With Health Reform, Some Health Plans Are More Equal Than Others

All animals are equal, but some animals are more equal than others.

George Orwell (1903-1950), Animal Farm (1945)

When Orwell, an avowed socialist, made this statement, he meant that the “haves,” the elites, felt that people in their class were equal, but the “have-nots” – working class and minorities- were less equal. Saying all people are equal was a way of making the “haves” look virtuous, although they don’t believe this in practice.

Orwell was being satirical. He was saying that equality of results didn’t work out that well when elites ran the country. Theoretically, the new health reform law should level the playing (and paying) fields between the haves and have-nots by redistributing health (and wealth) benefits – by covering more of the poor, children, young adults while taxing the rich – and giving all more or less equal care. But it doesn't work out that smoothly because some people always want more and to pay less than others.

As I read a Robert Pear piece in today’s March 20 New York Times, I thought of Orwell. The article “Health Law Waivers Draw Kudos and Criticism” concerns the offering of waivers to more than 1,000 health plans covering 2.6 million people. The reform plan, designed to cover 32 million more Americans and to protect and to make it more affordable for everybody, has a requirement to provide at least $750,000 in coverage to each person in their own health plans.

Regrettably, the reform plan raises costs significantly for many of the “have-nots,” who say they cannot afford it, and it drives insurers out of markets, leaving more uninsured in its wake.

In this case, those who claim to be “have-nots,” say the law is too strict, demanding, and expensive, and they want to opt out. They seek a reprieve, an exemption from the law. They need, they insist, to be classified as exceptions and to be “waivered out,” beyond the reach of the law.

To date, says Pear, “Such waivers have gone to entities as diverse as the Waffle House and Ruby Tuesday, health plans run by Aetna and Cigna, and labor unions representing Teamsters, electrical unions, carpenters and food and commercial workers.”

Without the waivers, says Kathleen Sebelius, Secretary of Health and Human Services, many employees would have to pay unaffordable premiums, employers would have to drop coverage, and health plans would have to withdraw from markets, leaving millions uninsured.

The law has a provision saying health plans must pay at least 80% of premium revenues for care and efforts to improve it. Maine was issued a waiver dropping this to 65%, and five other states – Florida, Georgia, Kentucky, Nevada, and New Hampshire – have requested similar waivers. A dozen other states may apply for waivers.

The need for waivers will continue to grow as Federal rules require health plans to increase the requirement of $750,000 in coverage to $1.25 million in coverage in 2012 and $2 million in 2013. By November, 2012, the date of the next Presidential election, we should know what health plans are more equal for what political animals.

Richard L. Reece, MD, blogs at Medinnovation and has a website under construction. www.doctorreece.com. He is the author of three recent books, Obama, Doctors, and Health Reform (Iuniverse, 2009), Innovation Driven Health Care (Jones and Bartlett, 2007), and an E-book, Pros and Cons of Accountable Care Organizations (Practice Support Resources, 2011). He works with but does not speak for The Physicians Foundation, a 501C3 organization representing physicians in state medical societies. Opinions expressed in his blogs are his alone. He can be reached at rreece1500@aol.com and 1-860-395-1501.

Health Reform Polls Show Confusion and Division

Americans Remain Divided, Confused About Health Law as Anniversary Nears

Phil, Galewitz, Title of paper, Kaiser Health News, March 18, 2011


Confused we stand. Divided we fall.

Anonymous

If you have a divided opinion and are confused about health reform, join the crowd. Consider these March 18 opinion polls about the health reform law.

• 42% of Americans favor the law while 46% are against it.

• 71% of Democrats back the law and 82% of Republicans oppose it.

• Of those against the law, 20% mention excess costs, 19% too much government, and 18% concerns over the individual mandate.

• 53% are confused about the law.

• 67% say states should be allowed to substitute their version of reform as long as its meets federal standards.

• 67% support repeal of the individual mandate.

• 52% of seniors have unfavorable views of the law, and 42% are for it.

• Poll averages of ten national polls indicate 39.0% favor the Obama plan and 51.9% oppose it.

