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Cute! Sorry to lose Hilary from the national stage, but she deserves a rest.

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Posted by on February 3, 2013 in Uncategorized

 

Three of Four Doctors Prefer Public Option

A new study by the Robert Wood Johnson Foundation, just published in the New England Journal of Medicine, shows that three of four physicians prefers Health Care reform that includes a public option. More than 62% of respondents opted for reform that includesa public option as an alternative, or in addition to, existing private health . Another 10%+ prefer a public-only, single-payer, system. Added together, this means that three of every four practicing physicians prefer a plan in line that proposed by President Obama.

Don’t just take my word for it. here is the text of the NEJM report:

Doctors on Coverage — Physicians’ Views on a New Public Insurance Option and Medicare Expansion

Posted by NEJM • September 14th, 2009 • Printer-friendly

Salomeh Keyhani, M.D., M.P.H., and Alex Federman, M.D., M.P.H.

In the past few months, a key point of contention in the health care reform debate has been whether a public health insurance option should be included in the final legislation. Although polls have shown that 52 to 69% of Americans support such an option,1 the views of physicians are unclear. Physicians are critical stakeholders in health care reform and have been influential in shaping health policy throughout the history of organized medicine in the United States.2

The voices of physicians in the current debate have emanated almost exclusively from national physicians’ groups and societies. Like any special-interest group, these organizations claim to represent their members (and often nonmembers as well). The result is a well-established understanding of the interests of physicians’ societies but little, if any, understanding of views among physicians in general. Faced with this absence of empirical data, we conducted a national survey of physicians to inform federal policymakers about physicians’ views of proposed expansions of health care coverage.

In April 2009, we obtained data on a random sample of 6000 physicians from the American Medical Association (AMA) Physician Masterfile, which includes current data on all U.S. physicians. We excluded physicians from U.S. territories because health care reform may not be as relevant to them, and we excluded physicians in training because of their limited experience with insurance; a sample of 5157 physicians remained. We categorized physicians into four groups: primary care physicians (in internal medicine, pediatrics, or family practice); medical subspecialists, neurologists, and psychiatrists; surgical specialists and subspecialists; and other specialties. The survey instrument we used was developed with the input of an expert panel, and we conducted cognitive testing and pilot testing to ensure its clarity and relevance. (More detailed information about our methods can be found in the Supplementary Appendix, available with the full text of this article at NEJM.org.)

NEJM Report Data

NEJM Report Data

Survey respondents were asked to indicate which of three options for expanding health insurance coverage they would most strongly support: public and private options, providing people younger than 65 years of age the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans; private options only, providing people with tax credits or subsidies, if they have low income, to buy private insurance coverage, without creating a new public plan; or a public option only, eliminating private insurance and covering everyone through a single public plan like Medicare. We also assessed the level of physician support for a proposal that would enable adults between the ages of 55 and 64 years to buy into the current Medicare program — a strategy that the Senate Finance Committee has proposed.

Data were also collected on additional variables that might be associated with preferences for different expansion options, such as time spent on clinical duties each week, whether physicians owned their own practice, salary status, and type of practice. The survey has been in the field for approximately 2 months (June 25, 2009, to September 3, 2009). All available data were analyzed on September 4, 2009. A third survey wave was initiated on August 27, 2009.

The final sample included 5157 physicians, but 221 of them had an incorrect or incomplete address or were deceased. Of the remaining 4936 physicians, 2130 returned the survey — a response rate of 43.2%. Women made up a smaller proportion of respondents than of nonrespondents (26.8% vs. 31.2%, P<0.001), and the average age of respondents was 1 year older than that of nonrespondents. There were no significant differences associated with practice location (census division or urban vs. rural setting), practice type, or specialty group. There were no significant differences in the characteristics of respondents to different survey waves (for details, see the Supplementary Appendix).

Overall, a majority of physicians (62.9%) supported public and private options (see Panel A of graph). Only 27.3% supported offering private options only. Respondents — across all demographic subgroups, specialties, practice locations, and practice types — showed majority support (>57.4%) for the inclusion of a public option (see Table 1). Primary care providers were the most likely to support a public option (65.2%); among the other specialty groups, the “other” physicians — those in fields that generally have less regular direct contact with patients, such as radiology, anesthesiology, and nuclear medicine — were the least likely to support a public option, though 57.4% did so. Physicians in every census region showed majority support for a public option, with percentages in favor ranging from 58.9% in the South to 69.7% in the Northeast. Practice owners were less likely than nonowners to support a public option (59.7% vs. 67.1%, P<0.001), but a majority still supported it. Finally, there was also majority support for a public option among AMA members (62.2%).

