By Jackson & Coker Research Associates
Jackson & Coker Industry Report, October 1, 2012

A new survey of physicians shows that if the Presidential election were held today, 55 percent would vote for Mitt Romney and 36 percent would support President Obama, according to a survey conducted by Jackson & Coker, a division of Jackson Healthcare, the third largest healthcare staffing company in the US.

When asked how they felt about the Affordable Care Act, 55 percent said “repeal and replace” the new law while 40 percent said “implement and improve” the ACA.

http://www.jacksoncoker.com/physician-career-resources/newsletters/monthlymain/des/PresidentialPoll.aspx

Comment:

By Don McCanne, MD

Rather than demonstrating where physicians are on their beliefs and understanding of health policy, this poll merely shows that the debate has been reduced to the politics of the Affordable Care Act (ACA). Of the 55 percent who would replace ACA, there is no breakdown on those who would replace it with Medicare for All (neither candidate)  and those who would replace it with policies that likely would shift more of the financial burden to patients (Romney). Also, of the 40 percent who would improve ACA there is no breakdown of those who would support the dubious strategy of modifying it incrementally as a means of eventually achieving single payer reform (neither candidate). We need surveys of physicians’ views on policy, not politics.

Results of the 2012 Physicians’ Presidential Poll

By Jackson & Coker Research Associates
Jackson & Coker Industry Report, October 1, 2012

A new survey of physicians shows that if the Presidential election were held today, 55 percent would vote for Mitt Romney and 36 percent would support President Obama, according to a survey conducted by Jackson & Coker, a division of Jackson Healthcare, the third largest healthcare staffing company in the US.

When asked how they felt about the Affordable Care Act, 55 percent said “repeal and replace” the new law while 40 percent said “implement and improve” the ACA.

http://www.jacksoncoker.com/physician-career-resources/newsletters/monthlymain/des/PresidentialPoll.aspx

Comment:

By Don McCanne, MD

Rather than demonstrating where physicians are on their beliefs and understanding of health policy, this poll merely shows that the debate has been reduced to the politics of the Affordable Care Act (ACA). Of the 55 percent who would replace ACA, there is no breakdown on those who would replace it with Medicare for All (neither candidate)  and those who would replace it with policies that likely would shift more of the financial burden to patients (Romney). Also, of the 40 percent who would improve ACA there is no breakdown of those who would support the dubious strategy of modifying it incrementally as a means of eventually achieving single payer reform (neither candidate). We need surveys of physicians’ views on policy, not politics.

Results of the 2012 Physicians’ Presidential Poll

By Jackson & Coker Research Associates
Jackson & Coker Industry Report, October 1, 2012
A new survey of physicians shows that if the Presidential election were held today, 55 percent would vote for Mitt Romney and 36 percent would support President Obama, according to a survey conducted by Jackson & Coker, a division of Jackson Healthcare, the third largest healthcare staffing company in the US.
When asked how they felt about the Affordable Care Act, 55 percent said “repeal and replace” the new law while 40 percent said “implement and improve” the ACA.
http://www.jacksoncoker.com/physician-career-resources/newsletters/month…

Rather than demonstrating where physicians are on their beliefs and understanding of health policy, this poll merely shows that the debate has been reduced to the politics of the Affordable Care Act (ACA). Of the 55 percent who would replace ACA, there is no breakdown on those who would replace it with Medicare for All (neither candidate)  and those who would replace it with policies that likely would shift more of the financial burden to patients (Romney). Also, of the 40 percent who would improve ACA there is no breakdown of those who would support the dubious strategy of modifying it incrementally as a means of eventually achieving single payer reform (neither candidate). We need surveys of physicians’ views on policy, not politics.

By Aaron Carroll, MD, MS
news@JAMA, October 3, 2012

When I talk about health policy, I often refer to the iron triangle of health care. The 3 components of the triangle are access, cost, and quality. One of my professors in medical school used this concept to illustrate the inherent trade-offs in health care systems. His point was that at any time, you can improve 1 or perhaps even 2 of these things, but it had to come at the expense of the third.

I can make the health care system cheaper (improve cost), but that can happen only if I reduce access in some way or reduce quality. I can improve quality, but that will either result in increased costs or reduced access. And of course, I can increase access—as the Affordable Care Act (ACA) does—but that will either cost a lot of money (it does) or result in reduced quality.

Anyone who tells you that he or she can make the health care system more universal, improve quality, and also reduce costs is in denial or misleading you.

We can make the system cheaper. We can make it more expansive. We can make it higher in quality. But we can’t do all 3.

http://newsatjama.jama.com/2012/10/03/jama-forum-the-iron-triangle-of-health-care-access-cost-and-quality/

Comment:

By Don McCanne, MD

We have heard for decades the meme that health care access, cost and quality are interdependent. Any change in one or two of them must produce a reciprocal change in either one or both of the others. Any improvement must always be offset with one or two impairments. Yet the single payer model shows that this is merely a replication of a seriously deficient concept that omits consideration of many other important health policies.

