This this one's my favorite:
Sunday, August 30, 2009
Sunday, July 19, 2009
Saturday, June 6, 2009
The Long View
It's Saturday. Maybe this is a good time to take the long view of the current healthcare debate.
The conservative revolution, which officially began in 1980 with Reagan's election, is now over. It accomplished many things, some of them good. After the bold experiments of Johnson's Great Society, a little reminder of the power of free-market capitalism was probably not a bad thing.
Over the two decades that conservatives tinkered with our government, their successes and failures became clear. Some areas of the economy thrived with a free-market boost, and others faltered.
It turns out that the free market was bad for healthcare. We kept loosening and loosening, giving the HMOs more and more rope. And guess what they did with it?
During GW Bush's presidency, there was a growing sense of frustration and desperation. These private HMOs were supposed to control costs and streamline delivery. We were supposed to have great care with lower costs.
But the opposite happened. Costs continued to spiral upward, and Americans were still denied care at unacceptable rates.
When your only tool is a hammer, you see nails everywhere. So GW Bush nailed healthcare --- with the free market. He did everything he could to promote private insurance, gave them subsidies, kept them from having to compete. All to promote the private insurance system. And what happened? Still millions of Americans without a doctor, and still sky-high costs.
Which is why today, a majority of Americans support a public health insurance option. We aren't idiots, and we've been paying attention.
So it's time to accept that the free market system just doesn't work in healthcare. I'm not saying this as an ideologue. I'm saying this after watching (and working within) the healthcare system during the 90s and 00s.
Plenty of free-marketeers have come to the same conclusion. Check out this article from Motley Fool, a well-known financial website. The people at Motley Fool are die-hard capitalists, and they argue that a public plan is actually the most capitalist choice.
It would have been nice if things had gotten better when we deregulated healthcare, like in the telecom industry. But they didn't. The opposite happened: costs rose, patients were still denied care, and frustration exploded.
So don't let anyone tell you that this is an ordinary liberal vs conservative debate, because it's not. This is not a battle of ideologies. This is a battle between people who are looking clear-eyed at the past twenty years of healthcare, and people who are clinging to ideology without looking at the world.
The conservative revolution, which officially began in 1980 with Reagan's election, is now over. It accomplished many things, some of them good. After the bold experiments of Johnson's Great Society, a little reminder of the power of free-market capitalism was probably not a bad thing.
Over the two decades that conservatives tinkered with our government, their successes and failures became clear. Some areas of the economy thrived with a free-market boost, and others faltered.
It turns out that the free market was bad for healthcare. We kept loosening and loosening, giving the HMOs more and more rope. And guess what they did with it?
During GW Bush's presidency, there was a growing sense of frustration and desperation. These private HMOs were supposed to control costs and streamline delivery. We were supposed to have great care with lower costs.
But the opposite happened. Costs continued to spiral upward, and Americans were still denied care at unacceptable rates.
When your only tool is a hammer, you see nails everywhere. So GW Bush nailed healthcare --- with the free market. He did everything he could to promote private insurance, gave them subsidies, kept them from having to compete. All to promote the private insurance system. And what happened? Still millions of Americans without a doctor, and still sky-high costs.
Which is why today, a majority of Americans support a public health insurance option. We aren't idiots, and we've been paying attention.
So it's time to accept that the free market system just doesn't work in healthcare. I'm not saying this as an ideologue. I'm saying this after watching (and working within) the healthcare system during the 90s and 00s.
Plenty of free-marketeers have come to the same conclusion. Check out this article from Motley Fool, a well-known financial website. The people at Motley Fool are die-hard capitalists, and they argue that a public plan is actually the most capitalist choice.
It would have been nice if things had gotten better when we deregulated healthcare, like in the telecom industry. But they didn't. The opposite happened: costs rose, patients were still denied care, and frustration exploded.
So don't let anyone tell you that this is an ordinary liberal vs conservative debate, because it's not. This is not a battle of ideologies. This is a battle between people who are looking clear-eyed at the past twenty years of healthcare, and people who are clinging to ideology without looking at the world.
Thursday, June 4, 2009
Why we need an alternative to the AMA
I read an article by Atul Gawande in the New Yorker yesterday that, for me, captures exactly why the National Physicians Alliance is an essential organization at this moment in history.
The author visits regions of the country where healthcare is very expensive, and places where it's very cheap. He hunts for sleazy healthcare executives who are intentionally over-utilizing, but he doesn't find them (or not too many of them). What he does find is lots of doctors:
This is a wake-up call for doctors. Those of us (and I'm looking in the mirror here) who like to blame insurance companies and drug companies for sky-rocketing healthcare costs --- we need to reread that paragraph above. He's absolutely right. We can blame PhRMA for making expensive drugs, but we can't blame them for writing the prescriptions. We can blame HMOs for denying the needed CAT scan, but we can't blame them for ordering the unnecessary scan.
Gawande concludes that all the insurance reforms and public plans will not solve our healthcare problem. Only when medicine returns to a patient-centered focus will we be able to control costs. Changing the culture of the medical profession is not just a lofty goal, it's an economic necessity.
To me, there is no more powerful argument than this for why the National Physicians Alliance exists and must continue to grow. Gawande connects something that even the most hardened conservative cares about --- the growth of healthcare costs --- to something that we all believe, the need to rebuild the covenant between patients and doctors.
I would urge everyone to read this article, or at least the conclusion. His way of framing the subject is the perfect tool to recruit supporters to our cause in general and our organization in particular.
The author visits regions of the country where healthcare is very expensive, and places where it's very cheap. He hunts for sleazy healthcare executives who are intentionally over-utilizing, but he doesn't find them (or not too many of them). What he does find is lots of doctors:
Health-care costs ultimately arise from the accumulation of individual decisions doctors make about which services and treatments to write an order for. The most expensive piece of medical equipment, as the saying goes, is a doctor’s pen. And, as a rule, hospital executives don’t own the pen caps. Doctors do.
