Wednesday, October 27, 2010

Understanding the Affordable Care Act



Here are two entertaining videos featuring Jack Black (Part 2 below) that satirize a very real occurrence going on across the country. The fierce debates that persisted in the run up to the new health reform law brought with them a slew of falsities and misinformation; death panels, socialized medicine, and jail-time for those who don't buy insurance are a few of the more popular ones. One of my personal favorites is 'national insurance cards with computer chips that monitor your every move.' Poll after poll currently show a roughly 50-50 split in support/opposition of the new law. That's not what concerns me. It is polls like this one that are most troubling:


I don't discount that the bill is incredibly complex. It is. The problem lies in the fact that opposition groups have taken advantage of this knowledge gap to create widespread confusion in the hope to weaken it's fundamental provisions.

What is most interesting are the surveys showing that when taken by it's individual components (guaranteed issue of insurance, subsidies to make insurance affordable, investing in primary care), these provisions are overwhelmingly supported, some by a 9 to 1 margin. And when these basic components are explained to poll responders before asking their opinion on the law, the favorability margin increases significantly.

The new law is not perfect, and it is crucial that our conversations revolve around how to improve it over the following years of implementation. National debate is what makes our country great, but it is important to stay in the realm of reality.

The Mis-Informant Part 2 - with Jack Black as Nathan Spewman

Monday, October 18, 2010

Health Reform in the Judicial Branch

If you need a high school civics refresher, just follow the new health care bill. The bill passed Congress, was signed by the President, and literally minutes later the law had a number of lawsuits filed against it. Of the 20 lawsuits, the major theme deals with the Individual Mandate, where starting in 2014 most individuals will be legally required to have some type of health insurance. Opponents claim that the provision in 'unconstitutional,' as citizens should not be required to purchase a private product. Though logical on the surface, the argument falls short on a number of levels especially in terms of finances.

For one, there is a 1986 law on the books that any individual who enters an Emergency Room (insured or not) can not be denied care (Thanks Reagan!). And that care is always paid for. If the individual happens to be uninsured, all those emergency room costs are more often then not picked up by the taxpayers in the form of 'uncompensated care.'  Opponents to the provision should understand that if we the taxpayer are going to pay for it anyway, health insurance and prevention are FAR cheaper than the emergency room, where an infection treated early through primary care costs a fraction of the price. This is a clear-cut way to reduce the public burden. The argument could develop into 'well then maybe they shouldn't get treated if they can't pay up front', but this would brew a whole new set of moral and ethical issues that only a distant band of the political spectrum would support.

The second financial argument deals with the insurance market reforms. Almost everyone likes the idea of banning pre-existing condition exclusions and rescissions, and guaranteeing access to health insurance, but these are impossible without the mandate. The three legged stool of 1) insurance subsidies, 2) consumer protections, and 3) individual mandate can not be separated, at risk of creating adverse selection, where individuals who are guaranteed insurance will simply wait to purchase it until they get sick. As all Americans  access the health care system at some point in their lives, this would inherently upend the entire insurance model, which is designed to spread risk across a pool and not concentrate it. Google the death spiral to learn more.

Back to the lawsuits, I would bet my right tunica albuginea that one of them eventually reaches the Supreme Court (most likely the Florida or Virginia case, as the Michigan suit was thrown out last week). When it does, the lawsuit will most likely be dismissed for 'not buying insurance' effects our society as a whole given the assessed costs, in addition to the basis of the 'Commerce Clause' where Congress has the right to regulate commerce. The use of this Clause would be unprecedented in this sense as now 'economic inactivity' (NOT buying insurance) would be included, so we can expect an increasingly fierce debate as one or more of the suits makes their way to higher benches.

Tuesday, October 12, 2010

Mapping our Health

I ran across digital cartographer Eric Fischer's Flickr site the other day, and perused his new series of maps on race and ethnicity in the nation's 40 largest cities. Below are two examples of the maps, featuring Los Angeles and San Francisco. The maps use the Census 2000 data, with each dot representing 25 people and colors corresponding to race (red=Caucasian, blue=blacks, orange= Hispanics, green=Asian). The striking geographic divides are clearly evidential in many of the cities, which can provide valuable information for learning tools and various community development endeavors.

I can't help but think of the myriad of applications when looking into race and other demographic factors like income, mortality, and per capita resources, especially with the Census 2010 data soon to be released. Specific to health care, imagine the wealth of information that could help develop strategies and outreach programs for issues like access limitations to health services, disease progression, and chronic disease management to name a few. For example, integrating data from multiple sources like hospitals, health plans, and health care providers can reveal important information regarding health costs, the effectiveness of treatments, and other factors so we in the medical field can make well-informed decisions when weighing treatment options. Real-time surveillance data could even help track and combat infectious disease outbreaks. The sheer volume of data needed for these efforts is staggering, but is becoming reality. Electronic health records will be central to this effort, and health reform also includes a number of provisions to improve data integration including insurance market data transparency and the new Patient Centered Outcome Research Institute which will help to synthesize the latest research for efforts in comparative effectiveness.


Wednesday, October 6, 2010

California, A New Pioneer for Health Reform

Much of the 'rubber meets the road' responsibility of health reform implementation falls to the states; this is by design as each state has a unique set of circumstances and qualities that must be adequately considered. Last week, California became the first state in the nation to make law one of the pillars of health reform, the health insurance exchange. The state bills, AB1602 and SB900, will establish what will be known as the California Health Benefit Exchange in 2014.

This Exchange will allow individuals and small businesses to easily compare health insurance plans on factors like price, performance, and consumer satisfaction, with many gaining access to insurance subsidies in order to help make insurance affordable. In all, nearly 3.5 million individuals will be eligible for these tax credits (totaling nearly $14 billion in tax cuts) who are today left to the unprotected, and overly expensive individual market. Moreso, the Exchange itself will be able to flex bargaining power in order to negotiate lower rates much like large businesses do now, and will force insurers to compete based on the quality of their product and not who can most effectively exclude 'unprofitable' individuals.

During his signing ceremony last Friday, Governor Schwarzenegger also unveiled a new web portal intended to provide pertinent information on reform's implementation, which will most likely become the online access point for the Exchange itself, as well. Check it out here.

Saturday, October 2, 2010

Health Reform: The Basics


Want to hear me ramble about health reform? Sure you do!

I had the opportunity to present this lecture to the UC Davis Medical School community last week as part of our AMA/CMA speaker series entitled Health Reform in America. The talk covers the basics of the new law, so if you are still unsure of what is actually in it or just want to understand it better go ahead and listen in. The video feed is a little hazy, so I've included the slides below that you can use to follow along with.

Health Reform in America: An Overview of the Patient Protection and Affordable Care Act