Books– New Voices of Health Reform: The 3 R’s-Rhyme, Reason & Reality. A Modern History of Reform

November 20, 2012 - I am now engaged in the process of producing a series of books. These books are collections of my Medinnovation blogs on specific subjects written over the last six years.  

The first of these books Physicians, Poetry & Humor is now available. It may be ordered by calling Bronwen Blaney at the RJ Julia’s bookstore in Madison, CT, at 1- 203-245-3959 and asking for a single or multiple copies of the book. It sells for $12.95 + 6% sales tax + shipping charge. The books will be 175 to 250 pages long.

Other books which have been completed but are not yet available include:

· Physician Culture & American Culture

· The Physicians Foundation – New Voice of American Medicine

· Primary Care & Specialty Care

· Medicare& Medicaid- Where Now?

· Medical& Health Care Innovation

· Electronic Health Records – Boon or Boondoggle

· Physician& Hospital Relationships

· Malpractice& Tort Reform- Physician Hot Button Issue

· Accountable Care Organizations – Who is in Charge?

· A Book of Health Reform Book Reviews

I will be announcing the availability of these books as they go online and are available in paperback. The first book, Physicians, Poetry & Humor would be an ideal Thanksgiving or Christmas book for physicians or patients.

Richard L. Reece, MD

The Turkey Is A Respectable Bird

It’s hard to soar with the eagles when you’re dealing with turkeys.

Anonymous turkey hater

I wish the bald eagle had not been chosen as the representative for our country; he is a bird of bad moral character…The turkey is a much more respectable bird, and withal a true original native of America.

Benjamin Franklin (1706-1790)

November 22, 2012

I do not wish to soar with the eagles that are bald.

I am much more with the lowly turkey enthralled.

Besides you cannot eat an eagle.

That would definitely be illegal.

Besides the turkey symbolizes Thanksgiving

About that I have not a single misgiving.

I am proud to be a physician living in America.

We have a fine health system for reasons numerica.

Let us not reform it beyond recognition,

For reasons defying reasonable cognition.

And let’s not reform with rules so murky,

That it causes doctors to quit cold turkey.

Books – New Voices of Health Reform: The 3 R’s- Rhyme, Reason & Reality. A Modern History of Reform

November 20, 2012 -  I am now  engaged  in the process of producing  a series of books. These books are collections of my Medinnovation blogs on specific subjects written over the last six years.  

The first of these books Physicians, Poetry & Humor is now available.  It may be ordered by calling Bronwen Blaney  at the RJ Julia’s bookstore in Madison, CT, at 1- 203-245-3959 and asking for a single or multiple copies of the book.   It sells for $12.95 + 6% sales tax + shipping charge.  The books will be 175 to 250 pages long.

Other books which have been completed but are not yet available include:

·         Physician Culture & American Culture

·         The Physicians Foundation – New Voice of American Medicine

·         Primary Care & Specialty Care

·         Medicare & Medicaid- Where Now?

·         Medical & Health Care Innovation

·         Electronic Health Records – Boon or Boondoggle

·         Physician & Hospital Relationships

·         Malpractice & Tort Reform- Physician Hot Button Issue

·         Accountable Care Organizations – Who is in Charge?

·         A Book of Health Reform Book Reviews

I will be announcing the availability of these books as they go online and are available in paperback. The first book,  Physicians, Poetry & Humor would be an ideal Thanksgiving or Christmas book for physicians or patients.

Richard L. Reece, MD

HHS Releases Proposed Rules On Essential Health Benefits, Other Key Parts Of Health Law

We have to have to pass the bill  to find out what’s it.

Nancy Pelosi,  House Democratic leader, March 9, 2010
\
Government is a poor manager. It is, of necessity, , concerned with procedure, for it is also, by necessity, large and cumbersome.  It has no choice but to become “bureaucratic.”

Peter Drucker (1909-2006)
November 20, 2012 -  Today, 2 years and 9 months, after Obamacare passage, we are finally learning  details of “what’s in” the law. The following news releases are from Kaiser Health News, which encourages people to use its material.

Nov 20, 2012

The Obama Administration Tuesday released some much anticipated rules that will govern the types of benefits insurers must offer in policies sold after 2014 and rules on how they can design wellness programs. States and insurers have been waiting for the proposed rules. One proposed rule looks at how insurers can vary premiums based on age, tobacco use, family size and geography. A second outlines proposed rules for essential health benefits. A third proposed rule would govern employer-based wellness programs.

