Health Reform and the Budget Battle: Who Won?

When they say it is the principle, and not the money, it is the money.

Maxim

April 10, 2011 – In the extraordinary budget battle just concluded, who won on the health reform issue ? Obama supporters or opponents?

The consensus is that those who would repeal Obamacare won. At least that’s the opinion of Donald J. Palmisano, MD, JD, former president of the AMA,as expressed in his widely read blog, DJP Update. He and many others felt the main issue in the budget deal was cutting $38.5 billion from the budget, not ending social programs like NPR or Planned Parenthood.

Palmisano gives three reasons why the deal favors opponents of the health reform law.

One, because the deal supports the position of those who say the health reform law is failing as articulated in the new book Why Obamacare is Wrong for America.

Two, because the deal guarantees a Senate vote on repeal of the health care law, gives lawmakers new tools in the form of studies and hearings to demonstrate negative impacts of the law, and denies new funds to the IRS to enforce the law’s mandates.

Three, because the budget battle deal somehow will culminate in a Supreme Court 5-4 decision declaring the health law unconstitutional.

I do not know whether Dr. Palmisano is right or wrong, but I thought it might be worthwhile reprinting the details of the alternatives to Obamacare as set forth in Why Obamacare Is Wrong for America.

It is not sufficient to repeal the law. A reasonable alternative must be offered.

Private Insurance

• Offer people a health credit to purchaser coverage on their own, through an employer, or through other groups.

• Allow greater flexibility in health benefits: consumers, not regulators, should decide what their health plans cover and not be forced into one-size-fits-all, government determined standard plans.

• Provide portability of health insurance and greater competition by allowing cross-state purchase of health insurance.

• Allow states to develop market mechanisms to help consumer find and enroll in the insurance that best meets their needs.

• Ensure more secure renewal of health insurance this is guaranteed so people who have insurance can keep it, and others without it will encourage getting insurance and maintaining their coverage continuously.

• Provide greater financial assistance to the states to create more functional high risk pools or state risk-transfer pools that allow people with preexisting conditions to purchase more affordable health insurance.

• Reform the medical malpractice litigation process at the state level.

Public programs

• Puts the savings from Medicare reform into saving Medicare.

• Convert Medicare for new enrollees into a market-based, consumer-choice program in which the beneficiaries select the coverage that best suits their needs with fixed support from the government.

• Allow people to escape from Medicaid by giving them health credits that they could use to purchase private coverage.

• Provide more flexibility to the states in running Medicaid programs so that can get the best value for taxpayers’ dollars, including allow Medicaid beneficiaries to enroll in state-designed consumer-choice models.

• Provide more options for Medicaid recipients, Medicare beneficiaries, and others on public programs to escape the restrictions that inevitably come from price controls and government micromanagement.

Richard L. Reece, MD, has posted 1725 blogs at medinnovation blog over the last four years. His main themes concern health reform and innovation and how they impact physicians and American culture as a whole. He works closely with the Physicians Foundation but his opinions are his alone. He has written eleven books. His latest book, The Health Reform Maze, is now at the publishers and will be released in June. Doctor Reece’s website, www.doctorreece.com, is now up and running He invites comments and questions on his blog trough his website and will respond to each comment or question on his blog or to him directly at 860-395-1501 or rreece1500@aol.com.

www.doctorreece.com – How Tweet It Is

My website, www.doctorreece.com, in now up and running. Its purpose is to simplify and explain health reform in human terms. Part of that process involves tweeting my blog entries.

A tweet, as you know, is a 140 character summary of what you’re doing today.

To find my tweets, go to the lower right corner of www.doctorreece.com and locate a "t" for twitter and up will come my tweets for today and yesterdays.

Here are recent tweets.

• My website, www.doctorreece.com, goes online today and is intended to give insight into divisive forces driving health reform.

• ACOs are consultants' dreams and hospital-physicians' nightmares, costing up to $ 1 million to set up and then maybe not even working.

• Patients and doctors are flocking to concierge medicine, which may threaten access to care for Medicare patients not in concierge practices.

• Cloud computing, transferring electronic health systems from doctor offices to Internet browser, may be EHR's salvation & huge opportunity.

• 3 books to read on health reform are; Why Obamacare Is Wrong for America, The Truth about Obamacare, and Health Reform Now!

• Vermont, a tiny state with 0.2% of US population, wants to introduce a single-payer health plan. Go for it, but do not expect US to follow.

•Republican health plans are more “progressive” than Obamacare. They offer universal tax credits, and national shopping for health plans.

• With the health reform law, some health plans are more equal than others, meaning some are now unaffordable and must be given waivers out.

• To tweet or not to tweet that is the question whether tis' nobler to suffer the slings and arrows of outrageous verbiage or to keep it short.

