As I’ve blogged about before (here, here, here and here), a big reason reform is going so badly is this: Reformers don’t understand how people react when you try to make changes to their health benefits.
Companies across America have been making changes to health benefits for years.
Reformers seem to have ignored the lessons of their experience.
These are plans that offer better coverage if care is done based on evidence-based guidelines. It’s similar to the “comparative effectiveness” ideas that are so important to some of the reform proposals.
The National Business Group on Health published a study of challenges companies face implementing these plans. The study tried to understand how employees feel about these kinds of changes to their benefits.
Here are three of the major findings.
1. Most employees believe that more care is better care. Employees tend to view the idea that sometimes less care is the right care as “both unfamiliar and counter-intuitive.” Quality care is viewed as “trying as many things as possible, including new or alternative treatments.” In other words, you get what you pay for, and efforts to pay less are interpreted as efforts to give less.
2. Employees are suspicious of their employer’s motives. Employees tend to assume that their employer just wants to save money, and doesn’t really care about the quality of care they get. They suspect that moving to an evidence-based plan design is really just the first step toward more severe restrictions on choice and access.
3. Employees worry that employers are overstepping their bounds. Employees report worries that their employer wants to influence treatment decisions. They feel strongly that those decisions should be made by them and their doctor.
Reformers made a big mistake by focusing so intently on health care cost savings as the “single most important fiscal issue we face as a country.” It’s almost as if they decided to pick a way to promote reform that would create the most resistance.
Spend less on health care? That was almost certain to be understood as meaning you want to deny me or my loved ones the care we deserve. A panel of government experts deciding what treatments are effective? Who are they to tell me and my doctor what’s right? And don’t you dare tell me the reason you want to do all this is to make sure I get the best care.
Reformers have stumbled into a trap of their own making. Based on the continuing effort to demonize those who raise objections, they still don’t see it.
This is why reform is going so badly.
*This blog post was originally published at See First Blog*
Teens living with a depressed parent need information and support. The inclination of most people living with someone who is depressed is to take on responsibility for the ill parent and other family members.
Life is difficult for anyone living with a depressed parent. The daily home life is complex – with little consistency, irregular habits, plans made at the last minute, little consideration for each person’s wishes or desires, and there is usually a huge decrease in communication. The depressed parent withdraws from the family and the teens are left to manage on their own, creating feelings of loneliness.
Teens are not likely to realize how much their life has changed, or how serious the depression is and need adults who see the changes to bring them to the attention of the family, medical and emotional professionals. Even if the depression lifts for a period, everyone in the family will likely be anxious about when it will returns.
I believe that all health care professionals are ethically responsible to help teens avoid the responsibility and loneliness associated with living with a depressed parent. As mentioned in a previous post, there are also many resources for those parents who are willing to admit the depression, as well.
Dear President Obama,
I am in favor of Health Care Reform and I agree with you that universal coverage and eliminating the abuses that both patients and doctors have suffered at the whim of the for-profit insurance industry must be curtailed.
But I also want you to fix Medicare. Medicare is so bureaucratic that expanding it in its current form would be the death knell for primary care physicians and many community hospitals. The arcane methods of reimbursement, the ever expanding diagnosis codes, the excessive documentation rules and the poor payment to “cognitive, diagnosing, talking” physicians makes the idea of expansion untenable.
May I give you one small example, Mr. President? I moved my medical office in April. Six weeks before the move I notified Medicare of my pending change of address and filled out 22 pages of forms. Yes, Mr. Commander in Chief…22 pages for a change of address. It is now mid-August and I still do not have the “approval” for my address change.
I continue to care for my Medicare patients and they are a handful. Older folks have quite a number of medical issues, you see, and sometimes it takes 1/2 hour just to go over their medications and try to understand how their condition has changed. That is before I even begin to examine them and explain tests, treatment and coordinate their care. Despite the fact that I care for these patients, according the Medicare rules, I cannot submit a bill to Medicare because they have not approved my change of office address.
I have spent countless hours on the phone with Medicare and have sent additional documentation that they requested. I send the forms and information “overnight, registered” because a documented trail is needed to avoid having to start over at the beginning again and again. I was even required to send a signature from my “bank officer” and a utility bill from the office. Mr President, I don’t have a close relationship with a bank officer so this required a bank visit and took time away from caring for patients…but I certainly did comply.
