Saturday, April 30, 2011

CAP talk by Atul Gawande - 42911. Reducing Health Care Costs Without Rationing: A Clinician's View

Went to Center for American Progress talk by Atul Gawande yesterday.  He has many excellent ideas for improving care while lowering costs.


Reducing Health Care Costs Without Rationing: A Clinician's View
Atul Gawande, M.D.
Here is link to video of talk

http://tinyurl.com/3ztwznf


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Health care, there are too many profit centers.  Patients are treated as profit centers.
5% of population counts for 60% of the costs
Many receive inappropriate care
Best quality care frequently has lower costs
Key steps
1.      1.  Recognize community failures and successes
2.       2. Devise group solutions
For hospital surgery, procedures, infections, death rates, complex patients, etc. , develop checklists

Need to develop productivity revolution in health care
One project reduced complications by 35% and deaths by 47%

Use of checklists adopted universally in England, Ireland, Spain and VA hospitals, but by only 25% of U.S. hospitals.

Need to move from individuals to organizations. Kaiser, and Mayo Clinic are two excellent examples that focus on group strategies and not cowboy approach

3.       3. Need to move from project thinking to portfolio thinking.

See hot spots article

The Hot Spotters

Can we lower medical costs by giving the neediest patients better care. 

In Camden, New Jersey, one per cent of patients account for a third of the city’s medical costs. Dr. Jeffrey Brenner has taken a comprehensive social approach to these issues and is lowering medical costs.  This is where we need to be. 

150,000 deaths per year post –op, half are avoidable.

End of Life care is inadequate, too many folks die in Emergency rooms
Too many catastrophic procedures
Need checklists for these.

Need policy levers to move these

IPAB is essential.  Independent Payment Advisory Board.  The Republicans want to do away with this.  Detect some inconsistency here with their desire to reduce the deficit.

Need more data and information at community level.  More funding for NCHS. National Center for Health Statistics

Denmark was very successful using medical homes

Need to reduce smoking, obesity, air pollution

Need to reward systems and individuals. 

“We are in a battle for the soul of our medical care.  We are fostering a learning system, there will be mistakes but inertia equals failure.”

Commonwealth fund newsletter 42911 issue

http://tinyurl.com/4yr5lb5

this issue of the commonwealth newsletter has lots of interesting articles


here are a couple of topics


Health Reform Will Make Insurance Affordable for Nearly All Families

Lessons from Abroad for U.S. Health Care


On another note,  here is a web site


http://www.protectyourcare.org/

which is putting together ad campaigns supporting health reform in key congressional districts.  It is affiliated with Center for American Progress. 

Thursday, April 21, 2011

OFA materials

Tonight I am participating in a training session on health reform for Organizing for America in Moco. 

here are my talking points and resource handout.


KEY BENEFITS AND MYTHS OF THE AFFORDABLE CARE ACT (ACA)

I.       What are some of the key benefits of the Affordable
Care Act

The law is already benefiting many Americans:

·       Children can stay on their parents' health plan until they
turn 26  - up to 3 million can benefit
from this provision.
·       Insurance companies cannot deny children coverage for
current medical problems or cancel coverage because of prior treatment – up to
5 million kid
·       Insurers can no longer put a dollar maximum on health
insurance coverage or cancel a plan if a person gets sick
·       Seniors who have higher Medicare prescription drug costs now
will get greater costs covered, and by 2019 all prescription drug costs will be covered – up to 3 million seniors
    ·       All 46 million seniors with Medicare will get new coverage of  several preventive services.

·       Small businesses get a 35% tax credit to help pay for
employees' coverage.  – up to 4 million
persons covered
Additional benefits and savings in 2014, when the law is fully in place:
·       Insurance companies won't be able to deny anyone coverage
for medical conditions or place a limit on your coverage.  N
ow
only kids cannot be denied.

·       People who don't get health coverage at work will choose
among a number of health plans, in a new marketplace run by state governments.  These will be better health
insurance plans than now available, and people will pay based on their income and other financial criteria.
·      The ACA will also improve quality, make health care more efficient, and reduce the deficit.

II.      Myths: Is there any misleading information being said about the law?

·       Charge: The law creates death panels
     Ø This is a totally false charge.

·       Charge: The Federal government will pay for abortions
Ø The bill specifically states that no Federal funds can
be used for abortion services.
·       Charge:  The law covers undocumented or illegal immigrants
Ø This is a totally false charge.
·       Charge: This is program run by the Federal Government.
Ø The bill specifically states that the Federal
Government will not operate any new insurance programs. 
·       Charge: the law increase deficits
Ø The Congressional Budget Office (CBO), which has
always been regarded by both parties until now as a unbiased scorekeeper says the law will reduce the deficit by a trillion in 20 years.  This is the only time that Republicans have questioned the Congressional Budget Office.


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KEY RESOURCES ON HEALTH REFORM
1) Massachusetts   http://tinyurl.com/3lnn246  *
Massachusetts health reform, myths vs facts

2) Videos
a) Families USA

http://healthreformaction.blogspot.com/2011/03/celebrating-one-year-of-health-care.html (via my blog) or direct http://tinyurl.com/4327hkl


From families usa with videos of 7 personal stories of folks and businesses helped
by ACA.  Highly recommended


b) Video: How Health Reform Really Works  [From Ellen-Marie
Whalen, CAP]


http://www.americanprogress.org/issues/2010/04/health_reform_video.html

3) Radio tape

http://healthreformaction.blogspot.com/2011/03/cbs-radio-interview-with-tony-hausner_28.html

Tape of my CBS Local Radio Interview on Affordable Care Act on 1 year anniversary. 

4) Kaiser Poll
http://healthreformaction.blogspot.com/2011/03/new-and-noteworthy-march-health.html

Kaiser poll on attitudes to affordable care act (ACA)

5) Summaries of ACA (Affordable Care Act):  Here are 4 of the best summaries of the ACA. 

a)      Times magazine  tinyurl.com/yj7pp82

This is the best package, has a simple set of charts, plus a good article on
the cost efficiency issues which has been missing for the most part from other reviews.

b)      Kaiser summary   http://www.kff.org/healthreform/8061.cfm   Excellent summary
c)  Consumer Reports  http://tinyurl.com/yj2ls4c  Excellent summary
d) Another useful source healthreform.gov  this site is operated by USHHS

* note tinyurl’s are shortened versions of websites.










Friday, April 15, 2011

Revised Package for OFA - MD

Have put together the following package which is briefer than what I shared previously. 
For those who might be interested. I am working with Organizing for America (OFA), Montgomery County Health Reform Team.  Our goal is to train folks to deal with myths and facts re ACA.  I would love to have more of you working with me on policy issues, training packages, etc.  Hopefully, this will be useful to other parts of the OFA teams across the country. 


1) Massachusetts

Massachusetts health reform, myths vs facts



here is a project from families usa which presents 7 personal stories of folks and businesses helped by ACA.  Highly recommended

 3) Radio tape


Tape of my CBS Local Radio Interview on Affordable Care Act on 1 year anniversary. 
see transcript below. However, recommend listening to tape first.   

4) Kaiser Poll

http://healthreformaction.blogspot.com/2011/03/new-and-noteworthy-march-health.html

Kaiser poll on attitudes to affordable care act (ACA)

5) Summaries of ACA

Here are four of the best summaries of the ACA. 

a) times magazine

tinyurl.com/yj7pp82

this is the best package, has a simple set of charts, plus a good article on the cost efficiency issues which has been missing for the most part from other reviews.

