Tort Reform does not necessarily equal caps

From the AMA.

Tort reform may still be coming, per President Obama’s Address last week. While caps are still the AMA’s favorite remedy, in this recent letter they outline some other considerations…

Alternative Reforms

While the AMA continues to advocate for proven reforms like MICRA, we are also committed to finding innovative solutions to the broken medical liability system such as offering of grants tostates to pursue alternatives to current tort litigation. These alternatives include:

• Health Courts. Health courts would provide a forum where medical liability actions could be heard by judges specially trained in medical liability matters and who hear only medical liability cases. The AMA developed and adopted health court principles in 2007 to assist state and local governments, insurers, hospitals and other entities interested in exploring this option for medical liability reform.
• Early Disclosure and Compensation Programs. Under an early disclosure and compensation model, providers would be required to notify a patient of an adverse event within a limited period of time. Notification does not constitute an admission of
liability. Providers offering to compensate for injuries in good faith would be provided immunity from liability. Payments for non-economic damages would be based on a defined payment schedule developed by the state in consultation with relevant experts and with the Secretary of Health and Human Services (HHS).
• Administrative Determination of Compensation Model. A state’s administrative entity would be charged with setting a compensation schedule for injuries, resolving claims for injuries, and establishing compensation based on the patient’s net economic loss, subject to periodic payment and offset by collateral payments from sources such as insurance.
• Expert Witness Qualifications. Several states have amended the statutory qualifications for those who may serve as medical expert witnesses at trial. Some states (e.g., Georgia, Texas, and Illinois) have created additional standards that medical expert witnesses must meet in order to ensure the testimony juries receive is presented by an individual with particularized expertise in the matter in question.

The AMA is committed to finding a solution to the challenges of the broken medical liability system, including federal reforms based on proven state solutions like California and Texas as well as alternative liability reforms like health courts. The AMA also supports protecting patients’ access to care by working in concert with
state medical associations to enact and defend strong medical liability reform laws.

Broken healthcare and broken lives – DFA’s Alex Blum

Broken healthcare and broken lives – latimes.com:

In the middle of one night during my training at a county hospital outside of Los Angeles, a 12-year-old boy arrived at the emergency room. He was having a seizure. From a brain scan, we made the terrible diagnosis: He had suffered a massive stroke. At best, he would be severely disabled for the rest of his life.

When I sat down with his mother to tell her the bad news, she told me that he had been a happy, healthy child through most of grade school. But there had been one other trip to the hospital. When he was 7, he’d had a stroke from which he recovered quickly and completely. His mother had been instructed to take him to a specialist to find out what was wrong so he would not have another stroke. But she was the family’s sole provider and simply could not afford the expensive out-of-pocket bills.

At first I was shocked and angry to learn she ignored a physician’s advice that could have prevented this tragedy. I quickly realized, though, that the true culprit was our broken healthcare system. Because this system denies millions of Americans access to care, my patient’s mother was forced to take a gamble on her child’s health. The result was a debilitating stroke that should have been prevented.

Until the system changes, health catastrophes like this will continue to be commonplace in America. Until we reform the system, Americans will continue to be forced to choose between feeding their families and taking them to the doctor.

From Doctors for America’s Alex Blum…

The Most Outrageous U.S. Lies About Global Healthcare | Foreign Policy

The Most Outrageous U.S. Lies About Global Healthcare Foreign Policy

As the U.S. Congress this summer holds its first serious health-care reform debate since the Clinton era, the resulting public furor has featured increasingly overheated claims about everything from so-called “death panels” to the supposed prowess of America’s homegrown medicine. Many of the most wildly inaccurate statements have been directed abroad — sometimes at the United States’ closest allies, such as Britain and Canada, and often at the best health-care systems in the world.

The lies rebutted include:

1. Stephen Hawking and Ted Kennedy would be doomed outside the US.
2. Canadians come to the US for urgent care.
3. All European health care systems are single payer.
4. Canada and Britain restrict health care choices.
5. The US has The Best Healthcare In The World. (TM)

The Ayn Randers and HC Reform

I was on a couple web sites today, the Mayo Clinic Health Policy Center’s and Ezra Klein’s, and looking at the comments is so disheartening. That people who consider themselves good people (Christians, secular humanists, whatever) can swallow the Ayn Rand crap and not have their heads explode from the cognitive dissonance is amazing.

