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I had to quit my job because of the stress I had to endure was putting me at high risk for a stroke or heart attack and I couldn’t physically keep up anymore
I’m 56 years of age
My job was 32 hours a week
But because of Obama care my insurance was costing me $600 dollars a month for just major medical!
No dental no eye care no life insurance
So by the time I paid my rent, electric, water, sewer, garbage, car insurance, house insurance etc, I had enough money to put gas in the car to get to work and buy ramen noodles and some cheap hot dogs for food!
Over 60% of my net pay went to insurance that covered nothing!
Now I am unemployed with ZERO insurance
Its pretty damn sad when all the damn medicaide and dissabilty cheats are eating steak with perfect teeth and new glasses and are in perfect health while I have to bust my damn ass just to eat ramen noodles wityh bad teeth , basbasd eyes, and life threatening health problems!!

So here I am, no job, no insurance, no hope

Patient’s story as posted on Obamacare stories

The average household income in the United States is $51,000. From that you pay for our food, shelter, children’s education, and movie tickets. Oh, yeah, and $5000 for a health insurance policy. One of the things that Obamacare did was begin to put a cost on our insatiable healthcare consumption. Turns out, that cost is VERY high.

If you are an average American, boy are you ticked off. Half of all Americans spend under $400 a year on healthcare. Pretty much a round of antibiotics for a sinus infection and, for women, a year’s worth of contraception. Not only that but because of high deductibles (to keep the cost down by discouraging consumption) you are paying $5,000 to the insurance company AND paying cash for your sinus infection visit and medicine. Then there are the drug companies and insurance companies that are colluding to raise the prices of formerly cheap antibiotics to get even more of your household income.

About 1% of the people in this country account for about a quarter (27%) of the health care spending. In 2014, this  was about $100,000 per sick person. Those in the top 5% of sick people were responsible for  almost $50,000 in health care costs. These numbers are unchanged since Obama was elected. So what has changed? Before, the costs of these people were hidden. They would get the care for “free” at a safety net hospital who would get money in other ways to pay for it. Or a sick person would use an insurance card then the payment would be denied as a pre-existing condition and the hospital would eat the cost. More likely, the sick person would get on disability, suffer for 2 years, and become Medicare eligible so we the taxpayer would pay. The care still cost money but was hidden in taxes. Insurance companies kept costs low, in other words, by shifting them to the federal government. Now folks under 65 who are sick can pick up an Obamacare policy and get exceptional care. Also on Obamacare stories are ones like this:

Thank you President Obama thanks to your healthcare plan I was able to continue to see specialists, this resulted in a diagnosis of a rare intestinal infection and even more concerning, two stage three colon cancer tumors, one on each side on each side of the colon. This required almost total colon removal from a top notch physician that was able to do my surgery without having to have a bag.

Only problem is, this type of care costs A LOT more than $5,000. .

So, if you bought an Obamacare policy and feel ripped off, let me tell you what your $5000 paid for. It wasn’t eye glasses and dental work for poor people that jacked up your bill. You spent your $5000 on people under 65 with heart disease and lung disease. You purchased them a lot of expensive tests, some time in the hospital, and some expensive drugs. You paid for the person with breast cancer’s $300,000 tab whose $5000 premiums were paid by the cancer treatment facility.  You paid for the person helicoptered in after rolling their car on Interstate 65 while trying to avoid a deer.  You paid for some very expensive medication for people with mental illness to keep them out of a mental hospital.

Did you pay too much? Yes. Other countries can do the same thing better for half as much or less. Perhaps the new adminstration will look at this as an opportunity to further retool our expensive, not very effective care delivery system and reign in some of the profiteering. Or maybe we’ll just continue to blame the poor…

 

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From a very good article regarding Obama’s legacy in Politico found here:

  1. First, through the use of the stimulus money, his administration  created the infrastructure necessary for change:

A $25 billion incentive program in the stimulus for health information technology has helped drag a pen-and-paper medical system into the digital age, with adoption soaring from about 10 percent of hospitals and 20 percent of doctors in 2008 to about 80 percent of hospitals and 80 percent of doctors today. E-prescriptions are ubiquitous, and digitization is already reducing fatal errors and unnecessary tests caused by sloppy handwriting and inaccessible files. There have been problems getting electronic systems to talk to each other, sparking a backlash of sorts from irritated doctors, but Farzad Mostashari, Obama’s former health IT czar, is confident online medicine will inevitably produce the efficiencies common in online banking and dating.

