By PAUL KECKLEY

Public understanding about how our health system operates is woefully low: surveys show only one in five adults has functional knowledge about how to choose a physician, hospital or insurance plan, or compare treatment options. The lexicon we use in our industry lends to this confusion: powerful words and phrases that convey something different depending on the user’s intent.

As we debate the replacement for the Affordable Care Act, it might be worthwhile to ask lawmakers to clarify what they mean when they use them and examine our own uses in tandem:

Quality: In U.S. healthcare, quality is not defined by a consistent set of metrics that address diagnostic accuracy and clinical outcomes.  Physicians associate it with access to a clinician; insurers associate it with necessary care; employers with provider network scale and premium costs and the public thinks it’s about scheduling and parking, not results. There are a dozen websites where information about the quality of care in hospitals and medical practices is available, but each has its own methodology and results vary widely. As a result, every hospital and every physician affirms they deliver “high quality care” and every insurer tells its enrollees, groups and regulators its plans are “high quality”. Little wonder quality is confusing.

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By STEVEN FINDLAY

“We’re telling those people that we’re not going to pull the rug out from under them, and if we do this too fast, we are in fact going to pull the rug out from under them.” 

– Rep. Tom MacArthur (R-N.J)

“The fact is, we cannot repeal Obamacare through reconciliation.  We need to understand exactly: what does that reconciliation market look like.  And I haven’t heard the answer yet.” 

– Rep. Tom McClintock (R-Calif)

“It sounds like we are going to be raising taxes on the middle class in order to pay for these new tax credits.” 

– Sen. Bill Cassidy (R-La) 

These quotes, and many others, from a leaked recording of the Republican closed-door strategy session in Philadelphia last week are both jarring and reassuring.   

They reveal in harsh light what the media, pundits, and commentators have been saying for weeks: the Trump administration and congressional Republicans are in a deep quandary about the best path forward on repeal and replace, and are just beginning to weigh the pros and cons of the complex policy options involved. 

But the discussion also shows us that rank and file Republican lawmakers understand the difficulty of the task and know the political price they’ll pay if they screw it up.  Their remarks also imply frustration with the cavalier, ill-informed, and mixed-message statements coming out of the White House.

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By KIP SULLIVAN

CMS began two Medicare ACO experiments in 2012 – the Pioneer program and the Medicare Shared Savings Program (MSSP). Data on these programs available at CMS’s website paints a discouraging picture of the programs’ ability to cut costs. But two papers published in the last two years in the Journal of the American Medical Association paint a much rosier picture. A paper written by David Nyweide et al. claimed to find the Pioneer ACO program generated gross savings two times more in 2012, and slightly more in 2013, than CMS reported. Similarly, a paper  by J. Michael McWilliams claimed to find the MSSP program saved money in 2014 while CMS’s data says it lost money.

What explains the discrepancy? Answer: The JAMA papers examined simulated ACO programs, not the actual Pioneer and MSSP programs. Moreover, Nyweide et al. neglected to report that shared savings payments would have greatly reduced the gross savings, and both Nyweide et al. and McWilliams ignored the start-up and maintenance costs the ACOs incurred. (JAMA’s editors redeemed themselves somewhat by publishing a comment  by former CMS administrator Mark McClellan which warned readers that Nyweide et al. failed to measure the “shared savings payments to the ACOs” and “the investments of time and money” made by the ACOs.)

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By HANS DUVEFELT, MD

It has been suggested that to improve quality in healthcare we must reduce variability in how diseases are diagnosed and treated.

It has been inferred that clinical outcomes would improve exponentially if doctors would only follow established guidelines instead of their own whims.

I take that to mean if doctors didn’t think for themselves so much, the health of our nation would be better. I take that to mean that we may be overqualified for the simple work of delivering “evidence based care”.

That is the fantasy of the non-clinician creators of our new medical world order.

Doctors spend all these years learning biology, biochemistry and physics. We learn about anatomy, physiology and pathology. Eventually we study diseases. Then we learn how to practice what we were taught. Finally, more than a decade after we started, do we earn the right to practice independently, only to become the obedient instruments of a healthcare system that demands conformity and disciplines those who put their training to use by questioning politically motivated health policies and overly simplistic clinical guidelines.  

