BHN reports: Push for single-payer lives on in Massachusetts

by Tinker Ready All rights reservedWith the ACA under constant fire, it’s easy to think that single payer is off the table.  Try getting that through Congress.  Still, seems, here in Massachusetts, single payer supporters are not ready to give up.

On Wednesday night,  Mass-Care invited former CMS director and gubernatorial candidate Don Berwick to a meeting on “What can be done legislatively to achieve Single Payer in Massachusetts.”  An overflow group filled a small meeting room in the Downtown Crossing office shared by Mass Care and other progressive groups like The Women’s Institute for Leadership Development and the Industrial Workers of the World.

Berwick, who added single payer to his campaign platform, didn’t really need to make a case for the plan. He was preaching to the converted when he argued that turning the government into our insurer would help the country achieve “better care, better health and lower costs.”

It will have to happen on the state level, he said. “I don’t expect national leadership on this from either party.”

He cited the usual statistics – we spend 40 percent more per-capita than any other nation. Then he added a few more. While running for governor, he took a look at 15-year tends in the state budget. Funding was down for almost every item, he said.  – local aid, parks, higher ed. For health care, state spending rose 72 percent in that period.

To pull that lens out a bit, he cited a recent  Commonwealth Fund study that estimate the costs savings had the US had adopted a single –payer plan similar to one used in Switzerland: $15.5 trillion over 30 years.

None of these arguments has provided single payer with the kind of traction it needs to move into the mainstream.

“When you say, don’t worry, the state is going to be your insurer, that’s a hard sell,” Berwick said.

So, he and others are starting to emphasize another point – we are spending money on health care that could be better spent elsewhere. In other words, the co-pay may be so high on your knee surgery, you’re might not be able to pay the rent.

“There is a transfer of opportunity in society from other things to health care,” Berwick said.

Or pay for a week at the beach or a private college for your kids.  As the discussion turned to how to sell the approach to the public, several people – including a group of medical students from BU – pointed out that high health care costs are not just a problem for the low–income and uninsured.

“How do we sell this to the middle class? “ asked Andy Hyatt, a first-year medical student at BU and a member of the school’s chapter of Physicians for a National Health Program. While it’s important to help the disadvantaged, he said, health for middle-income people “still sucks”

Just how to address that group is what these supporters of single payer health care are trying to figure out.

“We’re wondering what we as medical students can do,” asked Jawad M. Husain, also of the BU PNHP. “We want to practice in a system where we can treat people fairly.”

Berwick’s answer: “Political mobilization.” But he noted that the students will have to look outside the classroom for guidance on that. ” It’s not something I learned in medical school”

Compare Massachusetts doctors via quality reports and patient feedback

CR MA. Doc Ratings Insert_300Searching for health care services on the Internet can be like searching info about food, hotels or pets. You have to sort through a lot of low quality or scraped sites that don’t offer much.

Healthcare Compass looks like a good destination for Bay Staters.

On this website, there are two different ways to compare doctors’ offices:

  • A survey of more than 40,000 patients across Massachusetts that collected details about the care they receive at their own doctors’ offices.
  • Reports that measure how well the doctors’ offices achieve nationally recognized standards for high-quality primary care…

This website helps patients answer two questions about their health care quality:

Are primary care doctors giving their patients the correct preventive care services (such as cancer screenings) and chronic disease care (such as asthma or diabetes care)? The Clinical Quality report looks at how this of care was given to patients at doctors’ offices.
Learn more about the Clinical Quality Report

 How are patients’ experiences with their doctor office? Does their doctor’s office know about them and the care that they should be receiving? The Patient Experience Survey is a statewide survey that asks patients to report about their experiences with a specific primary care doctor and with that doctor’s office. 

Learn more about the Patient Experience Survey report

 

Also, click here for a source of raw data: Patient HealthDecider 

 

Dr. Hatch and the other Minutemen taking aim at Ebola

UMass Medical docs were already working in Liberia when the Ebola epidemic began raging. So, it’s no surprise that  Dr. Steven Hatch’s name keeps coming up in New York Times stories about Ebola care. (See links below)  Now, a $7.9 million grant will bolster the Umie effort by funding both care for patients and training for Liberian  docs. In this case, the UMass warrior mascot seems appropriate: Go Minutemen!