2. Then, with the ACA,  a plan to improve access was implemented to address the game of uninsured “hot potato”:

It has already extended medical coverage to some 18 million uninsured Americans. It also closed loopholes that insurers used to deny coverage to insured Americans when they got sick. And it eliminated co-payments for quit-smoking programs, birth control pills, certain cancer screenings and other preventive care. As Obama has suggested, it’s what he was talking about when he talked about change.

3. Despite the reality that the right had no stomach for system change and the left had no stomach for cost controls, the majority of the ACA was about those two things. Improving the care delivery system was attempted by putting every idea, good or bad, tried or not, into the law and incenting folks to “don’t just stand there, do something.” Amazingly, it is working. First, the cost side:

Less than one-fourth of the bill was devoted to access. The rest was stuffed with almost every cost-control idea in circulation, from new competitive bidding rules for wheelchairs to a government Innovation Center to test new payment models to a “Cadillac tax” on pricey employer-sponsored plans. “We did a smorgasbord of just about everything people thought could conceivably help,” says Peter Orszag, Obama’s former budget director.

And so far, the cost curve is bending even faster than White House officials had dreamed. Health care is still getting more expensive, but since 2010, the growth rate has slowed so drastically that the Congressional Budget Office has slashed its projection for government health spending in 2020 by $175 billion. That’s enough to fund the Navy for a year, or the EPA for two decades. “We wanted to throw a whole bunch of stuff against the wall to see if any of it would stick, which probably sounded bogus,” Orszag says. “But if these results continue, they’ll fundamentally change the fiscal trajectory of the country.”

And on the quality side:

One recent report found that infections and other “hospital-acquired conditions” have declined 17 percent since 2010, when Obamacare created financial incentives for hospitals to avoid them. That reduction saved an estimated 87,000 lives and $20 billion. A similar effort to incentivize better management of discharged patients has coincided with a decline in hospital readmission rates that’s keeping 150,000 more Medicare patients at home every day, according to Meena Seshamani, director of the administration’s Office of Health Reform.

When put together, it is leading to a much more rational system. Maryland, for example, is experimenting with an “all payers” system:

A recent New England Journal of Medicine article found the state’s hospital costs increased at less than half the expected rate in the program’s first year, saving Medicare $116 million.

And everywhere there are changes to change the payment from one of paying for volume to paying for value:

There are signs that Obama’s convoluted jumble of changes may be starting to rationalize an irrational system. Patrick Conway, the director of the new innovation center, told me about a new Independence at Home experiment that coordinates nurse and doctor visits for frail and disabled patients—and saved Medicare $3,000 per beneficiary in its first year. One elderly diabetic who had 19 hospitalizations the previous year had only one after enrolling in the program.

When Medicare was signed into law, I guess they could have called it LBJCare. Today, no matter what it is called, no one is calling for us to put Grandma back in the attic and let her die. Medicare is here to stay. I suspect that 20 years from now, no one will even think about going back to volume based care delivery with rationing based on income and willingness to pay. Wonder what we will call our care delivery sustem?

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Obamacare is 5 years old this past week. There have been many articles (such as this one on the economics of the lack of death panels and this one on how Obamacare zombie day never arrived). There are two very interesting articles that offer a fuller accounting of what Obamacare has accomplished.

The first was published in Medscape, an industry publication that goes mainly to physicians (thanks to our librarian Jie Li for calling it to my attention). Using a “by the numbers” approach, it shows how much has changed in 5 years. Some of the more interesting numbers:

37.2 million: Number of Americans who were uninsured in the first 9 months of 2014, a decrease of 23% from 2010, when the ACA was passed.

2.3 million: Number of young adults who gained coverage from 2010 through September 2013 by staying on their parents’ health insurance plan up to age 26 years

30,700: Jobs that Alabama would have gained each year through 2020 if it had expanded its Medicaid program.

900,000: Number of Americans whose individual or employer-sponsored health policies were cancelled for 2015 because they did not comply with the ACA.

$7.4 billion: Drop in uncompensated care for hospitals nationwide in 2014 resulting from ACA exchange coverage and Medicaid expansion.

87%: Percentage of 2015 enrollees in ACA exchange plans in the 37 states using healthcare.gov who receive a premium subsidy in the form of a tax credit.

$3960: Average premium subsidy (annual) in 2015.

$15 billion: Amount saved so far by 9 million Medicare beneficiaries receiving prescription drugs as a result of the law’s shrinkage of the infamous Part D “doughnut hole.”

Yeah, you say, but at what cost? Turns out, less than government was paying before:

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The second article of interest is a “fact check” on a statement President Obama made while celebrating the anniversary of the signing of the bill:

The Affordable Care Act is “a major reason why we’ve seen 50,000 fewer preventable patient deaths in hospitals.”

To make a long story short, the answer is that this statement is correct and is the consequence of the improvements in quality dictated by the ACA.

The question has to be why only a 41% approval after 5 years when it is reducing costs and improving quality? Maybe people are disappointed that the death panels are working in reverse?

26%/12%: Percentages of Republicans and Democrats, respectively, who said in March 2015 that an ACA government panel helps make decisions about patients’ end-of-life care. As in a “death panel.”

cartoon-plastic-surgeryAs a physician, I am continually amazed at what people tell me and what I can figure out for myself. I have heard tales that would curl your hair. A question from me such as “well, is there anything else?” gets us into the depths of the human condition. A wife whose “sore down there” ends up in an admission of infidelity by her husband and a divorce. A man who admits to being depressed on the anniversary of his son’s death and it turns out he was going to the son’s grave site and drinking. A lot. A woman whose husband had a vasectomy but she wanted to stay on birth control because, well, because she is seeing someone else. Almost always, these folks come in with a complaint of “headache,” “stomach ache,” or “I’m tired.” My job is to get them to talk about the real problem so I can help with the healing process.

Access to me is, as often as not, provided by an insurance company. That is the way we provide health care in this country. Most folks get access through their (or their spouses’) jobs, by virtue of being over 65, or by virtue of being extremely poor. When folks change jobs, they tend to change insurance and subsequently doctors. If folks lose their job and if they are fortunate enough to end up on Medicaid, they tend to change doctors. When folks turn 65, they end up on Medicare and may have to change doctors. These things were happening before Obamacare and will continue to happen unless we choose to go to a single payer system. My job, upon seeing a new patient, is to make them feel as if I am an old friend. What amazes me is how a person who doesn’t know me from Adam’s off ox will trust me with their secrets. I guess folks really want to talk about their problems, especially if they think it’ll make them feel better.

I am not particularly a fan of our current method of paying for health care.  I think it is far too convoluted and has too many moving parts. In addition, prior to the Obamacare mandate, there were far too many people (corporations are people too) trying to game the system to get out of paying what the system obligated them to pay. Although the Obamacare website is now working better, there are still many who are vocally dismissive of the entire law. Many of my friends were proponents of more intensive intervention such as single payer (as are 14% of Americans still). I have become more interested in how the less “liberal” folks would have allowed Americans to keep their doctor, keep their insurance, not increased expenses, and reduced the total cost for America. I found the answer in a recent article on Reason.com. They cite the falling of LASIK prices (you don’t want to wear those clunky glasses, do you?) and the ability to get dermatologic procedure pricing (how much did Sharon Osbourne pay for her vagina lift?) as evidence that the market will work in health care then proceed to describe the complete dismantling and reconfiguring of 20% of our economy. The details are below:

  1. Eliminate the tax preference for employer-sponsored health coverage in favor of very large, tax-free health savings accounts (HSAs) giving Americans direct control over their health expenditures. Wow, I can see that one being sold to the 85% of employed folks under 65 who get insurance through their jobs.
  2. “Guarantee renewability” to address the problem of people being dropped by insurers. Bet the insurers go for that without a mandate. If only Obama had asked for this instead of “getting rid of pre-existing conditions.”
  3. Health status insurance as a hedge against “the risk that one’s health status deteriorates in the current period—and thus, that future medical insurance premiums will increase.”  This is really complicated and a confusing explanation can be found here but  the bottom line is your health status becomes a financing instrument, kinda like the mortgages did before the Great Recession. This allows the financiers to bundle your health risks and trade them on a futures market. What could possibly go wrong?
  4. Eliminate mandatory benefits. For example, the federal government, to much fanfare, now dictates “mental health parity,” which raises costs by five to 10 percent, all by itself. Guess I’ll need to stop asking those pesky questions such as “Are you depressed?”
  5. Eliminate licensing restrictions on health care professionals. We can import more docs from countries where the pay isn’t as good. They must be as good as those trained in America, right? Who needs English skills?
  6. Loosen the noose of FDA regulations to ease the path of drugs to the market and reduce costs. This time, I’m just going use their words: The FDA might abandon its gatekeeper role and move to issuing the equivalent of a Good Housekeeping Seal instead, so providers and consumers could make informed choices for themselves. 

WOW…let’s see President Paul get this one passed.

magpul_stateline_final-2It has been said that the states are laboratories of democracy. OK, it is a little more complicated than that. Turns out Justice Brandeis in “New State Ice vs Leibmann” ACTUALLY said: “a state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.” It seems we are embarking on such an experiment, this time with health care.

The Affordable Care Act was passed with the intent to provide health care for almost all US citizens. It was to do this with minimum disruption to existing mechanisms of payment. SOOOO, people over 65 got to keep their Medicare. People who were really poor got to keep their Medicaid. People whose boss was nice enough to pay for health care got to keep getting it through their work. People who were in the military got to keep their Tricare insurance. Veterans got to keep their VA benefits. In fact, the only real changes were as follows:

  • Health “insurance”  was defined at the federal level, because it turned out a lot of people were paying for crap, especially for individual policies, and state regulators were not, well, regulating.
  • Children got to stay on their parents’ policies until they were 26, mostly because it was cheap and easy to do.
  • Preventive services were mandated because it was the right thing to do.
  • People were given subsidized access, either on the exchanges or (if they were really poor) through Medicaid, because we have a really expensive health system that rations inappropriately through cost and forces people to make irrational decisions on access.
  • Everybody was forced to pay into the system, because everyone eventually uses the system and no one wants higher taxes. In a nod to the market boosters, the money follows the people but no one gets a free ride.

Then the fighting started. After 40 votes to “repeal” (and return to the best imaginary health system in the world) and a weird Supreme Court ruling, D-day is here.

The upshot is that 24 states are doing all they can to uphold a vision of access for all of their citizens. 26 states (representing a disproportionate number of poor) are upholding a different vision. Massachusetts, now 6 years into the prototype (Romneycare) is one that is moving beyond access to better health. Don Berwick, a candidate for Governor and a physician, is selling Massachusettians (well, what do they call themselves?) on the slogan “Better Health, better care, lower cost” since 98% of the citizens are now covered.

Here in Alabama, Governor Bentley (also a physician) is proud of his record on health care as well. From the Montgomery Advertiser:

A Kaiser Family Foundation study released earlier this month found that 191,000 people will be left in a coverage gap without the Medicaid expansion, but Bentley indicated Monday he was satisfied with his decision.

“I can’t think of anything worse right now than to have expanded Medicaid and have all these people on an entitlement program right now and for this entire thing to go under, which I think is going to happen,” Bentley said. “So I think my decision is right. But I’ve always thought it’s right.”

And, when it was pointed out to him that without the additional Medicaid dollars many rural hospitals will close:

“There are some rural hospitals that may have to be redesignated as something other than a hospital,” he said. “They may have to work with the state health planning board and the (Certificate of Need) planning board as we work through these issues.”

So, as we move forward on our “novel social experiment” I will provide some baseline comparison information (from America’s Health Rankings). The curremt rankings of these two engines of experimentation are in parentheses. Let’s look back in five years, to see what’s changed.

