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August 17, 2009
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IN
THIS ISSUE
Editor's Column:
Numbers, Numbers On The Wall Which Are The Truest Of
Them All?
In My Opinion: Support For Real Dialogue
MSMS Weighs In On Federal Health Care
Reform Legislation
MSMS Letter To Congress
Dr. Smitherman Wins $25,000 Toward
Community Work As Kanter Prize Finalist
White House Back Away From Public Option
Crain's Health Care Leadership Summit
2009 Reader Survey
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Editor's
Column: Numbers, Numbers On The Wall, Which Are The
Truest Of Them All?
By
JOSEPH WEISS, MD
The roaring rhetoric in the health reform debate uses statistics
as if such were cannon balls to blast holes into the arguments of
opponents. Often a closer look at these statistics will reveal they
are not much more than a bubble holding hot air.
We can begin with the statement that 70 percent of Americans
are covered by health insurance. The best basis for these
numbers is the United States Census:
Income, Poverty, and Health Insurance Coverage in the United
States 2007. This document showed that the percentage of
Americans with health insurance was 67.5 percent. The Census
document made no statement regarding the adequacy of coverage.
Fortunately, in 2007, The Commonwealth Fund investigated
this question and found that 41 percent of adults with
insurance experienced difficulty in paying their health
bills.
Keep in mind that we are approaching 2010. The statistics
of 2007 are really more then two years old, as the downward
changes in employment and earnings was not even considered
in 2007.
A look at the reality and how it differs from the rhetoric
comes out when one investigates the health care of Congressmen.
Go to www.opm.gov/insure/rates/index.asp.
This website gives the premiums for the Federal Government
Health Benefits Program. The site also lists the benefits
each plan confers. The benefits and cost is similar to
what a MSMS member would pay for a Michigan State Medical
Society BCBS plan. That is, the plans are the same ones
you or I would choose for our office staffs and ourselves.
A congressman can provide coverage for a single, healthy
legislative assistant, age 24-28, for $5,000 a year. The
congressman, whether senator or representative, could provide
health care for his family at a cost between $12,000-$15,000
a year. Remember that these policies are at risk for the
same 8 percent- 20 percent increase we face with our Michigan
BCBS policies.
We must use caution in accepting the assertions of zealots
on the costs, gains, losses and supposed consequence of
action on health care in Washington. We must reject “facts” presented
to us without documentation or citation. Not only do “ figures
lie and liars figure,” but also zealots assert and assertions
without provenance are really just deceits. Just as in
the marketplace, if someone from the editorial page wants
to sell you on his or her product, recall the Roman admonition:
Let the buyer beware.
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In
My Opinion: Support For Real Dialogue
By H.
MICHAEL MARSH, MB BS
Exactly as Dr. Dobzyniak outlines in his column, “Support for What?” (7-27-09,
e-edition), the USA cannot afford the “ungodly, preposterous, irresponsible
and destructive deficit spending” spree launched by the prior Bush-Cheney
administration for two unwinnable wars and for an out of control
market-driven health care system, which currently gobbles up $1 in
every six of our Gross Domestic Product. With 30 cents of that health
care dollar being spent on “administration” for the current mess
(our health care system as driven by the market, controlled by the
current covey of “profiteering” third-party payers), where is the
value to our population from that current expenditure? We rank 42nd
in longevity and have some of the worst figures for other measures
of our population’s health amongst developed nations. We have about
48 million “uninsured”, with about the same number on Medicaid, which
in Michigan means under insured. This amounts to implicit rationing
of healthcare to our population through denial of equal access to
providers, some of whom refuse to accept uninsured or under insured
patients for obviously rational business reasons under the current
payment formulae. One cannot simply stand aside and allow the current
situation to continue if one has any sense of the community need,
distributive justice or fiscal responsibility.
Surely
hardworking physicians do need and should expect fair recompense
for their work in any system that is set up to address
this disaster. The AMA, by taking its current stance, has
simply sought to enter the dialogue around H.R. 3200 on
a positive note. Backbiting criticism of that action is
not likely to move the debate forward and exposes the usual
modus operandi for us as physicians, that is opposition
to change in any form, to deserved attack. Furthermore,
continuation of the current payment formulae will continue
to disincentivize family physicians amongst us, since they
are paid at about half the rates currently considered acceptable
for procedural specialists, including my own specialty
of Anesthesiology. This is not the way to re-engineer the
system for the future. We must accept the facts as they
are and come forward into this great debate over our own
future with positive plans for change which will improve
our nation’s health and provide a health care system which
actually works for the community, not just for some selfish
ends pertaining only to us.
H.R.
3200 is flawed and in my personal opinion does not go far
enough toward detailing the competitive public health system
which will bring the “profiteering” third-party payers
to bay. Nor does it really outline the ways in which our
own behavior must change, to allow re-engineering toward
the appropriate ends we would all accept as rational for
our community. We must have a scheme which ensures access
to all for basic affordable health care of real value to
the community if we are to justify the expenditure of 17
percent of our GDP to this end. Hopefully as this bill
and the Senate’s as yet unrevealed plans move forward we
will encourage and perhaps actually see our great Nation
make a silk purse out of the veritable sow’s ear. I live
in hope that Winston Churchill was correct when he is,
perhaps apocryphally, held to have stated; “One can always
count on the Americans to do the right thing, after they
have tried all the other alternatives first.” Let us, as
we enter the dialogue, focus on the basic principles which
we believe will work toward providing the best outcome
for our community, and try to forge together a positive
plan which may work to those ends, before we simply go
back on our usual rampage of opposition to others' suggestions.
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MSMS
Weighs In On Federal Health Care Reform Legislation
While
health care reform legislation currently in Congress addresses
many of the principles of the Michigan State Medical Society
(MSMS), serious concerns remain about a number of issues
including the public health insurance option and the need
for medical liability reform.
"It
is our objective to be a constructive partner with Congress
and our patients to arrive at health care reforms that
are meaningful, fair and sustainable," wrote MSMS
president Richard E. Smith, MD, a Detroit obstetrician/gynecologist,
in a letter sent to Michigan's Congressional delegation
on Monday. The letter was the culmination of significant
health care reform discussion at the annual MSMS Board
strategic planning session this past weekend.
In
the letter (which appears below), Dr. Smith noted that
a number of provisions of H.R. 3200 "are consistent
with principles held by MSMS." These include extending
insurance coverage through insurance market reforms, ensuring
choice of plans and eliminating coverage denials based
on pre-existing conditions, among others.
"Serious
concerns" remain, however, about the proposed public
health insurance option (PHIO). MSMS suggested that before
considering the creation of a full-fledged public option,
Congress should initiate pilot projects "that would
help provide data about how a PHIO would either positively
or negatively impact an existing health insurance market." MSMS
noted that physicians for many years have had bad experiences
with Medicare funding and are "justifiably skeptical
that a PHIO will be able to sustain the proposed physician
reimbursement after the initial authorization." MSMS
also believes that participation in any health plan, public
or private, should be voluntary.
The
cost of frivolous lawsuits against physicians also is a
significant "direct or indirect cost driver in health
care," the letter stated, and any health care reform
proposal should look at ways to minimize the impact of
liability on cost.
"It
is in the spirit of cooperation that we submit these comments
and will continue to engage in a constructive dialogue
to enact meaningful reform," Dr. Smith concluded.
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MSMS
Letter To Congress
July
20, 2009
The
Honorable (full name)
U.S.
House of Repesentatives
Washington,
DC 20510
Dear
Congressman/woman (last name):
On
behalf of the Michigan State Medical Society (MSMS), I
am writing in regard to the recent developments in the
US House and Senate related to Health Care Reform. We
appreciate that the debate for meaningful health care reform
has taken center stage in Washington and among the public. It
is our objective to be a constructive partner with the
Congress and our patients to arrive at health care reforms
that are meaningful, fair, and sustainable.