• To find the best hospitals, go to U.S. News and World Report, Castle Connolly Top Doctors, www.hospitalcompare.hhs.gov.

• Polls indicate Americans are confused and divided about the health reform law. Small wonder. It’s massively and fiendishly complicated.

• Technology and humanity are the two faces of medicine, Ideally, they should complement, but often machines distract from patients.

Links to Health Reform Voices on www.doctorreece.com

April 9, 2011 - Now that my website is up and running, I shall explain its components. On the right side of the site, I list links to influential voices of health reform. These are sites I regularly consult as a basis for my blogs.

• The Physicians Foundation- An organization representing physicians in state medical societies. Site contains information based on studies and surveys of membership.

• Kevin MD – Widely read site of Kevin Pho, MD, a New Hampshire primary care doctor who presents views of doctors in the trenches.

• The Health Care Blog - A San Francisco-based site that focuses on Web as source of patient empowerment.

• WSJ Health Blog - A quick and dirty take on market health reform happenings in business and health industry worlds.

• Health Leaders Media - A site for health care executives, aimed mostly at hospital market.

. Galen Institute - A free market think-tank take on health reform.

• Kaiser Health News – The health news of the day, as seen and interpreted by Kaiser. Non-judgmental, informative.

• Fierce Health Care - A Washington-based site full of business and government developments.

• Health Affairs Blog – Everything you ever wanted to know as seen from the Policy Wonk perspective in leading policy journal.

• DJP Update – A product from the mind of Donald J. Parlimisano, MD, JD, and a former AMA President who comments of health reform and malpractice issues of the day. Sent daily to 2334 medical leaders.

• Center for Studying Health System Change - A Washington, D.C. think tank studying change in communities across the land.

• ACP Advocate – A publication of the American College of Physicians, representing the nation’s internists who are pushing for a better deal for all primary care doctors.

• New England Journal of Medicine - Premier journal of academia. Its “Perspective” section articles tend to favor government-based reforms and leans towards Harvard mindset.

• Politico - A daily update of political events in the nation’s capital.

• Real Clear Politics - Comes out of Chicago. Contains a nice balance of liberal and conservative articles and editorials and a summary of national polls averages on Obama, Congress, direction of country, and health reform.

Six Health Reform Insights

A moments’ insight is sometimes worth a life’s experience.

O.W. Holmes, The Professor at the Breakfast Table

April 8, 2011- Today my website, www.doctorreece.com, goes online. What do I hope to accomplish with this act of egoism? Other than to spread the word of my existence and to direct people to my blog, medinnovation, I hope to give readers self-evident insights into what is going on beneath the surface of health reform.

• One – Health reform is about saving Medicare and Medicaid . These twin entitlement programs are eating federal and state budgets alive and are the single greatest contributors to the U.S. budget deficit.

• Two - The soaring deficit gives vivid testimony to that hackneyed cliché, “There is no such thing as a free lunch.” The burden falls on taxpayers. Those unloading the economic wagon exceed those loading it. The takers will soon outnumber the givers.

• Three - Government management of patient and physician expectations verge on the impossible because disease is emotional , personal, and sometimes tragic and is a mixed stew traceable to unhealthy behavior and Acts of God.

• Four - To ultimately control costs will require transferring enough costs to inform health care consumers and patients to sensitize them to true costs and value to help them decide between competing physicians and health care organizations.

• Five - No single reform solution works. Top-down solutions - herding doctors and hospitals into integrated groups like accountable care organizations (ACOs) or monitoring through pay-for-performance (P4P), electronic health records (EHRs) – has flaws. So does market-style and consumer driven reforms , as evidenced by the U.K experience (M. Roland and R. Rosen, “English NHS Embarks on Controversial and Risky Market-Style Reform in Health Care,” New England Journal of Medicine, April 7, 2011.

• Six - Reform hinges on ideologies - government vs. markets, collectivism vs. individualism, capitalism vs. socialism, globalism vs. nationalism. These conflicts date back to Bismarck’s social welfare programs and extend through FDR, Truman, Nixon, Reagan, and Obama. These muddles will be resolved through a hybrid model in which pragmatism trumps ideologies.

ACO Gold Rush: Consultants' Dream and Hospital-Physician Nightmare

Depend on it, sir, when a man knows he is to be hanged on a fortnight, it concentrates the mind wonderfully.

Samuel Johnson, September 18, 1777

April 7, 2011 - Yesterday I wrote a tongue-in-cheek blog on Accountable Care Organization (ACO) “buzz words.” I was only half-kidding. The 429 page Health and Human Services ACO “Rule” document just released guarantees a gold rush for consultants and lawyers to help hospitals and physicians form ACOs, which will start being certified on January 1, 2012, not so far away when you’re dealing with something as complex as ACOs.

