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Posts Tagged ‘Barack Obama’

President Obama appointed Dr. Donald Berwick to be the administrator of The Centers for Medicare & Medicaid Services (CMS) through a recess appointment that avoided a Congressional hearing.

Who is Donald Berwick? I’ve been hearing about him for years. He founded and led the Institute for Healthcare Improvement (IHI), a not-for-profit organization that has been pioneering efforts to improve of health care in the United States and elsewhere. His efforts have helped steer the U.S. health care system toward a greater recognition of the need to achieve health care excellence and, more importantly, have resulted in real, practical successes that have improved the care we receive in the U.S. health care system.

Some of Berwick’s detractors with respect to this appointment focus on statements he has made about rationing care and redistributing it to the people who need it most. Let me be very clear: health care will be rationed. It already is now, and the only question facing us as we try to address the spiraling cost of care is who will do the rationing in the future. Will we Americans choose to take responsibility to do it ourselves (by taking more responsibility for directly paying the cost of care), or will we leave it to insurers, politicians and other government regulators to do it for us?

So far it seems we don’t have the stomach to ration care ourselves, though I believe that increasing personal responsibility is the best way to control health care expenditures. If we are going to leave it to the government to control our health care costs, we could do a lot worse than having Don Berwick at the helm.

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In a July 19 article, Washington Post columnist Robert Samuelson describes Massachusetts health care reform measures as a model for the national health care legislation that passed Congress this year. He doesn’t paint a hopeful picture. True, marginally more people gained access to care — defined by having insurance coverage. But costs continue to spiral out of control.

The measures to control costs have been limited and largely ineffective. Wholesale changes in how doctors and hospitals would be paid were suggested, but without any specific plans. In Samuelson’s words, “The system’s fundamental incentives won’t change.” He raises the possibility of unpopular measures such as “accountable care organizations” or spending restrictions that would limit consumer choice of doctors and hospitals or raise the specter of essential care denied.

Samuelson leaves out the other path, the one that has been so successful in so much of the rest of the U.S. economy, a market-based approach in which consumers get to choose what care they want, but they must also face the economic impact of those choices. For more details, visit http://www.drscore.com and check out my White Paper on Health Care Reform.

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One way that recent health care reform legislation is supposed to help improve care while lowering costs is by encouraging more preventive care services to be offered. The Center for Medicare & Medicaid Services (CMS) announced new preventive health benefits created under the Affordable Care Act for seniors and persons with disabilities covered by Medicare.

Click here to learn more about these benefits.

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On Getting Better Health Care, physician Cynthia Koelker, M.D., describes practical ways people can lower their health care costs right now.

Koelker is author of the book 101 Ways to Save Money on Health Care.

We don’t need government to legislate health care reform to lower costs if we take some personal responsibility. Click here to listen to the show.

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Tribune Washington reporter Noam Levey reported that “the five largest health insurance companies racked up combined profits of $12.2 billion” in 2009 (http://seattletimes.nwsource.com/html/nationworld/2011050573_healthprofits12.html).

I’m sure there are many ways to spin this, but I’m not at all impressed that this is the cause of the high cost of health care. When the nation spends hundreds of billions, $12 billion in profit isn’t that striking. The article reported that profit margins for these large health insurers ran from roughly 3 percent to 7 percent, the higher numbers in part due to sale of part of the company. Growth in the stock market could have contributed as well.

We need to fix our health care system, no doubt about it. Demonizing one sector — like health insurers — is not the answer. Someone has to take responsibility for controlling costs. Right now, our third party payment system has taken much of that responsibility off of patients. That leaves high costs or rationing as the other options, neither of which is particularly palatable.

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I wonder if progress toward rational health care reform could be made if Congress would get some momentum moving forward by passing legislation everyone could agree on. So, I have decided to make a suggestion.

Aspects of good health care include:

1) giving patients instructions in writing, and

2) sending patients the results of any tests performed — whether the test found a problem or not.

These measures help ensure that patients have the information they need to be involved and responsible in their own care. I believe that linking payment incentives for quality to these measures would quickly change the culture of our medical system, which all too often fails to address these simple actions.

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The impact of the partisan debate hit home when someone told me she came in for care because she was worried that Obama would soon take away her Medicare.  How ridiculous is that I thought!  She went on to talk about how the proposed health care reform legislation includes plans to kill old people.  I had trouble believing that anyone would really accept such partisan nonsense, but here it was.

