June 2009 Archives

"At last count, the AMA claimed about 245,000 members, a number that has declined in recent years. Of these, 195,000 are practicing physicians. That's only about 20% of all practicing physicians in the U.S." 

"We don't know precisely how many doctors support a public-plan option. Polls indicate broad support among doctors for universal coverage and for other progressive measures, and even the AMA has pulled back slightly from its outright rejection of a public plan. A sizable minority of physicians actually supports a single-payer plan."

"A nurse came home and went over all my medications. She even went over the labels in our canned food," [a patient with congestive heart failure] said. "I knew salt was bad, but I still used it. But this nurse explained it more thoroughly and now we don't use salt." 

Experts don't agree on how many readmissions are avoidable. Dozens of promising initiatives designed to cut down on them are underway. But many experts say sweeping changes are needed in how health care is delivered and how hospitals and doctors are paid - sensitive issues that confront Congress and the medical industry in the debate on overhauling the health system.

From Politico, more GOP organization around opposing the public option:

While Democrats plow through a mammoth health reform bill in committee, Senate GOP leaders are using the congressional break to build the case against a government option for health care. 

Minority Leader Mitch McConnell (R-Ky.), Sen. John McCain (R-Ariz.) and Sen. John Cornyn (R-Texas) have set up a public discussion at the University of Texas MD Anderson Cancer Center in Houston on Tuesday, hoping to gin up public opposition to the public plan. 

Per the ever-impressive Monday Memo from the Deloitte Center for Health Solutions, some interesting "by the numbers" related to health care:

The Washington Post's "Daily Dose" has a good update of what to expect this week, with Congress on break and the White House "filling the health-care space with a series of events -- in person and over the Internet -- to keep the spotlight on the president's top domestic priority." Here's a brief overview on where things stand:

Senate Finance Committee members left Washington with no bill and no clear roadmap for how it intends to meet its goal of delivering comprehensive health coverage to the majority of Americans for no more than $1 trillion over the next decade. Much attention is being given to the panel because analysts expect it to offer the best hope of a bipartisan compromise.

With all the discussion about health reform and cutting costs out of the system, prevention and wellness are getting nods right and left. From today's LA Times Opinion page: 

Just as the incentives for insurers and providers must change, so must the incentives for consumers. Far too many healthcare dollars are being spent on ailments that could have been prevented. Doctors typically start by citing America's obesity problem -- this country has the highest obesity rate in the developed world by far, contributing to such costly chronic illnesses as diabetes and heart disease -- but they also point to simpler behavioral lapses, such as the high percentage of patients who don't take their medications as directed. Grocery giant Safeway has demonstrated that employers can save themselves and their workers money by providing financial incentives for healthy behavior and making workers responsible for a meaningful share of their healthcare expenses. 

The advertising wars around health care reform are, as expected, really heating up: 

Whether the advertising reaches the level of 1994 remains to be seen. Then, the health insurance industry ran a series of TV ads featuring a couple, Harry and Louise, that helped to bring down President Clinton's complex plan. 

This week's entries have been the most pointed so far this year. The U.S. Chamber of Commerce ran a full-page ad in Roll Call, a Capitol Hill newspaper, opposing the employer mandate and public insurance plan. "Health care reform that punishes employers would be bad for the economy and jobs," the ad warned.  

"You're too smart to go into family medicine." 

A few days ago we pointed out an article about the dearth of primary care doctors in the United States. Here's a different twist on the issue: "No relief: Shortage keeps older docs on the job / Young doctors opt for specialties, fueling looming lack of primary care." (http://www.msnbc.msn.com/id/31507763/ns/health-health_care/) 

The article highlights Dr. Kenneth Spady's story; at 81, he'd like to retire, but there's no one to take his place: 

After more than two years of trying, and several close recruiting calls, there's still no one to take his place in this rural community 100 miles north of Seattle, where the nation's shortage of primary care doctors has landed squarely at Spady's office door. 

"We've probably trotted eight or nine people through here," said Dr. David A. Lynch, president of the Whatcom County Medical Society, which is helping conduct the search. "At this point, we have not been able to get a doctor to commit." 

Sen. Chuck Grassley (R-IA) on a bipartisan health care reform bill:

As we posted the other day, both sides of the health care debate are clamoring for the attention and support of small business.

Not sure if today's news makes things more clear, but here we go....

Health Care for American NOW! reports that - in several anecdotal examples - small business owners are fed up with... um... everything about the current health care system and want "reform". They assert that there is growing support for the "public option".  We are looking for more polling here and will post what we find.

While over at Market Watch, they report that Micro Businesses (companies with 10 of fewer employees) are having a somewhat different and somewhat more nuanced reaction to the health care debate:

Health CEOs for Health Reform and the New America Foundation put out a series of papers recently which we found very interesting. You can find more information here.

It is worth browsing the summary of their proposals - but you can glean a lot from their vision statement:

Our Vision for Health System Reform:

Health care reform must make quality health care and health insurance affordable and accessible to all. Yet meaningful health care reform must also make our health delivery system sustainable for families, employers, providers, and governments. As health care leaders who operate in our current system, we firmly believe that upwards of 30 percent of the resources spent on health care in the United States are a result of too few efforts to coordinate care and not enough attention to quality. We must achieve higher value for our health care dollar to make affordable coverage and high-quality care available for all, including our most vulnerable, for years to come.

We will not control health care costs until we create clear incentives for providers - the people who deliver care - to focus on quality and efficiency.

Politico reports Sen. Chris Dodd has acknowledged that

...health care reform may not clear a key committee this week -- the latest logistical speed bump in President Barack Obama's push for new legislation addressing the country's health care crisis.

Dodd said today he would like to finish the process this week but that he was still waiting for cost estimates from the Congressional Budget Office about the cost of the bill.

Medical News Today reports this morning that the White House is planning to roll out a media blitz around their health reform efforts.

Roll Call went further: 

"Some of the events may have been planned before Obama's health care effort ran into difficulties, such as the decision by Senate Finance Chairman Max Baucus (D-Mont.) to delay today's planned markup - possibly until next month - and a suggestion by Sen. Dianne Feinstein (D-Calif.) on Sunday that the votes to pass the legislation do not yet exist."

Ashley Halsey at The Washington Post wrote this weekend about the lack of primary care docs to meet our current systemic needs... much less increased utilization under a system providing universal access. Read the article here.

As the debate on overhauling the nation's health-care system exploded into partisan squabbling this week, virtually everyone still agreed on one point: There are not enough primary-care doctors to meet current needs, and providing health insurance to 46 million more people would threaten to overwhelm the system.

Fixing the problem will require fundamental changes in medical education and compensation to lure more doctors into primary-care offices, which already receive 215 million visits each year.

As reform watchers awaited the Baucus proposal and a plan from House Democrats, attention this past week shifted to the price tag for key reform proposals and sources of funding. Tuesday, the Congressional Budget Office (CBO) put a price of $1 trillion on the Kennedy plan, noting it would reduce the ranks of the uninsured by only 16 million. Release of Sen. Max Baucus' much anticipated plan was delayed after a CBO estimate put the plan's cost at $1.6 trillion. Concern about the price tag for health reform gained momentum last week as notable Senate moderates including Charles Grassley (R-IA) and Kent Conrad (D-ND) indicated they were concerned about costs as well as their belief a public plan would crowd out commercial insurers.

To date, potential sources of funding have been discussed by the White House ($947 billion), as well as key trade and legislative groups. The most notable include: