Where’s Real Reform in Health Care?

Money-Driven MedicineThe Patient Accountability and Affordable Care Act (Obamacare) is a reasonable first step in health reform, but much more needs to be done. That’s primarily because Obamacare is still dependent on health insurance, which turned health care into an industry that profits from the perverse incentives of treating patients as paying customers. This health care industry  often works to keep patients as paying customers by treating their symptoms rather than providing real cures, and prescribing drugs, performing procedures, and doing unnecessary tests. Since that’s how practitioners are paid, it’s what they do.

The following videos explain how our money-driven system of medicine works, and what’s wrong with it. The video series then ends with an easy-to-understand animated explanation of Obamacare. Read More …

Nine States Deny The Poor Health Care

GOP Governors Deny The Poor Health Care
In Opposing Obamacare’s Medicaid Expansion

 

Where states stand on the Affordable Care Act (Obamacare)

By Peter S. Goodman and Jeffrey Young

RUSTON, La. — With no health insurance and not enough money for a doctor, Laura Johnson is long accustomed to treating her ailments with a self-written prescription: home remedies, prayer and denial.

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Texas Rankings Disappoint

Texas on the Brink: How Texas ranks among the 50 states (2011 version)
Click on the image to view:
“Texas on the Brink,” a 2001 report from the Texas Legislative Study Group that includes many more rankings and supporting statistics.
Not much has changed.

Texas near the Top:

Blessed with an abundance of land, rivers, oil and other natural resources, Texas pioneers built a great state, and even today, it seems that everything is bigger in Texas. I’ve lived in this “Great State of Texas” for most of my live, moving here from Arlington, VA in 1976, and I now live in the state capitol of Austin. So I call myself a Texan, but in many ways I’m not proud of my state. Here’s why. We relish in being #1 in many things, but not these:

  • Texas is #1 in the percent of population uninsured
    (as if that would be something to brag about).
  • We have the largest number of uninsured children (#1).
  • We have the most toxic chemicals released into water (#1).
  • We generate the most hazardous waste (#1).
  • We have the most carbon dioxide emissions (#1).
  • We also have the most executions (#1).
  • We have the second highest birth rate
    and are 4th in the number of kids living in poverty.
  • We have the second highest percent of population under 18.
  • We’re #2 in percent of population with food insecurity.
  • We’re #4 in percent of population living below poverty.

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Health Care Opportunities That Can Make a Real Impact

Refocusing on Health Care Opportunities That Can Make a Real Impact

Acute vs Chronic ConditionsBy Kenneth Thorpe, Chairman, The Partnership to Fight Chronic Disease (original on Huffington Post)

Now that the campaign smoke has cleared, we can expect a refocusing of the nation’s arguments from the question of who will get elected to what will be done about hot-button issues like health care. Expect pitched debates to begin imminently on battlegrounds including, but certainly not limited to, Medicare reform, revisiting the Affordable Care Act, the Independent Payment Advisory Board and medical device taxes.

The fact is though, the more time policymakers spend wrangling over these issues on which there are clear, and not easily bridged partisan divides, the more we’re missing the fundamental steps that can and must be taken if we’re going to contain health care costs without compromising the quality or accessibility of care.

It begins with acknowledging what we don’t know about improving health care, and what we need to do to broaden our knowledge base. And it has to do with the more than 75 million Americans who have not one, but multiple chronic illnesses. Our health care system in this country is quite adept at treating people who have a single disease. We don’t have an effective set of best practices, or an essential foundation of research, to know how to take care of those who are coping with more than one condition.

We have the opportunity to improve this situation, and it should begin with the Patient-Centered Outcomes Research Institute (PCORI.org), the entity created by Congress to evaluate different prevention and treatment therapies and offer scientifically-supported evidence on how to provide patients with the most effective care.

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Obamacare Fact vs. Fiction (Now that you Voted)

voteBy Wendell Potter, Analyst at the Center for Public Integrity, author of Deadly Spin (original on Huffington Post, slightly modified after the election)

Wouldn’t it be great if our candidates had to take a dose of truth serum every morning before hitting the campaign trail? If they did, those of us who recently voted wouldn’t be nearly as confused about what Obamacare is and what it isn’t, what it will do and what it won’t.

Since there is no such truth serum requirement, I believe that many of us actually voted against our own best interests and for candidates who scared them into believing that Obamacare is a government takeover of health care that will bankrupt the country while slashing Medicare benefits. Read More …

Social Media in Politics

Social Media In Politics - an InfographicI’ve posted several articles about social media in HEALTHCARE, including:

This article is about social media in POLITICS. While I try not to subject you to my own political views, they probably shows sometimes when I discuss things Obamacare, Medicare, regulatory oversight, and the future of medicine. But no matter what side of the issues you’re on, you may enjoy this infographic, because so many health-related issues are at stake in this year’s election. And if you feel  compelled to do so, share your thoughts below and justify your views to others.

