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Republican Misbehavior Promoted Health Professional Activism

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By MIKE MAGEE

If you wanted to create a motto for the summer of 2023 – one that would stand the test of time from the medical exam room of Ohio to the gilded bathroom of Mar-a-lago – it would have to be Jack Smith’s “Facts matter!” If that is true on a national scale, it is equally true in states across the nation where doctors increasingly are coming out from behind a self-imposed clinical curtain and going public.

As reported in ProPublica last week, “Doctors who previously never mixed work with politics are jumping into the abortion debate by lobbying state lawmakers, campaigning, forming political action committees and trying to get reproductive rights protected by state law.”

A few examples:

1. One thousand Ohio doctors signed a full-page ad titled “A Message to our Patients on the loss of Reproductive Rights” in the Columbus Dispatch in response to actions of a state legislature highjacked by radicalized Republicans enacting a 6-week abortion ban post the Dobbs decision. This was after their coalition delivered a protest letter with 700,000 signatures earlier to the State House.

2. Dr. Damla Karsan, a Houston obstetrician, faced off Texas legislators  on July 20th, lending truth to power when she said , ““I feel like I’m being handicapped. I’m looking for clarity, a promise that I will not be persecuted for providing care with informed consent from patients that someone interprets is not worthy of the medical exception.”

3. In Nebraska, the doctor-led “Campaign for a Healthy Nebraska” raised $400,000 to hire political consultants to launch a women’s health rights campaign which helped the Nebraska Medical Society “find its inner voice” and openly oppose abortion restrictions in that state. State Senator Danielle Conrad was impressed. She said, “It’s really just incredible from my vantage point to see how these doctors have been able to not be hobbled by those decades of political baggage, to step forward with this fresh, clear medical perspective and be able to engage more people.”

4. A month earlier, Dr’s Katie McHugh, Gabriel Bosslet, Caroline Rouse and Tracey Wilkinson penned an Op-Ed in STAT in support of their colleague, Dr. Caitland Bernard, who had come to the rescue of a 10 year old Ohio rape victim who had fled to Indiana to gain access to an abortion. Caitlin was shamefully fined $3,000 by the Indiana State Licensing Board. Her colleagues wrote, “While a relatively minor punishment, this finding should send a chill through the medical community and beyond. But that chill shouldn’t be silencing.”

5. In Michigan, a doctor-led group, the Committee to Protect Health Care, teamed up with the ACLU, and successfully passed “Proposal 3”,  a “constitutional amendment to enshrine reproductive rights into the state constitution.” Dr. Rob Davidson declared, “This is a historic victory for reproductive rights in Michigan, and the Committee to Protect Health Care was proud to help get Proposal 3 across the finish line.”

Yesterday’s indictment of  Donald Trump, the citizen, squarely places him and his legislative enablers in Washington and Republican led state houses across our nation, on the wrong side of the truth. As reported, he is accused of “three conspiracies: one to defraud the United States; a second to obstruct an official government proceeding, the certification of the Electoral College vote; and a third to deprive people of a civil right, the right to have their votes counted.”

But what he and his Republican supporters in Washington and state houses across the nation are primarily guilty of, is not simply lying and deceit, but attempting to destroy our democracy and disenfranchise our voters. That is why prosecution under Civil Rights statutes employed in the past to address the savagery of the KKK, are totally appropriate here. Jack Smith’s “stand tall” leadership is a model for us all, and that includes our doctors and nurses.

As I have repeatedly argued, the health of our democracy is inseparably interwoven with the health of our system of caring for each other. At the helm of this system, our health professionals have survived the hurricane force winds of a pandemic, an inequitable and inefficient health delivery system, and a medical-industrial complex that is more focused on seizing patents than serving patients.

And yet, today we take heart. Our physicians, in growing numbers, are rediscovering their strength and their voices. Like Jack Smith, they are speaking up, in opposition to a small group of bitter and evil leaders, who have earned our active condemnation, and now must face the weight of the law.

Mike Magee MD is a Medical Historian, regular THCB contributor, and the author of CODE BLUE: Inside the Medical-Industrial Complex.

