altman was asked to examine policy options. “I was sort of thrust into it,’’ Altman said.

The challenges he confronted – ballooning health care costs and high numbers of uninsured – were “the exact problems we have today,’’ he said. Watergate intervened before the administration’s proposal got very far, and Altman returned to teaching, at Brandeis, after Nixon resigned. But his involvement in policy making was far from over.

From 1984 to 1996, Altman chaired the congressional Prospective Payment Assessment Commission, an independent panel created to oversee Medicare payments to hospitals to help control health care costs. He worked on Clinton’s transition team, only to see his recommendations to build on the existing system rejected in favor of a more sweeping plan that died in Congress.

Altman later served on the Commission on the Future of Medicare during Clinton’s administration, and advised Obama on health policy during the 2008 campaign. Altman conceived the idea for his book during the early debates over Obama’s health care proposals. Ultimately, Obama got his overhaul passed without a single Republican vote.

Altman wanted to explore why health care has proven such a difficult, divisive issue, and why so many attempts to make it more available and affordable did not succeed. Franklin D. Roosevelt, Harry S. Truman, John F. Kennedy, Nixon, Clinton, and any number of lawmakers all failed to push through major proposals.

In fact, Altman and Shactman began their book assuming that Obama, too, would fall short. The book’s working title: “Failure Again.’’

Health care reform has been so intractable because it provides a lightning rod for long-running political and philosophical conflicts over the role of government, according to Altman. While the left favors a social safety net, the right fears creeping socialism. Conservatives prefer to let market forces meet health care needs, but liberals distrust the motives of private business. Advocacy groups representing special interests such as doctors, hospitals, and senior citizens fight any proposal that may cost them money, jobs, or influence.

With these opposing forces constantly in play, the history of health care reform is replete with attempts at compromise, but short on success stories.

In 1974, in a church basement near the US Capitol, opposing factions met in secret to craft a deal on universal health care. Among the attendees were Altman, representing the Nixon administration, and an aide to Kennedy, then advocating a single-payer system, similar to those in Europe and Canada.

“It would make a good ending to the story if the secret church meetings in June resulted in a successful compromise, but it was not to be,’’ Altman and Shactman wrote. “Neither side felt they could agree to the concessions necessary to make a deal.’’

At 74, Altman remains immersed in health care policy. He advises lawmakers, administration officials, and nonprofit groups about health care economics. Chris Jennings, a consultant in Washington who worked with Altman in the 1980s and ’90s, said Altman “is still incredibly relevant.’’

“He continues to be viewed as a substantive and intellectual health policy reform expert,’’ said Jennings.

Altman said the Patient Protection and Affordable Care Act, aka Obamacare, will reduce the number of uninsured Americans – if it survives court challenges and repeal efforts. If the law is undone, Altman predicted, the nation faces “the worst of all worlds’’: high numbers of uninsured and soaring medical costs.

Altman has donated to Democratic candidates, but he is more pragmatist than partisan. Incremental, rather than revolutionary, change, he said, is the best approach for improving the complex patchwork of government programs and private coverage that has evolved over the past century.

The insurance industry remains important to the US economy and must be included in overhaul efforts, he said. At the same time, the federal government’s involvement is vital to ensuring that all have access to health care.

“The idea that you can do it without the government is pure nonsense,’’ he said. “People have a legitimate concern with ‘too much government,’ but the question is, where is the balance?’’

Both the scientific and the social sides of medicine are needed @Medici_Manager @kevinmd

by  on October 21st, 2012 in PATIENT

The word medicine, in today’s world, seems to indicate a hard science in search of cures for many kinds of human ailments, such as cancer.  However, I believe that the true definition of medicine is the practice of healing.  Medicine is both an art and a science because it involves both human and technological interaction.  The art of compassionate care and social interaction must be combined with the science of human physiology and curative methods.  When such a combination of art and science is able to create healing, or at least the improvement of a person’s physical and mental well-being, then it is effective medicine.

The compassion, care, and human emotion required in the artistic side of medicine all make medicine very social.  For example, there are the interactions between a caregiver and a patient in a conversation, as part of a sign of affection, or in kind words of comfort.  A team of doctors and nurses discussing patients’ cases is also an example of the social side of medicine.  This team has social values and acts on those values.  Such values would be the ideals and priorities shared by the members of that team and they form an important component of a patient’s course of treatment.

I think of the scientific and the social sides of medicine not as two separate and mutually exclusive aspects of medicine, but as two important tools that need to be combined for effective healing.

Having been a two-time leukemia survivor, as well as an intern with my own pediatric oncologist, I have gained a deep and personal appreciation for both aspects of medicine.  For example, when I followed my oncologist and mentor on rounds, it was interesting to hear how differently the patients were being discussed outside their rooms as compared to inside their rooms.  Patients on charts were simply a list of facts and medical information.  Their details were analyzed with a focus on optimal medical outcomes.  On the other hand, patients in their hospital rooms are live, sensitive beings, with emotions, opinions, and often with many forms of discomfort.

I am intrigued by how a doctor starts with a lifeless chart of facts, walks into the room of a real person, and, if he or she is a truly effective physician, turns the diagnostic and planning process into a positive and compassionate social interaction with the patient.  In this way, a doctor improves the emotional and physical wellbeing of that person.

When examining the relationship between the scientific and social aspects of medicine, it seems to me that each aspect is necessary for the other to be effective in caring for patients.  My oncologist was very skilled at combining the two.  His ability to effectively combine them is what made him a leader in pediatric cancer care and what also made his patients smile brightly whenever he walked into their rooms.  I know because that is what I experienced when he cared for me.

Unfortunately, many doctors have not fully mastered that combination the way my oncologist had.   I experienced this also during my many hospital stays and visits for my two leukemia treatments, which took place at three different hospitals.   It is quite uncomfortable to have to deal with a doctor who acts indifferently, is uncomfortable talking to people, incapable of looking them straight in the eyes, or is rude when you, as a patient, feel miserable.  Poor bedside manners definitely do not help you get through your demanding cancer treatment.