This is a wake-up call for doctors. Those of us (and I'm looking in the mirror here) who like to blame insurance companies and drug companies for sky-rocketing healthcare costs --- we need to reread that paragraph above. He's absolutely right. We can blame PhRMA for making expensive drugs, but we can't blame them for writing the prescriptions. We can blame HMOs for denying the needed CAT scan, but we can't blame them for ordering the unnecessary scan.
Gawande concludes that all the insurance reforms and public plans will not solve our healthcare problem. Only when medicine returns to a patient-centered focus will we be able to control costs. Changing the culture of the medical profession is not just a lofty goal, it's an economic necessity.
To me, there is no more powerful argument than this for why the National Physicians Alliance exists and must continue to grow. Gawande connects something that even the most hardened conservative cares about --- the growth of healthcare costs --- to something that we all believe, the need to rebuild the covenant between patients and doctors.
I would urge everyone to read this article, or at least the conclusion. His way of framing the subject is the perfect tool to recruit supporters to our cause in general and our organization in particular.
Sunday, May 31, 2009
Me on Fox
If I could go back and redo this interview, my response to "We can't afford to do this" would be something snappy like "We can't afford not to."
Zing!
Thursday, May 21, 2009
Daily Show about Healthcare
Best stat, courtesy of Elizabeth Edwards: "$1 in every $700 dollars went to pay CEO of UnitedHealthcare"
| The Daily Show With Jon Stewart | M - Th 11p / 10c | |||
| Elizabeth Edwards | ||||
| ||||
The Republican Non-Alternative
Here's the Republican proposal. It's a non-alternative to the real efforts at healthcare reform. They call it the Patient Choice Act.
There's a lot of language in the PCA that makes it sounds progressive and forward-thinking. They throw around words like "accountability" and "prevention", "affordable" and "guaranteed". But the devil's in the details, and the details here are...well, there aren't any. Just vague posturing.
The details they do provide are complete non-starters. An example: they say that a "non-profit board would penalize insurance companies that cherry pick healthy patients." What criteria would this board use to decide if a company is cherry-picking? How would they penalize these companies? Would there be a fine? How much?
This board would be made up of political appointees, presumably. To me, this is exactly the wrong kind of government involvement in private insurance. I'd rather have an independent public health plan, and LESS regulation of private insurance. Let the two compete. Don't just have the government mess around in the private sector and call that a solution to our healthcare problems.
There's a lot of language in the PCA that makes it sounds progressive and forward-thinking. They throw around words like "accountability" and "prevention", "affordable" and "guaranteed". But the devil's in the details, and the details here are...well, there aren't any. Just vague posturing.
The details they do provide are complete non-starters. An example: they say that a "non-profit board would penalize insurance companies that cherry pick healthy patients." What criteria would this board use to decide if a company is cherry-picking? How would they penalize these companies? Would there be a fine? How much?
This board would be made up of political appointees, presumably. To me, this is exactly the wrong kind of government involvement in private insurance. I'd rather have an independent public health plan, and LESS regulation of private insurance. Let the two compete. Don't just have the government mess around in the private sector and call that a solution to our healthcare problems.
Wednesday, May 20, 2009
Thursday, May 14, 2009
Thursday, May 7, 2009
Great Factoid
Here's a good one to use when they tell you that a public plan will destroy the private insurance market:
And then throw in the many examples of private and public options existing side by side: FedEx and USPS, public schools and private schools, etc.
[Ms. Sebelius] said Mr. Obama did not support “dismantling the private market” and relying entirely on a public program. Indeed, she said, “the president and I want to stabilize the private insurance market.”
In more than two dozen states, she said, state employees have a choice between traditional private health insurance products and a public plan. Such competition does not destroy the marketplace but simply gives people an additional choice, she said.
And then throw in the many examples of private and public options existing side by side: FedEx and USPS, public schools and private schools, etc.
Wednesday, May 6, 2009
Gentlemen, Start Your Rebuttals!
There's a very illuminating article on Politico, from a big-time Republican consultant on how to defeat healthcare reform. He talks a lot about the language conservatives need to use to thwart our reform efforts.
Here are the phrases he thinks are winners for Republicans, followed by my rebuttals:
THEM: “One-size-does-NOT-fit-all.”
US: "Exactly. That's why we need options: private insurance or a public plan. American's deserve to have a choice."
**
THEM: “Would you rather … ‘Pay the costs you pay today for the quality of care you currently receive,’ OR ‘Pay less for your care, but potentially have to wait weeks for tests and months for treatments you need.’”
US: "We're in luck, we don't have to make that choice. By giving all Americans access to healthcare, we will lower costs by preventing the most serious illnesses. The money saved will be used to make sure that no one waits weeks or months for tests or treatments. And lower healthcare costs mean lower premiums for everyone, in both the public plan and private insurance."
**
THEM: “It could lead to the government rationing care, making people stand in line and denying treatment like they do in other countries with national healthcare.”
US: "Do you know someone without health insurance? Since that's 1 in 6 Americans, you almost definitely do. And those people --- your neighbors, your friends --- are on a very long waiting list: forever. Even people who have insurance in the U.S. are on waiting lists. I know a woman who is in constant knee pain, but her insurance plan only uses certain surgeons, so she has to wait until a spot opens up. It's been months of chronic pain, and she's still waiting."
**
THEM: “President Obama wants to put the Washington bureaucrats in charge of healthcare. I want to put the medical professionals in charge, and I want patients as an equal partner.”
US: "President Obama wants to keep healthcare private, but give Americans choices. In his recent press conference, Obama said "I have two wars to run. I have an economy to fix. I have enough on my plate." He has no interest in putting Washington in charge of healthcare. He supports a public plan because it's the only way to give quality, affordable healthcare to everyone in America. A public health insurance option is exactly that: an option. Doctors and hospitals will stay private, and decisions will always be made between doctor and patient."
