Congress is going into recess without completing its work on health insurance reform, and the advocacy groups are eager to use this time to whip up voter sentiment for or against reform. Unfortunately, the anti-reform pundits are all-too-ready to dip right back into the 1993 playbook that gave us Harry & Louise, playing on the fears of consumers with distortions and outright lies.
Ramona alerted me to one such piece published in the CNN/Money-Fortune segment, a “Special Report,” scarily titled:
Nice lede, eh? Can you guess without reading the article where this author is coming from?
The subsequent bits range from “accurate-but-deliberately distorted” to “complete BS that I made up but is really scary.”
Let’s start with the latter, as it’s more fun:
5. Freedom to choose your doctors
The Senate bill requires that Americans buying through the exchanges […] must get their care through something called “medical home.” Medical home is similar to an HMO. You’re assigned a primary care doctor, and the doctor controls your access to specialists. The primary care physicians will decide which services, like MRIs and other diagnostic scans, are best for you, and will decide when you really need to see a cardiologists or orthopedists.
Under the proposals, the gatekeepers would theoretically guide patients to tests and treatments that have proved most cost-effective. The danger is that doctors will be financially rewarded for denying care, as were HMO physicians more than a decade ago. […]
The bills do not specifically rule out fee-for-service plans as options to be offered through the exchanges.
So, just to recap: You won’t be able to choose your doctors because your primary care doctor (that you chose) might, under certain reimbursement schemes that aren’t actually mandated in the bill, have a hypothetical incentive to limit access to specialists.
Um, what?
Never mind the fact that TODAY, right now, your access to a specialist is limited by some drone at your insurance company who doesn’t have a medical degree and does have a very powerful direct financial incentive to deny authorization for referrals. Never mind the fact that there is nothing in the bill which states you will be “assigned” to a primary care doctor. Never mind that fact that the “Medical Home” is not in any way related to an HMO, conceptually or practically. This “gatekeeper” function isn’t in the bill at all! The medical home concept is designed not to ration care (which is the unspoken subtext of the above passage) but to coordinate and improve the quality of care. Never mind that, if a referral is granted by the wicked & parsimonious gatekeeper, your choice of a doctor is still not restricted under the bill.
Never mind all those inconvenient little facts that each individually or all together totally invalidate the thrust of the author’s argument. The problem for the whole concept is that there will be many plans offered for purchase on the exchange. If you don’t like the one you picked because it is too restrictive, you can switch to another plan! If WellPoint requires too much hassle to get to see a specialist, then you can dump them and pick Cigna! Granted, the ones which are more restrictive are also probably going to be cheaper, but that’s for the consumer to choose!
And yes, before you bother to say it, yes, this might result in adverse selection of sicker patients into the more lenient plans, but they will be risk-adjusted to correct for imbalances in their patient populations.
So that’s the easy point to debunk, and I would think that finishing up with the BIG LIE like that, there would be little need to review the rest of the hit-piece, but I’ll make the effort, my love of truth and good policy being as strong as it is. Other “freedoms” you would lose, according to the esteemed and honorable author:
1. Freedom to choose what’s in your plan
3. Freedom to choose high-deductible coverage
I put these together, because it’s a bit of a cheat on the author’s part to list them separately. I mean, it’s the same thing, innit? This is basically an assault on the concept of the mandate that all Americans be insured: you can’t just buy crappy insurance that doesn’t really cover anything meaningful and say that you’re covered. I respect those libertarians I have clashed with when they say that they should be free to “go naked” if they so choose, and have no or minimal insurance if that is their choice. I disagree, but I respect their honesty. This piece is a little less direct, but it’s basically the same thing — defending the right of people to choose crappy insurance that wouldn’t actually cover their health care needs should they fall ill.
There are two problems with that sort of policy approach. First, a fig leaf just ain’t clothing. You can glue one on and walk around town without getting arrested, but everybody who sees you knows you’re naked. Insurance that has the “We never pay” clause just isn’t actually insurance. It doesn’t accomplish the actual goal of getting every American access to quality health care.
The other problem, a bit more subtle, is that letting people opt out of health insurance, either explicitly or de facto by buying cheap fig-leaf insurance, defeats the purpose of the individual mandate: risk pooling. It’s a certainty that some of us are going to get sick. It’s also certain that those of us who do become sick will not be able to pay our individual costs, as health care is now so expensive that no individual can hope to pay their actual bills. By requiring all of us to have insurance, you create a situation where those huge costs are spread out among the largest possible number of people. Allowing opt-outs ensures that everybody who can, will, and these will be the healthier people who don’t see a need for insurance, at least not today. The result is a concentration of costs among the sick people who generate the most costs, which, as noted, exceed the ability of these individuals to pay. Of course, as people who were healthy become ill, according to nature’s inexorable dictates, they will transition from the low-cost insurance products they previously favored to the ruinously expensive plans that actually cover for people who are sick. And the system literally falls apart. No funding exists for the sick to pay for their (hugely expensive) health care, and the healthy contribute little (until they become sick).