It is my personal mission to gain a better understanding of how doctors can better combine the scientific and social aspects of medicine in order to increase the amount and quality of physical and emotional healing.   Training doctors in combining the scientific and social sides of cancer care is going to be important if we want to increase cancer survival rates and improve the quality of life for cancer survivors.

Clarissa Schilstra is a student at Duke University who blogs at Riding the Cancer Coaster: Survival Guide for Teens.

After The Election: A Consumer’s Guide To The Health Law @Medici_Manager @KHNews

By Mary Agnes Carey and Jenny Gold KHN Staff Writers NOV 08, 2012

Now that President Barack Obama has won a second term, the Affordable Care Act is back on a fast track.

Some analysts argue that there could be modifications to reduce federal spending as part of a broader deficit deal; for now, this is just speculation. What is clear is that the law will have sweeping ramifications for consumers, state officials, employers and health care providers, including hospitals and doctors.

While some of the key features don’t kick in until 2014, the law has already altered the health care industry and established a number of consumer benefits.

Here’s a primer on parts of the law already up and running, what’s to come and ways that provisions could still be altered.

I don’t have health insurance. Under the law, will I have to buy it and what happens if I don’t?

Today, you are not required to have health insurance. But beginning in 2014, most people will have to have it or pay a fine. For individuals, the penalty would start at $95 a year, or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5 percent of income, by 2016.

For families the penalty would be $2,085 or 2.5 percent of household income, whichever is greater. The requirement to have coverage can be waived for several reasons, including financial hardship or religious beliefs.

Millions of additional people will qualify for Medicaid or federal subsidies to buy insurance under the law.

While some states, including most recently Alabama, Wyoming and Montana, have passed laws to block the requirement to carry health insurance, those provisions do not override federal law.

I get my health coverage at work and want to keep my current plan. Will I be able to do that? How will my plan be affected by the health law?

If you get insurance through your job, it is likely to stay that way. But, just as before the law was passed, your employer is not obligated to keep the current plan and may change premiums, deductibles, co-pays and network coverage.

You may have seen some law-related changes already. For example, most plans now ban lifetime coverage limits and include a guarantee that an adult child up to age 26 who can’t get health insurance at a job can stay on her parents’ health plan.

What other parts of the law are now in place?

You are likely to be eligible for preventive services with no out-of-pocket costs, such as breast cancer screenings and cholesterol tests.

Health plans can’t cancel your coverage once you get sick – a practice known as “rescission” – unless you committed fraud when you applied for coverage.

Children with pre-existing conditions cannot be denied coverage. This will apply to adults in 2014.

Insurers will have to provide rebates to consumers if they spend less than 80 to 85 percent of premium dollars on medical care.

Some existing plans, if they haven’t changed significantly since passage of the law, do not have to abide by certain parts of the law. For example, these “grandfathered” planscan still charge beneficiaries part of the cost of preventive services.

If you’re currently in one of these plans, and your employer makes significant changes, such as raising your out-of-pocket costs, the plan would then have to abide by all aspects of the health law.

I want health insurance but I can’t afford it. What will I do?

Depending on your income, you might be eligible for Medicaid. Currently, in most states nonelderly adults without minor children don’t qualify for Medicaid. But beginning in 2014, the federal government is offering to pay the cost of an expansion in the programs so that anyone with an income at or lower than 133 percent of the federal poverty level, (which based on current guidelines would be $14,856 for an individual or $30,656 for a family of four) will be eligible for Medicaid.

The Supreme Court, however, ruled in June that states cannot be forced to make that change. Republican governors in several states have said that they will refuse the expansion, though that may change now that Obama has been re-elected.

What if I make too much money for Medicaid but still can’t afford to buy insurance?

You might be eligible for government subsidies to help you pay for private insurance sold in the state-based insurance marketplaces, called exchanges, slated to begin operation in 2014. Exchanges will sell insurance plans to individuals and small businesses.

These premium subsidies will be available for individuals and families with incomes between 133 percent and 400 percent of the poverty level, or $14,856 to $44,680 for individuals and $30,656 to $92,200 for a family of four (based on current guidelines).

Will it be easier for me to get coverage even if I have health problems?

Insurers will be barred from rejecting applicants based on health status once the exchanges are operating in 2014.

I own a small business. Will I have to buy health insurance for my workers?

No employer is required to provide insurance. But starting in 2014, businesses with 50 or more employees that don’t provide health care coverage and have at least one full-time worker who receives subsidized coverage in the health insurance exchange will have to pay a fee of $2,000 per full-time employee. The firm’s first 30 workers would be excluded from the fee.

However, firms with  50 or fewer people won’t face any penalties.

In addition, if you own a small business, the health law offers a tax credit to help cover the cost. Employers with 25 or fewer full-time workers who earn an average yearly salary of $50,000 or less today can get tax credits of up 35 percent of the cost of premiums. The credit increases to 50 percent in 2014.

I’m over 65. How does the legislation affect seniors?

The law is narrowing a gap in the Medicare Part D prescription drug plan known as the “doughnut hole.” That’s when seniors who have paid a certain initial amount in prescription costs have to pay for all of their drug costs until they spend a total of $4,700 for the year. Then the plan coverage begins again.

That coverage gap will be closed entirely by 2020. Seniors will still be responsible for 25 percent of their prescription drug costs. So far, 5.6 million seniors have saved $4.8 billion on prescription drugs, according to the Department of Health and Human Services.

The law also expanded Medicare’s coverage of preventive services, such as screenings for colon, prostate and breast cancer, which are now free to beneficiaries. Medicare will also pay for an annual wellness visit to the doctor. HHS reports that during the first nine months of 2012, more than 20.7 million Medicare beneficiaries have received preventive services at no cost.

The health law reduced the federal government’s payments to Medicare Advantage plans, run by private insurers as an alternative to the traditional Medicare. Medicare Advantage costs more per beneficiary than traditional Medicare. Critics of those payment cuts say that could mean the private plans may not offer many extra benefits, such as free eyeglasses, hearing aids and gym memberships, that they now provide.