**
THEM: “In countries with government run healthcare, politicians make YOUR healthcare decisions. THEY decide if you’ll get the procedure you need, or if you are disqualified because the treatment is too expensive or because you are too old. We can’t have that in America.”
US: "Creating a public health insurance option is not 'government run healthcare'. A public plan just adds an option for people who can't get health insurance through their employer. Private insurance exists exactly like before. If you like your current health plan, you can keep it. Politicians don't make healthcare decisions now, and they won't after the public plan is created."
**
THEM: “A balanced, common sense approach that provides assistance to those who truly need it and keeps healthcare patient-centered rather than government-centered for everyone.”
US: "Yes, by all means let's have a balanced approach. Let's not get rid of the insurance companies, but let's have an alternative to them. They can compete with each other on a level playing field, and everyone in America will have more choices. That sounds like patient-centered common sense to me."
**
THEM: “More access to more treatments and more doctors…with less interference from insurance companies and Washington politicians and special interests.”
US: "Republicans are trying to block reform by promising you anything you want as soon as you want it: more treatments, more doctors, more everything. But someone has to be responsible for controlling costs and making sure our premiums are not sky high. We are in favor of responsible reform, where every proven treatment is available to every American that needs it. Be suspicious when politicians start promising you the moon so they can block any kind of reform."
Here are the phrases he thinks are winners for Republicans, followed by my rebuttals:
THEM: “One-size-does-NOT-fit-all.”
US: "Exactly. That's why we need options: private insurance or a public plan. American's deserve to have a choice."
**
THEM: “Would you rather … ‘Pay the costs you pay today for the quality of care you currently receive,’ OR ‘Pay less for your care, but potentially have to wait weeks for tests and months for treatments you need.’”
US: "We're in luck, we don't have to make that choice. By giving all Americans access to healthcare, we will lower costs by preventing the most serious illnesses. The money saved will be used to make sure that no one waits weeks or months for tests or treatments. And lower healthcare costs mean lower premiums for everyone, in both the public plan and private insurance."
**
THEM: “It could lead to the government rationing care, making people stand in line and denying treatment like they do in other countries with national healthcare.”
US: "Do you know someone without health insurance? Since that's 1 in 6 Americans, you almost definitely do. And those people --- your neighbors, your friends --- are on a very long waiting list: forever. Even people who have insurance in the U.S. are on waiting lists. I know a woman who is in constant knee pain, but her insurance plan only uses certain surgeons, so she has to wait until a spot opens up. It's been months of chronic pain, and she's still waiting."
**
THEM: “President Obama wants to put the Washington bureaucrats in charge of healthcare. I want to put the medical professionals in charge, and I want patients as an equal partner.”
US: "President Obama wants to keep healthcare private, but give Americans choices. In his recent press conference, Obama said "I have two wars to run. I have an economy to fix. I have enough on my plate." He has no interest in putting Washington in charge of healthcare. He supports a public plan because it's the only way to give quality, affordable healthcare to everyone in America. A public health insurance option is exactly that: an option. Doctors and hospitals will stay private, and decisions will always be made between doctor and patient."
**
THEM: “In countries with government run healthcare, politicians make YOUR healthcare decisions. THEY decide if you’ll get the procedure you need, or if you are disqualified because the treatment is too expensive or because you are too old. We can’t have that in America.”
US: "Creating a public health insurance option is not 'government run healthcare'. A public plan just adds an option for people who can't get health insurance through their employer. Private insurance exists exactly like before. If you like your current health plan, you can keep it. Politicians don't make healthcare decisions now, and they won't after the public plan is created."
**
THEM: “A balanced, common sense approach that provides assistance to those who truly need it and keeps healthcare patient-centered rather than government-centered for everyone.”
US: "Yes, by all means let's have a balanced approach. Let's not get rid of the insurance companies, but let's have an alternative to them. They can compete with each other on a level playing field, and everyone in America will have more choices. That sounds like patient-centered common sense to me."
**
THEM: “More access to more treatments and more doctors…with less interference from insurance companies and Washington politicians and special interests.”
US: "Republicans are trying to block reform by promising you anything you want as soon as you want it: more treatments, more doctors, more everything. But someone has to be responsible for controlling costs and making sure our premiums are not sky high. We are in favor of responsible reform, where every proven treatment is available to every American that needs it. Be suspicious when politicians start promising you the moon so they can block any kind of reform."
Thursday, April 30, 2009
Let Me Get All Up In Your Healthcare Plan
Best pick-up line in a video ever: "my co-pays are quite modest"
Tried to embed it but no go. Check it out here
Tried to embed it but no go. Check it out here
Monday, April 27, 2009
Always Look on the Bright Side of Death
What's the Venn diagram containing both Monty Python fans and healthcare reform advocates?
At least one.
At least one.
Is Healthcare a Right...Yet?
A recent CNBC segment posed the question of whether healthcare is a right. They brought on commentators to argue in favor and against, one from the Cato Institute and one from the National Physicians Alliance. (you can see the clip at curethis.org).
The host started by posing the question to the conservative commentator, Michael Cannon. “I think it should be a right,” he replied. “And therefore I think physicians should work for nothing.” Sarcasm notwithstanding, his point was clear: healthcare cannot be a right because it involves payment. The exchange of goods and services for money equals capitalism, which puts healthcare squarely in the category of commodity.
Mr. Cannon backed up his point by contrasting healthcare with other things we commonly think of as human rights, like freedom of speech and religion. No one has to be paid in order to let us speak freely and worship freely, he implied, which is why they are rights and healthcare is not.
This argument is persuasive. We like to think that a human right is something you are born with, not something that has to be given. The very phrase ‘freedom of speech’ suggests its simplicity: just let people speak! It’s not that hard! Healthcare, on the other hand, is not accomplished by standing aside and letting citizens exercise their freedoms. For healthcare to be your human right, something has to actively be done to you.
