Musings on Medicine and the Health Care System

Healthcare.gov — Fail!

Yes, it’s a mess. No, I’m not talking about 17-year-old’s bedroom (the mounds of laundry on the floor and 15 empty Gatorade bottles on his desk are fodder for another blog) but, of course, healthcare.gov, the web site that is the gateway to individual insurance for millions of Americans but which, unfortunately, is working about as well as Congress.

In case you haven’t noticed, I’m a pretty big advocate of healthcare reform and, despite its many flaws, the Affordable Care Act. Which is why I feel like curling up in a fetal ball in the recesses of the teenager’s (scary) closet and not coming out until an entire day goes by without a story on NPR about healthcare.gov.

Unfortunately, I still have to earn a living so the closet is not an option.

So I will face the critics and admit it. Yes, the Obama administration screwed this up in the most humiliating, embarrassing way. Then I will tell them what I tell my kids: Now what?

We can point fingers and whine and moan about how bad things are, or we can focus our energy on fixing the problem. Obviously, since this is the federal government, many heads will … Continue Reading

Labels:
Affordable Care Act health insurance health insurance exchanges healthcare reform Obamacare

Why are we so divided?

I just finished teaching a class at the College of William and Mary on the US healthcare system. Of course it included a session on the Affordable Care Act. But before I could teach about the ACA, I had to teach about our system itself and its problems.  After all, how can you understand the need to improve things if you don’t understand the underlying problem in the first place? So here is the Cliff Notes version.

We spend more per capita than any other industrialized nation and yet are at the bottom on nearly every indicator of quality.(1) As the Institute of Medicine noted: “Much of health spending does little to improve health and. . .may be associated with poorer health outcomes.” Since 1945, the rate of healthcare costs in this country has risen so far above the rate of inflation, that if other prices had risen as much a dozen eggs would cost $55. The federal government spends more on health care than on defense. Medical errors in this country are so prevalent that they are now the third leading cause of death behind heart disease and cancer.(2) We waste $1 billion a year on overtreatment, errors, excessive … Continue Reading

Labels:
Uncategorized

More Questions About the Affordable Care Act

Before I get into the questions, I want to invite you to visit the Health Care Reform page for Prevention magazine. I’m now the editor-at-large for healthcare reform for Prevention, and have a story on the ACA in the October and November issues.

You can also participate in a Twitter chat with me on Monday, September 30, from 1-2 p.m. eastern. Join in using hastag #PVNHealth. My handle is @debragordon2012.

Plus, I have a couple of questions of my own:

 

— When people say that Americans “hate” the ACA and that the ACA is “destroying” the country, what do they mean, exactly? I think most Americans don’t understand the Act. . . how can you hate something you don’t understand? And I really want to know how it is destroying the country. Really.

— Why are people so opposed to providing a way for people who can’t get or can’t afford health insurance to get health insurance? No one 65 and older seems to be complaining about the Medicare program they participate in.

I also recommend this article in today’s Washington Post, where you can read about real people and the ACA.

 

Now, onto the questions (and please … Continue Reading

Labels:
Affordable Care Act health insurance health insurance exchanges healthcare costs healthcare reform Obamacare

Your Questions About the Affordable Care Act

I can’t take it anymore. I just can’t take the lies and misinformation out there about the Affordable Care Act (ACA) and healthcare reform. Nearly ever  time I tell someone something about the Act, or answer a question, they are surprised at how the truth differs from what they’ve heard.

To that end, I put out the word to friends and others to send me their questions about the ACA. Here’s the first batch. If you have any questions, send them on. I’ll keep answering them until we run out.

Question: Are the insurers currently participating in the system locked in on Jan 1st? Can they decide to pull out during the year?

Answer: If they decide to participate in the exchanges they must provide coverage for the year so no, they can’t pull out during the year. The only reason they can cancel your coverage is if you lie on the application.

Question: How will income be calculated?

Answer: Based on adjusted gross income (AGI), which includes certain deductions. Note that income is based on your household income, not individual, and that it is based on estimated income for the following year. If you estimate wrong and received a … Continue Reading

Labels:
Affordable Care Act health insurance health insurance exchanges healthcare costs healthcare reform healthcare system; Obamacare

Three Weeks and Counting

Can you feel the excitement in the air? Yes, it’s fall. Yes, it’s football season. Yes, wrestling is back in the Olympics. But that’s not what I’m talking about. I’m talking about the launch of the state and federal health insurance exchanges–the cornerstone of the Affordable Care Act–on October 1.

I don’t know about you, but I can barely sit still I’m so excited!

Ok, I admit that I am a health policy addict and I’m looking for a 12-step program. But seriously, these exchanges have the potential to revolutionize how we get health care in this country, provide an important burst of energy to the development of small businesses and entrepreneurship, and impact the health of a large chunk of the population.