From the UMass press office:

Hatch’s  latest appearance is in a story focusing on a clinic caring for a women who had lost both her husband and her infant to ebola. 

He and others often rely on their instincts and experience. When Ms. Sayon’s second blood test for Ebola came back, the results were negative, but the doctors were wary of releasing her. She was bent over in a chair, shaking. Her eyes and cheeks were sunken. Keeping her in the ward for suspected cases risked infecting her with the virus, but the physicians reasoned she already had significant exposure from her family, and virus detection can sometimes lag symptoms by up to three days. (They also suspected there might have been a mix-up because of labeling problems that day with blood samples that the new center quickly worked to fix.)

Overdiagnosis or overtreatment? Move to lung cancer screening fuels debate

A report from HLM on Siemens-sponsored, Atlantic-hosted event on “The Diagnostic Debate.”

Gregory Sorensen, the CEO of Siemens Healthcare North America opened the session by challenging the notion that screening drives overdiagnosis.

“We’re not over diagnosing,” he said. “We’re over treating.”

Sorensen used as an example, mammography. When doctors find a “low-grade” tumor like DCIS (ductal carcinoma in situ), they may resort to a lumpectomy or chemotherapy despite questions about the efficacy of those treatments, he explained.

“This in turn leads us to question the value the mammography, because it leads to overtreatment. It is not the mammogram that’s the problem,” Sorensen asserted. “It’s the [healthcare] system’s lack of discipline.”

Atlantic’s event site. 

 

Tufts talk: #Upstreamist docs look beyond clinic #SDOH

Richi Manchanda came back to Tufts earlier this month to talk about his “upstreamist ” approach to health care — address causes of  patient ills  before they start drowning in health problems. Usually, that involves a look into home or work issues — the so-called social determinants of health.

It was a homecoming of sorts. Manchanda is a triple Jumbo — BS, MPH and MD at Tufts. HLM reports.

The health care system needs to do a better job identifying and addressing the social, environmental and economic conditions that play into the health of patient communities.

That was the message Rishi Manchanda, MD, MPH, delivered to a group of medical students at Tufts Medical Center in Boston this month. Manchanda is a nationally known advocate of healthcare that looks beyond the clinic and into the lives of the people it serves.

 

Science in the News lecture series: Sugar, RNA, cancer and the brain

Former Tufts doc: “Widespread dishonesty” leads to unjustified health care fees #HCR

Former Tufts doc and current Mainer Howard A.Corwin comments this weekend on the latest in Elizabeth’s Rosenthal’s great NYTimes series on insane health care costs. In her latest piece, she reports that “In operating rooms and on hospital wards across the country, physicians and other health providers typically help one another in patient care. But in an increasingly common practice that some medical experts call drive-by doctoring, assistants, consultants and other hospital employees are charging patients or their insurers hefty fees.”

To which Corwin notes: 

To the Editor:

Doctors call such billing “gaming the system.” There is widespread dishonesty that leads to these unjustified expenses throughout the medical profession. Members of Congress beholden to medical lobbyists allow flawed reimbursement systems and perpetuate them by preventing reform. There is an enormous disparity between what different medical specialists and personnel earn. Unable to rectify these disparities, many physicians resort to these gaming techniques. Unnecessary expensive tests and procedures, upgraded coding, “scratch my back and I’ll scratch yours” referrals and, of course, outright greed lead to extra medical expense.

Honest doctors are demoralized and suffer from this system. Doctors must regain leadership of medicine to rectify these aberrant and destructive practices.

HOWARD A. CORWIN
Center Lovell, Me., Sept. 21, 2014

The writer is a former clinical professor of psychiatry at Tufts University School of Medicine.

Follow

Get every new post delivered to your Inbox.

Join 69 other followers

%d bloggers like this: