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Doctors’ Allegiance and the Hippocratic Oath: Patients vs. Profits

by Philip Caper, M.D.

The Maine Medical Association recently updated a 2008 poll of their members that asked the question “When considering the topic of health care reform, would you prefer to make improvements in the current public/private system (or) a single-payer system, such as a ’Medicare-for-all’ approach?” In 2008 52.3 percent favored the Medicare-for-All approach. In the updated poll, released last week, that number had risen to 64.3%.

It’s pretty unusual for two-thirds of a group of doctors to agree on something as controversial as a single-payer health care system. Until recently doctors formed the core ...
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How routine medical bills can harm your credit rating

by Don McCanne, M.D.

Our fragmented, dysfunctional system of paying medical bills is having a major impact on personal credit ratings. Half of all accounts reported by collection agencies now come from medical bills. The credit record of one-fifth of Americans is affected, and many of us are unaware of it. Are people so broke that they can’t pay their medical bills, or is something else going on here?

There are two major factors at play here. One is that with flat wages and increasing household costs, many people do have problems paying all of their essential bills, and ...
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Medicare’s Rollout vs. Obamacare’s Glitches Brew

by David Himmelstein, M.D., and Steffie Woolhandler, M.D.
re-posted with permission from authors from Health Affairs Blog (Jan. 2, 2014)

healthaffairs.org/blog/2014/01/02/medicares-rollout-vs-obamacares-glitches-brew/

The smooth and inexpensive rollout of Medicare on July 1, 1966 provides a sharp contrast to the costly chaos of Obamacare.
We won’t rehearse the chaos part here, just the costs.

As of March, 2013, federal grants for Obamacare’s state exchanges totaled $3.8 billion. Spending for the federal exchange is harder to pin down because funding has come from multiple accounts, including: the $1 billion Health Insurance ...
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VALUE TRANSFORMATION AND HEALTH CARE REFORM

by Samuel Metz, M.D.

In their recent paper in the Harvard Business Review, Messrs. Porter and Lee make an eloquent argument that their Value Transformation process will reduce health care costs and improve medical outcomes. They could be right. However, this strategy will certainly fail in the U.S. because it addresses delivery of health care, not financing of health care.

This distinction is crucial. Porter and Lee describe an ideal delivery system, addressing how providers are paid for patient care. Their proposal leaves untouched our financing system, which determines which patients participate, who pays, and how we collect.
...
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Plans from private insurance exchanges shift more costs to patients

by Don McCanne, M.D.

The activity around the implementation of the Affordable Care Act and the initiation of federal and state insurance exchanges has seemed to stimulate much interest in private insurance exchanges, in all of their various forms. While some may praise the private sector for coming to the fore, we should take a closer look at what these private exchanges mean for patients.

Perhaps the greatest concern is the fact that a recent Aon survey shows that about 33 percent of employers will be eliminating their own health benefit programs within the next three to five ...
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CATHOLIC HOSPITAL SYSTEMS: A GROWING THREAT TO ACCESS TO REPRODUCTIVE SERVICES

by John Geyman, M.D.

Expansion of Catholic hospital systems is accelerating around the country, partly by acquiring non-Catholic hospitals. This trend is posing an increasing threat to access to care in two major areas—reproductive services and end-of-life care. Ethical and Religious Directives for Catholic Health Care Services (the ERDs) are being enforced by the bishops more vigorously in many parts of the country, holding their employed physicians to strict adherence to the ERDs or loss of employment. Meanwhile patients in many locations, especially rural areas, are finding it increasingly difficult to gain access to essential care.

Ten of ...
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The Republican CARE Act and Health Care: “Common Sense?”

by Samuel Metz, M.D.

Despite the best efforts of a Democratic Congress, the Affordable Care Act (ACA, also “ObamaCare”) will still leave millions of Americans without health care and increase costs by billions of dollars. Or so predicts the Congressional Budget Office, and they should know. (1) Now Republicans offer their Plan B to replace what appears to be a failing Plan A.