One particular line of attack that disgusted me was this smug argument that food is necessary for life, why don’t we have national food insurance or some similar drivel.

My response on Ezra’s blog:

The difference between food and health care is several orders of magnitude.

I don’t see patients in my ICU beds due to lack of food, but due to lack of access to care. People rarely lose their homes, their cars, or file for bankruptcy due to food costs.

We have, as a nation, decided to help those in hunger with food stamps, WIC and other programs, we decided in 1965 that allowing the elderly to die and suffer without access to health care was no longer acceptable, and in 1935, we decided allowing the elderly to really suffer in poverty and hunger was not acceptable.

We are the only modern nation that still seems to believe, based upon our lack of action, that our poor do not deserve access to good quality health care on at least a comparable footing with the rest of us.
Go find a physician or a nurse and have a laugh with them with your comparison. Nearly all will be aghast at your callousness. You will find some who support you, but their numbers are thankfully dwindling. Those in the leadership of medicine KNOW that we must advocate for high quality health care for all Americans, not just those who can afford it.

I’ve compiled a list of physicians organizations advocating for health care, to give you an idea of how cold your statements are to those of us in the front lines actually taking care of those “undeserving sick.”

And some anecdotes for you and your friends to have a laugh about.

Organized Medicine on Reform

***Update: Now 8 of the 10 largest organizations are on board!***

Welcome to the blog. To make this a bit easier for everyone, here are the physician organizations FOR either HB 3200 or something close to it: AMA, AOA, ACP, AAFP, ACOG, ACS, AAP, ACC, AGA, ASCO, and SHM.

Squishy middle: AAO, AAOS, ACEP

Mo’ money, then we’ll talk: ASA, ACR.

Details below…

The American Medical Association, ~240K members:

[After passage of HB 3200 out of committee -cmhmd]… the American Medical Association sent a letter to House leaders supporting H.R. 3200, “America’s Affordable Health Choices Act of 2009.” “This legislation includes a broad range of provisions that are key to effective, comprehensive health system reform,” said J. James Rohack, MD, AMA president. “We urge the House committees of jurisdiction to pass the bill for consideration by the full House.” H.R. 3200 includes provisions key to effective, comprehensive health reform, including:

  • Coverage to all Americans through health insurance market reforms
  • A choice of plans through a health insurance exchange
  • An end to coverage denials based on pre-existing conditions
  • Fundamental Medicare reform, including repeal of the flawed sustainable growth rate (SGR) formula
  • Additional funding for primary care services, without reductions on specialty care
  • Individual responsibility for health insurance, including premium assistance to those who need it
  • Prevention and wellness initiatives to help keep Americans healthy
  • Initiatives to address physician workforce concerns

“The status quo is unacceptable,” Dr. Rohack said. “We support passage of H.R. 3200, and we look forward to additional constructive dialogue as the long process of passing a health reform bill continues.”

The American Osteopathic Association (“represents” 67K, per their website; not clear if this is actual membership)

Why is the AOA supporting H.R. 3200?
The “America’s Affordable Health Choices Act” (H.R. 3200) contains several provisions that reflect AOA priorities forhealth system reform. These priorities include: expanding the availability of affordable health care coverage to the uninsured, increased support for prevention and wellness services, investments in the physician workforce, increased Medicare payments for primary care services without cutting payments for other services and, importantly, it represents our best hope for eliminating the current sustainable growth rate (SGR) formula for updating Medicare physician payments. The AOA continues to work with members of the House of Representatives to improve the bill by seeking additions and changes in the legislation. Specifically, we are working to include expanded graduate medical education provisions, medical liability reform, and student loan financing reforms. Favorable action on a House bill is necessary to move the process to the end game negotiations that will determine the specifics of a final bill.