b) kaiser summary

http://www.kff.org/healthreform/8061.cfm

good summary

c)  consumer reports

d) another useful source

healthreform.gov

this site is operated by USHHS




Key points from CBS Local Radio Interview

1. What are the benefits of this new law
the law is already benefiting most Americans:
  • Children can stay on their parents' health coverage until they turn 26
3.million
  • Insurance companies cannot deny children coverage for pre-existing conditions or cancel coverage because a person has been treated in the past
5 million kids
  • Insurers can no longer put a lifetime benefit limit on your coverage or cancel your plan if you get sick
  • Seniors who fall into the Medicare prescription drug "doughnut hole" get $250 toward costs
3 million
46 million preventive svcs
  • Small businesses get a 35% tax credit to help pay for employees' coverage.
4 million
Additional benefits and savings in 2014, when the law is fully in place:
  • Insurance companies won't be able to deny anyone coverage for pre-existing coverage or place lifetime limits
Now only kids
  • People who don't get health coverage at work will chose among a number of health plans, in a new marketplace run by state govts, these will be better plans than now available, pay on a sliding scale
  • The Medicare drug doughnut hole will continue to shrink until totally eliminated.
Improve quality, make system more efficient, and reduce deficit.
2) 2.    Is there any misleading information about the law?
Charges: Death panels, not true
Charge: govt will pay for Abortion, not true
Charge: undocumented Immigrants, no
Charge: Govt run, not true
Charge: increase Deficits
Cong. Budget office, which has always been regarded by both parties until now as a unbiased scorekeeper says will reduce deficit by a trillion in 20 years.  Only time repbul have questioned cbo
3. Do you know anyone who has been helped by the ACA (Affordable Care Act)
A) " Lindsay, is 23 years old with 6-year-old son who has asthma.
Husband has new job, hlth ins will not cover because pre existing cond
She waits tables, but they can’t afford his medical bills
New law means husband’s ins covers her son.  Can’t deny children with pre-existing
B)  "Brian is a small business owner. He's had his auto company in Maryland for many years and provides health insurance for his employees
Brian worries about the 15-20% hike in premiums.
"The new health law provides Brian and other small business owners with a tax credit to help with the costs of covering their employees
c) David was covered under his employee plan, coverage dropped, because he hadn't listed hemorrhoids as a 'digestive disorder' or mentioned high triglycerides and cholesterol—which he had no idea he even had
insurance company went back in his record and cancelled his plan retroactively. Appealed denied.
"Under the new law, it is illegal for health insurance companies to take coverage away from people like David who play by the rules, pay all of their premiums,

4. What about the individual mandate and court challenges
this is the main issue being challenged in court
Requires everyone to have insurance,  same as auto ins
If a person gets sick, avoids drs. ends up in ER costing everyone more money
Spreads the costs to everyone, makes it cheaper for all of us
If a person chooses not to get insurance, Why should we bear the burden when they get sick.
As indicated main court challenge is on indiv mandate, won’t know until supreme court rules and there is uncertainty about this,
can revise the law if mandate is rejected
6. what if the law is repealed
Then 30 million will not have hlth ins and won’t get hlth care,morally wrong, everyone is entitled to education and to health care, it is a basic right
Ins companies can deny if pre existing or set lifetime limits, this is unfair
Have a much greater deficit, poorer quality, less efficient. 
We can’t let this happen

7. Impact on business
·       Small businesses get tax credit in 2011
·       Small businesses employees under 100 can get insurance thru exchanges in 2014
·       Need to reduce rate of health care inflation, which is twice as high as rest of developed world, seriously hurting small and large businesses
·       Better health care makes more productive employees both for the employees and their families which also effects employees
·       More health care jobs


Myth vs. Fact: Health Care Reform in Massachusetts

Myth vs. Fact: Health Care Reform in Massachusetts

The State Model for the Affordable Care Act Is Working and Broadly Popular


http://tinyurl.com/6cquqzs

Friday, April 8, 2011

Outrage that government may shutdown because of unfair attacks on planned parenthood.

http://tinyurl.com/63k7sq8

see the statement by planned parenthood director on potential govt shutdown

they republicans are accusing them of being abortion mills instead of the vital prenatal care services, etc that they provide.

Wednesday, April 6, 2011

CBO analysis of ryan proposal

http://tinyurl.com/6kbgyln

rob from the poor, give to the rich.

A Call for Change: The 2011 Commonwealth Fund Survey of Public Views of the U.S. Health System

http://tinyurl.com/3rckrva

this is an excellent survey re changes to health care system.  from commonwealth fund

CBPP on Republican's Budget plan, reverse robin hood

http://bit.ly/e85tJD

This is from one of the top progressive budget experts. He points out that Republican budget package is reverse robin hood. Steal from the poor, give to the rich. Hard to believe that they could be so blatant.

Tuesday, April 5, 2011

Kaiser poll: Medicaid more popular than expected

http://www.kff.org/pullingittogether/A-Public-Opinion-Surprise.cfm

Kaiser conducted a survey to determine public opinion on the Medicaid program. Very favorable ratings, almost as good as social security and medicare.  Drew Altman was pleasantly surprised.   Glad to see this.  Especially given Republican proposals to undermine the program.