Friday, October 21, 2011

Random Survey of Passing Health Reform Scene

I am monarch of all I survey.

William Cowper (1731-1800)

October 21, 2011- This morning I shall take a shot at what I see on the passing health care reform scene.

• After three years of the Obama presidency, the number of uninsured is now over 50 million. The high number of uninsured can be traced to a lousy economy, high unemployment, and the Medicaid mix. This mix includes those in poverty, legal and illegal immigrants who don’t know how to become Medicaid recipients, and healthy “young invincibles” who have other things on their minds. The rate will continue to rise until the economy gets better and when, and if, Obamacare survives until 2014, when 32 million are slated to enter Medicaid. The health law’s survival depends on the Supreme Court’s decision on the constitutionality of the Affordable Care Act and Republican’s efforts to repeal the law.

• According to The Washington Report, a periodic news analysis, prepared for the Physicians Foundation, a nonprofit organization representing over 500,000 physicians in state medical societies, the Super Committee appointed to resolve the budget deficit by November 23 is having a huge problem breaking the deadlock between Democrats and Republicans. Democrats insist there be no cuts in Medicare and Medicaid, Republicans that there be no tax increases. If this issue remains unresolved, across the board cuts will kick in, cutting Medicare and Medicaid and slashing hospital and physician revenues. Meanwhile, the Obama administration is backing off its initial position on Accountable Care Organizations, by reducing the number of regulations from 65 to 33 and ending demands that all physicians joining ACOs have electronic medical records. Changes and add-ons increased the number of pages in the CMS final rules from 429 to 696, showing again the penchant of the administration for bureaucratic verborrhea, and in the process, stiffening resistance of physician groups and hospitals to ACOs.

• Finally, Robert Samuelson, of Newsweek, in a column “Obamacare’s Broken Promises,” predicts, “ Hard times continue for the Affordable Care Act (aka Obamacare). The administration has scrapped the law's long-term care insurance program, covering nursing homes and home health care. The program was deemed unrealistic. This is a harbinger. As the law is implemented -- assuming the Supreme Court doesn't declare it unconstitutional or Republicans don't repeal it -- disappointments will mount.”

As a solution to paper over these broken promises, Samuelson cites a paper in the New York Review of Books by Arnold Relman, MD, former editor of the New England Journal of Medicine, and a champion of single-payer and salaried physicians in large groups.

Here is what Relman has to say,

"Physician-owned not-for-profit groups, particularly those that pay their doctors at least partly by salaries, are not as likely to provide unnecessary services or to recommend hospitalization when it is optional. Their physicians have few financial incentives to do so, and the services of their specialists are coordinated with their primary care doctors, who usually recommend the simplest and least expensive choices consistent with good medical care. In today’s political climate these reforms have no chance, but this could change if physicians continue to join groups and transform the organization of medical care.”

Relman thinks this movement could snowball, An apt metaphor. I give Relman's plan the chance of a snowball in hell.

Tweet: Health reform scene - uninsured have passed 50 million, the super committee to cut debt is deadlocked, and hard times plague Obamacare.

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