But is it true that freedom of speech requires no involvement by the government? Let’s imagine taking a trip to place where there is very little government, for example Somalia. You might have the basic human right to freedom of speech there, but it’s not worth much. If you stand on a milk crate (assuming you can find one) and give a speech that others find disagreeable, those people may choose to gag you, stuff you in the trunk of a car, drive you 20 miles out of town, and perhaps kill you. The government has done nothing to take away your freedom of speech, but they haven’t done anything to protect it either.
We often ignore the role of infrastructure, such as our police force and civil and criminal court system, in allowing rights like freedom of speech and religion to flourish. The U.S. legal system is a highly complex bureaucracy, and it plays an important role in keeping the right to free speech alive.
The same principles apply in healthcare. We have a complex bureaucracy in place — doctors, nurses, hospitals — to protect our right to health. There’s no difference, in principle, between free speech and healthcare, so why is one an unquestioned human right while the other is relegated to a commodity?
In fact, no matter what human right you can name, there is an infrastructure in place to protect and defend it. And the professionals who manage that infrastructure need to get paid. So it’s foolish logic to argue that since doctors are paid a salary, healthcare cannot be a right.
Now, an opponent of the idea that healthcare is a right could argue that sure, the legal system keeps freedom of speech alive. But it also does other things. We would need cops and judges around to deal with violent crime, even if society had no right to free speech. So the added cost to society from having freedom of speech is pretty minimal.
But the same argument could be made for healthcare. The medical industry has to exist regardless of whether healthcare is a right or not. Once again we can see that healthcare and freedom of speech are identical.
Still, let’s be generous. Let’s say we do accept the distinction that Mr. Cannon was trying to make when he drew a bright line between healthcare and freedom of speech. I think what he was trying to get at was that there are two types of rights. And actually, he’s correct. Philosophers and ethicists commonly refer to them as “positive” rights and “negative” rights.
In the U.S., we are very comfortable with the latter category. Negative rights are when a person has the right not to have something done to him. For example, the right not to be tortured, not be persecuted for your religion, and not to be thrown in jail for disagreeing with the government.
Healthcare falls into the category of positive rights, for obvious reasons. (i realize, by the way, that i’m not using the strict philosophical definition of these terms. If you really care about the subtleties, check out this.) We Americans, when polled on this subject, have always been uncomfortable with positive rights. Positive rights seem to imply whininess, laziness, petulantly asking others for help.
But positive rights are actually a strong part of our tradition. Universal public education was introduced in the U.S. in the late 1800s, and today it is as American as apple pie. Ask any fourth-grader if she has a right to go to high school, and you’ll get a quizzical look because the answer is so obvious. We still fight about ways to improve education in the U.S., but no one has seriously proposed abolishing the public school system. Why? Because we understand what an incredible boon to our country it has been to have a well-educated workforce.
So we’ve established that healthcare, from the standpoint of principles, is no different than other accepted human rights. And from a practical standpoint, we see that Americans already support rights that are very similar to healthcare, like education.
So it seems to me that healthcare is a right. Other people, of course, can disagree. What they can’t do is pretend that there are objective, empiric differences between healthcare and other accepted human rights.
The host started by posing the question to the conservative commentator, Michael Cannon. “I think it should be a right,” he replied. “And therefore I think physicians should work for nothing.” Sarcasm notwithstanding, his point was clear: healthcare cannot be a right because it involves payment. The exchange of goods and services for money equals capitalism, which puts healthcare squarely in the category of commodity.
Mr. Cannon backed up his point by contrasting healthcare with other things we commonly think of as human rights, like freedom of speech and religion. No one has to be paid in order to let us speak freely and worship freely, he implied, which is why they are rights and healthcare is not.
This argument is persuasive. We like to think that a human right is something you are born with, not something that has to be given. The very phrase ‘freedom of speech’ suggests its simplicity: just let people speak! It’s not that hard! Healthcare, on the other hand, is not accomplished by standing aside and letting citizens exercise their freedoms. For healthcare to be your human right, something has to actively be done to you.
But is it true that freedom of speech requires no involvement by the government? Let’s imagine taking a trip to place where there is very little government, for example Somalia. You might have the basic human right to freedom of speech there, but it’s not worth much. If you stand on a milk crate (assuming you can find one) and give a speech that others find disagreeable, those people may choose to gag you, stuff you in the trunk of a car, drive you 20 miles out of town, and perhaps kill you. The government has done nothing to take away your freedom of speech, but they haven’t done anything to protect it either.
We often ignore the role of infrastructure, such as our police force and civil and criminal court system, in allowing rights like freedom of speech and religion to flourish. The U.S. legal system is a highly complex bureaucracy, and it plays an important role in keeping the right to free speech alive.
The same principles apply in healthcare. We have a complex bureaucracy in place — doctors, nurses, hospitals — to protect our right to health. There’s no difference, in principle, between free speech and healthcare, so why is one an unquestioned human right while the other is relegated to a commodity?
In fact, no matter what human right you can name, there is an infrastructure in place to protect and defend it. And the professionals who manage that infrastructure need to get paid. So it’s foolish logic to argue that since doctors are paid a salary, healthcare cannot be a right.
Now, an opponent of the idea that healthcare is a right could argue that sure, the legal system keeps freedom of speech alive. But it also does other things. We would need cops and judges around to deal with violent crime, even if society had no right to free speech. So the added cost to society from having freedom of speech is pretty minimal.
But the same argument could be made for healthcare. The medical industry has to exist regardless of whether healthcare is a right or not. Once again we can see that healthcare and freedom of speech are identical.
Still, let’s be generous. Let’s say we do accept the distinction that Mr. Cannon was trying to make when he drew a bright line between healthcare and freedom of speech. I think what he was trying to get at was that there are two types of rights. And actually, he’s correct. Philosophers and ethicists commonly refer to them as “positive” rights and “negative” rights.