Congress,
the President, patients, businesses, physicians, and many
others within the health care community agree that health
care reform is needed. As physicians we are concerned
that the expectations of the public, coupled with the desire
of some health care interest groups to derail health reform,
raises the stakes in terms of getting reform right the
first time. Failure to enact reforms that are meaningful
to the public as well as financially viable for the long-term
will squander this confluence of goodwill and cooperation.
While
MSMS has serious concerns with aspects of the legislation
in its current form, many of the provisions of H.R. 3200
are consistent with principles held by MSMS:
Promises
to extend coverage to all Americans through health insurance
market reforms;
Provides
consumers with a choice of plans through a health insurance
exchange;
Includes
essential health insurance reforms such as eliminating
coverage denials based on pre-existing conditions;
Recognizes
that fundamental Medicare reforms necessary for its long-term
viability, including repeal of the sustainable growth rate
formula, are essential to the success of broader health
system reforms;
Encourages
chronic disease management and care coordination through
additional funding for primary care services, without imposing
offsetting payment reductions on specialty care;
Addresses
growing physician workforce concerns;
Requires
individuals to have health insurance, and provides premium
assistance to those who cannot afford it;
Includes
prevention and wellness initiatives designed to keep Americans
healthy;
Makes
needed improvements to the Physician Quality Reporting
Initiative that will enable greater participation by physicians;
and
Initiates
significant payment and delivery reforms by encouraging
participation in new models such as accountable care organizations
and the patient-centered medical home.
These
aspects have been previously communicated by the American
Medical Association, and represent tremendous progress
in terms of changing the health care system and are welcome
developments by the physician community.
MSMS
Recommendations for Further Improvement
In
order to address aspects of the legislative packages that
raise concerns and to create health care reform that is
viable and sustainable into the future, MSMS recommends
action on the following:
Understanding
the Public Health Insurance Option – Much debate has occurred
over what transformation will take place if a public health
insurance option (PHIO) is offered. However, all
of these predictions are speculative at this point. What
is certain is that the health insurance marketplace will
be transformed. Such a significant transition warrants
further study. Pilot projects would help provide
data of how a PHIO would either positively or negatively
impact an existing health insurance market.
Funding
Concerns over the Public Health Insurance Option – Physicians
have spent much of the last decade working with the Congress
to assure that Medicare funding has been maintained. Physicians
have endured a great deal of uncertainty with respect to
Medicare funding due to the flawed sustainable growth rate
methodology. This exercise has eroded much of the
trust between physicians and the Medicare program. Furthermore,
the projected shortfall for the Medicare program is well
documented. It is for these reasons that physicians
are justifiably skeptical that a PHIO will be able to sustain
the proposed physician reimbursement after the initial
authorization.
Clarity
of Physician Participation Rules – MSMS believes that participation
in any health plan should be voluntary. Any Public
Health Insurance Option should unambiguously stipulate
that physician participation in Medicare or any other program
not be contingent on participation in the PHIO.
Recognition
of Local Reimbursement and Quality Initiatives – Care should
be taken not to restrict local quality and reimbursement
efforts when determining national quality and reimbursement
programs. Instead, efforts should be made to support local
experimentation, pilots, and solutions, including experiments
with local accountable care organizations. Successful
local initiatives can serve as models that can be replicated
at the national level.
Medical
Liability Reform – The physician community understands
that health care reform has resulted in long overdue scrutiny
of the various drivers of health care cost. Medical
liability is a direct and indirect cost driver in health
care, and any health care reform proposal should not shy
away from innovation in the area of medical liability reform
in order to help minimize the impact this has as a driver
of cost.
The
success of health care reform will not be measured the
day a bill is signed by the President. Rather, it
will be at least a decade before we can determine whether
we were successful in adopting reforms that were sustainable
and affordable. It is in the spirit of cooperation
that we submit these comments and will continue to engage
in a constructive dialogue to enact meaningful reform.
Sincerely,
Richard
E. Smith, MD
President
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Dr.