American College of Physicians (ACP, represents 126 K internal medicine physicians including primary care and medical subspecialists like me):

H.R. 3200 does much of what ACP asked Congress to do in terms of coverage, support for the primary care workforce, payment and delivery system reform, based on long-standing policies that have been adopted by this organization. No bill is perfect, but H.R. 3200 delivers on our major priorities in a way that is remarkably consistent with ACP policies, policies that were developed by the College’s leadership over many years and always guide how ACP’s leadership, Key Contacts and staff advocate for internal medicine physicians and their patients.

American Academy of Family Physicians, 94K members:

On behalf of the 94,600 members of the American Academy of Family Physicians, thank you for the positive steps you have taken toward broader, affordable coverage that will mean improved health care based on primary care. We believe that the America’s Affordable Health Choices Act (H.R. 3200) will make significant progress toward payment and delivery system reforms and contribute to building a primary care workforce for the future. AAFP supports this legislation and we will be pleased to work with your committees to improve it further.
……
The public plan option developed by your committees reflects most of these principles very well.

American Academy of Pediatrics, 60 K members:

“The American Academy of Pediatrics (AAP), which represents 60,000 pediatricians, pediatric medical subspecialists, and surgical specialists, praises the U.S. House Energy and Commerce Committee for its vote today on H.R. 3200, America’s Affordable Health Choices Act, and applauds all three House Committees for their continued and steadfast work in the effort to pass significant health care reform.
“The Academy continues to support the process of bringing comprehensive health care reform to America’s children. While there is still work to be done, H.R. 3200 makes significant progress in achieving the Academy’s priorities of covering all children in the United States, providing children with age-appropriate benefits in a medical home, and establishing appropriate payment rates to guarantee children have access to covered services.

American College of Surgeons, 76 K members:

They have a letter of support for HR 3200, but you can’t copy and paste… maybe a little gun-shy about letting the membership see it!

American College of Obstetrics and Gynecology, 52 K members:

“ACOG President Gerald F. Joseph, Jr. MD provides ACOG endorsement of HR3200 (proposed America’s Affordable Health Choices Act of 2009).”

[The rest is behind a password protected section.]

American Academy of Ophthalmology, 7 K members:

Have not yet taken a position on any specific bill, but:

Meanwhile, the Academy, AMA and the American College of Surgeons have been up on the Hill pushing medicine and ophthalmology’s agenda. The Senate bill is expected to contain a rate-setting commission proposal that the Academy helped defeat in the House bill and other troublesome provisions affecting medicine and surgery.

and…

Acknowledging that the status quo in health care is unsustainable and that issues of access to coverage, quality of care and cost control must be addressed, and given legislative momentum in Congress, the Academy is advancing components for bills that protect patients and physicians. While reform discussions are still ongoing and no pending legislation is perfect, we are committed to continue collaborating with health leaders in Congress to improve bills being considered. The Academy is actively engaged with other physician organizations as key House and Senate committees debate legislation that puts a long-term sustainable growth rate (SGR) fix in play, in addition to other top issues.

American Association of Orthopedic Surgeons, ~17 K members:

The AAOS is committed to ensuring that the final bill be as beneficial as possible to the Orthopaedic community, including our patients. We will not make any decisions in support or opposition until something closer to a final bill is available.

Ooops! Perhaps phrased poorly!

American College of Cardiology, 37 K members:

On behalf of the American College of Cardiology (ACC), representing 37,000 cardiovascular members, I am writing to commend you for H.R. 3200, the “America’s Affordable Health Choices Act of 2009.” This legislation makes a significant financial commitment to comprehensive health system reform and we are committed to working with you on this effort.
ACC is especially pleased that H.R. 3200 takes extraordinary measures to extend coverage to every American and takes positive steps to strengthen Medicare. Among the Medicare provisions the College supports include:
• Funding to eliminate the accumulated debt from the flawed Sustainable Growth Rate (SGR);
• Establishment of a positive Medicare physician payment update (MEI) for 2010
and favorable spending targets for updates in the future;
• Significant payment and delivery reform models such as incentives for physicians to participate in Accountable Care Organizations; and
• Expansion and improvements to the Physician Quality Reporting Initiative (PQRI) to encourage successful participation;

American Society of Clinical Oncology:
Can’t find anything on their website. The American Cancer Society, on the other hand, has made access to health care via serious reform their top priority. And, by the way, on palliative care? They’re for it.