Sources: Kaiser Health News and Real Clear Politics

Why this mixed picture? In my unpolled opinion, there are three factors: 1) Ramming through the law against unanimous Republican opposition without thinking though the consequences; 2) lack of a cohesive story of what the law is all about ; 3) a fundamental misunderstanding of culture is about in a culturally diverse country like the U.S.

On a lighter note, reasons exist to mistrust polls, which are merely a snapshot in time. As the late Erma Bombeck noted, “I haven’t trusted polls since I read 62% of women had affairs during their lunch hour. I have never met a woman in my life who would give up lunch for sex.” Will Rogers chimed in that polls in the South will always indicate the voters will vote dry, “As long as everybody is sober enough to stagger to the polls.” Warren Buffet concluded soberly, “A public opinion poll is no substitute for thought.”

There is nothing like a poll,

It signals the eventual whole.

There is nothing like a poll.

It resembles an early stroll.

In the end, it takes finally an election,

To see if polls point the right direction.

You can’t always trust them.

When there’s political mayhem.

Besides, to use an obvious example,

You can slant your population sample,

Just ask the right questions,

And give leading suggestions.

The Search for the Very Best Hospitals

I am easily satisfied with the very best.

Winston Churchill (1874-1965)

Two Items caught my attention this week,

• A March 16 Press Release, “U.S. News & World Report and Castle Connolly Collaborate to Help Consumers Find the Best Hospitals and the Top Doctors.”

• A March 17 New York Times article“What Makes a Hospital Great? “ By Pauline Chen, MD.

I am not a disinterested reader.

For the last ten years, I have been on the Medical Advisory Board of Castlr Connolly’s “Top Doctors ®” publications. The Castle Connolly Top Doctors selection process begins with online surveys of physicians in both academic and private practice positions across the U.S. They are asked to nominate physicians they consider best in their respective areas of medicine. Once these professional peer nominations are processed, a unique, physician-led research team carefully reviews the credentials of every physician being considered for inclusion as a Castle Connolly Top Doctor. This review includes, among other factors, scrutiny of medical education, training, hospital appointments, administrative posts, professional achievements, and malpractice and disciplinary history. Doctors do not and cannot pay to be included in any Castle Connolly listing or guide.

I have followed U.S. News and World Reports annual publications announced the best hospitals in the U.S. The U.S. News Media Group is a multi-platform digital publisher of news and analysis, which includes U.S. News & World Report, the digital-only U.S. News Weekly . The media group ranks colleges, graduate schools, hospitals, nursing homes, and more.

I am also interested because my upcoming book, with a tentative title of The Health Reform Maze, will soon be published by Greenbranch Publishers.

In the section of hospitals, I say:

“The centerpiece of the American health system are American hospitals and the physicians who use them as workshops. Hospitals account for 31% of health costs. The health reform envisions lowering of costs and improving care through new organizations creating collaboration between hospitals and doctors by having government pay for bundling services between the two. These collaborative organizations, called Accountable Care Organizations (ACOs) have their up and down sides and their supporters and distractors.”

The controversy surrounding ACOs is beyond the scope of this blog. But the search for the best hospitals is not. In her New York Times piece, Dr. Chen cites a study in this week’s Annals of Internal Medicine (“What Distinguishes Top-Performing Hospitals in Acute Myocardial Infarction Mortality Rates”, in which the authors conclude,” High-performing hospitals were characterized by an organizational culture that supported efforts to improve AMI care across the hospital. Evidence-based protocols and processes, although important, may not be sufficient for achieving high hospital performance in care for patients with AMI.”

In other words, it isn’t electronic medical records, superstar physicians, adherence to protocols, high-tech equipment, or data on re-admission rates that make a hospital great, it’s the culture - how people communicate and support each other and the organization – that counts. The organizational culture is what makes hospitals the very best.

I Spoke Too Soon: President Obama Puts Candle on !st Birthday Cake of Health Reform Law

Yesterday, I wrote Republicans were celebrating the failures of Obamacare on its first birthday while Democrats were remaining silent.

