Check out WBUR’s story on medical homes.
Then, check out this week’s health and science events on the Nature Network Calendar
Mass. single-payer advocates take on limits of state health reform
October 28, 2011 — by Tinker ReadyBefore you write off these folks, note that a recent survey of doctors by the Massachusetts Medical Society found that a growing number of doctors support the idea of a single-payer system. More than 40 percent, up from 34 percent last year. So do a lot of folks at Occupy Boston.
Massachusetts Health Reform in Practice and The Future of National Health Reform
OVERVIEW: While the Massachusetts health reform law of 2006, widely regarded as the model for the new federal health law, reduced the uninsured population in the state, it did so at the cost of rapidly rising underinsurance, increased health care premiums, and a financial crisis among the state’s safety-net hospitals and community health centers. And the financial burden of the reform has fallen disproportionately on lower-middle-class families.
Those are some of the findings in a new, exhaustively documented report on the outcomes of the Massachusetts reform law released by Mass-Care and Massachusetts Physicians for a National Health Program. The report draws on hundreds of sources, including academic studies, government statistics and scientific surveys, in the first compilation of its kind.
EXECUTIVE SUMMARY
The Massachusetts Health Reform Law of 2006 expanded Medicaid coverage for the poor and made available publicly subsidized private health insurance for additional low-income residents of the state. It also mandated that all but the poorest uninsured residents either purchase private health insurance or pay a substantial fine (up to $1,212 in 2011). Smaller fines (up to $295 per employee) were also levied on employers who fail to offer insurance.
Four years after full implementation of the law, Massachusetts has not achieved universal coverage, although one-half to two-thirds of the previously uninsured now have some type of insurance policy. Most of the gains in coverage have come from expansions in publicly subsidized insurance. This largely represented a shift of patients from the state’s former Free Care Pool, which compensated hospitals and community health centers directly for care of the uninsured, to private insurance plans, which is a more costly way to provide care. The reform did not lead to a sustained increase in employer-sponsored coverage, but did slow declining employer coverage. Instead of dropping coverage, employers in Massachusetts have increased cost sharing, shifting costs on to employees, leading to rapidly rising underinsurance after health reform. The use of high-deductible plans more than tripled for residents with private insurance, and good insurance coverage at small businesses all but disappeared over a few short years after reform.
Reform has had a positive impact on access to care in the state, but this impact has affected a modest share of residents, and for some patients has been negative. For example, some low-income patients who previously received completely free care under the state’s prior free care program faced new co-payments and premiums after becoming insured, which impeded their access to care. Reform has not reduced the burden of medical bills and medical bankruptcy on Massachusetts’ families.
The growth of residents with insurance coverage has exacerbated a primary care shortage in Massachusetts by increasing wait times for appointments and decreasing the portion of physicians accepting new patients, creating access problems even for those with coverage. Reform did not reverse growing use of the state’s emergency departments for care, despite expectations that expanding insurance coverage would reroute patients through primary care offices. There is no evidence as of yet that expanding insurance coverage has had an impact on health outcomes or disparities in health outcomes. Reform has also created a financial crisis for safety net providers that specialize in care for low-income communities and the uninsured, by shifting resources away from safety net providers while patient demand for safety net care has actually increased.
The public cost of reform has been high, exceeding $800 million in fiscal 2009 for a state with a total budget of $32.5 billion. However, federal taxpayers paid for the bulk of the law’s public expenses. The state has made a broad range of cuts to the original law in order to its keep costs down, cutting back coverage for over 30,000 documented immigrants, curtailing some benefits, increasing cost sharing, and increasing the share of enrollees required to pay premiums. Substantial funds from the federal stimulus bill were also used to sustain the reform law, but this was a short-term fix only.
Public payments account for only a portion of the reform law’s costs. A central premise of the law was that the state, employers, and individuals would all have to sacrifice financially to approach the goal of universal coverage. This premise of “shared responsibility” for the costs of the reform was in many ways disingenuous. Although employers, individuals, state and federal government have shared the burden of increased costs roughly equally, this overlooks the fact that governments pass on their spending to taxpayers, and employers pass on their costs to employees. The actual burden of health reform was regressive, with increased spending after health reform falling disproportionately on lower-middle income residents.
The reform failed to “bend the cost curve” in Massachusetts because it contained no significant cost-control provisions. Health care costs in Massachusetts are higher than in any other state in the nation, and reform has been found to accelerate the rising costs of employer-sponsored health care. There is general agreement that the Massachusetts reform is itself not sustainable without effective cost control.
Massachusetts enjoyed favorable circumstances at the outset of reform, such as previously high levels of spending on health care for the poor, high personal incomes, and relatively low rates of uninsurance. Without controlling costs, national reform will run up against the same difficulties as Massachusetts: growth in public insurance coverage will prove unsustainable and will accompany the rapid erosion of private insurance benefits, while modest gains in access to care will be threatened in the short term by unsustainably high costs that are increasingly shifted on to patients.