THCB Spotlight: Dexcare CEO, Derek Streat

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According to their press release, “Dexcare is a care-access platform to manage the logistics of digital-care delivery. The platform enables healthcare systems to forecast and predict demand and manage how and where care is merchandized to consumers – throughout the digital ecosystem”. What does that mean? How does it compare to a bunch of other digital health companies trying to manager consumer operations inside providers? And having been incubated not that long ago at Providence, how has this demand generation and management service grown so fast. And why has Iconiq Growth just pushed another $75m worth of chips onto the poker table in front of them?

Derek Streat has been around digital health for a while, having founded and sold an early Health 2.0 favorite, Medify. I took him through his market and what Dexcare does in a lot of detail, so hopefully you’ll find this look very educational, not only about Dexcare but also about the consumer market environment health systems are operating in. Matthew Holt

THCB Gang Episode 132, Thursday July 27

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Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday July 27 at 1pm PST 4pm EST are Olympic rower for 2 countries and DiME CEO Jennifer Goldsack, (@GoldsackJen); patient advocate Robin Farmanfarmaian (@Robinff3); Kim Bellard (@kimbbellard); and medical historian Mike Magee @drmikemagee.

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Sach Jain, CEO of Carrum Health talks to Matthew Holt

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The concept of “centers of excellence” has been around for a few decades. Surely sending health plan members and self-insured employers’ employees to the best and most effective providers should improve health outcomes and save payers’ money? Sach Jain is CEO of Carrum which has been working on this problem, partnering with the best providers and aggregating that demand from employers…and putting it all on a state of the art platform. As you might suspect, it’s not as easy as it looks. Carrum raised $45m from Omers Ventures a few weeks back, on top of a decent raise from Tiger Global a couple of years back. So are they getting it right? Sach told Matthew Holt that they are for sure on their way….

Is More Physician-Owned Hospitals the Solution to our Health Cost problem?

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BY JEFF GOLDSMITH

Robert Frost once said,  “Home is where, when you have to go there, they have to take you in.”

Increasingly, in our struggling society, that place is your local full service community hospital.  During COVID, if it wasn’t your local hospital standing up testing sites, pumping out vaccinations and working double overtime helping patients breathe, we would have lost several hundred thousand more of our fellow Americans.  

But it wasn’t just COVID where hospitals leaped into the breach.    As primary care physicians’ practices collapsed from documentation overburden and chronic underpayment, hospitals took them in on salary.  If it wasn’t for hospitals, vast swatches of the northern most three hundred miles of the US and large stretches of our inner cities would be a physician desert.  Hospitals subsidize those practices to a tune of $150k a year to have a full service medical offering and keep their own doors open.  

As our public mental health system withered, the hospital emergency department  (and, gulp, police forces). became our main mental health resource.   Tens of thousands of mentally ill folks languish overnight in hospital observation units because, despite not being “acutely ill”, there is nowhere for the hospital to place them.  And as our struggling long term care facilities withered under COVID, those mentally ill folks were joined in observation by seriously impaired older folks too sick to be cared for at home.  As funding for public health has withered on the vine, hospitals have become the de facto public health system in the US.  

Continue reading…

Health Care, Disagree Better

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BY KIM BELLARD

On one of the Sunday morning news programs Governors Spence Cox (UT) and Jared Polis (CO) promoted the National Governors Association initiative Disagree Better. The initiative urges that we practice more civility in our increasingly civilized political discourse. It’s hard to argue the point (although one can question why NGA thinks two almost indistinguishable, middle-aged white men should be the faces of the effort), but I found myself thinking, hmm, we really need to do that in healthcare too.  

No one seems happy with the U.S. healthcare system, and no one seems to have any real ideas about how to change that, so we spend a lot of time pointing fingers and deciding that certain parties are the “enemy.”  That might create convenient scapegoats and make good headlines, but it doesn’t do much to solve the very real problems that our healthcare system has. We need to figure out how to disagree better.

I’ll go through three cases in point:

Health Insurers versus Providers of Care

On one side, there are the health care professionals, institutions, organizations that are involved in delivering care to patients, and on the other side there are health insurers that pay them.  Both sides think that the other side is, essentially, trying to cheat them.

For example, prior authorizations have long been a source of complaint, with new reports coming out about its overuse in Medicaid, Medicare Advantage, and commercial insurance.  Claim denials seem equally as arbitrary and excessive.  Health insurers argue that such efforts are necessary to counter constantly rising costs and well documented, widespread unnecessary care. 

