March 7th, 2011 by Elaine Schattner, M.D. in Health Policy, Opinion
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[Recently] a short article in the New York Times, New Kidney Transplant Policy Would Favor Younger Patients, [drew] my attention to a very basic problem in medical ethics: Rationing.
According to the Washington Post coverage, the proposal comes from the United Network for Organ Sharing, a Richmond-based private non-profit group the federal government contracts for allocation of donated organs. From the Times piece:
Under the proposal, patients and kidneys would each be graded, and the healthiest and youngest 20 percent of patients and kidneys would be segregated into a separate pool so that the best kidneys would be given to patients with the longest life expectancies.
This all follows [the recent] front-page business story on the monetary value of life.
I have to admit, I’m glad to see these stories in the media. Any reasoned discussion of policy and reform requires frank talk on healthcare resources which, even in the best of economic times, are limited.
*This blog post was originally published at Medical Lessons*
March 7th, 2011 by RyanDuBosar in Health Policy, News
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A federal judge who’d ruled healthcare reform was unconstitutional and that his decision as a federal judge was the equivalent of an injunction has relented. Healthcare reform can continue in the states, pending appellate and Supreme Court review.
“The sooner this issue is finally decided by the Supreme Court, the better off the entire nation will be,” wrote federal judge Roger E. Vinson, who’d decided that the healthcare reform act’s mandate that people buy insurance or face penalties overextended Congress’ powers under the commerce clause of the constitution.
One reason for granting a stay, despite his previous clear intent that healthcare reform cease, includes his statement (on page 18) that:
“Can (or should) I enjoin and halt implementation of the Act in a state where one of its federal courts has held it to be Constitutional? In addition, many of the plaintiff states have publicly represented that they will immediately halt implementation of the Act in light of my declaratory judgment, while at least eight plaintiff states (as identified by the defendants in their motion and reply) have suggested that, in an abundance of caution, they will not stop implementing the Act pending appeal. In addition to these apparent disagreements among the plaintiff states, there is even disagreement within the plaintiff states as to whether the implementation should continue pending appeal. For example, while the plaintiffs (a group that includes the Attorney General of Washington) have requested that I enjoin the defendants from implementing the Act, the Governor of Washington has just filed an amicus brief specifically opposing that request.”
The decision gives the Obama administration seven days to file an appeal against his decision, which a U.S. Department of Justice spokesperson said the administration intends to do. Read more »
*This blog post was originally published at ACP Internist*
March 4th, 2011 by DavidHarlow in Health Policy, Opinion
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Medicaid has been front and center this week as President Obama addressed the National Governors Association, and several governors testified before the House Energy and Commerce Committee. Obama told the governors that he supports the Wyden-Brown bill, which would accelerate the availability of waivers under the Affordable Care Act (ACA), so that states would not have to first create health insurance exchanges under the law, and then have the right to dismantle them and replace them with other mechanisms to achieve coverage goals of the law without additional cost to the federales. (See Wyden-Brown fact sheet.) The sponsors’ home states, Oregon and Massachusetts would otherwise have to dismantle parts of their own health reform efforts in order to align with the federal mandates. (Wyden has been a longer-term proponent of experimentation and innovation in health reform.)
The mini-med waivers granted to states (in addition to those granted to corporations and unions) are just one example of interim steps needed to harmonize federal and state health reform. When in 2014 mini-med plans will no longer be permitted at all under the federal health reform law, there will either need to be a significant dislocation of the underinsured “Young Invincibles” in Massachusetts and underinsured employees in capped health plans elsewhere in the country, or a change in the law.
Similar difficulties await state Medicaid programs, which will be faced with expanded eligibility, and other state agencies, which will need to set up exchanges per the ACA. The cost associated with eligibility expansion will be overwhelming — or maybe it won’t. There are, of course, expert opinions across the board on the financial impact of health reform on state budgets. As the saying goes, “Where you stand depends on where you sit.” Some reports inflate state expenses by not accounting for the fact that the federal share of Medicaid expansion covers 92 percent of the total. Read more »
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
March 2nd, 2011 by Jessie Gruman, Ph.D. in Better Health Network, Opinion
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The other day I came across this photo of a couple clasping each other in a dramatic tango on the cover of an old medical journal — a special issue from 1999 that was focused entirely on doctor-patient partnership. The tone and subjects of the articles, letters and editorials were identical to those written today on the topic: “It’s time for the paternalism of the relationship between doctors and patients to be transformed into a partnership;” “There are benefits to this change and dangers to maintaining the status quo;” “Some doctors and patients resist the change and some embrace it: Why?”
Two questions struck me as I impatiently scanned the articles from 12 years ago: First, why are these articles about doctor-patient partnership still so relevant? And second, why did the editor choose this cover image?
I’ve been mulling over these questions for a couple days, and I think an answer to the second question sheds light on the first. Here are some thoughts about the relationship between patients and doctors (and nurse practitioners and other clinicians) evoked by that image of the two elegant people dancing together:
It takes two to tango. Ever seen one guy doing the tango? Nope. Whatever he’s doing out there on the dance floor, that’s not tango. Without both dancers, there is no tango. The reason my doctor and I come together is our shared purpose of curing my illness or easing my pain. We bring different skills, perspectives and needs to this interaction. When in a partnership, I describe my symptoms and recount my history. I talk about my values and priorities. I say what I am able and willing to do for myself and what I am not. My doctor has knowledge about my disease and experience treating it in people like me; she explains risks and tradeoffs of different approaches and tailors her use of drugs, devices, and procedures to meet my needs and my preferences. Both of us recognize that without the active commitment of the other we can’t reach our shared goal: To help me live as well as I can for as long as I can.
Each dancer adjusts to his or her partner. In tango, each partner has different moves; the lead shifts subtly and constantly between them throughout the dance. In a partnership, when I am really ill, I delegate more decisions to my physicians; when I am well we freely go back and forth, discussing treatment options and making plans. Read more »
*This blog post was originally published at CFAH PPF Blog*
February 28th, 2011 by EvanFalchukJD in Health Policy, Opinion, True Stories
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Media reports on misdiagnosis continue to mount. A recent study on patients with Alzheimer’s found that half had been misdiagnosed. Half.
Another headline blared “4 out of 10 patients being misdiagnosed.” The article encouraged patients to “see another doctor” if they are worried about their diagnosis.
You know what it makes me think about? Starbucks. Why? Because the way Starbucks revolutionized coffee drinking shows a way forward for healthcare.
Starbucks realized that since our lives focus on two places — home and work — most of us don’t have a “third place” to go. A place where we can be free of everyday distractions and take care of ourselves. Starbucks set out to create that “third place” by making its shops comfortable, inviting places. It works. “Third place” makes customers’ lives better — and Starbucks has almost 20,000 shops to prove it.
It’s time for a kind of “third place” in healthcare. Healthcare focuses on two places, too: The doctor’s office and the hospital. Both places are difficult for patients. Patients complain of not getting enough time from their overworked doctors, and studies of things that go wrong in hospitals are equally disturbing.
There really isn’t a “third place” to go to in healthcare. Somewhere that you can step outside of the difficult process of being sick. Somewhere you can get a quiet, clear perspective of what is going on.
Now, some people are lucky and can turn to relatives or friends who are doctors to provide some of that “third place” experience. But most people can’t. At Best Doctors, we’re creating the experience of a healthcare “third place.” We do it by taking the time to review each case, have doctors think about what’s happening, consult with experts, and share advice. Read more »
*This blog post was originally published at See First Blog*
