Thursday, June 28, 2012

3 Progressive Doctors Running For Congress Answer The Questions About What We Do Next


Despite Fox's and CNN's-- and Virginia Foxx's-- idiotic reports that the Supreme Court struck down the individual mandate in the Affordable Care Act, the Court upheld it as a power of Congress to levy taxes. Even as egregious a corporate whore as Chief Justice John Roberts couldn't vote to kill it based on the spurious arguments put forward by the confused Obama-haters who tried to throw it-- and the entire health care reform law-- out. Basically, the whole Affordable Care Act was deemed constitutional other than the ability of the federal government to terminate states' Medicaid funds. AP summed it up like this:
The decision means the huge overhaul, still only partly in effect, will proceed and pick up momentum over the next several years, affecting the way that countless Americans receive and pay for their personal medical care. The ruling also hands Obama a campaign-season victory in rejecting arguments that Congress went too far in requiring most Americans to have health insurance or pay a penalty.

Breaking with the court's other conservative justices, Chief Justice John Roberts announced the judgment that allows the law to go forward with its aim of covering more than 30 million uninsured Americans. ...The court found problems with the law's expansion of Medicaid, but even there said the expansion could proceed as long as the federal government does not threaten to withhold states' entire Medicaid allotment if they don't take part in the law's extension.

...Republican campaign strategists said presidential candidate Mitt Romney will use the court's ruling to continue campaigning against "Obamacare" and attacking the president's signature health care program as a tax increase.

"Obama might have his law, but the GOP has a cause," said veteran campaign adviser Terry Holt. "This promises to galvanize Republican support around a repeal of what could well be called the largest tax increase in American history."

Deranged right-wing extremist Virginia Foxx embarrasses North Carolina again

Wednesday morning I watched reactionary Wyoming Senator John Barrasso, a doctor/legislator, on TV explaining why he opposes ObamaCare. The bill had too many pages and he couldn't understand them. And Sarah Palin says it's death panels so... it must be death panels. Chilling. I spoke to 3 actual doctors, each of whom is running for Congress on a progressive platform and each of whom was largely impelled by concerns over the healthcare reform debate to run. We've written about all three before, Dr. Lee Rogers, who's taking on Buck McKeon in Los Angeles, Dr. David Gill, who has already frightened off the incumbent and is now running for an open seat in east-central Illinois, and Dr. Syed Taj, running for the suburban Detroit seat that was just abandoned by Thaddeus McCotter. Dr. Rogers and Dr. Gill have already won the Democratic nominations. Dr. Taj goes up against a demented LaRouchie running on a platform-- for the Democratic primary-- of impeaching President Obama.

In light of today's Supreme Court ruling I wanted to get into the minds of distinguished medical practitioners who have some kind of an understanding of politics-- and see if we could get behind the rote chant that anyone worth their salt has been asking for all along: Medicare-For-All.

We got the ball rolling by asking each doctor to share a short story from his medical career that illustrates the need for healthcare reform. Working east to west, let's start with Dr. Taj, the Chief of Medicine at Oakwood Hospital in Dearborn, Michigan.
As a physician with 30 years experience in the medical field, I’ve personally dealt with just about every major flaw in our health care system. I’ve witnessed countless patients being denied care because of a cap on total lifetime benefits or preexisting conditions. But while private insurance companies persistently find new ways to deny care to raise their revenues, we’ve always provided care to those who don’t have or can’t afford insurance: the emergency room. Inevitably, these costs are increasingly borne by taxpayers. This is the greatest contradiction and biggest flaw in our health care system.

A system so reliant on emergency care treats only the most severe cases, never with deference to preventative measures. Within this system, I could treat patients but never follow up on their conditions, nor would they monitor their treatment with another primary care physician. Medicaid services like emergency medical cards do little for long-term care for those who can’t afford insurance because there is no follow-up. The problem that brought them to the ER might not be fixed until another emergency occurs.