  • Overall state rankings
    • Mass (4)    AL (45)
  • Cancer Deaths
    • Mass 191 deaths per 100K (24)  AL 214 deaths per 100K (44)
  • Cardiovascular Deaths
    • Mass 231 deaths per 100K (6)  AL 330 deaths per 100K(46)
  • Diabetes
    • Mass 8% adult population (6) AL 11.8% Adult population (46)
  • Early prenatal care
    • Mass 87.5% pregnant population (2) AL 78.7% Adult population (23)
  • Infant mortality
    • Mass 5.1 per 1000 live births (5) AL 8.9 per 1000 live births (48)

I have to admit to not following Newt Gingrich’s career closely. I have heard hime speak in the context of health care and knew that he had given some thought to the subject. When I commented on his PSA stance, I must admit that I just assumed he had always been against death.

Imagine my surprise when I read that his stance on death once reflected a belief that we all might die:

Since the mid-1980s, Gundersen Lutheran hospital has been building a reputation as a national leader in end of life care — encouraging local residents to develop “advance care directives” that give the hospital clear instructions in how aggressive to be in treating various end of life conditions. Today, more than 90 percent of the hospital’s patients complete advance care directives, many of them years before they become seriously ill. Not surprisingly, the hospital relies more heavily than others on palliative care and spends 30 percent less than the national average on end of life medical treatment. As one admirer put it in a July 2009 blog post, “If Gundersen’s approach was used to care for the approximately 4.5 million Medicare beneficiaries who die every year, Medicare could save more than $33 billion a year.”

That admirer? Newt Gingrich. The former House Speaker had close knowledge of Gundersen’s approach: in 2006, the father of his wife Callista passed away at Gundersen after a battle with lung cancer. Gingrich has been open about how well the hospital handled his father-in-law’s end of life care. “What they create is a family relationship in a difficult period so that the families end up being very satisfied,” he said in an April 2009 article in the Columbia (Mo.) Daily Tribune. “The families feel there was dignity, there was dialogue, people were collectively doing something.”

According to this report, it was this Gundersun Lutheran whose experiences informed the Affordable Care Act’s foray into paying for end-of-life counseling (which morphed into “death panels” for some odd reason). As I pointed out a while back, it takes a lot of time and energy to counsel folks regarding options around terminal events, time for which we are not getting paid. I vaguely recalled thinking that Mr. Gingrich might be an ally in this fight. A belief that may have been brought about, in part, by his statement in 2009:

“Government health programs should reward organizations that adopt these best practices through higher reimbursements.”

I was in a meeting last Monday and one of my bosses allowed as how we ought to be planning for the repeal of ObamaCare. Not planning for that as a contingency but planning for the certainty of an overturn of the law by the Supreme Court. I was glad to see that the Obama administration is pressing for an early ruling on the mandate. This should put an end to speculation of what might happen.

On the other hand, maybe there is an advantage to planning based on supposition. The  Kaiser Family Foundation reported an increase in health care costs for privately insured folks as well this week. Despite some media reports to the contrary, only 2% of the  increase could be blamed on ObamaCare. The rest is due to the following:

These premiums were generally set in 2010, when insurance companies thought medical costs would be significantly higher than they turned out to be. The Bureau of Labor Statistics found that the health insurance employer cost index (a measure of the price of health care services) was the lowest it has been in over 10 years in the first half of 2011. Additionally, some insurers assumed  that the Affordable Care Act would dramatically raise their costs. In the end, both assumptions were wrong – but insurance companies still charged high premiums and earned impressive profits. Wall Street analysts’ review of results from the first quarter of 2011 found that 13 of the top 14 health insurers exceeded their earnings expectations, with profits that were over 45 percent higher than estimated.

Or, in other words, their record profits were based on supposition. Maybe my bosses should take some lessons.

There has been much in the news about the Affordable Care Act (or ObamaCare as it is sometimes called). The one year anniversary of its passage is today and there are many opinions regarding the intent, effectiveness, and ultimate benefit the new law will provide for people who are employed and already have health insurance. It is important to not let the misconceptions color the reality of what has been accomplished by the passage of this law.

