Towards an Ethic of Physician Responsibility
By now we are all familiar with the statistics: the United States spends a disproportionate amount of money on health care for results that are, at best, comparable to countries that spend far less. Whatever your diagnosis of this problem, whether it is a result of misaligned incentives, under-investment in primary care, or government interference, and whatever your prescribed treatment – Accountable Care Organizations, increasing access or unleashing the free market – there is one inescapable common denominator. If any reform is to be successful, physicians must have more knowledge of and be more responsible for costs in our health care system.
Physicians in the United States have historically been granted a substantial degree of autonomy. We were slow to develop a system of private insurance, largely because physicians saw private insurers as a threat to their independence. Likewise, the United States was, until recently, one of the few developed nations without a national health policy providing universal coverage, in large part due to opposition from physician's groups. Even the Affordable Care Act avoids the overt government involvement of a single payer plan, instead preferring a lighter touch that defers to doctors and hospitals
This deference to the autonomy of physicians gives the medical community a moral obligation to address the challenges that face our industry. As a profession, physicians cannot stand idly by while costs in the health care system – costs which are largely under their control – grow to consume an ever larger share of economic output, pricing ever more people out of the system. Whether you believe in the power of free markets or the necessity of government intervention, the case for practicing more efficient and less wasteful medicine is clear.
Of course, nearly any physician you ask will acknowledge the importance of this goal. After all, who stands for wasteful spending? And yet, at an absolute minimum, in excess of twenty percent of our health care dollars are wasted. The question then is not whether physicians should commit themselves to eliminating waste, but rather what are the obstacles standing in the way of this commitment?
The primary obstacle is one of education. A recent study showed that physicians don't understand basic cancer screening statistics. They mistakenly valued less important indicators like increased early detection and improved survival times over more definitive indicators, such as reduced mortality, when evaluating whether a screening test was worthwhile. Another study looked at oncologist's readiness to assess the cost-effectiveness of various treatments and found them unprepared. They were inconsistent in how they weighed the cost of expensive new therapies against the benefits they provided in additional months of life, first saying a treatment adding one year to a patient's life would be worth $100,000, and then later, when presented with a hypothetical patient, endorsing much higher levels of spending.
Many would pause here claiming that it is not the physician's role to assess the cost effectiveness of the tests and interventions they provide. They argue that physicians ought to do whatever their patients wish, regardless of the costs incurred. Wasteful spending in one area, however, leads inevitably to higher insurance premiums and higher taxes, and the costs we incur therefore fall upon society as a whole. For this reason, physicians should work to reduce these costs not only as stewards of our patient's overall well-being, seeking to provide the highest quality care that we can for our patient's dollars, but also as citizens of our nation, attempting to utilize limited resources in the most efficient way possible.
The other major barrier to the practice of cost-effective medicine is the problem of misaligned incentives. Because doctors and hospitals are mostly paid on a fee-for-service basis, rather than for entire episodes of care, they are rewarded for performing more tests and procedures instead of for providing quality care efficiently. This means that even if doctors are well informed about cost-effectiveness research it will be difficult to translate this knowledge into practice without damaging their own bottom lines.
We are beginning to solve this latter problem. With the Affordable Care Act's move towards Accountable Care Organizations and reimbursing physicians for the quality of care they provide rather than the quantity, the fee for service model will hopefully soon be a thing of the past.
Equipping physicians with the knowledge needed to make this transition is a more difficult matter. The recent list of overused medical tests compiled by a group of medical societies led by the American Board of Internal Medicine Foundation was a good first step. The move by organizations like Costs of Care to bring price transparency to health care will aid physicians in making these cost-conscious decisions. Increasing the emphasis on cost-effectiveness in the education of medical students like myself will also be an important change. In the end, this transition will require the acknowledgment of physicians as a whole that understanding the costs of the care they provide is as integral to being a high-quality clinician as understanding the benefits.
Transforming the American health care system will not be easy. But no matter what your political persuasion, no matter what reforms you think are necessary, no reform can succeed unless physicians are ready and willing to eliminate wasteful spending and perform their jobs more efficiently. It is the single change upon which all others ultimately rest.