Under a properly designed single payer model, access is improved by removing financial barriers to care for absolutely everyone. The comprehensive design features of single payer also significantly improve quality, simply stated, by ensuring that patients receive the care that they need while reducing or eliminating care that is detrimental. And costs are the forte of the single payer system. Single payer reduces waste, redirecting those funds to patient care, and puts into place economic mechanisms that slow the rate of increase in future health care costs. Spending can be contained while both quality and access are improved.

It is time to retire the meme that improving access, costs or quality can be done only by introducing impairments. Don’t let the policy community get away with that claim anymore. Aaron Carroll’s integrity is of such a high caliber that he certainly is not misleading us, but he clearly needs to end his denial.

JAMA Forum — The “Iron Triangle” of Health Care: Access, Cost, and Quality

By Aaron Carroll, MD, MS
news@JAMA, October 3, 2012
When I talk about health policy, I often refer to the iron triangle of health care. The 3 components of the triangle are access, cost, and quality. One of my professors in medical school used this concept to illustrate the inherent trade-offs in health care systems. His point was that at any time, you can improve 1 or perhaps even 2 of these things, but it had to come at the expense of the third.
I can make the health care system cheaper (improve cost), but that can happen only if I reduce access in some way or reduce quality. I can improve quality, but that will either result in increased costs or reduced access. And of course, I can increase access—as the Affordable Care Act (ACA) does—but that will either cost a lot of money (it does) or result in reduced quality.
Anyone who tells you that he or she can make the health care system more universal, improve quality, and also reduce costs is in denial or misleading you.
We can make the system cheaper. We can make it more expansive. We can make it higher in quality. But we can’t do all 3.
http://newsatjama.jama.com/2012/10/03/jama-forum-the-iron-triangle-of-he…

We have heard for decades the meme that health care access, cost and quality are interdependent. Any change in one or two of them must produce a reciprocal change in either one or both of the others. Any improvement must always be offset with one or two impairments. Yet the single payer model shows that this is merely a replication of a seriously deficient concept that omits consideration of many other important health policies.
Under a properly designed single payer model, access is improved by removing financial barriers to care for absolutely everyone. The comprehensive design features of single payer also significantly improve quality, simply stated, by ensuring that patients receive the care that they need while reducing or eliminating care that is detrimental. And costs are the forte of the single payer system. Single payer reduces waste, redirecting those funds to patient care, and puts into place economic mechanisms that slow the rate of increase in future health care costs. Spending can be contained while both quality and access are improved.
It is time to retire the meme that improving access, costs or quality can be done only by introducing impairments. Don’t let the policy community get away with that claim anymore. Aaron Carroll’s integrity is of such a high caliber that he certainly is not misleading us, but he clearly needs to end his denial.

Plans with lower premiums burden members with potentially crushing costs

By Steve Sternberg and Chris I. Young
U.S. News & World Report, October 3, 2012

A first-ever U.S News analysis of nearly 6,000 health insurance plans marketed to individuals and families reveals that many of the consumers who enroll in these plans may confront budget-wrecking out-of-pocket costs that deplete their savings.

Each of the plans in the U.S. News database was scored and assigned a rating of one to five stars; plans available to both individuals and families were rated separately for each. A plan’s score depended on completeness of coverage in as many as two dozen benefit categories and subcategories—hospitalization, outpatient surgery, name-brand prescription drugs, and emergency room visits are just a few examples—and how much of the cost consumers have to pay.

The plans U.S. News rated, which are those sold to individuals and families who have no access to employer or public coverage, currently cover some 14 million people. That number could very well double once the major provisions of health reform’s Affordable Care Act take effect in 2014, according to the bipartisan Congressional Budget Office, because the ACA mandates that everyone must have health insurance or pay a penalty.

U.S. News spent several months working with data obtained from the Centers for Medicare and Medicaid Services (CMS), a federal agency that summarizes plan coverage and pricing on a consumer page but does not rate or rank plans against each other. The analysis posed many challenges, including constant flux in the number of plans available in the federal database. That is because of incomplete reporting and because health insurers periodically create new plans and stop enrolling applicants in established ones.

Research into purchasing behavior shows that health insurance shoppers are strongly influenced by the size of the monthly premium. It is a regular outlay, like a mortgage or rent payment, so weighing its impact on one’s monthly budget makes sense—to a point. An individual or family that opts for an easily affordable premium can be blindsided in the event of traumatic injury or major illness. A plan that may seem like a good choice because it has a lower monthly premium may require consumers to pay much more out-of-pocket every time they need medical care.

Plans are often far from transparent about how much consumers must pay for medical services. The term “out-of-pocket maximum,” supposedly meaning the most a consumer will have to pay for medical services, is misleading; 90 percent of plans exclude some combination of deductible, copays (upfront fees paid for service), and coinsurance (the consumer’s share of the charges). Nearly 100 plans exclude all three. A plan member with average coverage who needs surgery could end up paying thousands more than their out-of-pocket cap.

If a hospital’s physicians aren’t members of a health plan’s network, the cost may climb even higher, an expense that often comes as a shock to plan members who assume their care is covered. The same is often true for hospital services, such as occupational therapy, that are not provided by physicians.

The higher you have to climb the deductible ladder before benefits are paid out, the more vulnerable your income and savings. Medical bills tend to come in waves. A routine doctor’s visit that starts with an annual physical and progresses to a tentative diagnosis can trigger a cascade of expenses, from lab tests to prescription drugs to inpatient or outpatient hospital procedures. Plans rarely cover more than a portion of those costs, which may add up to tens of thousands of dollars when severe illness strikes.

http://health.usnews.com/health-news/health-insurance/articles/2012/10/03/many-insurance-plans-heap-healthcare-costs-on-consumers

Comment:

By Don McCanne, MD

No surprise. The title of this article says what we already knew: “Many Insurance Plans Heap Healthcare Costs on Consumers.” Further, individuals and families most often select plans based on how easily affordable the premium is, and those plans can easily exceed the supposed out-of-pocket maximum.

The Affordable Care Act includes some measures that will reduce some of the abuses of these plans, but it still leaves in place the fundamental infrastructure of private health plans. Shoppers in the state health insurance exchanges should understand that the plans they purchase will ensure neither financial security nor health security. We can do far better, beginning with establishing a single payer infrastructure.

By Brett O’Hara and Kyle Caswell
United States Census Bureau: Current Population Reports, October 2012

There is a U-shaped relationship between health status and having any type of health insurance coverage. Among all people who reported excellent health, 85.0 percent were insured. For those who reported good health, 80.2 percent had health insurance coverage. Finally, 85.1 percent of people who reported poor health also had health insurance coverage.

This U-shaped relationship for the overall insurance rate is partially attributable to trends in the type of health insurance coverage. For example, 15.7 percent of people with excellent health reported having only public insurance, compared with 44.7 percent of people with poor health. On the other hand, the percentage of people with excellent health who had private health insurance was 69.3 percent, compared with 40.4 percent of people in poor health.

http://www.census.gov/prod/2012pubs/p70-133.pdf

Comment:

By Don McCanne, MD

This seemingly mundane observation from this Census Bureau report provides great insight into the problems with health care financing in the United States.

It is astonishing that a country that spends so much on health care would have a U-shaped curve, or any curve for that matter, on the relationship between health status and whether or not one is insured.

Considering our financing system, the curve is easy to understand. People in excellent health also tend to have favorable socioeconomic circumstances that would result in higher enrollment in private insurance plans. Likewise, people in poor health tend to have less favorable socioeconomic circumstances that would result in higher enrollment in public insurance programs. People in good health would fall in between and thus would lie in the trough of the U-shaped curve, with lower rates of insurance than those well off and those benefiting from government programs.

If we had a decent health care financing system, wouldn’t those in good health be as well covered as those in excellent health and those with public programs? More importantly, shouldn’t either end of the U-shaped curve reach 100 percent coverage? And wouldn’t the trough be wiped out so everyone with good health were covered as well?

The Affordable Care Act might shift the entire curve up as more are covered, but the 30 million who will remain uninsured will perpetuate the bizarre U-shape of the curve. We need a flat line, at the top, with 100 percent coverage. That’s everyone, like we would have in an improved Medicare for all.

Health Status, Health Insurance, and Medical Services Utilization: 2010

By Brett O’Hara and Kyle Caswell
United States Census Bureau: Current Population Reports, October 2012
There is a U-shaped relationship between health status and having any type of health insurance coverage. Among all people who reported excellent health, 85.0 percent were insured. For those who reported good health, 80.2 percent had health insurance coverage. Finally, 85.1 percent of people who reported poor health also had health insurance coverage.
This U-shaped relationship for the overall insurance rate is partially attributable to trends in the type of health insurance coverage. For example, 15.7 percent of people with excellent health reported having only public insurance, compared with 44.7 percent of people with poor health. On the other hand, the percentage of people with excellent health who had private health insurance was 69.3 percent, compared with 40.4 percent of people in poor health.
http://www.census.gov/prod/2012pubs/p70-133.pdf

This seemingly mundane observation from this Census Bureau report provides great insight into the problems with health care financing in the United States.
It is astonishing that a country that spends so much on health care would have a U-shaped curve, or any curve for that matter, on the relationship between health status and whether or not one is insured.
Considering our financing system, the curve is easy to understand. People in excellent health also tend to have favorable socioeconomic circumstances that would result in higher enrollment in private insurance plans. Likewise, people in poor health tend to have less favorable socioeconomic circumstances that would result in higher enrollment in public insurance programs. People in good health would fall in between and thus would lie in the trough of the U-shaped curve, with lower rates of insurance than those well off and those benefiting from government programs.
If we had a decent health care financing system, wouldn’t those in good health be as well covered as those in excellent health and those with public programs? More importantly, shouldn’t either end of the U-shaped curve reach 100 percent coverage? And wouldn’t the trough be wiped out so everyone with good health were covered as well?
The Affordable Care Act might shift the entire curve up as more are covered, but the 30 million who will remain uninsured will perpetuate the bizarre U-shape of the curve. We need a flat line, at the top, with 100 percent coverage. That’s everyone, like we would have in an improved Medicare for all.