Will I have to pay more for my health care because of the law?

No one knows for sure. Even supporters of the law acknowledge its steps to control health costs, such as incentives to coordinate care better, may take a while to show significant savings. Opponents say the law’s additional coverage requirements will make health insurance more expensive for individuals and for the government.

That said, there are some new taxes and fees. For example, starting in 2013, individuals with earnings above $200,000 and married couples making more than $250,000 will paya Medicare payroll tax of 2.35 percent, up from the current 1.45 percent, on income over those thresholds. In addition, higher-income people will face a 3.8 percent tax on unearned income, such as dividends and interest.

Starting in 2018, the law also will impose a 40 percent excise tax on the portion of most employer-sponsored health coverage (excluding dental and vision) that exceeds $10,200 a year and $27,500 for families. The tax has been dubbed a “Cadillac” tax because it hits the most generous plans.

In addition, the law also imposes taxes and fees on several major health industries. Beginning in 2013, medical device manufacturers and importers must pay a 2.3 percent tax on the sale of any taxable medical device to raise $29 billion over 10 years. An annual fee for health insurers is expected to raise more than $100 billion over 10 years, while a fee for brand name drugs will bring in another $34 billion.

Those fees will likely be passed onto consumers in the form of higher premiums.

Has the law hit some bumps in the road?

Yes. For example, the law created high-risk insurance pools to help people purchase health insurance. But enrollment in the pools has been less than expected. As of Aug. 31, 86,072 people had signed up for the high-risk pools, but the program, which began in June 2010, was initially expected to enroll between 200,000 and  400,000 people. The cost and the requirements have been difficult for some to meet.

Applicants must be uninsured for six months because of a pre-existing medical condition before they can join a pool. And because participants are sicker than the general population, the premiums are higher.

Enrollment has increased since the summer, after the premiums were lowered in some states by as much as 40 percent and some states stepped up advertising.

A long-term care provision of the law is dead for now. The Community Living Assistance Services and Supports program (CLASS Act) was designed for people to buy federally guaranteed insurance that would have helped consumers eventually cover some long-term-care costs. But last fall, federal officials effectively suspended the program even before it was to begin, saying they could not find a way to make it work financially.

Are there more changes ahead for the law?

Some observers think there could be pressure in Congress to make some changes to the law as a larger package to reduce the deficit. Among those options is scaling back the subsidies that help low-income Americans buy health insurance coverage. The amount of the subsidies, and possibly the Medicaid expansion as well, could be reduced.

It’s also possible that some of the taxes on the health care industry, which help pay for the new benefits in the health law, could be rolled back. For example, legislation to repeal the tax on medical device manufacturers passed the House with support from 37 Democrats (it is not expected to receive Senate consideration this year). Nine House Democrats are co-sponsoring legislation to repeal the law’s annual fee on health insurers.

Meanwhile, the Independent Payment Advisory Board (IPAB), one of the most contentious provisions of the health law, is also under continued attack by lawmakers. IPAB is a 15-member panel charged with making recommendations to reduce Medicare spending if the amount the government spends grows beyond a target rate. If Congress chooses not to accept the recommendations, lawmakers must pass alternative cuts of the same size.

Some Republicans argue that the board amounts to health care rationing and some Democrats have said that they think the panel would transfer power that belongs on Capitol Hill to the executive branch. In March, the House voted to repeal IPAB.

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Forecasting Health Policy For The Post-Election Landscape @Medici_Manager @KHNews

Various news stories examine how the outcome of the presidential election could lead to very different  courses for the health law’s implementation and approaches to Medicare reform.

Kaiser Health News: How The Health Law Might Be Changed By The Next President
On the presidential campaign trail, Republican Mitt Romney has repeatedly called for repeal of the 2010 health law and President Barack Obama has vowed to implement it. Yet both men could face obstacles: Romney may be stymied by the lack of a majority in Congress to do his will and Obama could be forced by fiscal concerns or public opinion to revamp parts of the law. Here is a look at how Obama and Romney might change the health law in the years ahead based on interviews with health policy experts (Carey, 10/31).

The Medicare NewsGroup: Romney Presidency Could Mean Substantial Changes In Access To Health Care, Approaches To Medicare Reform
If Mitt Romney wins the presidential election, this much is certain: He will do everything he can to make good on his vow to repeal the Affordable Care Act, President Obama’s 2010 health care overhaul. However, his ability to follow through on this promise depends on more than just winning the presidential election. There are several “what ifs” that would need to fall into place to bring about substantial changes to Medicare and the Affordable Care Act (ACA) in a Romney presidency; and chief among them is the shape of Congress after next Tuesday’s election (Pasternak, 10/31).

The Medicare NewsGroup: A Second Term For Obama: What It Would Mean For Medicare
If President Obama wins the election and another four years in office, Medicare would be saved from the major overhaul GOP candidates Mitt Romney and Paul Ryan have endorsed. Right? Well, sort of. The notion that Obama is “saving Medicare” certainly is one the Obama campaign hopes will stick with the voting public and, in particular, with seniors and soon-to-be seniors in key swing states, such as Florida, Ohio and Virginia, who want to maintain Medicare in its current form. An Obama victory would almost certainly mean another four years would pass without the possibility that Medicare would be converted into a premium-support, or voucher, program, the GOP’s plan for reform (Szot, 10/31).

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Medicare, Health Law Part Of Obama, Romney Pitches For Votes @Medici_Manager @KHNews

In the campaign’s final days, President Barack Obama and GOP challenger Mitt Romney deliver closing arguments about their health care positions, among other issues.

Los Angeles Times: Romney Resumes Criticizing Obama On The Stump
With five days to go until election day, Romney said voters faced a clear choice, and painted a dim picture of the nation’s future if Obama were reelected – seniors unable to find doctors who were taking additional Medicare patients, middle-aged Americans seeing stagnant wages, annual trillion-dollar debts (Mehta, 11/1).