Celebrating Women and Health Reform on Mother's Day
On this Mother’s Day, I woke up with a sincere gratitude that comes with having three children who are healthy and thriving. I am also thankful for my own good health, as well as that of my husband’s. Before becoming a mom, I had taken much of my good health for granted as I assume most young people do. But once I began the journey of motherhood, it was an obstacle course of doctor’s visits, medical tests, ultrasounds, vaccinations, X-rays, E.R.visits, and hospitalizations. Becoming a mom is a huge wake- up call to what is good and what still needs improvement in our healthcare system.
Being in the profession grants me an advantage over many other families. Or so one would think. My first son was born during my third year of residency training, when the new childhood pneumococcal vaccine was introduced. It was held as a revolution in reducing the incidence of bacterial pneumonia and meningitis. Although I was able to provide it to my clinic patients, mostly Tenncare Medicaid families, I had to take my son to the health department to get this valuable vaccine at a reduced cost. Our private insurance hadn’t yet covered the vaccine, which was almost two hundred dollars out of pocket. That was the first time I questioned why the premiums I paid do not go back to the health care of my child.
My generation of physicians in training got to witness the effectiveness of this vaccine in evolution over a fairly short period of time. In the beginning of my residency, it was commonplace to see children with bacterial pneumonia and meningitis, often caused by pneumococcus. By the end of my training, we saw a significant decline in admissions for bacterial pneumonia. And for the first time ever, we had more admissions for viral than bacterial meningitis. The former often is benign but the later can be devastating. The vaccination was available for many of low income families, through Tenncare, the state’s form of Medicaid. And though it still is an ever changing endeavor in the dynamic field of medicine, it provided the necessary vaccine at the right time to the most vulnerable and made the biggest impact in the process.
On this Mother’s Day, I am grateful for the provisions in the Affordable Care Act that benefit moms and their families. That 80% of our paid premiums will go back to the actual health care is an honest way of getting what we paid for. Preventive visits, routine screening of hearing, vision and developmental delays, and vaccinations should be covered at no additional cost. Don’t we all pay enough for coverage - shouldn’t we get covered for what is most important for our families?
Celebrate this Mother's Day, and start of National Women's Health Week, by telling the important women in your life how the Affordable Care Act benefits them and those they love.
You can learn more about how the ACA benefits women and families by clicking here.
Happy Mother’s Day to all,
Anna Tran, MD
Texas State Director
A slower rise on the rise: a sliver of hope?
There has quite the discussion regarding the most recent health care expenditure numbers released by the Center for Medicare and Medicaid Services (CMS) in January. Health care spending increased by only 3.8 and 3.9 percent in 2009 and 2010, respectively. To put this in perspective, this seems disproportionately small relative to the prodigious growth in the 1980s and 1990s (13.1 and 11.0%, respectively). Furthermore, healthcare expenditures as percentage of GDP held steady at 17.9% for 2009 and 2010.
Naturally, it would be intuitive to attribute the recent recession to the plateauing in growth. Indeed, the recession was one of the most severe since the Great Depression. We saw the first decline in overall GDP in sixty years in 2009. The highest unemployment rate in 27 years translates into a larger loss of private employer-based healthcare coverage for consumers. Moreover, employers are increasingly more cautious of hiring in an economic downturn. With the lowest median inflation-adjusted household income since 1996, tightening household budgets further hamper consumers from affording the premiums for coverage and the deductibles and copays when seeking health services. Consequently, there is increasing impetus to postpone medical care, as demonstrated by the slowing growth in ER visits, outpatient visits, outpatient surgeries, and decreasing in median inpatient admissions in 2010. The recession has not only affected consumers and employers, but also the public arena, too. Tightening state budgets decreased growth in overall nursing home spending, which tends be a major expenditure for Medicaid.
Thus, there may be evidence to support the recessional effect in mitigating the acceleration of health care costs. But given the already evidenced deceleration health expenditures prior (7.6% and 4.7% in 2007 and 2008) to the official start of the economic downturn, could there be other potentially prominent factors contributing to the slowing? One can look as the Medicare expenditures as a likely indicator. Medicare utilization is typically unassailable to the effects of recessions given the federal government mostly pays for coverage. Regardless, inpatient utilization for Medicare beneficiaries in many states nonetheless dropped. Furthermore, nine states with 2010 unemployment rates lower than the national average demonstrated declines in health care utilization. Whether these states had an increasing unemployment rate during the economic downturn that is still considered absolutely low is another question. Growth in retail prescription drug spending has reached a historical low of 1.2 percent, emblematic of the increasing use of generic drugs, a dearth of in the introduction of novel drugs, and brand names such as Flomax and Lovenox coming off patent. There also has been an increasing prevalence of the high-deductible plans, which entails lower premiums but also increases cost-conscientiousness on the part of the consumer. Importantly, it is very possible the health care reform legislation process that ultimately led up to the ACA in 2009 and 2010 fomented an incipient nationwide dialogue on our complicated health care system that robustly affected consumer, provider, and corporate behavior. Lastly, the shift in provider culture to more coordinated care and quality measures, as evidenced by the inception of accountable care organizations (ACO) across the nation (with ACA provisions playing a major role in assisting providers set up ACOs) may not contribute significantly to 2010 figures due to its fledgling scope, but will prove most important in the future.