A Kaiser Family Foundation tracking poll found here regarding the health care law questioned Americans a series of true or false statements. Over 65% of Americans knew that the new law provides subsidies to low and moderate income Americans, prohibits insurers from denying coverage because of health status, provides tax credits to small business who offer coverage to their employers, and requires everyone to have some type of insurance. A smaller number of Americans know that the law expands Medicaid to cover more poor people. Unfortunately almost 60% of Americans do not know that the law contains nothing about “death panels”, does not offer assistance to illegal immigrants to help them get insurance, does not reduce benefits for those on Medicare (although it does reduce payments to some plans), does not create a new government run plan, and does not require businesses to provide health insurance. 22% believe the law has already been repealed. Those believing in the information that was untrue tended to rely on certain media outlets as the source of information regarding the health reform law.

The federal government has put together a very good website that discusses what is in the Affordable Care Act, the timeline for implementation, and has some very specific information for people with special needs. In addition, there is a very easy to use section that allows people to look up health care providers (currently hospitals, nursing homes, home health agencies, and dialysis facilities) and compare when looking for a service.

Despite political posturing, the longer the law is in place the more likely it is to remain in effect. Already in happening is better access to insurance for people with pre-existing conditions, the ability to keep children on the parents insurance until they turn 26, the requirement that insurances must pay for preventive services. In addition, policies can’t be canceled because of problems with paperwork. This year prescription drug discounts for seniors, an elimination of co-pays for preventive services for seniors, a requirement that insurance companies spend over 85% of the money collected on care, and better access to home care will take effect. In addition, several quality initiatives should result in better, less expensive care. I would encourage you to go the government’s website and look at the benefits for yourself rather than relying on media to provide information. Here is another source of information regarding current benefits.

Those of you that read this blog on a regular basis are no doubt aware that I feel very strongly about the need for the American health care delivery system to perform better. This is based on many years of working with a group of patients who would be in much better health had they had sufficient access to high quality health care. In addition, I have been training physicians for many years, helping them to develop the skills to deliver high-end family medicine interventions to a group of patients in need only to have them take jobs in lucrative areas of health care that lead to high patient satisfaction but do not improve health outcomes. Lastly, I work in a medical school setting where we deliver very expensive care very inefficiently. As a potential consumer of health care, I have to wonder why others can’t see what I am certain of: change is needed and fast.

In the 1990s, it was apparent that the health care system in America was causing a problem. As I have written previously, the high cost of health insurance led to lower real wages (all increases went to health insurance premiums), 15% of Americans were denied all but emergency access to health care, and care providers who were so inclined were able to game the system and make lots of money. Good managed care was able to co-opt the system and this resulted in better access, reduced costs, and better quality to a certain extent. We believed that the value of excellent managed care was self-evident so were surprised when the entrenched establishment was able to take several glaring examples of bad managed care and tar the entire care delivery process with them.

Those interested in care reform then took the intellectual high road. Crossing the Quality Chasm, published in 2001 by the Institute of Medicine, had as its opening paragraph:

The American health care delivery system is in need of fundamental change. Many patients, doctors, nurses, and health care leaders are concerned that the care delivered is not, essentially, the care we should receive (Donelan et al., 1999; Reed and St. Peter, 1997; Shindul-Rothschild et al., 1996; Taylor, 2001). The frustration levels of both patients and clinicians have probably never been higher. Yet the problems remain. Health care today harms too frequently and routinely fails to deliver its potential benefits.

Aside from a few headlines regarding deaths caused by medical errors, those in health care continued to deliver expensive procedures regardless of potential benefit to the patient. Kaiser Family Foundation began documenting disparities in 1994 and became one of the best sources of data documenting health disparities, but the disparities continued unabated through the 2000s.

President Obama took public interest in changing our broken health care system, combined with support for change from major corporations as a mandate. He took the evidence from the IOM report, the data from Kaiser, the support from industry and used it to convince Congress of the need for change. The passage of the Affordable Care Act is the consequence of these forces coming together. While not perfect, the bill offers a significant increase in access to health care with the potential to improve care and reduce costs. Unfortunately the hard work has not yet been completed. Building a framework for change into a law is one task. Convincing people that the framework is necessary and sufficient is another. The vast majority of people are fed up with the “system” but happy with their doctor(s). They are unhappy with the cost of other people’s care but unconcerned with the cost of their care. Why would they want to move out of their “comfort zone?”