In the U.S., we are very comfortable with the latter category. Negative rights are when a person has the right not to have something done to him. For example, the right not to be tortured, not be persecuted for your religion, and not to be thrown in jail for disagreeing with the government.
Healthcare falls into the category of positive rights, for obvious reasons. (i realize, by the way, that i’m not using the strict philosophical definition of these terms. If you really care about the subtleties, check out this.) We Americans, when polled on this subject, have always been uncomfortable with positive rights. Positive rights seem to imply whininess, laziness, petulantly asking others for help.
But positive rights are actually a strong part of our tradition. Universal public education was introduced in the U.S. in the late 1800s, and today it is as American as apple pie. Ask any fourth-grader if she has a right to go to high school, and you’ll get a quizzical look because the answer is so obvious. We still fight about ways to improve education in the U.S., but no one has seriously proposed abolishing the public school system. Why? Because we understand what an incredible boon to our country it has been to have a well-educated workforce.
So we’ve established that healthcare, from the standpoint of principles, is no different than other accepted human rights. And from a practical standpoint, we see that Americans already support rights that are very similar to healthcare, like education.
So it seems to me that healthcare is a right. Other people, of course, can disagree. What they can’t do is pretend that there are objective, empiric differences between healthcare and other accepted human rights.
Tuesday, April 14, 2009
The Latest in Cancer Treatment
IV drugs administered in the doctor's office are covered. But the same medicines in pill form are not.
I hardly need to comment on this. So I won't.
I hardly need to comment on this. So I won't.
This Fight Will Get Dirty
In case you thought the private insurance industry was going to sit back and let healthcare reform happen....well, check out this article in a local Massachusetts paper:
It gets worse:
Got it? The fight will be dirty. AHIP knows that to block healthcare reform, they will have to get rough. And they're not going to sit back and let the groundswell of support for healthcare reform wash over them.
Conservative estimates are that AHIP has $100 million set aside to fight against healthcare reform. And they seem to have every intention of playing dirty with it.
So this is it. We've been warned. Consider this a shot across our bow. It's going to be a serious, heavy-duty fight.
And if we fail to reform the system because we don't fight back hard enough.... well, i was going to say we have no one to blame but ourselves. But we can always blame the big bad insurance industry. We can fail, and then we can comfort ourselves that they had more money, and they played dirty.
But I'd rather not comfort myself. I'd rather win. And we can. We have the truth on our side, and better arguments, and oh yeah, history is on our side too, both in the U.S. and around the world. Those are far more powerful than a willingness to play dirty.
Smears can always be defeated by the truth. But someone has to speak that truth. Unfortunately, the truth never speaks for itself.
"I did not write a letter to the editor. It's not from me," said Gloria Gosselin, 75, of Lawrence.
Gosselin's name was on one of three strikingly similar letters touting the Medicare Advantage program that were sent to The Eagle-Tribune.
...
The letters were, in fact, composed and sent by the Boston office of [Dewey Square], a national political consulting firm, attempting to create the appearance of a "grass-roots" movement for Medicare Advantage.
America's Health Insurance Plans, an industry trade group, hired Dewey Square to defend the Medicare Advantage program.
It gets worse:
The Eagle-Tribune received a call from a man who turned out to be an intern at the Boston office of the Dewey Square Group, a national political marketing and consulting firm.
The man, who identified himself as Noah, wanted to know if Gloria Gosselin's letter had been published. Asked what interest he had in the letter, Noah replied that he was Gosselin's grandson.
Gosselin does not have a grandson named Noah working in Boston. Her only grandson is a student at Central Catholic.
Got it? The fight will be dirty. AHIP knows that to block healthcare reform, they will have to get rough. And they're not going to sit back and let the groundswell of support for healthcare reform wash over them.
Conservative estimates are that AHIP has $100 million set aside to fight against healthcare reform. And they seem to have every intention of playing dirty with it.
So this is it. We've been warned. Consider this a shot across our bow. It's going to be a serious, heavy-duty fight.
And if we fail to reform the system because we don't fight back hard enough.... well, i was going to say we have no one to blame but ourselves. But we can always blame the big bad insurance industry. We can fail, and then we can comfort ourselves that they had more money, and they played dirty.
But I'd rather not comfort myself. I'd rather win. And we can. We have the truth on our side, and better arguments, and oh yeah, history is on our side too, both in the U.S. and around the world. Those are far more powerful than a willingness to play dirty.
Smears can always be defeated by the truth. But someone has to speak that truth. Unfortunately, the truth never speaks for itself.
Monday, March 23, 2009
multimedia
I was on WBAI this afternoon, talking about the upcoming battle over healthcare reform. Check it out.
March 23, 2009: Health Action
http://archive.wbai.org/
March 23, 2009: Health Action
http://archive.wbai.org/
Monday, March 16, 2009
Why It's Time IV: Stay Ahead of Your Illness
Okay, I'm not the only doctor out there who supports healthcare reform. I'm sure plenty of us docs have anecdotes that highlight the need for universal healthcare. And I don't want to be immodest.
But I gotta say, it's hard to imagine a better argument for universal healthcare than Juan Avista (not his real name).
Three years ago, Juan started having headaches. He tried Tylenol and Ibuprofen, and when those didn't work he went to his doctor. A slight loss of vision in his lateral fields, known as homonomous hemianopsia, led the doctor to get a CAT scan of the head.
Which is when they found the mass growing in his pituitary.
This sounds bad. But it's not as bad as you might think. Juan's mass is known as a prolactinoma, meaning a hormonal tumor that secretes prolactin. The treatment is not to open up Juan's brain and tinker with it, but to give him medications that block the effects of the hormone and thus prevent the mass from growing larger.
I'm writing about healthcare reform, so you can see where this story is going. Juan's medication cost $40 per pill, and since he worked part-time for UPS, he had no health insurance and had to pay out of pocket. He made an effort to take the medicines for a few months, but he was raising two children on $11 per hour and eventually he couldn't find the money for it.