There is no doubt with the statistical trends we are witnessing, this is an encouraging moment for our society given Medicare and Medicaid expenditures precariously impact the long term solvency of our nation. However, it is important to keep in mind that a decrease in the rise attributed to a decrease health care utilization may not necessarily be a good thing. If decrease utilization precludes consumers from appropriately seeking care, we are only exacerbating the problem down the road. Ultimately, it may be too premature to confidently attribute the exact causes in the flattening in the growth health care spending. Nevertheless, it would provide a sliver of hope that taming the intractable rise in health care expenditures is not just a dream but also a reality.
Equal Pay for Equal Work
I love it when I see Medicaid patients on my schedule for the day. Working at a community health center, our doors are open to all people, regardless of their ability to pay. It’s hard to run a medical office when you get $20 for a visit, which is what our uninsured patients pay. So when a patient has Medicaid we know we’ll get paid a decent reimbursement for that visit.
On average, Medicaid pays 34% less for a primary care visit than Medicare, which itself pays less than private insurance. In contrast to my situation, many doctors won’t take Medicaid because it pays so much less than what they’re getting from their other patients with private insurance. The people covered by Medicaid - poor women, children, the elderly sick and the disabled - need more choices of where they can get their care, not fewer.
Which is why it was great news to hear earlier this week that because of the Affordable Care Act, in 2013 and 2014 Medicaid rates will increase to be the same as Medicare rates. This should get more doctors to participate in Medicaid which will expand access for this vulnerable population.
Just as important, it corrects an injustice. The message of the current payment structure is that society, by paying less for Medicaid than for Medicare, values the lives of the poor less than the elderly. It speaks ill of us when we short change vulnerable populations because they can’t afford lobbyists and devalue the providers taking care of them by paying them less for equal work.
For our clinic it will mean that we will be able to expand our services. We will finally be able to buy an audiometer to screen children for hearing problems. We can get more vaccines to vaccinate our diabetics. We can subsidize medication costs for those who can’t afford it. And, we can see even more uninsured patients with the extra money that we get.
The cost of all this is $5.5 billion dollars a year which is just over a 1% increase in the budget for Medicaid. It’s already paid for since it’s a part of the Affordable Care Act but there’s a showdown coming in 2015 when this pay increase is set to expire. Ideally, this pay disparity will be eliminated once and for all but that seems a dim prospect given the way this Congress operates. So when the time comes to fight, ask yourself this: Isn’t caring for your child worth at least as much as caring for your parents?
We are all in this Together
We are a month away from hearing the Supreme Court decision regarding the Affordable Care Act, and this week 2 studies highlight the need for the ACA.
We know that being uninsured is detrimental to one’s health, resulting in worse health outcomes, but a new study by a healthcare economist shows that high rates of uninsured mean worse outcomes even for those with coverage. From 1999 to 2006, California had a 19% reduction in mortality from heart attacks. Across the state there was a large variation: San Francisco and Los Angeles had decreases between 26 percent and 30 percent, while in Sacramento, the drop was just 13 percent.
The author compared outcomes for insured heart attack patients in these cities, controlling for basic demographic information, as well as preexisting conditions. He found that in cities where more uninsured patients are treated there were worse outcomes for insured patients.
The author estimates that, if a lack of insurance were eliminated, there would be 3 to 5 percent fewer deaths among those who already had coverage.
He describes this phenomenon as “negative spillover”. Hospitals that treat more uninsured patients have a higher rate of uncompensated care which takes away resources that could be used to upgrade medical equipment, improve staffing or other investments that improve health outcomes. This results in worse care for ALL patients treated at the facility. Conversely, increasing insurance coverage might have “positive spillover” effects – improving the quality of care for the already insured. The author concludes that policies aimed at addressing the uninsured may have additional benefits to insured patients in the same communities.
