Why conservatives are so obsessed with guns.

PLOS ONE: Healthcare Reform and the Next Generation: United States Medical Student Attitudes toward the Patient Protection and Affordable Care Act

Of medical students surveyed, 94.8% agreed that the existing United States healthcare system needs to be reformed, 31.4% believed the PPACA will improve healthcare quality, while 20.9% disagreed and almost half (47.7%) were unsure if quality will be improved. Two thirds (67.6%) believed that the PPACA will increase access, 6.5% disagreed and the remaining 25.9% were unsure. With regard to containing healthcare costs, 45.4% of participants indicated that they are unsure if the provisions of the PPACA will do so. Overall, 80.1% of respondents indicated that they support the PPACA, and 78.3% also indicated that they did not feel that reform efforts had gone far enough. A majority of respondents (58.8%) opposed repeal of the PPACA, while 15.0% supported repeal, and 26.1% were undecided.

Conclusion

The overwhelming majority of medical students recognized healthcare reform is needed and expressed support for the PPACA but echoed concerns about whether it will address issues of quality or cost containment.

Partisanship guides American attitudes on health-care reform – DC Breaking Local News Weather Sports FOX 5 WTTG

Partisanship guides American attitudes on health-care reform

Predictably, individual views on the law’s effects — for good or ill — also fell along party lines. Twenty-two percent of Democrats say the ACA has had an overall positive effect on their lives, compared to only 4 percent of Republicans. Similarly, 42 percent of Republicans deem the overall effect as negative, compared with 9 percent of Democrats.

“Republicans are much more likely to see negative effects of the ACA, including some effects (increased taxes or a decline in quality of care) which are almost certainly not linked to the Affordable Care Act,” Taylor said. “Democrats tend to see positive effects that [also] may be real or imagined.”

Although the poll numbers appear mixed, Ron Pollack, executive director of Families USA in Washington, D.C., believes that public attitudes will lean more toward the positive as 2014 approaches and more of the law’s key elements are enacted.

Obamacare Is Not Causing Small Businesses To Drop Their Employees’ Coverage | ThinkProgress

And a new study assuages similar fears that small business owners might drop coverage for their employees before Obamacare takes effect in order to avoid being hit with crippling expenses. The Midwest Business Group on Health surveyed businesses across 16 states, ranging in size from small companies with fewer than 1,000 employees to larger corporations that employ more than 5,000, and found “little indication that employers plan to drop health care coverage.”

As Forbes reports, while employers understand that they may want to adjust the scope of their health benefits plans, they are not anticipating the need to drop coverage for their employees because of the health reform law’s implementation…

Health care for all: Expanding Medicaid would save lives, suffering and money – Pittsburgh Post-Gazette – Printer friendly

My Piece on Medicaid expansion from the P-G:

