Comments on: The complexity of health care reform http://www.medrants.com/archives/4310 Internal medicine, American health care, and especially medical education Sat, 11 Feb 2012 15:15:48 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: A “Townhall” Event: Cincinnati, Ohio - Smart Girl Nation http://www.medrants.com/archives/4310/comment-page-1#comment-528929 A “Townhall” Event: Cincinnati, Ohio - Smart Girl Nation Wed, 05 Aug 2009 04:26:45 +0000 http://www.medrants.com/?p=4310#comment-528929 [...] The complexity of health care reform (medrants.com) [...] [...] The complexity of health care reform (medrants.com) [...]

]]> By: rocky http://www.medrants.com/archives/4310/comment-page-1#comment-527774 rocky Tue, 09 Jun 2009 04:38:22 +0000 http://www.medrants.com/?p=4310#comment-527774 this is a nice post this is a nice post

]]> By: Michael Kirsch, M.D. http://www.medrants.com/archives/4310/comment-page-1#comment-527479 Michael Kirsch, M.D. Wed, 03 Jun 2009 03:07:04 +0000 http://www.medrants.com/?p=4310#comment-527479 When the Massachusettes 'Miracle" plan was inaugurated in 2006, it was heralded as a health care crisis panacea. The shine on the promise has tarnished. First, there weren't enough primary care physicians and now there isn't enough money. If we can't get universal coverage (Massachusettes was not exactly universal) right in a small state, shouldn't we learn from our mistakes and misjudgments before jumping off a higher cliff? Health care reform is a Hydra that has tamed American presidents since World War II. I agree that we desperately need it, but I don't want our treatment to be worse than the disease. wwwMDWhistleblower.blogspot.com When the Massachusettes ‘Miracle” plan was inaugurated in 2006, it was heralded as a health care crisis panacea. The shine on the promise has tarnished. First, there weren’t enough primary care physicians and now there isn’t enough money. If we can’t get universal coverage (Massachusettes was not exactly universal) right in a small state, shouldn’t we learn from our mistakes and misjudgments before jumping off a higher cliff? Health care reform is a Hydra that has tamed American presidents since World War II. I agree that we desperately need it, but I don’t want our treatment to be worse than the disease. wwwMDWhistleblower.blogspot.com

]]> By: Bohdan A. Oryshkevich, MD, MPH http://www.medrants.com/archives/4310/comment-page-1#comment-527464 Bohdan A. Oryshkevich, MD, MPH Tue, 02 Jun 2009 17:09:17 +0000 http://www.medrants.com/?p=4310#comment-527464 Dear Friends: I agree with everyone here but Igor here. I have posted on this very subject including a summary of things that have to be done with reference universal insurance and primary care. I did not want to repeat myself here. http://healthcare.change.org/blog/view/why_does_controlling_health_care_spending_cost_money I would appreciate any comments. Bohdan A. Oryshkevich, MD, MPH Dear Friends:

I agree with everyone here but Igor here.

I have posted on this very subject including a summary of things that have to be done with reference universal insurance and primary care.

I did not want to repeat myself here.

http://healthcare.change.org/blog/view/why_does_controlling_health_care_spending_cost_money

I would appreciate any comments.

Bohdan A. Oryshkevich, MD, MPH

]]> By: Dr. Bob (FP) http://www.medrants.com/archives/4310/comment-page-1#comment-527463 Dr. Bob (FP) Tue, 02 Jun 2009 15:17:16 +0000 http://www.medrants.com/?p=4310#comment-527463 It takes both coverage (health insurance) and access (enough PCP's) to make the system work. Any reform needs to address both issues. Many of the universal access people forget about the access side of the equation. My biggest fear is that congress will take the easy fix and just expand Medicare to cover the uninsured and the system will implode after a couple more years as access to primary care declines. The system will be unsustainable unless they focus on the inputs to the problem that drive costs - 1. decreasing the numbers developing chronic diseases which will require major public health initiatives, and 2. decreasing the need for specialty referrals and unnecessary procedures (e.g, MRI's & coronary stents) by focusing on primary care and prevention. An example for stents: We had a CME given by a cardiologist last week on cardiac rehab. He flipped up a slide and said "Here is a study most of us cardiologists don't want to become widely known." It was a study showing that putting a patient in cardiac rehab was much better than angioplasty for stable angina (88% event free vs. 70%). In my area of the country, it seems like almost everybody here gets the stent first, and then maybe cardiac rehab if insurance covers it. The patients demand it and the cardiologists are more than willing to oblige. Our system always covers the stent (and pays very well), but often doesn't cover the cardiac rehab. It covers the $200 a month prescription for Actos, Byetta, or Januvia, but often does not cover the referral to the dietician that might prevent the need for the $200 a month medication. It takes both coverage (health insurance) and access (enough PCP’s) to make the system work. Any reform needs to address both issues. Many of the universal access people forget about the access side of the equation. My biggest fear is that congress will take the easy fix and just expand Medicare to cover the uninsured and the system will implode after a couple more years as access to primary care declines. The system will be unsustainable unless they focus on the inputs to the problem that drive costs – 1. decreasing the numbers developing chronic diseases which will require major public health initiatives, and 2. decreasing the need for specialty referrals and unnecessary procedures (e.g, MRI’s & coronary stents) by focusing on primary care and prevention.

