PNHP

Primary care a primary concern: Thousands of new patients will stress already burdened health care system

Primary care a primary concern: Thousands of new patients will stress already burdened health care system

By Charles McMahon
Portsmouth (N.H.) Herald, July 15, 2012

When more than 100,000 state residents are thrust into the health care system on Jan. 1, 2014 — the date the Affordable Care Act will go into full effect — local primary care physician Dr. Thomas Clairmont said he has only one piece of advice.

Be prepared.

Clairmont, who specializes in geriatric care and is the New Hampshire chairman of Physicians for a National Health Program, said the expected addition of approximately 134,000 uninsured residents into the system will likely be burdensome on a system already struggling to meet patients’ needs.

“Adding that many more patients will be a real problem,” Clairmont said, adding his office in Portsmouth has few openings for new patients.

With his specialty focused around elderly care, Clairmont said he believes there are several things that will need to happen before the floodgates open.

“We need more people doing geriatrics and primary care,” he said.

Clairmont said perhaps the biggest challenge to attracting more people into his line of work is the amount of debt tomorrow’s doctors carry when graduating from medical school.

Having paid $375 a semester when he was in school, Clairmont said he knows of some who are borrowing $75,000 just for the first year of their education. When it’s all said and done, Clairmont said it seems graduates end up with so much debt that most of them only consider high-paying areas of the medical field.

“It’s not because primary care isn’t fun or challenging,” he said. “It’s a matter of income.”

Clairmont said he believes one way the health care law can be improved is by including mandates for raises in salaries for primary care physicians.

This is where someone like Jeanne Ryer comes into play.

As a member of the state’s Primary Care Workforce Commission, Ryer is on the front lines of helping develop strategies to address expected shortages in the field of primary care.

Ryer, who is also director of the New Hampshire Citizens Health Initiative, said she was focused on the issue long before the Affordable Care Act came into play.

Having been in the field for some time now, Ryer said New Hampshire has struggled with shortages in the primary care workforce for years.

“New Hampshire has gone through spasms where it has had problems with primary care and provider shortages in the past,” she said.

Those shortages occurred in the 1990s and in the middle of the last decade, according to Ryer.

Despite the historical trends, Ryer said she believes the fear of a shortage may be exaggerated. She said the more than 100,000 chronically uninsured people in New Hampshire pales in comparison to other states.

“I don’t think we’ll see these floodgates open up,” she said.

The reason being, according to Ryer, is that those who are uninsured will likely fall back on the community health centers, rather than on primary care practitioners.

Ryer said that is the reason why if the state wants to prepare itself, it will invest in community health centers.

“We should be better supporting the community health centers now so they can recruit and retain people now,” she said.

Ryer said another important issue that must be addressed is the creation of more preceptor sites to train nurse practitioners and physician assistants.

“There needs to be places for people to train and practice,” she said. “Where people train is where people stay.”

All in all, Ryer said it’s clear that the state needs to do more.

Ned Helms, director of the Institute for Health Policy and Practice at the University of New Hampshire, said if the state wants to prepare itself it should look to Massachusetts.

Helms, who is also a presidential appointee to the National Prevention Strategy Advisory Group, which is part of the Affordable Care Act, said what happened in Massachusetts was that more and more people ended up filtering into the system than anticipated. When that happened, Helms said it became harder and harder for people to find a primary care practitioner.

With more than 30 years of experience in New Hampshire health policy and politics, Helms said he agrees there aren’t enough primary care physicians because of the compensation.

“We do not pay for and focus on primary care,” he said. “Historically our system is more specialty focused.”

Helms said despite there being uncertainty, the Affordable Care Act is loaded with incentives for people to go into primary care, including grants and incentives for loan repayment if a prospective doctor chooses to go into that field.

“There’s a lot of reform taking place at the local level, in that people are realizing that we have to put a heck of a lot more emphasis on primary care and that we need to start getting folks into the doctor’s office instead of the emergency rooms,” Helms said.

Dr. James Fieseher, a board-certified family practitioner who works with Clairmont, said over the last two years there has been an uptick of medical students going into primary care. However, even if a slight uptick continues, Fieseher said New Hampshire still won’t be nearly prepared enough to meet the demand in 2014. Fieseher said he imagines his office will likely need to add more physicians, but agrees with Ryer that some patients will continue to rely on health centers rather than primary care doctors.

