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Health Reform: What Do Americans Really Want?

As part of their closing argument against health reform, Republicans argue that Democrats who vote for the bill will be ignoring the will of the American people, at their own political peril. Senate Minority Leader Mitch McConnell accuses Democrats of wanting “to plow ahead on a partisan bill Americans don’t want.” McConnell is correct that just about every recent poll shows that majorities of Americans dislike the current legislation. But supporters of the legislation counter that it really has more public support than a simple “for it or against it” poll would yield.

The Kaiser Family Foundation tracking poll finds that the country is evenly divided on the legislation, but large majorities support many of the major provisions in the bill. And when asked about the next steps for health reform:

32% said that Congress should “Move soon to pass the comprehensive legislation that has already been approved by the House and Senate.”

22% want to “Put healthcare on hold, so Congress can work on other priorities and try to deal with it later in the year.”

20% want to “Pull out a few key provisions where there is broad agreement and pass those, even though this won’t be comprehensive reform.”

19% want them to “stop working on healthcare” this year. Read more »

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

Why Physicians Should Weigh In On Healthcare Reform

It’s interesting to see how different things are over at The Health Care Blog.  First, it’s different to have to write “health care” instead of healthcare.  I personally am all for not using up or resources by adding the space between the two words.  Ihaveconsideredeliminatingspacesaltogether, but it gets confusing.  Iwon’tdothat.

One of the big differences I see is the perspective of the readers and commenters.  I write here for a group of people I largely consider friends, cohorts, or at least sympathetic to my cause.  After all, people are coming here by their own volition (I assume nobody is getting this blog forced upon them as some sort of punishment, although that may be a bad assumption).  But the readers at THCB (as we insiders call it) are much more argumentative and much more likely to be “experts” in the area of healthcare delivery.  Certainly the other folks writing there are far more sophisticated than me (not that that’s a hard thing), and are much more well-read in the area of HC reform.  The debates in the comments section are quite stimulating, although sometimes you have to wipe a little blood off of your screen. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Introducing The New

A year and a half ago we unveiled Medpolitics, a website for doctors to blog about the legislative, regulatory, and public policy issues revolving around the business of medicine.

Today we’d like to present the new and much improved Medpolitics, that anyone can join and participate in using the new, more intuitive and much spiffier interface. Whether you are a health care strategist, doctor, nurse, patient, or just a citizen concerned about the state of medicine, this is the place for you to bring up debates, offer solutions, announce events, organize groups, or find friends and establish professional contacts.

Healthcare is obviously a major topic today in society, and we feel that there should be a real forum for everyone to express their views, offer new ideas, and discuss details that are often ignored by all the noise in the media. Medpolitics allows anyone to blog, post videos from YouTube, and create discussion forums by topic.

If the future of healthcare is important to you, this network will be an ideal outlet for expressing your individual voice. Registration takes seconds and you can start right away.


*This blog post was originally published at Medgadget*

The 5 Best And Worst Recent Health Policy Quotes

I’ve been attending a series of health policy conferences recently – and twittering them live. I’ve heard a lot of smart ideas and a lot of not-so-smart ideas. For your consideration, I offer you my best and worst recent health policy quotes:

The best quotes:

1. Evan Falchuk, Best Doctors: “Since the leading cause of misdiagnosis is a failure of synthesis – a failure by the doctor to put together available information in a way that leads them to the right conclusion – our system ought to be built around helping make sure this happens each and every time.”

2. Aneesh Chopra, Federal CTO“HIT should not be in a box unto itself – put in a corner, making a capital-sucking sound.”

3. Clay Shirky, New Media Guru: “The problem is that, since we all die eventually, everyone will be unhappy with their healthcare at some point. This creates a social dilemma that’s neither transitory nor small. First, there will always be snake oil salesmen peddling ‘eternal life,’ and second, there will always be an unhappy faction who rail against the medical establishment.”

4. Joshua Ofman, Amgen, on comparative clinical effectiveness research: “We don’t want 2 different evidence standards. One to gain market access and a second to lose market access… There is a role for observational data to gain insights. There is a great allure of large, readily accessible databases that are fast – but the power and speed cannot overcome bias and confounding.

