Obama says: Let's keep our eyes on the Health Reform prize

So, Americans, what's the big deal?  What's at stake?  Here's from the Man at the top, his take:

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Healthcare Reform (don't miss the train!)

Dear friends & colleagues,

Health Insurance/Healthcare reform has come a long way, and it's not too late to learn what it's all about (esp. with the holidays coming up, so that you'll be able to converse about healthcare with others back home), and more importantly, to make a difference by adding your uniquely influential voice as a medical student/future physician.  For an easy & quick way to learn about/add your voice to this reform that will significantly affect us all, check these out:

1. Doctors for America is a grassroots group of 16,000 physicians and medical students.  I've pasted their latest email update for you to see (below).  Within it is this fantastic link to a poll of the "6 key reforms," which, when you click on each reform's "see how the bills address this," will give you a very clear & succinct synopsis.  Joining their listserve is easy, and the resources on their website are just as user-friendly & informative: http://drsforamerica.org/

2. Sign on to the American Academy of Family Physician's "Connect for Reform" group.  You must first register here (free for medical students) to become an AAFP member.  Then after you register, go to http://www.aafp.org/ and click on the "AAFP Connect for Reform" button to sign on.
    •    receive periodic emails with the inside scoop on Health Reform, and easy ways that healthcare professionals and students can join to help.
    •    Connect with other members, and add your voice to advocacy actions.

3. If you have any other ideas/suggestions/links for how students can join the conversation and help, or if you'd like to write any kind of healthcare-related article yourself, please email me and I can post onto DownstateCafe.blogspot.com .

Best,
Abe

from: Vivek Murthy MD, MBA
to: abraham.young
date: Fri, Dec 18, 2009 at 1:18 PM
subject: Moving Forward
Abraham -

Need your input: What's most important to you in this health reform bill?

Rank Your Priorities

 So we can take a stand together

After a whirlwind week in the health reform fight you might be wondering what all the developments mean for reform, whether a bill is still worth supporting, and what our community of physicians should fight for at this moment.

What happened:

This week, the public option and its substitute (the Medicare early buy-in provision) were both dropped from the Senate bill as Senate leadership worked to win 60 votes for the overall bill. This was quite a disappointment to our members after working for a public option for many months and considering it to be an important component of successful reform.

Aside from the public option, the Senate - unlike the House - has not included provisions to address defensive medicine. The Senate also does not include a permanent fix to the flawed Medicare payment formula (SGR); there is currently only a one year patch of the SGR.  The bill is certainly far from perfect.
 
What didn't happen:

Health reform isn't over and the final bill hasn't been written. Moreover, a lot of very important provisions are still in both the House and Senate bills. And that's because time-after-time we've spoken out for the issues we care about - expanding coverage, strengthening primary care, making premiums affordable, investing in prevention and improving quality.

As it stands, the current bill will cover 31 million more Americans, establish the strongest restrictions on insurance companies in history, and invest substantially in improving our health care delivery system - all while reducing the national deficit over 10 years. (See below for more details).

What now:

This brings us to this moment. The ultimate success of health reform depends on what we do in the next few weeks. The Senate is working to secure the 60 votes necessary to stop a filibuster on the Senate floor. Once they do so and pass a bill, the Senate and House bills will then be merged. 

While there are provisions in the bill that help doctors and patients, any of these can be weakened or stripped altogether from the final bill. So your voice is as important now as ever.  As the Senate hammers out the details over the next 24-48 hours, tell us:

We have identified 6 key reforms which are at risk. Please rank these issues according to what you believe is most important.

Your efforts have brought us to the brink of history and we hope that you will continue to fight with us to enact health reform for all Americans.

Thank you for all that you've done.
Vivek Murthy MD, MBA

President
Doctors for America

Overview of the Senate Bill
Key Element of the bill:
    •    Cover the uninsured: Expands health insurance coverage to 31 million previously uninsured Americans.

    •    Regulate the insurance industry: Prevent insurers from denying coverage based on pre-existing conditions, dropping individuals who become ill and imposing caps on health care spending. 

    •    Help people afford insurance: Subsidize insurance premiums on a sliding-scale for small businesses and the middle class.

    •    Support primary care: Investments in physician workforce expansion, including new loan forgiveness programs, scholarships and National Health Service Corps funding - for primary care.

    •    Payment reform: Payment reform that rewards value in health care delivery through new pilot programs for the medical home and accountable care organizations. 

    •    Investments in prevention and public health: Establishes fund of $7 billion dedicated to prevention and public health related activities. 

    •    Control Cost: Multiple cost control mechanisms with the potential to reduce national health care spending by $683 billion over a decade.
Reasons to keep fighting:
... to make insurance coverage affordable for all Americans.
... to ensure that enough doctors are there to take care of the newly insured.
... to secure fair pay for the hard work physicians routinely do.
... to create a truly fair insurance market via increased regulation.
... to cultivate innovation and efficiency in health care delivery.

For more information about the Senate bill and how it affects doctors, seniors, children and women – visit the DFA resource center.

--
Doctors for America is a grassroots group of over 16,000 physicians and medical students in all 50 states. Together we are committed to building a health system that works better for us and better for our patients. To contact us please e-mail info@drsforamerica.org

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Dr. Neil Calman, president/founder of the Institute for Family Health, blogs about talking with Downstate medical students

(To read the full post & other invaluable writings of Dr. Calman, visit http://neilcalman.blogspot.com/)

"On a rainy and blustery evening last week, I had the pleasure of speaking to an amazing group of first and second year medical students at Downstate Medical School in Brooklyn... My message was that patients are increasingly demanding primary care as a trusted way of negotiating an otherwise incredibly confusing and fragmented health care system. I stressed that primary care physicians must stay focused on the needs of their patients above all else and that our loyalty and responsibility towards our patients must always remain first and foremost in our minds and actions – unfettered to the maximum extent possible – by advertising and loyalties to our hospitals or peers.

...A tougher question came from a young man in the front of the room who asked how our community health care system could survive financially taking care of the number of uninsured that we currently cared for.

...I stood there proud that our organization – the Institute for Family Health – had been able to accomplish this.

Yet I missed a real opportunity to underscore the fundamental reason we need health reform in this country. People need health insurance. Our country cannot depend solely upon health centers like ours as the safety net for everything patients who are uninsured need for their care. They must have coverage to pay for all the essential health care services they need. Primary care is the front end of an entire health care system which must provide access to people for diagnostic services, treatments, hospitalizations and medicines. With people of color 2 to 3 times more likely to be uninsured in New York City providing insurance for everyone is an absolutely essential step towards eliminating racial and ethnic disparities in health outcomes. And with primary care providers already struggling to create viable practice models in underserved areas, only full insurance coverage of the people who need these providers can sustain these practices and attract new doctors to these areas. 

