Cartoon – Meeting Minutes
Monthly Archives: June 2017
Cartoon – Termination or Slow Painful Phaseout?
Cartoon -We’ve downsized everyone who knew
Hospitals Attack GOP Health Bill in $1 Million Ad Campaign
Powerful hospital and medical school lobbying groups are spending at least $1 million on television ads opposing Senate Republicans’ plan to repeal and replace Obamacare.
The ads ask viewers to consider whether they’ll be among the millions of Americans projected to lose their health coverage under the Senate proposal, Rick Pollack, chief executive officer of the American Hospital Association, said Tuesday in a conference call with reporters.
The bill, which Republicans have put on hold until after the July 4 recess amid growing opposition within their own party, would leave an additional 22 million people in the U.S. without insurance, the non-partisan Congressional Budget Office estimated. Hospitals have a lot to lose under the current version of the bill, and the AHA, which represents about 5,000 institutions, last week told GOP senators to “go back to the drawing board.”
It’s the second time that the coalition will run ads opposing Republicans’ attempts to replace the Affordable Care Act, often called Obamacare. The group also ran ads opposing the House’s health bill, which passed in May. The House proposal would also increase the number of uninsured by more than 20 million, according to the CBO.
Samantha Dean, a spokeswoman for the AHA, said the campaign’s ads have already begun running and will cost seven figures. She wouldn’t give a precise amount.
The advertisements will continue to run “for as long as needed,” Dean said.
Mediocre Evidence Behind Many Primary Care Decisions
Only 18% of clinical recommendations were based on high-quality, patient-oriented evidence, a primary care research study shows.
Research-based evidence to help primary care physicians make decisions seems to be hard to come by, according to research from the University of Georgia.
Researchers, led by Mark Ebell, epidemiology professor at UGA’s College of Public Health, analyzed 721 topics from an online medical reference for generalists and found that only 18% of the clinical recommendations were based on high-quality, patient-oriented evidence. Their work appears in the journal BMJ Evidence-Based Medicine.
“The research done in the primary care setting, which is where most outpatients are seen, is woefully underfunded, and that’s part of the reason why there’s such a large number of recommendations that are not based on the highest level of evidence,” Ebell said in a statement.
The researchers used Essential Evidence, an online, evidence-based, medical reference for generalists to identify areas of care that are supported by high-quality studies and others that are not. Each of Essential Evidence’s topics are graded A, B, or C using the Strength of Recommendations Taxonomy (SORT), the study said.
They found that topics related to pregnancy and childbirth, cardiovascular health, and psychiatry had the highest percentage of recommendations backed by research-based evidence. Hematological, musculoskeletal and rheumatological, and poisoning and toxicity topics had the lowest percentage.
In addition, just 51% of the recommendations overall were based on studies reporting patient-oriented outcomes, such as morbidity, mortality, quality of life, or symptom reduction, instead of laboratory markers like blood sugar or cholesterol levels.
“Practice should wherever possible be guided by studies reporting patient-oriented health outcomes,” Ebell said. “You would want your care to be guided by studies that have demonstrated that what the physician recommends will help you live better or longer. We should all want that kind of information to guide care.”
The study authors also note that the lack of funding for primary care research stands in stark contrast to patients’ primary care usage: Primary care visits account for 53.2% of all physician office visits, according to the CDC.
Analysis: Mitch McConnell Plans To Hide Trumpcare’s Pain Until After Midterms
The Better Care Reconciliation Act bill may make the health insurance markets look better almost immediately by giving insurers a more predictable, more lucrative market.
Senate Majority Leader Mitch McConnell is well aware of the political peril of taking health benefits away from millions of voters. He also knows the danger of reneging on the pledge that helped make him the majority leader: to repeal Obamacare.
Caught between those competing realities, McConnell’s bill offers a solution: go ahead and repeal Obamacare, but hide the pain for as long as possible. Some of the messaging on the bill seems nonsensical (see: the contention that $772 billion squeezed out of Medicaid isn’t a cut). But McConnell’s timetable makes perfect sense — if you are looking at the electoral calendar.
Here are a few key dates in McConnell’s “Better Care Reconciliation Act” (BCRA) that seem aimed more at providing cover for lawmakers than coverage for Americans:
2019: First major changes and cuts to the Affordable Care Act exchanges happen after the 2018 midterm cycle, allowing congressional Republicans to campaign on a “fixed” health system, even though Obamacare is still largely in place next year.
2019: States share $2 billion in grants to apply for waivers under a much looser process through this fiscal year. These waivers could allow insurers to sell skimpy plans that have low price tags but don’t take adequate care of people with preexisting conditions. None of those waivers has to go into effect, however, until after 26 Republican governors face re-election in 2018.
2020: Stabilization cash that makes the markets more predictable and fair for insurers flows through the congressional midterm cycle and the 2020 presidential cycle. Then it disappears. Medicaid expansion funds hold steady through this crucial political window, too.
2024: States enjoy their last few sips of Medicaid expansion cash at the end of 2023 — just as, perhaps, a second Republican presidential term is ending.
