The Moral Healthcare Blog

What’s on my MP3 Player…

…aren’t I cool?

Center for American Progress Events (Audio):

Can Health Reform Deliver for Providers?
Tuesday, April 14, 2009, 5:13:49 PM
Half-way through this and it’s very good. Dr. Paulus of Geisinger is very impressive..

Medicare’s Lessons for Health Reform
Thursday, April 02, 2009, 1:04:18 PM

Health Reform: “Now is the Time for Action”
Friday, March 27, 2009, 10:59:49 AM
This features Sen. Baucus as opener, then has some good discussion with Paul Begala and Norm Ornstein and Karen Tumulty…

The Ideology and Politics of the Millennial Generation
Wednesday, May 13, 2009, 1:10:51 PM

“The Age of Stupid”
Wednesday, April 29, 2009, 12:12:33 PM

Arch Intern Med — Abstract: Discussions With Physicians About Hospice Among Patients With Metastatic Lung Cancer, May 25, 2009, Huskamp et al. 169 (10): 954

Arch Intern Med — Abstract: Discussions With Physicians About Hospice Among Patients With Metastatic Lung Cancer, May 25, 2009, Huskamp et al. 169 (10): 954:

“Background Many terminally ill patients enroll in hospice only in the final days before death or not at all. Discussing hospice with a health care provider could increase awareness of hospice and possibly result in earlier use.

“Methods We used data on 1517 patients diagnosed as having stage IV lung cancer from a multiregional study. We estimated logistic regression models for the probability that a patient discussed hospice with a physician or other health care provider before an interview 4 to 7 months after diagnosis as reported by either the patient or surrogate or documented in the medical record.

“Results Half (53%) of the patients had discussed hospice with a provider. Patients who were black, Hispanic, non-English speaking, married or living with a partner, Medicaid beneficiaries, or had received chemotherapy were less likely to have discussed hospice. Only 53% of individuals who died within 2 months after the interview had discussed hospice, and rates were lower among those who lived longer. Patients who reported that they expected to live less than 2 years had much higher rates of discussion than those expecting to live longer. Patients reporting the most severe pain or dyspnea were no more likely to have discussed hospice than those reporting less severe or no symptoms. A third of patients who reported discussing do-not-resuscitate preferences with a physician had also discussed hospice.

“Conclusions Many patients diagnosed as having metastatic lung cancer had not discussed hospice with a provider within 4 to 7 months after diagnosis. Increased communication with physicians could address patients’ lack of awareness about hospice and misunderstandings about prognosis.”

First, having these conversations with patients is the right thing to do for a multitude of reasons, not the least of which is our duty to help our patients weigh the benefits and burdens of medical treatment. The reduction of unwarranted suffering is hard to over estimate.

Second, imagine the economic impact of doing the right thing. No rationing, just having the appropriate conversations with our terminally ill patients.

U.S. Physicians’ Views on Financing Options to Expand Health Insurance Coverage: A National Survey

U.S. Physicians’ Views on Financing Options to Expand Health Insurance Coverage: A National Survey:

MAIN RESULTS

1,675 of 3,300 physicians responded (50.8%). Only 9% of physicians preferred the current employer-based financing system. Forty-nine percent favored either tax incentives or penalties to encourage the purchase of medical insurance, and 42% preferred a government-run, taxpayer-financed single-payer national health insurance program. The majority of respondents believed that all Americans should receive needed medical care regardless of ability to pay (89%); 33% believed that the uninsured currently have access to needed care. Nearly one fifth of respondents (19.3%) believed that even the insured lack access to needed care. Views about access were independently associated with support for single-payer national health insurance.

CONCLUSIONS
The vast majority of physicians surveyed supported a change in the health care financing system. While a plurality support the use of financial incentives, a substantial proportion support single payer national health insurance. These findings challenge the perception that fundamental restructuring of the U.S. health care financing system receives little acceptance by physicians.

This is the article referenced in the post below this one on physicians and physicians’ organizations views on health care reform. The full article is here and in PDF.