I am sorry I missed the opportunity to explain more to the students in Brooklyn last week about the failings of our current health care system. But I am not worried that their education will be lacking for very long. Soon the students will begin their clinical rotations in the hospital and there they will no doubt experience, first-hand, the failings of our current system to provide health care for all our people. They will see people suffering the effects of poorly treated chronic diseases – losing their legs and their kidneys to long-standing diabetes. They will see people with cancers that would have been curable if only they had been detected earlier. They will see people with advanced infections that have gone untreated for days or months and now require prolonged hospitalizations. These lessons will hit hard and perhaps some of them will understand and will choose to become the next generation of primary care physicians and the new champions for needed change in our health care system."

(To read the full post & other invaluable writings of Dr. Calman, visit http://neilcalman.blogspot.com/)

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Welcome to Primary Care Week @ Downstate!!!

 (**Speaker Bios below)
Tuesday, November 10th - Primary Care 101

When: Noon to 1 PM
Where: Student Center Main Lounge
FREE Food: Heros/Kosher Sandwiches
Speaker: Dr. Michael Gusmano, Research Director for Alliance for Health & the Future (Dr. Gusmano will be speaking about the growing need for primary care physicians and about public health policy)

Wednesday, November 11th - Faces of Primary Care

When: 5:30 PM to 7 PM
Where: Student Center Main Lounge
FREE Food: Italian/Kosher Sandwiches
Speakers:

Dr. Margaret Golden, Pediatrics Clerkship Director at Downstate

Dr. Heather Paladine, Director of Women's Health at Columbia University Medical Center
Anthony Accurso, 4th Year Medical Student at Downstate

(This is more of a Q&A session - a great opportunity to ask the panelists about their personal experiences in primary care)

Thursday, November 12th - Future of Primary Care

When: 5:30 to 7 PM
Where: Student Center Main Lounge
FREE Food: Thai
Speakers:

Dr. Neil Calman, Family physician and President/CEO of the Institute for Family Health, NY

Lauren Hughes, National President of AMSA

(Dr. Calman will be talking about the future of primary care and how PCPs contribute to the community)

So, come learn more about the unsung heroes of medicine! Hope to see all of you there!!!  (We will also be giving out PRIZES! If you would like Kosher food to be served, please e-mail Regina Finan at Regina.Finan@downstate.edu.)

**Speaker Bios: 

Neil Calman, M.D.
Neil Calman, MD, is president and co-founder of the Institute for Family Health, developing family health centers in the Bronx and Manhattan.  In 2002, the Institute became one of the first community health center networks in the country to implement a fully integrated electronic medical record and practice management system, improving both preventive and chronic care treatment outcomes. In recognition, Dr. Calman received the 2006 Physician's Information Technology Leadership Award, presented annually by the Healthcare Information and Management Systems Society.  Dr. Calman serves on the Primary Care Health Information Consortium, the NYSDOH's Information Technology Stakeholder Group Planning Committee, is the Chair of the Clinical Committee of the Community Health Care Association of New York State. He has also been appointed to the Health Policy Roundtable of the Aspen Institute, a group charged with delineating the values and principles on which the United States must base its future health care system.

Heather Paladine, M.D.
Heather Paladine, MD, attended Mount Sinai School of Medicine in New York.  She then completed a residency in Family Medicine at Oregon Health and Science University and went on to do a fellowship in Maternal and Children's Health Care at California Hospital in Los Angeles.  After working in Washington, Oregon, and California, she recently returned to New York City to become faculty at the New York Presbyterian/Columbia University Family Mediciine residency program, where she is Associate Residency Director and Director of Women's Health.

Michael Gusmano, M.A., Ph.D.

Dr. Michael Gusmano is the director of research for the Alliance for Health & the Future and co-director of the World Cities Project at the International Longevity Center-USA. Dr. Gusmano's work has focused on comparing the health status and use of health and social services for older persons. His other research interests include politics of healthcare reform, Medicare, Medicaid, and comparative welfare state analysis. Dr. Gusmano was a senior research associate in the Division of Health and Science Policy at the New York Academy of Medicine.

Margaret Clark-Golden, M.D.
Associate Professor at Downstate Medical Center
Pediatrics Clerkship Director at the Children's Hospital at Downstate

M.D. - Duke University School of Medicine

Residency: Cook County Hospital (Pediatrics) and Michael Reese Hospital Medical Center (Pediatrics)

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Taking Action with Doctors for America

Doctors for America
"As physicians and medical students, we can make the difference and make sure we get strong, effective health reform this year! Here's how:

1. Get informed.
2. Take action.
3. Help others do the same!

Visit our Action Center to learn more."

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The Economist: "His is a bold ambition indeed; but this week the president looked a bit closer to fulfilling it."

I've posted an article once before ("4 emails debating health reform!") from the magazine, The Economist.  Their editorials are (I believe) usually thoughtful and objective, and here's what they had to say this week about Obama's health-care speech.  For the wonkier/wonkiest, below that are snippets from a 2nd article that goes into much more detail explaining the significance of this speech where "Mr Obama also unveiled the main elements of his own centrist reform plan for the first time." Click on the link to read the full article at economist.com. 

The art of the possible

A fine, measured piece of oratory from the president. But there is still tough work to do

“I AM not the first president to take up this cause, but I am determined to be the last.” Thus Barack Obama, late in the day, took his quest to reform America’s expensive and flawed health-care system to the floor of Congress with a mighty speech that will surely stand as one of the defining moments of his presidency, whether it leads to eventual triumph or disaster. His is a bold ambition indeed; but this week the president looked a bit closer to fulfilling it.

Politics, as everyone knows, is the art of the possible; and there have been times over this ill-tempered summer when the idea of tackling a system that costs almost twice as much as any other rich country’s, yet yields substandard results and leaves tens of millions of people with no health insurance at all, has seemed simply impossible. Mr Obama has to find a package of policies that is fiscally and politically moderate enough to win over a vital few Republicans to his side (and also prevent the defection of nervous conservative Democrats). But at the same time he has to keep the support of the leftish Democratic Party base, which wants to see a more expansive and costly set of reforms. He may well fail. But on September 9th the president for the first time laid out in some detail what such a plan might look like. Cleverly borrowing good ideas from both sides of the party divide, his proposals at least look like a plausible basis for agreement (see article).

The plan obliges everyone to take out health insurance while creating a tapering subsidy for poorer families to help them afford it. It also requires insurance companies to end various nefarious practices, such as refusing to insure people with existing conditions or cancelling their coverage just when they need it most. To pay for these long-held liberal goals (the cost is put at $900 billion over ten years), the president has committed himself to several policies that Republicans, if only they could remove their partisan spectacles, should applaud.

There is, for instance, a tax on insurance companies that offer “Cadillac” plans to richer individuals; since this will inevitably be passed on to consumers, it is a useful step towards making individuals aware of the cost of their coverage. He has made a cast-iron pledge that he will not sign a health bill that increases the deficit, and has promised automatic spending cuts if savings do not materialise. He wants to set up a new technocratic committee that could mandate changes to the hugely expensive Medicare system of health care for the elderly (an idea that cleverly takes such difficult decisions out of the hands of politicians, who have displayed a lamentable failure to grapple with them). And the president also promised conservatives reform of America’s mad tort system. The risk of being sued pushes up costs, obliging doctors to practise “defensive medicine” in the shape of needless tests and procedures.