2025: The bill changes the formula for the entire Medicaid budget (not just the Obamacare expansion), dramatically reducing federal funding over time. That starts eight years and two presidential election cycles from now.
McConnell insists everything about the bill has been aboveboard and transparent.
“Nobody’s hiding the ball here. You’re free to ask anybody anything,” McConnell said on June 13.
But he and his working group did literally hide the bill from Democrats and most Republicans, crafting it behind closed doors until there was just a week left before his goal to secure a vote on it. (That timing was thrown off Tuesday with the announcement the vote was delayed, but the dealmaking is just beginning.)
Meanwhile, at least two policy details in the bill may obscure the effects for several years and make the health insurance markets look better almost immediately by giving insurers a more predictable, more lucrative market.
One is a stipulation that compels the federal government, for two years, to pay the cost-sharing reduction payments to insurance companies that President Donald Trump has threatened to end. The payments are part of the Affordable Care Act, and they flow to insurers on behalf of low-income marketplace customers to cover their out-of-pocket health expenses. Republicans had sued to stop the payments, adding considerable instability to ACA marketplaces next year. McConnell ends that uncertainty for two years.
On top of that cash infusion, the BCRA proposes a “Short-Term Stabilization Fund” that would also aim to help lower premium costs and could attract a few more insurers into counties that are sparsely covered now. It would dish out $50 billion to insurers — $15 billion per year in 2018 and 2019 and $10 billion per year in 2020 and 2021.
Medicaid, a “broken program that harms its beneficiaries”
I asked on Twitter for policymakers’ expressions of harm caused by Medicaid.
Seen a *policymaker* justify BCRA Medicaid changes because “Medicaid causes harm”? Send me the link. cc @aaronecarroll
By email, Andrew Goodman-Bacon came through in a huge way. The bullets below are a lightly edited version of what he sent me, shared with his permission. (For the record, Medicaid does not cause harm. More about that soon.)
- The Sommers/Epstein paper surveyed governors and found that five of those who opposed expansion felt that Medicaid was a “broken program that harms its beneficiaries.”
- Senator Ted Cruz has said that Medicaid hurts health care access
- In one of Tom Price’s recent testimonies he said ,“Medicaid is a program that has, by and large, decreased people’s ability to access care.”
- Speaker Paul Ryan comes close on pg 24 of “A Better Way
- A Healthy Indiana report (notably produced by the Pence administration) cites Roy and LaPar, but doesn’t go all in on the “harms” claim
- Here is the American Action Forum saying “harm”
- See also, this brief from a policy shop in MI, this brief from a policy shop in NC, and this brief from a policy shop in PA
- Here is ALEC citing that study, although not going so far as to say patients will be “harmed”
To these, I will add this quote of Representative Bill Cassidy (via Aaron) and this op-ed by Seema Verma (via Adrianna). Note: I have not looked through everything in the above list. If you find errors or have more contributions, let me know.
“BEYOND COMPETENCY – WHY CHARACTER, COURAGE, AND COMMITMENT SETS YOU APART”
Watch this clip – “Beyond competency – why character, courage, and commitment sets you apart”
Rather than having fear and trepidation about the concept of accountability, Lee briefly explains the positive aspects of courageous accountability as a means to achieving your goals.
The key is to establish an authentic foundation of character, courage, and commitment so you can build consistency and trust with yourself and others. Please watch and share your comments – thank you
Further rumination on success
The Wall Street Journal’s lead editorial on June 23 featured an article by Kay S. Hymowitz entitled, “Is there Anything Grit Can’t Do?” The article is about the work of Angela Lee Duckworth. In my article about career advancement, I talked about hard work, paying a price and the perseverance necessary for career success. Here we have another excellent example of a researcher that has dedicated themselves to the study of a specific topic. If you do not believe a researcher in academia can become the undisputed authority on a subject, check out Dr. Duckworth’s CV. For those of you interested in further study of this topic, the list of grants, articles and presentations in Dr. Duckworth’s CV reads like the literature review in a dissertation. In the case of Dr. Duckworth, her expertise flies in the face of a lot of conventional ‘wisdom’ and political correctness.
The ideology of indoctrination of children in too many failed government schools vacillates between victim-hood and entitlement insuring the continuing institutionalization of poverty. In my opinion, public education has deteriorated markedly over the past thirty years. The US Department of Education was founded in 1979. In federal fiscal 1980, the department’s budget was $14 billion. By FFY 2015, the bureaucracy’s budget had ballooned to $73.8 billion. I do not know anyone that thinks that public education is any better for this spectacular increase in investment. I have heard Eric Von Hessler and others advocate for the elimination of the Department of Education in its entirety as a means of balancing the federal budget. I think a lot of people would agree that education is better-managed locally and not from a central federal government bureaucracy. Too few young people are being taught that the thing that has the greatest potential to make a positive difference in their life is drive or ‘grit’ as described by Dr. Duckworth and not the narrative of the NEA. There are probably not very many people who have done a more thorough job than Dr. Duckworth understanding how to help children and adults succeed.
Cartoon – The Test Results
HENRY KOTULA 