“I already know a number of people that aren’t my patients, who want to be, but don’t have the money to come into the office,” he said.

Looking toward 2014, Fieseher said he believes the uninsured will be a tad “skittish” about how to use the new health care law, meaning the immediate influx of new patients won’t be as bad as most anticipate.

“I think 2014 will be a little bit of a shock,” he said. “But in 2015 and 2016, we won’t be able to churn out primary care physicians fast enough.”

http://www.seacoastonline.com/articles/20120715-NEWS-207150338

Health care reform: Much still to do

By Rob Stone, M.D.
Herald Times (Bloomington, Ind.), July 15, 2012

The Supreme surprise June 28 upholding the constitutionality of President Obama’s health reform still leaves much to be done before the American people will have a health care system worthy of a civilized nation. The Affordable Care Act (ACA) will never live up to its name as it contains insufficient cost controls to make care affordable. Hospitals will still charge $265 for a $2.25 tetanus shot. Insurance companies will continue to drive up premiums.

It was never designed to cover all the uninsured. The Congressional Budget Office had previously estimated that the bill would leave 26 million of the nation’s 50 million uninsured still uncovered, even when fully implemented. We await new projections, but preliminary data suggest that the Medicaid expansion ruled unconstitutional by the court will cut perhaps 8 million from the number who could otherwise expect to have been covered, leaving 34 million, or 11 percent of Americans uninsured. In the developed world, there is no other country with more than 3 percent of its population uncovered.

Too many of those insured under the ACA will have coverage so skimpy it has been described as “unaffordable underinsurance.” Millions will still be one job loss or illness away from bankruptcy.

Although the law is often referred to as “Obamacare,” it should better be called “Romneycare,” since the idea was originated by the Heritage Foundation, a conservative think tank, and famously passed by Gov. Romney in Massachusetts. Many have argued, myself included, that “Romneycare” doesn’t go far enough. Is it a step in the right direction?

What we really need is an improved Medicare for all — everybody in, nobody out. That solution is clearly constitutional. If we replaced our dysfunctional, profit-seeking, private insurance industry with a streamlined, single-payer system, we could save over $400 billion squandered annually on administrative overhead, enough to cover all of the uninsured and eliminate co-pays and deductibles for everyone else. Only a single-payer system can control costs and reduce our nation’s deficit over the long term.

In his weekly column in the Herald-Times, July 11, 2010, conservative commentator George Will wrote, “The new health care legislation is a step toward elimination, by slow strangulation, of private health insurance and establishment of government as the ‘single payer.’” May his prediction come true.

The American people need a universal health system that delivers comprehensive, equitable, compassionate and high-quality care, with free choice of provider and no financial barriers to access.

My dream is that Americans will one day join the citizens of other industrialized, capitalist democracies, from Canada to Germany, in being able to see a doctor without fear of personal debt or national deficit.

Dr. Rob Stone of Bloomington is director of Hoosiers for a Commonsense Health Plan.

http://www.heraldtimesonline.com/stories/2012/07/15/digitalcity.health-care-reform-much-to-do.sto?1342367352

Why not a single-payer system?

By Ivan Moore
Anchorage Press, July 12, 2012

To be honest with you, I’m not much of a fan of the “individual mandate.”  I don’t think it’s much of a solution, given the soaring costs of health care and health insurance, to say “You must have it!” and fine people if they don’t. I’d much prefer a single-payer system.

Single-payer is the jargon that refers to a system whereby the health insurance companies are replaced by government funding of health care. The single-payer option didn’t get much traction back when the overhaul of the health care system was being considered, which is why we ended up with the mandate.

I wonder why not?

A single-payer option would work something like this. As I pointed out last week, more money gets spent per capita on health care in the U.S. from government funding than most other countries spend in total expenditures. These government-funded programs, for better or worse, would provide the care they currently provide … Medicare, Medicaid, the VA, health insurance programs for public employees, plus those lavish Congressman and Senator benefits. The rest, the portion that is currently financed through private health insurance, would be made public.

The tax structure most often discussed would entail a personal tax on income of about 2 percent, plus a payroll tax on businesses of about 6-7 percent. This would raise a sufficient amount of revenue to entirely replace the private portion of health care expenditures, and render every single person in the country covered.

