Article: A Footnote in History: Why the Obamacare Ruling May Not Matter

A Footnote in History: Why the Obamacare Ruling May Not Matter

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Political Jockeying In Anticipation Of Supreme Court Ruling – Kaiser Health News

Political Jockeying In Anticipation Of Supreme Court Ruling

Mary Agnes Carey and Marilyn Werber Serafini join Jackie Judd to talk about the permutations of the impending Supreme Court decision on the constitutionality of the health care law. Carey says much is at stake for all people who touch the health care system while Werber Serafini outlines some of the Republican alternatives to the law.

via Political Jockeying In Anticipation Of Supreme Court Ruling – Kaiser Health News.

Notes on Prevention, Disease Care and Delivery Systems

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May_30_Health_Care_Rally_NP (641) (Photo credit: seiuhealthcare775nw)

I have, for some years now, said that, for all our talk as a nation about our “health care delivery system,” we do not actually HAVE one!  Rather, I believe that we have a “disease care industry” that thrives as a market-driven economic engine to the tune of over $2 trillion and approaches one-fifth of our national economy.   And that is a good thing, as far as it goes.  It just doesn’t help us get healthier!  Today’s Health Affairs Blog entry, “It’s Too Late to Turn Back Now – A Transformation to Wellcare is Underway,” got me started thinking.

What would a true “health care delivery system” look like?  Here’s my take:

  • It would focus on primary care, providing a more robust and better-paid primary care workforce, including interprofessional teams of nurses, physicians, pharmacists,  dentists, psychologists, nutritionists and social workers
  • There would be a single-payer reimbursement system (could be public or private), where a basic level of care would be covered for everyone.  Basic coverage must include preventive services, and the full services of a Patient-Centered Medical Home (PCMH)
  • A PCMH would be defined as a clinical practice in which
    • Every patient has a designated primary care provider (doctoral-trained physician or nurse – we can’t train enough physicians for this to only be a role for physicians – the need is too great, and our nursing colleagues bring a lot to the table for this role)
    • Every patient has a documented care plan with benchmarking and accountability, both for the patient and the practice team
    • All patients in the practice have access to the full-scope interprofessional team as needed
    • The practice manages the health of its patients as a population
    • The practice has a fully functional electronic health record (EHR) that includes robust capacity for patient registry functions and data mining
    • The practice commits to regular practice quality improvement and patient safety as a hallmark
    • Each patient undergoes a formal health risk appraisal, and all risks get managed through evidence-based primary, secondary or tertiary prevention efforts as part of the patient’s documented care plan
    • All patients have access to a smart-phone, tablet computer or similar technology to interact with the practice electronically
    • The practice gets reimbursed to interact with patients by telephone, electronically, and using telemedicine technology.
  • A local mechanism for accountability, through regional planning boards, report cards, or other similar mechanisms would give public feedback about performance of each PCMH, and about the health outcomes of the populations they serve.  To read an interesting piece about the current status of such accountability options, take a look at the following articles:  Consumer Reports Starts Rating Primary Care Practices (American Medical News) and Evidence-Based Policy Making (Health Affairs).

I know that some elements of what I propose are controversial, including the provision that not all PCMH practices are led by physicians.  I actually believe that the “work” of primary care physicians will be something different from anything we have ever seen, but I will save that content for another post.

What would YOUR definition of a “true health care delivery system” look like?  Post your comments, and let’s begin a conversation!

A Guide to the Supreme Court Arguments – ACA

Another resource in advance of the Supreme Court decision about the Affordable Care Act.

Webcast Replay: Deconstructing The Supreme Court’s Historic Health Law Arguments – Kaiser Health News.

A Blog From a Respected Colleague – Wilson Huhn

Just letting folks know about a gifted colleague who has done a great deal of writing about the constitutionality of the Affordable Care Act.  His work could be useful as we approach the Supreme Court’s decision come forth in the next few weeks. (And maybe even this coming week. . )

Wilson Huhn:

Using the ER for Dental Problems – Symptom of a Non-System for Health Care

More patients with routine dental problems turn to hospital emergency rooms –

I know that patients I see defer so much care for dental issues. This report confirms what I see in the clinic every time I’m there.

The Accountable Care Act Turns Two! Thoughts on an Anniversary

As a preventive medicine, public health and health policy-trained family physician from a rural community, who has worked with underserved folks for nearly 25 (yes, really!!) years, I have to share this infographic. The Accountable Care Act is not perfect, but it moves us toward more equitable distribution of health care, provides for cost reductions, quality improvement, increased access and maintains our capacity as a nation to lead the world in health care innovation.

The fundamental problem is that we are no longer able as a society to pay for all the things we can DO in medicine, and we are struggling to come to terms with that.

If the ACA goes away, all the things in this graphic will go away. If the mandate goes away, the whole thing falls apart, because the insurance companies won’t play.

For those who are NOT celebrating the two-year anniversary of the ACA, I would issue a polite, but firm, challenge: Design a program, using public policies you can agree with, that would achieve these things. I have seen no other such proposal anywhere; absent one, I will support the ACA, and yes, celebrate it!

INFOGRAPHIC: The Affordable Care Act Turns Two


Today, I posted this, my most political post ever, to Facebook. With some trepidation. I know those who follow me on Facebook are made up of a number of folks who probably disagree with the premise; I know some of them will respond negatively. But I firmly believe that our current “status quo” in health care is not a “health care system,” but a “disease care industry.” I also firmly believe that the moral decision that over 50 million human beings who live in the richest country on the planet should be excluded from access to the most basic of health care is a hideous and unethical choice we have made for over 30 years. I believe these things to be unacceptable to me as a human being.

The political winds blow in many directions, and a lot gets lost in the crosswinds. The bottom line is, more people have more access, and costs are going down, and quality is going up (yes, physicians are being held accountable for the health of the populations they serve, and so are hospitals, health systems, educational institutions, and perhaps even politicians). This law has many things that need to be tweaked, and if it survives the Supreme Court challenge that begins week, many of those issues will be addressed, hopefully in a bipartisan fashion. But the ACA provides forward motion that leads to more people being able to afford basic health care, improvement in the quality of that health care, and more concern for the experience of patients, who are, in fact, a primary reason the industry exists – all of this is good.

Two years ago last week, I was in Washington, DC on the day the law was signed. I found myself in Washington again over the weekend, and was glad to be there for the second anniversary.