The Washington Post: Obama Returns To Campaign Trail To Deliver Closing Argument In Whirlwind, Multi-State Trip
Republican presidential nominee Mitt Romney spent the day in the battleground state of Virginia, where he hammered home the central theme of his closing argument to voters: that he is a champion of business whose policies would usher in new jobs and rising incomes for America’s workers and entrepreneurs. … Then [Obama] ticked off more policies he said Romney would pursue that did not represent change: rolling back Wall Street reform, giving a tax cut to the wealthy and overturning the Affordable Care Act, Obama’s signature health-care reform legislation. “Turning Medicare into a voucher system is change, but we don’t want that kind of change,” Obama said (Nakamura, 11/1).

The Associated Press/Washington Post: Obama Harkens Back To The Past And Pitches Change In Closing Argument To Voters
Obama blitzed Thursday from Wisconsin to Nevada to Colorado, where he wrapped up his day with a 10,000-person rally in Boulder. The president acknowledged that many Americans may be “frustrated” that change hasn’t come fast enough. To them, Obama offered a new definition of change that included passing the health care overhaul, bailing out the auto industry, ending the Iraq war and putting the U.S. military on a path to leave Afghanistan (11/2).

The Associated Press/Washington Post: Former CEO Romney Would Enter White House With Broad Agenda, Focus On Data Over Ideology
Should he prevail Tuesday, Mitt Romney would bring a CEO’s eye to the White House and a policy agenda based on a general set of principles and focused more on data than ideology. … Chief on the “To-Do” list, out of necessity: dealing with the so-called fiscal cliff of tax increases and budget cuts. He also promises to start repealing and replacing the president’s signature health care law and overhauling the nation’s tax system. And he would likely have to work with a divided Congress to accomplish it all (11/2).

NPR: Romney’s Baffling Claim About Medicare Pay Cuts For Doctors
Health care in general — and Medicare, in particular — have been big parts of this year’s presidential campaign. But over the last couple of weeks, Republican Mitt Romney has been making a new claim that doesn’t quite clear the accuracy bar. It has to do with $716 billion in Medicare reductions over 10 years included in the federal health law, the Affordable Care Act. And it’s become a standard part of Romney’s stump speech (Rovner, 11/2).

ABC: Obama, Biden Now Sing Different Tune On Medicare ‘Cuts’
Democrats have defended the $716 billion in Medicare savings in the health care law by arguing that seniors would not be affected because  the only spending cuts would be in future payments made to Medicare providers — there would be no cuts whatsoever to actual Medicare benefits. But in 2005, then Sens. Joe Biden and Barack Obama had an entirely different view of spending reductions to Medicare providers. First, some context: The $716 billion in Medicare cost savings in the health care law includes $415 billion in reduced future payments to providers (primarily hospitals, Medicare Advantage, home care, and about $20 billion in fraud prevention). These are only “cuts” in the way Washington defines “cuts” — the payments to providers continue to rise, but at a slower rate (Karl, 11/1).

Detroit Free Press: As Election Draws Near, President Barack Obama Expands Lead In Michigan
President Barack Obama heads into the final weekend of the campaign with a 6-percentage-point lead in Michigan over Republican rival Mitt Romney, a new Free Press/WXYZ-TV (Channel 7) poll shows. The survey suggests that the Democratic incumbent has regained some momentum heading into Tuesday’s election. Obama had 48% support to Romney’s 42%. Ten percent of likely voters were undecided or chose a third-party candidate. … Three-quarters of Romney’s supporters considered themselves enthusiastic — about the same as the number for Obama. Obama got higher marks in the poll on issues such as protecting Social Security and Medicare; making health care available to everyone, and handling the war in Afghanistan. Romney, who made a fortune in private equity and venture capital, slightly topped the president — 46%-44% — on handling the economy and creating jobs (Spangler, 11/1).

The New York Times’ The Caucus: In Swing States, Obama Leads On Handling Medicare
President Obama continues to lead Mitt Romney on the question of who would better handle Medicare in the crucial swing states of Florida, Ohio and Virginia, recent polls of likely voters in all three states found. But as Election Day nears Mr. Romney has narrowed the gap in Florida and Virginia. A series of Quinnipiac University/New York Times/CBS News polls released this week found that while Mr. Romney still trails Mr. Obama on Medicare in all three states, he has made up ground in Florida and Virginia (Cooper and Kopicki, 11/1).

The Washington Post: Michael Bloomberg Endorses Obama
New York City Mayor Michael Bloomberg endorsed President Obama on Thursday, citing climate change as the primary factor and Hurricane Sandy as the event that impelled him to make a choice. The mayor also cited the education competition Race to the Top, health-care reform, gay marriage and abortion rights as reasons to vote for Obama (Weiner, 11/1).

The Wall Street Journal: Union Is Top Spender For Democrats
The Service Employees International Union has emerged as the top outside spender on Democratic campaigns this year, surpassing even President Barack Obama’s main super PAC. SEIU has had particular success in recent years in organizing workers in the health-care and service industries. About half of its members work in health care, including everything from janitors and nurses to home-care workers and security officers. The union’s membership of 2.1 million is up from 1.6 million 10 years ago, even after it lost some during the economic downturn (Trottman and Mullins, 11/1).

Medscape Today: The Last Medscape 2012 Election Survey
When looking at how the responses trended, the surveys suggest that, like the general electorate, healthcare providers’ opinions on President Barack Obama and former Governor Mitt Romney have shifted over time — sometimes dramatically. The surveys provide insight into what healthcare professionals think about the platforms of the presidential candidates and highlight the role of healthcare in the upcoming election (Peckham, 11/1).

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Romney unlikely to repeal health reform law @Medici_Manager

The Republican candidate shows gains in voter support on healthcare issues
October 31, 2012 | By 

Despite vows to repeal the health reform law on his first day of office, Republican presidential candidate Mitt Romney isn’t likely to entirely repeal the Affordable Care Act, attorney experts wrote in a Journal of the American Medical Association.