Why the rush? Well, it’s not only the Gold, it’s the fear of being left hanging out there in the Medicare Cold and the unknown. Nobody knows if these new-fangled things called ACOs will really work but you can't take a chance on them not working.

Frankly, I agree with Robert Laszewski, an expert in such matters, who wrote in today's The Health Care Blog,

"ACOs won’t succeed in the near term any more than capitated HMOs and IPAs accomplished anything in their day because there is no reason—no imperative—for the health care industrial complex to want them to succeed."

"Here’s a flash for the policy wonks pushing ACOs: They only work if the provider gets paid less for the same patient population. Why would they be dumb enough to voluntarily accept that outcome?"

An April 2 Kaiser Health News article, “ACOs Spell Gold Rush for Health Care Consultants,” produced in collaboration with the Washington Post lays out the Gold field stakes.

It quotes Ian Morrison, the eminent futurist and founding partner of Strategic Health Perspectives in Menlo Park, California.

“The ACO issue has all the pieces that drive consulting. There are legal, information technology, and cultural changes needed to make it work, so lawyers are happy as hell, and so are management consultants.”

In response to the ACO hoopla, oversold ACO conferences abound, and consultants are charging $25,000 to $ 1million to create and launch ACOs. Hospitals and physicians are fretting and posturing about who should control these as-yet-ill-defined-evolving entities.

Premier, a Charlotte alliance of 2400 hospitals and 70,000 physicians, is charging $150,000 for an annual membership for access to its team of ACO consultants. The Camden Group charges $200,000 to $500,000 and the Advisory Board up to $1 million for implementing ACOs.

Yet nobody knows if ACOs will function well in the current hospital-physician environment. But history tells us fools rush in when stakes are high but unknown.

What’s the rush? Health and Human Services will conclude its public comment requests by May 30, 2011, and will issue its final Rule by year’s end. The first ACOs will be launched in January 2012.

No hospital or physician group wants be left hanging out there in the January cold, swinging in the reform breeze, without an ACO plan.

Tweet: ACOs are consultants' dreams and hospital-physicians' nightmares, costing up to $ 1 million to set up and then maybe not even working.


Richard L. Reece, MD, has posted 1723 blogs at medinnovation blog over the last four years. His main themes concern health reform and innovation and how they impact physicians and American culture as a whole. He works closely with the Physicians Foundation but his opinions are his alone. He has written eleven books. His latest book, The Health Reform Maze, is now at the publishers and will be released in June. Doctor Reece’s website, www.doctorreece.com, will be up and running in several days. He invites comments on his blog and will respond to each comment on his blog or to him directly at 860-395-1501 or rreece1500@aol.com.

Accountablecareorganizationmanship

Ordinary health, remember , is highly gambit-prone.

Stephen Potter, One-Upsmanship

When I was editor-in-chief of Minnesota Medicine, I wrote a playful editorial “healthcaremanship.” In that editorial, I had a section called “Buzz Bomb.”

It read:

"This last gambit I shall describe should only be used in desperation, never indiscriminately.

"A few years ago, a member of the U.S. Department of Agriculture , now forgotten but not gone, first described “buzz words.”

"These words serve as bureaucratic bombs. If you are cornered, you drop three of them in quick succession. You simply arrange your favorite words in three columns – two qualifying adjectives and and an abstract noun. Then, if anyone asks you an embarrassing question, you trigger your buzz words in 1-2-3 order. “

I gave this example

1, 2, 3

total, management, care

regional, supportive, coordinator

universal, health, analyses

primary, integrated, centers

comprehensive, ambulatory, services

national, resource, priorities

quality, pilot, planning

interdependent, involvement, costs

preventive, paramedical, studies

systematic, effectiveness, utilization

feasible, digital, implementation

delivery, scientific, objectives

unmet, outreach, systems

community, allied, maintenance

centralized, medical, parameters

longterm, multiphasic, feedback

If your questioner asks, “Do you regard accountable care organizations as necessary to bring down costs? Counter with “Centralized integrated systems are essential to bring down community allied costs.”

But, alas, this list is not sufficient in these health reform days of accountable care organizations (ACOs). You need new buzz words. Here, courtesy of Cheryl Clark, a senior editor for Healthleadersmedia.com, are 13 buzzwords to use should you be engaged in conservation about ACOs.

1, 2, 3

paperwork, reduction, act

safety, zone, harbors

primary, service, areas

retrospective, assignment, beneficiaries

procompetitive, service, organizations

rule of reason, feasible, guidelines

tax, identification, numbers

dominant, provider, limitations

mandatory, antitrust, review

group, practice, options

domain, quality, metrics

ACO, professional, candidates

eligibility, joint-venture, arrangements

There, that’s all you need to know when intelligently discussing accountable care organizations. These buzzwords are what Accountablecareorganizationmanship are all about.