The Moral Healthcare Blog

Flaws And All, Medicaid Can Improve Adults’ Health : Shots – Health Blog : NPR

But a study just published online by the New England Journal of Medicine adds to a growing body of evidence that Medicaid, in fact, does improve the health of those it covers.

The study, whose Harvard-affiliated authors include one currently advising the Obama administration and one who worked for President George W. Bush, compared three states (New York, Maine, and Arizona) that expanded Medicaid coverage to childless, non-disabled adults in recent years to three neighboring states that did not. Those adults will be the primary beneficiaries of the expansion envisioned under the Affordable Care Act.

It found that Medicaid expansions were associated with “a significant reduction in adjusted all-cause mortality,” as well as decreased rates of care being delayed due to cost, and more people reporting themselves to be in “excellent” or “very good” health.

Now if that sounds obvious, it’s not. “Prior to Oregon, we didn’t have very good data for adults” and Medicaid, lead author Benjamin Sommers told Shots.

By Oregon, he’s referring to a landmark study from last year that was able to compare adults who got Medicaid coverage through a lottery with those who didn’t. Such a randomized trial is almost unheard of in health policy research because it most cases it would be unethical. The Oregon study was facilitated by state budget considerations.

One reason critics of Medicaid have been able to maintain the debate is that some earlier studies have, indeed, found that people with Medicaid, particularly adults, sometimes had worse medical outcomes than those who didn’t.

Sommers says that should hardly come as a shock. “We know Medicaid is designed to cover the sickest of the sick” he says. “So it’s not surprising that people who have Medicaid do worse than those who don’t.”

Sommers says this new study, which includes some of the same team working on the Oregon data, complements that one. “While it’s not a randomized study,” he said, it has a larger sample (more than 68,000 people) and examines a longer period of time (five years before and after the Medicaid expansion).

Affordable Care Act will expand mental health coverage, but budget cuts a worry – Philly.com

Mentally ill people will have a much easier time accessing care two years from now, thanks to the new federal health care law. But advocates worry that current budget cuts may create a shortage of the very mental health services the newly insured will want to use. In 2008, 67,560 uninsured people in Pennsylvania did not get mental health care because they could not afford the services, according to the Pennsylvania Insurance Department. That number should drop dramatically by 2014, when the Affordable Care Act (ACA) requires all American citizens to have health coverage that will include mental health services.

The Conservative Misinformation Campaign About Obamacare Has Worked Really, Really Well | Mother Jones

Andrew Sprung draws my attention to a Kaiser quiz about Obamacare from a few months ago, and you’ll be unsurprised to learn that most Americans don’t know much about it. I put the responses into graphical form, and what’s most interesting, I think, is to look at the right side of the chart: the questions that were most frequently gotten wrong.

All of them are tied together by a single thread: they’ve been the main targets of the conservative misinformation campaign against the Affordable Care Act. The tea party folks have never spent much time talking about low-income subsidies or tax credits or Medicaid expansion or pre-existing conditions. And guess what? Most people know how the law works in those areas.¹

But conservatives do spend a lot of time rabble-rousing about death panels and illegal immigrants and Medicare cuts. And they also spend a lot of time bewailing the “government takeover” of healthcare, which includes things like the public option (“a new government run insurance plan”) and a supposed mandate that small businesses will all be required to offer health insurance for their employees. Sure enough, those are the areas where misunderstanding is highest.

That’s why I disagree with Andrew that misinformation about small businesses amounts to a “foot fault” by current standards of public discourse. In a way, he’s right, of course: it’s not a major flash point and it hasn’t gotten a lot of news coverage. But there’s a reason it’s the single most misunderstood issue. The Rush/Fox/Drudge axis has been screaming about the government takeover of healthcare for three years now, and it’s sunk in. Most people believe it. That’s why, faced with a question most of them really have no idea about, their immediate reaction is to believe that, in fact, government is once again planting its jackboot directly on the necks of America’s small businesses. It’s a small issue, but it’s also a bellwether that the broader conservative misinformation campaign has burrowed very deeply into the American psyche.

Why I’m skeptical that HSAs will work to reduce spending greatly – Parts 1 & 2 | The Incidental Economist

Why I’m skeptical that HSAs will work to reduce spending greatly – Part 1 | The Incidental Economist

You’ve seen a slide like this before, I bet. But basically, what it’s showing is that a small number of people account for a ton of personal health care spending. In fact, the bottom 50% of spenders account for only $36 billion in personal health spending. That’s less than 3% of all of it.

