After ACA Ruling: Next Urgent Steps for Internal Medicine

After ACA Ruling: Next Urgent Steps for Internal Medicine

Medscape: We're very interested to hear what the ACP thought about the Supreme Court ruling on the ACA.

Dr. Bronson: I think the decision is highly supported by our organization and we can now move forward.

Medscape: Will the ruling have any impact on internists or internal medicine?

Dr. Bronson: I think it will be positive for internal medicine, broadly speaking, because it gives more patients access to care through insurance. It will increase demand for services, but that's a positive thing.

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After the ACA Ruling: Next Urgent Steps for Family Medicine

After the ACA Ruling: Next Urgent Steps for Family Medicine

Medscape: What was your initial impression when you learned of the Supreme Court ruling on the ACA?

Dr. Stream: I didn't know what to expect. I had a difficult time separating what I wanted the outcome to be from what I could intellectually predict it would be. I'm pleasantly surprised.

Medscape: Will this ruling change any of the AAFP's expectations about the impact of the ACA on family physicians?

Dr. Stream: I don't believe so. We've been working for over 2 years under a strategy that the ACA was the law of the land, and we wanted to focus on those areas important to family medicine and patients and to make those areas as successful as possible. We also wanted to work on provisions that weren't part of the ACA or were not fully addressed by it, particularly replacing the sustainable growth rate (SGR) formula and achieving meaningful medical liability reform.

Having the mandate upheld is consistent with what has been AAFP policy for over 20 years. We have advocated for healthcare coverage for everyone and access to at least basic health services, including good primary care with prevention and chronic illness care. You can argue whether the mandate is the only means to get there, but at least in the analyses that I've seen, it was one of the best identified ways to get everyone covered.

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Next Steps in Healthcare Reform: Repealing IPAB and SGR

Next Steps in Healthcare Reform: Repealing IPAB and SGR

Medscape: When Medscape interviewed AMA CEO Dr. James Madara in April, he reiterated the AMA's support of the ACA, but he stressed that like all things, it's a work in progress. Now that the law has been upheld, what are the next steps to improving the healthcare system? What areas of healthcare are in most need of improvement?

Dr. Lazarus: We think the things in the act that we'd like to get rid of, like IPAB, would help. We would like to see comprehensive medical liability reform, which we think would help on the cost side and bring down the cost of care. We would like to see a repeal of the SGR in Medicare. And we, in our own strategic planning, are looking at new delivery and payment models that will work better, both for physicians and patients. We think this will give physicians more satisfaction in whatever kind of practice situation they're in, and it will enable them to deliver better care to patients at a reduced cost. We need to have time to do that. It's a 5-year plan, and we're excited about that part of our strategic plan.

Medscape: Do you have any parting thoughts on the future of medicine and the ACA?

Dr. Lazarus: This is something that we had been working on for a long time. We had been advocating for health insurance coverage for all Americans for many years, and we were pleased with the outcome. It gives us at least a roadmap to where we're going. It eliminates the uncertainly about where things were going. As the law is implemented, we'll see what other changes need to take place. But we were pleased at the outcome.

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Stunning Healthcare Overture from Bipartisan Group of US Senators - 2007

Healthcare Legislation in This Congress? - Michael Barone (usnews.com)

I followed Ezra Klein's link to this letter from 10 Senators, 5 Republicans and 5 Democrats, written just two years before President Obama took office! Read it, as it is stunning how far the Republican Choo Choo has gone around the bend.  [Courtesy USNews.com and Michael Barone.]

Now Wyden and nine other senators, five Democrats and five Republicans, have sent the following letter to Bush. Very interesting.

In addition to Wyden, the letter was signed by Republicans Jim DeMint of South Carolina, Robert Bennett of Utah, Trent Lott of Mississippi, Mike Crapo of Idaho, and John Thune of South Dakota, and Democrats Kent Conrad of North Dakota, Ken Salazar of Colorado, Maria Cantwell of Washington, and Herb Kohl of Wisconsin.

