Saturday, August 29, 2009
Aaron Fox on NY1
David Herszenson on ABC
LA Times (AP)
MSNBC / Washington Post
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Thursday, August 27, 2009
Sharon Phillips, NPA NY, wrote a compelling letter to the editor to Wicked Local, Concord, MA to share her support for health care reform.
To the editor:
Although I am currently a family doctor practicing in the Bronx, I grew up in Concord. I was disappointed to read of the angry opposition Congresswoman Niki Tsongas received at her Town Hall meeting on Aug. 8. As a physician, I strongly support a public health insurance plan. While private insurance companies pay high executive salaries and operate to maximize shareholder profits, a public health insurance plan would be designed to pay solely for the needs of its members.
While protesters of health reform fear that their options will decrease, the truth is that a public health insurance plan will provide an affordable alternative to prohibitively expensive private insurance and will foster competition to guarantee that quality, affordable coverage will be there for everyone in America when they need it.
Every day I see patients who cannot get the health care they need, either because they have lost their job, their insurance premiums have become unaffordable, or because their insurance company has denied a necessary treatment in order to save money. Several of my patients have been admitted to the hospital this year because they couldn’t afford their medications, turning controllable chronic conditions into emergencies.
Guaranteeing coverage for all through a public health insurance plan will mean that I can spend time with my patients and know that neither of us needs to worry about whether they will have access to the care they need in the future.
My patients deserve this peace of mind. I urge your readers to contact Congresswoman Tsongas to affirm their support for health care reform that includes a strong public health insurance option.
Sharon Phillips, M.D.
Montefiore Medical Center
Monday, August 24, 2009
Over the last several days, I participated in several amazing events hosted by various organizations in the NYC metro area. My first event was a Thursday afternoon grand rounds at Bronx Lebanon Hospital. Dr. Bill Jordan, NPA NY, gave a lecture about physicians' role in health care advocacy. He engaged an audience of 50 plus medical students, residents, and faculty in cases discussion about green markets in NYC and NPA action in health care reform debate. Later that night, leaders of grassroots organization gathered at CIR/SEIU for a teach-in on the various legislative plans being considered and for a support-strategy meeting. On Friday, we held a press conference at Ryan Chelsea health center to let our congressional leaders and our President know that we support the public health insurance option. Community members/health activists shared their stories demonstrating the failure of our current health care system. Among them, Dr. Manisha Sharma's personal experience illustrated that even insured patients (premium paying members) are not immune from insurance companies' profit mongering (watch video here). And tonight, I joined a few members of NPA NY and NYC for Change at a Nine Inch Nails concert to rally support among young adults, who are commonly affected by the lack of affordable health insurance.
Though we are a group of local NY/NJ physicians, I know we don't stand alone. About a half million doctors nationwide support the public health insurance option. And we stand with our millions of patient - insured, under-insured, and uninsured - as we fight for a public health insurance option.
We are mobilizing, standing strong, and will make our voices heard.
Stand with us, show your support:
Unity Rally for Health Care, August 29th, 2pm
Karen Wang, MD
NPA NY Local Action Network
More photos, courtesy of Eva Brams
Wednesday, August 19, 2009
An article today in Kaiser Health News discussed the measure of Americans' confidence in reform of our current health care system - confidence is down just in case you were wondering. Much of what was cited in the article was fear of change. That fear was found to be based on mistaken beliefs about the current proposals - a government take-over of health care, covering all 'illegal immigrants' etc.
On a daily basis, whether practicing medicine in the clinic or the hospital, we as physicians counsel patients on their diagnoses and best choices of therapies. Recently, I talked to a mother about getting a spinal tap done to rule out meningitis in her young son with fever. She had significant fears about what this meant and what the risks were. I listened, tried to address those fears and any questions she had while advocating that this was the best therapeutic choice. We are all trained in this, either formally or informally, and it is essential to practicing good medicine.
In discussing the health care reform process, some of us seem to be forgetting some of the basic tools that we use to encourage patients to follow what we see as the best choice of therapy. Listening, addressing questions and concerns in plain language and taking into account where the person is coming from while advocating for what we see as the best option are things we should consider applying to our engagement in the current debate.
There are significant fears in people’s minds about health care reform as the article pointed out. I think a lot of that fear can be assuaged through using language that is neutral yet accurate – others have proposed talking about ‘a family doctor for every family’ or a ‘pediatrician for every child’ instead of ‘universal health care.’ Specifically asking what is it about government-run health care that people are afraid of and then addressing whatever fear that is – bureaucrats will not be taking the place of your doctor.
As physicians, we counsel patients on a daily basis to take medications and undergo procedures that have inherent risks, that they have fears about but that we think are the best option. We have the training to do so. While this is nothing new, this study I think serves as a good reminder that we should use the training that we have to advocate for the health care reform that we see as best for our patients and try not to fall back on political rhetoric (even if instigated by the ‘opposing side’), confusing terminology or brush off people’s concerns and fears. I believe that the current proposal with a public health insurance option is the best for my patients, but the patients have to want it too.
Alex Foster, MD, MPH
Sunday, August 16, 2009
The Whole Foods Alternative: Organic Produce (and Health Insurance Reform) for those who can afford it.