Health care for all: Expanding Medicaid would save lives, suffering and money

One of the most common questions I get asked about the new health care law concerns how expanding health insurance coverage to millions of low-income families through Medicaid will affect those who already have insurance. “What will all of those new people with access to health care do to the rest of us? Will it make it harder to get access to our doctors? Will they clog up our emergency rooms and hospitals?”
As someone whose profession takes a strong position in favor of universal access to health care, I have a hard time saying anything but, “What a great problem to have!” It turns out to not even be a problem.
Massachusetts did this many years ago, as we are being frequently reminded, and the results are in. Use of emergency rooms is down, waiting times to see a primary care doctor are essentially unchanged and there has been a vast expansion in the use of preventive services: mammograms, colon cancer screens and prenatal care, for instance. Doctors and the people of Massachusetts overwhelmingly favor continuation of their program, and they are now proceeding to the really hard part: getting costs under control. Stay tuned!
An even more interesting experiment is being conducted in Oregon via an unhappy accident. Due to a shortage of funds, Medicaid eligibility was determined by lottery, creating a natural experiment of haves and have-nots. In the first year, those who were enrolled were 70 percent more likely to have a usual source of care, were 55 percent more likely to see the same doctor over time, received 30 percent more hospital care and received 35 percent more outpatient care, and much more.
Every doctor you know can tell you stories about how the lack of access to health insurance and health care has injured a patient’s health, life, limbs, finances or all of the above. I’ve had patients who work full time in jobs that fall far short of the American dream. They get by, but they can’t afford health insurance.
There’s the cabbie who recognizes his diabetes and determines to work harder and longer so he can buy insurance before he is stricken with the label even worse than diabetes: preexisting condition! He doesn’t make it and ends up in the ICU with diabetic ketoacidosis.
There’s the construction worker who has a controllable seizure disorder that goes uncontrolled. He ends up in the ICU multiple times.
There’s the woman who stays home to care for her dying mother and loses her insurance along with her job. When she finally gets to a doctor for herself, her cancer is far advanced.
So, for me and my profession, the most expansion for the most people is a best-case scenario. But others see expanding health insurance only through a short-term budgetary lens and consider covering nearly everyone a worst case.
For one thing, this view ignores the incredible deal states get when they accept Medicaid expansion. According to the Kaiser Foundation, by 2019 Pennsylvania would add about 482,000 new enrollees; another 282,000 who are eligible but don’t know it would come into the program. That’s more than three-quarters of a million people with access to care.
Critics point to the potential cost to the state of more than a billion dollars over six years. That’s a lot of money, but the federal government would pay more than $17 billion — over 94 percent of the cost. Furthermore, the additional billion would be only 1.4 percent more than Pennsylvania’s currently scheduled spending over that period. Even in a best-case scenario, with insurance for an additional 1.1 million Pennsylvanians, this figure would rise to only 2.7 percent.
One can choose to focus on the costs to the state and federal governments, but we spend many of those dollars already on the wrong end of the care continuum. Our governments already pay for patients who cannot pay for themselves, largely by cutting big checks to hospitals.
You can take care of a lot of diabetic cabbies for a lot of years for the cost of a stay in the ICU. Just because the costs don’t show up as a line item in a government budget — it could be labeled “Exorbitant Amounts of Money for Preventable Complications and Deaths” — doesn’t mean we don’t pay them.
A frequent talking point against expanding access to health care, “You can always go to an emergency room,” is actually dead on. Literally.
The law requires emergency rooms to treat and stabilize patients even if they have no means to pay. But no emergency room does cancer screening. Or prenatal care. No emergency room manages diabetes. Or congestive heart failure. As a result, many people don’t seek treatment until they are nearly dead.
Patients forgoing care or medicines because they can’t afford them simply shifts the costs from keeping people healthy to our extremely expensive system of “rescue care.” And remember, Massachusetts’ early experience and Oregon’s current experiment are showing the benefits to the entire system of getting people taken care of before they need an ER or ICU.
Not long ago, expanding access to health care was a nonpartisan goal. As recently as 2007, a bipartisan group of U.S. senators, including Republicans Jim DeMint and Trent Lott, wrote a letter to then-President George W. Bush pointing out that our health care system was in urgent need of repair. “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.’ “
Their No. 1 priority? “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.”
Medicaid expansion, as well of the rest of the new health care law, represents our best effort so far in reaching these once-bipartisan goals. Pennsylvanians deserve an expansion of health insurance and health care, a healthier state, a healthier workforce and to continue the journey toward my profession’s goal: excellent, affordable health care for all.
Christopher M. Hughes practices intensive care and hospice medicine in Pittsburgh and is the Pennsylvania director of Doctors for America (www.drsfor america.org).

First Published October 4, 2012 12:00 am

Obama’s healthcare law: Historic reform and signature failure – latimes.com

His [Obama’s] one condition was a healthcare plan that would protect Americans and could pass,” said Neera Tanden, a former senior White House health advisor.

Several Republican lawmakers signaled interest in working with Obama. But almost at the outset, the GOP leadership was dug in.

“There were legitimate policy disagreements,” said John McDonough, a former aide to the late Sen. Edward M. Kennedy (D-Mass.), “but the clear message we heard from the GOP staffers was they couldn’t move without a signal from McConnell.”

The Republican Senate leader pressured GOP senators to stop negotiating with Obama. “It was intense and it was constant,” said one former Republican aide, who asked not to be identified discussing internal party tensions.

Healthcare leaders got a similar message. One executive said he received several calls from senior GOP lawmakers warning that he would regret participating in the process. Another said he was told that Republicans would not do anything to make the legislation better. “Republicans were going to vote against the law, no matter what,” a third executive said.

All three declined to speak publicly for fear of angering GOP congressional leaders.

Despite the hostility, Obama spent most of 2009 pursuing Republican votes.

🙁

Let health reform do its job

A patient loses his insurance and it puts his life at risk. Everyday stuff in America.

Health insurance is essential for living well with chronic disease, and the loss of access to care is a major cause of preventable illness and death, but it is also ultimately much more costly to society than long-term continuous primary care. As a doctor, I know how to help people. I can’t do it when I don’t see them because they cannot afford to come in. We need to shift our care to the doctor’s office and away from the expensive emergency room.

The Affordable Care Act is in the process of correcting that fatal flaw in our health care system. With the benefits for seniors including making medications more affordable and shoring up Medicare, Medicaid expansion, health insurance exchanges (that would help people like Mr. Smith), subsidies to purchase insurance and spreading of risk across large populations to make possible the ending of exclusion for pre-existing conditions, the coverage gap for patients such as mine should ultimately be a thing of the past.

Most medical organizations are supporting the ACA. Most primary physicians favor it as at least a major step toward access to health care. Those who oppose it and work to create barriers to implement it have yet to offer a reasonable alternative that would help patients such as Mr. Smith. If they have one, it is time to tell the American people what they have in mind, and if not, they should step aside and let reform do what it was designed to do.

From Doctors for America member Ian Gilson.

An Effort To Cut Through Romney-Ryan Doublespeak And Explain What They Really Want To Do | The New Republic

Ryan and Mitt Romney have called for the most profound, radical changes in the program’s history. But rather than clarifying the differences between their position on Medicare and President Obama’s, they’ve done their best to obscure them. They’ve accused Obama of “raiding” Medicare when Ryan’s own budget calls for reducing the program’s funding by the same amount of money. They have insisted they won’t do anything to affect current retirees, even though they have pledged to repeal the Affordable Care Act, which bolsters Medicare’s drug coverage and makes preventative care available without out-of-pocket expenses.

Romney and Ryan have also been less specific than you might have heard. That’s particularly true for Romney, whose “proposal” consists of a fact sheet, plus a few speeches, statements, and op-eds. This allows them to escape responsibility for the inevitable trade-offs that their vision, like every effort to reform Medicare, would require. And it gives them a political advantage over President Obama, who must defend reforms of Medicare in the Affordable Care Act and his latest budget—right down to the last legislative clause and dollar figure.

Yes, I keep reading that Romney and Ryan have been “brave” and “serious” about Medicare, while Obama has ducked hard choices. I would say it’s the other way around.

An Effort To Cut Through Romney-Ryan Doublespeak And Explain What They Really Want To Do | The New Republic

The Republican ticket’s big Medicare myth

Obama’s Medicare reform plan isn’t that hard to find. It’s largely in Title III of The Patient Protection and Affordable Care Act. The basic strategy has three components: First, figure out what “quality” in health care is. Second, figure out how to pay for quality rather than paying for volume. Third, make it easier for Medicare to quickly update itself to reflect both advances in knowledge about what quality is and how to pay for it.

And so, in Title III, you’ll find dozens of different efforts to achieve these goals. The most famous of them is Section 3403, which establishes the Independent Payment Advisory Board (IPAB). But there’s also Section 3021, which creates the Center for Medicare and Medicaid Innovation, and Section 3025, which cuts hospital reimbursements if too many of their patients are readmitted, and Section 3001, which establishes value-based purchasing for hospital services, and Section 3015, which collects data on quality, and Section 3502, which advances the medical home model.

Some of the efforts are outside Title III. The Patient-Centered Outcomes Research Institute is actually in Title VI of the law. And then there are the subsequent reforms the administration has proposed to save more money. Those can be found on pages 33-37 of the president’s 2013 budget proposal. They include expanding IPAB’s mandate such that it can change Medicare’s benefit package and setting a growth cap on Medicare of GDP+0.5 percentage points — which is, by the way, the same growth cap that Rep. Paul Ryan imposes in the latest iteration of his budget.

Papa John’s: ‘Obamacare’ will raise pizza prices – POLITICO.com

If you thought Obamacare was going to be expensive, Papa John’s is here to show exactly how little an effect on businesses it will be to buy health insurance for employees – less than 15 cents a pizza! As Pete Townshend once said, “I call that a bargain, the best I ever had!”

Pizza chain Papa John’s told shareholders that President Obama’s health care law will cost consumers more on their pizza.

On a conference call last week, CEO and founder John Schnatter (a Mitt Romney supporter and fundraiser) said the health care law’s changes — set to go into effect in 2014 — will result in higher costs for the company — which they vowed to pass onto consumers.

“Our best estimate is that the Obamacare will cost 11 to 14 cents per pizza, or 15 to 20 cents per order from a corporate basis,” Schnatter said.

PolitiFact | Mitt Romney says ‘Obamacare’ adds trillions to the deficit

Here, we’re fact-checking Romney’s claim that “Obamacare adds trillions to our deficits and to our national debt.” It’s a topic we’ve researched before.

We asked the Romney campaign for their evidence for this statement, but we didn’t hear back.

For claims about laws that are not yet fully enacted, our go-to source is the Congressional Budget Office. It’s a nonpartisan, widely respected agency with an expert staff that generates projections and reports about how proposed laws affect the federal budget.

The Congressional Budget Office is not always right in its projections. In recent years, for example, it overestimated how much it would cost to cover prescription drugs for seniors in Medicare. The program actually came in under projections.

But for claims about deficits, we consider the Congressional Budget Office, often called the CBO, to be the standard by which we fact-check claims.

The CBO said this about the health care law back in 2010: It lowers the deficit, by about $124 billion over 10 years.

And in 2011, when Republicans offered a bill to repeal the health care law, the CBO said that increased the deficit, by about $210 billion over 10 years.

Now, is the CBO infallible? Certainly not. And good questions have been raised about some of the CBO’s methods in accounting for the health care law’s effects. We reported on some those concerns in great detail in a fact-check of statement from U.S. Rep Paul Ryan, R-Wisc. He said the law was “accelerating our country toward bankruptcy.” We rated that Mostly False.

The CBO itself acknowledges the uncertainty surrounding its estimates. Its reports regularly warn that uncertainty increases as it makes projections farther into the future.