"Insurance Insecurity"

HealthReform.gov has published "Insurance Insecurity" which is a fast read intended to bolster public perception that the health insurance industry has failed to serve the public interest. Sources are also provided, which will be helpful to professionals and academics.

A Sort-Of Historical Speech

It was a textbook, "let's make a deal" speech, aimed at obtaining concensus on the principles which President Obama laid out, so  that later, the principles could be expanded to provide the real muscle and meaning behind the vague wording. For its purpose, it was well done. I found myself asking for more specifics, but having watched/listened to several of Obama's internet-based presentations, knew that I and other Americans stood no chance of getting specifics  tonight. It was not what I had hoped for in my blog of September 6, 2009.

Having spent a long afternoon today at a biomedical ethics meeting dealing with serious issues of life and death, I resented the failure of Obama to discuss anything other than the business of health reform.   I also found myself resentful of the Republicans, massed and unsmiling in their dark blue suits, unwilling to let their politics yield to human and national needs, and almost expecting someone among them to stand up to demand that Social Security be repealed.

In all,  it was  not a memorable night.  Perhaps there will be substance soon to come.

And don't forget  ethics.

The One Bright Spot in Our Severe Unemployment Landscape

Current American employment and unemployment statistics are dismal, except for health care which is helping to carry our economy.  Government reports show increasing non-health industry numbers for the unemployed and  underemployed. Congress, in its infinite wisdom, may  pass health reform legislation which profits its political contributors and philosophical allies, but cripples our health care system and puts health care workers out on the street for "efficiency's sake" while protecting those in the financial industry who are responsible for our economy's collapse. 
 

This is a dangerous time for health care and for our economy.

In summary of the report:

1. In August, the number of unemployed persons increased by 466,000 to 14.9 million, and the unemployment 

rate rose by 0.3 percentage point to 9.7 percent. The rate had been little changed in June and July, after increasing 0.4 or 0.5 percentage point in each month from December 2008
through May. Since the recession began in December 2007, the number of unemployed persons has risen by 7.4 

million, and the unemployment rate has grown by 4.8 percentage points. 

2. Total non-farm payroll employment declined by 216,000 in August. Since December 2007, employment has

fallen by 6.9 million. In recent months, job losses have moderated in many major industry sectors. In August, 

construction employment declined by 65,000, in line with  the trend since May. Monthly losses had averaged

117,000 over the 6 months ending in April. Employment in the construction industry has contracted by 1.4 million

since the onset of the recession. Starting in early 2009, the larger share of monthly job losses shifted from 

the residential to the nonresidential and heavy construction components. In mining, employment 

declined by 9,000 over the month.

In August, manufacturing employment continued to trend downward, with a decline of 63,000. The pace of job loss 

has slowed throughout manufacturing in recent months. Motor vehicles and parts lost 15,000 jobs
in August, partly offsetting a 31,000 employment increase in July.

Financial activities shed 28,000 jobs in August, with declines spread throughout the industry. Job loss in 

financial activities has slowed since the beginning of the year. Employment in the industry has declined by 

537,000 since the start of the recession.

Wholesale trade employment fell by 17,000 in August. Employment in information continued to trend down 

over the month.

Employment in the retail trade industry was little changed in August. Employment also was little changed 

in professional and business services over the month. From May through August, monthly employment
declines in the sector averaged 46,000, compared with 138,000 per month from November through April. 

Job loss in its temporary help services component has slowed markedly over the last 4 months.

Employment was little changed in August both in transportation and warehousing, and in leisure and hospitality.

3. Employment in health care continued to rise in August (28,000), with gains in ambulatory care and in nursing and residential care. Employment in hospitals was little changed in August; job growth in the industry slowed in early 2009 and employment has been flat since May.  Health care has added 544,000 jobs since the start of the recession.

A Season Of Discontent?

For Jews, the month of Elul is a time of stocktaking, introspection, reconciliation and spirituality, activities which America's  leadership might emulate with respect to our health care system. It is not a time for  a Quicken-type printout of  life's balance sheet and a perfunctory paper plan for change, nor is it a time to measure health care only in economic terms.  It is a time to ask how our health system reflects out national values, where have we achieved our goals and where have we fallen short, to genuinely express regret over our national failure to provide appropriate health care to all Americans, to recognize that our unwillingness to take societal responsibility for health care represents a serious deficiency in the American spiritual system, to acknowledge that there is a greater good which must be achieved,  to describe, adopt and implement an appropriate Health Plan and then move-on.

This is not a season of discontent.  It is a time for hard work and political commitment  which will bring appropriate health care to all Americans, the poor, the rich, the weak, the old, and all of our children. It is a time when our mirrors' reflections should allow us to observe ourselves with pride, knowing that as a nation we have done the right thing.

Kathleen Sebelius Secretary, HHS: Reform To Help Older & Senior Women

Strengthening the Health Insurance System: How Health Insurance Reform Will Help America’s Older and Senior Women

Executive Summary

While all Americans shoulder the burden of rising health care costs and increasingly inadequate health insurance, the 17 million older women (ages 55-64) and 21 million senior women (ages 65 and older) in America have unique situations and health care needs that make them particularly susceptible to rising costs – at a time in their lives when access to affordable health care is increasingly important. Health insurance reform will remove these hurdles to ensure that older and senior women, along with all other Americans, get the quality, affordable health care they deserve.


