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Addressing Healthcare Spending: “Cowardice” Or Bravery?

In assessing the “best and worst” of the recommendations from the National Commission on Fiscal Responsibility, Washington Post blogger Ezra Klein accuses the Commission of “cowardice” in addressing healthcare spending:

“The plan’s healthcare savings largely consist of hoping the cost controls . . . and various demonstration projects in the new healthcare law work and expanding their power and reach. . . In the event that more savings are needed, they throw out a grab bag of liberal and conservative policies . . . but don’t really put their weight behind any. . .[their] decision to hide from the big questions here is quite disappointing . . . ”

Pretty harsh words, considering that in other respects Klein gives the Commission high marks. But I think there is a lot more to the Commission’s recommendations on healthcare spending than meet’s (Klein’s) eyes, even though I have my own doubts about the advisability and political acceptability of many of them. Read more »

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

Healthcare Reform Law Is Gaining Public Support

GOP hardliners soon to be in control of the House have made repeal of the detested healthcare reform law a cornerstone of their agenda, despite the impossibility of actually being able to repeal it, politically, at least until an election or two has passed, and despite the fact that their ascent to power had more to do with the terrible economy and high unemployment than any mandate to repeal the law.

It seems that, finally, there may be movement towards increased public support for the law. A new McClatchy poll shows a majority of Americans now in favor of the law:

A majority of Americans want the Congress to keep the new health care law or actually expand it, despite Republican claims that they have a mandate from the people to kill it, according to a new McClatchy-Marist poll.

The post-election survey showed that 51 percent of registered voters want to keep the law or change it to do more, while 44 percent want to change it to do less or repeal it altogether.

Driving support for the law: Voters by margins of 2-1 or greater want to keep some of its best-known benefits, such as barring insurers from denying coverage for pre-existing conditions. One thing they don’t like: the mandate that everyone must buy insurance.

Of course, it is the mandate that makes the whole thing hang together. And it’s hardly news that people like the individual provisions and protections found within the law. Read more »

*This blog post was originally published at Movin' Meat*

Where’s My Government-Provided Healthcare?

Freshman Republican Congressman Andy Harris, who was elected on a promise to repeal the Patient Protection and Affordable Care Act (PPACA), is outraged that he’s going to go a whole month before his government-provided health insurance kicks in. From Politico:

A conservative Maryland physician elected to Congress on an anti-Obamacare platform surprised fellow freshmen at a Monday orientation session by demanding to know why his government-subsidized health care plan takes a month to kick in.

Republican Andy Harris, an anesthesiologist who defeated freshman Democrat Frank Kratovil on Maryland’s Eastern Shore, reacted incredulously when informed that federal law mandated that his government-subsidized health care policy would take effect on Feb. 1st –- 28 days after his Jan. 3rd swearing-in.

“He stood up and asked the two ladies who were answering questions why it had to take so long, what he would do without 28 days of health care,” said a congressional staffer who saw the exchange. The benefits session, held behind closed doors, drew about 250 freshman members, staffers and family members to the Capitol Visitors Center auditorium late Monday morning.”

All the more embarassing because he’s a doctor, for Pete’s sake. You’d think he’d have a better idea of how insurance works. Guess the dude’s never heard of COBRA. Also, it’s pretty standard that this is how enrollment happens. And it’s idiots like this that want to repeal the PPACA. Read more »

*This blog post was originally published at Movin' Meat*

Health Reform: “Compete And Succeed” Or “Repeal Or Replace?”

Senator Scott Brown (R-MA) thinks so. So does Senator Ron Wyden (D-OR). And Senator Bernie Sanders (I-VT). Senators Brown, Wyden and Sanders have introduced the “Empowering States to Innovate Act.” Ezra Klein blogs that the Senators may have found a way forward on health reform.

“If a state can think of a plan that covers as many people, with as comprehensive insurance, at as low a cost, without adding to the deficit, the state can get the money the federal government would’ve given it for health-care reform but be freed from the individual mandate, the exchanges, the insurance requirements, the subsidy scheme and pretty much everything else in the bill,” Ezra Klein writes. “If conservative solutions are more efficient, that will be clear when their beneficiaries save money. If liberal ideas really work better, it’s time we found out. Forget repeal and replace, or even reform and replace. How about compete and succeed?”

The Wonk Room reports that Wyden, Brown, Sanders, who co-sponsored the original innovative waivers amendment, believe that their home states of Oregon, Massachusetts, and Vermont are leading the pack in adopting innovative approaches. These include the well-known Massachusetts program that Brown voted for as a state legislator, and single payer bills that have been introduced in Vermont and Oregon. The bill, though, also could appeal to states seeking a more conservative, less regulatory solution, since they would be able to decide how they wanted to provide comprehensive coverage to the uninsured, free of most of the mandates of the Affordable Care Act (ACA). Read more »

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

Happy Birthday, Baby Boomers: One More Eligible For Medicare Every 8 Seconds

Today begins a lame duck session of Congress before it breaks for Thanksgiving. It’s the final chance to work out a temporary patch to Medicare reimbursement before a 23 percent cut takes effect Dec. 1. Doctors are going to stop taking new Medicare patients if the cuts happen. And, as one breast cancer surgeon explains, if Medicare stops paying, so to private insurers and even military health programs. Congress will meet in December, but the damage will be done.

This all is happening two weeks before the baby boomers become eligible for Medicare. That populous generation starts to turn 65 beginning on Jan. 1, which means they become eligible for Medicare on Dec. 1, which, as we mentioned, is the day the 23 percent Medicare pay cut kicks in. Boomers will continue to become eligible for Medicare, one person every eight seconds, until December 2029. (CNN, The Washington Post, USA Today)

*This blog post was originally published at ACP Internist*

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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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?

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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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