By Aaron Fox, MD
National Physicians Alliance
Wasn’t it just last year that we heard from political pundits that arugula munching Barack Obama was out of touch with average Americans. Well apparently John Mackey, CEO and co-founder of Whole Foods Market, not only shares President Obama’s concern with the price of arugula but also the price of health care in America. In a Wall Street Journal op-ed piece, he shares an eight point plan for controlling health care costs, some of which is derived from his own experience in providing health insurance for his employees. His plan includes promoting high deductable health insurance plans, deregulating health insurance markets and strengthening the individual market, and solving the problem of 46 millions uninsured Americans through charity. Well sorry, Mr. Mackey, like many of the luxury goods at Whole Foods Market, your health reform ideals are out of touch with the lives of many Americans.
High deductable health insurance plans, or consumer directed health reform, where individuals are responsible for the first $1,000 - $2,500 of health care that they consume (not including premiums) and the insurance company covers catastrophic care, is not a new innovation introduced by Whole Foods and other forward thinking entrepreneurs. These plans have been around for decades, and while they are certainly less expensive than comprehensive health care benefits, evidence so far shows that they have only had a moderate effect on controlling costs and their impact on quality of care is unknown.
Unlike CEO Mackey, as a physician, I am not just worried about health care costs, but also the quality of care for my patients. In the 1970’s, the RAND health insurance experiment studied the impact of different types of health plans, including free care and plans where patients had increasing levels of responsibility for the costs of their care. Families who were randomly assigned to higher levels of cost sharing consumed less health care than those receiving free care, but they did so by avoiding both necessary and unnecessary care. For the poorest families, going without care may have saved money, but it also had a real health impact. In just a decade, it was estimated that the option with free care reduced deaths by 10% for patients with hypertension and low socioeconomic status. While high deductible plans are attractive to the young and healthy, like those who work at Whole Foods markets, we need to provide high quality health care that is affordable to everyone, especially those who are sick and struggling economically. In a review of consumer directed health care reform, including high deductible plans with health savings accounts, health economist M. Gregg Bloch, “if consumer-directed plans achieve market dominance, disparities in care by class and race will probably grow.”
Case in point, this week I saw Ms D, who works as a mental health counselor and receives health insurance through her employer. Her plan covers office visits, but she has high co-pays for her medications, which she cannot afford. Her blood pressure and cholesterol have been very elevated, and she requires medication to reduce the risk of heart attack and stroke. This past visit her blood pressure was great, but her cholesterol had not responded to medications, so I inquired more. It turns out that she chose to purchase the blood pressure medications because they are cheaper. While empowering patients in health care decision making is a noble intention, my patient’s decision is one that no one should have to make.
Mr. Mackey uses his op-ed forum to criticize socialized medicine and emphasize personal responsibility, but creating a dichotomy where “government controlled” health care is bad and individual health care decisions are good serves more as a political tool for inciting rage, rather than a model to improve our current dysfunctional health care system. The bill being debated in the House of Representatives is a compromise between a single payer government plan and one that favors private health insurance, and it seeks to improve the health care system not make a political point.
I agree with Mr. Mackey’s emphasis on healthful living and disease prevention, but not everyone can afford to shop at Whole Foods and purchase organic produce. I recommend a healthful diet to all my patients, and many tell me that fresh fruits and vegetables are either too expensive or unavailable in the local convenience shops or “bodegas” where they do most of their shopping. To respond to the need for affordable produce, the City Council and Department of Health in New York City have developed programs to promote green markets throughout the city and provide incentives where food stamps recipients can use their benefits cards to purchase fresh produce and healthful foods. Sometimes, the government can do good, and there are provisions for strengthening the federal public health infrastructure within the House health reform bill.
In terms of increasing health care costs, one of the problems shared by both Medicare and private insurance is expanding use of new technologies, and the perverse incentives for doctors to provide more care whether it is beneficial or not. The House proposal seeks to address these perverse incentives, first, with its funding of comparative effectiveness research, which would help doctors understand which treatments and technologies are of high value, and second, with its Medicare reimbursement reforms, which would pay doctors for improving health outcomes not simply for performing procedures. To control growth in health expenditures, we should be making it easier for people to access high value care while limiting payment for care with limited or no value. For example, cutting co-payments for extremely effective cholesterol lowering medications could save $1 billion per year by preventing patients from skipping doses due to costs and therefore preventing heart attacks and strokes. Sometimes providing free care SAVES MONEY. Patients should also be involved in deciding what care is of high value, but suggesting that a patient with cancer could rationally decide what care is worth the costs is unrealistic.
Socialism and personal responsibility are value laden terms, but we should not let our ideology get in the way of reform that would improve the lives of millions. Charity is a nice idea, and Americans are very giving in times of need, but patients should not have to grovel for health care when they are sick; healthful living and prevention is a must, but there are millions of people in need of immediate medical care and who have no means to pay for it; the argument over the “right” to health care has already been decided - people cannot be turned away from emergency rooms if they are ill. Now, we need to create a rational health care system that serves all Americans, emphasizes healthful living and prevention, and controls the growth in health care costs, not simply one that fits the fantasies of free market ideologues.