Give me public options, but not now

Still up in the air is the trickiest question of all: whether the government should create a “public option”, its own insurance provider, which people could use if they dislike what the free market has to offer. Medical insurers and most Republicans say a public plan would enjoy unfair advantages and destroy competition. Liberal Democrats say the insurers will not cut prices without it. Both sides have a point. This newspaper still thinks the best solution would be to keep the public option as a threat: to set up a formal provision in the bill whereby a public plan would be introduced in, say, five years’ time if certain targets were not met. In his speech Mr Obama hedged his bets, sticking with the public option but signalling a willingness to compromise. This may come back to haunt him. But overall, this performance was a big step forward.

Fired up and ready to go

As Congress returns to work, two big bills before it may determine the fate of Barack Obama’s presidency—and he knows it. First, health care

“THE time for bickering is over. Now is the time for action.” With those fiery words, delivered to a special joint session of Congress on September 9th, Barack Obama made his case for reforming America’s troubled health system....

The speech was a success on several measures. It was passionate, which is essential if he is to win over a sceptical American public and energise his liberal base....

....Reading from a letter he had received from [Senator Edward Kennedy] posthumously, as his widow listened from the gallery, Mr Obama made the moral case for change: “At stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”

During this passage, he cleverly reminded Americans that leading Republicans currently hostile to Democratic efforts at health reform—including Senators Orrin Hatch and John McCain—had worked hand-in-hand with Mr Kennedy on earlier, smaller efforts at health reform. That points to the second reason to think that Mr Obama’s speech may yet succeed in kick-starting reform this autumn: it managed to position the president as a reasonable and moderate adult in a room full of petty and partisan ideologues....

...He also announced a surprising idea to use executive authority to encourage state-level experiments in curbing malpractice abuses.

Mr Obama also unveiled the main elements of his own centrist reform plan for the first time. He wants to expand coverage to some 30m Americans without insurance, principally by introducing an individual mandate for cover, insurance exchanges, subsidies for the less well-off and heavy regulation of insurers. He also accepted an important proposal to tax the most lavish of insurance plans.

Crucially, he made it plain that he would not accept a health-reform bill from Congress that raises the deficit—not now, not ever. He also vowed that most of the $900 billion his plan will cost—again, the first time he has given a firm figure for his initiative—will come not from taxes on the rich, as the current bills in the House envision, but from internal savings to be realised within the health system.

He offers two reasons to suppose that this claim is not complete bunk. The first is the White House’s support for empowering an independent panel of experts to cut costs in Medicare and other government health schemes. This matters, because Congress has shown it is incapable of making such difficult cuts. More impressive is his vow this week that any final bill must include provisions for mandatory spending cuts that would kick in if budgeted cost savings do not materialise.

Will this speech be enough to get the president’s reform agenda back on track? It just might be. One reason to think so is the deft way Mr Obama signalled a willingness to compromise on the “public option” this week. The left has insisted on a government-run insurance scheme, but this ill-founded idea is strongly opposed by the health-care industry and by Republicans. It also has no hope of passing the Senate, as Max Baucus, the head of its Finance Committee, confirmed this week. Mr Obama voiced theoretical support for the idea, but by also supporting other options—including, crucially, the idea that such a plan could be triggered only if necessary later—he has, in effect, dealt it a death blow.

Several committees in the House have already passed versions of health bills, but all contain the public option and are seen as too far to the left of the Senate—and now, it is clear, of where Mr Obama stands. So all eyes are now on the Senate Finance Committee, where a “Gang of Six” led by Mr Baucus has been working to forge a moderate bill that could provide the backbone for any final health law this year. Mr Baucus this week unveiled his own $900 billion proposal (also a moderate approach without the public option), and announced plans to finalise a bill next week.

Earlier this week that effort seemed to be flagging, as two of the Republicans in the gang, Charles Grassley and Mike Enzi, appeared to be undermining its efforts. That leaves Olympia Snowe, the free-spirited Republican from Maine, as the most courted legislator in recent memory. Mr Obama’s speech and sensible proposals, which are similar to those drafted by Mr Baucus, and his openness to the trigger option favoured by Ms Snowe, can only boost efforts at compromise.

Whether it is enough to keep Ms Snowe and perhaps one or two other Republicans firmly on board remains to be seen. But even if it does not, the next few weeks could yet produce a bill that is better than anything seen thus far and which would be worth passing. He was not the first president, Mr Obama said, to take up health-care reform; but he was determined to be the last.

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Hear me out: This is the time for all of us in health care to act. It will take you 1 min.

Obama did a good job in his speech making clear why we--as individuals & as a country--must succeed on health reform now.  But since most people already understood that urgent need... even more importantly, his speech succeeded in eliciting exactly what this reform means for 3 categories of people--which together include all Americans:

1. people already w/ health insurance (majority),
   
2. Americans without health insurance (~30 million folks), and
   
3. (the following category overlaps onto category #1) those who currently pay the rising bills for the uninsured when they get sick.
   

Take a look at the speech yourself:
[jump ahead 5:00 min to skip the monotonous clapping]

As I watched the speech together with a friend--and noticed that in one after another of Obama's statements, precisely 1/2 the chamber stood up and clapped, while the other 1/2 sat stoically across the aisle--she said, "OH that's why I hate politics!" 

Agreed.  It's as if these Representatives and Senators whom we all elected to act as leaders during this crucial time can't even think with their own brains once in awhile, instead they stick to "party lines" as if those lines were the only hardwired neuronal pathways they owned in their cortex.

Here is 1 suggestion I have to every single person in the health care profession, including myself as a student.  The simple fact of our profession not only gives us & those we will serve a bigger stake, personally, in the outcome of health reform; but it also truly bestows upon us an added credence when we have something to say (I've seen the special attention paid by politicians to a doctor or nurse at a phone banking or rally for health care; also, see the YouTube below of the ER doc in the audience at a recent town hall).  And what we can say, what we all can absolutely agree upon--but this still is in danger, not because of merit but merely because of political games--is that WE STAND BY THE NEED TO PASS HEALTH REFORM NOW, THIS YEAR.  (Click here if you are willing to make this simple statement to your representatives, it will convince hesitant politicians that the will is there, and it will only take you 1 minute)

Aside from the 1 Senator who wants to block health reform because "it will break" Obama, every single leader and expert of all persuasions knows that achieving health reform is crucial for America's health, economy, and sustainability in the very near future.  We are on an exponential downward path if we keep our current system and don't act now.  And this is another thing Obama got right in emphasizing tonight: that 80% of the components within Health Reform already has bipartisan support (and these include drastic positive reforms such as outlawing insurance companies from denying care based on "pre-existing conditions"--see the last 2 paragraphs of my letter on "Where'd all the fear come from?" below).  However, this crucial national effort is still on the verge of being sabatoged by people like that shameless Senator who wants to "break" Obama by breaking health reform. 

What I respect about some of Obama's big speeches to date is that he (or his speechwriter) gets the precision to tweak out at the exact point of confusion, of our paralysis, the truer narrative of what has really been happening on a national landscape (he did this in his "Reverend Wright/Race" speech, and he did this to some extent here on health reform): "I will not waste time with those who have made the calculation that it's better politics to kill this plan than improve it." 