Link To Report: http://www.healthreform.gov/reports/seniorwomen/index.html

Health Reform: Freedom and Responsibility for Physicians

Harold S. Luft, Ph.D, of the Palo alto Medical Foundation Research Institute and the University of California, San Francisco (Luft:) recently published a New England Journal of Medicine paper, "Health Care Reform - Toward More Freedom, and Responsibiity, for Physicians" (N Engl M Med 361;6 NEJM Org 8/6/09). His  concept of "more freedom and responsibility" particularly resonated with me, because it is consistent with research which I performed as a Fellow of the Health Research Council of the City of New York in the 1960s (HRC) ), which demonstrated that health care organizations under physician leadership and professional control provided patient care far more effectively and efficiently than non-physician led organizations.  My years of practice and organizational responsibilities in a large physician practice (San Jose Medical Group), as hospital chief of staff, as a member and officer of the board of trustees of a large health system, and as a director of the California Hospital Association, confirmed my academic conclusions: physicians must have the freedom (a right) to practice medicine, the responsibilities (obligations) consistent  with a highly professional exercise of those responsibilities, and  must organize themselves (with adequate capitalization) to accomplish the goal of appropriate patient care in the public interest.

 Luft is pessimistic: he doubts the ability of government to slow health care cost growth. He views insurers' (including a public system) tools for health care cost control to be only two: financial disincentives for patients and fee reductions for providers, neither of which have reduced historic health care inflation. He proposes a two-prong system consisting of  universal coverage for high cost services (the 60% solution - my term, not his) , such as hospital care and ongoing care for chronic illness, and a reorganized ambulatory care (the 40% solution) system. Hospitals and their physician systems would receive bundled payments to be allocated internally under each system's unique internal arrangements under the 60% solution. Ambulatory physicians and groups would receive payment at usual and customary rates. Luft proposes measures to avoid conflicts of interest, a highly sophisticated care and outcome information system and other strategies to encourage high quality outcome achieval with high level efficiency. His focus is on rational incentives for patients, physicians, other providers and institutions.

Patients, in ambulatory care, would chose programs meeting their own health care needs, financial capacities and philosophies. Credit-card type fee payment, from the program level chosen by the patients, would be processed just like any commercially existing credit card (drawing down the program pool left for use by the patient), eliminating ravenous administrative overhead. If patients wanted more care, they would  buy a plan offering more; if they felt they could get by with less extensive and expensive ambulatory care, they would save money through Luft's structure.  If they become very ill, requiring hospitalization or ongoing chronic care, they would be covered through the 60% solution pool.

Luft's paper deserves to be read and widely discussed. Whether his rational and sensible approach can be implemented in an environment of  inflammatory politics, economic uncertainty, greed, ego-involvement and scant attention to serious ethical issues, is something for each reader to consider. Check with your local medical library for the New England Journal's August 6 edition, pp. 623-28.

9/1/2009 - Link to cited article: Link to article: http://ihps.medschool.ucsf.edu/News/news/luftnejm.pdf

Inflation Is In The Eye Of The Beholder

On Agust 24, 2009, the LA Times carried an AP report that Social Security payments (LA Times)  for 2010 (and maybe 2011)  won't be increased because there is no inflation, leading to a decrease in net Social Security checks because the drug benefit premiums will rise.  Sounds reasonable: no inflation, no COLA, no increase in those monthly deposits to Social Security beneficiaries.

But wait - There's more! See what the U.S. Department of Health and Human Services has to say about inflation , when it comes to the government's ability to "charge" for inflation.

"HHS Issues Rules Adjusting Penalties under the Patient Safety and Quality Improvement Rule for Inflation (Penalty Inflation)


"As required by the Federal Civil Penalties Inflation Adjustment Act of 1990 (Inflation Adjustment Act), the U.S. Department of Health and Human Services (HHS) issued both a direct final rule and a proposed rule today adjusting for inflation the maximum civil money penalty amount for violations of the confidentiality provisions of the Patient Safety and Quality Improvement Act. These confidentiality provisions are enforced by the Office for Civil Rights (OCR).

"The Inflation Adjustment Act requires HHS to adjust for inflation the Patient Safety Act’s civil money penalty amount at least once every four years, beginning from the Patient Safety Act’s date of enactment, which was July 29, 2005. These rules adjust the maximum civil money penalty amount for a violation of the confidentiality provisions of the Patient Safety and Quality Improvement Act from $10,000 to $11,000.

"The public has 30 days to comment on these rules. If no adverse comments are received, the direct final rule will go into effect 90 days after publication, and the proposed rule with be withdrawn. If, however, adverse comments are received during the comment period, the direct final rule will be withdrawn. For more information, visit the OCR web site at http://www.hhs.gov/ocr/privacy/."

While there may be a perfectly sensible reason for the penalty inflation adjustment (such as a catch-up to the time that there was inflation 4 years ago), it seems incongruous to deny Social Security beneficiaries a COLA while now imposing a COLA equivalent on government-levied penalties.