In his important work Leading Change: Why Transformational Efforts Fail, John Kotter identifies the 10 reasons that large-scale change fails to occur at the corporate level. Error #1 is not establishing a great enough sense of urgency. In the 1990s, the HMO system was dismantled in many areas very quickly because of patient demand. A sense of urgency prevailed. Those who want to see “Obamacare” fail are doing their best to establish a sense of urgency for “repeal and replace.” Their case is  not being made with data and policy suggestions but through hyperbole and outright deception.

Mike Huckabee, currently “not running” for the Republican nomination for the presidency, has come out against the “comparative effectiveness research” aspect of the ACA. Although

even Republicans [likely] recognized that we shouldn’t be spending so much money on drugs, devices, and procedures that don’t actually make people better than existing treatments.

But Republicans and their allies in the conservative movement no longer say such things. Instead, they say that government will use CER to deny people beneficial treatments–that it is, as Huckabee puts it, “the poisonous tree of which death panels will grow.”

What could be more urgent than stopping that?

Or what about the claim that if the federal government can mandate health coverage they can force broccoli ingestion as well. That should put fear into many Americans regarding the overreaching federal government as well as mandatory broccoli burgers. STOP THE BROCCOLI!

Those of who want to see most (if not all) Americans with access to high quality health as well as leave something in the national treasury for our children need to yell from the rooftops that the ststus quo is unacceptable and the ACA, while not perfect, is the best start on improvement we’ve had in 20 years. My friend Paul Grundy is doing his part. Don Berwick will likely lose a job as a result as well. Let’s all be real clear: #37 is UNACCEPTABLE.

NPR ran a story several days ago about the “conservative” strategy as it relates to health care “repeal and replace.” As you may be aware, public media (radio and television)  is under budget scrutiny itself perhaps in part because they are an unbiased source of reporting. This story reports on a memo from the director of FreedomWorks to members of the House Republican party regarding ObamaCare dated February 14, 2011. The memo, found here, identifies the “conservative principles” that this group (a group claiming to speak for TEA party affiliated Americans) believes should inform our new health care system:

1. Every intelligent, adult human being has a right to make his or her own health care choices.
2. Patients are customers and have a right to shop around and take their business elsewhere.
3. Health care professionals have a right to be paid for their services, at market rates.
4. Doctors and patients should have the right to freely enter into contracts with each other.
5. People should bear the consequences of their own free choices.
6. People should be free to opt out of public insurance programs.
7. In a free society, the moral way to help those who are less fortunate is through private charity — or failing that, through targeted subsidies — not mandates and regulations.

I don’t feel compelled to address each of these “principles” independently. I will say that collectively they will lead to some folks paying a little less into the system (although recent history suggests they will be suckered into spending more on unneeded care), most folks paying about the same (and continuing to spend money poorly), and some folks running out of health care and suffering the market based consequences. Our experience in Mobile suggests #7 is especially problematic.

What do they propose replacing ObamaCare with? They propose a voluntary portable system of coverage for health problems so people can opt out should they choose. Just as people can opt out of driving and walk to work, they should be able to seek other alternatives to government-funded health care.  Secondly, they do support funded high risk pools. Prior to the passage of the Affordable Care Act they were seen as too expensive for people to use but interestingly are being used more now making repeal a little problematic.Thirdly, they believe that transparent pricing would help people make better health decisions. Unfortunately people have never used price effectively in health care but perhaps this time they’ll do a better job. Fourth, fifth,and sixth converting Medicare, Medicaid, and private insurance to a defined contribution plan and letting the patients negotiate their care. Given that 10% of patients account for 90% of the costs, there’s going to be a bunch of people with money left over and some folks who run out of health care in July every year unless we fix the catastrophic care problem. Laslty, they believe that the states can lower health care costs by reducing regulation. Hard to see how that is any different than before the ACA passed.

In trying to figure out who could best offer a response to these points, I again found myself at HealthCare.gov. This is a very good site. it includes information about the Affordable Care Act, how to stay healthy, how to pick out an insurance plan, how to pick a health provider based on quality, and allows you to personalize this information. Although I find much to disagree with in Freedomworks proposed “replacement” for the ACA, I am grateful that I was led to the improved website and encourage everyone to go there for unbiased, updated information. For that, Mr Armey, thank you.

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