20090914_keyh_f1Physicians’ Support of Options for Expanding Insurance Coverage and Medicare.

Panel A shows the proportion of survey respondents who favored public options only, those who favored both public and private options, and those who favored private options only. Panel B shows the proportions of respondents (according to their medical specialty) who supported, opposed, or were undecided about the expansion of Medicare to include adults between the ages of 55 and 64 years. The proportion of support was consistent across all four specialty groups (P=0.08).

20090914_keyh_t1

Overall, 58.3% of respondents supported an expansion of Medicare to Americans between the ages of 55 and 64 years (see Panel B of graph). This support was consistent across all four specialty groups, with proportions in favor ranging from 55.6% to 62.4% (P=0.08).

Physicians’ groups have strongly influenced efforts in health care reform throughout modern U.S. history2 and in so doing may have often obscured the collective views of individual physicians across the spectrum of specialties, interests, and regional affiliations. Given the enormity of the current effort to reform health care and its potential effect on future generations of Americans, policymakers need to hear the views of the whole range of physicians on the key elements of reform.

On one of the most critical elements — expansion of coverage — our study of a national sample of physicians showed that a clear majority support a combined public–private approach to expanding health insurance. We found that physicians’ support for including a public option in the reform package largely mirrors the support revealed in national public polls conducted throughout the spring and summer of this year.1 A similar proportion of physicians also supported the expansion of Medicare to help cover the near-elderly population. Support of public and private options was consistent across a wide range of physicians, including those from the traditionally conservative southern regions of the United States, those with a financial stake in their practice, and members of the AMA — despite that organization’s history of opposition to reform efforts.2 The AMA’s 2009 platform on health care reform originally endorsed an expansion of health insurance through private means.3 But the organization recently came out in support of a House proposal for reform that includes a new public option4 — a position that our data suggest is consistent with the views of its members.

Some limitations of our study deserve comment. First, our response rate was 43.2%, which is modest, though typical of the most recent national physician surveys and surveys in general. There were no significant differences between survey respondents and nonrespondents in important characteristics, such as specialty, practice location, and practice type. Second, physicians’ opinions about strategies for expanding health insurance coverage may have evolved during the period of data collection, given the intensive press coverage of the issues. However, we found no significant differences between respondents in the first and second waves of the survey. Finally, we did not ask physicians their views on other proposed solutions, such as insurance cooperatives.

Nonetheless, it seems clear that the majority of U.S. physicians support using both public and private insurance options to expand coverage. A majority of physicians also support the expansion of Medicare. Support for the public option is consistent across physician specialties, practice settings, and regions of the country, and therefore should be carefully considered by lawmakers as they finalize legislation to reform health care and provide coverage for 47 million uninsured Americans.

No potential conflict of interest relevant to this article was reported.

Source Information

From the James J. Peters Veterans Administration Medical Center, Bronx, NY (S.K.); and the Department of Health Policy (S.K.) and the Division of General Internal Medicine (S.K., A.F.), Mount Sinai School of Medicine, New York.

This article (10.1056/NEJMp0908239) was published on September 14, 2009, at NEJM.org.

 
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Posted by on September 15, 2009 in Health Care Debate

 

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Florida Gov. Charlie Crist & Hurricanes

Perpetually orange/tan Florida Gov. Charlie Crist told a group of Florida real estate agents last Friday that he has been personally placing, or having someone else place, a prayer in the Western Wall of the ancient Temple in Jerusalem once a year since he became Florida’s governor.

Commonly referred to as “The Wailing Wall” the structure in question is the only remaining portion of the Second Temple in Jerusalem. Originally built around 960 BC by King Solomon, according to the Bible (and numerous non-religious sources, as well), the “First Temple” was destroyed by the Babylonians in the war leading to the Babylonian Captivity which dominates a good segment of the Old Testament.

Rendering of Solomon's Temple

Rendering of Solomon's Temple

Around 516 BC, Persian Emperor Cyrus the Great, in a move heretofor unique in history, set the Hebrews free and underwrote, out of his treasury, much of the reconstruction of the city of Jerusalem AND the Temple. Amazing! The gift of freedom and economic support to a former enemy by an absolute monarch of a completely different ethnic culture and religion. A burst of generosity and peace completely unprecedented in human history. And never equaled except, perhaps, when Pres. Harry Truman created the plan to rebuild Europe and named it for his Secretary of State Gen. George C. Marshall. (Marshall was awarded the Nobel Peace prize in 1953.)