Why is this important? Well, because the entire idea of health savings accounts and increased cost sharing is to encourage people to spend less on personal health spending. The idea is that people who don’t really need the care will choose to spend less. What we often ignore, however, are the high spenders. Those people, on the right side, would blow through their health savings account pretty quickly. At that point, they have no more deductibles and no more co-pays, and there are no more incentives to spend less. So the whole idea won’t work on then. It might, however, work on people who don’t spend as much.

But as the chart shows, there’s not that much to save there.

Why I’m skeptical that HSAs will work to reduce spending greatly – Part 2 | The Incidental Economist

Health savings accounts, and increased cost sharing, will likely work for those who don’t need the care and are healthy. But they spend so little, that even if they are influenced, we won’t save much. Those who are spending the real money are older, sicker, and need help. If they spend less, it’s more likely they will suffer. And it’s likely many won’t spend less, since there’s no chance of their keeping money in their accounts. If they don’t spend less, then we can’t save real money.

I get why people think cost sharing and HSAs will work. But when the theoretical possibilities meet the real demographics and patterns of spending, I can’t see how this will work.

Everything you ever wanted to know about Canadian health care in one post

After the ACA Ruling: Next Urgent Steps for Cardiologists

Medscape: What was the reaction from the ACC to the Supreme Court ruling on the ACA?

Dr. Zoghbi: We are pleased with the ruling, particularly from the angle that we are not setting back the clock on healthcare reform. However, we have a lot of work ahead. All the stakeholders — professional societies, payers, healthcare professionals, hospitals, device and pharmaceutical companies — have to work together to develop a sustainable healthcare system. The ACA doesn’t necessarily give us all the solutions. It is a step in the right direction that would need adjustment and refinement. We need to work on payment reform that rewards quality rather than volume, with the ultimate goal of having a sustainable system that provides win-win situations and aligns incentives of all involved, eliminating waste and rewarding quality and value. I think you won’t see too many people disagreeing with that. Where I see the need to focus is spreading the message that we need to work together; we cannot target one or the other segment of the stakeholders involved in healthcare.

Medscape: What are the ACC’s specific goals in the coming year in regard to the ACA? What is particularly important to focus on?

Dr. Zoghbi: The immediate urgent matter, which Congress keeps kicking down the line, is the flawed sustainable growth rate (SGR) formula. It is not part of the ACA directly, but it will impact it. The growth of the debt is always in the background and it gets worse and worse over time. We need a solution, paired with good payment reform, that would emphasize quality, integration of care, and, importantly, elimination of waste. Administrative costs and hassles to provide care have to decrease significantly.

After ACA Ruling: Next Urgent Steps for Internal Medicine

Medscape: We’re very interested to hear what the ACP thought about the Supreme Court ruling on the ACA.

Dr. Bronson: I think the decision is highly supported by our organization and we can now move forward.

Medscape: Will the ruling have any impact on internists or internal medicine?

Dr. Bronson: I think it will be positive for internal medicine, broadly speaking, because it gives more patients access to care through insurance. It will increase demand for services, but that’s a positive thing.

After the ACA Ruling: Next Urgent Steps for Family Medicine

Medscape: What was your initial impression when you learned of the Supreme Court ruling on the ACA?

Dr. Stream: I didn’t know what to expect. I had a difficult time separating what I wanted the outcome to be from what I could intellectually predict it would be. I’m pleasantly surprised.

Medscape: Will this ruling change any of the AAFP’s expectations about the impact of the ACA on family physicians?

Dr. Stream: I don’t believe so. We’ve been working for over 2 years under a strategy that the ACA was the law of the land, and we wanted to focus on those areas important to family medicine and patients and to make those areas as successful as possible. We also wanted to work on provisions that weren’t part of the ACA or were not fully addressed by it, particularly replacing the sustainable growth rate (SGR) formula and achieving meaningful medical liability reform.

Having the mandate upheld is consistent with what has been AAFP policy for over 20 years. We have advocated for healthcare coverage for everyone and access to at least basic health services, including good primary care with prevention and chronic illness care. You can argue whether the mandate is the only means to get there, but at least in the analyses that I’ve seen, it was one of the best identified ways to get everyone covered.

Next Steps in Healthcare Reform: Repealing IPAB and SGR

Medscape: When Medscape interviewed AMA CEO Dr. James Madara in April, he reiterated the AMA’s support of the ACA, but he stressed that like all things, it’s a work in progress. Now that the law has been upheld, what are the next steps to improving the healthcare system? What areas of healthcare are in most need of improvement?