With a social platform based on “repeal and replace,” according to the candidate’s website, the former Massachusetts governor will likely target the individual mandate, federal Medicaid payments to states and the controversial Independent Payment Advisory Board, according to John Kraemer at the Georgetown University School of Nursing and Health Studies and Lawrence Gostin at Georgetown University Law Center.

“‘Repealing and replacing’ the ACA is unlikely, requiring Obama to lose the presidency and Republicans to hold the House and 60 Senate seats to prevent a filibuster,” they wrote.

The Constitution requires the president execute on laws regardless of whether he disagrees with them, unless Congress grants discretion. The ACA does not provide a blanket waiver that allows states to disregard the ACA’s key provisions, as they would likely violate the “take-care” clause, the authors noted.

However, the ACA does allow waivers for certain provisions that can better fulfill the act. Nevertheless, states must specifically request waivers, which would not become available until 2017. Obama has sought an amendment to make innovation waivers available by 2014.

Romney, although unclear on how it would be carried out, says, he “will issue an executive order that paves the way for the federal government to issue Obamacare waivers to all fifty states,” suggesting states could waive all or parts of the ACA.

According to a Kaiser Family Foundation poll, Romney is gaining ground on voter support for healthcare issues. For instance, Obama and Romney are neck and neck on which candidate would do better for Medicare, with 46 percent support, compared to 41 percent, respectively, according to Kaiser Health News.

For more information:
– read the JAMA article
– see the Romney website details on healthcare
– here’s the Kaiser Health News article and Foundation poll

Related Articles:
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Will health reform survive the election?
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Obama, Romney go head to head on healthcare
Obama vs. Romney on healthcare platforms
Obama or Romney? Hospitals aren’t waiting for election results
Will November bring health reform repeal?

KFF Poll: Obama Lead On Health Issues Lessens @Medici_Manager


OCT 31, 2012

The latest Kaiser Family Foundation health care tracking poll — the last one that will be released before the election — found that President Barack Obama’s advantage on several health issues has diminished.

Kaiser Health News: Capsules: Poll: Romney Narrows Gap With Obama On Medicare Issue
Most troublesome for Obama is that, among likely voters, GOP candidate Mitt Romney has pulled nearly even with him on which candidate would do a better job with Medicare — an issue that resonates in battleground states with large elderly populations like Florida and Pennsylvania. … While the economy remains voters’ most important issue, the poll found over a third of likely voters polled say the Affordable Care Act and Medicare are ”extremely important” to their vote. The law appears to be motivating supporters and opponents of the law about equally (Galewitz, 10/30).

Los Angeles Times: Obama Edge Over Romney On Healthcare Issues Shrinking
More likely voters still trust Obama to do a better job than his Republican challenger in handling the Medicare and Medicaid programs, lowering healthcare costs and determining the future of the healthcare law he signed in 2010. But Romney has cut the president’s lead in half on most issues and nearly eliminated it entirely on Medicare, the Kaiser survey found, compared with a similar poll taken in September (Levey, 10/31).

Politico Pro: Kaiser: Obama’s Lead On Health Issues Drops
[J]ust 46 percent of likely voters now say they trust Obama over Mitt Romney, while 41 percent say they prefer Romney. That’s a sharp drop from the 52 percent-36 percent lead Obama had over Romney in the September poll. And even though 72 percent of seniors opposed a premium support system for Medicare — the overhaul Romney and Paul Ryan are proposing — they actually trust Romney more than Obama on the future of Medicare. Forty-eight percent of those age 65 or older said they trust Romney more, while 43 percent say they prefer Obama (Smith, 10/31).

(KHN is an editorially independent program of the Kaiser Family Foundation.)

In related news, the Los Angeles Times takes a look at what Mitt Romney might do about the health law if he wins –

Los Angeles Times: Romney Says He’ll Undo Obama Healthcare Reform On Day 1. Can He?
Mitt Romney has pledged to do away with President Obama’s healthcare reform law if he wins next week’s election. But would he — or any other president — have the power to do so? Not exactly, according to two Georgetown University professors writing this week in the online version of the Journal of the American Medical Assn. But there are some things President Romney would be able to do if he won … The ACA does allow the president to issue waivers to the states, but only so that they can implement alternatives to the law that are better, not worse, write John D. Kraemer and Lawrence O. Gostin. In any case, those waivers won’t be available to states until 2017 (Kaplan, 10/30).

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Candidates Talk Medicaid In Washington Governor’s Race @Medici_Manager

By Ruby de Luna, KUOW

OCT 25, 2012 

This story is part of a reporting partnership that includes KUOWNPR and Kaiser Health News.

Medicaid – and how to expand the program – has become an issue in the competitive governor’s race in Washington State.

In June, the U.S. Supreme Court ruled that the Affordable Care Act went too far by requiring states to expand Medicaid or else lose all federal funding for the program that covers the poor and disabled.

The ruling left it up to states to decide whether or not to open up the program to cover more low-income people without insurance.  In Washington State, Chris Gregoire, the current Democratic governor, chose to continue with plans for expansion.  But Gregoire is not seeking reelection, and whoever is elected governor this fall could change that course.

Inslee (Photo by Ronald Woan via Flickr)

The issue is playing out in an extremely tight racepitting Democrat Jay Inslee, an eight-term congressman from Seattle, against Republican Rob McKenna, the attorney general.Inslee voted for the health law in Congress and he would follow Gregoire’s lead, expanding Medicaid as mandated by the Affordable Care Act. McKenna says he’s for expansion, but with restrictions. For example, he’d like to require current as well as new Medicaid beneficiaries to share costs.

“We’re only one of the few states where there’s not even a $5 co-pay… what we’re saying is that everyone has to have some financial skin in the game, even just a little bit,” McKenna said.

Currently more than 1.2 million Washington residents get health coverage through Medicaid.  Enrollment to the program has gone up since 2008. The state restricts Medicaid to low income children and their parents, people with disabilities, and the elderly.