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by LYGEIA RICCIARDI

In these first days of the Trump Administration, there is a great deal of uncertainty, but it’s clear that healthcare will remain in the spotlight. Repealing and replacing “Obamacare” is still at the top of the Republican party’s—and President Trump’s—agenda.

Congress and Trump have already taken steps to repeal the Affordable Care Act (ACA), though a replacement for it has yet to be articulated. Trump promises “insurance for everybody” in a form that is “much less expensive and much better,” but has yet to reveal details about how to meet his goals.

While changes in healthcare policy will have ramifications for all Americans, members of underserved populations are likely to be disproportionately impacted because they are statistically less healthy  and are also the least likely to have health insurance coverage. Parts of the ACA address Medicaid, which provides health insurance to 70 million people—by definition among the poorest Americans. Nine million whites make up the largest racial group of people who have gained coverage as a direct result of the ACA, but significant numbers of minorities, including 3 million African Americans and 4 million Hispanics, have also gained coverage. The ACA also helps LGBT Americans by forbidding discrimination due to gender or sexual orientation, and by enabling same-sex families to apply for joint healthcare coverage. According to a report issued by the nonpartisan Congressional Budget Office on January 17^th, if the ACA were to be rolled back without a replacement, 18 million people would lose health insurance in the first year. There would also be significant restrictions in reproductive health services for women.

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By ALLISON BOWLES

Now I have insurance. But I can’t use it. What am I supposed to do? I know this one is long but it’s worth a read if you want to understand issues pertinent to the Affordable Care Act. My personal story illustrates many of the problems with the ACA.

I started taking notes on the Health and Human Services Secretary hearing, and I will share more as I scrutinize the hearing in more detail but let’s start with the breakdowns below and my experience with Obamacare.  Here goes:

These are the breakdowns of who gets what coverage in the United States:

Medicare 18% – 52m

Employer 61% – 178m

Medicaid 22% – 62m

Individual 6% – 18m (exchanges cover 4% of the 6%–these are the people who have been forced onto the Obamacare plans)

Note: this writer is in the BOTTOM of the barrel here (Individual). Most of the individuals in the “Individual” category are either the upper contingent of the working poor, those who work for small businesses like restaurants or family owned grocery stores and the like that don’t provide health insurance benefits (more and more common these days), and/or sole proprietors like myself. Many health care providers are self employed hence we have been forced into the Obamacare exchanges if we are not high earners. High earners won’t buy on the marketplace and will purchase individual plans outside of the marketplace.

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By COURTNEY GILDENGIL and LAURA FAHERTY

On January 10^th, then-President-elect Donald Trump met with Robert F. Kennedy Jr., a vocal skeptic of vaccine safety. Although the details and implications of the session are still unclear, the meeting and several of Trump’s tweets have raised questions among public health experts who wonder what, if anything, Trump might do on the issue as president. A chorus of celebrities and politicians continue to question vaccine safety and propagate a myth linking vaccines and autism, fueled by a fraudulent 1998 article by Dr. Andrew Wakefield that was later retracted.

In 2014, RAND undertook a rigorous and independent systematic review of vaccine safety for all populations, including pregnant women and children. From our review we found that while some vaccines are associated with serious side effects, these events are rare and are far outweighed by the benefits of vaccination. For example, we found evidence that the combined measles, mumps, and rubella (MMR) vaccine is associated with febrile seizures, which are seizures or convulsions that occur when a child has a high fever. But while these seizures are certainly unpleasant and can be frightening for parents to witness, there is no evidence that they cause any long-term harm to children.

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 By YEUNG, MAY and TRUJILLO

How can we gauge whether America is prioritizing health and well-being? Since public attitudes toward health-related topics are widely shared on social media, we gazed into the mirror that is Twitter and tried to answer that question by sifting through 32 million health-related tweets, one of the largest social media samples ever collected for health research.

Posts and conversations on Twitter have the potential to shed light on the public’s views about a seemingly endless array of health-related topics—obesity, exercise and fitness, safe sex, alcohol use, medication adherence and mental health. Accordingly, researchers have turned to social media to better understand these topics.Continue reading…