Dr. Lazarus: We think the things in the act that we’d like to get rid of, like IPAB, would help. We would like to see comprehensive medical liability reform, which we think would help on the cost side and bring down the cost of care. We would like to see a repeal of the SGR in Medicare. And we, in our own strategic planning, are looking at new delivery and payment models that will work better, both for physicians and patients. We think this will give physicians more satisfaction in whatever kind of practice situation they’re in, and it will enable them to deliver better care to patients at a reduced cost. We need to have time to do that. It’s a 5-year plan, and we’re excited about that part of our strategic plan.

Medscape: Do you have any parting thoughts on the future of medicine and the ACA?

Dr. Lazarus: This is something that we had been working on for a long time. We had been advocating for health insurance coverage for all Americans for many years, and we were pleased with the outcome. It gives us at least a roadmap to where we’re going. It eliminates the uncertainly about where things were going. As the law is implemented, we’ll see what other changes need to take place. But we were pleased at the outcome.

Stunning Healthcare Overture from Bipartisan Group of US Senators – 2007

Healthcare Legislation in This Congress? – Michael Barone (usnews.com)

I followed Ezra Klein’s link to this letter from 10 Senators, 5 Republicans and 5 Democrats, written just two years before President Obama took office! Read it, as it is stunning how far the Republican Choo Choo has gone around the bend. [Courtesy USNews.com and Michael Barone.]

Now Wyden and nine other senators, five Democrats and five Republicans, have sent the following letter to Bush. Very interesting.

In addition to Wyden, the letter was signed by Republicans Jim DeMint of South Carolina, Robert Bennett of Utah, Trent Lott of Mississippi, Mike Crapo of Idaho, and John Thune of South Dakota, and Democrats Kent Conrad of North Dakota, Ken Salazar of Colorado, Maria Cantwell of Washington, and Herb Kohl of Wisconsin.

The text of the letter follows:

February 13, 2007

The Honorable George W. Bush
1600 Pennsylvania Avenue
Washington, D.C. 20500
Dear Mr. President:

As U.S. Senators of both political parties we would like to work with you and your Administration to fix the American health care system.
Each of us believes our current health system needs to be fixed now. Further delay is unacceptable as costs continue to skyrocket, our population ages, and chronic illness increases. In addition, our businesses are at a severe disadvantage when their competitors in the global market get health care for “free.”
We would like to work with you and your Administration to pass legislation in this Congress that would:
1)Ensure that all Americans would have affordable, quality, private health coverage, while protecting current government programs. We believe the health care system cannot be fixed without providing solutions for everyone. Otherwise, the costs of those without insurance will continue to be shifted to those who do have coverage.
2)Modernize Federal tax rules for health coverage. Democratic and Republican economists have convinced us that the current rules disproportionately favor the most affluent, while promoting inefficiency.
3)Create more opportunities and incentives for states to design health solutions for their citizens. Many state officials are working in their state legislatures to develop fresh, creative strategies for improving health care, and we believe any legislation passed in this Congress should not stymie that innovation.
4)Take steps to create a culture of wellness through prevention strategies, rather than perpetuating our current emphasis on sick care. For example, Medicare Part A pays thousands of dollars in hospital expenses, while Medicare Part B provides no incentives for seniors to reduce blood pressure or cholesterol. Employers, families, and all our constituents want emphasis on prevention and wellness.
5)Encourage more cost-effective chronic and compassionate end-of-life care. Studies show that an increase in health care spending does not always mean an increase in quality of outcomes. All Americans should be empowered to make decisions about their end of life care, not be forced into hospice care without other options. We hope to work with you on policies that address these issues.
6)Improve access to information on price and quality of health services. Today, consumers have better accessto information about the price and quality of washing machines than on the price and quality of health services.
We disagree with those who say the Senate is too divided and too polarized to pass comprehensive health care legislation. We disagree with those who believe that this issue should not come up until after the next presidential election. We disagree with those who want to wait when the American people are saying, loud and clear, “We want to fix health care now.”
We look forward to working with you in a bipartisan manner in the days ahead.

Skyrocketing costs! Competetive disadvantage! Universal access to health care! Class warfare! Inefficient US health care! Wellness! Prevention! Cost effectiveness! Compassionate end of life care! Expanding palliative care services! Health care in the US is broken!

Who knew Jim DeMint was a socialist before he was a Tea-Partier?