After expansion, the program will open up to include adults without children.  And eligibility will be based on income. For a single person, that threshold is just under $15,000 in annual income.  For a family of four, it’s $30,657.

McKenna (Photo by KCTS 9 via Flickr)

McKenna’s position is not a standard issue Republican stance. He doesn’t support the reform plan put forward by the Republican presidential ticket of Mitt Romney and Paul Ryan.  As Washington Attorney General, McKenna joined the lawsuit that challenged the Affordable Care Act, but only the part of the lawsuit that opposed the mandate that most individuals must buy insurance.

The Supreme Court rejected that argument, but  McKenna says the Medicaid portion of the ruling gives states some leverage to negotiate with the feds on how to run the program.

Early projections found that about 500,000 Washington residents would qualify under the expanded program, and roughly half of them would enroll.

McKenna wants Medicaid to be maintained as a safety net.  But he fears that many employers will stop providing health insurance for their lower wage employees and those people will end up on Medicaid. He wants more flexibility from the federal government to keep that from happening.

“Our goal needs to be keeping as many people on private coverage as much as possible, and not moving as many people as possible on to Medicaid.”

Inslee says the expansion will help people without insurance, but there are fiscal benefits for the state as a whole, too, because right now everyone bears the cost for those who don’t have health coverage.

“We know that when people do not have insurance, they get their health care in one place, and that’s the emergency room,” Inslee said. “Instead of getting routine treatment for the flu, their asthma, or whatever, from a primary care doctor, they go into the emergency room.  And that costs four to five times more money to have the same treatment in the emergency room.  And you know who it costs—it costs you and me.”

Inslee says those charges are billed to insurance carriers, and the carriers pass on those costs to consumers.  He also argues that expanding Medicaid is one way to make sure that federal taxes paid by Washington residents are used to help Washington.

“Look, we’re going to pay these taxes one way or another.  This money is going to Washington, D.C. one way or another.  The question is where does it go then—does it go just to Florida and California, or does it come back to the state of Washington by hundreds of millions of dollars?”

If Washington continues with Medicaid expansion, the federal government will pick up 100 percent of the tab for the first three years.  Over time, the federal match tapers to 90 percent by 2020.

This story is part of a reporting partnership that includes KUOW, NPR and Kaiser Health News.

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L’endorsement per Barack Obama del New York Times. @Medici_Manager

The economy is slowly recovering from the 2008 meltdown, and the country could suffer another recession if the wrong policies take hold. The United States is embroiled in unstable regions that could easily explode into full-blown disaster. An ideological assault from the right has started to undermine the vital health reform law passed in 2010. Those forces are eroding women’s access to health care, and their right to control their lives. Nearly 50 years after passage of the Civil Rights Act, all Americans’ rights are cheapened by the right wing’s determination to deny marriage benefits to a selected group of us. Astonishingly, even the very right to vote is being challenged.

That is the context for the Nov. 6 election, and as stark as it is, the choice is just as clear.

President Obama has shown a firm commitment to using government to help foster growth. He has formed sensible budget policies that are not dedicated to protecting the powerful, and has worked to save the social safety net to protect the powerless. Mr. Obama has impressive achievements despite the implacable wall of refusal erected by Congressional Republicans so intent on stopping him that they risked pushing the nation into depression, held its credit rating hostage, and hobbled economic recovery.

Mitt Romney, the former governor of Massachusetts, has gotten this far with a guile that allows him to say whatever he thinks an audience wants to hear. But he has tied himself to the ultraconservative forces that control the Republican Party and embraced their policies, including reckless budget cuts and 30-year-old, discredited trickle-down ideas. Voters may still be confused about Mr. Romney’s true identity, but they know the Republican Party, and a Romney administration would reflect its agenda. Mr. Romney’s choice of Representative Paul Ryan as his running mate says volumes about that.

We have criticized individual policy choices that Mr. Obama has made over the last four years, and have been impatient with his unwillingness to throw himself into the political fight. But he has shaken off the hesitancy that cost him the first debate, and he approaches the election clearly ready for the partisan battles that would follow his victory.

We are confident he would challenge the Republicans in the “fiscal cliff” battle even if it meant calling their bluff, letting the Bush tax cuts expire and forcing them to confront the budget sequester they created. Electing Mr. Romney would eliminate any hope of deficit reduction that included increased revenues.

In the poisonous atmosphere of this campaign, it may be easy to overlook Mr. Obama’s many important achievements, including carrying out the economic stimulus, saving the auto industry, improving fuel efficiency standards, and making two very fine Supreme Court appointments.

Health Care

Mr. Obama has achieved the most sweeping health care reforms since the passage of Medicare and Medicaid in 1965. The reform law takes a big step toward universal health coverage, a final piece in the social contract.

It was astonishing that Mr. Obama and the Democrats in Congress were able to get a bill past the Republican opposition. But the Republicans’ propagandistic distortions of the new law helped them wrest back control of the House, and they are determined now to repeal the law.

That would eliminate the many benefits the reform has already brought: allowing children under 26 to stay on their parents’ policies; lower drug costs for people on Medicare who are heavy users of prescription drugs; free immunizations, mammograms and contraceptives; a ban on lifetime limits on insurance payments. Insurance companies cannot deny coverage to children with pre-existing conditions. Starting in 2014, insurers must accept all applicants. Once fully in effect, the new law would start to control health care costs.

Mr. Romney has no plan for covering the uninsured beyond his callous assumption that they will use emergency rooms. He wants to use voucher programs to shift more Medicare costs to beneficiaries and block grants to shift more Medicaid costs to the states.

The Economy

Mr. Obama prevented another Great Depression. The economy was cratering when he took office in January 2009. By that June it was growing, and it has been ever since (although at a rate that disappoints everyone), thanks in large part to interventions Mr. Obama championed, like the $840 billion stimulus bill. Republicans say it failed, but it created and preserved 2.5 million jobs and prevented unemployment from reaching 12 percent. Poverty would have been much worse without the billions spent on Medicaid, food stamps and jobless benefits.