Senators Burr, Coburn, and Hatch affirm their CARE plan (Patient Choice, Affordability, Responsibility, and Empowerment Act), as a response to the probable devastation of the Affordable Care Act, is founded on “common sense.” Common sense, they ...
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Outrageous Pricing of Pharmaceuticals – The Nexavar Example

by Don McCanne, M.D.

At a recent forum sponsored by Financial Times, Bayer Chairman Marijn Dekkers caused quite a flap with his comments about their oncology product, Nexavar (sorafenib) (1). So what did he say?

Dekkers complained about the fact that the Indian government granted Bayer a patent for their product, but then said that it was too expensive, so they granted a mandatory license to an Indian generic company to manufacture and distribute the product, while Bayer was to receive a six percent royalty merely for owning the patient. What he said next raised eyebrows:
...
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Replacing the SGR + Add-Ons

by David Gimlett, M.D.

It was announced yesterday that U.S. Senate and House negotiators have reached a bipartisan agreement to repeal the Sustainable Growth Rate (SGR). So far we have just a one-page summary of the agreement. (1) Like most congressional actions the devil will be in the details. So far there is no announcement of how we will pay the some $120-$150 billion cost of the repeal.

Most significantly, the SGR has to go. It has been overridden for the last decade and has served no function but to hang as an albatross around the necks of ...
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WHO IS THE HEALTH CARE SYSTEM FOR?

by Joshua Freeman, M.D.

Two major trends now accelerating under the Affordable Care Act (ACA) are the increasing acquisition of physician practices by hospital systems and the emergence of accountable care organizations (ACOs). Both trends pose threats to patients’ access, costs, and quality of health care.

These trends are examined in a recent series of articles, “Doctors Inc”, by Alan Bavley of the Kansas City Star. According to the American Hospital Association, the number of doctors on hospital payrolls nationwide has risen by one-third since 2000. This trend is driven by the “financial model”, which generates internal referrals, ...
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CONTINUITY OF HEALTH CARE: GOING, GOING . . . ALMOST GONE!

by John Geyman, M.D.

We have heard the promises as the Affordable Care Act (ACA) was being sold to the public, including—you can keep your doctor and insurance if you like it. We now know those promises to be mostly false as the ACA enters its fifth year of implementation.

Under the guise of “competition” and “efficiency”, the ACA has unleashed a new round of disruption throughout the health care system. We are seeing further fragmentation of care, with less continuity of care with patients’ physicians. The physician-patient relationship itself is at risk in a ...
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HOW OBSCENE PROFITS ARE A BARRIER TO HEALTH

by Joshua Freeman, M.D.

After a year of reporting in a series of articles in the New York
Times on the crisis in health care, Elisabeth Rosenthal summarized her conclusions in a Times piece on December 22, 2013. As the title, “Health Care’s Road to Ruin”, makes clear, those conclusions are not positive. She summarizes highlights from her investigations that look at the extremely high cost of health care in the U.S. compared to other countries, the extreme variability in pricing depending upon where you are in the U.S., the opaque and incomprehensible methods of coming up with pricing, and ...
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Americans Are Paying For Health Care With More Than Money

by Philip Caper, M.D.

 Americans now spend close to $3 trillion a year for health care, around 18% of our GDP. That works out to almost $9,000 per person in Maine, almost twice as much per person as the average for other wealthy nations that provide healthcare for all their people.

Not only do we pay more, but we pay in far more ways than any other country. Some are obvious. They include health insurance premiums, “out of pocket” co-pays and deductibles, and payments for health care products and services that are not covered by insurance. Out-of-pocket payments ...
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THE AFFORDABLE CARE ACT: NOT A GOVERNMENT TAKEOVER BUT A PRIVATIZED BONANZA

THE AFFORDABLE CARE ACT: NOT A GOVERNMENT TAKEOVER BUT A PRIVATIZED BONANZA

by John Geyman, M.D.

“(Obamacare) is not a government takeover of medicine.
It’s the privatization of health care.”

