Author: cmh

Medical Professional Organizations’ Views on Legislative, Regulatory, and Other Issues: Health System Reform

ACS Views on Legislative, Regulatory, and Other Issues: Health System Reform:

Since November 1, 2004, representatives (one elected leader and one staff person) from 11 physician organizations have held three health reform summits, with the goal of developing consensus on approaches that might lead to health care coverage for all, control of exploding health care costs, and sensible adjustments to America’s medical justice system.

Participating organizations included:

  • American Academy of Family Physicians
  • American Academy of Orthopaedic Surgeons
  • American Academy of Pediatrics
  • American College of Cardiology
  • American College of Emergency Physicians
  • American College of Obstetricians and Gynecologists
  • American College of Osteopathic Family Physicians
  • American College of Physicians
  • American College of Surgeons
  • American Medical Associatio
  • American Osteopathic Association

    The Board of Directors of 10 of the 11 participating organizations approved the final set of “Principles for Reform of the U.S. Health Care System”; the AAP did not sign on.

    The goal when signing on to the principles was for each organization to be able to say: “These principles are consistent with our organization’s policy, and therefore we support them.”

Now is the time for the organizations to begin discussions about how we might wish to introduce these important principles to various external audiences — key decision makers, policy makers, the media — and to consider any other “next steps” that we might consider regarding this important issue.
…………….
1.Health care coverage for all is needed to ensure quality of care and to improve the health status of Americans.
2.The health care system in the U.S. must provide appropriate health care to all people within the U.S. borders, without unreasonable financial barriers to care.
3.Individuals and families must have catastrophic health coverage to provide protection from financial ruin.

………….

6. Access to and financing for appropriate health services must be a shared public/private cooperative effort, and a system which will allow individuals/employers to purchase additional services or insurance.

…
11.Comprehensive medical liability reform is essential to ensure access to quality health care.

This was news to me, and it is something to build on…

National Journal Online — Health Care Experts — The Public Plan: Time Bomb?

National Journal Online — Health Care Experts — The Public Plan: Time Bomb?:

“Can Congress fashion a public health plan option so that it does not blow up health care reform this year?”

I didn’t get invited to leave a response, so here’s mine:

Interesting discussion.

Dr. Nichols wonders if we have examples of regulated private insurers brhaving properly. At the risk of venturing beyond our shores, don’t we have examples in Switzerland, Germany and other Social Health Insurance Model countries? His examples of public plans already alive and well in the US seem like good models to consider.

Ms. Turner and Mr. Goodman seem to be arguing opposite sides of magical market place coin: One laments that privte insurers will never be able to compete with the public option, and the other that the private insurers will eat the public plans’ lunch. It is possible for them to co-exist, again, if one is willing to suspend the idea of American Exceptionalism and benefit from the experiences of other nations. I will venture to say that if Mr. Goodman is correct and the private insurers provide efficiency, quality and win-out, then “Hallelujah!”, and all of us skeptics of the efficiency and value of private insurers will have been proved wrong, will eat crow, and happily allow the private insurers to be our vehicles for value.

I don’t think this will happen, and it seems that Mr. Goodman may be conflating the role of private insurers in their function as Medicare Carriers and ther role as profit making (even when ostensibly “not for profit”) insurers, dominating their regional markets, and squeezing their policy holders and providers alike.

Dr. Reinhardt, of course, always nails things and does again here. I think he may have overlooked another latent demand among physicians and other providers. Depending upon where you practice medicine, Medicare may be your most reliable, hassle free and even, in some markets, your best payer. Private insurers, while paying significantly more in some regions, may cost providers more in time, hassle, staffing costs and the like that their reimbursement warrants.

Ms. Davis also frames the debate well by focusing in on the acknowledged truth that we must pay smarter, not just more and more and more.

Cheers,

AMNews: March 16, 2009. White House summit takes 1st step in health system reform discussion … American Medical News

AMNews: March 16, 2009. White House summit takes 1st step in health system reform discussion … American Medical News:

AMNews had a more complete list of physicians in attendance than I did in an earlier post about the Summit:

“President Obama invited more than 100 people to a White House summit on health system reform on March 5, including the following physicians.
Rep. Michael Burgess, MD (R, Texas)
Ted Epperly, MD, American Academy of Family Physicians president
Oliver Fein, MD, Physicians for a National Health Plan director
Jeffrey P. Harris, MD, American College of Physicians president
Risa Lavizzo-Mourey, MD, Robert Wood Johnson Foundation president and CEO
Nancy H. Nielsen, MD, PhD, American Medical Association president
Irwin E. Redlener, MD, Columbia University Mailman School of Public Health professor
Elena V. Rios, MD, MSPH, Hispanic Medical Assn. president
Michael Salem, MD, National Jewish Health hospital system president
Henry E. Simmons, MD, MPH, National Coalition on Health Care president
David T. Tayloe Jr., MD, American Academy of Pediatrics president
Ho Luong Tran, MD, MPH, Asian and Pacific Islander American Health Forum president and CEO
W. Douglas Weaver, MD, American College of Cardiology president”

For my own edification, I did some research on membership numbers:
First, total number of ohysicians in US about 800K.