When I admitted Juan to the hospital three days ago, he had been off his meds for five months. He had been having headaches again, and his vision was so blurry that he could barely tell how many fingers I was holding up. The CAT scan showed that the mass had almost doubled in size, and was pressing down on his optic chiasm, the place where the nerves that connect his eyes to his brain cross.
If Juan had been over 65, Medicare Part D would have covered at least part of his medicines. But he is 45. Now, maybe this doesn't need to be said, but let's say it anyway: if we kept the same Medicare structure, the one that senior citizens consistently give high ratings, and extended it to people between 18-65, we could solve all of Juan's problems, and those of thousands of other people caught between a diagnosis and a paycheck.
If we do nothing? Well, then Juan will continue to not afford his medicines, his pituitary mass will grow larger, and he will go blind.
At that point, or maybe slightly before, the neurosurgeons will decide to operate on him to remove the mass. He will have to undergo a very dangerous operation, since the pituitary is exactly in the center of the head, and is difficult for a surgeon to reach no matter what route is taken. Juan will require a long hospitalization and possibly further surgeries.
Who wins and who loses under this current healthcare system? The hospital wins, gaining reimbursements for multiple admissions and operations, rather than simple outpatient visits. The surgeons win: they only get paid when they operate, so preventing the need for surgeries is not likely to be a high priority of theirs. The big HMOs win too: since Juan didn't have a job that provided health insurance when he got his diagnosis, none of the HMOs will have to pay for his expensive care.
(By the way, it's worth noting that Juan had a full-time job with complete healthcare benefits from 1999 to 2004, but was laid off as the result of a merger. So none of the giant healthcare conglomerates --- not Aetna, US Healthcare, Tenet, or Humana, each of whose profits were greater than $1 billion last year --- will have to pay a cent to treat Juan's disease. But one of them collected between $60,000 - 80,000 from him in premiums. Does that seem fair?)
So there's our list of winners. Who are the losers? First, and most important, there's Juan: he would prefer to control his disease with a daily pill and be able to see his daughter's face, rather than undergo risky surgeries and hospitalizations.
The other loser is us, the taxpayers. We're the ones paying for Juan's expensive care, and the care for many other Juans out there who have fallen through the cracks.
It's our tax dollars and our health. (Not to use scare tactics, but any of us could find out tomorrow that we're Juan.) So why don't we use those tax dollars wisely, and ask our government for a healthcare system that emphasizes cheap prevention of early disease, rather than expensive technological treatments of late-stage disease?
It's time for a publicly accessible healthcare plan, that allows all U.S. residents access to the medicines they need. Does it really seem like too much to ask?
But I gotta say, it's hard to imagine a better argument for universal healthcare than Juan Avista (not his real name).
Three years ago, Juan started having headaches. He tried Tylenol and Ibuprofen, and when those didn't work he went to his doctor. A slight loss of vision in his lateral fields, known as homonomous hemianopsia, led the doctor to get a CAT scan of the head.
Which is when they found the mass growing in his pituitary.
This sounds bad. But it's not as bad as you might think. Juan's mass is known as a prolactinoma, meaning a hormonal tumor that secretes prolactin. The treatment is not to open up Juan's brain and tinker with it, but to give him medications that block the effects of the hormone and thus prevent the mass from growing larger.
I'm writing about healthcare reform, so you can see where this story is going. Juan's medication cost $40 per pill, and since he worked part-time for UPS, he had no health insurance and had to pay out of pocket. He made an effort to take the medicines for a few months, but he was raising two children on $11 per hour and eventually he couldn't find the money for it.
When I admitted Juan to the hospital three days ago, he had been off his meds for five months. He had been having headaches again, and his vision was so blurry that he could barely tell how many fingers I was holding up. The CAT scan showed that the mass had almost doubled in size, and was pressing down on his optic chiasm, the place where the nerves that connect his eyes to his brain cross.
If Juan had been over 65, Medicare Part D would have covered at least part of his medicines. But he is 45. Now, maybe this doesn't need to be said, but let's say it anyway: if we kept the same Medicare structure, the one that senior citizens consistently give high ratings, and extended it to people between 18-65, we could solve all of Juan's problems, and those of thousands of other people caught between a diagnosis and a paycheck.
If we do nothing? Well, then Juan will continue to not afford his medicines, his pituitary mass will grow larger, and he will go blind.
At that point, or maybe slightly before, the neurosurgeons will decide to operate on him to remove the mass. He will have to undergo a very dangerous operation, since the pituitary is exactly in the center of the head, and is difficult for a surgeon to reach no matter what route is taken. Juan will require a long hospitalization and possibly further surgeries.
Who wins and who loses under this current healthcare system? The hospital wins, gaining reimbursements for multiple admissions and operations, rather than simple outpatient visits. The surgeons win: they only get paid when they operate, so preventing the need for surgeries is not likely to be a high priority of theirs. The big HMOs win too: since Juan didn't have a job that provided health insurance when he got his diagnosis, none of the HMOs will have to pay for his expensive care.
(By the way, it's worth noting that Juan had a full-time job with complete healthcare benefits from 1999 to 2004, but was laid off as the result of a merger. So none of the giant healthcare conglomerates --- not Aetna, US Healthcare, Tenet, or Humana, each of whose profits were greater than $1 billion last year --- will have to pay a cent to treat Juan's disease. But one of them collected between $60,000 - 80,000 from him in premiums. Does that seem fair?)
So there's our list of winners. Who are the losers? First, and most important, there's Juan: he would prefer to control his disease with a daily pill and be able to see his daughter's face, rather than undergo risky surgeries and hospitalizations.
The other loser is us, the taxpayers. We're the ones paying for Juan's expensive care, and the care for many other Juans out there who have fallen through the cracks.
