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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But let’s say that the seemingly impossible happened, and the ACA was repealed.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*

Repealing Healthcare Reform To Gain Campaign Ammunition

Repealing healthcare reform has become a way of stockpiling ammunition for the campaign trail. The Republican-led House has scheduled a repeal of healthcare reform for Wednesday, Jan. 12, and they’d garner as allies some but not all 13 Democrats that voted against healthcare reform to begin with. The House’s quixotic vote would then promptly die in the Democrat-held Senate.

But recording votes on repeal would put pressure on already vulnerable lawmakers, as well as give a quick boost to incoming ones. A Gallup poll shows 46 percent of Americans want healthcare reform to be repealed, 40 percent don’t want repeal.

Unfortunately, not only can’t the law be passed, it would add $230 billion to the federal debt by 2021, according to the Congressional Budget Office. House Speaker John Boehner said, “I don’t think anyone in this town believes that repealing Obamacare is going to increase the deficit,” although Republicans have already exempted a repeal of the healthcare law from new rules prohibiting legislation from adding to the federal debt. (Politico, Kansas City Star, [Aurora, Ill.] Beacon-News, USA Today, CNN)

*This blog post was originally published at ACP Internist*

Corporate Executives Astonished By Average Physician’s Income

By Stanley Feld MD, FACP, MACE

Physicians in practice work hard and have little time for political and legal trickery. They assume their leadership will look out for their interests while they take care of patients.

The problem is that physicians do not have effective leadership, explaining the difficulties practicing physicians have every day with the healthcare insurance industry, hospital administrators, the government and the threat of liability. Most physicians are caring professionals who are not looking to rip off anyone. Physicians do expect reasonable compensation commensurate with their training, level of expertise and level of responsibility.

I recently presented a physician income survey to a group of corporate executives. The executives were astonished by the level of physician income relative to their level of responsibility.

The unanimous reaction of these corporate executives was the average physician’s income was that of a low mid-level manager. It is true some practice specialties earn more but the average income of practicing physicians is not commensurate with their knowledge and responsibility. Read more »

*This blog post was originally published at Repairing the Healthcare System*

Why Healthcare Reform Is Good For Medicare

You may have noticed, uncharacteristically for me, that I haven’t posted a blog in week. I thought it would be better to allow the readers to post their own reflections, and you did — with comments ranging for unabashed pride to skepticism to disdain for the law and the American College of Physician’s (ACP’s) role in bringing in about.

I respect the principled arguments made by those who believe that the legislation gives the government too much control or those who fear that it will add to the deficit and public debt, even though the Congressional Budget Office (CBO) says otherwise. But there is one claim made by some of the critics that sticks in my craw, which is that the legislation will result in “massive cuts” to Medicare. Here are the facts. Read more »

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

Highlights From The Medicare Policy Summit: What’s On The Mind Of The Congressional Budget Office (CBO)?

There is no doubt in anyone’s mind that the U.S. healthcare system, in its current form, is financially unsustainable. Many in Washington believe that 2009 will usher in more sweeping reform than we’ve seen in decades. I attended the Medicare Policy Summit (along with about 100+ industry insiders and one other physician, Dr. Nancy Nielsen) to try to read the “tea leaves” regarding Medicare’s likely reform – and how that will impact the healthcare system in general.

I took 49 pages of notes during the two-day conference, but will spare you the gory details and simply capture (in a series of blog posts) what I found to be the most interesting parts of the discussion. This post is devoted to highlights from Bruce Vavricheck’s lecture, “The President’s Budget and What It Means for Entitlements.”

Bruce Varvichek is the Assistant Director for Health and Human Resources, Congressional Budget Office.

Bruce explained that if we continue on our current healthcare spending path, over 50% of all federal spending will go towards funding Medicare, Medicaid, and Social Security entitlement programs by 2018.

What are the underlying causes for this rapid rate of growth in spending?

1.    Chronic Illness. The sickest, top 5% of Medicare beneficiaries account for 43% of all Medicare spending. Cost containment should focus on identifying these 5% early, and intervening so as to prevent advancement of disease where possible. Solution: The “medical home” model may help to identify people who are likely to become sick, and engage them in preventive health programs early.
2.    Obesity. Rises in obesity rates is directly related to increased heart disease, diabetes, cancer, and other chronic disease prevalence. The fastest growing segment of the population that is becoming obese is the high income bracket. Bruce concludes: “This can’t just be explained by McDonald’s.”
3.    Non outcomes-based spending. Medicare beneficiaries with the same medical conditions receive widely different medical services depending on where they are in the country. More services, however, do not correlate with improved outcomes.
Solution: Comparative Effectiveness Research

What changes in Medicare benefits is the Congressional Budget Office considering?

1.    Creating Medicare insurance buy-in for people ages 62-64.
2.    Reduce or eliminate 24 month waiting period for disabled people to become eligible for Medicare.
3.    Increase the age of eligibility of Medicare beneficiaries to 67. This encourages people to work longer since average lifespan has been steadily increasing.

CBO Strategies to improve quality and efficiency of care:

1.    Bundle Medicare payments so that hospital and post-acute care are linked. This will incentivize hospitals to do a better job of follow up once patients are discharged from the hospital.
2.    Reduce payments (after risk-adjustment) to hospitals with higher re-admission rates.
3.    Offer physicians performance-based payments for managing and coordinating care for their patients (the medical home model).
4.    Create incentives and penalties to promote adoption and use of HIT.

CBO strategies to streamline payment structure and benefits:

1.    Modify the Sustainable Growth Rate (SGR) formula used to determine payments to physicians. Put a cap on total spending.
2.    Change Medicare Advantage program to fee for service.
3.    Replace the current beneficiary cost-sharing structure with a unified deductible and uniform cost-sharing plan. Add catastrophic limit for out-of-pocket spending.
4.    Require drug manufacturers to pay a rebate to Medicare for drugs covered in Part D.
5.    Fill in the “donut hole” in Part D.

***

Next up: Grace Marie Turner and the free market gang debate the merits of a government-run healthcare system.

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