Those words were spoken by Tom Scully, former administrator of the Centers for Medicare and Medicaid Services (CMS) during the George W. Bush administration. The occasion was as keynote speaker at an event in late October, 2013 hosted by the Potomac Research Group, a Beltway firm that advises large investors on government policy. He went on to say that Obamacare is more capitalistic ...
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The High Costs of Complexity in Healthcare Reform

by Philip Caper, M.D.
Special to the Bangor Daily News
 
I have great admiration for the political courage of President Obama and the  Congressional leaders who were willing to take on healthcare reform, justifiably called the third rail of American politics. Our system cries out for reform. But I think they made a fatal mistake in allowing the law to be drafted by Congress, which is composed of 535 members with vastly varying values, goals and interests.

Consequently, the resulting law is a conglomeration of ideas from across the political spectrum, thrown together and lacking any ...
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After Obamacare

by David Gimlett

As the smoke begins to rise from the newly built structures of the Affordable Care Act (ACA) it is becoming more obvious that there is a real fire that will destroy this latest attempt at managed care. Expensive, complicated, bug-infested computer programs, loss of insurance policies by individual purchasers, and expanding underinsurance created by the act and copied in new employer sponsored plans are the kindling that will stoke the fire. Long before the Republicans declared war on Obamacare, long before there was Obamacare, there was a community of health care reform advocates who knew, and spoke to the fact, ...
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INEQUALITY FOR ALL...

by Don McCanne, M.D.

The United States has by far the highest level of health care spending of all nations. According to Milliman, the average health expenditures for a typical working family of four is now over $22,000 — more than one-third of the median household income. (1) Since most families cannot afford to pay that amount, it is no wonder that, in our obsession with private insurance solutions, we have developed an administratively complex, wasteful, fragmented system of financing health care — a system that is being expanded and perpetuated by the Affordable Care Act.

The problem of ...
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COST SHARING: AN INTUITIVE COST CONTAINMENT CONCEPT THAT WILL NEVER CONTROL HEALTH CARE COSTS

by John Geyman, M.D.

This country has endorsed and expanded the concept of cost sharing—between patients and the payers of health care, especially insurers and employers—as a way to contain health care costs for some 40 years. This approach has been accepted by most economists without critical evaluation. It might sound intuitively correct to assume that patients with more “skin in the game” (more out-of-pocket costs) will be more judicious in seeking their own health care, and that they will avoid unnecessary and inappropriate care, thus decreasing the costs of health care. As a basic principle of consumer-directed health care, this concept has ...
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ACA’s bungled rollout aside, government health insurance works

by Dr. Philip Caper, Special to the BDN

The lead story in the Oct. 13 New York Times details the ongoing problems of the Affordable Care Act’s websites intended to facilitate access by individuals to the law’s hallmark online marketplaces. Those problems continue.

To summarize, many of the state-run and all of the 36 federally run websites are currently experiencing significant problems providing access to the exchanges, and nobody seems willing or able to predict when they will be fixed. This failure to launch President Obama’s signature domestic achievement is hugely embarrassing for the administration, and ...
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A Doctor’s Perspective on Health Care Reform

by Stephen B. Kemble, M.D.

Published by the Honolulu Star-Advertiser as “More health care regulations mean more middlemen, fewer doctors” on November 27, 2013. Reprinted with permission.

I attended the recent Hawai`i 2013 Healthcare Summit, on how Hawai`i is implementing the Affordable Care Act and transforming healthcare. The keynote address by Dr. Abraham Verghese was inspiring – all about the sanctity of the doctor-patient relationship and how health care should be focused on the living patient, not the “iPatient” in the computer.

In the panel discussions, Hawaii`i’s health plans and ...
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CAN THE U.S. PROVIDE BETTER CARE TO MORE PEOPLE FOR LESS MONEY?

by Samuel Metz, M.D.

It can’t be done. At least it can’t be done if we use private insurance companies to provide that care. More care for more people means more insurance policies. More policies cost more money. Pretty simple.

How much more money will it cost to expand comprehensive health care to all Americans? Projecting from a 2009 study in California, expanding care to the entire country would cost $210 billion more each year. And that’s without the administrative costs of private health insurance.