Think about what a 2 percent tax on your income would be, what it would come to dollar-wise. If you haven’t currently got health insurance, you just got a screamer of a bargain. If you do have health insurance, the 2 percent is very likely to be less than the amount you currently have to pay each year to cover deductibles, co-pays and those procedures your insurance company says they won’t cover.

Now think about the 6-7 percent payroll tax on employers. If the employer currently provides health insurance to their employees through a private plan, the payroll tax amount is very likely to be less than what they currently pay. The only employers who lose out are the ones who don’t currently provide insurance benefits to their employees.  Oh dear, so sad.

(This raises the side question of why, in a country where the vast majority of health insurance is employer-provided, we aren’t talking about an employer health insurance mandate. Shouldn’t companies who hire people and put them to work be mandated to provide health insurance to those employees? You could argue that a company that provides health insurance to their employees puts themselves, at least in respect to labor costs, at a competitive disadvantage over those that don’t. Great incentive, that.)

A single-payer system is one where everyone is covered. Where everyone receives access to the same standard of care. Where there are no longer any out-of-pocket expenses that you have to fork over. Where insurance companies don’t refuse to cover something that goes wrong with you. Where they don’t jack your premiums up or cut you off if you get too expensive.

The thing that people opposed to a system like this don’t get is that the health care itself remains pretty much unchanged. The doctors aren’t suddenly working for the government. They have their private clinics just like they do now. You would be able to choose your doctor freely, instead of being restricted to a roster chosen by your insurance company. Health care decisions wouldn’t suddenly be made by government bureaucrat death panels, they’d still be made by you and your doctor, just like now.

The bill just gets paid by the government, out of one big pool. The single payer.

It’s so simple. So bleeding obvious. Bleeding obvious… that’s a good Englishism for you. The American equivalent is “Duh!!!”

So why didn’t it happen? Well, the health insurance companies and their army of lobbyists on Capitol Hill, the ones with an iron grip on the wherewithal of every single Congressman and Senator, made sure it didn’t happen.

It’s quite a cash cow, the health insurance racket. Makes them lots of money. Your money. And they’re not letting go of it without a fight. So they dole out enough campaign contributions to keep their elected representatives quiet, no doubt in good Abramoff style, whisk them off on junkets, on holidays and to sporting events, and the end result is that single-payer doesn’t even get off the ground.

God forbid, they’d have to switch to peddling other forms of insurance, because health insurance essentially wouldn’t exist any more.

Think about all that expense for a minute. Not only the insurance company lobbyists, but the CEO salaries and the bonuses, the staggering administrative costs, the advertising costs so they can all compete against each other, and so on… all passed on to YOU in your premiums. The overhead cost for a government program like Medicare is about 3 percent, your average HMO spends 20 percent. Think about it, all of that would be gone.

So yes, I know what you’re thinking… a single-payer system really would be cheaper.  Once everyone’s covered, what would be the point of having these government programs targeted towards the more needy populations, the Medicares and Medicaids and VA programs? They’re all safety net programs that only exist because our health care is not universal. So yes, gradually, bureaucracy would decrease. And costs would go down.

And yet, people still rail against the idea. Rail against something that is categorically in their interest to support.

Funny how that happens, hey?

Ivan Moore is a public opinion pollster who lives in Anchorage.

http://www.anchoragepress.com/opinion/moore-report-why-not-a-single-payer-system/article_a9779bdc-cc98-11e1-9f91-0019bb2963f4.html