2. Freedom to be rewarded for healthy living, or pay your real costs
This is pretty tightly related to the above point, with a slight distinction. Again, as pointed out, nobody who is sick can pay their real costs. So again, there’s the risk-pooling issue. But there’s another, more pernicious assumption here: that health is a controllable feature of lifestyle.
Bullshit. I’m healthy, and I like to assume that’s because I’m virtuous and athletic and take care of myself. Right? Except that it’s strictly a matter of luck that it was not my kid that got sick and died of neuroblastoma. Or medulloblastoma. It was a matter of luck that my wife pointed out a funny-looking freckle that turned out to be a very thin melanoma (and lucky for her that she married someone who could tell the difference). Cancer is easy to cite, but the list goes on and on of health conditions that have nothing to do with lifestyle: crohn’s disease, MS, bipolar, Type 1 diabetes, glomerulosclerosis, etc, etc, etc. And none of us know in advance when our — or our family’s — number is up.
So we are all in this together. We all pay a premium: and bet or a hedge against illness. Those of us who win the genetic lottery and stay healthy lose the “bet” and wind up paying for a service we didn’t need. If you let some people hitch a free ride and pay a minimal premium, they are not paying their fair share to cover the cost of those who have already become ill. When President Obama talks about “Shared Responsibility,” this is what he means.
There’s a lot more chicanery in this article — I’ve neglected Point #4 entirely, as I covered that the other day. No plan will remain the same in perpetuity. I’ll stick to the main policy points and leave, for the moment, the sly little insinuations and falsehoods scattered throughout the article like so many candy sprinkles on an ice cream cone.
Strangely enough, I’ve finally found a point of serious, substantive agreement with (former) Alaska governor Palin. She and I are united in wishing that the gosh-darned liberal media would just stop making stuff up.
*This blog post was originally published at Movin' Meat*
A hospital can be extremely frightening and overwhelming.
Hospitals generally are loud, cold, and sterile mazes of chaos. Unfortunately medical errors happen and it’s estimated that nearly 100,000 people die of medical errors each year.
As a registered nurse on the front lines of the health care, I understand how important it is for patients and their families to take charge and be an advocate for their health.
In my role as an administrative head nurse, I always encourage patients and family members to be proactive in their health care. I am passionate about encouraging patients to be proactive and kudos to CNN, and Consumer Reports for recently addressing the issue of patient safety; andThe Wall Street Journal for recently addressing the issue of parents being active to ensure their child’s safety in hospitals.
I’ve written on this topic before, I have been quoted in national magazines, talked about it on web/TV and I’ll continue to speak out regarding this critical topic.
While hospital safety may seem daunting, the good news is that you can be an empowered patient and help eliminate medical mistakes.
My top tips to keep you safe in a hospital
Carry your medication list and personal medical history form with you
During your admission assessment, whether you were brought to the ER or directly admitted to the hospital, you will be asked multiple times by multiple staff for a list of your medications, past hospitalizations, if you have any allergies and emergency contact numbers. Carry this personal medical history and medication form in your wallet at all times; in case of an emergency or for a scheduled hospital visit; you’ll be prepared.
Believe you are empowered: Give yourself permission to be in charge, an engaged patient
Unless you know how to be assertive and believe that you are an empowered patient all the tips in the world won’t help. Treat your doctors and nurses as partners in your health care team.
Communicate in a non-threatening manner
Communication between patients and health care professionals are critical for positive patient outcomes. Communication is imperative for patient safety and good quality patient care. In a hospital, which is a very fast-paced environment, where seconds can mean the difference between life and death, it’s crucial that communication flows consistently and thoroughly between patients, their families and staff. Speaking up and communicating needs to be continuous.
The Joint Commission, otherwise known as JCAHO, launched a national campaign in 2002 to urge patients to become active in their health care to help prevent errors. Speak Up™ encourages patients to:
Speak up if you have questions or concerns, and if you don’t understand, ask again…
Any breakdown in communication can result in a breakdown of quality patient care, and the results can be devastating. If you don’t understand something, ask for clarification. If you need assistance, ask!
If you find that communication between you and your doctor or nurse is not flowing, and your questions are not being answered, or if you do not feel your needs are met, you ask to speak to the nurse manager. (On evenings, nights, weekends and holidays, it may be the administrative head nurse, assistant director of nursing or nursing supervisor who will help you address any issues.)