While Massachusetts health reform has enjoyed support from a majority of residents in the state, that support has declined since national health reform instigated a broader debate over alternatives to the Massachusetts plan. Moreover, while residents support the Massachusetts reform law over no change at all, they have expressed increasing skepticism that the law is working for vulnerable communities, and more residents report that the law is hurting them than helping them.
We believe that the data in this report should give pause to those concerned with national health care reform. Although not without its successes, the Massachusetts reform has not addressed the fundamental deficiencies in the health care system – treating symptoms rather than causes – and even its modest successes are unsustainable for the state and Massachusetts residents.
Health policy digest takes on reform loopholes and clueless reporters
October 28, 2011 — by Tinker ReadyThe latest edition of the roaming digest of health policy blogs;
Health Wonks – the SuperHero Edition!!!
The deficit battle is on and politicians are in full voice – both in Washington and out on the hustings, where GOP candidates are loudly denouncing health reform as unAmerican and a job killer. Hipsters and greying hippies are occupying Wall Street and Main Street, while Tea Partiers are claiming they hold the title of most outraged. The one percent is wondering what the 99 percenters are so upset about, while the 99 percenters are after their well-coiffed scalps.
Into the bloody fray, with nary a fear for life or health, reputation or career, plummet our worthies, those denizens of the blog-o-sphere that specialize in separating the non- from the -sense, the BS from the fertilizer, the ill-formed opinion from the logically-based interpretation!
Join us as we follow their heroic deeds, gasp as you read their trenchant and timely missives, awed by their grasp of the incredibly-esoteric and yet critically important.
Occupy Health Care: Boston protesters say Wall Street makes them sick
October 23, 2011 — by Tinker ReadyWhile health reform may not be at the top of their agenda, some of the Occupy Boston protesters down at Dewey Square had no problem linking the high cost of medical care to their complaints about Wall Street. Some support Obama’s reforms; others called for a single payer system. But, nearly everyone interviewed had universal health care on his or her list of demands.
Even MIT professor Noam Chomsky said the health care system is tainted by what he described as a government dominated by private corporations. Speaking on Saturday night, he told the crowd that the federal budget deficit could be eliminated if the US had a health care system like other countries in the developed world — presumably single payer.
Medicare itself is not the problem, he said.
“It’s a problem because it goes through the privatized, unregulated system,” he said. “It is totally dysfunctional. You can’t talk about this in Washington because of the power of the financial institutions. “
More from the rank and file below.
Like this:
Tweets from Boston meeting on health, the Internet and mobile communication
October 20, 2011 — by Tinker ReadyCheck out #chs11 f for tweet from the Connected Health Symposium in Boston. Each year, Partners sponsors this meeting to look at how the Internet and mobile communication are changing the health care system. Here’s a link to the Tweetstream and a few samples below from a session on social networking and health.
| “ | RT @MGHDiabetesEd: “online patient communities can increase engagement, decrease isolation.” #chs11 | |||
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| “ | @taracousphd at #SoMe panel at #chs11: 35% of young people search for #healthcare informaton online | |||
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| “ | Giving patients the choice to use an alias-based identity on social networks is a key way to address privacy concerns #chs11 | |||
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| “ | @dsgold How so? Alias identity does not equal unidentifiable, does it? I’d be concerned this is a false sense of security. #chs11 | |||
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| “ | Facebooking health @taracousphd facebook campaigns have huge opportunity for reaching teens, can use it for health literacy #chs11 | |||
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| “ | @lisagualtieri : There are credit #literacy programs for teenagers, why not more health literacy ones? #chs11 | |||
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| “ | We need to be inter-generational in our social media “prescription” including seniors as well as youth #chs11 | |||
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| “ | Social media can help make a disease more than just a disease for teens @drjosephkim #chs11 | |||
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| “ | @drdannysands telling about how he prescribed acor to @epatientdave & it save his life #chs11 #s4pm | |||
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| “ | Next up, Facebooking Health moderated by my wonderful #TUSM colleague @lisagualtieri #chs11 | |||
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| “ | @meyouhealth Chris Catter shows first ever social graph to visually render well-being among participants in social networks #chs11 | |||
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| “ | CDC traditional data tracked same as social media during H1N1 #chs11 | |||
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| “ | should MDs, nurses, etc recommend online pt communities? -yes! #chs11 | |||
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“Most-cited” nutrition researcher on ‘taters, breast cancer and the unknowns of dairy
October 19, 2011 — by Tinker ReadyLast night, Harvard’s Walter Willett — who, according to his introduction is
the most cited nutrition scientist in the world — spoke to a small group
gathered in a Harvard Yard’s Emerson Hall. While he spoke, he spilled the beans
- extremely health substitute for red meat, by the way – on his upcoming paper
on alcohol and breast cancer
Boston Globe editorial: Prostate screening limits “too sweeping”
October 17, 2011 — by Tinker ReadyA staff editorial in today’s Globe echoes comment made by prominent docs in town: The US Preventative Services Task Force went too far in calling for limits on prostate screening.