American Gastroenterological Association, 17 K members:

On behalf of the American Gastroenterological Association (AGA), representing over 17,000 physicians and scientists who research, diagnose and treat disorders of the gastrointestinal tract and liver, I am writing to express our appreciation and support for several provisions in H.R. 3200, America’s Affordable Health Choices Act. The AGA appreciates your leadership and shares in your goal to expand health care coverage to the uninsured, improve coordination of care, and enhance quality.

American College of Emergency Physicians, 27 K members:

“It is important to note, however, that a common theme supported by members of the House and Senate (Democrats and Republicans), as well as the White House, is to extend coverage to nearly all Americans, although there are differences of opinion as to how this objective is best achieved. ACEP supports this endeavor to provide universal health care as a benefit for patients and its outcome of drastically reducing the burden of uncompensated care provided by emergency physicians.
ACEP encourages you to discuss and promote these issues with your members of Congress during the August recess. Your message to lawmakers:
These provisions will improve your constituents’ access to vital emergency medical care services and they must be part of the final health care reform package that is sent to President Obama.
Due to the fragmented, unpredictable nature of the process, and the lack of a final product in the House or Senate, ACEP has refrained from taking a public position on the overall legislative proposals. This has been, and remains, a very fluid process and we want to assure you that ACEP will continue to monitor these plans and advocate
for the needs of emergency physicians and your patients.”

American Society of Anesthesiology, 43 K members:

“ASA members may be confused by a request for support of H.R. 3200 by other medical associations, including most recently the AMA. ASA CANNOT AND WILL NOT SUPPORT THE BILL IN ITS CURRENT FORM. Members are strongly encouraged NOT to respond to AMA’s request to support H.R. 3200. The bill, the ‘America’s Affordable Health Choices Act,’ includes a public plan option based upon Medicare payment rates for anesthesia services. A Medicare rate-based public plan would be detrimental to the medical specialty of anesthesiology.

“ASA has consistently urged lawmakers to address anesthesiology’s ‘33 percent problem’: the fact that Medicare pays 33 percent of what private insurers pay for anesthesia services (while Medicare pays an average of 80 percent of what private insurers pay for most other medical specialties). This 33 percent payment level simply does not reflect the costs of providing anesthesiology medical care. As such, Congress must not use this payment level as a model for any health care plan.

“We acknowledge that there are many laudable provisions included in H.R. 3200. Still, many issues remain unresolved, and questions linger about how various provisions would impact anesthesiology. We must remember that there is no other organization involved in the reform debate that is speaking for anesthesiology. In fact, some groups are actively lobbying for provisions that would harm our specialty. Anesthesiologists’ shared voice is the only way to ensure that the important and unique concerns of our specialty, our practices and our patients are heard in the halls of Congress. “

American College of Radiology, 32 K members:

Best I could find on their website:

Unfortunately, it seems ACRs position regarding the House version of healthcare reform, HR 3200, has been incorrectly characterized. As many of the details of overall health care legislation remain fluid, the College has not taken a position, for
or against, any of the current overall congressional proposals, including HR 3200.
Regarding HR 3200, we continue to educate congressional leaders that the imaging and radiation therapy provisions, including a raise in the equipment utilization rate assumption to 75 percent and a further 25 percent cut to contiguous imaging, are flawed ideas that will ultimately harm patient access to care particularly in rural areas.
Until negotiations regarding such provisions are complete or are clearly at an impasse, ACR will not take an official position on the entire House bill. Any information that ACR has offered its support or opposition to HR 3200 is incorrect.

Update: I almost forgot to include some rather contrarian sentiments from the South Carolina Medical Association, as well as some “Old School” conservative physicians to round out the round up. They are not alone, as some other deeply red states’ Medical Societies have expressed similar dire warnings. But for them, this is really about ideology, not solutions.

