It’s often said that the beleaguered emergency department (ED) is the initial point of care for many patients. In this current broken healthcare delivery system, that means an umbrella which “covers” the uninsured as well as those who are underinsured. The total cost for these points of acute care notwithstanding, how is the best way to explain new numbers out of the CDC this week?

The CDC’s National Center for Health Statistics reported the numbers in its annual summary of U.S. data on disease conditions, health behaviors and use of medical services. The scan figures are based on visits to roughly 500 hospitals and 3,000 doctor’s offices and outpatient clinics.

According to this survey data, the CDC says that the use of imaging modalities in the ED has quadrupled since the mid-1990s. Besides being just another point of confirmation of the origin of skyrocketing healthcare costs in this country, the heavy emphasis placed on tech will not abate anytime soon. Issues pertaining to defensive medicine, integration of such tech into ingrained training of new physicians, and the cost of using such technology within the medical device market are all good reasons to try to begin attacking this startling — yet, unsurprising — statistic. | LINK

The funny thing about 20/20 vision in politics besides its keen ability to note history as it unfolds in the political process…is the ease with which it gives pundits in any genre a basis to pontificate^[1] or, rather…create, new issues and stories.  A recycling of information, if you will — the lifeblood of the blogosphere.

For Doctor Pundit’s inaugural accounting of its yearlong then-and-now pontifications on healthcare policy, we begin with an issue whose posting on this blog became its #1 blog entry for all of 2009 (according to Google Analytics statistics). Obama’s ascendancy to the the highest elected seat in the land carried along with it the hopes and dreams of the disenfranchised in this country who were hungry for change — any change — from the stranglehold that (they thought) was the Bush administration’s clamp on any meaningful attention to domestic policy in favor of its affinity for foreign policy and the War in Iraq. Healthcare was just one of those domestic policy points Obama supporters were clutching as possible rallying points for galvanizing their candidate’s ability to win the nation’s highest office — one which, for the first time, seemed a real possibility for an African-American candidate.

Enter Barack Obama, who not only won the 44th presidency, but also answered his party’s mandate in doing so. As part of his commitment to the people who placed him there (or to himself, as healthcare policy reform was as self-serving a legacy accomplishment for Obama as was any other domestic issue), Obama would finally make healthcare accessible to all. And he would get the Republicans and Democrats — and Pharma and Insurance — to work together to make it possible. Lofty? To Obama, at the time, not especially.

Apparently, expansion of the federal government’s role in financing Medicaid is a priority. According to the WaPo, Obama plans on allowing states temporarily to sign up jobless residents for Medicaid, with the federal government for the first time paying the entire cost of doing so. Even more boldly, the new president will also provide “unprecedented” federal subsidies to increase the affordability of COBRA, a temporary coverage mechanism for laid-off workers that, for many, remains unaffordable.

Fast forward 12 months later, and Obama is fighting for not only a candidate’s political life but also his own legacy as it applies to the reform of healthcare on a national level. A year ago, Obama had high hopes on expanding both Medicare and Medicaid to deliver high quality healthcare to those who needed it the most. At the time, it appeared to Obama, at least, that cost was no object. A year later, multiple iterations of CBO analyses have shed light on what lawmakers, Obama, and now the American people know only too well: Obama’s promises to increase healthcare access to the almost 50M uninsured have broken down on a massive level, its overarching meaning reduced at this moment to a vote this Tuesday in the state of Massachusetts on an open U.S. Senate seat. Twelve months and thousands of contentious healthcare townhalls later, Obama’s dreams of the affordability, bipartisan entreaties, and corporate cooperation of Pharma and Insurance with respect to healthcare reform are turning into a cruel reality on how he just seemed to lose all control of the debate.

1. …or rant, although I’ll try to stay away from heavy-handed verbal drama [↩]

The Democrats have essentially cleared the way for the passage of a health reform bill that is poised to become the largest overhaul to social welfare in this country in more than half a century. The plan to cover more than 30 million uninsured is the result of the individual mandate inherent in the bill’s language which is meant to spread the risk pool which also shares (spreads) the cost of coverage.