Jack Bernard's message for his fellow Republicans

Head-in-the-sand ‘solution’ is killing GOP

By Jack Bernard
DesMoinesRegister.com, July 16, 2012
We Republicans have ourselves to blame for the Affordable Care Act, or Obamacare.
Our reaction to the Clinton health reform proposals in the early 1990s was to have conservative think tanks come up with a free competition model based on expansion of private insurance and Medicaid. That idea became Romneycare, which evolved into Obamacare.
It is our baby, ugly or not.
It is the height of hypocrisy for us now to criticize our own idea unless we have something better to replace it. And, the replacement needs to be comprehensive, not just a series of unacceptable statements and proposals based on doing away with traditional Medicare by turning it into a voucher program and gutting Medicaid by making it into a block grant.
Using vouchers for Medicare just dumps the cost problem into the lap of the powerless patient, rather than the federal government that has clout, making the cost escalation problem worse. The block grants for Medicaid idea just shifts the cost issue onto the states rather than the federal government, which once again solves nothing and only makes things worse.
States will just cut services and people from their Medicaid roles, creating more uninsured. Don’t Iowa hospitals serve enough uninsured in their emergency rooms now?
This gets us to what we as Republicans should do: throw out our rule book and be innovative. People my age will remember how we Republicans were 100 percent against recognizing China before Richard Nixon, the anti-communist crusader, came out for it. We must do the same with health care.
There is only one way to control health care costs and insure universal access — and that is by first admitting that the U.S. system has failed and then adopting ideas that have been proven to work elsewhere. We should take a look at how health care is financed and delivered in other developed nations with lower cost and better morbidity and mortality rates.
A Commonwealth Fund study was issued in May 2012 which did just that for 13 countries. The bottom line is that we spend 17.4 percent of our gross national product on health care, far more than other developed nations, which averaged 9.5 percent. Our per-capita spending was $7,960 versus $3,182 for the group as a whole.
Why? One key factor is prices. For example, U.S. pricing on the 30 most commonly prescribed brand name drugs is one-third higher than Canada and double France, both of which have a form of Universal Medicare.
From looking at the international data, if we Republicans really want to dump the Affordable Care Act, the way to go is Medicare for all. Studies show that the nations with universal health care have better overall health care outcomes than we do, not worse.
And, according to the respected Physicians for a National Health Program, www.pnhp.org, yearly savings generated under Medicare for all would be $400 billion. That would go a long way towards paying for universal coverage, versus the Affordable Care Act, which will increase systemic costs because it relies on private insurance.
The canard about waiting times to see doctors is just a tactic to scare the public. If you need a knee replacement for a knee that has been going bad for years, waiting a little longer for an operation should not be a major issue for the patient. Despite the scare tactics, no one who needs immediate care in Canada is ever left to sit in a line. In any case, there should be no waiting lists at all here. Canada spends just $4,363 per capita on health care versus our $7,960.
If we Republicans took the Medicare-for-all approach, it would thrust us into the vanguard of reform. Instead of the Democrats stealing our ideas, we could steal theirs. When it was implemented and turned out to be widely accepted, as was Medicare in the 1960s, we would be the party the public would look to for the future.
Of course, there is an alternative. We can stick our heads in the sand and push for infeasible actions. That approach is killing us regarding immigration and will work just as well for health care.
(JACK BERNARD of Monticello, Ga., is a retired health care executive who worked extensively with Iowa health care providers, including Iowa Health System. He now is a member of the Jasper County (Ga.) Board of Commissioners and Jasper County Board of Health. Contact: bernard_jack@hotmail.com)
http://www.desmoinesregister.com/article/20120716/OPINION01/307160040/

This article should be distributed widely. Although it is written by a Republican, targeting his fellow Republicans, if his party can understand this message, then the Democrats and others who bailed on Medicare for all should be able to understand it as well.

U.S. women face higher health care costs

Oceans Apart: The Higher Health Costs of Women in the U.S. Compared to Other Nations, and How Reform Is Helping

By Ruth Robertson, David Squires, Tracy Garber, Sara R. Collins, and Michelle M. Doty
The Commonwealth Fund, July 2012

Abstract

An estimated 18.7 million U.S. women ages 19 to 64 were uninsured in 2010, up from 12.8 million in 2000. An additional 16.7 million women had health insurance but had such high out-of-pocket costs relative to their income that they were effectively underinsured in 2010. This issue brief examines the implications of poor coverage for women in the United States by comparing their experiences to those of women in 10 other industrialized nations, all of which have universal health insurance systems. The analysis finds that women in the United States — both with and without health insurance — are more likely to go without needed health care because of cost and have greater difficulty paying their medical bills than women in the 10 other countries. In 2014, the Affordable Care Act will substantially reduce health care cost exposure for all U.S. women by significantly expanding and improving health insurance coverage.

From the Conclusion

When fully implemented, the Affordable Care Act will correct much of the inequity in the U.S. system. A substantial expansion of affordable health insurance options is expected to reduce the percentage of uninsured working-age women from 20 percent to 8 percent.

http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Jul/1606_Robertson_oceans_apart_reform_brief.pdf

Comment: 

By Don McCanne, MD

Over 35 million working-age women in the United States potentially face financial hardship should they need health care either because they are uninsured or because their insurance exposes them to excessive out-of-pocket expenses. That’s not acceptable.