American College of Physicians (Internists and Medical Specialists) 126,000 members
American Academy of Family Physicians 94,000 members
American Academy of Pediatrics 60,000 members

Amercian College of Cardiology 36,000 members

AMA 240,000 including students and residents (free membership) and retired.
— maybe 140,000 practicing physicians (Approximately 20 % or less of all physicians)

Hispanic Medical Association 36,000 members

Others:

American College of Surgeons 76,000 members

American College of Obstetricians and Gynecologists 52,000 members

American Society of Anesthesiology 43,000 members

American Psychiatric Association 38,000 members

American College of Radiology 32,000 members

American College of Emergency Physicians 27,000 members

American Academy of Dermatology 16,000 members

American Academy of Ophthalmology 7,000 members

American Orthopaedic Association (AOA) 1,500 members

These numbers are from the organizations own websites, except for the AMA data which is from Wikipedia – I actually have the actual data from the membership committee buried in my office somewhere, and if I can find it, I’ll post it.

In any case, some of the numbers include medical students, residents and fellows, and international members. But at least a rough guide, suggesting that there really is no single big gorilla, but I know some small groups put their money where their mouths are and have outsized political clout…

Some State Membership numbers, from their web sites:

California Medical Association 35,000

Texas Medical Society 43,000

Medical Society of New York 30,000

Florida Medical Association 19,000

Illinois State Medical Society _____

Pennsylvania Medical Society 20,000

Massachusetts Faces Costs of Big Health Care Plan – NYTimes.com

Massachusetts Faces Costs of Big Health Care Plan – NYTimes.com:

““Frankly, it’s very hard for the average consumer, or frankly the average governor, to understand how some of these companies can have the margins they do and the annual increases in premiums that they do,” Mr. Patrick said in an interview. “At some level, you’ve just got to say, ‘Look, that’s just not acceptable, and more to the point, it’s not sustainable.’ ”

“The threat seems to have been heard. Insurers seeking to participate in the state’s subsidized insurance program, Commonwealth Care, recently submitted bids so low that officials announced last week that they would keep premiums flat in the coming year. That may provide cover for the program as the state seeks ways to fill a nearly $4 billion gap in its 2010 budget.”

The Concerns of “Harry and Louise” circa 1994

YouTube Link to videos here.

Because my daughter is working on her undergraduate thesis on comparing the health care reform policy environment in 1994 and now, we were looking at the old Harry and Louise videos.

It is funny, because there are two issues raised in the commercials. In the first, set “Sometime in the Future,”the concern is about having to choose among “insurance plans designed by government bureaucrats” and the lack of choice among doctors, hospitals, etc., should this happen. And the cute little line about, “Remember our old plan? That was a good one.”

Well, of course, those ships have all sailed. Our insurers now dictate our provider choices ever more restrictively. If you’ve ever changed your insurer, you probably have come to terms with looking through the provider book and figuring out which PCP practice to switch to, whether to go “out-of-network” to keep your old specialists, and whether to drive to a new hospital in your network. Unless, of course, you are in a federal plan, designed by bureaucrats, which generally will provide you with substantially more choice than your private plan.

It’s also worth saying that in most markets, insurance consolidation has resulted in ever dwindling choice in private insurers. So, the choice thing? Not so much.

The second commercial talks about the dangers of “community rating” to the premiums of the younger and healthier. This is exactly right, and Uwe Reinhardt has been warning about this lately. If not forced to buy insurance, those who are at lower risk of needing health insurance will opt out, driving up the premiums for those buying insurance, particularly small employers who can’t spread the risk out. A genuinely fair concern that is still in the mix of issues that need to be dealt with today.

So, how to deal with it? Everyone must be in. We must accept the societal bargain that when we are healthy, we subsidize those who are not. When our kids are healthy, we subsidize our neighbors’ kids with diabetes and autism and cancer. When our parents have chronic illnesses, we spread the risk amongst us all.

Dr. Oliver Fein reports on the White House health summit – PNHP’s official Blog

Dr. Oliver Fein reports on the White House health summit – PNHP’s official Blog

An excerpt:

What was my role in all of this? Despite my best efforts, I was unable to make a public statement at the meeting, although thanks to the PNHP staff in Chicago we were able distribute my prepared remarks to the media while the summit was under way. Our staff member in Washington, Danielle Alexander, also handed out hard copies to summit participants as they left the White House.

