Is it a good thing that some states refuse to implement the health care reform law (Obamacare)?

One of the more significant results of President Obama’s reelection is the impact on the health care reform law- his reelection eliminates the threats to repeal the law on “day one”.  However, some states are actively resisting the law’s implementation.

Specifically, one aspect of the law requires states to set up health care exchanges, where individuals could buy insurance at a competitive price (the exchange does not actually provide the insurance, but determines which insurers can participate).  Many states are refusing to set up the exchange.  One notable example is Texas.  Recently, Texas’ governor Rick Perry refused to implement an exchange in his state.

The Federal government will step in and operate the exchange in states that are unwilling or unprepared to implement an exchange on their own.  The deadline for implementation by the states is January 1, 2014.

So here is the question- how do you feel about states that refuse to implement the health care reform law, even after the Supreme Court decision and the reelection of President Obama?

How do you feel about states that refuse to implement the health care reform law even after the election and Supreme Court decision?

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It’s really going to be on us.

Now that the dust has settled somewhat on the recent Supreme Court decision, we are seeing some states dig in and harden their positions against expanding health care coverage.

I truly believe that at the end of all of this, we will have a significant portion of our population who either:

  • continues to lack health coverage,
  • has coverage, but no physicians or hospitals will accept it, or
  • has coverage, but so much is excluded that the financial burden on families continues to be devastating.

And so the path forward, for many, will require:

  • a very high level of personal involvement
  • engagement with an effective support network and/ or advocacy group
  • active use of online research and management tools
  • activism- vote- engage your elected representatives.

Stay tuned, as this blog will comment on each of these issues.

 

Maybe Doctors Can Learn From Lawyers

On May 2, an article was published in the New York Times, titled “Top Judge Makes Free Legal Work Mandatory for Joining State Bar”.  The article describes how more and more people need urgent legal services but cannot afford them.  It goes on to describe the pros and cons of requiring lawyers to provide some free services (pro bono) as a condition for joining the New York State Bar.

We have a similar problem in health care- a large number of people who cannot afford health care services.  And I am not talking about insurance.  I am talking about the doctor and hospital visit.

In health care, we have doctors refusing to see patients because Medicare or Medicaid do not pay enough.  And these patients have nowhere else to turn.  The doctors use the threat of refusal as a key part of their strategy when negotiating for higher reimbursement.

How can we allow this?

In a previous post on this blog, I have proposed that doctors be required to accept Medicare as a condition for receiving or renewing their DEA license (federal level- the DEA license is what allows them to prescribe), and to accept Medicaid as a condition for receiving or renewing their Medical license (State level).

We place physicians on a professional and social pedestal, and their incomes are higher than that of any other profession.  In return, we should require something of them- not grant the right to walk away from persons in need.  Doctors, take a lesson from the lawyers, or lose your protected, lucrative turf!

 

Fourteen Zeroes!

Part 1- the problem.

If you look at our present level of health care spending ($2.6 Trillion), and project it forward, growing at 6% annually for the next 20 years, the total exceeds $100 Trillion.

That’s 14 Zeroes:

  • Just for health care
  • Just in America
  • Just for the next 20 years (if we look at 30 years, the number is over $200 Trillion).

That number is incomprehensible.  Not only is it not sustainable, it is not even possible to finance this number.  Yet, that is the path that we are on.

The present discussion aims to “bend the cost curve” and to somehow shift the burden:

  • Blame the insurers
  • Blame the pharmaceutical companies
  • Reduce provider reimbursement
  • Limit what Medicare pays on behalf of seniors.

Whomever we choose to blame, we are clearly headed for a scenario where we all  work our entire lives just to pay for health care, and when we get old, all of our assets, if there are any left, get paid over to our huge, for-profit health system.

We must fundamentally restructure our health care system, and our expectations of living and of dying, or life will become one long health-care payment treadmill.

Part 2- the discussion.  Please answer the following questions. One answer per question:

What is the responsibility of consumers (the system calls us "patients")?

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What is the responsibility of insurers?

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What is the responsibility of the government?

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What is the responsibility of providers (doctors and hospitals)?

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What is the responsibility of suppliers (pharmaceutical companies and device manufacturers)?

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Now, please consider all of the answers you provided.

What do your answers, taken together, mean for the 14 zeroes in our future?  Something to think about…