Bad Medicine

 Disability, Health Care  1 Response »
May 272013
 

The Times examines the reasons why people with disabilities continue to receive substandard medical care. Most outpatient clinics are ill-equipped to serve patients with disabilities, particularly those of us who have limited or zero mobility. The staff have little training on how to safely transfer people with disabilities and the exam rooms lack accessible equipment. As a result, people with disabilities may only receive partial exams that may overlook potential problems.

I experienced this firsthand a couple months ago when I went to see my doctor with what turned out to be a urinary tract infection. The exam room lacked a table that would allow me to lie prone, which made it difficult for the doctor to examine me. She nearly sent me home to collect a urine sample, which would have only delayed my diagnosis and treatment. It might have made more sense for me to simply go to the emergency room, but I shouldn’t be forced to visit the ER to receive adequate care for a relatively minor issue.

That Medicaid Study Everyone Is Talking About

 Health Care, Wonkery  No Responses »
May 032013
 

Conservatives are seizing upon a new study that shows Medicaid recipients tend to consume more health care while their overall health remains unimproved as proof that the forthcoming expansion of Medicaid under the Affordable Care Act is a waste of money. It’s a willfully stupid conclusion for the following reasons:

  • People on Medicaid have low incomes. People with low income tend to have more chronic health conditions. So it’s no surprise that they would consume more health care once they receive access to affordable health care.
  • The study in question tracked people for only two years. It’s unlikely that a huge improvement in a chronic condition is going to show up after a couple years. And some conditions may never improve. Does that mean health care is wasted on such people? Is it wasted on me?  If we focus only on measurable improvement as the yardstick for justifying public health care expenditures, we’d better be prepared to have some really difficult conversations with our elderly and disabled.
  • The study did show that Medicaid recipients were substantially less likely to experience depression, which can be as debilitating as any physical impairment.
  • That lower incidence of depression might be related to the finding that Medicaid recipients experience far less financial stress.

Expanding Medicaid is undoubtedly a cost to society. But this study does nothing to undermine the basic assertion that Medicaid makes a real and positive difference in people’s lives.

The Indestructibles

 Health Care  No Responses »
Apr 292013
 

The Times, like a lot of other news organizations, is discovering there’s a lot of mileage to be had reporting on the challenges of implementing the Affordable Care Act. The Times article gives particular attention to the need to convince healthy young people to purchase health insurance. If only sicker, older people buy coverage, costs will quickly spiral out of control and we’ll be back to where we started; health insurance will remain unaffordable to the vast majority of Americans. It’s going to take some skillful marketing to convince twentysomethings already saddled with mountains of student loan debt to buy something they might not regard as necessary. But without the millennials, this whole endeavor could collapse under its own weight.

They Do Things Differently In Arkansas

 Health Care  No Responses »
Apr 242013
 

Legislators can get some curious ideas when drafting legislation, particularly legislators who reluctantly decide to participate in the Medicaid expansion under the Affordable Care Act. When Arkansas passed a law authorizing its Medicaid expansion, they included language that does its best to make damn sure beneficiaries understand that this ain’t no entitlement. The language reads:

(i) An eligible individual enrolled in the program shall affirmatively acknowledge that:
(1) The program is not a perpetual federal or state right or a guaranteed entitlement;
(2) The program is subject to cancellation upon appropriate notice; and
(3) The program is not an entitlement program.

This provision only applies to adults enrolling in the expansion, so we can assume that children and people with disabilities aren’t required to comply with this empty gesture. I’m not sure the courts or the feds would allow Arkansas to use this language as a future escape clause from the expansion. The strained legal reasoning of local conservative lawmakers doesn’t change the fact that Medicaid is an entitlement.

Preparing For The Worst

 Health Care, Wonkery  No Responses »
Apr 172013
 

In what may be a sign of things to come, Senator Max Baucus delivered a stern warning to Health and Human Services Secretary Sebelius for not doing enough to educate people about what the Affordable Care Act means for them. He has a legitimate point; the feds need to step up their public relations efforts soon if they hope to get people enrolled in health coverage beginning in the fall. But Baucus should be more concerned about the implementation of the federal exchange that will be serving over thirty states. The success of health care reform hinges upon the work of anonymous programmers and web designers who must construct a website that is stable and functional on a massive scale from day one. Getting the word out is important, but it won’t matter much if the exchange website is overwhelmed or difficult to use.