The authors of this Commonwealth Fund report note how the Affordable Care Act “will correct much of the inequity in the U.S. system.” But not enough. Not only will underinsurance remain a problem, 8 percent of working-age women will have no insurance at all. That’s not acceptable either, especially since we already know how to fix our system and can afford to do so. We simply have to do it.

U.S. women face higher health care costs

Oceans Apart: The Higher Health Costs of Women in the U.S. Compared to Other Nations, and How Reform Is Helping

By Ruth Robertson, David Squires, Tracy Garber, Sara R. Collins, and Michelle M. Doty
The Commonwealth Fund, July 2012
Abstract
An estimated 18.7 million U.S. women ages 19 to 64 were uninsured in 2010, up from 12.8 million in 2000. An additional 16.7 million women had health insurance but had such high out-of-pocket costs relative to their income that they were effectively underinsured in 2010. This issue brief examines the implications of poor coverage for women in the United States by comparing their experiences to those of women in 10 other industrialized nations, all of which have universal health insurance systems. The analysis finds that women in the United States — both with and without health insurance — are more likely to go without needed health care because of cost and have greater difficulty paying their medical bills than women in the 10 other countries. In 2014, the Affordable Care Act will substantially reduce health care cost exposure for all U.S. women by significantly expanding and improving health insurance coverage.
From the Conclusion
When fully implemented, the Affordable Care Act will correct much of the inequity in the U.S. system. A substantial expansion of affordable health insurance options is expected to reduce the percentage of uninsured working-age women from 20 percent to 8 percent.
http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Jul/1606_Robertson_oceans_apart_reform_brief.pdf

Over 35 million working-age women in the United States potentially face financial hardship should they need health care either because they are uninsured or because their insurance exposes them to excessive out-of-pocket expenses. That’s not acceptable.
The authors of this Commonwealth Fund report note how the Affordable Care Act “will correct much of the inequity in the U.S. system.” But not enough. Not only will underinsurance remain a problem, 8 percent of working-age women will have no insurance at all. That’s not acceptable either, especially since we already know how to fix our system and can afford to do so. We simply have to do it.

WP's Richard Cohen on Obama and single payer

Terror among the rich

By Richard Cohen
The Washington Post, July 9, 2012

I wrote last year that Obama had lost the Hamptons. Nothing has changed. He is roundly denounced for not doing a Heimlich on the economy, for his allegedly socialist ways, for Obamacare, for low employment, for high unemployment, for not returning phone calls, for not asking advice — for being cold, distant and, increasingly, just for being president of the United States. The man, it seems, has to go.

I share some of these sentiments. The economy remains in the doldrums, the occasional good month followed by two or three bad ones. Obama is something of a cold fish, which may be something he cannot help, but he is also a lazy politician, unwilling — not unable — to do the telephoning and backslapping that his job requires.

As for Obamacare, it is both a legal and programmatic mess not because it is even modestly socialist but because it is not socialist enough. A government-run health-care system such as the ones used in virtually all the industrialized world — the so-called single-payer system — would have been the way to go. Instead, we have a system in which private insurance companies will abuse doctors and patients alike in the cause of profit. This, alas, truly is the American Way.

http://www.washingtonpost.com/opinions/richard-cohen-obama-the-ineffable/2012/07/09/gJQA3mcCZW_story.html

Comment: 

By Don McCanne, MD

Obviously, this quote is being distributed because of the strong endorsement of single payer, a vastly superior model of financing health care when compared to the current “American Way” of using private insurance companies.

Although, in this opinion article, Richard Cohen blasts President Obama for his, shall we say, inaction, he doesn’t include here the difficulties Obama faced from the obstructionism by the opposition party, nor from the inaction of the electorate which suffers from a combination of being uninformed and misinformed, thus unable to advocate effectively for policies that would benefit us all. Of course, the candidate of the opposition party spent the weekend in the Hamptons hauling in millions in campaign donations from the “terrified rich,” thus offering little hope that the November elections would bring us any relief from our political quagmire.

Political leaders do not lead; they follow. We will have to lead by promoting education, coalitions, and grassroots efforts. It will be not be easy, but there is no substitute for massive citizen activism.