I took the opportunity to talk one-on-one with six senators and seven representatives and suggested that if their committees held hearings on health
reform, at least one or two single-payer advocates should be included on the
hearing panel. I also said that single-payer bills like H.R. 676 should be
compared with all other proposals for health care reform by the Congressional
Budget Office. There was considerable receptivity to these ideas among some of
the Congress members. We will pursue these leads.

The media took great interest in the successful battle by Rep. Conyers and myself to get into the summit, with stories in the Congressional Quarterly, The Wall Street Journal, and The New York Times, among other places. We have also been able get the single-payer message out on radio, with myself and Drs. Walter Tsou, Steffie
Woolhandler, David Himmelstein and Quentin Young, among others, being invited to
appear on the air, often on programs with national reach. This was a plus.

In sum, I came out of the White House Health Care Summit with conviction that
single payer – that is, publicly funded, privately delivered health care, which
removes the wasteful for-profit, private health insurance companies as middlemen, remains the only solution that can guarantee access to comprehensive, quality health care with choice of doctor and hospital, and reduce overall cost. Single-payer, an improved and expanded Medicare-for-All, is the gold standard against which all other proposals for health care reform should be measured.

Rep. Roy Blunt on Healthcare reform – RNC Weekly Address

Republican • National • Committee:

A snippet from Roy Blunt’s response to the Obama weekly address, on Health Care Reform:

“Just imagine a health care system that looks like a government run operation most of us are all too familiar with – the local DMV. Lines, paper work, taking a number. Or how about another government agency – the IRS.”

Now, Mr. Blunt gets his health care through his job, I imagine, which puts him in the federal program, and most of my patients get their health care courtesy of Medicare, and I don’t hear much complaining from them, while I hear LOTS of complaining from those who have private health insurance. All the time.

Eight principles of Health Care Reform – from Obama Budget

• Guarantee Choice. The plan should provide Americans a choice of health plans and physicians. People will be allowed to keep their own doctor and their employer-based health plan.

• Make Health Coverage Affordable. The plan must reduce waste and fraud, high administrative costs, unnecessary tests and services, and other inefficiencies that drive up costs with no added health benefits.

• Protect Families’ Financial Health. The plan must reduce the growing premiums and other costs American citizens and businesses pay for health care. People must be protected from bankruptcy due to catastrophic illness.

• Invest in Prevention and Wellness. The plan must invest in public health measures proven to reduce cost drivers in our system—such as obesity, sedentary lifestyles, and smoking—as well as guarantee access to proven preventive treatments.

• Provide Portability of Coverage. People should not be locked into their job just to secure health coverage, and no American should be denied coverage because of preexisting conditions.

• Aim for Universality. The plan must put the United States on a clear path to cover all Americans.

• Improve Patient Safety and Quality Care. The plan must ensure the implementation of proven patient safety measures and provide incentives for changes in the delivery system to reduce unnecessary variability in patient care. It must support the widespread use of health information technology with rigorous privacy protections and the development of data on the effectiveness of medical interventions to improve the quality of care delivered.

• Maintain Long-Term Fiscal Sustainability. The plan must pay for itself by reducing the level of cost growth, improving productivity, and dedicating additional sources of revenue.

Nothing over the top in here. The principles, I think, are not very assailable.

The Politico offers their “translation” and I think zeroes in on what may become the critical throw down issue: Will we have a public insurance option to compete with private insurers in a system where all are required to have insurance?

Henry Waxman told AMA members in DC that a public option was in his plans, and Obama and Sen. Baucus have also indicated support for a public option.

Here is a link to the AMA National Advocacy Council news site. I have to say, the list of speakers is impressive. No Cato, Fraser, Heritage to be found (at least on the fist day – Tuesday) speaker list. Mostly progressive speakers.

The White House – Press Office – White House Forum on Health Reform Attendees and Breakout Session Participants

The White House – Press Office – White House Forum on Health Reform Attendees and Breakout Session Participants

I was curious who was invited, so click on the link to see the complete list.

The physicians groups that I saw are below.

American College of Physicians, Jeff Harris, President
American Academy of Pediatrics, David Tayloe, President
American College of Cardiology, W. Douglas Weaver, President
American Academy of Family Physicians, Ted Epperly, President
American Medical Association, Nancy Nielsen, President
National Medical Association, Mohammad Akhter, Executive Director
Physicians for a National Health Plan, Dr. Oliver Fein, Director
University of Chicago Medical School, Eric Whitaker, Executive Vice President For Strategic Affiliations

And only one nurses group?

American Nurses Association, Rebecca Patton, President