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Understanding Obamacare

Healthcare became a hot potato during this political season, even though the U.S. Supreme Court ruled that the Affordable Care Act is constitutional. Governor Romney wants to repeal “Obamacare,” but what’s actually in the law and why was introduced in the first place? To address these common questions, I’m reposting one of my first articles on the topic.

This article describes a great presentation by Dr. James Rohack on Health System Reform. Rohack is a practicing cardiologist and Director of Scott & White Center for Healthcare Policy. He is also a professor at Texas A&M Health Science Center and was the president of the American Medical Association from 2009 to 2010 during debates over Obama’s Healthcare Law.

The presentation was held in Sun City, a planned community north of Austin for retirees with active lifestyles. It didn’t include handouts, but I was able to find some of Rohack’s slides online and offer them below with my notes.

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The Waiting Room, a feature length documentary

 

The Waiting Room - Title Text

Certified Nurse Assistant Cynthia Y. Johnson at Highland Hospital in The Waiting Room

Certified Nurse Assistant Cynthia Y. Johnson at Highland Hospital in The Waiting Room

The Waiting Room is like a punch to the gut for people cast off and left out of our U.S. medical care system, what some call the best in the world. When Democrats and Republicans vie for your votes and debate healthcare reform, remember that these are not the people they are talking about. Most don’t even notice the plight of those at the bottom — this ugly underside. But our politicians, and the billionaires who set their agenda, should be made to watch this documentary, because these are the 47 percent they talk about — the people left out of the American Dream. They’re real people.

This character-driven documentary film uses unprecedented access to go behind the doors of Oakland’s Highland Hospital, a safety-net hospital fighting for survival while weathering the storm of a persistent economic downturn. Stretched to the breaking point, Highland is the primary care facility for 250,000 patients of nearly every nationality, race, and religion, with 250 patients – most of them uninsured – crowding its emergency room every day. Using a blend of cinema verité and characters’ voiceover, the film offers a raw, intimate, and often uplifting look at how patients, staff and caregivers cope with disease, bureaucracy, frustration, hope and hard choices during one typically hectic day.

The ER waiting room serves as the grounding point for the film, capturing in vivid detail what it means for millions of Americans to live without health insurance. Young victims of gun violence take their turn alongside artists and uninsured small business owners. Steel workers, cab drivers and international asylum seekers crowd the halls. (movie trailer follows)

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Poverty in America — it’s not what you think.

As our presidential candidates debate the issues, what will they say about Poverty in America? And how do they plan to address the problem?

Click to send a custom tweet, saying Lets Talk Poverty

 

The Line is an important documentary that cover the stories of people across the country living at or below the poverty line. They have goals. They have children. They work hard. They are people like you and me. Across America, millions are struggling every day to make it above The Line.

Poverty is a drag on the economy that also affects the cost of healthcare, as I’ve written before in this blog.

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As Our Health Goes, So Does Our Economic Recovery

 

It’s the Health Care, Stupid:

As Our Health Goes, So Does Our Economic Recovery

As Our Health Goes, So Does Our Economic RecoveryBy Peter Abaci, M.D., Chronic pain specialist
(original on Huffington Post)

“We cannot solve our problems with the same thinking we used when we created them.”
— Albert Einstein

As we head into the final stages leading up to election day, expect the fight over whom and what is best for our economy to rage on. Debating how best to stimulate the economy has been anointed as the de facto topic of importance heading into our upcoming election, but let’s not forget that the health of Wall Street and Main Street is inextricably linked to the health of our citizens. As I have written here in the past, I am no economic expert, but I do work in the trenches every day in a profession that impacts our nation’s budget like no other.

The fact that doctors like me seem to drive the spending of tax dollars more than other occupations like teachers, governors, and generals tells you right there that health care is the elephant in the room of any debate on our economic future.

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Will the Affordable Care Act Help Telehealth Flourish?

Nurse Jennifer Witting

Nurse Jennifer Witting stands beside newly installed telemedicine equipment at the Aspirus Keweenaw Hospital in Laurium, Mich., on June 20, 2012. Photo courtesy of Flickr Creative Commons.

By Brian Heaton (original article at govtech.com)

Opportunity is knocking for telehealth to become a common method of practicing medicine in the U.S.