Last year, Mr. Obama introduced a jobs plan that included spending on school renovations, repair projects for roads and bridges, aid to states, and more. It was stymied by Republicans. Contrary to Mr. Romney’s claims, Mr. Obama has done good things for small businesses — like pushing through more tax write-offs for new equipment and temporary tax cuts for hiring the unemployed.The Dodd-Frank financial regulation was an important milestone. It is still a work in progress, but it established the Consumer Financial Protection Bureau, initiated reform of the derivatives market, and imposed higher capital requirements for banks. Mr. Romney wants to repeal it.If re-elected, Mr. Obama would be in position to shape the “grand bargain” that could finally combine stimulus like the jobs bill with long-term deficit reduction that includes letting the high-end Bush-era tax cuts expire. Stimulus should come first, and deficit reduction as the economy strengthens. Mr. Obama has not been as aggressive as we would have liked in addressing the housing crisis, but he has increased efforts in refinancing and loan modifications.Mr. Romney’s economic plan, as much as we know about it, is regressive, relying on big tax cuts and deregulation. That kind of plan was not the answer after the financial crisis, and it will not create broad prosperity.
Foreign Affairs
Mr. Obama and his administration have been resolute in attacking Al Qaeda’s leadership, including the killing of Osama bin Laden. He has ended the war in Iraq. Mr. Romney, however, has said he would have insisted on leaving thousands of American soldiers there. He has surrounded himself with Bush administration neocons who helped to engineer the Iraq war, and adopted their militaristic talk in a way that makes a Romney administration’s foreign policies a frightening prospect.Mr. Obama negotiated a much tougher regime of multilateral economic sanctions on Iran. Mr. Romney likes to say the president was ineffective on Iran, but at the final debate he agreed with Mr. Obama’s policies. Mr. Obama deserves credit for his handling of the Arab Spring. The killing goes on in Syria, but the administration is working to identify and support moderate insurgent forces there. At the last debate, Mr. Romney talked about funneling arms through Saudi Arabia and Qatar, which are funneling arms to jihadist groups.Mr. Obama gathered international backing for airstrikes during the Libyan uprising, and kept American military forces in a background role. It was smart policy.In the broadest terms, he introduced a measure of military restraint after the Bush years and helped repair America’s badly damaged reputation in many countries from the low levels to which it had sunk by 2008.The Supreme CourtThe future of the nation’s highest court hangs in the balance in this election — and along with it, reproductive freedom for American women and voting rights for all, to name just two issues. Whoever is president after the election will make at least one appointment to the court, and many more to federal appeals courts and district courts.Mr. Obama, who appointed the impressive Justices Elena Kagan and Sonia Sotomayor, understands how severely damaging conservative activism has been in areas like campaign spending. He would appoint justices and judges who understand that landmarks of equality like the Voting Rights Act must be defended against the steady attack from the right.

Mr. Romney’s campaign Web site says he will “nominate judges in the mold of Chief Justice Roberts and Justices Scalia, Thomas and Alito,” among the most conservative justices in the past 75 years. There is no doubt that he would appoint justices who would seek to overturn Roe v. Wade.
Civil Rights
The extraordinary fact of Mr. Obama’s 2008 election did not usher in a new post-racial era. In fact, the steady undercurrent of racism in national politics is truly disturbing. Mr. Obama, however, has reversed Bush administration policies that chipped away at minorities’ voting rights and has fought laws, like the ones in Arizona, that seek to turn undocumented immigrants into a class of criminals.The military’s odious “don’t ask, don’t tell” rule was finally legislated out of existence, under the Obama administration’s leadership. There are still big hurdles to equality to be brought down, including the Defense of Marriage Act, the outrageous federal law that undermines the rights of gay men and lesbians, even in states that recognize those rights.Though it took Mr. Obama some time to do it, he overcame his hesitation about same-sex marriage and declared his support. That support has helped spur marriage-equality movements around the country. His Justice Department has also stopped defending the Defense of Marriage Act against constitutional challenges.Mr. Romney opposes same-sex marriage and supports the federal act, which not only denies federal benefits and recognition to same-sex couples but allows states to ignore marriages made in other states. His campaign declared that Mr. Romney would not object if states also banned adoption by same-sex couples and restricted their rights to hospital visitation and other privileges.Mr. Romney has been careful to avoid the efforts of some Republicans to criminalize abortion even in the case of women who had been raped, including by family members. He says he is not opposed to contraception, but he has promised to deny federal money to Planned Parenthood, on which millions of women depend for family planning.For these and many other reasons, we enthusiastically endorse President Barack Obama for a second term, and express the hope that his victory will be accompanied by a new Congress willing to work for policies that Americans need.

Fact and fiction in the US election healthcare debate @Medici_Manager

Interessante puntualizzazione di Michael McCarthy sul BMJ!

La grande corsa alla Casa Bianca in dieci articoli @Medici_Manager

Possiamo chiedere ai nostri candidati alle prossime elezioni politiche, e ai giornalisti che li intervistano,  di farci sapere che cosa si impegnano a fare per il nostro Servizio Sanitario Nazionale?

Comunque, interessante sintesi de LINKIESTA

RomneyCare vs. ObamaCare – which is better? @Medici_Manager @HarvardHSPH

Possiamo chiedere ai nostri candidati alle prossime elezioni politiche, e ai giornalisti che li intervistano,  di farci sapere che cosa si impegnano a fare per il nostro Servizio Sanitario Nazionale?

Posted by John McDonough  August 27, 2012

Mitt Romney has ended his self-imposed silence on his signature achievement as Massachusetts Governor — declaring himself “very proud” of his signing of the Massachusetts Health Reform law (aka: RomneyCare, Chapter 58) in April 2006.

Appearing on Fox News and other outlets, Romney also declared that the Massachusetts Health Reform law is “better” than the Affordable Care Act (aka: ObamaCare).