“Doctors, too, are ready for CHANGE” | The Register-Guard | Eugene, Oregon

“Doctors, too, are ready for CHANGE” The Register-Guard Eugene, Oregon:

“For most of the last century, no single group was a bigger obstacle to universal health care than organized medicine. Today, perhaps no single group stands more united in support of some form of universal coverage.

“Before their lost battle against President Lyndon Johnson and Medicare, the opposition of major medical organizations and individual physicians guaranteed doom for various state and presidential efforts to establish either a national health plan or other means to achieve universal health insurance.

“Now, surveys reveal that overwhelming numbers of physicians resent the current crazy patchwork health care system, which fixes their reimbursements, regulates and too often denies patient care, and piles physicians with paperwork so unending and from so many directions that the average doctor has little time left over to challenge the status quo.

“Add to all this the frustration arising from working for no pay to coordinate care and provide care after hours, from struggling with the cost of health care insurance for their own employees, and from seeing their uninsured and underinsured patients go without recommended care, and what emerges is widespread physician support of radical reform.

“More than four-fifths of physicians now agree that our health care system either needs fundamental changes or should be rebuilt completely.”

Keep reading, this is a nice summary of where the specialty societies are coming down on health care reform, and it is encouraging…

Medical News: AMA: Membership Bounces Back Slightly – in Meeting Coverage, AMA from MedPage Today

Medical News: AMA: Membership Bounces Back Slightly – in Meeting Coverage, AMA from MedPage Today:
“According to Dr. Maves, the AMA signed up 3,300 more physicians in 2005 than it did in 2004, which is a 2.5% increase. The increase, he said, came in regular members plus physicians in their first or second year of practice and military physicians—all membership categories that reflect ‘real, practicing physicians.’

“There are more than 850,000 MDs in the United States and 56,000 osteopathic physicians. About a quarter of this total, including interns, residents, and retirees, who pay sharply reduced dues, are members.

“The increase in members added $500,000 to AMA coffers, but represented only a small fraction of the $28.1 million operating profit that Dr. Maves reported for 2005.

“Regular members pay $420 a year. Physicians in the second year of practice pay $315, military physicians pay $280, and first-year physicians pay $210.
“Overall, AMA membership in 2005 was 244,005, a number that includes medical students, who pay $20 a year to join the AMA and residents who pay $45 year.

“The AMA will not, however, release the number of practicing physicians who are members, but using the 3,300 figure to calculate the total membership the math works to where 132,000 members in the ‘real, practicing physicians’ were in this category in 2004 and 135,300 in 2005.

“‘The first year I was here, we lost 17,000 members, so this is definitely a victory,’ Dr. Maves said in an interview. But he added that the AMA has still not increased its market share which was 26% in 2004.

“That stands in stark contrast to the 80% membership market share claimed by national medical specialty societies.”

PNHP : Good links in letter for members

Dear PNHP Colleagues,

This Friday evening (May 22) the Bill Moyers Journal on PBS at 9 p.m. EDT will feature a discussion with Dr. David Himmelstein, co-founder of PNHP, and other single-payer advocates, asking the question “why isn’t a single-payer plan on the table in Washington?”

This important media event is emblematic of a recent surge in media interest in the single-payer alternative (see below) – a surge in large part fueled by the bold and courageous acts of civil disobedience undertaken by PNHP members and others before the Senate Finance Committee earlier this month.

Yesterday the conservative editorial board of the Times-Union in Albany, N.Y., made an impassioned appeal to Congress to put single payer on the table.

Dr. Margaret Flowers, one of the first persons arrested by the committee for speaking up for single payer, explains why she did so in this op-ed in the Baltimore Sun. She has given radio and newspaper interviews almost every day since her arrest.

Others who took part in the D.C. actions have been profiled in the media, too: see, for example, these portraits of Dr. Judy Dasovich and Dr. Carol Paris.