Rebuilt over several hundred years, the Temple was again destroyed in 70 AD, this time by the Romans. Never since reconstructed, the only portion of the original (2nd) structure is the wall on the Western side, hence the Western Wall. The sobriquet “Wailing Wall” comes from the tradition of offering prayers, in the form of chants to Yahweh while facing the Temple Wall, most often from a standing position while rocking back-and-forth. Particularly important prayers are commonly written out on tiny “scrolls” of paper and inserted in the crevasses between the stones of the wall. It is this tradition, the written prayer inserted in the Western wall, that Gov. Crist, a Methodist, was referring to.

Prayers inserted in the Wailing Wall

Prayers inserted in the Wailing Wall

What does this have to do with hurricanes?  That is exactly what the governor was purporting to explain to the meeting of agents. He noted that in the two years before his elevation to the governor’s chair, Florida had been hit by a total of eight hurricanes.

“Do you know the last time it was we had a hurricane in Florida? It’s been awhile. In 2007, I took my first trade mission. Do you know where I went?” said Crist, a Methodist, referring to a trip to Israel.

He then told of going to the Western Wall and inserting a note with a prayer. He said it read, “Dear God, please protect our Florida from storms and other difficulties. Charlie.”

Crist had a friend, Sen. Nan Rich, place the same prayer in the Wall on a trip to Israel during 2008. This year, in May, another friend repeated the same task.

“May, June, July, August — we’re getting closer,” Crist said. “Knock on wood. I would ask you all to say a prayer.”

Afterward, he said he’s not taking credit for the lack of storms in this hurricane-prone state.

“I give that to God,” Crist said. “But it’s nice.”

Florida Gov. Charlie Crist

Florida Gov. Charlie Crist

Nice that Charlie doesn’t want to hog all the credit. But here’s my question. Is God, in all his bloodthirstiness, sitting out there just itching to blast significant portions of Florida away, killing a few of his beloved subjects in the process, and only held in check as long as Orange Charlie keeps sticking scrolls in the wall?

Follow up question: Given the state of the real estate market throughout Florida, do you think that what the agents most wanted to hear was about how Charlie is in good with The Lord?

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Posted by on August 25, 2009 in Uncategorized

 

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Howard Dean Sets Record Straight on Palin “death panels” Remark

Howard Dean speaking at DNC event
Image via Wikipedia

Commenting on former-Gov. Sarah Palin’s recent creation of the term “death panels,” Gov. Howard Dean, former Chairman of the DNC published the following on his blog carried at Huffingtonpost.com:

Former Governor Sarah Palin made some preposterous claims over the weekend which attracted mainstream media attention. She made up the term “death panel” and claimed that part of the health care reform bill now working it’s way through Congress required that families with children with disabilities, or elderly people who are infirm, could be judged by one of these death panels, which could control their fate and decide if they would die. GOP leadership repeated this outrageous claim across the airwaves on the Sunday morning talk shows. The mainstream media gave this claim credibility simply by repeating it.

My wife and I have practiced medicine for over forty years combined. There is no truth now, nor has there ever been any truth to the idea that the government encourages euthanasia or infanticide.

Our country is in trouble. Claims like these are routinely refuted by people who know better, but they are recirculated because they are sensational, and the MSM purports to take a balanced position without a thoughtful assessment of the facts. Fox News actually has people on in support of these outrageously false claims.

In fact, these kinds of claims are lies. There is no nice way to say it. This kind of stuff is far beyond the usual politicians’ tricks of shading words and imputing meanings that aren’t there. To quote a famous American who began the process of ending the McCarthy era in the fifties I address the MSM: “At long last, Have you no sense of decency?”