The other study, by the Urban Institute, shows that access to care is eroding for millions – even those with insurance. The findings suggest that more privately insured Americans are delaying treatment because of rising out-of-pocket costs, while safety-net programs for the poor and uninsured are failing to keep up with demand for care. Overall one in five American adults under 65 had an "unmet medical need" because of costs in 2010, compared with one in eight in 2000.
People with private or public health insurance have significantly better access to care than the uninsured. If the ACA is overturned or scaled back, "we would be likely to see further deterioration in access to care for all adults -- uninsured and insured alike," it concludes.
While the Affordable Care Act does not solve the US healthcare paradox of both overtreatment and undertreatment it is certainly a first step in the right direction. Quality healthcare for all Americans starts by covering all Americans.
An Illusory Freedom of Choice
As Americans, we are surrounded by multiple options in most aspects of our lives: Twenty varieties of boxed cereals line grocery store shelves, rows of shiny cars in a rainbow of colors, three new iPad versions and plenty more on eBay, and so it goes. On the surface at least, health care options are just as plentiful and abundant: anybody on US soil is confronted by an array of medical options unheard of elsewhere in the world.
Is more truly better? Heaven forbid that we should mention …shhh...rationing… Stop! Not a permitted word! Images of impassioned politicians (fighting for YOUR freedom) and fiery political rhetoric immediately spring to mind (death panels, anyone?). How dare anyone suggest limiting our choices in our most intimate health needs?! However, as health professionals already know, the grim reality is that our nation’s choices are already being limited, manipulated, and marketed, often by nonmedical forces.
…Let’s order an MRI for that back pain that started last week because you need it… or (most common) because you are insistent and I have neither time nor energy to argue about how unnecessary it is… or (more unusual but still present) because I fear a lawsuit for a rare and unlikely diagnosis… or (more cynical and thankfully quite rare) because I am part owner in the local imaging group…
The “Choosing Wisely” initiative is a welcome relief from the excessive waste that has infiltrated all levels of our national health infrastructure. Led by the American Board of Internal Medicine Foundation, the campaign’s aims are to promote discussion about choices that are supported by evidence, not duplicative of other tests of procedures already received, free from harm, and truly necessary. Nine specialty societies have already risen to the challenge and identified lists of the top five things that warrant patient-doctor discussion in their specialty, e.g. when to use antibiotics for acute sinusitis or when to order imaging for headaches. Such a broad multispecialty campaign is powerful in advocating for truly excellent health care choices for the entire nation.
U.S. healthcare presents itself as being an open forum for informed consent, patient autonomy, and shared-decision-making models, but it often ends up being a prison of too many options, too little realistic information sharing, and too much fear of litigation to allow for honest discussions of the magical thinking many patients, families, and doctors believe. Until there is a nationalized health system with quality outcomes-based protocols, individuals will be faced with paralyzing decisions and will never have true freedom to know that they were offered the best advice that their money could buy… At least now, the Choosing Wisely initiative is a good place to start.
For more information, please go to www.choosingwisely.org.
If not now, when?
My comments at a plenary panel for the national leadership meeting of Doctors for America, a health care advocacy group. These have been edited for a different context.
Thank you for having me today. It’s an honor and a pleasure to be here among friends. We have a short time and a long list of issues. I hope we will get into the mechanics of accountable care organizations, mandates, exchanges, and the rest. But I want to open with something different. It will seem like a tangent. It actually speaks to this meeting’s larger purpose.
On April 6, the distinguished Chinese physicist and dissident Fang Lizhi passed away. According to the Economist’s obituary, Fang got in trouble writing a 1972 paper “A solution of the cosmological equations in scalar-tensor theory, with mass and blackbody radiation.” Unfortunately for Fang, Maoist propagandists found Einstein’s field equations politically unacceptable. At some 50,000 foot level, the big bang theory was deemed contrary to proper Marxist-Engels thought regarding the transition to state socialism. At a more practical level, apparatchiks rightly feared the democratic potential and intellectual authority of scientific inquiry. Their claims of unique insight couldn’t stand that scrutiny.