That’s too bad and premature. I apologize. I pride myself on being even-minded about health reform. But sometimes my skepticism overcomes my objectivity, and my bias shows through. As the late E.B. White, America’s premier essayist, observed, “A writer's style reveals something of his spirit, his habits, his capacities, his bias.... It is the Self escaping into the open.”

As it turns out, the Obama administration has its strategy to celebrate the event. It consists of having a half-dozen cabinet members fanning out around the country praising the positive accomplishments of the law. These accomplishments include tax credits for small businesses, rebates for seniors who fall in the Donut Hole due to high prescription drug costs, coverage of young adults up to 26 under their parents’ health plans, and an attack on health plans as the main culprits for rising premiums.

Also, after the fanfare over the 1st anniversary blows over, and the 1st candle has been blown out, Democrats are relying on:

• $105 billion they cleverly set aside to automatically fund implementation to blunt Republican efforts to defund the bill;

• putting out a final version of the Accountable Care Organization provision forcing hospitals and doctors to collaborate by paying them on the basis of fixed budgets for Medicare populations.

Now is not the time to focus on the virtues or faults of Obamacare. Let’s face it. President Obama has bigger issues on his plate with disasters in Japan and Libya. Dealing with health reform can wait for another day, Now is a time for good sense, candor, civility, and support on bigger international issues rather than on the string of unforeseen and unfortunate consequences of health reform.

Republicans Congregate in D.C. on 1st Anniversary of Obamacare

Next Wednesday, March 23, is the first anniversary of the passage of the Patient Protection and Affordability Act. Give that this health reform law is the biggest piece of social legislation since Medicare, you would think this would be cause of celebration for Democrats and for consternation for Republicans.

Not this year. The Democrats are mute. Maybe this is because of the unpopularity of the law. A Rasmussen poll on March 15 showed 62% want the Affordability Act repealed.

Republicans are converging on Washington from across the U.S. to hold events calling for its repeal. A Republican physician Congressman , Michael Burgess,M.D. of Texas, and physician Senators Tom Coburn, MD, of Oklahoma, and Pat Roberts of Kansas, and John Barasso, MD of Wyoming, are glad to lend a hand to the proceedings, which resemble a wake more than a birthday party.

A wag once said D.C. stands for “Darkness and Confusion.” This year for Republicans D.C. might stand for “Desecration and Condemnation.” Some of the events being held are book parties. Grace-Marie Turner, founder and president of the Galen Institute, and her three co-authors will appear at the National Press Club on March 24 to launch their book Why ObamaCare is Wrong for America, and on March 23, Congressman Michael Burgess will celebrate the release of his book, Doctor in the House: A Physician Turned Congressman Offers His Prescription for Scrapping Obamacare – and Saving America’s Health System.

Meanwhile Senator Pat Roberts of Kansas, commenting on the first anniversary of Obamacare bill, issuing these figures in a press release. He did not give a time frame for these dire estimates.

∙ $2,100 in higher premiums;

∙ 800,000 fewer jobs;

∙ $118 billion in new unfunded state mandates;

∙ $311 billion in higher health care costs;

∙ $529 billion in Medicare cuts to fund new entitlement spending;

∙ $813 billion in new taxes;

∙ And $2.6 trillion in new federal spending.

From other Republicans there is a drumbeat of criticism citing negative ore questionable consequences flowing from the bill.

• Over 1000 waivers for union, corporations, and state adversely effected.

• Marketplace impacts, with insurers pulling out of individual , child, small group, and Medicare Advantage markets.

• Doctor shortages, particularly in the South and Mountain West states.

• Negative impacts on health care brokers.

• A growing movement for repeal,

• Protests from cash-strapped states unable to handle the new Medicaid burdens.

Some first anniversary. Some birthday party. I have scoured the Internet in search of Democratic events celebrating the first anniversary of Obamacare. So far I have come up empty. Nancy Pelosi and Harry Reid made some subdued, understated comments of praise, but nothing else. Maybe when you think you hold the aces, you don't feel a need to comment. I am confident events are being held to commemorate the positives of the law and its contributions to public welfare, but they are not getting any national publicity.

Health Reform Thought for Today

The “devil,” they say,“ is in the details.”

That is why government often fails,

The government devil,

Is not at ground level.