Agreed.  Whatever your political persuasions, whichever your thoughts on the remaining 20% of health reform still in debate, or even if you don't have opinions on either, let's get ALL OF OUR political leaders to work on improving the health care plan and get it passed, rather than kill it.

Click here it'll take you 1 min.

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Feisty!, fiery!, a.k.a. Anthony Weiner's health care town hall

[Below is an essay published here written by a med student... Read what he now thinks about the impracticality of private insurers, the (un)free market of healthcare, and the 3 words that mock anti-Government conservatives.  Enjoy!]

My name is Cameron Gibson, and I'm an MS1er here at Downstate, and a bit of a closet political junkie.  I spent much of my summer abroad, so when I saw on the news Americans yelling and screaming about something, I assumed that the Yankees had just lost a pivotal game.  When I found out that in fact people were yelling and screaming about health care reform, my interest was peaked.  I couldn’t learn much from the regular media sources (who can?) about these “town hall meetings”, so I thought I should experience one for myself.  So, with my white coat in hand and a bottle of anti-anxiety pills at the ready, I set off to Rep. Anthony Weiner’s town hall meeting last Tuesday.  Suffice it to say, I had to down the entire bottle by the end of the night!...
...and through it all I sat quietly listening to what Rep. Weiner and the audience had to say.  It was exciting, it was scary, but most of all, it was eye-opening.  
Read Cameron Gibson's full essay...

My name is Cameron Gibson, I’m an MS1er here at Downstate, and a bit of a closet political junkie.  I spent much of my summer abroad, so when I saw on the news Americans yelling and screaming about something, I assumed that the Yankees had just lost a pivotal game.  When I found out that in fact people were yelling and screaming about health care reform, my interest was peaked.  I couldn’t learn much from the regular media sources (who can?) about these “town hall meetings”, so I thought I should experience one for myself.  So, with my white coat in hand and a bottle of anti-anxiety pills at the ready, I set off to Rep. Anthony Weiner’s town hall meeting last Tuesday.  Suffice it to say, I had to down the entire bottle by the end of the night!

Now, I feel I must point out the author’s inherent bias.  Since learning anything about the American healthcare system, I’ve always known that something was wrong.  I’m a firm believer that healthcare is an inalienable right, on the same level as freedom of speech and religion.  However, I went to Rep. Weiner’s meeting a skeptic of the “single-payer option”.  After hearing Rep. Weiner--a major supporter of a single-payer system--present his argument, I was practically a convert:

• Private insurers have gargantuan 20-40%! overhead costs. Medicare and Medicaid have ~4% overhead cost.  Therefore, that alone in a single-payer system = a savings of ~$300 billion.   
• A single-payer option is one of the best ways to insure the 47+ million Americans who are currently uninsured.
  
  

Now you’re probably saying, “Wait a minute, there are a number of reasons why we shouldn’t throw out our current system.”  Well, you’re not alone in making this argument.  In fact, there were many people--not even including the folks outside who handed out flyers of Obama’s face with a Hitler-mustache…!--there who were vehemently opposed to healthcare reform, and they made themselves known early in the evening (I think my grandmother in Oregon even heard them!). 

I would now like to elucidate a few of the arguments I heard that night against current health reform W/ the public option, and show why they are inherently flawed:

We can’t afford to reform healthcare!

In fact-and Weiner said this as well-We can’t afford NOT to!

• We currently spend more in real dollars and % GDP on healthcare than most western countries 
• but we are only ranked 37th worldwide by the WHO for quality of healthcare (if you went to Morocco you would receive better care!).   
• While more and more of us can’t afford our healthcare, private insurance continues to bring in astronomical profits year after year.  As things stand, they have no incentive to change the system, If there ever is a dip in their profit margin, all they have to do is raise the premium on their customers and the coffers are refilled! 
  
  

So, without the government stepping in in some form, whether through regulation or outlawing certain practices, we are currently set on a path of economic implosion solely from healthcare costs.

But we are a capitalist society, let the market fix the problem!

Without even mentioning the obvious example of 2008, it has been proven that the market cannot fix all of life’s problems.  Without the government, there would be no freeways, no electrical grid, no public school system (a blessing and a curse, for some), or Medicare/Medicaid (opponents sometimes conveniently forget that these are in fact government programs). 

Regarding healthcare, capitalism is not the most effective economic model because it reduces healthcare to a commodity, equal to insuring your belongings (i.e. renter’s insurance).  This ignores the fact that when someone gets seriously sick and their survival is in question, they can’t just choose not to seek medical help because they don’t feel like it (well, they could, but it would run against their Darwinian instincts).  If my TV is stolen and I don’t have insurance, I’m out a TV, whereas if I’m diagnosed with a curable cancer but have no insurance to pay for it, I either lose my life or go bankrupt (and so do my wife, siblings, parents, grandparents, etc.).  Viewing healthcare as a commodity ignores the reality & human side of healthcare.

The Government is wasteful and does a poor job of running national programs.

3 words: Med-i-care.  Ask anyone over the age of 65 with Medicare how they think the government is doing with their healthcare, and 96% of them will say they’re doing a DAMN good job!  (I’m almost certain that no other health insurance company can brag about such high customer satisfaction).

(This last point has less to do with current proposals for health reform being considered--i.e. Health Insurance Reform W/ the Public Option—and instead is only in response to a government Single-Payer system)

I don’t want my taxes to go up.

Sure, your taxes would probably go up.  You’d be paying more into Medicare, but guess what!  YOU’RE ALREADY PAYING MORE TAXES, just in a different form!  What does the middle class think their premiums are, a gift to their insurance company for doing such a good job?  Premiums have risen so drastically that the average individual now pays over $4000 each year for health insurance with a private insurer.  My question to the nay-sayers then is this: if you had the same coverage as you do now, but never had to argue with your insurance on the phone because of hidden fees, never had to search for a doctor that accepted your insurance, who cares whether the money is going to the private sector or the government!?  In fact, if everyone was paying into the same pot for healthcare, the young and old, sick and healthy, our premiums would probably go down or at least stay the same.  Spread the risk around and no one person is stuck with the bill!

These were just a few of the things that I heard being said/shouted, and through it all I sat quietly listening to what Rep. Weiner and the audience had to say.  It was exciting, it was scary, but most of all, it was eye-opening.  We are the land of freedom, where anyone has the right to express their individuality without fear of persecution or reprisal.  Somewhere along the way we lost our moral compass and veered off-course, to a place where we no longer care about the common good of our society.  We will send millions in aid to Africa every year to help the world’s poor and destitute, but I’ll be damned if I’ll help my neighbor with leukemia.

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"Health Care Sound and Fury"

Health care debate has heated up, some of the added volume to drown actual discussion, other voices shouting to remain heard above the crowd. But this news segment goes on from there to summarize a new PBS documentary, "Money-Driven Medicine," which is gradually earning people's ears & attention, because of its thought and willingness to actually listen & learn from the stories of doctors and patients in America.

