By GEORGE KALOGEROPOULOS 

Reports coming out of Washington suggest that Republicans may have bitten off more than they would like to chew with repealing & replacing the ACA, with a proliferation of proposals and no consensus on which to support, or how to get the 60 Senate votes needed to turn an eventual consensus plan into law.

There is a general consensus in the GOP to proceed with the budget reconciliation process, but if they pass the bill the House passed in 2015, it will immediately defund plan subsidies and the Medicaid expansion, setting up 25 million or more to lose their coverage right around midterm elections in 2018.

Even a less drastic budget reconciliation bill, for example one that gets rid of the individual and employer mandates by deleting the penalties associated with them, would leave us with a, “zombie ACA”, with everything not budget-related still in place, but malfunctioning with unintended consequences.

All this uncertainty is bad—it’s bad for the government, it’s bad for industry, and most importantly, it’s bad for the tens of millions of confused consumers trying to make informed decisions about how and if they can get health coverage.

Taking a step back

As the saying goes, when you have a hammer, every problem looks like a nail. In this case, when you have a legislative majority, every problem looks like it should be solved by changing the law.

But does that have to be the case? What if Congressional Republicans were to take a back seat and let Tom Price and the Department of Health and Human Services (HHS) begin the process of reforming health reform?

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By CHELSEA POLANIECKI

What do you do when your doctor says something serious, like, “Make an appointment with a Cardiac electrophysiologist stat” or “here is a prescription for some XYZ.” A what? And a whom?! “Oh, and you’ll need to get an MRI too.” Well, that’s overwhelming. It’s no surprise that about 20 percent of first-time prescriptions are never filled, according to a 2010 Harvard Medical School study¹.

Patients often come to a road block and fail to follow through with doctors’ orders because of perceived financial burdens, or simply because they don’t know where to find what they need. The Robert Wood Johnson Foundation (RWJF) feels that no one should be at a loss for health care services because they don’t know where to go for affordable services. The RWJF Choosing Care Challenge will therefore bring tech-enabled solutions to the forefront of this issue.

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By JIM PURCELL

In 1891, Dr. Luther Gulick proposed a red triangle as the YMCA symbol. In his words, the equal sides of the triangle stood for “man’s essential unity– body, mind and spirit– each being a necessary and eternal part of man, being neither one alone but all three.” True then, and equally true today, it highlights what is missing from most traditional approaches to wellness–the mental, emotional, and spiritual components. Hardly surprising given the remarkable resistance mental illness treatments encounter.

The term “mental illness” usually refers to recognized mental illnesses in accordance with the Diagnostic and Statistical Manual (DSM) published by the American Psychiatric Association. These include depression, anxiety, psychotic disorders, and bipolar disorder. While substance abuse and addictions are not so neatly categorized and are sometimes referred to as “behavioral disorders,” an indeed odd phrasing, we will refer to all such afflictions as “mental health or “mental illness.”

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By JOE FLOWER

The economic fundamentals of healthcare in the United States are unique, amazingly complex, multi-layered and opaque. It takes a lot of work and time to understand them, work and time that few of the experts opining about healthcare on television have done. Once you do understand them, it takes serious independence, a big ornery streak, and maybe a bit of a career death wish to speak publicly about how the industry that pays your speaking and consulting fees should, can, and must strive to make half as much money. Well, I turn 67 this year and I’m cranky as hell, so let’s go.

The Wrong Question

We are back again in the cage fight over healthcare in Congress. But in all these fights we are only arguing over one question: Who pays? The government, your employer, you? A different answer to that question will distribute the pain differently, but it won’t cut the pain in half.

There are other questions to ask whose answers could get us there, such as:

• Who do we pay?
• How do we pay them?
• For what, exactly, are we paying?

Because the way we are paying now ineluctably drives us toward paying too much, for not enough, and for things we don’t even need.