One-on-one Web-based video chats and other electronic consultation between doctors and patients isn’t new — it’s been used throughout the U.S. in varying degrees for a few years now. But health-care reform, a ballooning  and aging population and a shortage of available family physicians may be a perfect storm that could blow the doors open for telehealth to go mainstream.

As states’ health insurance exchanges — online marketplaces where citizens can compare and purchase insurance plans — begin to debut in advance of the 2014 deadline set forth by the Affordable Care Act (ACA), access to health-care providers should expand for many Americans. Obtaining insurance coverage soon may be easier, but the gap between the number of incoming patients and available primary care doctors is widening.

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A Disease-Creation Economy

Money, Politics and Health Care: A Disease-Creation Economy

By Mark Hyman, MD, practicing physician (original on Huffington Post)

“There is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things. For the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new order.” —Niccolò Machiavelli, The Prince and The Discourses

Medical Economics - follow the MoneyMoney in politics is making our nation sicker, threatening our national security, and ultimately destroying the very economic prosperity the “money in politics” seeks to achieve. It is undermining our capacity to care for our citizens and threatening our global economic competitiveness in invisible, insidious ways. The links, connections and patterns that promote obesity and chronic disease are clear, though. The economic and social impacts are evident. As health care consumes an increasingly large percentage of our federal budget, the negative impacts of money in politics have become too alarming too ignore, and never more obvious than in this election cycle of 2012.

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A Hybrid, Public/Private Model of Health Care

Occupy Healthcare is a movement to influence and impact the future of healthcare, as well as an online community to discuss healthcare reform issues. They invited me to submit my perspectives, and below is what I sent.

Occupy Health Care – a proposal from Wayne Caswell, Modern Health Talk

Historically, the biggest impact in health outcomes has come from public health initiatives such as clean water, sewage systems, immunization programs, and smoking cessation. But that success is minimized by a “sick care” system that is profoundly broken. Perverse incentives cause practitioners to view patients as paying customers, diagnose and treat their symptoms, and keep them coming back, paying, for each test, drug, treatment and procedure.

The ACA was meant to fix that, with more emphasis on positive outcomes, wellness, and prevention, both to minimize the need for medical care in the first place and thus reduce costs, and to maintain a healthy and productive workforce that contributes to a vibrant economy. The ACA was a good start, but there’s still more work to be done, and it won’t come from private industry or the insurance model, because natural incentives prevent it, or work to sabotage it progress.

Contrasting Incentives

I often say the key to health reform is getting the incentives right, and that means getting private insurance companies out of BASIC health care entirely. Their profit motive gives them an incentive to increase costs, knowing that higher costs = more insurance customers paying higher premiums. What I proposed instead is a hybrid public/private model that would capitalize on contrasting incentives, eliminates the need for health insurance, and saves over $1 trillion per year.

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Healing America’s Health Care System

By Susan Blumenthal, M.D., Former U.S. Assistant Surgeon General
Written in Collaboration with Jenny Shelby
(Original text and statistics graphic from Huffington Post)Healing Health Care

Not all threats to our nation are overseas. Within our own borders, enemies such as chronic and infectious diseases, as well as rising medical costs, threaten individuals, families, communities, and the national security of our country. Health care costs constitute 18 percent of the Gross Domestic Product (GDP) of the United States, amounting to $2.6 trillion. In comparison, approximately 6 percent of the GDP is spent on defense. Although the U.S. spends twice as much on health care as any other nation, the World Health Organization (WHO) reports that the United States ranks 50th in life expectancy and 39th on the overall health status of its citizens worldwide. America’s health care system is in crisis: It is a “sick care” system, not a health care system. However, healing has now begun. Just over a month ago, the United States Supreme Court handed down its landmark ruling to largely uphold the Patient Protection and Affordable Care Act of 2010, a major step toward redesigning the U.S. health care system and improving the health of all Americans. Read More …

Is Obesity a Disease? What do YOU think?

Donuts Don't Grow On Trees (a music video by Barry David Butler)The American Medical Association (AMA) recently took up the question of whether obesity should be classified as a disease but deferred any decision to a later date. As noted in HBO’s The Weight of the Nation, obesity has now become the largest threat to the health, wellness and future survival of our nation. It’s an epidemic and one that needs swift action and an unprecedented public health campaign. But is it a disease? And what would it mean if we called it that? What do YOU think?

American Heritage Dictionary defines DISEASE as (1) an abnormal condition of a part, organ, or system of an organism resulting from various causes, such as infection, inflammation, environmental factors, or genetic defect, and characterized by an identifiable group of signs, symptoms, or both AND (2) a condition or tendency, as of society, regarded as abnormal and harmful.