Smitherman Wins $25,000 Toward Community Work As Kanter
Prize Finalist
Herbert
Smitherman Jr., MD, President and CEO of the Health Centers
Detroit Foundation, Inc. in Detroit, Michigan, was among
four finalists to receive cash awards toward community-based
work last week, as a finalist for the J.H. Kanter Prize.
He is running three community-based health centers in urban
Detroit and works with culturally diverse communities to
improve urban-based primary care delivery systems. He is
dedicated to organizing, expanding and improving access
to cost effective, high quality healthcare for the uninsured
and has volunteered his time without pay to see that patients
get the care they need, regardless of income. Dr. Smitherman
was nominated by the Michigan State Medical Society and
the Wayne County Medical Society of Southeast Michigan.
Dr.
James O'Connell of Boston was awarded the prestigious J.H.
Kanter Prize for his exceptional work to enhance health
care delivery for hundreds of low income and homeless people
in Boston.
The
inaugural prize, named for Joseph H. Kanter, a pioneering
advocate for electronic medical records, is sponsored by
the Health Legacy Partnership (HELP) a public private partnership
with the Agency for Healthcare Research and Quality (AHRQ.)
Dr. O'Connell will receive a $100,000 award to help continue
his amazing work.
Dr.
O'Connell is President of Boston's 'Health Care for the
Homeless' and on the front lines in his service to the
poor. Often referred to as a "street doctor," he
created a model of healthcare for the homeless, bringing
care to them where they reside: on the street. He established
integrated relationships with Boston area hospitals so
patients typically arrive with medical charts and have
received enhanced outpatient strategies prior to acute
hospitalization. Dr. O'Connell designed and implemented
a medical records system for the care of homeless patients
and authored books on care of the homeless.
Dr.
O'Connell, selected from more than 50 practicing physicians
submitted from around the nation, military and US territories,
was nominated by the Massachusetts Medical Society which
receives $10,000 for nominating him.
A
total of four finalists each received prizes in the amount
of $25,000.
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White
House Backs Away From Public Option
Aug
17 2009
Obama
administration officials are signaling their willingness
to compromise on a public plan option in any health reform
proposal.
The
Wall Street Journal: "Health and Human Services
Secretary Kathleen Sebelius said Sunday that a new, government-run
health-insurance program wasn't the 'essential element'
of any overhaul plan … A day earlier, President Obama
defended the public option at a town-hall meeting in
Grand Junction, Colo., while leaving the door open to
alternative approaches that expand coverage and reduce
costs, but don't increase the federal deficit. The public
option, 'whether we have it or we don't have it, is not
the entirety of health-care reform,' Mr. Obama said.
'This is just one sliver of it, one aspect of it'" (Williamson
and Cole, 8/17).
The
Washington Post: "Yet even as the Obama team
hinted it could accept concessions that moderate Democrats
are seeking, one of the leaders of that faction raised
another hurdle for the administration. He warned that
Senate Finance Committee negotiators may not meet the
president's Sept. 15 deadline for producing a bill. 'We
will be ready when we are ready,' Sen. Kent Conrad (N.D.)
said on 'Fox News Sunday.' 'We will not be bound by any
deadline.'"
"Sebelius
and other administration aides have said Obama is open
to a nonprofit cooperative model as an alternative to the
public option and the existing private plans. Finance Committee
members have been studying utility co-ops as a possible
model" (Connolly, 8/17).
Politico: "A
White House aide said in an e-mailed statement Sunday
afternoon that the president is not backing away from
the public plan. 'Nothing has changed,' said Linda Douglass,
communications director for the White House Office of
Health Reform. 'The president has always said that what
is essential is that health insurance reform must lower
costs, ensure that there are affordable options for all
Americans and it must increase choice and competition
in the health insurance market. He believes the public
option is the best way to achieve those goals'" (Budoff
Brown, 8/16).
The
New York Times: "In an interview on Sunday,
Mr. Obama's senior adviser, David Axelrod, said the president
remained convinced that a public plan was 'the best way
to go.' But Mr. Axelrod said the nuances of how to develop
a nonprofit competitor to private industry had never
been 'carved in stone'" (Stolberg, 8/16).