During the Cultural Revolution, Fang was apparently exiled to a coal mine carrying only one book: Landau and Lifschitz ‘s Classical Field Theory. I actually know that book. I broke my pencil on it a quarter-century ago in engineering school. Landau and Lifschitz were two great Jewish Soviet physicists. They were both protected and persecuted by one criminal regime locked in a death struggle with an even worse one.
I learned something about Landau and Lifschitz from a wonderful, now-deceased theoretical physicist Abraham Pais. He had spent the war years hiding from Hitler in an Amsterdam attic. Rather than write a poignant diary as someone else might do, Pais wrote a distinguished dissertation on particle physics. That’s humbling for many of us who have head-tripped over our own dissertations. Forty-five years later, Pais would frequent the Princeton math library where I worked nights checking out books. With great difficulty, I read his award winning scientific histories of modern physics.
Last week was Holocaust Remembrance Day. How do we honor survivors such as Pais? How do we honor people like Fang, as well? Continuing, in our own lives, their commitment to science and to human rights is one excellent way to do so. In a keynote address to DFA members, Harvard lecturer Marshall Ganz noted his own connection to the Holocaust through his father’s work with survivors in DP camps. This experience led Ganz to trek from Harvard down south for civil rights work, and later to assist the United Farm Workers.
Ganz wasn’t alone. During Mississippi’s Freedom Summer, a disproportionate number of civil rights activists spoke of the Holocaust in explaining why they were willing to face real dangers in the Deep South. Andrew Goodman and Mickey Schwerner gave their lives in this struggle.
Not a few physicians such as Jack Geiger made the same trek. When Mississippi delta children presented with malnutrition, he wrote them prescriptions for food. Called on the carpet, an unrepentant Geiger responded: “The last time I checked my textbooks the specific therapy for malnutrition was, in fact, food.”
I’m a policy wonk. But I’ve worked the past four years with DFA for a simple reason, because I believe access to affordable health care is a human right. On the campaign trail in 2008, I met people facing medical bankruptcy because they were medically uninsured, because they had maxed out their coverage, because they just couldn’t pay high copayments and deductibles when they got really sick. I see so many people around the Chicago southland facing similar difficulties.
The Affordable Care Act, complex and imperfect as it is, has already made a difference. It ensures that our health care system treats people with greater decency. It will make an even bigger difference once fully implemented. Opponents of ACA dance around what “repeal and replace” really means, which is to deprive thirty million people of affordable and effective health coverage.
Opponents of ACA are acting with a sense of political urgency. They know, as former Bush official James Capretta told me, that after 2014, “once the money starts flowing,” neither state governments nor individual recipients will allow these benefits to be taken away.
Health reform raises technical issues. It raises political and ideological issues. But at bottom, it raises an inescapable moral issue. We spend $2.8 trillion on health care. We still don’t treat people decently.
I see this every day, as a relatively affluent person helping to care for someone with an intellectual disability. Some of you have read my columns about my brother-in-law’s care. He has his basic needs met. Many of his peers close to home or around the country have poor and worsening access to dental care—an optional service that may be dropped in Illinois Medicaid. These men and women face punishing copayments. Those who are not on Medicaid were effectively barred—in the absence of the ACA—from gaining health insurance coverage.
Then there are the direct care workers who care for them. These are the people we trust when we’re not there to see: to calm our loved-one when he is anxious, to occasionally change some soiled linins, to keep him safe and healthy. Around the country, their average wage is $11.24/hour. Many go uninsured. Representative Paul Ryan recently told reporters:
“We don't want to turn the safety net into a hammock that lulls able-bodied people to lives of dependency and complacency, that drains them of their will and their incentive to make the most of their lives.”
That’s not the way to think about, or talk about, working poor people who are the chief beneficiaries of Medicaid, CHIP, and other benefits, too. We have to stand up to that. We must also understand that we’re all in this together. My household needs help to care for a disabled family member. Someone else needs health insurance or maybe help finding a job. A high school senior needs a Pell grant to attend college. Rather than each of us fighting for our own special interest or need, we need a larger vision in which each of us chips in to help others when they—when we—need help.
I recently read Theda Skocpol and Venessa Williamson’s wonderful book on the Tea Party. Their book was a rare combination of sympathetic understanding for admirably passionate, politically engaged fellow Americans, with a properly scathing critique of what those passionate, engaged Tea Partiers are actually trying to accomplish. I am so disappointed to see many people richly benefit from Medicare and Social Security—and then turning around to oppose efforts to deploy public resources to meet other social needs. We should be equally passionate and engaged on behalf of something different.