Even doctors disagree. Read More …

Too Much Hype in the Mobile Health App World?

Barbara Ficarra, RN, BSN, MPABy Barbara Ficarra, RN, BSN, MPA

[Original post, “Too Much Hype in the Mobile Health App World?” published on The Huffington Post on 7/23/12 in the Healthy Living/Health News Section.]

The Wild West of mobile health (mHealth) is taking the health care industry by storm, but “there are no rules to the game,” said Joseph C. Kvedar, M.D., founder and director at the Center for Connected Health in a recent interview. Mobile health is a “game changer,” he added, but there is a lot of hype because there are a lot of people developing health apps just to “get rich quick.”

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Now the Real Work of Healthcare Reform Begins

Roberts Saves Obamacare: Now the Real Work of Reform BeginsArianna Huffington
By Arianna Huffington

The narrow survival of the Affordable Care Act last week was certainly cause for celebration. But as the jubilation subsides, it’s important to realize that having avoided what would have been a giant step backward doesn’t mean we’ve taken a giant step forward. Because the law as it now stands is only the first step toward health care reform.

On Sunday’s This Week, Vicki Kennedy (Ted Kennedy’s widow) spoke movingly of how “health care reform was the cause” of her husband’s life. “He believed that it was a moral issue,” she said, “that it defined the character of who we were as a society, who we were as a country, and that decent, quality, affordable health care should be a fundamental right and not a privilege.” She went on to say, “Families can go to sleep relaxed and happy knowing that their children who have asthma or diabetes or allergies are covered by insurance and aren’t barred because they have a pre-existing condition.” Read More …

High Court upholds Obamacare. What it means for YOU

Supreme Court says, "ACA OK"By Linda Bergthold (original on Huffington Post)

In a surprise decision, the U.S. Supreme Court has upheld the constitutionality of the Affordable Care Act passed in 2010. You will hear a lot of commentary from legal and policy experts in the next few weeks about this decision, but this post is about what the Court action means for YOU personally.

The outcry from the right will be deafening, and there will be attempts by the House Republicans between now and November to take out sections of the law, although the Senate Democratic majority is not likely to approve any of those actions. Obviously, if the Republicans win the presidency and the Senate in November, the full ACA may be whittled away before its full 2014 implementation date. Now is the time to acquaint yourself with what the health reform law really means to you — while you still have it.

1. If you are employed and enjoy health insurance as part of your work benefit package: The Affordable Care Act does not currently have a large impact on large self-insured companies; however, as the law is fully implemented in 2014 and beyond, there is a chance that your employer may determine that employees can get cheaper coverage through a state exchange and over time some employers may drop employer-sponsored coverage. If you work for one of those companies, you may actually have more choice of plans through an exchange and depending on whether or not the employer subsidizes you or you are eligible for a federal subsidy, you may pay less than you do now. Until that time, you will see a few benefits of the ACA — no lifetime limits on your benefits; restrictions on annual limits; preventive services without co-pays; and adult children allowed to stay on parents’ plans until age 26. Read More …

Health Reform needs a WELLNESS emphasis

This intimate but tasteful photo of a man and wife in bed shows how Sex can be used to promote Health & Wellness.How can healthcare systems encourage patients to take greater ownership of their health so they live longer? That was the question posed to a Linkedin discussion group that generated some interesting responses. I initially weighed in with:

Public Health and Social Programs

We don’t often think of clean running water, indoor toilets, sanitation systems, and school vaccinations as having profound effects on the health of our citizens, but they have. So too would programs that address poverty, unemployment, and the widening income gap. That’s why next on my list is access to nutritious food, exercise opportunities, and full-time employment, which translates into access to health insurance.

Others said consumers would need support from various health care organizations and suggested several initiatives designed to move from medical response systems to health, wellness and prevention systems. Read More …

Telemedicine becoming the new house call

 

Travis Proctor logged onto his computer, turned on his new webcam and clicked his mouse. Within seconds, the 42-year-old father of three was face to face with Dr. Kelvin Burton, his primary care physician.

Just months ago, Proctor would have had to drive for nearly an hour round-trip from his home in Powder Springs to Burton’s Douglasville family care practice just for a checkup. Not anymore. (Read more at The Atlanta Journal-Constitution).

The referenced article by Gracie Bonds Staples prompted a Linkedin discussion where I couldn’t help but respond. Here’s what I said:

Telemedicine includes video calls with patients, video consultations among specialists, remote monitoring of sensor devices, and more, all aimed at increasing service, improving outcomes, and lowering costs.

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