An example for stents: We had a CME given by a cardiologist last week on cardiac rehab. He flipped up a slide and said “Here is a study most of us cardiologists don’t want to become widely known.” It was a study showing that putting a patient in cardiac rehab was much better than angioplasty for stable angina (88% event free vs. 70%). In my area of the country, it seems like almost everybody here gets the stent first, and then maybe cardiac rehab if insurance covers it. The patients demand it and the cardiologists are more than willing to oblige.

Our system always covers the stent (and pays very well), but often doesn’t cover the cardiac rehab. It covers the $200 a month prescription for Actos, Byetta, or Januvia, but often does not cover the referral to the dietician that might prevent the need for the $200 a month medication.

]]> By: Igor Marxomarxovich http://www.medrants.com/archives/4310/comment-page-1#comment-527462 Igor Marxomarxovich Tue, 02 Jun 2009 14:42:21 +0000 http://www.medrants.com/?p=4310#comment-527462 Old Russian saying...You can tell same lie 1000 time but not change truth! Difference between USSR Communist media and USA "mainstream media" In Russia government make media say what they want - even if lie. In USA "mainstream media" try make government what they want - even if lie.. .....eventually they become same thing?! Do we really want someone who can not even show his own birth certificate try "reform" healthcare I Igor produce Obama Birth Certificate at <a href="http://www.igormarxo.org/" rel="nofollow">www.igormaro.org</a> Old Russian saying…You can tell same lie 1000 time but not change truth!

Difference between USSR Communist media and USA “mainstream media”

In Russia government make media say what they want – even if lie.
In USA “mainstream media” try make government what they want – even if lie..
…..eventually they become same thing?!

Do we really want someone who can not even show his own birth certificate try “reform” healthcare

I Igor produce Obama Birth Certificate at http://www.igormaro.org

]]> By: solo dr http://www.medrants.com/archives/4310/comment-page-1#comment-527458 solo dr Tue, 02 Jun 2009 12:15:36 +0000 http://www.medrants.com/?p=4310#comment-527458 In my area of Illinois, only an FP residency accepts new Medicaid patients. Outpatient office visits for a 99213 pay $32, including the $2 copayment. ER visits have no copay for Medicaid patients. I can track patients by health coverage, and my Medicaid patients have a 4 times greater likelihood of not showing up to visits and have 2-3 times more phone calls to the office than my privately insured patients. I don't accept new Medicaid patients, outside of ER follow up call. Most of the new ones from the ER don't show up. Illinois tried an All Kids with expansion to All Families, without success, by trying to assign primary care doctors to the patients for a $2 a month capitation average. Most patients still use the ER and don't see their assigned primary care providers. In my area of Illinois, only an FP residency accepts new Medicaid patients. Outpatient office visits for a 99213 pay $32, including the $2 copayment. ER visits have no copay for Medicaid patients. I can track patients by health coverage, and my Medicaid patients have a 4 times greater likelihood of not showing up to visits and have 2-3 times more phone calls to the office than my privately insured patients.
I don’t accept new Medicaid patients, outside of ER follow up call. Most of the new ones from the ER don’t show up. Illinois tried an All Kids with expansion to All Families, without success, by trying to assign primary care doctors to the patients for a $2 a month capitation average. Most patients still use the ER and don’t see their assigned primary care providers.

]]> By: Valuable Internet Information » The complexity of health care reform http://www.medrants.com/archives/4310/comment-page-1#comment-527457 Valuable Internet Information » The complexity of health care reform Tue, 02 Jun 2009 12:07:18 +0000 http://www.medrants.com/?p=4310#comment-527457 [...] Read the original post:  The complexity of health care reform [...] [...] Read the original post:  The complexity of health care reform [...]

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