5. Vivek Kundra, Federal CIO: “We need to bake security into the architecture that we purchase from the private sector. The sprinkler system is part of any house you purchase – you don’t have to add it later.”

The Worst Quotes:

1. Senator Tom Harkin: “The NCCAM has failed to do their job of validating complementary and alternative medicine therapies.”

2. Senator Max Baucus: “Going to the doctor is like buying a car, except buying a car is a lot more fun.” Bonus quote: “If men liked shopping, they’d call it research.” [???]

3. Theresa Cullen, CIO, Indian Health Service : “At some point we’ll have to tell providers ‘you have to use EHR, we’ve drawn a line. If you don’t use it you’ll have to leave.'”

4. Sean Tunis, Center for Medical Technology Policy: “Randomized Clinical Trials can be designed with generous inclusion and exclusion criteria. Their limited inclusion criteria are not a permanent defect… We can’t wait 5 years for RCTs to be done. We have to find new methods that we can use (a “silver level of evidence” rather than the RCT “gold level”) to help inform our care decisions.”

5. Congressman Pete Stark: “I’m sick of rich doctors driving up in their Porsches saying ‘I’m pulling out of Medicare.’”

Will Rationing Care Become Part Of Reform?

The impetus for government to control healthcare costs should be obvious to us all and intervention now appears unavoidable.  Two issues will soon come to light: the exorbitant costs to fight disease at the end of life, often when the approach of death is barely retarded and the wide disparity in costs between different geographical regions of our country for similarly aged patients.  It is estimated that 27% of Medicare’s annual $327 billion budget – one fourth of its operating budget – goes to care for patients in their final year of life while Medicare averages $20,000 more dollars for patients in Manhattan than in some rural areas of our country.

With this in mind, I share a deep concern with many of my colleagues that part of the healthcare reform debate will turn to the rationing of healthcare. This appears a logical progression from the proposed establishment of guidelines and advisory committees currently allowed for in the Health Reform bill already passed. The question as to who should receive possibly futile care is not clear, rather it is fraught with complexity, often relying as much on evidence-based research as it is on assessments made by the medical practitioner in light of the relationship the doctor has with the patient.

At the heart of the rationing issue are two, often warring, sides of medicine:  art and science. Medicine began as an art thousands of years ago, and moved more towards science when, in Ancient Greece, Hippocrates taught physicians to observe the results of their treatments and make adjustments. However, art should not be removed from medicine, for this is where the doctor-patient relationship comes to play, serving as a cornerstone of effective and humane medicine.  It would be impossible for physicians to uphold the noble traditions of the medical profession, adequately serve society, or preserve the dignity of human life if doctors were to become, purely, scientists.  As long as we are treating people, medicine should never become solely a science.

Rationing, however, would be based purely on science, completely devoid of any art and, I believe, serve as a blow against the sanctity of the medical profession.  Setting up rationing guidelines as they pertain to the end of life would circumvent patient’s trust in the doctor-patient relationship and risk the very soul of medicine by negating the importance of the doctor-patient relationship. Evidence-based recommendations can and should be set forth pertaining to protocols for offering treatments as the end of life seems near.  This would likely reduce some of the high and disparate costs in caring for our elders; however, it is important to consider the input of a doctor aware of the needs and desires of his patient.

I come to this argument both as a physician and from personal experience. Several years ago, my 75 year old father was hospitalized four times over five months.  His medical team, led by a kind and experienced surgeon, unburdened by guidelines or anyone else’s recommendations, gave him a chance despite long odds against his survival.  Medically speaking, I am still surprised he made it out of the hospital to live a normal life again.  During the subsequent five years, he has welcomed three grandchildren into our family; I would challenge anyone to assign a monetary value for that life experience.  My professional and personal experience leaves me quite sure that he would have fallen a victim of any rationing guidelines that could ever exist.

In short, as the average life span increases most of us nurture the hope to live longer, cheering as science opens the door to seemingly innumerable advancements. Yet are we, as a society, equipped, whether it be emotionally or fiscally, to handle the decisions that must be made as the end of life draws near? More importantly, should government be allowed to set up strict guidelines without an active debate from physicians and patients?  These guidelines could sacrifice what has long been and should still remain most important to healthcare: the doctor-patient relationship.

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

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