The
Associated Press/Boston Globe: "Former Democratic
Party Chairman Howard Dean... said Monday he doubts
there can be meaningful health care reform without a
direct government role." He urged the Obama
administration to stand by its earlier insistence "that
such a public option was indispensable to genuine change." But
a White House spokesman refused to say this approach was
a make-or-break decision. "'What... the bottom line
for this for the president is, what we have to have is
choice and competition in the insurance market,' White
House press secretary Robert Gibbs said Sunday" (Elliot,
8/17).
Obama's position regarding the public option could end up triggering
a fight with liberals, The
Hill reports: "The left wing of the Democratic party already
has been irritated by concessions its leaders have made on healthcare
to centrists in the House and Senate. Rep. Eddie Bernice Johnson
(D-Texas) told CNN on Sunday it would be 'very difficult' for her
and other liberals to support legislation that does not include a
public option" (Swanson, 8/16).
But
a shift away from that approach in favor of a privately
run cooperative could gain favor on the right, The
Associated Press reports in a second story. Sen.
Richard Shelby, R-Ala., "says a potential administration
shift... is something that opponents like him should
consider." Shelby, an opponent of Obama's health care
overhaul, "says he sees insurance co-ops as 'a step
away from the government take over of the health care system.' Shelby
appeared on 'Fox News Sunday' with Sen. Kent Conrad, D-N.D.,
who "has been pushing the co-op system as an alternative
to a government-run public option to help cover the nation's
nearly 50 million uninsured" (8/16).
This
information was reprinted from kaiserhealthnews.org with
permission from the Henry J. Kaiser Family Foundation.
You can view the entire Kaiser
Daily Health Policy Report, search the archives and sign
up for email delivery. © Henry J. Kaiser Family Foundation.
All rights reserved.
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Crain's
Health Care Leadership Summit
Crain's
Health Care Leadership Summit
Thursday,
Oct. 15, 2009
Hospital
trustees, physicians, researchers, administrators and business
leaders will gather Oct. 15 to tackle health-care issues
and opportunities in Southeast Michigan. Some of the region's
top names in health care will participate in a unique on-stage
discussion. Breakouts will cover such topics as reducing
cost and medical errors, electronic medical records, federal
stimulus dollars, patient-centered homes, health care as
an economic driver and new ideas for handling uninsured
people. A luncheon program will honor Crain's "Health
Care Heroes."
Date:
Thursday, Oct. 15
Time:
8 a.m. - 5 p.m.
Tickets:
$50 Luncheon ONLY
$149
Full Day Conference (Includes 1 yr. subscription to Crain's
Detroit Business
$140
each for groups of 5 or more (for group tickets call 313.446.1652)
Location:
Rock Financial Showplace, 46100 Grand River, Novi, MI.
48374
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2009
Reader Survey
Detroit
Medical News/WCMSSM Reader Survey August 2009
**Please
feel free to cut and paste into an e-mail and send to
arj@msms.org or
fax to (313) 874-1366**
What
is your specialty:________________________________
What
is your age:____________________________________
How
often do you read the DMN magazine? (please circle one):
Every
issue Sometimes Infrequently Never
How
often do you read the DMN weekly e-edition? (please circle
one):
Every
week Sometimes Infrequently Never
For
what do you read the magazine for most? (please circle
one):
News Features Opinion
pieces
Other (please describe):_________________________________
For
what do you read the e-edition for most? (please circle
one):
News Features Opinion
pieces
Other (please describe):_________________________________
The
magazine is published six times yearly. Is this (please
circle one):
Too
often Not often enough Just
right
The
e-edition is published weekly. Is this (please circle one):
Too
often Not often enough Just
right
Are
you a member of social or business networking site?
Yes No
If
so, which one(s)?:
Facebook Twitter Linked
In Sermo.com
Other:________________________
Are
we covering the right issues in the magazine and e-edition?
Yes No Usually
Sometimes Not often Never
What
are the issues that most affect you:
1:__________________________________________
2:__________________________________________
3.__________________________________________
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