Saturday, April 27, 2013

Obama Says New Abortion Laws Turn Back The Clock

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Friday, April 26, 2013

Family Doctors Consider Dropping Birth Control Training Rule

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Thursday, April 25, 2013

Boston ER Doctor Finds Marathon Memories Hard To Shake

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Wednesday, April 24, 2013

Beyond Obamacare

How a Single-Payer System Can Save US Health Care

As Minnesota�s physicians, health care leaders and legislators grapple with the complex changes brought by the Affordable Care Act (ACA), many are concerned that even after the law is fully implemented, hundreds of thousands of people will remain uninsured while health care costs continue to spiral.

What if there were a simple, streamlined solution that would guarantee health coverage for every Minnesotan while saving the state billions of dollars? A growing number of Minnesota physicians are endorsing what they consider to be such a solution: single-payer health care. Weary of having to comply with hundreds of different insurance plans� administrative requirements while their patients are denied needed tests and treatments, these physicians are drawn to the simplicity, cost-effectiveness and truly universal coverage offered by a single-payer system.

Their views were supported by an independent analysis last year demonstrating that with a state-based single-payer system, every Minnesotan could have comprehensive coverage while the state would save billions annually.

A deeply flawed system

The desire for meaningful reform comes in the face of the U.S. health care system�s long-recognized dysfunction. Despite health care accounting for 18 percent of the nation�s economy�twice that of other wealthy democracies�48 million Americans lack health coverage. Another 29 million are underinsured, having poor coverage that exposes them to unaffordable out-of-pocket expenses. Health insurance premiums have doubled over the past decade, with the average annual cost for family coverage now exceeding $15,700; and health care costs now account for two-thirds of personal bankruptcy filings in the United States.

At the root of these problems is the fact that we have a fragmented, highly inefficient system. Employed Americans younger than 65 years of age have job- based insurance, if their employer chose to provide it; the elderly and disabled are covered through Medicare; the poor by Medicaid; military veterans through the Veterans Administration; and American Indians through the Indian Health Service. Persons who do not fall into any of those categories must try to purchase individual coverage in the private market, where it is often prohibitively expensive or unobtainable if they have a pre-existing health condition.

Owing largely to this fragmentation and inefficiency, a staggering 31 percent of U.S. health care spending goes toward administrative costs, rather than care itself. Inefficiency exists at both the provider and payer level. To care for their patients and get paid for their work, physicians and hospitals must contend with the intricacies of numerous insurance plans�which tests and procedures they cover, which drugs are on their formularies, which providers are in their network. Meanwhile, private health insurance companies divert a considerable share of the premiums they collect toward advertising and marketing, sales teams, underwriters, lobbyists, executive salaries and shareholder profits. The top five private insurers in the United States paid out $12.2 billion in profits to investors in 2009, a year when nearly 3 million Americans lost their health coverage.

The ACA of 2010, known widely as Obamacare, is expected to extend coverage to 32 million more Americans But it accomplishes this goal primarily by expanding the current fragmented, inefficient system and maintaining the central role of the private insurance industry in providing coverage. As a result, the ACA is expected to do little to rein in health care spending. Furthermore, it will fall far short of achieving universal coverage, as tens of millions of Americans (including 262,000 Minnesotans) will remain uninsured after its full implementation.

The solution

The central feature of a single-payer health care system would be one health plan that covers all citizens, regardless of their employment status, age, income or health status. Having a public fund that pays for care would slash administrative inefficiencies and eliminate profit-taking by the private insurance industry.

Under a single-payer system, the way society pays for health care would change, but the market-based health care delivery system would remain. Physicians and hospitals would continue to compete with one another based on service, quality of care and reputation. The chief difference is that they would bill a single entity for their services, rather than numerous insurers.

Individuals would benefit immensely by having continuous coverage that is decoupled from their employment. This would alleviate �job lock,� in which people remain in undesirable employment situations in order to maintain coverage. In a single-payer system, individuals could choose to see any provider, in contrast to the current system in which choice is restricted to those who are in-network. Deductibles and copays would be minimal or eliminated, removing cost as a barrier to obtaining needed care.

A single-payer system would be funded through savings on administrative costs, along with modest taxes that would replace the premiums and out-of-pocket expenses currently paid by individuals and businesses. The cost savings to individuals, businesses and government would be considerable. The nonpartisan U.S. General Accounting Office concluded that single- payer health care would save the United States nearly $400 billion per year, enough to cover all of the uninsured.

Physician support for a simplified, universal health care system is robust and growing. A 2008 survey published in Annals of Internal Medicine found that 59 percent of physicians supported a national health insurance system�up from 49 percent in 2002. Physicians for a National Health Program, a national organization advocating for single-payer reform, reports a membership of 18,000. In Minnesota, single payer has been formally endorsed by nearly 800 physicians, other providers and medical students.

The Minnesota model

Recognizing the implausibility of achieving single-payer reform at the national level in the current political climate, many single-payer advocates have turned their attention to state-level reform. The ACA provides for �state innovation waivers� to be granted beginning in 2017, allowing states to implement creative plans they believe would work best for them. With this in mind, organized single-payer movements have taken root in states as varied as Colorado, Hawaii, Illinois, New York, California, Oregon and Vermont. Vermont�s governor and Legislature passed a law in 2011 setting the path for the state to move toward single payer.