Administrative costs of private health insurance? But isn’t the ...
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Serious Mental Illness and the ACA: No Relief for the Weary

by Pippa Abston, M.D.

As a pediatrician whose patients and their families sometimes develop serious mental illnesses (SMI), and as a family member and caregiver, I can tell you that the word “serious” is a euphemism, a polite understatement. I have a friend with stage IV cancer who has received life-saving treatment for many years—she is able to work, care for her family, and enjoy her life despite the fatigue and side effects. If she were to stop treatment she would likely die quickly. Her illness is serious. Treated, illnesses like schizophrenia and bipolar with psychosis settle to the level of serious. Untreated, ...
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Carving Out the Brain

Pippa Abston, M.D.

How Our Insurance System Fragments Mental Illness Care

“Dr. Abston, I’m worried my son has ADHD. He’s having trouble keeping up in class and the teacher says he isn’t paying attention. Can you test him?”

That’s a common phone question in my pediatric practice, especially after school starts in the fall. To answer the parent, I must respond first with another question: “What insurance do you have?” If the child has Alabama Medicaid, I can say yes. ...
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The SGR---Again and Again and Again and Again…

by David M. Gimlett, M.D.

Announcement. The Senate Finance and House Ways and Means committees are working on a new SGR (Sustainable Growth Rate) repeal proposal. The two congressional committees, working in a bipartisan fashion, reacted to physician concerns regarding a proposal from October to repeal the SGR and create a more streamlined pay-for-performance (P4P) or Value Based system.

Apparently the committees are readying to vote this week on a 3 month patch for the non-functional sustainable growth rate (SGR) payment formula for physicians.(1) The non-functioning of this formula for the last ten years mirrors the accomplishments of our ...
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DEAD MAN WALKING: DO PEOPLE REALLY DIE FOR LACK OF HEALTH INSURANCE?

by Joshua Freeman, M.D.

There seems to be a widespread perception that people don’t just die in America if they don’t have health insurance. After all, we all have access to hospital emergency rooms even if uninsured, so what’s the problem?  As former President George Bush famously said in July, 2007, "I mean, people have access to health care in America. After all, you just go to an emergency room."  On the same theme, another leading Republican, Mitt Romney, declared repeatedly during the 2012 Presidential campaign, that “No one dies for lack of health insurance,” despite many studies to the contrary.

...
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Health Reform’s Problems Run Deeper than a Glitchy Website

by Philip Caper, M.D. Previously published in the Bangor Daily News; reprinted with author’s permission.

Serious problems with the websites created by the Affordable Care Act continue, and probably will for a long time. Although frantic efforts at incrementally improving them are being made by the Obama administration, and some sites are working better than others, they are a long way from working well.

The causes of the website’s problems are far more serious than poor software design. They are baked into the law by its extreme complexity.
There is growing frustration and anger at the ...
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SINGLE-PAYER IN STATES: A STEPPING STONE TO UNIVERSAL ACCESS?

Don McCanne, M.D.

A recent report from Public Citizen, A Road Map to "Single-Payer: How States Can Escape the Clutches of the Private Health Insurance System, outlines steps that can be taken by states to achieve single-payer financing of health care at the state level. (1) This very useful report serves two important functions.

First, although the Affordable Care Act is providing a few beneficial tweaks to the financing of our health care system, by now it is obvious that, by building on our dysfunctional, fragmented system, intolerable health care injustices will be perpetuated. Yet Congress itself is currently ...
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We Are All Underinsured - The Many Faces of UnderInsurance

by David Gimlett. M.D.

As the Affordable Care Act (ACA) kicks in we are moving into an era where a larger and larger percentage of our population will be unable to afford medical care and we will see an increase in an already high number of medically preventable illnesses and deaths and medically related personal bankruptcies. This will result from lack of control over medical inflation and a tidal shift of medical insurance policies into a lethal pattern of underinsurance. The ACA is predicted to decrease the number of uninsured Americans to about 30 million. (1)  Lack of medical insurance leads to at ...
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CAN THE U.S. PROVIDE BETTER CARE TO MORE PEOPLE FOR LESS MONEY?

by Samuel Metz M.D

It can’t be done. At least it can’t be done if we use private insurance companies to provide that care. More care for more people means more insurance policies. More policies cost more money. Pretty simple.