For the young and “invincible”, as many wonks and health plan actuaries like to call them, the decision to participate in an insurance mandate is as individual as the potential patient considering the decision. Why should a young, healthy patient buy insurance (even if mandated by the government) if he/she feels perfectly healthy? It’s that point that has many healthcare economists concerned. Opting to pay a penalty is just another another mechanism by which compliance with any mandate is not guaranteed.

There are many imperfections in the reform bill; engineering social norms in such a way that perfectly healthy people feel just as determined to purchase health insurance as they do when they are required to wear seatbelts — well, that pill may take a while to go down. | LINK

On the second day of Senate debate on the healthcare reform bill, former pres candidate and current Republican senator John McCain (R-AZ) is poised to bring his amendment to a vote today or tomorrow. Using “rationing” rhetoric to explain his desire to prevent what he says are close to half a billion dollars in cuts to Medicare to fund a portion of the reform bill, McCain hopes to counter Democrats’ plans for eliminating what they see are superfluous and unnecessary costs to run the program.^[1] Dem. Senator Barbara Mikulski (D-Md), on the other hand, is proposing government funded guaranteed coverage for mammograms without co-pays to plans as a way to combat “discrimination” at the hands of insurance companies.

Amendments to the bill in its current form will more than likely constitute the strategy Republican senators as a partisan body will undertake early in the debate — staking out its political territory and making its points early. Democrats will not only have to counter those issues by vote, they will also have to solidify their goals in order to reach agreement among themselves. The Mikulski amendment attempts to frame the debate in terms of policies many Democrats can agree on — abolishment of claim denials based upon discrimination by Insurance and making government financed care (Medicare) more efficient. | LINK

1. McCain’s amendment would also strive to eliminate a proposed federal CMS payment commission which would decrease costs to Medicare and Medicaid over 10 years. [↩]

Innovation continues to rule the day in Minnesota, a state known for its rich pioneering social spirit. Faced with a looming budget shortfalls with respect to its GAMC funding (a component of its Medicaid state dollars), its governor’s rogue unallotment process, and the cancelation of many employer-based coverage programs (for those still lucky enough to have jobs) — some communities in the state are utilizing that ethic and establishing local private-public partnerships to guarantee healthcare delivery to the uninsured.

Dubbed access-to-care plans, the care delivery programs are being sustained through the state’s Dept. of Human Services, which receives its grant funding from HHS. What’s interesting about this initiative is that each program appears to establish its own set of protocols and guidelines for its beneficiaries. Even those programs with generous levels of funding are still finding even more money via partnerships of local and municipal origins. Schools, employers, and participating healthcare systems form networks of care within which patients are enrolled. Preventive medical care is emphasized and the goal is optimal patient outcomes and care accessibility. It’s because of this last point that many primary care clinics are also on board. Very cool. | LINK

If there were any doubt that President Obama’s photo ops touting his healthcare reform agenda (a) resemble his vigorous campaign for president and (b) carry the slightest whiff of the urgency of an informercial, then those concerns were clearly reinforced today as he took to the stage in the South (strategically) to make his pitch once again.

It’s a well known fact that now, the battle for the health reform scorecard reads CRITICS 1 : OBAMA 0.

That’s why Obama has completely reframed the focus of his push for this legislation from that of thinly veiled entitlement to one of consumer choice, noting that, for those who have insurance, their coverage will only be strengthened by those who are trying to obtain access. It’s a move that not only shows some desperation on the part of Barack Obama, but also continues to play to the strength of his Republican critics. Case in point:

As for Bristol, Mr. Obama did not do well in rural Virginia at all in last year’s election, but his numbers there were not as low as many expected, and he still won the previously red state. Still, Creigh Deeds, the Democratic nominee for governor of Virginia, will not be by Mr. Obama’s side at the Bristol event. The Deeds campaign said that Mr. Deeds is missing the event because it is official White House business with no connection to his campaign, but Republicans were quick to e-mail reporters pointing out that this is the second Obama event in Virginia which Mr. Deeds has missed.