In Minnesota, two advocacy organizations�Health Care for All Minnesota and the Minnesota chapter of Physicians for a National Health Program�are garnering public support for a single-payer system. Gov. Mark Dayton has expressed support for single payer, and Sen. John Marty (DFL-Roseville) has authored legislation to establish such a system in Minnesota. Known as the Minnesota Health Plan, it would replace the current inefficient patchwork of private and public health plans with a single statewide fund that would cover the health needs of all Minnesotans�inpatient and outpatient services, preventive care, prescription drugs, medical equipment and mental health and dental care. A 2012 study by the Lewin Group confirmed the feasibility of single payer in Minnesota. It concluded that adoption of a single-payer system would provide coverage to every Minnesotan, including the 262,000 left uncovered by the ACA, while saving the state $4 billion in the first year alone. The average Minnesota family would save $1,362 annually in health costs, while the average Minnesota employer that currently provides insurance would realize savings of $1,214 per employee per year. The analysis showed these savings came primarily from administrative simplification; provider compensation remained unchanged.

Conclusion

With nearly 50 million uninsured people in the United States and skyrocketing health costs, the need for profound reform of our health system could not be more clear. The ACA is a start, but it will fall far short of achieving universal coverage, and it allows unsustainable spending growth to continue. Single-payer health care would eliminate administrative waste and inefficiency, thereby creating an opportunity to achieve truly universal, cost-effective health care.

This article originally appeared in the April 2013 issue of Minnesota Medicine.

Friday, April 12, 2013

Wait For Obamacare Price Tags Could Last Months

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Wednesday, April 10, 2013

Lawyers Join Doctors To Ease Patients' Legal Anxieties

Enlarge image i

Lawyer Meredith Watts (left) visits client/patient Shirley Kimbrough at her apartment in north Akron, Ohio. Kimbrough is being helped by a program under which lawyers partner up with health providers to supply patients with legal advice.

Jeff St. Clair/WKSU

Lawyer Meredith Watts (left) visits client/patient Shirley Kimbrough at her apartment in north Akron, Ohio. Kimbrough is being helped by a program under which lawyers partner up with health providers to supply patients with legal advice.

Jeff St. Clair/WKSU

Two professions that have traditionally had a rocky relationship � doctors and lawyers � are finding some common ground in clinics and hospitals across the country.

In Akron, Ohio, for instance, doctors are studying how adding a lawyer to the health care team can help improve a patient's health.

As a TV drones in the background, about a dozen women and children wait for their names to be called at the Summa women's clinic in Akron.

In the clinic's conference room, Meredith Watts is awaiting her next case. She's not a doctor or a nurse. She's a lawyer who specializes in housing and consumer work.

Legal Advice To Help Health Patients

Watts works for Community Legal Aid, a nonprofit that gives free legal help to low-income people in eight Ohio counties. Her firm is housed in a downtown office tower. But Watts prefers working out of the clinic.

"So if somebody comes in to the clinic and they get sent to me and it's a housing problem and I'm here, I can give them advice directly on site," she says.

Watts' role on the team is to help solve issues that might affect a patient's health but are outside a doctor's control.

"Let's say you're under threat of eviction because of something that happened," she says. "That's going to cause a significant amount of anxiety, potentially, and then you're suffering from these anxiety problems that wouldn't have happened if we had been able to intervene and perhaps help with the eviction problem," she says.

A Type Of Preventative Law

And, as a lawyer, Watts makes house calls. One of her clients, Shirley Kimbrough, lives in a subsidized housing unit in a north Akron neighborhood.

The clinic referred Kimbrough to Watts, who last year helped her move into this handicapped-accessible apartment to care for her disabled granddaughter.

"If I hadn't had her to help me I would have lost my granddaughter because I had already lost my daughter, and I don't think I could have stood that," Kimbrough says.

Attorney Marie Curry runs Akron's medical-legal partnership.

"It's exciting to be able to do what we think of as preventative law, rather than always being crisis intervention because you can help something not happen, before it becomes a crisis," Curry says.

'It Doesn't Make Any Sense'

But not all lawyers are quick to embrace a cozy new relationship with their old adversaries.

"I don't understand how a medical clinic needs an attorney to be a part of its team. It doesn't any make sense to me," says Allen Schulman, a malpractice attorney in nearby Canton who takes a more traditional view of the two professions.

"I think there has historically been an animosity between lawyers and doctors. I think we share some of the blame, and I think the medical profession shares some of the blame," he says.

But back at the Akron women's clinic, researcher Michele McCarroll says doctors here like having a lawyer down the hall from the examination room.

A 'One-Stop Shop'

"We are trying to meet the needs of the patients right here on site in kind of a one-stop shop where we know things ... such as social issues, can make a difference in health issues," she says.

McCarroll and Akron's Community Legal Aid lawyers have enrolled 100 women in the first randomized study to determine whether having a lawyer on-site really does improve health outcomes.

They're measuring conditions like blood pressure, stress and other health factors in two groups of women who had legal issues. One group was introduced to a clinic lawyer; the other group was given a number for the legal help line.

They plan to present their results next week at the national Medical-Legal Partnership Summit in Washington.

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Wednesday, April 3, 2013

New Medical School Wants To Build Ranks Of Primary Care Doctors

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