Germs are lurking throughout the hospital
Don’t assume that your doctor, nurse or anyone else that comes in contact with you just washed their hands. It’s okay to ask them if they’ve just washed their hands. After all hand washing is the single most effective way to stop the spread of infections.
Make sure your visitors wash their hands. Washing your hands for 30 seconds with warm soapy water will do the trick. If a sink isn’t nearby, alcohol based hand sanitizers work great. In fact, some hospitals even make hand dispensers available not only by each patient’s room door, but inside each room.
Make sure you ask anyone that comes in contact with you if they have clean hands. It’s okay to ask them if they’ve washed their hands. It’s not rude, you’re not being obsessive–you are keeping yourself safe and alive. You do not want any infections.
Bring a trusted family member with you
Ask a trusted family member or friend to be your patient advocate. The hospital environment can be very frightening and overwhelming and often answering simple questions can be difficult.
If you have an advocate with you they can speak up on your behalf and answer questions for you. Make sure your advocate understands your plan of care and whether there is an advance directive. An advance directive will allow a designated person to make medical decisions for you in case you are unable to.
Understand the medications that are ordered for you in the hospital. When the nurse administers your medication, make sure you understand what it is for and its potential side effects. Also, make sure your nurse identifies you as the correct patient before any medications are administered.
Before administering any medications the nurse should perform five checks: Right Patient, Right Drug, Right Dose, Right Route, and Right Time. If you believe you are about to receive the wrong medication let your nurse know immediately.
Going home? Not so fast!
When discharge instructions are handed to you, make sure to review them with your doctor or nurse. In most cases, it will be your nurse. Go over each step. Repeat back the information.
If you need to write down information that will help you decipher what the doctor or nurse tells you, than do so. If you are given prescriptions for medications, make sure you understand what you will be taking. Be clear about how to take your prescription, when to take it, the dosage, and any side effects. Also ask if it will interfere with any other medications that you may be taking.
*This blog post was originally published at Health in 30*
After surgery I am often asked, “When can I get back in the tanning bed?” I say something like, “I would rather you not use a tanning bed. You need to protect you new scar from the sun, that includes tanning beds, for at least 6 months.”
“But, if I cover up the scar, when can I get back in the tanning bed?” is the usual response.
I then counter with, “IF you feel you must, then yes cover the scars. Please, limit or reduce the time you spend in the tanning bed. I would rather you not use a tanning bed.”
Most see “no harm” in using a tanning bed. After all, it’s not like laying out in the sun for hours. Too many see tanning beds as a “safe” way to get a tan. It isn’t.
These same experts have moved tanning beds and ultraviolet radiation into the top cancer risk category, deeming both to be as deadly as arsenic and mustard gas. The new classification also puts them in the list of definite causes of cancer, alongside tobacco, the hepatitis B virus and chimney sweeping, among others.
I would not mind tanning bed extinction. Regular use increased the risk of melanoma. It is much better to have a “peaches and cream” complexion or to use self-tanning creams. Skin cancer is no fun.
This week’s CBS Doc Dot Com features 42-year-old Dara Torres, who has been in five Olympics and won every kind of medal a swimmer can win. She juggles motherhood (her 3-year-old daughter, Tessa, is a gold medalist in being cute), a career, and philanthropy. And to top it off, as she proudly displayed during my interview with her, she has serious abs – world class.
But it wasn’t her abs that impressed me the most. Not nearly. It was the pride she took in her work. She understands that there’s no free lunch, that every one of her achievements has been paved by hard work and attention to detail.
I am always moved by a person who rolls up their sleeves, committed to doing a good job – whatever that job is. When I first started dating my wife, Kate, I took her to one of my favorite Italian restaurants. As we sat at our table, I suddenly saw her eyes well up with tears. She explained that she had been observing a bus boy carefully set a large, round table across from us. Seconds from finishing, he had noticed a small stain on the tablecloth. Rather than hide the spot by covering it up, he had painstakingly removed everything, replaced the tablecloth, and begun setting the table again. She was touched by his work ethic and I by her sensitivity and powers of observation.
Ponzi schemers may hog the headlines but I’ll bet most people still believe in the value of an honest day’s work.
Which brings us back to Dara Torres’ abdominal muscles. They didn’t just appear. She swims for two hours every morning and then does about seventy five minutes of core exercises. The take-home lesson from Dara Torres isn’t about her abs; it’s about the work ethic that lies beneath them.
Scott Amron from Amron Experimental has a new idea for our gilded age, the leather bandage. Three of these will cost you $15, but will look very appropriate next to your Armani jacket.
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A hospital can be extremely frightening and overwhelming.