I am still waiting to hear from Medicare. At my last call they said they had not received yet another document, but when I gave them the post office tracking number, they said it was received after all. They could not tell me when or if they will accept my address change.
I have bills stacking up since April and I just found out that they will not accept them if they are over 30 days old. I have cared for patients for 5 months and will not receive any reimbursement from Medicare. The rules state I cannot bill the patient or their supplemental Medicare insurance either.
Believe me, Mr. President, I commend you for taking on such a huge task. Please also know that Medicare reform is needed along with health care reform.
A loyal American ,
Internal Medicine (aka: primary care) physician
Like many other people, Ms. Krinsk thought that her prescription information was private. But in fact, prescriptions, and all the information on them — including not only the name and dosage of the drug and the name and address of the doctor, but also the patient’s address and Social Security number — are a commodity bought and sold in a murky marketplace, often without the patients’ knowledge or permission.
But given the money involved, I’m afraid it isn’t.
But with the pharmaceutical industry soon to release $150M dollars of ads promoting health reform as they cozy up to Congressional leaders, the conflicts of interest for patient’s privacy are staggering. Further, the promotion of the electronic medical record, personal health records, and ultimately, cloud computing (where no one will know where health data resides), are firmly part of the health reform landscape.
Now before people think I’m totally against the EMR, let me be candid: I’m not. It does facilitate care and is an incredible means of communication between physicians and laboratories and pharmacies and the like. When used properly, they are miraculous.
But the risks of losing information remain huge. Certainly, the above referenced New York Times article notes that safeguards are supposed to be enacted to prevent this wholesale marketing of your health data.
But suddenly, we learn of a White House snitch line where they will collect e-mails of people who might be spreading “misinformation” about the health reform efforts underway. (Thanks to my previous blog post, I am happy to report I’ve been reported! ;)) But this occurs at a time when privacy issues in health care must be seen as paramount and electronic medical records protected as secure.
Ooops.
So now we have a White House eager to build a snitch line as they cozy up to pharaceutical interests that are already selling personal information from prescription data, all while trying to promote the security of electronic medical records to the masses.
Who are they kidding?
But then, shucks, just think of the marketing possibilities for the government:
And lest people think I’m too partisan (who me?), the Republicans with their travel junkets aren’t any better.
Sheesh!
-Wes
Reference: White House blog with snitch e-mail link at flag@whitehouse.gov .
*This blog post was originally published at Dr. Wes*
I have never been one to shy away from the truths about our world. An Inconvenient Truth was a movie that affected many of us profoundly. Most of my family does not like Al Gore because they are in denial about what is happening to our planet, and our role in that. A new movie does the same about our food sources in America. It is called Food, Inc. It may upset you, but I highly recommend it. The authors explore just where our food comes from, the chicken, the beef, the grains and how our big corporate food industries operate.
I am not an anti-corporate person. I agree with Calvin Coolidge that the business of America is business. In our modern life, we have accomplished many things through industry. Our supermarkets contain a richer variety of food than ever available before in the history of mankind. But, there are important issues for us to address. What are the implications of feeding our cattle corn meal when that is not their best food source? What danger do we have of serious bacterial contamination? How do the big food corporations treat our farmers? These are all questions explored in this film. Like Anderson Cooper on CNN, this film “keeps them honest”.
Two of the main characters in the movie are authors I admire a lot: Eric Schlosser, who wrote Fast Food Nation, and Michael Pollen, author of The Omnivore’s Dilemma. These men are dedicated to keeping our food supply safe and healthy and for us to avoid the traps that make us unhealthy and obese.
Should you become a “locavore”? That is a new word to describe someone that only eats locally grown food. That may be an option for some but not for others depending on where you live. Locally grown food, like what is found in a Farmer’s Market, is more likely to be fresh and have fewer questions than other commercially developed foods. I saw an interesting bumper sticker today, “Supermarkets have branches, Farmer’s Markets have roots”.
The tagline for Food, Inc. is “You’ll never look at dinner the same way again”. I must say that is true. I continue to shop in supermarkets and eat in restaurants, but I am much more mindful about what I put in my body. We all should be.
*This blog post was originally published at eDocAmerica*
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