These are grand goals, I know. So let’s swoop down from the 50,000-foot view that most of us have received from the media to the ground level. Let’s talk about two women, Sharon and Karen.

Sharon is a good friend of mine, a Realtor in her 50s. As such, she’s self-employed and has to purchase her own health insurance. Sharon is very healthy today–but she had a severe cardiovascular complication after her son’s birth 26 years ago. … Continue Reading

Labels:
Affordable Care Act health insurance health insurance exchanges healthcare reform Obamacare

The FDA and Plan B: Another Epic Fail

UPDATE: The Justice Department appealed the New York ruling tomorrow and asked for a stay on the order to make Plan B available to all women over-the-counter. Another epic fail!

I’m not happy with the front-page news that greeted me this morning: The FDA has agreed to make Plan B, aka, emergency contraception, available over the counter for girls as young as 15, although all women will have to show an ID. Previously, you had to be 17 to access it without a prescription and even older women had to ask a pharmacist for it, which is not only embarrassing, but the pharmacist could refuse to provide it and, if the pharmacy was closed, she was out of luck.

So I do have to (grudgingly) applaud the FDA for at least getting rid of the pharmacy requirement. Given that many drugstores are open 24 hours a day, women will now have access to Plan B when they need it. But the rest of the ruling. ..meh.

I’ve written about the Plan B controversy before, when the FDA recommended it be available over the counter with no age restrictions and when, in a highly unusual, this-never-happens-move, Health and Human Services Secretary … Continue Reading

Labels:
Uncategorized

Prejudice and Discrimination in the Doctor’s Office

I have a friend who is so beautiful you want to suggest that she model. She is also very overweight. She is well aware of her weight problem and it makes her miserable. This, in turn, sets up  an awful feedback loop in which she feels terrible because of her weight, which drives her to eat, which leads to weight gain, which makes her feel terrible.

Last week, she had horrific abdominal pain that kept her in bed for days. Why didn’t she go to the doctor? I asked. Because, she answered, she feared what the doctor would say about her weight and how she’d be treated–like a pariah who didn’t deserve medical care until she loses weight. The doctor will lecture her, look at her in disgust, and treat her disrespectfully, she said. She knows this because that’s how her gynecologist treated her. So she won’t go back which means she won’t receive needed medical care.

Her experience is not unique. Physicians are simply terrible at working with overweight patients. Studies find they often don’t diagnose patients with obesity, don’t understand the medical repercussions of obesity on overall health, attribute their patients’ weight to a lack of discipline, and … Continue Reading

Labels:
overweight weight

Step Away From that Test

My best friend turned 57 in October (but you’d never know it by looking at her; she doesn’t look a day over 45). Like most of us of a certain age, she has a few medical issues. Years of working as an editor has left her with carpal tunnel syndrome. Years of living with cats has left her with asthma. Years of sun worshiping behavior has left her with basal cell skin cancer. Years of good eating have left her with a borderline high LDL level. And, as a result of being, well, 58, she has a pain in her left shoulder. Sound familiar?

My friend recently switched doctors and found a new primary care physician who, upon hearing her medical history and current concerns, performed and ordered several tests, including:

— A pelvic exam/Pap

— A routine physical

— A baseline EKG

— A complete fasting blood panel, including a special test that measures LDL-particles (LDL-P)

— A mammogram and an ultrasound on her right breast, because the doctor felt a suspicious tissue mass (my friend has a family history of breast cancer)

— A right carotid artery ultrasound based on a bruit,  the swooshing sound the doctor said could … Continue Reading

Labels:
healthcare costs healthcare system; high-deductible health plan ineffective procedure waste

Wise Words From a Retired Hand Surgeon

Those of you who know me know I like wine. A lot. And food. Even more.

Put the two together and I’m there! So that’s where I was last night, at a wine tasting dinner enjoying the wines from Ferrari-Carano, which, by the way, are excellent and very reasonably priced (we bought a case).

We were sitting across from an older couple and, of course, got to talking. Turns out he’s a retired hand surgeon from New Jersey who retired to Williamsburg. He heard me say that I was giving a talk about healthcare reform.

“I figured out how to fix the healthcare system,” he said.

At this point, I kicked my husband under the table. I was sure I was about to be treated to some diatribe about “Obamacare” and getting the government out of healthcare, and vouchers and moochers (most members of the wine club that hosted the dinner are, ahem, somewhat conservative).

But I’m learning about Buddhism, trying to be more patient and to listen, really listen, rather than always jumping in. So I bit my lip, took a deep swallow of the red, and listened. Then he said the sentence that brought joy to my heart:

… Continue Reading

Labels:
Affordable Care Act healthcare reform healthcare system; Obamacare