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Posted by on August 25, 2009 in Health Care Debate

 

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Health Care Myths Just Keep on Rollin’

Here is another example of how misunderstood or, more likely, misconstrued the details get in the debate over health care reform. In a post dated Wednesday, August 19, 2009 on a blog called StandByLiberty.com, BLW wrote:

What is one thing sure to come from the government option, how about government employees, unionized government employees to be more exact. To give you some idea of what I’m talking about, the British National Health Administration is the worlds third largest employer, behind only the Communist Chinese Army and the Indian National Rail Road. We are just a hair bigger than Britain don’t you think? So how many new government employees do you think we will have? This is simply a way to feed the democratic/liberal cause with union members and the dues they pay. They will be depending on the government for their jobs. Bigger government just for you, don’t worry they can just raise taxes to pay for them. But don’t fret, the new government employees won’t have to endure the same health care as you as they will not be included in the new government option.

So, what’s wrong with that? Practically everything.

The British National Health Administration owns almost all of the hospitals, clinics, medical offices and diagnostic facilities. There are a very, very few private medical practices and facilities that cater to an extremely wealthy clientele that can pay totally out-of-pocket for what is typically called “Concierge” medical care.

What that means is that the entire British health care industry operates like the VA does. veterans go to a government-owned, VA operated facility and receive treatment from physicians who are either in the military, on payroll to the VA, or hired under a specific contract to work within a VA facility.

Anybody who thinks this is being proposed in the profferred legislation, or is even in the current discussion either doesn’t (or can’t) read, or is purposely distorting the facts.

Take out the administrators, doctors, nurses, nurses aides, lab technicians, radiology techs, cashiers, secretaries, cafeteria workers, supply personnel, janitors, maintenance staff and parking lot attendants and I bet the employee count in the British system would be quite small.

This is NUTS!!

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Posted by on August 19, 2009 in Uncategorized

 

Health Care Myths & Facts – part 2

Health Care Reality Check symbol

8 common myths about health insurance reform

Myth 1 Reform will create “rationing” which does not exist in the present system: It’s a myth that reform will mean a “government takeover” of health care or lead to “rationing.” To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies.

Myth 2We can’t afford reform: It’s the status quo we can’t afford. It’s a myth that reform will bust the budget. To the contrary, the President has identified ways to pay for the vast majority of the up-front costs by cutting waste, fraud, and abuse within existing government health programs; ending big subsidies to insurance companies; and increasing efficiency with such steps as coordinating care and streamlining paperwork. In the long term, reform can help bring down costs that will otherwise lead to a fiscal crisis.

Myth 3Reform would encourage “euthanasia: It does not. It’s a malicious myth that reform would encourage or even require euthanasia for seniors. For seniors who want to consult with their family and physicians about end-of life decisions, reform will help to cover these voluntary, private consultations for those who want help with these personal and difficult family decisions.

Myth 4Vets’ health care is threatened: It’s a myth that health insurance reform will affect veterans’ access to the care they get now. To the contrary, the President’s budget significantly expands coverage under the VA, extending care to 500,000 more veterans who were previously excluded. The VA Healthcare system will continue to be available for all eligible veterans.

Myth 5Reform will hurt  small business, and their employees: It’s a myth that health insurance reform will hurt small businesses. To the contrary, reform will ease the burdens on small businesses, provide tax credits to help them pay for employee coverage and help level the playing field with big firms who pay much less to cover their employees on average.

Myth 6Your Medicare is in jeapordy: It’s myth that Health Insurance Reform would be financed by cutting Medicare benefits. To the contrary, reform will improve the long-term financial health of Medicare, ensure better coordination, eliminate waste and unnecessary subsidies to insurance companies, and help to close the Medicare “doughnut” hole to make prescription drugs more affordable for seniors.

Myth 7You must drop your current insurance: It’s myth that reform will force you out of your current insurance plan or force you to change doctors. To the contrary, reform will expand your choices, not eliminate them.

Myth 8The new plan authorizes the government to make withdrawals from your bank account: It is an absurd myth that government will be in charge of your bank accounts. Health insurance reform will simplify administration, making it easier and more convenient for you to pay bills in a method that you choose. Just like paying a phone bill or a utility bill, you can pay by traditional check, or by a direct electronic payment. And forms will be standardized so they will be easier to understand. The choice is up to you – and the same rules of privacy will apply as they do for all other electronic payments that people make.

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Posted by on August 15, 2009 in Uncategorized

 

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Health Care Myths and Facts – part 1

Health Insurance Reform Reality Check

8 ways reform provides security and stability to those with or without coverage

  1. Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.
  2. Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
  3. Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
  4. Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
  5. Ends Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.
  6. Ends Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
  7. Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.
  8. Guarantees Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won’t be allowed to refuse renewal because someone became sick
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Posted by on August 14, 2009 in Health Care Debate

 

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