And speaking of emergency rooms, Dr. Gill is an emergency room physician at Advocate BroMenn Medical Center in Normal, Illinois and he told me he has dozens of stories he could share with us.
The one I tell most often, out on the stump, is this: A few yrs ago, a 39 year old woman, Susan, came in by ambulance, in full cardiac arrest... tried to resuscitate her, to no avail-- she died... She worked at a job that had no insurance, & her hubby was a stay-at-home dad... He was grieving fiercely in the E.R. (appropriately), and he told me that one week earlier, Susan had had chest pains and was seen at a different E.R.... She'd received nitroglycerin, the pain subsided, and it was recommended (appropriately) that she be admitted for further evaluation, including a stress test... But because of her lack of insurance, she & her husband decided that they couldn't afford to have her stay at that hospital... And now, a week later, here she was with me, stone cold dead, leaving behind 2 beautiful daughters (ages 6 & 4)... She had joined the ranks of the Americans who die every 12 minutes just for lack of insurance...

Lee Rogers, a former national spokesperson for the American Diabetes Association is the director and founder of the Amputation Prevention Center at Valley Presbyterian Hospital in Van Nuys, CA. He's also a Contributing Editor of the Journal of the American Podiatric Medical Association. He has a somewhat different perspective on the question:
It's bad enough to be uninsured, and we all have many stories about how doctors try to help the uninsured but can't get access to hospital admission, the operating room, or equipment they need. Some of my more memorable cases illustrating the need for insurance reform actually pertain to patients who have good insurance. I may recommend a procedure to save their leg from being amputated. The insurance company (HMO or PPO) even gives a prior authorization for the procedure. But they always include disclaimer language that "prior authorization does not guarantee payment." I think, what good is it then? We'll go ahead and perform the necessary procedure and then 2 or 3 months later the insurer will deny payment on the claim. It's infuriating to patients and doctors.

Then a question you might think is obvious: How does being uninsured or underinsured affect a patient's access to quality healthcare? This time we'll start on the West Coast and work our way East. So, Dr. Rogers:
I have numerous patients who are uninsured and underinsured. Being underinsured is almost worse. People expect when they have insurance, it will cover whatever the doctor needs to do to save their life, their limb, or just make them better. Not the case. Patients may be insured to have surgery in the OR, but the underinsured patient may not be able to get the latest equipment or products, leaving them with suboptimal care. I find myself compromising my care frequently based on the type of insurance a patient has.

Pretty horrifying, right? Dr. Gill comes to the same point-- ultimately about where the real death panels are:
The uninsured or underinsured simply can't get in to see providers. That's why they come to my E.R.-- we take all comers... What's one of the first question asked by providers' offices when you call? Of course-- they want to know your insurance status,

And Dr. Taj seems to have had the same experiences. He fleshes it out a bit more:
The uninsured or underinsured typically cannot afford coverage, though most needed services are financially impossible to receive without it. Instead, people go to the ER to treat severe conditions and never to the doctor for checkups or preventative care. They simply can’t afford it. Nor can they receive adequate medicine or consultation to conditions they treat at home. Overall, not only do the uninsured receive a significantly lower quality of care, if they receive any at all, but at an astronomical cost that often leads to bankruptcy and/or legal action on behalf of hospitals.

The burden always lies on those healthy people to help to subsidize the sick, the main logic behind health insurance generally. We currently have nearly 40 million uninsured in the United States and, as this number increases, greater costs will inevitably be borne by the insured and/or taxpayers. Smaller insurance pools mean more people in need of care, meaning less revenue for insurance companies and greater prices for the insured. The healthiest that can’t afford coverage then drop out and the system becomes even more expensive. This is a fundamental flaw with our health care system and the reason why the individual mandate at the present time is so essential to the Affordable Care Act.

I wish I could get Barrasso to answer this one too, but the third question tries to get into what each doctor feels is the best type of healthcare system for providers and patients and if there's a system where both win. Alphabetical this time-- so Dr. Gill is up first. He's short and to the point... no frills:
Single-Payer ("Improved Medicare for All") is obviously a system where both patients & providers win... The only losers would be the private health insurance companies who would see their business wane...