The text of the letter follows:

February 13, 2007

The Honorable George W. Bush
1600 Pennsylvania Avenue
Washington, D.C. 20500
Dear Mr. President:

As U.S. Senators of both political parties we would like to work with you and your Administration to fix the American health care system.
Each of us believes our current health system needs to be fixed now. Further delay is unacceptable as costs continue to skyrocket, our population ages, and chronic illness increases. In addition, our businesses are at a severe disadvantage when their competitors in the global market get health care for "free."
We would like to work with you and your Administration to pass legislation in this Congress that would:
1)Ensure that all Americans would have affordable, quality, private health coverage, while protecting current government programs. We believe the health care system cannot be fixed without providing solutions for everyone. Otherwise, the costs of those without insurance will continue to be shifted to those who do have coverage.
2)Modernize Federal tax rules for health coverage. Democratic and Republican economists have convinced us that the current rules disproportionately favor the most affluent, while promoting inefficiency.
3)Create more opportunities and incentives for states to design health solutions for their citizens. Many state officials are working in their state legislatures to develop fresh, creative strategies for improving health care, and we believe any legislation passed in this Congress should not stymie that innovation.
4)Take steps to create a culture of wellness through prevention strategies, rather than perpetuating our current emphasis on sick care. For example, Medicare Part A pays thousands of dollars in hospital expenses, while Medicare Part B provides no incentives for seniors to reduce blood pressure or cholesterol. Employers, families, and all our constituents want emphasis on prevention and wellness.
5)Encourage more cost-effective chronic and compassionate end-of-life care. Studies show that an increase in health care spending does not always mean an increase in quality of outcomes. All Americans should be empowered to make decisions about their end of life care, not be forced into hospice care without other options. We hope to work with you on policies that address these issues.
6)Improve access to information on price and quality of health services. Today, consumers have better accessto information about the price and quality of washing machines than on the price and quality of health services.
We disagree with those who say the Senate is too divided and too polarized to pass comprehensive health care legislation. We disagree with those who believe that this issue should not come up until after the next presidential election. We disagree with those who want to wait when the American people are saying, loud and clear, "We want to fix health care now."
We look forward to working with you in a bipartisan manner in the days ahead.

Skyrocketing costs! Competetive disadvantage! Universal access to health care! Class warfare! Inefficient US health care! Wellness! Prevention! Cost effectiveness! Compassionate end of life care! Expanding palliative care services! Health care in the US is broken!

Who knew Jim DeMint was a socialist before he was a Tea-Partier?

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The Republican turn against universal health insurance

The Republican turn against universal health insurance

In 2007, Republican Sen. Jim DeMint of South Carolina sent a letter to President George W. Bush.

DeMint said he would like to work with Bush to pass legislation that would “ensure that all Americans would have affordable, quality, private health coverage, while protecting current government programs. We believe the health care system cannot be fixed without providing solutions for everyone. Otherwise, the costs of those without insurance will continue to be shifted to those who do have coverage.”

Read that closely. DeMint does not say he wants legislation that would ensure all Americans have “access” to coverage — the standard rhetorical dodge of politicians who don’t want to oppose universal coverage, but also don’t want to do what’s necessary to achieve it. He says that he wants legislation that ensures all American actually have coverage. He says that without making sure every American has coverage, “the health care system cannot be fixed.” For good measure, DeMint wants to achieve this “while protecting current government programs.”

It is amazing how crazy - and mean-spirited - conservatives have become. None of that WWJD girly nonsense for the new conservative movement.

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AlterNet: 10 Reasons Most People Like Obamacare Once They Know What's Really In It

AlterNet: 10 Reasons Most People Like Obamacare Once They Know What's Really In It

There are two Affordable Care Acts. There's the legislation passed by Congress in 2009, and then there's the mythical Affordable Care Act – the perfidious “government takeover” decried and demagogued by so many conservatives (and quite a few liberals). The former is quite popular, the latter gets decidedly mixed reviews.

Don't take my word for it. A recent poll by the Kaiser Family Foundation found Americans split down the middle, with 41 percent approving of the law, and 40 percent saying they didn't like it (PDF). But then Kaiser asked about 12 specific provisions in the legislation, and found that, on average, 63 percent of respondents approved of the nuts and bolts of Obamacare. Of the 12 measures they tested, only one – the controversial mandate to carry health insurance or pay a penalty – received the approval of less than half of Americans (35 percent).

Or consider this divide: while only 12 percent of Republicans had a positive view of the law overall, 47 percent, on average, viewed its specifics favorably.

Follow the link to read the ten reasons...

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Ezra Klein: No, ‘Obamacare’ isn’t ‘the largest tax increase in the history of the world’ (in one chart)

No, ‘Obamacare’ isn’t ‘the largest tax increase in the history of the world’ (in one chart)

Since the Supreme Court decision, Republicans have been calling the Affordable Care Act “the largest tax increase in the history of the world.” Politifact rates this false. Kevin Drum’s got a table of the 15 significant tax increases since 1950, and the Affordable Care Act, which amounts to a tax increase of 0.49 percent of GDP, comes in 10th. Austin Frakt took Drum’s table and made a chart:

So no, the Affordable Care Act isn’t the “biggest tax hike in history.” It’s not even the biggest tax hike in the past 60 years. Or 50 years. Or 30 years. Or 20 years.

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