Lost cause for Obama? Probably not. Panic time? You betcha. | LINK

Smaller chain pharmacies are trying to compete with the big boys, and in trying to earn store-brand loyalty among their (un- and underinsured) consumers, they are throwing free antiobiotics their way. Last week, the CDC sent out letters those several chain pharmacies that offer no-cost prescription antibiotics to low-income consumers urging them to promote responsible use of antibiotics. The agency is concerned that the no-cost drugs could promote the wrong message and might worsen the problem of drug resistance. Of course it comes as no surprise that the new round of CDC warnings arrive as some pharmacies offering no-cost antibiotics have linked the offers to the cold and flu season, neither of which should be treated with antibiotics. | LINK

In a new Barack Obama administration you helped to place into office just before your were pinkslipped in December, you are finally starting to see results. You are scrambling  like mad, trying to cobble together financial documents so that you not only can refinance your lower valued home under new Fannie/Freddie rules, but now you just found out that you qualify for the promised government subsidy for COBRA coverage under Obama’s healthcare stimulus package! 

Employers have 60 days from date of enactment (that is, by April 17) to send notices to assistance-eligible individuals who lost coverage between Sept. 1, 2008, and Feb. 16, 2009. For those eligible for the assistance who lost employment-based health insurance on or after Feb. 17 of this year, the employer generally has 44 days from the date the employee lost coverage to provide a COBRA notice that includes an explanation of the subsidy. Being laid off never felt so good. | LINK

President Obama’s soaring healthcare rhetoric got a huge PR boost last night, as he addressed Congress head-on for the very first time on this issue. Reform is necessary in the healthcare sector as it is needed in practically every financial sphere. After all, it’s all about wasteful government spending during economic distress. The difference, according to Obama, is that healthcare delivery in this country — a largely unregulated gentlemans’ agreement between Big(s) Pharma, Insurance, and the providers — will ultimately need to enlist “buy-in” from those whom it directly affects, the individual patient. Read the rest of this entry »

It’s official. Barack Obama will begin doling out the almost $15B portion of the economic stimulus package to states in the form of expanded Medicaid benefits. It is clear what his intentions are: jumpstarting the healthcare economic sector for states who wish to participate. According to the president, this includes, in part,  imporoved healthcare access for the newly unemployed and those partially covered under COBRA. 

Beyond aid to the states, the federal stimulus plan includes tax cuts, increased unemployment benefits and food stamps, and health insurance aid for the poor and jobless.

What’s not quite as clear is how Republican governors of states which stand to benefit from the healthcare stimulus package will react, especially if a source of revenue (read: higher taxes on employers to compensate, for example) is needed once those individual states’ stimulus amounts run dry. | LINK

A 19-year old who uses vigorous exercise to sweat off a viral illness. A 23-year old asthmatic who uses his inhalers only during a severe attack finds himself back in the ED when he runs out in the middle of one. A 28-year old who racked up almost $20 000 in hospital charges for a two-day stay for the treatment of a common gastrointestinal ailment. A 27-year old journalism student and type I diabetic who has taken the desperate step of using needle syringes to inject insulin at the risk of severe complications after running out of stockpiled ($900/month) tubing needed to maintain his continuous insulin-infusing pump. Are the health behaviors of these patients irresponsible, reckless, and shortsighted — or are they merely necessary?

Read the rest of this entry »

During tough economic times, the vicissitudes of human nature essentially dictate that something good has to come out of all this negativity everyone is experiencing in this severe economic downturn. So, it comes as no surprise that a recent poll found that the majority of Americans think the future is, indeed, brighter. It just has to be. With respect to healthcare, attidues toward the concept of access as more of a right than a privileged commodity are in the majority. Most Americans surveyed thought that nationalization of healthcare is the way of the future, a complete reversal of 30 years ago, when less than a third of all citizens thought such a plan is best equipped for emergencies on a national scale. Will this info be enough to shake Obama out of his current stoicism on healthcare policy? Perhaps he’s just waiting for the right HHS Secretary for that notion. | PDF LINK

She’s a divorced 57 year-old female who was forced to step down from her job because of the debilitating side effects from the chemotherapy used to treat her breast cancer. Initially, from the time she was diagnosed, she was able to continue to work as a high powered executive. All of that came to a halt when she stopped working and subsequently had to sell her house in order to meet her co-pay and former employer health insurance costs. Now cancer free — but still needing expensive chemo — she survives on disability income and somehow manages to meet the constant out-of-pocket expenses she now has for medical services outside of her current physician network. Comparing herself to the Bionic Woman, the woman muses, “Sometimes you sit there and think: Am I really worth this?” | LINK | PDF of study here