Dr. Rogers has come to similar conclusions and he's going from Simi Valley to Porter Ranch to Santa Clarita to the Antelope Valley trying to explain it to nervous voters who don't know what to believe or who to trust. Although, obviously, there's one person most people in the area know for sure they can't trust:

Here's Doctor Rogers:
I'm open to listening to all options, but as I see it right now the only system where both win is a single payer system, like Medicare-for-all. But the big losers would be the health insurance companies. Just the opposite of Obamacare, where the big insurers made out like bandits-- 46 million new customers and no caps on premiums. Many people are afraid of single payer healthcare, thinking it is a government takeover of healthcare. It's not a take over; the government already controls healthcare. Medicare's administrative costs are about 3%, compared with up to 25% for private insurers being profit and going to investors and CEOs. Single payer healthcare would be good for our economy. Business should really be embracing it. The second largest expense for most businesses is health insurance. In 1950, Americans spent 3% of their income on health insurance or healthcare, now we spend 17%. Imagine that cost being shifted to a more efficient system with lower overhead-- where treatments were offered to patients based on their levels of evidence. Imagine no pre-existing conditions, preventative care covered, and prescriptions covered. Single payer can accomplish this. A larger focus on preventative care would improve the economy, because sick employees are less productive. If we reduce obesity, and its related diseases like diabetes, arthritis, back pain, we can have more productive workers.

And Dr. Taj is one of the only candidates I've ever heard-- other that Mitt Romney (see video below)-- actually try to explain why the individual mandate isn't the villainous plot the Republicans-- who first thought it up-- have made it out to be the second they tricked the Democrats into accepting it. Although, in the end, he too senses the inevitability of a single-payer system.

Health care is much more than a consumer good or service. The best system treats access to top-notch medical care as a right of every American. No one should be denied care because of a lifetime limit or preexisting condition, and any successful and ethical health care system should not incentivize providers to deny coverage for those in need. Speaking from experience, the key to an effective health care system is to practice preventative medicine rather than reactive medicine. Prevention is a key to better outcomes for patients. It is also less costly to treat a problem early on than to wait.

I’m encouraged by Affordable Care Act and President Obama’s willingness to compromise. I support the individual mandate as a way to enlarge the insurance-pool to lower costs, treatment of pre-existing conditions, how it lowers overhead costs to focus exclusively on care, and the state exchanges. However, the law is not without its flaws, and as a member of Congress I will advocate a patient-outcome model of health care based on patient outcomes and quality care in conjunction with the ACA. The ACA was the intellectual product of decades of bipartisan research and discourse and I believe political posturing, not a healthy discussion of policy, has unfortunately driven much of the resistance to the law. In the end, the ACA is simply an improvement within an inherently imperfect system. I would like to see us develop and implement protocols and incentives for evidence-based medicine. We should use data-driven medicine focusing on patient outcomes and quality care; reduce costs by implementing electronic medical records keeping and a single billing system that would further streamline health care and reduce costs; work with pharmaceutical companies to reduce the costs of prescription drugs and make generics more readily available.

Overall, studies have confirmed the significant cost savings involved in a “single-biller” system and polls consistently show great public support for it. Such a system would reduce administrative costs, focusing almost exclusively on care, and take away the incentive to deny coverage for increased profits. In Congress I will support evolving our health care system through a range of policies to eventually move our country toward this system.

So, last question, the one everyone is probably waiting for... what now? In light of the Court's decision today, what should be the next steps forward? Dr. Taj kicks it off:
The Supreme Court’s ruling on the Affordable Care Act and the individual mandate means that those of us that support reform of our health care system must now act to build on what has been done and improve it. For one, health care costs are a major contributor to the federal deficit that must be reigned in if we’re to put our nation on a stable fiscal foundation. The individual mandate is the centerpiece of the ACA and projected cost reductions would have been impossible without a larger insurance pool. It would have meant increasingly less take-home pay for middle class families to pay for the same or worse coverage. There's a lot we must do to improve the legislation.

The decision gives us the opportunity to keep reforming and designing a better system. Polls have shown widespread public support for a universal health care system and this is the window of opportunity for our leaders to act. A recent report by economist Gerald Friedman shows that this would “save as much as $570 billion now wasted on administrative overhead and monopoly profits.” While there are costs involved with insuring millions of uninsured and underinsured we’d save much more by eliminating middlemen and simplifying the system as a whole, especially by eliminating the incentive to deny care for larger profits. Even with its virtues, the ACA doesn't do nearly enough to bring down long-term costs or correct the deeply rooted problems of our health care system.