Continue reading…

Outpatient Vascular Care: Good, bad or ugly?

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BY ANISH KOKA

Filling in the holes of recent stories in the New York Times, and Propublica on the outpatient care of patients with peripheral arterial disease

Most have gotten used to egregiously bad coverage of current events that fills the pages of today’s New York Times, but even by their now very low standards a recent telling of a story about peripheral artery disease was very bad.

The scintillating allegation by Katie Thomas, Jessica Silver-Greenberg and Robert Gebeloff is that “medical device makers are bankrolling doctors to perform artery clearing procedures that can lead to amputations”.

The reporters go on to tell a story about patient Kelly Hanna, who presented to a physician, Dr. Jihad Mustapha, in a private clinic with a festering wound. After being diagnosed with a poor flow to her leg that was likely contributing to the wound, Dr. Mustapha performed multiple procedures on her leg to improve blood flow in an attempt to ward off a future amputation. The procedures were unsuccessful, and Ms. Hanna ultimately did need an amputation.

Continue reading…

Matthew’s tidbits: Obesity Summer

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Every time I get around to sending out the THCB READER I add a short & usually not to sweet commentary on some aspect of health care.–Matthew Holt


I saw the obesity crisis up close this week. And by that I’m not just referring to my addiction to Salted Caramel with Pretzel Ice Cream, bad though it is. Instead I felt thin because I went to Disneyland. But while I tip the scales at a BMI of 30 if I’m lucky, I genuinely felt that looking around Disneyland more than 50% of the crowd were obese and many morbidly so.

The rest of my trip to Southern California was quite a contrast because I’ve been watching a girls water polo tournament. Those young women and most of their families, as you’d expect, look very different. In this crowd I am definitely on the other end of the spectrum.

Obviously there’s a big socio-economic difference between the Disneyland attendees and a crowd centered around a sport largely played by rich, white kids. But at a time where we are arguing about whether Ozempic and its fellow anti-obesity drugs should be available via insurance, we seem to have no other strategies to fight the nation’s slide to obesity.   

You’ve probably seen those photos of people on the beach in the 1960s where everyone is thin. I won’t claim to understand the science of what happened but clearly the prevalence of high fructose corn syrup and other highly processed food has much to do with it. As does the free rein food companies have had to advertise what are addictive products. I don’t know how we get to be a nation where everyone eats and exercises like a water polo player. But clearly we need significant changes in our agriculture and nutrition policies. We did it with smoking, so we know it can be done. If you don’t think we need it, I recommend a trip to Disneyland (and that’s the only reason I recommend one!)

Truthfully, the Physician Shortage Doesn’t Exist!

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BY HANS DUVEFELT

Conclusion: For every hour physicians provide direct clinical face time to patients, nearly 2 additional hours is spent on EHR and desk work within the clinic day. Outside office hours, physicians spend another 1 to 2 hours of personal time each night doing additional computer and other clerical work. (Sinsky et al, 2016)

If we only had the tools and the administrative support that just about every one of us has been asking for, there wouldn’t be a doctor shortage.

The quote here is from 7 years ago and things have gotten even worse since then.

Major league baseball players don’t handle the scoring and the statistics of their games. They just play ball.

Somehow, when the practice of medicine became a corporate and government business, more data was needed in order to measure productivity and quality (or at least compliance with guidelines). And somehow, for reasons I don’t completely understand and most definitely don’t agree with, the doctors were asked not only to continue treating our patients, but also to more than double our workload by documenting more things than we ourselves actually needed in order to care for our patients. Even though we were therefore becoming data collectors for research, public health and public policy, we were not given either the tools or the time to make this possible – at least not without shortchanging our patients or burning ourselves out.

We didn’t sign up to do all this, we signed up to care for our patients. And we were given awkward tools to work with that in many ways have made it harder to document and share with our colleagues what our clinical impressions and thinking are.

Continue reading…

THCB Gang Episode 131, Thursday July 20

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Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday July 20 at 1pm PST 4pm EST are futurists Jeff Goldsmith; patient advocate Robin Farmanfarmaian (@Robinff3); Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune); and our special guest Investor at Bessemer Sofia Guerra (sofiaguerrar)

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

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