Update II:

Society of Hospital Medicine ( ~6 K members, represents hospital based physicians):

On behalf of the Society of Hospital Medicine (SHM), I am writing to express our support for provisions in H.R. 3200, the “America’s Affordable Health Choices Act of 2009” regarding delivery system reform. SHM represents the nation’s hospitalists—physicians whose primary professional focus is the general medical care and management of hospitalized patients. We agree that the time has come for comprehensive health reform and appreciate your leadership and commitment in pursuit of this worthy goal.

Daily Kos: A few anecdotes about medical care in America…

Daily Kos: A few anecdotes about medical care in America…

I posted this on DailyKos tonight. Please go read the rest and chime in!

On many levels, I hate to venture into anecdote territory when it comes to health care reform. I don’t think it informs the debate in a helpful manner, and yet, it seems to be one of the two major arms of the conservative campaign against health care reform. First, they argue, look how awful it is everywhere else and how wonderful we have it here in America with THE Best Health Care System in the World (TM) and second, they find even Medicare, Social Security and unemployment benefits ideological anathema.

I can’t do anything about the second one, but I do have something to
say about the first.

TR Reid Busts International Health Care Myths

This was in my Pittsburgh Post-Gazette, but also in other papers as well. TR Reid, of PBS “Sick Around the World” has done the leg work and homework to become perhaps the most knowledgable journalist in the world on internation health care.

As Americans search for the cure to what ails our health-care system, we’ve overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they’ve found ways to cover everybody — and still spend far less than we do.

I’ve traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as ‘socialist,’ we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:

Myth 1: It’s all socialized medicine out there.
Not so.

Read on about myths 2-5:

MYTH 2: Overseas, care is rationed through limited choices or long lines.
MYTH 3: Foreign health-care systems are inefficient, bloated bureaucracies.
MYTH 4: Cost controls stifle innovation.
MYTH 5: Health insurance has to be cruel.

The pope’s social encyclical — Part 2 | National Catholic Reporter

The pope’s social encyclical — Part 2 National Catholic Reporter:

Pope Benedict also chastises those who think that a ‘market economy has an inbuilt need for a quota of poverty and underdevelopment in order to function at its best.’ On the contrary, the market is not merely ‘an engine for wealth creation.’ It must also function ‘as a means of pursuing justice through redistribution’ (n. 35).

In the most recent presidential campaign in the United States, the concept of redistribution was hung around the neck of one of the major-party candidates as if he were a Socialist. If so, that term of opprobrium would apply to Pope Benedict XVI as well.

If it weren’t for the sex stuff, the Pope and Catholic tradition would be out there with Michael Moore and ralph Nader…

“Common Sense” Health Care Reform Principles

Uwe Reinhardt Economix Blog

The All-American Wish List for Health Reform

  1. Only patients and their own doctors should decide what clinical response is appropriate for a given medical condition, even if that response involves
    unproven clinical procedures or technology.
  2. Neither government bureaucrats nor private insurance bureaucrats should ever refuse to pay for whatever patients and their doctors have decided to do in response to a given medical condition. An insurer’s refusal to pay for a medical procedure is tantamount to rationing health care.
  3. Rationing health care is un-American.
  4. Cost-effectiveness analysis should never be the basis of any coverage decision by public or private third-party payers in health care, for to do so would put a price on human life — which, in America, unlike everywhere else, is priceless.
  5. Government should not require individuals to purchase health insurance. Such a mandate would violate the constitutional rights of freedom-loving Americans.
  6. Americans have a moral right to life-saving and potentially highly expensive medical care, should they fall critically ill, even if they are uninsured and could not possibly pay for that care with their own financial resources. (Why else would God have created hospitals and their emergency rooms?)
  7. Government should stay out of health care. Specifically, government should not control health care prices, nor should it increase its spending on health care, which is out of control.
  8. Even small reductions to the future growth of Medicare spending — called “cuts” in Washington parlance — unfairly burden the elderly, along with the
    doctors and hospitals that serve them and the manufacturers of health products, lest the pace of technical innovation be impaired.

And so on, and so forth. Any health policy analyst over the age of 40 could easily double the list. It might make for a good parlor game at a bar.

Readers may believe I am jesting. But follow the editorial pages or punditry, especially of the conservative news media, over some time.