The feds are certainly capable of pulling this off, but I wonder if elected officials really understand how much technical wizardry is necessary to make health care reform a reality. And I wonder how many other Democrats will start predicting failure as a means of political damage control.

 Permalink  Health Care  No Responses »
Apr 022013
 

The Obama administration announced yesterday that it is delaying implementation of a provision of the Affordable Care Act that helps small employers offer an assortment of health insurance plans to their employees. In most states, only one health plan will be available on the small-business version of the exchange (also called the SHOP). The administration attributed the delay to “operational challenges”, which is a bureaucratic way of saying “This is a little more complicated than we thought.”

This isn’t the first time that the administration has delayed implementing a provision of the ACA. It has already told states that basic health plans—a program meant to assist individuals who earn too much to qualify for Medicaid but may not be able to afford coverage on the Exchange—won’t be available until 2015. The major provisions of the law, like the subsidies and the Medicaid expansion, will still go into effect next year and these delays might not have a significant impact. But news like this provides ample ammunition for the law’s critics who argue that the government isn’t up to the task of regulating health care. The administration may have done the smart thing; better to delay implementation than botch things up and invite even harsher criticism. But these delays make it even more important that the administration and the states implement the rest of the law without mention of “operational challenges”.

Minnesota Gets An Exchange

 Health Care  No Responses »
Mar 202013
 

Governor Dayton signed legislation today creating a health insurance exchange for Minnesota. The Legislature managed to get the bill on Dayton’s desk in a little over two months, which is a little like making the Kessel run in 12 parsecs. Much work remains to be done to get MNsure (the official name of the exchange) up and running, but people should be able to start comparing insurance plans beginning in October. Minnesota is taking a chance in running its own exchange rather than letting the federal government administer it. If the launch is bumpy, Republicans are sure to be chanting variations of “I told you so!” in unison. I remain hopeful that any kinks will be will be worked out quickly and Minnesotans will soon have access to better coverage at more affordable prices.

 

Required Reading

 Health Care, Wonkery  No Responses »
Mar 042013
 

Steven Brill’s longform piece in Time on the high cost of health care is getting a lot of attention from policy wonks. I know what you’re thinking. Time? Isn’t this the same magazine that runs cover stories on pressing topics like Jesus’ favorite snack foods? Someone in the magazine’s upper echelons must still care about old-fashioned investigative journalism because the piece itself is quite good. It begins by looking at the exorbitant medical bills incurred by people with little or no insurance. In Brill’s quest to understand why people with the least amount of coverage are forced to pay the most outrageous prices for care, he examines the major players in the health care ecosystem: the non-profit hospitals that really aren’t non-profit, the medical device and pharmaceutical companies that can generate huge profit margins by charging whatever they like for their products, and a federal government that is legally prevented from negotiating prices that could make health care far less costly.

None of this is exactly news to those of us in health care policy circles, but the article is excellent at illustrating just how dysfunctional the health care marketplace has become. It also reminds us that the process of reforming our health care system didn’t end with the passage of the Affordable Care Act.

Evolving On Medicaid

 Health Care, Wonkery  No Responses »
Feb 212013
 

Republican resistance to the Medicaid expansion in Obamacare continues to crumble. Florida governor and Tea Party mascot Rick Scott announced yesterday that he will accept federal funding for a Medicaid expansion, joining a growing list of GOP governors who have developed amnesia about their previous fierce resistance to the health care law. Other states (I’m looking at you, Wisconsin) continue to hold out, but I’m guessing they’ll come around eventually–assuming they remain in office. Now, if only this epidemic of conservative sanity could spread to Congress.

Expanding The Safety Net

 Health Care  No Responses »
Feb 142013
 

The Minnesota Legislature sent a bill expanding Medicaid to Governor Dayton today, moving Minnesota one step closer to fully implementing health care reform. Tens of thousands of people will gain comprehensive health care coverage beginning next year at little additional cost to the state. I’m actually a little surprised that the bill passed this quickly, but I’m also pleased that this Legislature seems intent on getting things done. Legislators must now decide what becomes of MinnesotaCare, the health care program that served many of the people who will now receive Medicaid. It’s likely to continue in one form or another, but the details need to be worked out.

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