To watch the full PBS documentary see below:

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Where'd all the fear come from? Somewhere that led to my mom's email inbox

My mom received an email about "Health Care Info," from a large community listserve, sent by a person who received the email "routed from a credible former colleague," originally written by... Who knows; maybe Sarah Palin? Here is my response:

The first sentence is not only written to scare (with no explanation whatsoever), but it is a complete outright lie: "...is over 1,000 pages long and puts the government in charge of our health care system."  The mention of 1,000 pages is a pointless scare tactic (as someone said, the last Harry Potter book was >700 pages long), and nothing proposed by anyone even comes close to "government in charge of our health care system." 

For the past 30 years, it is the insurance companies who are already dictating how doctors practice, and what care patients can or cannot get.  This has happened while every year there are over a million more Americans without health insurance (this year now there are 48 million uninsured), many of these uninsured people either get very sick or end in the hospital--which all Americans have paid for via high & rising premiums, and bankrupt public hospitals--while insurance companies have shown record profits year after year & their CEOs earn increasing salaries in the millions. 

If you or anyone you know have ever dealt on the phone with an insurance company trying to deny you care, I strongly urge you to read this New York Times article on Wednesday explaining why.   This former executive in the health insurance industry, who's job was to devise ways to scare Americans from important health reform (just like the email below), reached his conscience and now is speaking out strongly in support of needed health reform.

Insurance companies are also afraid of & against progressive ideas like the Health Info "Exchange" (mentioned in the email below) which will promote free-market competition and make it much easier for you to individually compare & contrast different health plans (currently, sorely lacking), and therefore improve health coverage + bring down premiums by competition.The types of rules that health care reform plans indeed want to enact that do affect health care are things like requiring all health insurance plans to cover annual checkups, cancer screenings--saving lives & saving costs by preventing end-stage hospitalizations--and to outlaw insurance companies from denying care based on "pre-existing conditions."  These are all changes in the current Health Insurance Reform that everyone (except insurance company CEOs & others people trying to scare Americans) agrees are good and necessary.

Therefore, I would indeed agree with going online "AND WRITE YOUR REPS"--as the email below urges you--but I would advocate for contacting them in support of real substantial health reform aspects like these (instead of the vague scare tactics announced elsewhere).
-Abe

 [The original email forwarded, forwarded, forwarded, from some unidentified "guru," into my mom's inbox is right here below:]

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Saturday's Health Care Rally @ Times Square

See slideshow of Healthcare Rally also in New York Times.

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New York Times Op-Ed: Health Care Fit for Animals

http://www.nytimes.com/2009/08/27/opinion/27kristof.html?_r=1

By NICHOLAS D. KRISTOF

Opponents suggest that a “government takeover” of health care will be a milestone on the road to “socialized medicine,” and when he hears those terms, Wendell Potter cringes. He’s embarrassed that opponents are using a playbook that he helped devise.
“Over the years I helped craft this messaging and deliver it,” he noted.
Mr. Potter was an executive in the health insurance industry for nearly 20 years before his conscience got the better of him. He served as head of corporate communications for Humana and then for Cigna.
He flew in corporate jets to industry meetings to plan how to block health reform, he says. He rode in limousines to confabs to concoct messaging to scare the public about reform. But in his heart, he began to have doubts as the business model for insurance evolved in recent years from spreading risk to dumping the risky.
Then in 2007 Mr. Potter attended a premiere of “Sicko,” Michael Moore’s excoriating film about the American health care system. Mr. Potter was taking notes so that he could prepare a propaganda counterblast — but he found himself agreeing with a great deal of the film.
A month later, Mr. Potter was back home in Tennessee, visiting his parents, and dropped in on a three-day charity program at a county fairgrounds to provide medical care for patients who could not afford doctors. Long lines of people were waiting in the rain, and patients were being examined and treated in public in stalls intended for livestock.
“It was a life-changing event to witness that,” he remembered. Increasingly, he found himself despising himself for helping block health reforms. “It sounds hokey, but I would look in the mirror and think, how did I get into this?”
Mr. Potter loved his office, his executive salary, his bonus, his stock options. “How can I walk away from a job that pays me so well?” he wondered. But at the age of 56, he announced his retirement and left Cigna last year.
This year, he went public with his concerns, testifying before a Senate committee investigating the insurance industry.
“I knew that once I did that my life would be different,” he said. “I wouldn’t be getting any more calls from recruiters for the health industry. It was the scariest thing I have done in my life. But it was the right thing to do.”
Mr. Potter says he liked his colleagues and bosses in the insurance industry, and respected them. They are not evil. But he adds that they are removed from the consequences of their decisions, as he was, and are obsessed with sustaining the company’s stock price — which means paying fewer medical bills.
One way to do that is to deny requests for expensive procedures. A second is “rescission” — seizing upon a technicality to cancel the policy of someone who has been paying premiums and finally gets cancer or some other expensive disease. A Congressional investigation into rescission found that three insurers, including Blue Cross of California, used this technique to cancel more than 20,000 policies over five years, saving the companies $300 million in claims.
As The Los Angeles Times has reported, insurers encourage this approach through performance evaluations. One Blue Cross employee earned a perfect evaluation score after dropping thousands of policyholders who faced nearly $10 million in medical expenses.
Mr. Potter notes that a third tactic is for insurers to raise premiums for a small business astronomically after an employee is found to have an illness that will be very expensive to treat. That forces the business to drop coverage for all its employees or go elsewhere.
All this is monstrous, and it negates the entire point of insurance, which is to spread risk.
The insurers are open to one kind of reform — universal coverage through mandates and subsidies, so as to give them more customers and more profits. But they don’t want the reforms that will most help patients, such as a public insurance option, enforced competition and tighter regulation.
Mr. Potter argues that much tougher regulation is essential. He also believes that a robust public option is an essential part of any health reform, to compete with for-profit insurers and keep them honest.
As a nation, we’re at a turning point. Universal health coverage has been proposed for nearly a century in the United States. It was in an early draft of Social Security.
Yet each time, it has been defeated in part by fear-mongering industry lobbyists. That may happen this time as well — unless the Obama administration and Congress defeat these manipulative special interests. What’s un-American isn’t a greater government role in health care but an existing system in which Americans without insurance get health care, if at all, in livestock pens.

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Join "Rally for Health Care Reform" this Saturday!

Saturday, August 29

Downstate Contingent Joining

UNITY RALLY FOR HEALTH CARE REFORM

(Please join at any point!)

10am-12pm:

· TABLING @ GRAND ARMY PLAZA

· Gathering signatures supporting a public option (for Sen. Schumer)!

· Flyering for the 2pm rally at Times Square to demonstrate our support for PROGRESSIVE health care reform!

• RSVP here!

12pm: leave together for Times Square

2pm-4pm:

· HEALTH INSURANCE REFORM RALLY @ TIMES SQUARE

· A partnership of NYC grassroots groups and Organizing for America

· Speaking program begins at 2pm. Arrive early!

“It's our health care. It's our time. Save the date to make your voice heard.”

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Helping Primary Care NOW!