It's our tax dollars and our health. (Not to use scare tactics, but any of us could find out tomorrow that we're Juan.) So why don't we use those tax dollars wisely, and ask our government for a healthcare system that emphasizes cheap prevention of early disease, rather than expensive technological treatments of late-stage disease?
It's time for a publicly accessible healthcare plan, that allows all U.S. residents access to the medicines they need. Does it really seem like too much to ask?
Sunday, March 1, 2009
Down This Road?
The Boston Globe (fairly in touch with events in Massachusetts) recently declared the Mass. healthcare reform effort a failure:
Sad but true. We can continue to fear "socialized medicine" irrationally, or we can rationally embrace a simple solution: extend Medicare to all U.S. citizens.
Created solely to achieve universal insurance coverage, the plan does not even begin to address the other essential components of a successful healthcare system. What would such a system provide? The prestigious Institute of Medicine, part of the National Academy of Sciences, has defined five criteria for healthcare reform. Coverage should be: universal, not tied to a job, affordable for individuals and families, affordable for society, and it should provide access to high-quality care for everyone.
The state's plan flunks on all counts.
Sad but true. We can continue to fear "socialized medicine" irrationally, or we can rationally embrace a simple solution: extend Medicare to all U.S. citizens.
Tuesday, February 3, 2009
Reach Out and Touch Someone
I have a new plan for healthcare reform. Take HMO and pharma executives on mandatory tours of the ER.
How did I come up with this brilliant plan, you ask? Let me talk you through it...
Last night I admitted a 23 year-old woman to the hospital. Let's call her Marisa. Her only medical problem, diagnosed when she was fourteen, was Crohn's disease, which is an inflammatory condition of the bowel that causes unpleasantness like chronic diarrhea, vomiting and abdominal pain.
For many years Marisa's disease was well-controlled with Azathioprine, meaning she had very few of the disagreeable symptoms i just listed. Then a year ago her insurance (which was chosen by the university she attended --- none of that mythical free-market "choice") decided that they weren't going to cover azathioprine, because for most patients cheaper medicines would do the trick just as well.
There's a problem with basing overall policy on how most patients react. I've never met someone named Most Patients. Every real human being is a little bit different than the composite they create from research. It may be true that in a study of 4000 people, the average Diarrhea Symptom Index score (i just made that up) was not significantly different between Azathioprine and another medicine. But what does that matter to Marisa? For her the "average" patient is meaningless. She needs exactly this medicine to treat her disease.
We have a gargantuan, multi-billion dollar profit-making pharmaceutical industry in this country. The industry is constantly pumping out new drugs, each of which does almost exactly the same thing as its predecessor. Most of the time, it doesn't matter which of the ten available drugs is chosen. But in the rare cases where it does matter --- like now, with Marisa lying on a stretcher in front of me --- shouldn't the patient have access to the drug? Why do we have this massive pharmaceutical industry otherwise?
Marisa couldn't get her Azathioprine six months ago, so she was forced to try inferior alternatives, none of which have done the trick. She came to the ER last night because things had gotten so bad she'd begun to experience rectal bleeding. Not just blood in her stool, mind you: this is blood dripping from her rectum at random intervals without her control. She's twenty-three and she has to wear a diaper.
I could almost justify a system of huge profits, shameless marketing, and ridiculous unnecessary drugs, if at least that system gave this one 23 year-old the relief she was crying out to me for.
But it didn't. I had nothing to offer her.
The dinosaurs who believe in free-market healthcare carry around a certain fantasy --- something akin to elementary school civics class. Remember "How a Bill Becomes a Law"? We learned that there are three branches of government, and each branch provides checks and balances to the other two. None of them can get too strong, because the others are watching.
The free-marketeers think the same thing will happen in healthcare. They are deluded into thinking that although the pharmaceutical industry will ply us with expensive new medicines, the HMOs will keep them in line. In turn, consumers will keep the HMOs in line by demanding that they cover the medicines that work. Checks and balances.
But in the case of Marisa, we have an example of how the checks and balances only serve to slam every door and leave the patient out in the cold. The patient has no voice. It's not a coincidence that they call them for-profit entities, not for-patient entities.
You might think I'm naive to expect a giant HMO or pharmaceutical company not to pursue profit. And it's true, I would not expect otherwise. But that's why situations like Marisa's make me want to cry: corporations may be evil, but the human beings inside them aren't. If any of the people working for Aetna or Merck met this poor girl, and heard her story, I know they would do everything they could to get her the medications she needs. They would be touched, they would see her as a human being, and they would act compassionately.
But the people who work for Aetna and Merck haven't met Marisa. They don't know her story. They are are blissfully removed from her life, and from the lives of millions of other people they affect daily. For them, this 23 year-old Crohn's patient exists only as an account payable, a number to be spindled and manipulated and shifted into the proper column. If enough of these faceless numbers move in the right direction, the workers get a healthy year-end bonus. Hey, they're just doing their job. Nothing cruel or heartless about that.
Which is why it's time for the mandatory ER tours. Sign-up sheets will be posted soon.
How did I come up with this brilliant plan, you ask? Let me talk you through it...
Last night I admitted a 23 year-old woman to the hospital. Let's call her Marisa. Her only medical problem, diagnosed when she was fourteen, was Crohn's disease, which is an inflammatory condition of the bowel that causes unpleasantness like chronic diarrhea, vomiting and abdominal pain.
For many years Marisa's disease was well-controlled with Azathioprine, meaning she had very few of the disagreeable symptoms i just listed. Then a year ago her insurance (which was chosen by the university she attended --- none of that mythical free-market "choice") decided that they weren't going to cover azathioprine, because for most patients cheaper medicines would do the trick just as well.
There's a problem with basing overall policy on how most patients react. I've never met someone named Most Patients. Every real human being is a little bit different than the composite they create from research. It may be true that in a study of 4000 people, the average Diarrhea Symptom Index score (i just made that up) was not significantly different between Azathioprine and another medicine. But what does that matter to Marisa? For her the "average" patient is meaningless. She needs exactly this medicine to treat her disease.
We have a gargantuan, multi-billion dollar profit-making pharmaceutical industry in this country. The industry is constantly pumping out new drugs, each of which does almost exactly the same thing as its predecessor. Most of the time, it doesn't matter which of the ten available drugs is chosen. But in the rare cases where it does matter --- like now, with Marisa lying on a stretcher in front of me --- shouldn't the patient have access to the drug? Why do we have this massive pharmaceutical industry otherwise?
Marisa couldn't get her Azathioprine six months ago, so she was forced to try inferior alternatives, none of which have done the trick. She came to the ER last night because things had gotten so bad she'd begun to experience rectal bleeding. Not just blood in her stool, mind you: this is blood dripping from her rectum at random intervals without her control. She's twenty-three and she has to wear a diaper.
I could almost justify a system of huge profits, shameless marketing, and ridiculous unnecessary drugs, if at least that system gave this one 23 year-old the relief she was crying out to me for.
But it didn't. I had nothing to offer her.
The dinosaurs who believe in free-market healthcare carry around a certain fantasy --- something akin to elementary school civics class. Remember "How a Bill Becomes a Law"? We learned that there are three branches of government, and each branch provides checks and balances to the other two. None of them can get too strong, because the others are watching.
The free-marketeers think the same thing will happen in healthcare. They are deluded into thinking that although the pharmaceutical industry will ply us with expensive new medicines, the HMOs will keep them in line. In turn, consumers will keep the HMOs in line by demanding that they cover the medicines that work. Checks and balances.
But in the case of Marisa, we have an example of how the checks and balances only serve to slam every door and leave the patient out in the cold. The patient has no voice. It's not a coincidence that they call them for-profit entities, not for-patient entities.
You might think I'm naive to expect a giant HMO or pharmaceutical company not to pursue profit. And it's true, I would not expect otherwise. But that's why situations like Marisa's make me want to cry: corporations may be evil, but the human beings inside them aren't. If any of the people working for Aetna or Merck met this poor girl, and heard her story, I know they would do everything they could to get her the medications she needs. They would be touched, they would see her as a human being, and they would act compassionately.
But the people who work for Aetna and Merck haven't met Marisa. They don't know her story. They are are blissfully removed from her life, and from the lives of millions of other people they affect daily. For them, this 23 year-old Crohn's patient exists only as an account payable, a number to be spindled and manipulated and shifted into the proper column. If enough of these faceless numbers move in the right direction, the workers get a healthy year-end bonus. Hey, they're just doing their job. Nothing cruel or heartless about that.
Which is why it's time for the mandatory ER tours. Sign-up sheets will be posted soon.
Wednesday, January 7, 2009
Second Verse, Same as the First
I have a patient with hepatitis C. She had some signs of cirrhosis (fibrosis in the liver, which is one of the effects of the virus), and she wanted to get treated, which usually requires a liver biopsy. So I referred to the liver clinic.
They sent her back to me saying that she needed an ultrasound beforehand. The ultrasound showed a possible mass, which could be liver cancer (hepatoma). In my discussions with the liver people we decided that she needed an MRI to rule out the hepatoma before moving forward with her Hep C treatment.
So like a good little monkey, I ordered her an MRI, filling out all the forms and getting all the prior approvals, kissing all the rings on all the HMO fingers.
But since it wasn't an emergency, they gave her an MRI date five months in the future.
One week before she's supposed to get scanned, I am contacted by the MRI techs. Why? Her ultrasound (remember that?) is now TOO OLD, so she needs to get a new ultrasound before she can get her MRI.
So okay. That would be a good end to the story: unnecessary bureaucracy causing the need for multiple imaging, the waste, etc etc.
Except that's not the end of the story. Because of course, it's impossible to get an ultrasound in one week, so she ends up missing the MRI appointment that it took so long to get. Now it'll be God knows how long before she gets scheduled for another MRI. (And by the time it rolls around, the repeat ultrasound i'm getting today will be outdated. Repeatedly. Again.)
All this time, there might be a liver cancer growing in her belly.
Could a thing like this happen under another system of healthcare? Absolutely. Might a single-payer system require non-emergency MRIs to wait a few months? Of course.
So really, this story is for those who live in fear that single-payer healthcare will give us long waiting periods. Let's be clear about it: we've already been given long waiting periods. The HMOs gave them to us.
But what the HMOs giveth, we can taketh away. We just have to decideth to.
They sent her back to me saying that she needed an ultrasound beforehand. The ultrasound showed a possible mass, which could be liver cancer (hepatoma). In my discussions with the liver people we decided that she needed an MRI to rule out the hepatoma before moving forward with her Hep C treatment.
So like a good little monkey, I ordered her an MRI, filling out all the forms and getting all the prior approvals, kissing all the rings on all the HMO fingers.
But since it wasn't an emergency, they gave her an MRI date five months in the future.
One week before she's supposed to get scanned, I am contacted by the MRI techs. Why? Her ultrasound (remember that?) is now TOO OLD, so she needs to get a new ultrasound before she can get her MRI.
So okay. That would be a good end to the story: unnecessary bureaucracy causing the need for multiple imaging, the waste, etc etc.
Except that's not the end of the story. Because of course, it's impossible to get an ultrasound in one week, so she ends up missing the MRI appointment that it took so long to get. Now it'll be God knows how long before she gets scheduled for another MRI. (And by the time it rolls around, the repeat ultrasound i'm getting today will be outdated. Repeatedly. Again.)
All this time, there might be a liver cancer growing in her belly.
Could a thing like this happen under another system of healthcare? Absolutely. Might a single-payer system require non-emergency MRIs to wait a few months? Of course.
So really, this story is for those who live in fear that single-payer healthcare will give us long waiting periods. Let's be clear about it: we've already been given long waiting periods. The HMOs gave them to us.
But what the HMOs giveth, we can taketh away. We just have to decideth to.
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