Dr. Paul DeMarco, writing in the Spartanburg (S.C.) Herald Journal, explains why, as a conservative, he supports single payer and the principle of mutual aid. (His op-ed ran directly alongside an opposing view by Sen. James DeMint, R-S.C.).

In their May 16 letter to The New York Times, Drs. Arnold Relman and Marcia Angell, past editors of the New England Journal of Medicine, explain how “We don’t need more money; we need a new system.” In another recent NYT letters column, Dr. Laura Boylan writes, “As long as the logic of our system is set by a huge for-profit multi-payer bureaucracy, we will continue to get low value on the health care dollar.”

This is just the tip of the iceberg. For example, Dr. Himmelstein was on NPR’s Diane Rehm Show Monday, along with Sen. Bernie Sanders (I-Vt.) and others.
……………..
I thought this was worthwhile to pass along…

UPDATE: Fixed the links! Sorry about that!

Public Plan Options: Strong, Weak, and MRP?

Courtesy of Health Affairs Blog, and Harold Luft:

“The two options are the “strong” and the “weak” versions of a public plan, referring not to the strength of the proposals, but the power of the public plan. The “strong” version, as advocated by Jacob Hacker, among others, is a near-clone of Medicare adapted for those under age 65. It uses Medicare’s buying power in setting fees for providers, thereby keeping down the premium cost relative to private plans without such leverage. Not surprisingly, providers and private insurers vigorously oppose the idea, which they see as inevitably leading to a “Medicare for all” single-payer system. The proposal has other important features largely tied to parallel changes that need to be legislated for Medicare. Holding out for the “strong” plan risks having a political stalemate kill any chance of reform, but even if passed, it will not transform the health care system. “
….
“A “weak” public plan, as proposed by Len Nichols and John Bertko, would compete with private insurers by being transparent, nonprofit, and well-intentioned. It would follow all the rules required of private plans and not leverage Medicare’s buying power. Such a plan will need public funding to get started, probably bringing the public contracting, employment, and other rules that would hobble its ability to compete. An alternative to the “build your own” version is what many states have developed for their employees: a public plan that designs benefits and provider networks and carries risk, but leaves administration up to contractors.”
….
“I propose an alternative avoiding the weaknesses of both the public solutions such as Medicare for all and current private insurance plans, while building on the strengths of each. It establishes a publicly chartered major risk pool that eliminates the need for the problematic behaviors of private health plans while enhancing choices for providers and patients.

“The new entity would be publicly chartered, but nongovernmental. Independence from direct
congressional oversight means that it avoids being hamstrung by special-interest groups. It has a publicly appointed board with long terms, similar to the Federal Reserve, with even higher expectations for transparency. Aside from some start-up funding, the pool is self-financing.

“The major risk pool would not itself offer coverage directly to consumers; instead, it would offer reinsurance for hospitalization and chronic care — the most expensive components of health care — to health plans, which would sell comprehensive wraparound packages. In my book, Total Cure: the Antidote to the Health Care Crisis, I use the term “Universal Coverage Pool,” or UCP to describe most of these functions. The plan for health reform called SecureChoice in Total Cure has income-based subsidies and other features that may or may not be included in the current legislative discussion. Here I use the term “major risk pool,” or MRP, to describe a more narrowly construed publicly chartered plan.

‘The rationale for the MRP is twofold. (1) By pooling risk for the most expensive and financially threatening components of health care, it spreads risk broadly. Allowing health plans to buy coverage at demographically determined rates, it eliminates significant administrative and marketing expenses. (2) By paying in new ways for what covers, it will transform the delivery system.”

I will admit that this is beyond my amateurish economic capabilities to evaluate well. So, I’ll wait until Hacker or Nichols or others do, and keep you posted…

McKinsey: What Matters: Way too much for way too little

The title says it all. A great review of the American health care non-system.

Goes over administrative waste (83 cents of premium dollars go to actual health care at most in PHI market), outcomes, costs and prices, administrative burden, practice variation, and rationing (QALY’s CER).

Some good response letters as well.