Reasonable question: which is better? Personally, I am delighted that the two presidential contenders might debate which government-engineered scheme to expand affordable health insurance is better. Let me try and offer my own answer.

There is no simple answer. On some things, RomneyCare wins, on others, it’s hands-down ObamaCare. And on some, it’s more complicated. Let’s look at some details:

Ways that RomneyCare (RC) is better than ObamaCare (OC):

1. RC provides deeper premium support and cost sharing subsidies to make health insurance more affordable to those receiving public subsidies.

2. RC established an insurance exchange (Connector) with a directive to be an advocate to keep consumers’ health insurance premiums more affordable.

Ways that ObamaCare is better than RomneyCare:

1. OC premium support and cost sharing subsidies help families with incomes up to 400% of the federal poverty line, vs. 300% FPL under RC.

2. OC bans lifetime and annual benefit caps and RC does not.

3. OC eliminates medical underwriting and pre-existing condition exclusions for all health insurance policies. Massachusetts did this in the 1990s and so there was no need for this to be addressed in RC.

4. OC requires health insurance companies to spend at least 80-85 cents of every premium dollar on medical costs as opposed to profits, marketing and overhead.  RC includes no such provisions.

5. OC allows young adults to stay on their parents’ health insurance policies until they reach age 26. RC allows young adults to stay on their parents’ plan for up to two years after they are no longer dependent, and no older than age 25.

6. OC requires that all health insurance policies cover preventive care services (ie: contraception) with no co-pays or other cost sharing. RC has no such protections.

7. OC requires that all Members of Congress and their staffs can receive federal health insurance coverage via the new state health insurance exchanges. RC did not make any similar requirement on Massachusetts state legislators.

8. OC improves Medicare for its beneficiaries by: closing the prescription drug “donut hole;” providing an annual wellness checkup with no cost sharing; lowering beneficiary premiums; and extending the life of the Hospital Insurance/Part A Trust Fund by about 8 years. RC does not address or improve Medicare at all.

9. OC instigates a significant effort to lower the health care system’s administrative costs. RC has no such provisions at all.

10. OC instigates a series of reforms in the delivery of medical care services, including the establishment of accountable care organizations, medical homes, value-based insurance designs, penalties for excessive rates of hospital acquired infections and readmissions, and more. RC does not address delivery system improvements at all.

11. OC establishes a series of programs and initiatives to improve public health, prevention and wellness, including the creation of the first-ever national prevention strategy. RC provides funding for some existing public health programs, though no new public health or prevention initiatives.

12. OC requires every chain restaurant with at least 20 outlets to post on menus and menu boards the calories of every item on its menu. RC has no such public information requirement.

13. OC includes major new funding for community health centers and the National Health Service Corps to improve the nation’s supply of primary care services. RC has no such provisions.

14. OC requires the establishment of a National Health Workforce Commission — appointed, though blocked from convening by House Republicans. RC does not address health care workforce needs at all.

15. OC establishes major new provisions to combat health care fraud and abuse in Medicare, Medicaid, and private insurance. RC includes no provisions addressing fraud and abuse in any sector.

16. OC establishes new standards and a national framework to combat elder abuse, including violence, neglect, and financial exploitation. RC includes no such provisions.

17. OC requires that drug, medical device, and medical supply companies publicly report all gifts, honoraria, and other gratuities to physicians and other licensed medical professionals. RC includes no such provisions.

18. OC directs the Food & Drug Administration to create a pathway for the approval of so-called “bio-similars” or generic-like versions of biopharmaceutical drugs, provisions strongly supported by the pharmaceutical and biotechnology industries. RC has no such provisions.

19. OC includes provisions to ensure that nursing patients and their families are able to obtain transparent information about the ownership and corporate responsibility of nursing homes. RC includes no such protections.

20. OC establishes a new 10% tax on indoor tanning services, which have been linked to the explosion in serious skin cancers, especially melanomas, among young women ages 15-35. RC does not address this epidemic.

OK — 20 versus 2. You may have others which will add or subtract from either column. My verdict — as a BIG fan of MA health reform — ObamaCare wins easily.

Now, one other BIG difference: financing. Here’s Mitt:

“My health care plan I put in place in my state has everyone insured, but we didn’t go out and raise taxes on people and have a unelected board tell people what kind of health care they can have,” Romney said in an interview with CBS’ Denver affiliate, KCNC.

So which plan is better when it comes to financing? Again, fair question.

It’s true, there were no tax increases (unless you count individual and employer tax penalties for non-coverage) associated with MA health reform. But there’s a big difference — Massachusetts got the federal government to pick up the lion’s share of the cost. MA health reform would have been impossible without the Administration of President George W. Bush playing Sugar Daddy.

I would propose — the appropriate comparison is how ObamaCare was financed in comparison with the major health achievement of Obama’s predecessor, George W. Bush.

In 2003, with Bush’s strong support, a Republican-controlled House and Senate approved the Medicare Modernization Act (MMA) that created the Medicare Part D prescription drug benefit, a big advance sought by senior citizen groups for many years. How was that law financed? 25% was financed by Medicare enrollee premiums and 75% was financed by lathering the costs onto the federal deficit. The Congressional Budget Office estimates that between 2010 and 2019, the MMA would increase the federal debt by about one trillion dollars.

In 2010, with Obama’s strong support, a Democratic-controlled House and Senate approved the Affordable Care Act (ACA). White House and Congressional leaders decided that the law needed to be entirely self-financed so that it would not increase the federal debt at all. The CBO estimated in 2010 that the ACA would reduce the federal debt by about $140 billion 2010-2019.

Mitt Romney and the Republican Party support the Part D drug program and indicate no desire to eliminate it. They also indicate no desire, retrospectively, to develop a plan to pay for it beyond allowing the Chinese (and other purchasers of U.S. debt) to finance it. Barack Obama and the Democrats support the ACA and made the most difficult decision to pay for it. You can easily disagree with how they chose to pay for it — and still respect their integrity in taking the political hits to pay for it.

Advantage — Obama and ObamaCare.