Professor Ganz stole my concluding lines by citing the most quoted line in all of Judaism. It is not from the Bible. It’s from Rabbi Hillel: "If I am not for myself, who will be for me? But if I am only for myself, who am I? If not now, when?" That’s not bad as a parable about health reform, in everything from the responsibility implied by the individual mandate to the fundamental argument to protect each other through social insurance.
Will we continue to allow cancer patients to lose their homes? Will we allow poor people to die sooner than they otherwise would because they lack insurance coverage? Will we protect each other from burdens that would crush any one of us, were we forced to bear these burdens alone? Will we delay another generation before moving towards universal coverage? Speaking across two millennia, Rabbi Hillel might be asking these same questions.
Harold Pollack is Helen Ross Professor of Social Service Administration, and Faculty Chair of the Center for Health Administration Studies at the University of Chicago. He has published widely at the interface between poverty policy and public health. His research appears in such journals as Addiction, Journal of the American Medical Association, American Journal of Public Health, Health Services Research, Pediatrics, and Social Service Review. His essay, "Lessons from an Emergency Room Nightmare," was selected for The Best American Medical Writing, 2009.
Cutting our Nose to Spite our Face
Earlier this week, I wrote about the false choice being made through legislation to either keep student loan interest rates low, or cut funding to preventive health programs. As a physician who needed federally subsidized student loans to get through medical school, I would like to see interest rates kept low AND focus more of our health dollars on preventive strategies. Both legislative priorities help Americans in very real ways – they should not be pit against one another.
But in this age of deficits and debt, many are concerned about government spending. Certainly, as a near-DC resident here in Virginia, deficit talk dominates inside-the-beltway punditry.
Apparently, deficit concerns are now trained on eliminating a 2009 program designed to boost enrollment in the Children’s Health Insurance Program (CHIP). Since 2009, States have been eligible to receive bonus payments from the federal government for reducing the administrative burden of enrolling children in CHIP, and finding vulnerable populations who were previously hard to reach. The program has been successful, helping hundreds of thousands of children become newly insured. In South Carolina, the program awarded the State for its streamlined program called Express Lane Eligibility that helped enroll 84,000 children. South Carolina automatically enrolled children of families who had already had been identified (and verified) need through the food stamps program.
What the deficit hawks are failing to realize is that this program SAVED MONEY for the State of South Carolina, through reducing redundant administrative waste.
This seems yet another example of legislators, who may be hiding their true agenda of dismantling positive health reform through a thousand cuts, making a decision to cut our noses to spite our face. From my perspective, we as a nation should want our children to be healthy. We should want those healthy children to be able to afford a college education. We should want those healthy college graduates to have access to health and wellness programs, because those healthy college graduates are our future.
I am not a member of Congress, but I would guess there are other areas of the federal budget that can be tweaked in order to continue to pay for the SCHIP bonus program. Just this week alone, I have read about costly weapons programs, the ongoing cost of tax cuts, the savings realized from cracking down on health care fraud, and the waste of poor resource allocation in our health care system. Dear Congress: read these last 4 links and you will find TRILLIONS of dollars to pay for the Prevention Fund, Subsidized Student Loans and continue to incentivize States to ease enrollment in CHIP. You’re welcome.
Columnist not horrible, but surely not good
An email was going around last year, warning voters of yet another unbelievably atrocious component of ObamaCare which, of course, was untrue. I had received the same email from my sister-in-law last November, courtesy of her family, and posted the debunking, courtesy of FactCheck, on my blog. Since these things never die, largely because the right wing noise machine does not want even discredited, bogus charges to die, it came around again to one of our DFA members.
The gist of the charge is here, in the original language:
The per person Medicare insurance premium will increase from the present monthly fee of $96.40, rising to: $104.20 in 2012; $120.20 in 2013; And $247.00 in 2014. These are provisions incorporated in the Obamacare legislation, purposely delayed so as not to 'confuse' the 2012 re-election campaigns. Send this to all seniors that you know, so they will know who's throwing them under the bus.
REMEMBER THIS IN NOVEMBER 2012 & VOTE ACCORDINGLY
I actually cut and pasted this into my original blog post, just so people Googling for information would find it, and my post still comes up second when you do this. I've gotten almost 1400 hits on it, so at least some people know the power of The Google in fighting disinformation.