WP’s Richard Cohen on Obama and single payer

Terror among the rich

By Richard Cohen
The Washington Post, July 9, 2012

I wrote last year that Obama had lost the Hamptons. Nothing has changed. He is roundly denounced for not doing a Heimlich on the economy, for his allegedly socialist ways, for Obamacare, for low employment, for high unemployment, for not returning phone calls, for not asking advice — for being cold, distant and, increasingly, just for being president of the United States. The man, it seems, has to go.

I share some of these sentiments. The economy remains in the doldrums, the occasional good month followed by two or three bad ones. Obama is something of a cold fish, which may be something he cannot help, but he is also a lazy politician, unwilling — not unable — to do the telephoning and backslapping that his job requires.

As for Obamacare, it is both a legal and programmatic mess not because it is even modestly socialist but because it is not socialist enough. A government-run health-care system such as the ones used in virtually all the industrialized world — the so-called single-payer system — would have been the way to go. Instead, we have a system in which private insurance companies will abuse doctors and patients alike in the cause of profit. This, alas, truly is the American Way.

http://www.washingtonpost.com/opinions/richard-cohen-obama-the-ineffable/2012/07/09/gJQA3mcCZW_story.html

Comment: 

By Don McCanne, MD

Obviously, this quote is being distributed because of the strong endorsement of single payer, a vastly superior model of financing health care when compared to the current “American Way” of using private insurance companies.

Although, in this opinion article, Richard Cohen blasts President Obama for his, shall we say, inaction, he doesn’t include here the difficulties Obama faced from the obstructionism by the opposition party, nor from the inaction of the electorate which suffers from a combination of being uninformed and misinformed, thus unable to advocate effectively for policies that would benefit us all. Of course, the candidate of the opposition party spent the weekend in the Hamptons hauling in millions in campaign donations from the “terrified rich,” thus offering little hope that the November elections would bring us any relief from our political quagmire.

Political leaders do not lead; they follow. We will have to lead by promoting education, coalitions, and grassroots efforts. It will be not be easy, but there is no substitute for massive citizen activism.

Rejected single-payer plan would have saved billions

By Milton Hirshberg, M.D.
Cap Cod Times, Letters, July 12, 2012

Economists at the Centers for Medicare and Medicaid Services have projected that all of medical care spending will grow at an annual average of 5.8 percent over the period 2010 to 2020. The growth is only slightly faster than that of the core system we had in the absence of the new legislation.

So what part of that 5.8 percent growth is attributable to the new act? Well, it’s one-tenth of one percent. Using the total spending in 2010, $2.6 trillion, as an example, the increase amounts to about $26 billion now and $40 billion by year 2020.

We realize it’s the core system, now tried and demonstrated to be a debacle, that deserves our economic concern for replacement. Its cost is projected to double by 2020.

Unfortunately for us, Congress has consciously chosen over the years to take the road to folly. In 2009, senators, in their unwisdom, evicted doctors who came with a rescue plan: implementation of a publicly supported, universal, single-payment mechanism for management and claims processing, estimated to save more than $300 billion a year. Go figure.

Dr. Milton Hirshberg resides in South Harwich, Mass.

http://www.capecodonline.com/apps/pbcs.dll/article?AID=/20120712/OPINION/207120332/-1/NEWSMAP

WP's Richard Cohen on Obama and single payer

Terror among the rich

By Richard Cohen
The Washington Post, July 9, 2012
I wrote last year that Obama had lost the Hamptons. Nothing has changed. He is roundly denounced for not doing a Heimlich on the economy, for his allegedly socialist ways, for Obamacare, for low employment, for high unemployment, for not returning phone calls, for not asking advice — for being cold, distant and, increasingly, just for being president of the United States. The man, it seems, has to go.
I share some of these sentiments. The economy remains in the doldrums, the occasional good month followed by two or three bad ones. Obama is something of a cold fish, which may be something he cannot help, but he is also a lazy politician, unwilling — not unable — to do the telephoning and backslapping that his job requires.
As for Obamacare, it is both a legal and programmatic mess not because it is even modestly socialist but because it is not socialist enough. A government-run health-care system such as the ones used in virtually all the industrialized world — the so-called single-payer system — would have been the way to go. Instead, we have a system in which private insurance companies will abuse doctors and patients alike in the cause of profit. This, alas, truly is the American Way.
http://www.washingtonpost.com/opinions/richard-cohen-obama-the-ineffable/2012/07/09/gJQA3mcCZW_story.html

