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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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