A few facts, the old-fashioned non-alternative kind:

• Cost: Healthcare in the U.S., the whole system, costs us something like $3.4 trillion per year. Yes, that’s “trillion” with a “T”. If U.S. healthcare were a country on its own it would be the fifth largest economy in the world.
• Waste: About a third of that is wasted on tests and procedures and devices that we really don’t need, that don’t help, that even hurt us. That’s the conservative estimate in a number of expert analyses, and based on the opinions of doctors about their own specialties. Some analyses say more: Some say half. Even that conservative estimate (one third) is a big wow: over $1.2 trillion per year, something like twice the entire U.S. military budget, thrown away on waste.
• Prices: The prices are nuts. It’s not just pharmaceuticals. Across the board, from devices to procedures, hospital room charges to implants to diagnostic tests, the prices actually paid in the U.S. are three, five, 10 times what they are in other medically advanced countries like France, Germany, and the U.K.
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By JASON CHUNG

Sports Illustrated’s new swimsuit issue is touted as a “diversity issue” intended to celebrate female models of different ages, ethnic backgrounds and figures.  But in featuring plus-size models, does diversity threaten to go too far?

On its face, any movement toward diversity in modelling is admirable – contemporary models of all stripes generally still skew too young, too white and too thin.  And where these models are insufficiently perfect, Photoshop exists to make them even more wrinkle-free, fairer and skinnier.

Luckily, there has been a movement in Europe to rectify at least one of these issues.  Via “skinny model” legislation, France, Italy, Israel and Spain have banned models from working if they are underweight.  In France, penalties for agencies and brands breaking this law range from jail time to hefty fines.  French law also mandates a fine for firms if they fail to clearly note within ads if models have been digitally altered.

From a health perspective, European countries appear to be serious in their attempts to rein in advertisers, designers and photographers.  This is great news –this year’s rookie Sports Illustrated swimsuit model Myla Dalbesio  echoes a concern voiced by many models – that industry-imposed parameters can be arbitrary and demeaning with years of being told that one is “too fat, then too thin”.  Movement toward regulating an industry which, for far too long, has promoted eating disorder-derived emaciated looks such as “heroin chic” deserves oversight and regulation.

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By FRED TROTTER

First, let me candidly admit that I have no idea if putting Health Savings Accounts (HSAs for short) at the center of the Trump healthcare rework is a good idea. I do, however, have some insights into what made Bush-era HSA plans fail.

Bush-era HSA’s were unavailable to many Americans, because their health insurance companies and employers ultimately made the decision about whether they would be able sign up for an HSA. Many employers elected not to participate in HSA’s by not purchasing health plans that “came with an HSA”.

I was working at the UT School of Biomedical Informatics during the Bush administration’s attempt to deploy HSA’s. I wanted to research and understand how HSA’s would impact the healthcare system, and I knew that the first step was to sign up for one myself. 

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By NIRAN AL-AGBA, MD

Sean MacStiofain said “most revolutions are caused… by the stupidity and brutality of governments.” Regulation without legitimacy, predictability and fairness always leads to backlash instead of compliance.

Here’s a prediction for you: If something is not done to stop MACRA implementation, more physicians will opt-out of Medicare and Medicaid than is fathomable.

Once DRexit begins, there will be no turning back.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is destructive to the physician patient relationship because it prevents physicians from prioritizing patient care. MACRA supporters like to point out this legislation was passed with bipartisan support; in reality, it was passed simultaneously with repeal of the Sustainable Growth Rate Formula.

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By CRFB.org

As policymakers debate repealing and replacing the Affordable Care Act (ACA or “Obamacare”), disagreement remains over how to address the ACA’s “Cadillac tax.” Rather than repealing the 40 percent tax on high-cost insurance plans outright, many advocates of “repeal and replace” have proposed replacing it with a limit on the tax exclusion for employer-sponsored health insurance (ESI). Doing so would be a wise choice, and limiting the ESI exclusion would both generate significant revenue to pay for an ACA replacement and help to limit the overall growth of health care spending. In this piece, we discuss some of the options available for replacement. 

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By McFADYEN, HALL & McBRIDE-FOLKERS

The McFadyens in 2010. Gabriel, Ellen, Andrew and Issac, aged 6.

In both the House of Representatives and the Senate, legislators have introduced “Right to Try” bills, which purport to give terminally ill patients access to experimental medications prior to Food and Drug Administration (FDA) approval. Vice President Pence recently met with Right to Try advocates, expressing support for the movement in a tweet. Forbes has published perspectives from both sides on the issue: first, a Right to Try proponent, Nathan Nascimento, defended the legislation, while medical ethicist Arthur Caplan’s response illustrated why Right to Try is – at its core – bad policy. A key voice missing from this dialogue, and the one needed most, is that of the patient.

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