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Posts Tagged ‘health care reform’

Two judges have ruled the massive new health care law unconstitutional.  Two other judges have ruled that the law is constitutional.  What does this mean?

Dr. Mark Hall, Professor of both Law and Social Sciences & Health Policy at Wake Forest University explains the implications of these rulings, their underlying basis in constitutional law and what happens next in a wonderful article in the New England Journal of Medicine.

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Doctors strive to give their patients great medical care, but Dr. Evan Levine, author of the book, What Your Doctor Won’t (or Can’t) Tell You, and of the blog, Healthcare – A Behind the Scenes Look, believes there’s another side to the story:

Doctors engaging in unethical practices and taking advantage of patients to make money.

Hear from Dr. Levine and find out what he thinks you should watch out for on Getting Better Health Care.

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Health care reform — beyond the hype.

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We are inundated with partisan bickering over health care reform. What does the health care reform legislation really do? Is it truly a government takeover of health care?

Dr. Jack Resnick followed health care reform for the American Medical Association (AMA)  and the American Academy of Dermatology. He has read the whole bill and tells us the real story without the bias.  You can hear my interview of Dr. Resnick on Getting Better Health Care.

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Podcasting on the rise.

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The Wall Street Journal (10/27, A1, Mathews, McGinty) reported a committee of doctors called the Relative Value Scale Update Committee (RUC) decides how much Medicare pays for various medical procedures. This committee wields considerable power over how Medicare dollars are spent.

It is good to have doctors deciding this?  Who would be better?  Government regulators?  In private insurance plans, the insurer and the doctor contract for what those prices should be.

We now have a health care system that largely removes from patients the direct responsibility of paying for care.  So if patients aren’t going to decide how much they will pay, it’s left to someone else — either the insurer or the government.  It may seem that leaving this in the hands of doctors may not be a great idea, but the RUC can’t pay doctors whatever it wants. It just sets the relative amount that one procedure gets paid vs. another.  It’s a zero-sum game, so that if one procedure is paid more, another is paid less.

So while the RUC is controlled by physicians, those physicians don’t change Medicare’s overall costs.

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The Financial Times reported on September 30, 2010, that England will try to revise drug prices to get them in alignment with their value for patients. That sounds good, but can governments and regulators really make good decisions about this?

In a socialist world where government takes responsibility for providing medical care, government has to decide what it will and won’t pay, and what it will and won’t cover.  Another approach is for patients to decide how much to pay by deciding how much a drug treatment is worth to them.  That system seems to work well in the rest of the economy.

So many of us have come to rely on others — insurers or the government — to make our health care decisions for us.  I’m not saying whether that’s good or bad, just that it is.  If we want to control the cost of health care, we’re either going to have to let insurers or the government make those decisions for us, or we’re going to have to change to a system in which we make those decisions for ourselves.  But to do that, we have to be responsible for paying for our health care.  I discuss this in more detail in my Primer on Health Care Reform, available for free by clicking here.

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There is such a thing as bipartisan health care legislation, really …

In late September, we witnessed  a rare, but encouraging, sign of bipartisan collaboration. The House of Representatives passed HR1745, the Family Health Care Accessibility Act of 2010.

This bill would give  liability protection to physicians who volunteer at public or nonprofit community health centers receiving federal funds for serving medically underserved areas.  The bill passed by a near-unanimous 417-1 vote. (The only nay came from physician Ron Paul. Why he voted no, I have no idea).

This well-focused legislation that everyone (well, almost everyone) can agree on seems like a positive step that will help patients.  I hope more such legislation follows.

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On September 22, 2010, many of the popular parts of health care reform legislation went into effect:

  • dependents will be covered under parent’s insurance up to age 26,
  • children will no longer be denied coverage because of preexisting medical conditions, and
  • lifetime limits on coverage will be eliminated.

It might have been nice to put such popular reforms into law by themselves, instead of as part of an enormous reform package that few can get their heads around.

Unfortunately, the world isn’t perfect, and reforms like these can’t work without addressing other issues.  For example, if children can’t be denied coverage because of pre-existing conditions, something would have to prevent all children from being left uncovered until they got sick.  Since carrying insurance isn’t yet a requirement, some insurers are balking at selling child-only health insurance policies.

To get the benefits of expanded coverage, mandated coverage is essential.  Is the cost worth the benefit?  It will be interesting to see how important people find the new benefits and whether they will be willing to gut them in the future.

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What do doctors think?

Writing anything about physicians’ perspectives is difficult. Physicians’ perspectives vary incredibly across pretty much any dimension one would look at.  That makes the American Medical Association’s job pretty difficult.  As the organization that represents doctors, The AMA represents people across a broad spectrum of opinions.  The AMA weighs in on issues that can be very controversial, including measuring doctor quality and health care system reform.

Today on Getting Better Health Care, I interview AMA president Dr. Cecil Wilson.  He explains what the AMA is, how it works, and why it chose to be a productive participant in developing health care reform legislation.

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