In regards to a proposed 8 percent increase in reimbursement rates to primary care physicians in the 2010 Medicare fee schedule, an email from the American Academy of Family Physicians notified me that "As you would expect, the subspecialists are mobilizing their members to oppose this change."
On the other hand: Below is the "comment" I left at the Regulations.gov webpage to show my support, and if you believe so too, you can do so too here.

I am happy/relieved to hear of this proposed 8% increase in Medicare reimbursement rates to primary care physicians. Happy because it is the first I have learned of an indication that consideration for primary care is valued; relieved because even in my brief introduction into medicine so far it has been hard not to become cynical sometimes about where I was headed.

Whereas access to primary care has

proven to be the leading indicator for an individual's and community's health, the reputation of primary care medicine has sunk to the bottom of the barrel, in the eyes of this whole generation of students entering the medical profession. Primary care physicians "make the least," "are the most ignored and undervalued in society," and they "are not respected"--these are just a few of the "truisms" I have heard mentioned by many peers so far.

I am on my way to become a second year medical student, and one of the few medical students remaining these days thinking of pursuing primary care medicine (down to only about 1% of us, in fact, despite an exponential explosion in the nation's impending need). I urge all of my peers & our political leaders to push & pass this increase in reimbursement to primary care physicians. If so, this will help encourage more future physicians to fill the much-needed primary care roles that will accompany America's increasing demand and (hopefully) expanded health insurance coverage. If not, the alarming trend of medical students' aversion to primary care will continue, and folks like me will be even lonelier, and maybe even altogether discouraged.

Sincerely, Abraham Young

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NYT: Wisdom on ankle injuries!

How to Fix Bad Ankles

By Gretchen Reynolds

July 8, 2009, 10:30 am

[Click on link above to NYT article for video on ankle exercises!]

Ankles provide a rare opportunity to recreate a seminal medical study in the comfort of your own home. Back in the mid-1960s, a physician, wondering why, after one ankle sprain, his patients so often suffered another, asked the affected patients to stand on their injured leg (after it was no longer sore). Almost invariably, they wobbled badly, flailing out with their arms and having to put their foot down much sooner than people who’d never sprained an ankle. With this simple experiment, the doctor made a critical, if in retrospect, seemingly self-evident discovery. People with bad ankles have bad balance.

Remarkably, that conclusion, published more than 40 years ago, is only now making its way into the treatment of chronically unstable ankles. “I’m not really sure why it’s taken so long,” says Patrick McKeon, an assistant professor in the Division of Athletic Training at the University of Kentucky. “Maybe because ankles don’t get much respect or research money. They’re the neglected stepchild of body parts.”

At the same time, in sports they’re the most commonly injured body part — each year approximately eight million people sprain an ankle. Millions of those will then go on to sprain that same ankle, or their other ankle, in the future. “The recurrence rate for ankle sprains is at least 30 percent,” McKeon says, “and depending on what numbers you use, it may be high as 80 percent.”

A growing body of research suggests that many of those second (and often third and fourth) sprains could be avoided with an easy course of treatment. Stand on one leg. Try not to wobble. Hold for a minute. Repeat.

This is the essence of balance training, a supremely low-tech but increasingly well-documented approach to dealing with unstable ankles. A number of studies published since last year have shown that the treatment, simple as it is, can be quite beneficial.

In one of the best-controlled studies to date, 31 young adults with a history of multiple ankle sprains completed four weeks of supervised balance training. So did a control group with healthy ankles. The injured started out much shakier than the controls during the exercises. But by the end of the month, those with wobbly ankles had improved dramatically on all measures of balance. They also reported, subjectively, that their ankles felt much less likely to give way at any moment. The control group had improved their balance, too, but only slightly. Similarly, a major review published last year found that six weeks of balance training, begun soon after a first ankle sprain, substantially reduced the risk of a recurrence. The training also lessened, at least somewhat, the chances of suffering a first sprain at all.
Why should balance training prevent ankle sprains? The reasons are both obvious and quite subtle. Until recently, clinicians thought that ankle sprains were primarily a matter of overstretched, traumatized ligaments. Tape or brace the joint, relieve pressure on the sore tissue, and a person should heal fully, they thought. But that approach ignored the role of the central nervous system, which is intimately tied in to every joint. “There are neural receptors in ligaments,” says Jay Hertel, an associate professor of kinesiology at the University of Virginia and an expert on the ankle. When you damage the ligament, “you damage the neuro-receptors as well. Your brain no longer receives reliable signals” from the ankle about how your ankle and foot are positioned in relation to the ground. Your proprioception — your sense of your body’s position in space — is impaired. You’re less stable and more prone to falling over and re-injuring yourself.

For some people, that wobbliness, virtually inevitable for at least a month after an initial ankle sprain, eventually dissipates; for others it’s abiding, perhaps even permanent. Researchers don’t yet know why some people don’t recover. But they do believe that balance training can return the joint and its neuro-receptor function almost to normal.

Best of all, if you don’t mind your spouse sniggering, you can implement state-of-the-art balance training at home. “We have lots of equipment here in our lab” for patients to test, stress, and improve their balance, Hertel says. “But all you really need is some space, a table or wall nearby to steady yourself if needed, and a pillow.” (If you’ve recently sprained your ankle, wait until you comfortably can bear weight on the joint before starting balance training.) Begin by testing the limits of your equilibrium. If you can stand sturdily on one leg for a minute, cross your arms over your chest. If even that’s undemanding, close your eyes. Hop. Or attempt all of these exercises on the pillow, so that the surface beneath you is unstable. “One of the take-home exercises we give people is to stand on one leg while brushing your teeth, and to close your eyes if it’s too easy,” Hertel says. “It may sound ridiculous, but if you do that for two or three minutes a day, you’re working your balance really well.”

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4 emails debating health care reform! (Please chime in w/ comments!)

EMAIL #4

Hi all classes,
Glad to see this "healthy" debate among Brandon, Kate, and Anthony, and probably others (like me) who would be itching to jump into this conversation and interact with everyone's viewpoints--if not for these damn things they call exams.

But just wanted to throw in this article from this week's The Economist (a right-leaning magazine in regards to business/economy, as its name gives away; but I find a very smart, clear-minded, progressive, and not-shy voice in-general): it provides no blanket verdict of "Yay" or "Nay" on the issue of the Medicare-based public plan, but it does succinctly elicit the subtleties and nuances of the whole situation.

Enjoy! And in any case hope U.S. health care gets some form of huge overhaul for the better in the next year(s), otherwise Healthcare itself may become the cause of morbitiy & mortality not only on the growing uninsured, but also on all other sectors of American society by the time we're retired (as the article aptly forecasts).
-Abe

PS. I have copied the article below, along with all the discussion so far (Kate and Anthony, if you'd like me to remove your responses from the website I'd be glad to do so) on the website:
http://DownstateCafe.blogspot.com/
Please feel free to continue the lively discussion there (via "leave a comment"), or if there is any other articles/items you'd like to suggest for the website, please let me know.

THE ECONOMIST: "The future of health-care reform"

The moment of truth

Jun 4th 2009 | WASHINGTON, DC
From The Economist print edition

Congress is about to tackle health care, for the first time since the debacle of 1993-94. Do the reformers stand a chance this time?