A better course would be for physicians to talk with their patients about both the uncertainties inherent in the PSA test and the relative innocuousness of most prostate cancers. Some patients may find the panel’s recommendation reason enough to forgo the test. Others patients might prefer to have it done, but to monitor their PSA levels rather than seek immediate treatment when the results are borderline.
Insurance companies often use the panel’s recommendations as their criterion for whether to cover a test. But until there’s a better test to detect prostate cancer or a broader consensus about skipping this one, insurers should continue to cover it.
Note that The New York Times editorial staff supports the limits and notes that the USPSTF guidelines allow for doctor patient conversations:
Critics, including urologists, who diagnose and treat prostate cancer, charge that the task force’s recommendations are misguided and will hurt patients. They have already been held up for two years lest they ignite charges of government rationing. That’s absurd. The recommendations are intended as guidance to help men and their doctors decide whether to use the test and how to react if it is positive. This is information patients need to know.
Designing spaces with health outcomes in mind Boston
October 13, 2011 — by Tinker ReadyThe annual Connected Health meeting is coming up. More on that in coming posts. Here we link to one of the groups that will be presenting as part of a panel called “Start Up: Four Entrepreneurs under the Age of 40 Discuss Their Ventures in Consumer Health IT.”
Mass Design Group: MASS creates well-built environments using appropriate design, local investment, and innovation to break the cycle of poverty. We collaborate with governments, NGOs, private sector firms, and health care experts to advocate for the most underserved and provide scalable models of community-based development and training…
Design for Health Outcomes
MASS works with a broad range of interdisciplinary partners to better understand the correlation between design and health outcomes. This type of extensive research paves the way for design innovation that produces results like a reduction in the transmission of airborne diseases.
A CNN video describes a hospital the group built in Rawanda with aid group Partners in Health.
Massachusetts General Hosp. oncologist defends prostate cancer test
October 11, 2011 — by Tinker ReadyThe limits of cancer screening continue to emerge. In addition to the USPSTF rejection of PSA tests for prostate cancer, the NYTimes offered a story this weekend with the headline — Can cancer ever be ignored? Today, the paper features a blog post with the headline “The Shortfalls of Early Cancer Detection” and an editorial entitled “Questioning Prostate Cancer Tests.”
Critics, including urologists, who diagnose and treat prostate cancer, charge that the task force’s recommendations are misguided and will hurt patients. They have already been held up for two years lest they ignite charges of government rationing. That’s absurd. The recommendations are intended as guidance to help men and their doctors decide whether to use the test and how to react if it is positive. This is information patients need to know.
But, on the letters page, MGH’s Dr. Donald Kaufman defends the tests:
Used correctly, the P.S.A. test is invaluable. It allows us to identify men who merit a biopsy. A biopsy that reveals cancer should not trigger a radical prostatectomy, with its potential for dire, life-changing side effects. Rather, it should lead to a discussion between doctor and patient and a careful analysis of whether any treatment at all is required.
Active surveillance should always be considered before any treatment is advised. Many men with proven cancer will never require treatment.
10/8 rally in Lynn in support of Mass. payment reform
October 9, 2011 — by Tinker ReadyHealth Care For All has been working hard to rally support for payment reform in Massachusetts. From the Lynn Item:
LYNN – Two local organizations, the Lynn Health Task Force and Health Care for
All, teamed up Thursday to take the pulse of the city and to try and pinpoint
what exactly residents want in terms of health care.
“We wanted a sense of what the needs of the community are,” said Leslie Greenberg, chairman of the
Lynn Health Task Force (LHTF). “We’ll also ask people to do a few things. We’ll
ask them to work with us.”
See tweets and photos below or http://www.hcfama.org/
| “ | The big event is TONIGHT. Join us in Lynn as we work together to improve health care quality: http://flic.kr/p/asT89S | |||
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| “ | “We are the only industrialized country in the world that doesnt have a universal health care system…that needs to change” Kevin M. | |||
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| “ | Naomi, high schooler and Food Project coordinator “kids shouldn’t have to go to the dr to get checked for diabetes at 13…it’s not fair” | |||
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| “ | “If there’s no translation for kids or adults, they can’t get the care they need” Diego, youth ambassador | |||
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| “ | A theme is developing for the night on topics of #healthcare prevention, education, cost and quality: “We deserve better” | |||
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| “ | “We don’t have a health care system. We’ve made the most progress nationally but that’s scary. We deserve better.” Lori B | |||
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| “ | The breakout groups have wrapped up. Common concerns about quality care, access to care and unaffordable medication and appointments raised | |||
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| “ | “I haven’t had health insurance for 9 years because I can’t afford it” another example of the need for #HealthcareReform | |||
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| “ | “The principles discussed here tonight are great…everyone deserves access to affordable care and high quality care” Rep. Conroy | |||
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| “ | “We’re working on this diligently at the statehouse with Health Care For All and we want to get to a patient centered model” Rep. Conroy | |||
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| “ | Last night’s Lynn Community Fall Kick Off Rally for Health was a huge success! Check out photos from the event here: http://flic.kr/s/aHsjwu2Ggb | |||
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