How much more money will it cost to expand comprehensive health care to all Americans? Projecting from a 2009 study in California, expanding care to the entire country would cost $210 billion more each year. And that’s without the administrative costs of private health insurance.

Administrative costs of private health insurance? But isn’t the ...
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Coordination vs. Competition in health care: remember the patient!

Joshua Freeman, M.D.

Two of the most prominent policy recommendations for improving health care in the U.S. have been increasing coordination of care and competition. Both have very positive aspects, but also have very real pitfalls.

Coordination of care sounds like a no-brainer. Everyone would like the physicians caring for them in one setting (e.g. in the hospital, in a specialist’s office, or in a rehabilitation facility or nursing home) to know what has been done for them previously, what the results were, and what their previous providers thought. At minimum, we want to think that there is ...
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Should health care in America be a right?

By Philip Caper
Originally posted in the BDN:  Nov. 17, 2011, at 11:43 a.m.

America is the only wealthy country in the world that does not guarantee its people access to health care as a fundamental right. More than 15 percent of Americans are uninsured and many more are seriously underinsured. That was the bottom line message of T.R. Reid, author of the best-selling book “The Healing of America” and the television documentary based on it “Sick Around The World.”

All other wealthy democracies provide universal health care to their residents, and do it for about half of ...
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THE HIGH COST OF HEALTH CARE: IT’S NOT THE COLONOSCOPIES, IT’S THE PROFITS

Joshua Freeman, M.D.

Taken together, two investigative reports in the New York Times in recent months go a long way in understanding why the costs of health care in the U.S. are so high. One, entitled The $2.7 trillion medical bill: Colonoscopies explain why the US leads the world in health expenditures, is a damning article about the U.S. health care system, and the fact that our costs are much higher than those in other countries but our outcomes are often worse, and large portions of our population are not even covered. (1) The second article shows how one hospital, Bayonne Medical Center ...
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Is Fee-For-Service Really the Problem?

Stephen B. Kemble, M.D.

In their article “Phasing Out Fee-for-service Payment,” published online by The New England Journal of Medicine earlier this year, Drs. Schroeder and Frist, along with many other contemporary health policy experts, conclude that the most important cause of high health care expenditures is fee-for-service reimbursement, and that the solution is to move to payment arrangements such as bundled payment, capitation, and increased financial risk sharing. However, their diagnosis of the problem misses the mark. If fee-for-service were a root cause of runaway health costs, then how are other countries that use fee-for-service payment of doctors able to cover everyone and spend ...
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RAND PAUL ON HEALTH POLICY

Joshua Freeman, M.D.

While politicians are rarely elected to office because of their profession, the fact is that often fellow legislators often turn to their colleagues with expertise in a certain area to understand bills with technical implications. Legislators who are physicians, nurses and pharmacists, for example, may have influence on bills related to health care. Thus, physicians like former U.S. Senate Majority Leader Bill Frist, a cardiac surgeon, had great influence on medical matters.

So it is relevant to look at statements by Sen. Rand Paul (R. KY) about health care. He is known as a prominent libertarian ...
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The Policies Offered By Insurance Exchanges: The Fast Food of Health Care

The exchanges may not be cheap but at least they have low value.

       

Now that October 1 has come and gone we are moving into the era of medical insurance exchanges. These exchanges were created by the Affordable Care Act and are slated to take effect on January 1, 2014. They are designed to be state marketplaces where individuals and small businesses can shop for health insurance. Insurance companies are required to offer essential health benefits of various, but comparable, levels ...

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WHAT IS CONSERVATISM IN HEALTH CARE?

John P Geyman M.D. Conservatives in Congress, (aka most House Republicans and those Senate Republicans in the camp of Sen. Ted Cruz from Texas), are giving conservatism a bad name. They are displaying an extreme disregard for the public interest, all in the name of conservatism, in bringing us to the brink of government shutdown if they don’t get their way in repealing or delaying Obamacare. That forces us to re-examine what conservatism means in health care.<< MORE >>

Premiums aren’t everything! Sticker shock is just beginning.

John P Geyman M.D.

COMMENT on AP 9-25-13 # 1069


 

It is already obvious that many basic promises made under the Affordable Care Act (ACA) cannot be kept—many millions will not be able to keep, or afford, the insurance they previously had through their employment; many millions will pay more for insurance with less coverage; and so on. As new health insurance markets open on October 1st, the Obama administration is unveiling ...

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NARROW NETWORKS: Less Choice, More Cost Shifting

David Gimlett M.D.

As the Affordable Care Act (ACA) unfolds we are now entering the era of the health insurance exchanges. In response to the law’s various requirements the insurance industry is remodeling its concept of provider networks to create new “narrow” networks for the individual and small group markets.  This is a throwback to the failed HMO concept of severely limiting patients’ choices of physicians and hospitals in a cynical effort to control costs. In the exchanges the insurance companies must offer products that cover the list of Essential ...

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WHY THE CENSUS BUREAU REPORT ON THE UNINSURED IS NOT REASSURING

Don McCanne M.D.

While many are celebrating the fact that the Census Bureau reported a slight decline in the percentage of individuals who are uninsured, decreasing in one year from 15.7 percent to 15.4 percent, that celebration is premature since the total number of uninsured has not changed significantly, remaining at 48 million. If you look at the numbers of uninsured in isolation from the other changes in health care financing, next year’s numbers will be more impressive since many will enroll in the expanded Medicaid program and others will enroll in the plans to be offered in the state Marketplaces (state insurance exchanges) – more impressive numbers, yet deceptive.
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THE REPUBLICAN NON-PLAN FOR HEALTH CARE: CYNICISM AND BETRAYAL OF THE PUBLIC INTEREST

John P. Geyman M.D.

Is Congress committed to the public interest or to special interests? The recent bill passed by the Republican-controlled House of Representatives, that will defund the Affordable Care Act (ACA) as a part of its continuing resolution to keep the government running, is a flagrant example of government gone awry. Especially when it is obvious to all that such a bill is unlikely to pass the Senate, will be vetoed by the president, and splits its own party down the middle. Where is any judgment or concern for such a bill’s outcomes?

We can all debate the merits or failings of the ACA. But ... << MORE >>

HIGH-RISK POOLS: ANOTHER FAILED POLICY IN THE REPUBLICAN QUIVER

by John P. Geyman M.D

My last blog discussed how little, if anything, there is to the Republican alternative health care plan as it seeks to defund the Affordable Care Act (ACA). Now, a large group of House conservatives are trotting out one more already failed attempt at “reform”—high-risk pools. They are pushing a bill that would increase government funding for high-risk pools while providing expanded tax breaks for consumers who purchase their own insurance.

High-risk pools have been tried in many states for years with the hope to increase opportunities for people to get health insurance in ...
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Where’s the outrage over our failed health care system?

Philip Caper M.D.

For the next few months we’ll be bombarded by messages from the Obama administration urging people, especially young, healthy people, to sign up for insurance provided under the Affordable Care Act. Without them, premiums for that insurance will soon climb to unaffordable levels.

We’ll also hear plenty of noise from the ACA’s opponents. It will be hard to get any other health policy messages across during the upcoming PR blitz.

But there are some other important and noteworthy things going on in the policy world. Perhaps the most important is the growing ...
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COST SHARING AND ITS RESULT — UNAFFORDABILITY OF HEALTH CARE

John P Geyman M.D.

Cost sharing (the sharing of health care costs among insurers, employers, and individual patients) has been a dominant strategy to contain health care costs for several decades. The premise is that the more patients have “skin in the game”, the more prudent they will be in their health care choices and the more health care costs can be contained. A seemingly attractive, intuitively correct concept—but a failed strategy based on many years’ experience in this country.
Cost sharing has been adopted by both political parties, and remains an essential part of the Affordable Care Act (ACA) in ...
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Primary Care Payment Quick Fix

David M. Gimlett, M.D.
 
There is a quick fix to the inequity of Medicare and Medicaid payments to primary care physicians. It is hidden in the Conversion Factor. So bear with me.

It is generally conceded that medical care reform in our country depends on redeveloping a strong primary care base. At the present time payments for primary care physicians services are not competitive with those of specialties that perform procedures. Not only does that reward doing procedures whether they are indicated or not but it overvalues the time spent doing procedures as compared with time spent in personal, ...
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Health care spending: A 21st century gold rush

By Dr. Philip Caper, Special to the BDN
Originally Posted Feb. 14, 2013, at 11:38 a.m. at the Bangor Daily News.


Winston Churchill once remarked, “Americans will always do the right thing, once they’ve exhausted all alternatives.” His observation, at least the second half of it, is proving itself as we continue to struggle with our health care system, especially its out-of-control costs that are crippling the budgets of businesses and government alike.

There is a lot of money in our health care system, and no enforceable budget. That leads to carelessness when it comes ...
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The end of Obamacare? Think again

By Dr. Philip Caper, Special to the BDN,
Originally posted on July 18, 2013, at 1:49 p.m. at the Bangor Daily News

In July, the Obama administration announced a delay in the the requirement that many employers offer health insurance to their employees or pay a hefty fine, a key part of Obamacare, the federal health care reform legislation. This was greeted (with glee) by many who oppose the law as a sign that it is beginning to unravel.
I disagree. Unless we are able to do something much simpler and more effective sooner, implementation of this incredibly complex and ...
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Health Care and Undocumented Immigrants

Samuel Metz, MD


If immigration reform isn’t tough enough, watch the fireworks when we include the health care needs of undocumented immigrants. For many Americans, subsidizing health care of the undocumented by higher taxes and more expensive insurance policies is intolerable. We surely cannot afford the expense of providing more care at greater cost to a population of uninvited outsiders.


This is where immigration reform ...

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The End of the Sustainable Growth Rate (SGR)?

David Gimlett, M.D.

It is well recognized that the Medicare system for determining physician compensation has played a major role in increasing costs and minimizing primary care and the quality of care in the United States. The RBRVS (Resource Based Relative Value Scale) and SGR (Sustainable Growth Rate) apply to Medicare payments but they also determine the bases used by private insurance plans. Recent articles have well described how the RBRVS system has distorted physician payments away from primary care and to the benefit of specialist dominated procedural medicine. Never mind that the RBRVS is an invention of the specialist dominated American Medical ...
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CAN HEALTH CARE REFORM BE A MULTI-PARTISAN ISSUE?

CAN HEALTH CARE REFORM BE A MULTI-PARTISAN ISSUE?
J P Geyman MD 8-19-13

    The current debate over health care reform could not be more sharply divided and polarized along party lines. Republicans in Congress are mobilized to repeal or defund the Affordable Care Act (ACA) or Obamacare, while liberals on the left defend against further cuts in safety net programs and many in the political center are caught up in the details of the ACA’s difficulties in implementation as they wonder what its longer-term impact will be. Aside from polarization and gridlock over next steps toward health care reform, what debate we have is over details that completely miss the ... << MORE >>

EMPLOYERS VS. HEALTH AND WELLBEING OF WORKERS AND UNIONS

By   Don McCanne, M.D.

  The recent decision by the Obama administration to delay by one year the Affordable Care Act’s requirement mandating employers to offer health insurance to their full-time employees is one more broken promise to many millions of Americans. The Affordable Care Act (ACA) was intended to keep insurance obtained through employment intact, while adding coverage for the uninsured through new state insurance exchanges and through an expansion of Medicaid. Among the programs to be protected were the multi-employer Taft-Hartley plans that were collectively bargained between unions and employers. Yet ...

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