Corbis

A PICTURE of a handsome young man riding a bucking bronco hangs in the office of Max Baucus. The Democratic senator from Montana was a novice in the rough world of rodeo three decades ago, but when challenged he did not hesitate. The nerve-racking ride that ensued foreshadowed his current wild adventure. As chairman of the Senate’s Finance Committee, this relatively unknown figure has emerged as a central force in the struggle over health reform.

Barack Obama has made health care a domestic priority. But rather than designing his own plan, he is leaving it to Congress to take the lead by crafting a bill which he hopes to sign before year’s end. Last month he gathered insurance and health-industry executives at the White House. This week he called in leading Democratic senators working on the issue. And on June 6th Organising for America (a political group that sprang from Mr Obama’s presidential campaign) plans to raise the heat further. Its website declares that “in thousands of homes across the country, we’ll gather to launch our grassroots campaign for health care.”

For the first time since Hillary Clinton’s failed attempt of 1993-94 Congress has taken up health reform in earnest. On May 20th Senator Tom Coburn from Oklahoma and three fellow Republicans (including the up-and-coming congressman Paul Ryan) introduced their version of a health-reform bill. On June 2nd Judd Gregg, a conservative Republican senator, introduced another. An innovative earlier bill by Ron Wyden, a Democratic senator, has a number of Republican co-sponsors. All this, says Mr Gregg, proves that his party is willing to participate in, rather than obstruct, efforts at health reform this time round.

That pledge of bipartisanship may not survive. And it may not matter much, for Mr Obama has made it clear that he will sign health reform as part of the budget reconciliation process if necessary—a controversial manoeuvre that would need only 50 votes in the Senate, not the normal 60. So the reins are firmly in the hands of two senior Democrats: Mr Baucus and Edward Kennedy, the head of the Senate’s Health Committee. Both are expected to deliver their own bills this month. Although Mr Kennedy’s is expected to tilt further to the left, insiders expect that the two will be merged fairly easily. That hybrid bill will be the one that matters.

For much of the presidential campaign, the debate on health reform seemed to hinge on cost versus coverage. John McCain appeared more concerned about reining in runaway health inflation, while Mr Obama seemed more concerned about extending coverage to the nation’s uninsured. Confronted by the financial crisis, however, the new president has made it clear that he now wants to tackle both objectives. Christina Romer, the head of Mr Obama’s Council of Economic Advisers (CEA), believes that “there are linkages in both directions”.

She points out that extending insurance to all can save money because tens of billions of dollars are spent today on the uninsured, who get late and expensive care in emergency rooms. In a new report the CEA argues that any reform that slowed the annual growth rate of health costs by 1.5% would boost America’s economic output by over 2% and increase the average household’s income by $2,600 in 2020. The CEA analysis suggests that universal coverage would lead to a healthier, more mobile and more productive workforce.

Those forecasts are probably a bit rosy, but the report also spells out the implications of failure. The CEA forecasts that health spending, which will account for perhaps 18% of America’s GDP this year, will soar to over one third of output by 2040. More politically salient is its warning that health inflation will squeeze wages hard as an ever larger share of compensation comes in the form of health insurance (see chart). A new report from the Urban Institute, a think-tank, adds that doing nothing means the number of uninsured will grow from perhaps 49m today to 62m in a decade. Taken together, all these factors explain why there is such momentum behind health reform.

Details please

But what will the reformers actually come up with? Although the final details will not be known until the Baucus and Kennedy bills are unveiled, a few important elements are already clear. Despite the hopes of some, there is, in the words of Mr Baucus, “no chance” of a single-payer system advancing in legislation this year. “We’re not Sweden, Britain or Canada,” he says, “and we’ll come up with an American solution” that will involve both government and the private sector.

That points to a fight over some form of government-run insurance plan. Many on the left, including Mr Obama, argue that reform must include a “public plan” that would provide an alternative to rapacious private insurers. But industry types are convinced that any government plan would enjoy unfair advantages, like implicit government guarantees and huge pricing power, and suspect it would serve, in Mr Gregg’s words, as “a stalking horse for a single-payer system”.

Who is right? Neither side, perhaps. Andrew Stern, the head of the Service Employees International Union and an influential labour boss, believes a compromise is possible. But Douglas Elmendorf, the head of the non-partisan Congressional Budget Office (CBO), observes wryly that “the closer a public plan is to a private plan, the less the gain.” Old lags of health reform suggest that some in Congress want to pick a fight over the public plan issue to distract from other, bigger reforms in the works.

One of those is the once controversial notion of an individual “mandate” to purchase insurance. Without such a requirement in place, too many healthy people choose not to pay for insurance. This leaves less money to cover the sick, and some of the uninsured inevitably turn up at emergency rooms. A mandate would need to be coupled with comprehensive insurance-market reforms. This would involve stronger regulation of insurance firms to force them to offer insurance to everyone, the creation of central exchanges for buying insurance, and subsidies for the poor.

Pioneering reforms in Massachusetts have helped win over many liberals to the mandate idea. Mr Kennedy’s bill is likely to be an expanded version of those reforms. And a U-turn by the industry is also winning over Republicans. The health insurance lobbies now say they are willing to live with rules forcing them to accept all patients without regard to pre-existing medical conditions—but only if this is accompanied by an individual mandate. Mr Gregg’s proposal has just such a requirement, while Mr Ryan’s bill has a similar proposal for “automatic enrolment” of people into private insurance schemes.

The other surprising area of possible agreement concerns the most important question: how to pay for these reforms, which may cost $1 trillion or more over the next 10 years. The biggest available pool of money is the tax exclusion granted on employer-provided health insurance. Jonathan Gruber of the Massachusetts Institute of Technology thinks eliminating this distorting giveaway would net some $2.3 trillion over the next decade or so. When Mr Wyden proposed abolishing that tax break to pay for universal coverage in 2006, many thought the notion outlandish, but it now looks likely to happen, at least in part.

Mr Stern warns of a “middle-class riot” if any such reform is seen as a tax increase on working folk with insurance. But as everyone involved in reform piously vows their plan will be “budget neutral”, this cow is suddenly no longer so sacred. Mr Ryan’s bill would end the tax break for the most expensive of these plans. A cap on this benefit is proposed by Mr Gregg, who reckons this is “the most logical way to raise money.” Mr Baucus also supports capping this perk, though not abolishing it. One problem for Mr Obama is that, during the presidential election, he excoriated Mr McCain for exactly this idea. He also opposed individual mandates. This week, though, he hinted in a letter to Democrats at a compromise on both issues.

There are many other good ideas to cut costs making the rounds. They range from investing in prevention to expanding the use of health information technologies to rejigging incentives so that doctors get paid for health outcomes rather than for treatments. Alas, most of these ideas will not get counted by the Congressional Budget Office, which is charged with evaluating such proposals, as savings, either because their pay-off is too uncertain or because they require short-term investments that pay out far off in the future.