Obviously, this quote is being distributed because of the strong endorsement of single payer, a vastly superior model of financing health care when compared to the current “American Way” of using private insurance companies.
Although, in this opinion article, Richard Cohen blasts President Obama for his, shall we say, inaction, he doesn’t include here the difficulties Obama faced from the obstructionism by the opposition party, nor from the inaction of the electorate which suffers from a combination of being uninformed and misinformed, thus unable to advocate effectively for policies that would benefit us all. Of course, the candidate of the opposition party spent the weekend in the Hamptons hauling in millions in campaign donations from the “terrified rich,” thus offering little hope that the November elections would bring us any relief from our political quagmire.
Political leaders do not lead; they follow. We will have to lead by promoting education, coalitions, and grassroots efforts. It will be not be easy, but there is no substitute for massive citizen activism.

Dr. David Scheiner on CNBC’s “Closing Bell”

Watch Dr. David Scheiner in this excerpt from his appearance on CNBC’s “Closing Bell” with Maria Bartiromo on June 28, 2012. Dr. Scheiner, an internist, was President Barack Obama’s personal physician from 1987 till 2008 while the latter was based in Chicago. He is a member of Physicians for a National Health Program and an outspoken advocate of single-payer health reform. The other person being interviewed in this segment was David Cordani, CEO of Cigna, the giant insurance company.

Myths about ED use by Medicaid patients

Dispelling Myths About Emergency Department Use: Majority of Medicaid Visits Are for Urgent or More Serious Symptoms

By Anna Sommers, Ellyn R. Boukus, Emily Carrier
Center for Studying Health System Change, July 2012

Contrary to conventional wisdom that Medicaid patients often use hospital emergency departments (EDs) for routine care, the majority of ED visits by nonelderly Medicaid patients are for symptoms suggesting urgent or more serious medical problems, according to a new national study by the Center for Studying Health System Change (HSC). About 10 percent of nonelderly Medicaid patient ED visits are for nonurgent symptoms, compared with about 7 percent for privately insured nonelderly people.

Misconceptions

Policy makers and providers frequently point to Medicaid patients’ heavy reliance on hospital emergency departments as a problem that contributes to crowded emergency departments, long wait times and high costs, as well as poor management of chronic conditions. Recent research has dispelled misconceptions linking ED use to crowding, finding that most crowding results from emergency patients admitted to the hospital but waiting for an inpatient bed—so-called ED boarding—not a high volume of nonurgent ED visits. Other research has dispelled the mistaken belief that most ED users have Medicaid coverage, are uninsured or do not have a usual source of care. In fact, people with private insurance account for most ED use, and people with higher incomes and a private physician as their usual source of care are driving ED visit increases over time.

Other misconceptions about Medicaid patients’ ED use continue to drive policy. In response to state budget crises, some Medicaid programs have sought to cut ED use by denying payment for emergency care viewed as unnecessary, increasing patient cost sharing to discourage visits and penalizing patients for too many ED visits—all based on the assumption that Medicaid patients commonly use EDs to evaluate symptoms that could wait for a primary care clinician to treat. Media coverage of so-called frequent flyers—a small number of people with hundreds of ED visits—may have contributed to commonly held views that Medicaid and uninsured patients often use emergency departments inappropriately.

http://www.hschange.com/CONTENT/1302/

Comment: 

By Don McCanne, MD

In an effort to control health care spending we are seeing efforts to punish Medicaid patients for their excessive use of our Emergency Departments (EDs). This reports adds to the policy literature that confirms that this premise is flat out wrong. Just like privately insured patients, most Medicaid patients use EDs for urgent and emergency conditions.

Rather than penalizing patients for attempting to receive urgent care that they should have, we should direct our efforts to incorporating health system design changes that would improve access to urgent care services, both through EDs and through other community resources such as extended-hour practices and urgent care centers. As an example, EDs could use community physicians during peak hours to provide care for less intensive problems that have been sorted out by triage.

With a single payer system we could adjust incentives to encourage more effective and efficient use of our health care delivery system. Under our current fragmented financing system, dominated by private health plans and perpetuated by the Affordable Care Act, rational coordination of care for urgent conditions is not possible because of conflicting interests, financial and otherwise.

We can do a much better job of getting our priorities straight through a single payer national health program.