We could go into detail, but let me just say those ideas are ridiculous.  I don’t think the Democratic plan to solve our health care crisis is the right one, but ending Medicare or plans to kill old people are not the problems with it.  One thing we should keep in mind is that those people promoting health care reform, both Democrats and Republicans, are simply trying to help Americans get better care without going broke doing it.

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A Jan. 5 New York Times article reported that health care spending grew in 2008 at the slowest pace in 48 years, only up 4.4 percent from the previous year (down from an average increase of 7 percent a year in the decade from 1998 to 2008). A Feb. 4 Washington Post article reported that health care spending in the United States grew by 1.1 percent in 2009 compared with 2008. While the slowing of health care costs growth may seem somewhat promising, it is shocking that health care expenses continued to increase despite the rest of the economy shrinking. Health care costs are gradually approaching 20 percent of the overall economy.

The idea that health care spending should take up 20 percent of the economy seems totally out of proportion and unsustainable (although one uncle of mine suggested that spending on health care may be money better spent than using that money for weapons). The costs continue to grow, while the number of uninsured continues to increase. The idea that government is going to take over health care is already here, at least in terms of paying for much of it.

The last presidential election and subsequent elections seem to have made clear that there needs to be an open consensus process on how to solve the problem. There is a growing minority of people who have poor access to care, and everyone agrees that the problem needs to be fixed. There is a shrinking majority who are paying heavily for access. Their costs continue to grow, and everyone agrees that that problem needs to be fixed, too.

The hard part is coming to a uniform consensus about what needs to be done. The solution will need to consider that there are no free lunches to fixing the problem. Patients can’t have unfettered access to any treatment at any price paid for by some third party — whether it is government or a private payer — if we’re going to reign in the cost of care. We’ll need to come to a consensus about which is the lesser evil: continued explosive growth in health care costs, rationing the health care options patients have, or making patients themselves more responsible for the costs of their health care decisions.

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I’m back from a trip to the American Academy of Dermatology’s annual meeting where Dr. James Leyden was given one of the Academy’s highest awards, the Livingood Lectureship. Leyden’s talk was about health care reform and how insurance was the problem, not the solution. Mirroring a lot of the things I’ve been thinking, Leyden pointed out the problems of having health care paid by a third party. The lack of accountability warps the market and leads to uncontrollable cost. 

Leyden had many specific analogies. One of my favorites was that we now have a health insurance system that would be like having auto insurance that paid for oil changes and gasoline. It isn’t efficient, and it doesn’t make sense.

Instead of demonizing insurers or drug companies, attorneys or anyone else, let’s focus on the real problem, accountability for cost. Who will be accountable? Do we want the insurers to tell us what drugs we can or can’t have?  Do we want the government to do it?  If not, we need to take responsibility ourselves. 

For more details on my thoughts, see my article in the last issue of the North Carolina Medical Journal (http://www.ncmedicaljournal.com/Jan-Feb-10/ReadersForum.pdf).

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In a March 10 letter to members, the North Carolina Medical Society reports asking North Carolina Congressional Delegation to consider several areas of concern with national health system reform. In a March 8, 2010 letter, the Delegation was asked to consider the following priorities:

  • A permanent repeal of Medicare’s flawed physician payment formula
  • Meaningful liability reform
  • Physicians and patients having the right to privately contract without penalties
  • Increased provider reimbursement to offset Medicaid expansion
  • Medicare bonus payments for primary care and the expansion of primary care residency positions
  • Elimination of penalties for physicians who do not successfully participate in the Physician Quality Reporting Initiative (PQRI)
  • Elimination of the proposed Medicare Independent Payment Advisory Board (IPAB)
  • Safeguards on Accountable Care Organizations and payment-bundling pilot programs
  • Limit barriers to new physician-owned hospitals

Everyone agrees that there is too much being spent on health care and that we need to control the growth in cost. Where among these priorities are cost reduction measures? None of these priorities seems to address that central issue. Arguably liability reform might help, but not directly. Some of these priorities clearly increase the cost. Come on, let’s step up with a plan to help reign in the cost of health care. We spend more per capita, lots more, than so many other countries, yet we still have so many uncovered people. These “priorities” may be important, but if we want to lead, we need to do it with a plan that won’t add to the cost of health care.

If we doctors don’t come up with such a plan, someone else is going to do it for us.

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