Bingo! And Bingo for Dr. Rogers as well.
I think the whole panel would obviously agree that we need doctors at the table making healthcare decisions. Not bureaucrats or lawyers. This decision draws attention to the good parts of Obamacare and the bad parts. Most of us can agree that eliminating pre-existing conditions to qualify for insurance, allowing adult children to stay on parents insurance, and extending coverage for preventable diseases are good things. Where Republicans and Democrats disagree is how to pay for it. Healthcare is so important for the well-being of our nation, that it should be a high priority. We're wasting a lot of money on a war which we already won, on military aid to wealthy nations, on redundant nuclear weapons systems when we could already destroy the planet multiple times over, on putting nonviolent drug offenders in prison instead of in treatment, giving away billions in subsidies to big oil companies, and many other things that should take a back seat to making sure our citizens have access to quality, affordable care.

The Supreme Court ruled that the federal government has the Constitutional authority to regulate nearly all aspects of healthcare including a provision that requires citizens to purchase health insurance. People who have benefited from the law will continue to benefit. That's the good part. The bad part is that the law still needs to be fixed. No law is perfect, but this one benefits the big insurance companies like no other. It mandates you purchase a product but has no cost controls on that product. We need to put patients first, not big insurance companies.

Dr. Gill sums it up in one short, sweet, easy-to-digest sentence: "We need to once again push for Improved Medicare for All." How would you like to see men like this in Congress rather than partisan imbeciles like John Barrasso-- or Buck McKeon or the psychotic LaRouchie running against Dr. Taj? These 3 doctors have something else in common: the DCCC is ignoring all three races, even though all 3 districts were won by Obama and all 3 races could be easily won if Steve Israel, chairman of the DCCC, hadn't decided to put all his cash behind Blue Dogs like Mike McIntyre, John Barrow and Jim Matheson-- all three of whom oppose health care reform, vote with the GOP and... just to make sure everyone knows where they stand politically, all announced yesterday they would back Darrell Issa's, John Boehner's and Eric Cantor's vicious obstructionist war against President Obama by backing today's effort to find Attorney General Eric Holder in contempt of Congress, a place Mr. Holder shares with between 80 and 90% of Americans. In any case, you can help support Dr. Rogers' and Dr. Gill's campaigns here and Dr. Taj's campaign here.

UPDATE: Manan Trivedi

Pennsylvania congressional candidate Manan Trivedi responded to our questions too late to be included in the post. Dr Trivedi served as the battalion surgeon for the 1st Battalion, 5th Regiment Marine Corps Infantry Battalion in Iraq and when he returned to the U.S. he went on to serve as health policy advisor to the Navy Surgeon General and became a professor at the Uniformed Services University of Health Sciences. Today he's a primary care physician at Reading Hospital and Medical Center and looks likely to defeat Republican hack Jim Gerlach in a southeast Pennsylvania district Obama won with 53% in 2008. He's been a critic of the Affordable Care Act and his perspective on today's Supreme Court ruling takes that into account.
The problem with the ACA was that it was too complicated and did not do enough to rein in healthcare costs or hold the insurance companies accountable.  The SCOTUS decision still allows for an opportunity to pursue a much more simplified system, like a Medicare buy-in, which would provide competition in the marketplace and provide patient consumers public and private choices. This coupled with a much greater focus on comparative effectiveness research, so we can better figure out what works and what doesn't work, would be a system that covers everyone, brings costs down and improves the quality of healthcare for everyone.

His approach speaks volumes to why we need to elect sensible medical professionals instead of just more and more lawyers and multimillionaires to Congress. If we want a reasonable healthcare system in this country, we'll need to embed leaders like Trivedi, Rogers, Taj and Gill into Congress. And... the last word (for now):

OK, the real last word-- El Presidente a few minutes ago:

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At 10:50 AM, Blogger Elisabeth M said...

I am running against Virginia Foxx and am a Physician Assistant. Please like my FB page at Elisabeth Motsinger for Congress or look at my website

At 1:42 PM, Blogger Pats said...

I realize this is probably a gross oversimplification of the individual mandate, but how is it different from requiring people who drive to have at least some minimal car insurance? It protects everyone. Yes, not everyone drives because not everyone wants to pay for car insurance. But there are no government subsidies for car insurance. I really don't see why people are having a breakdown over this, while requiring car insurance is largely accepted.

At 2:29 AM, Anonymous Hummer Hire Sydney said...

Doctors should be given a chance to run for congress. We may be shock that they have a lot to contribute than the others. Especially in the health bills.


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