Kaiser Health News: Administration Releases New Health Law Rules For Insurers, Employers
Long-awaited details on how insurers can structure health benefits and premiums for policies that will cover tens of millions of Americans starting in 2014 were released by the Obama administration Tuesday. The three proposed rules reaffirm key elements of the federal health law, including its requirement that insurers accept all applicants, even those with health conditions, and not charge higher rates based on health, gender or occupation. But the proposals add additional details on how premiums can vary based on age and tobacco use, including an exemption from the extra costs faced by tobacco users if they enroll in programs aimed at helping them quit (Appleby, Hancock and Carey, 11/20).

NBC News: Federal Government Releases Long-Awaited Health Reform Rules
As the 2010 health reform law requires, insurers will no longer be able to dump patients who are starting to cost too much, they won’t be able to charge women more than men, they have to cover anyone who can pay and they’ll have to pay for maternity care, eye exams for kids and for mental health services. “Insurers will not be able to charge someone more just because she is sick or because she used to be sick,” Health and Human Services Secretary Kathleen Sebelius told reporters on a conference call (Fox, 11/20).

Washington Post: Three Ways Obamacare Changed Tuesday
To call the regulations long would be an understatement: Taken together, the three new regulations weigh in at 333 pages. Largely, they preserve the big provisions that the Affordable Care Act includes: Preventing insurers from denying coverage to those with pre-existing conditions and limiting how much consumers can be expected to pay out of pocket. Still, there are a few important changes that the Obama administration made Tuesday. Culled from the 333 pages of federal regulation, here are the three most important changes that happened (Kliff, 11/20).

NPR: Administration Lays Down Rules For Future Health Insurance
Now that the Supreme Court has found the Affordable Care Act constitutional and the president's re-election made clear that big chunks of the law will take effect Jan. 1, 2014, the administration is finally releasing rules of the road that states and insurance companies have been clamoring for. The big one makes clear how companies will have to comply with anti-discrimination requirements starting in 2014 (Rovner, 11/20).

National Journal: Obama Admin Fills in Health Law Details
The new rules issued by the Health and Human Services Administration spell out how a centerpiece of the law—its requirement that insurers cover even sick or old applicants—will work. They also sketch out what minimum package of benefits must be included in health plans sold on state exchanges. Both rules will have a big impact on the insurance industry and will influence the cost of insurance. The rules are in draft form, which means there will be time for public comment and revisions before they are finalized (Sanger-Katz, 11/20).

Politico Pro: EHB Rule Gives States More Time To Pick A Plan
States will have about a month more to select an essential health benefit package under a proposed rule issued by HHS on Tuesday morning. They’ll have until the end of the proposed rule's 30-day comment period to pick a plan or change their decision — setting up a new Affordable Care Act deadline for right around Christmas. The proposed rule lists the plans that states this fall indicated would serve as a benchmark for required benefits under the Affordable Care Act. As a fallback, the benchmark for any states that don't choose a plan will be the largest plan in their small-group market (Millman, 11/20).

Politico Pro: Health Plans Can Reward Health Behavior, Nonsmoking Programs
[N]ew rules proposed Tuesday would increase the financial leverage insurers will have to incentivize healthy behavior, especially not smoking. The rules would raise the maximum reward for participation in certain wellness programs starting in 2014 from 20 percent to 30 percent of the total cost of coverage in employer-sponsored plans. It would go even higher — 50 percent — for programs that aim to reduce smoking or other tobacco use (Norman, 11/20).

The Hill: HHS Releases Rules Requiring Coverage Of People With Pre-Existing Conditions
The Obama administration released new regulations Tuesday that require insurance companies to cover people with pre-existing conditions. The new rules represent one of the first steps taken by the Health and Human Services Department to implement some of the most popular — and most expensive — provisions of President Obama's signature healthcare law. ... Another regulation released Tuesday begins to flesh out the definition of "essential benefits" — the services that individual insurance plans will have to cover, beginning in 2014 (Baker, 11/20).

Modern Healthcare: HHS Releases Proposed ACA Insurance Regulations
Starting in 2014, the Patient Protection and Affordable Care Act will make it illegal for health insurance companies to discriminate against people who have pre-existing conditions, which HHS estimates affect some 129 million nonelderly Americans. In the proposed rule, health insurance issuers would generally be barred from denying coverage for such conditions, and individuals would have new special enrollment opportunities in the individual market when they have certain losses of other coverage. Under the regulation, insurance companies will be permitted to vary premiums within limits based on age, tobacco use, family size and geography. Health insurance companies will no longer be able to use factors such as pre-existing conditions, health status, claims history, gender and occupation as reasons to increase premiums (Zigmond, 11/20).

USA Today: Obama Moves Ahead With Health Care Law
The Department of Health and Human Services said Tuesday it is putting in place provisions that would make it illegal for insurance companies to discriminate against people with pre-existing conditions, enable consumers to compare health plans, and encourage employers to promote employee wellness (Jackson, 11/20).

