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Accountable Care Act Unconstitutional? The Fate Of Americans’ Health

A Florida’s judge’s ruling that the Accountable Care Act (ACA) is unconstitutional doesn’t resolve the underlying constitutional issue (which will ultimately have to be decided by the U.S. Supreme Court) but it has introduced new uncertainty for the $2.3 trillion health care industry, and emboldened the law’s critics to push even harder for repeal (not that they weren’t trying already).

The Wall Street Journal’s (WSJ) health blog reports that “states and companies that are supposed to be implementing the law trying to figure out what to do next. The WSJ reports that the 26 states that are parties to the suit are considering whether to ask the Supreme Court to take up the case now, before it has fully wended its way through the legal system. The New York Times (NYT) quotes the governor of Florida as saying that until the fate of the law is clear, “we’re not going to spend a lot of time and money” to implement it. Other states, even if part of the suit, will move ahead,” the NYT says. The WSJ also reports that most health care companies plan to “stay the course” and continue to plan for the law’s implementation. Meanwhile, the Obama administration says that the judge’s ruling will have no effect on the implementation of the law or the requirement that states (including those who brought the suit) comply with its mandates and claims that most constitutional experts agree with the administration.

Now, I am not a lawyer, so I don’t have any expertise on the legal arguments over the ACA’s constitutionality. For those of you who want to hear more about the constitutional questions from people who might actually know what they are talking about, I recommend this Health Care Blog post from attorney Mark Hall, a critic of the Florida judge’s ruling. He notes that “at least half of the relevant part of the opinion is devoted to discussing what Hamilton, Madison, Jefferson and other Founding Fathers would have thought about the individual mandate” (Judge Vinson concluded that they would not have approved of it) but “the same Founders wrote a Constitution that allowed the federal government to take property from unwilling sellers and passive owners, when needed to construct highways, bridges and canals.” The Washington Post’s Ezra Klein — a supporter of the Affordable Care Act — has posted an excellent overview of what legal experts are saying about the ruling, pro and con, including a link to a posting that argues Judge Vinson ruled correctly. Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Should Doctors Be Allowed To Self-Refer?

Federal law generally prohibits physicians from referring their own patients to a diagnostic facility in which they have an ownership issue — a practice called “self-referral” — unless the facility is located in their own practice. This exemption exists to allow patients with access to a laboratory test, X-ray, or other imaging test at the same time and place as when patients are seeing their physician for an office visit. Less inconvenience and speeder diagnosis and treatment — what could be wrong with that?

Much, say the critics, if it leads to overutilization and higher costs and doesn’t really represent a convenience to patients. This is the gist of two studies by staff employed by the American College of Radiology, published in the December issue of Health Affairs.

One study analyzes Medicare claims data and concludes that patients aren’t really getting “one-stop-shopping” convenience when their physician refers them to an imaging facility that qualifies for the “in-office” exemption.

“Specifically, same-day imaging was the exception, other than for the most straightforward types of X-rays. Overall, less than one-fourth of imaging other than these types of X-rays was accompanied by a same-day office visit. The fraction for high-tech imaging was even lower — approximately 15 percent.” Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Healthcare Repeal: How Would It Affect Coverage And Cost?

[Soon] the new GOP-controlled House of Representatives will be voting on and is expected to pass a bill to repeal the Affordable Care Act (ACA) – lock, stock, and barrel. There is virtually no chance the repeal bill will get through the Senate, though, which maintains a narrow Democratic majority, and President Obama would veto it if it did.

But let’s say that the seemingly impossible happened, and the ACA was repealed. What would the impact be on healthcare coverage, costs, and the federal deficit?

In a letter to Speaker John Boehner (R-OH), the Congressional Budget Office (CBO) released its preliminary estimates of the impact of repeal on the deficit, uninsured, and costs of care, and found that it would make the deficit worse, result in more uninsured persons, and higher premiums for many:

– Deficit: repeal of the ACA would increase the deficit by $145 billion from 2012-2019, by another $80 to $90 billion over the 2020-21 period, and by an amount “that is in the broad range of one-half percent of the GDP” in the decade after 2019* — or about a trillion dollars. Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

2011: The New Year Begins With A (Baby) Boom

On January 1, Kathleen Casey-Kirschling became the first of the baby-boom generation to qualify for Medicare. She’s hardly alone: The baby-boom generation will cause enrollment in Medicare to soar. According to the Kaiser Family Foundation, Medicare enrollment will increase from 47 million today to 64 million in 2020 to 80 million people by 2030. At the same time, the ratio of workers paying into the program to support each Medicare enrollee will drop from 3.4 (2010) to 2.8 (2020) and then to 2.3 workers per beneficiary in 2030, denying the program the tax revenue needed to sustain it.

What happens then? Well, the President and Congress would have a dismal menu of political and policy choices. They could impose huge tax increases, inflicting great harm on working families and the economy, and they probably couldn’t raise enough money anyway from taxes without other changes in the program.

They could slash benefits for everyone enrolled in Medicare, impose means-testing so only low-income elderly would qualify, increase beneficiaries’ out-of-pocket contributions, limit access to beneficial services (rationing, anyone?), cut how much Medicare pays doctors and hospitals, and/or privatize the program (but if you are over 65 and have chronic health conditions, good luck finding affordable private health insurance). Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

The Twelve Days of Healthcare Reform

Today’s blog will be my last for 2010, as I will be taking a break to spend the Christmas and New Year’s holidays with family and friends.

In keeping with a tradition I started two years ago, I again have taken the liberty of mangling a beloved holiday song, story, or rhyme to give a humorous (I hope!) perspective on current politics. In December, 2008, I adapted “Twas the Night Before Christmas” to convey President-elect Obama as being a not-so-jolly old elf besieged by lobbyists demanding stimulus gifts. Last year, I depicted the GOP as the Grinch trying to stop “ObamaCare” from coming.

Today, I’ve re-written the “Twelve Days of Christmas” carol so that it is the government bestowing “gifts” (based on actual provisions of the Affordable Care Act) that the new Congress may later take away. (Of course, in the real world, the ACA’s changes won’t take place over 12 days, but over many years.) Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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