Three decades ago, as he got on that bucking bronco, the Western senator was given this advice: “Don’t look at the ground, because if you do that’s where you’re going to end up.” There has been an air of civility and bipartisan co-operation around health reform so far, but it may not last long. Mr Baucus should keep looking forward and hang on tight.

EMAIL #3

On Sat, Jun 6, 2009 at 4:06 PM, Anthony wrote:

Greetings Classmates,

After reading the Action Alert, I would like to make one change:

Update: Support a Medicare-based public plan

I am firm supporter of a move towards a public funding source for health care in this country.

And with no offense intended towards my esteemed acquaintance Brandon, I would like to applaud Kate for helping us all to see both sides before acting on Action Alerts.

Cheers to Brandon and Kate for encouraging us all to think critically about health care as a political issue and educate ourselves about both sides.

I've written some arguments for a move towards a public plan below, with links.

Anthony Accurso, COM 2010
Member: American Medical Student Association
Member: Physicians for a National Health Program



Reasons for a move towards a public plan:

AMSA: our medical student professional organization - openly supports a single-payer Medicare-for-all system.

- The U.S. is the only industrialized nation in the world that relies primarily on a for-profit privately funded health care system. We pay more for our system than any other nation, but it lands us between 20th and 30th worldwide in Life Expectancy and Infant Mortality. Frontline.

- Polls show that upwards of 62% of U.S. citizens and 59% of U.S. physicians would prefer a single payer system, publicly financed, privately delivered (resembling Medicare Parts A and B). ABC/Washington Post Poll Question 47, Annals Int Med, p566

- AHIP (America's Health Insurance Plans) and other powerful lobbies have vested interests in sustaining their industry. Data from the rest of the world shows us that public options would likely cover all Americans, ensure choice of doctor, prevent discrimination against people with pre-existing conditions and provide improved efficiency that would help to control costs.

For more information about the potential of publicly funded health care:
- PNHP is a professional organization of 14,000+ physicians who support creation of a publicly funded, privately delivered health care system. Also PNHP-NY
- California Nurses Association
- PHIMG

EMAIL #2

On Sat, Jun 5, 2009 at 9:42 PM, Kate wrote:

Hello,

I am writing to encourage all of you to contact the numbers below to
encourage our senators to support a government-run insurance option.
I'll try keep my response brief, but there are a few things that I feel
should be addressed.

First of all, President Obama's proposal would not mandate that all
American's enroll in a government run health plan; it would potentially
mandate that all Americans posses some form of health insurance,
private OR public, unless they are found to be unable to pay for it.

Consider the following:

18% of people under 65 in the US are uninsured and rising

The percentage of people with employment-based health insurance has
dropped from 70 percent in 1987 to 62 percent in 2007. This is the
lowest level of employment-based insurance coverage in more than a
decade

Rapidly rising health insurance premiums are the main reason cited by
all small firms for not offering coverage. Health insurance premiums
are rising at extraordinary rates. The average annual increase in
inflation has been 2.5 percent while health insurance premiums for
small firms have escalated an average of 12 percent annually.

Lack of insurance compromises the health of the uninsured because they
receive less preventive care, are diagnosed at more advanced disease
stages, and once diagnosed, tend to receive less therapeutic care and
have higher mortality rates than insured individuals.

The United States spends nearly $100 billion per year to provide
uninsured residents with health services, often for preventable
diseases or diseases that physicians could treat more efficiently with
earlier diagnosis.

The uninsured are 30 to 50 percent more likely to be hospitalized for
an avoidable condition, with the average cost of an avoidable hospital
stayed estimated to be about $3,300.

The majority of us, I hope, entered this field because we are dedicated
to caring for others and serving them to the best of our abilities. I
have no desire to underplay the frustrations we all experience from
being underpayed for our hard work, however we are, as physicians, a
relatively well-off group (I'm looking at you, future anesthesiologists
of America!). In the end, I am certainly more concerned with adequate
coverage and care for all of my family and friends than I am about my
own income, which, even with Medicare/Medicaid reimbursement will prove
adequate.

Please look into this issue on your own. This is a chance for our
country and our profession to provide effective care for everyone.
It's a chance to truly save lives -- and not just the lives of those
who are fortunate enough to be able to pay for the high insurance
premiums that allow private insurance companies to reimburse us more
"adequately."

http://www.nchc.org/facts/coverage.shtml
http://www.nytimes.com/2009/06/05/opinion/05krugman.html?scp=3&sq=krugman&st=Search

EMAIL #1

-----Forwarded by Brandon on 06/05/2009 07:41PM -----

To: Brandon
Date: 06/05/2009 06:16PM
Subject: Action Alert

Action Alert Update: Oppose a Medicare-based public plan More Info Contact your Senators TODAY! Last week I sent an Action Alert asking you to contact your U.S. Senators and urge them to oppose a Medicare-based public plan. If you have not yet taken action, I urge you to do so immediately. Your action on health care reform has never been more crucial. As a result of developments this week, it appears all but certain that the key Senate committees are proceeding with legislation that includes a public plan option - a government sponsored health plan that would compete with commercial health insurance products. Though the ASA has not taken a stand either for or against a public plan, we have a strong stand against any public plan whose payment to anesthesiologists is based on Medicare rate. Please urge your Senators to reject a Medicare-based public plan, and to ensure that physicians can voluntarily participate. Please contact your Senators today: Call the Capitol Switchboard, (202) 224-3121, and ask to be connected to your Senators Use CapWiz to send emails (templates are provided at this link) Recently released documents suggest that key U.S. Senate health care committees-the Senate Finance Committee and the Senate Health, Education, Labor and Pensions (HELP) Committee-are likely to propose the creation of a new government plan when they unveil their health system reform legislation in the coming weeks. According to one document circulating around Capitol Hill, this new plan or "public option plan" would be based upon Medicare payment levels. Additionally, participation in the plan would be mandatory. Just days ago, President Obama sent a letter to Senate Finance Committee Chairman Max Baucus (D-MT) and HELP Committee Chairman Edward Kennedy (D-MA) urging inclusion of "a public health insurance option operating alongside private plans." As ASA has consistently stated, we remain open to a wide range of options for health reform. However, any public plan option considered by Congress must NOT be based on Medicare's unacceptably low payments. As it stands, Medicare pays 33% of what private insurers pay for anesthesia services (according to the U.S. Government Accountability Office - GAO-07-463) and significantly discounts payments for pain services. An extension of this broken payment system would severely damage our specialty. Further, physicians should be able to voluntarily participate should a public plan be established. For those of you who have already responded to this action alert, thank you. Your involvement in our efforts will help ensure that Congress understands the unique challenges that our specialty faces. Your ASA Washington Office staff is available to answer questions or provide additional information. You can reach the office at (202) 289-2222. To stay up-to-date on the latest health care reform news, please use the following ASA tools: Visit ASA's Health Care Reform webpage Subscribe to ASA's RSS feed Sign up for the ASA Grassroots Network Join "ASA Grassroots Network" on Facebook Follow @ASAGrassroots on Twitter We are at a critical juncture. Please contact your U.S. Senators and urge them to oppose a Medicare-based public plan, and to allow physicians and hospitals to voluntarily participate should a public plan be created.

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