Bloomberg: Obama Pushes Health Law Forward With Rules for Insurers
UnitedHealth Group Inc. and other health insurers would be able to vary their premiums based only on age, tobacco use, family size or geography under proposed U.S. rules meant to protect people with pre-existing illnesses. In addition, the Department of Health and Human Services outlined various conditions and services insurers must cover, and laid out rules to let companies expand employee wellness programs, according to proposed regulations posted online today. The proposals mark the Obama administration’s move to begin formalizing core provisions of the 2010 Affordable Care Act (Wayne, 11/20).

Tweet:  HHS is finally releasing details of health care law that tell how much individuals, health plans, businesses, and states  will have to pay.

To order Physicians, Poetry & Health Reform, call Bronwen Blaney at 203-245-3959 at RJ Julia;s bookstore in Madison, CT., give your credit care #, and the book will be mailed to you for $12.95 + 6% tax + shipping charge.

 

States’ Last Ditch Stand Against Federal Medicaid Expansion

There is one certain means by which one can be sure never to see a country’s ruin. I will die in the last ditch.

William III (1650-1702), Hume’s History of England

At its core, Obamacare is a massive entitlement expansion. Between vastly increasing Medicaid eligibil9ity and new premium subsidies, it is expected to bring 30 million more people onto the federal government’s entitlement rolls. Rhe alw anctipates that the states will take on the burden and implement the expansion, but the states can opt out of both.

“Capretta and Levin: Why Obamacare Is No Sure Thing,” Wall Street Journal,  November 18, 2012

November 19, 2012 -  In their gloating over President Obama’s decisive electoral college victory, Democrats may think the road to Obamacare implementation has been cleared. 

They are missing several realities.

1.  30 states have Republican governors, 

2. 20 of these states have said they want nothing to do with Medicaid expansion.

3. the employer mandate to refer patients to these exchanges may be on itw way to the Supreme Court.

4. Chief Justice Roberts decision of the constitutionality of the individual mandate allows to opt of federal Medicaid expansion.

The exchanges would provide for greater subsidies  than those of employer plans.  This would increase state Medicaid costs.  Also federal exchanges would enforce federal law and regulations, vastly increasing Medicaid costs for states.  By declining exchanges,  states would pass the burden and expense of setting up exchanges and implementing them back to the federal government – where they belong.

There is another factor as well.  The influx of 30 million more Medicaid recipients flies in the fact of the escalating doctor shortage. Further, 50%  of doctors no longer accept new Medicaid patients because of low reimbursements and often indecipherable time-consuming regulations.

The states prefer a block grant allowing them to provide benefits more efficiently than the muscle-bound federal government, which has difficulties getting out of its own way.

Tweet:  Obamacare has a rough row to hoe if it expects state govenments to passively implement health exchanges that would bankrupt them.

Of “Black Swans” as Spoilers of the Health Care’s  “800 Pound Gorilla” Theory:  a Prose Poem

A rare bird on earth, comparable to a black swan

Juvenal (A.D c.55-c.130), Satires

November 19, 2012

This is for you,

You true blue believers in Big Government’s health reform,

Who believe in ideologically-driven data as the ultimate answer

To social justice conundrums and a blessing for us all.

Who believe somehow from on high in the blue sky

You can shape all events with equal outcomes for all

Who maintain the 800 pound gorilla  known as Obamacare,

Provides the  fairest solution for us all

But alas there is a spoilsport phenomenon out there known as the Black Swan

Black swans are large events that are both unexpected and highly consequential

Most of these large unexpected  spoiling events surprise the Gorilla.

Who attributes them to conservative troublemakers resembling Atilla.

The events have a major unexpected effect,

Due to the 800 pound Gorilla theory’s defect.

But the Gorilla always rationalizes the surprises as expected,

Because hindsight data shows the surprises  could have been corrected.

Take the problem of rises in costs rather than reductions in expenses,

Entitlement programs are said to be free-  to mitigate markets’ offenses.

Instead premiums rise, access for the insured goes down, hospital-employed doctor fees go up,

Electronic records drive costs up, health care benefits plunge,

How can we this volatility, variability, and disorder expunge

What are the lessons to be learned 

According to NN Taleb, author of the Black Swan Theory:

1) Human beings need some dose of disorder to develop

2) We shoud favor business that learn from their mistakes

3) Small is beautiful, but it also more efficient

4. Trial and error beats academic knowledge

5) Decision makers must have skin in the game.

Tweet:  Health reform produces unexpected surprises called Black Swans which surprises  the 800 pound federal Gorilla and which he did not expect

Sources

1.      N.N.Taleb,  “Learning to Love Volatility,  WSJ November 17-18, Wall Street Journal

2.      N.N.Taleb, The Black Swan: The Impact of the Highly Improbable,  Penguin, 2007