As a comedian once said, I told you that story so I could tell you this one.
We picked up the local conservative newspaper this Sunday (short version: my niece and her adorable puppy were supposed to be in it -they weren't), Richard Mellon Scaife's Pittsburgh Tribune Review. On the front page of the business section, was this article,
"Obamacare not horrible, but surely not good." by Jack Markowitz.
OK, so it's not a new 3.5 percent "sales tax" on your house to pay for Obamacare. It's still bad tax policy.
A number of readers have pointed out a misstatement in last Sunday's column that possibly scared people. It said the new Affordable Care Act will pay for insuring millions more people by slapping a new tax on the sale of houses.
That was too loose a way of stating it. Most sellers will never have to fork over. They're not rich enough.
So apparently this seasoned journalist got this in his email:
UNDER THE NEW HEALTH CARE BILL – DID YOU KNOW THAT ALL REAL ESTATE TRANSACTIONS ARE SUBJECT TO A 3.8% “SALES TAX”?
YOU CAN THANK NANCY, HARRY & BARACK (AND YOUR LOCAL CONGRESSMAN) FOR THIS ONE.
IF YOU SELL YOUR $400,000 HOME, THIS WILL BE A $15,200 TAX.
Verified
Higher taxes on real estate investments. The 3.8% Medicare surtax would hit average, middle-class investors in real estate. A middle-class taxpayer who happens to sell real estate for a gain in a particular year would be liable for this new tax, regardless of how low her income might be in other, more typical years.
Of course, it is BS, and the debunking is here, again courtesy of FactCheck. But did you notice the inscrutable trick that fooled our Trib journalist? It said, "Verified," which seems to be short for "Verified bySnopes," which means that this information has been checked and verified by a trusted, independent organization. No need to check for yourself, or for that matter, subject the assertion being promulgated to the "is this so stupid that it burns?" test.
Apparently, the reporter and "The Trib" are embarrassed about this little faux pas, as I searched a number of ways and cannot find the original column from just last week on the web site. Good for them, I guess.
One of the recurring conversations at our Second Annual Doctors for America Meeting last week was the massive amounts of misinformation and downright scandalous lying that takes place about the Affordable Care Act. We get emails from relatives, or in conversations at family gatherings with some of the most outrageous stuff. Patients, sometimes thinking we will be kindred ideological spirits, share some of it with us.
It is good that they ask, for otherwise we can't set them straight. And it's good for you to ask, too, if you're not sure, because we all need to be the educators so that we can keep this train moving forward.
Tired of all the myths, misinformation and lies? Check out the truth about the affordable care act, and then sign up to educate your community as we aim to educate one million Americans about the benefits of health reform.
Community Health Centers Get a Boost
Community health centers across the country are getting a big boost from the Affordable Care Act: over the next five years, we will get $9.5 billion to expand services, and $1.5 billion for major construction and renovation projects.
Health and Human Services Secretary Kathleen Sebelius announced this week that $728 million have already been awarded for 398 renovation and construction projects in health centers across the country. With this money, there are 67 new health centers under construction now, and 190 health centers that will be able to renovate and expand their services. This will build the capacity to serve an anticipated 860,000 additional patients.
Federal funds have already helped the Chicago Family Health Center, where I work, in the South Side of Chicago. When I first began working there in 2008, we had three established clinic sites, and I was hired to help establish a tiny school-based clinic. Now we have five clinic sites, serving more patients. America’s Reinvestment and Recovery funds enabled us to move out of the two converted band rooms in the local high school and in 2009 open a street-front clinic with five medical exam rooms and three dental rooms. Within a year, the East Side Clinic team was serving over 100% of our target number of patients, with the number of patients served limited only by the size of the clinic and small staff.
From awards made possible by the Affordable Care Act, the Chicago Family Health Center has received another $6 million to renovate our outdated and outgrown Pullman Clinic. Before, patient overflow from the waiting room occasionally spilled onto the sidewalk. With more rooms, and more space, we can comfortably serve more of the patients who will be entering the primary care system in 2014.
Hooray for ACA funding to build infrastructural capacity in community health centers!
But if you build it, will they come?
Who will staff these better and brighter and newer clinics?
Next up: recruiting additional providers into the primary care workforce, and strengthening inter-professional teams to optimize cost-effective, quality care for communities across America.
