Rep. Bachmann- Is the Tea Party Out of Touch Too?

Minnesota Representative Michele Bachmann certainly stuck to her talking points on Sunday’s Meet the Press.

Despite David Gregory’s persistent attempts, Bachmann danced around almost every question. She had a point to make and that point didn’t include responding to Gregory’s questions. She was sticking to her message and she was going to make it- no matter how embarrassing the outcome might be.

Her new “revelation” focused on the discovery of $105 billion in appropriations funding supporting the Patient Protection and Affordable Care Act passed last year. Her web site comments, “Recently, I read startling information about the funding of ObamaCare. . .” and goes on, “Because now, months after passage, we are discovering an astonishing $105,464,000,000 has already been appropriated to the Health and Human Services Secretary for ObamaCare through FY2019.”

Bachmann even sandwiched her “support card” showing the $105 billion number to all viewers in response to a totally unrelated question thinking it would provide extra emphasis.

She credits her revelation to an article she recently read- and the rest is history. She was off and running- despite the fact that these numbers have been out there since the beginning.

The numbers are true. There were a lot of appropriations made in the ACA for grants and funding in many different areas. These include funding for the health insurance exchanges, school-based health centers, expanded primary care residency programs, health care education at the community levels, and others. There were allocations made for many “oversight” organizations we could probably do without considering where we are from a fiscal perspective.

But unless you simply didn’t read the law, or are totally uninformed of what is included, this should not have been “startling information” especially for someone in Congress.

The Congressional Research Service published a report last October identifying the appropriations included in the law. There is nothing hidden. Representative Bachmann must just be getting to reading it now- or she has been waiting for another source to read it for her.

The costs of our health care system are continuing to increase and will continue to increase if nothing is done. The ACA needs a lot of work to fix if we’re going to fix it, or another approach had better be ready if we’re going to repeal it. Politics aside, we’re at a tipping point in health care.

If Representative Bachmann is going to be speaking for the Tea Party, I would recommend she get her facts straight before talking to a national audience again. If she is “shocked and surprised” at this late stage that is her fault for not being informed.

She shouldn’t assume the rest of the American people are as uninformed as she is.

Finally- A Business Case For Hospital Readmissions

A study in the New England Journal of Medicine concluded 1 in 5 elderly patients are readmitted to the hospital 30 days after leaving. This results in 2.3 million individuals being readmitted at a cost of over $17 billion to Medicare. A significant number of the readmissions are avoidable.We’ve known this has been an issue for a long time, but there was never the ability to develop the “business case” to fix it. Business cases are a big deal in healthcare. Even though we know it’s the right thing to do, if it costs in the short term or you can’t make money at it in the long term, things don’t change.

One part of The Affordable Care Act focuses on reducing avoidable hospital readmissions and will begin to penalize (reduce payment) to hospitals if their readmissions exceed certain targets. Suddenly, there is a business case and hospitals are taking steps to fix the problem and, for the most part, the initial steps to fix the problem are very simple: Make sure patients understand their responsibilities to care for themselves and get the follow-up care that is required. It may take a little more time to educate the patient or their care givers than before, but now the extra time is justified by the potential of lost revenue down the road.

While health care couldn’t make the business case before, I think about the 1 in 5 elderly patients who had to suffer being readmitted and the economic consequences that may go along with it. Somebody has to pay for it. And, I wonder why it takes threatening a reduction in what a hospital is paid to just take a little extra time to educate patients and care givers and do the right thing.

I guess that’s why it took a law to fix it. Our incentives are all screwed up.

My Journey Through The PPACA: Patient-Centered Research

Trying to read the PPACA is brutal. I've skimmed it twice and am now going through in a little more detail- reading the words. I have no intention of being an expert on this- but, I do want to be informed with what it is and what it isn't. So, I'm going to share some thoughts as I go through it on the blog.

As with any legislation (not just health care) the words and the organization (sections, titles, and all the rest) probably makes sense to the lawyers but I doubt even the politicians can explain it. That is a large part of the problem with this- it is just hard to explain what is written. Very few have tried.

I was particularly interested in the "patient-centered" stuff. Section 6301 page 609 creates the "Patient Centered Outcomes Research Institute" and a boatload of money is allocated to it.

Here's the definition/purpose:

"to assist patients, clinicians, purchasers, and policy-makers in making informed he

alth decisions by advancing the quality and relevance of evidence concerning the manner in which

disease, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored, and managed through research and evidence synthesis that considers variations in patient subpopulations and the dissemination of research findings with respect to the relative health outcome, clinical effectiveness, and appropriateness of medical treatments services and items--"

Whew. Take a breath.

While this diatribe probably means something to those in health care- (health care loves to use a lot of words or acronyms to say simple things)- the average person will have no clue what this is and why it may be important. How this definition of purpose even remotely relates to anything "patient centered" is beyond me.

I've found there are some good things in the law and some things that make no sense. Many times I had to work to find them. The lack of education, communication and explanation of this reform approach at a very basic consumer level remains a huge part of the problem as this debate continues.

Beginning to organize the information in the health care system is a good thing. Starting to organize system-wide "best-practices" and prevention methods is a good thing for everyone involved. Unfortunately, the consumer is never going to know why this is important because nobody is telling them and they have to try figure it out on their own with the 77 word definitions provided. Or, they just do the easiest thing and listen to the talking points of cable news or the politicians.

We all know how balanced these sources are.

A Wake-Up Call For Our Country

It’s unfortunate that sometimes it takes a significant event to force us to step back, reflect, and determine where we are. These events occur for us individually as well as collectively as a society and as a nation.

The tragic events in Tucson this past weekend is one of those.

The finger-pointing and accusations were flying within hours of the shootings even before any facts were known. We still don’t know many facts today and we never may know the real reasons for this insane act.

New York Times Nobel Prize winning columnist Paul Krugman quickly jumped to blaming the Tea Party, Glen Beck, Sarah Palin and conservatives in general. He commented, “Violent acts are what happen when you create a climate of hate.” He believes conservatives created this environment of hate.

Florida Democratic Congressman Alan Grayson didn’t help to create an environment of unity when he referred to Tea Party Challenger Daniel Webster as “Taliban Dan” during the mid-term elections. The rhetoric during these elections across-the-board was brutal.

Let’s just call it even. There is enough blame to go around on all sides. Regardless of whether the accused was politically motivated or not, we all know our political process and dialogue has grown toxic and does not help the cause of addressing the challenges we face as a country. We have serious challenges ahead of us. Whether we want to accept it or not- they will not be solved as Republicans, Democrats, or Tea Party; they will be solved as Americans.

Commentator David Gergen states it best, “This is not a moment to point fingers and make accusations. But it is a time to pray for the victims- and pledge to each other that we will struggle for a more civil and decent America.”

To honor the victims, and with prayers for Gabrielle Giffords, let’s come together to at least agree on that.

Health Care In 2011: Defining Ourselves as a Country

2010 was another memorable year. We had the Gulf Oil spill, the passage of health care reform, the rise of the Tea Party, and an attempt to rebuild an economy devastated by the Recession of 2008. The November elections pointed out that Americans were tired and wanted change. The election results will change the course of politics in 2011. And, the wars in Iraq and Afghanistan (except for little spurts of topics) remained a side-issue for most Americans (2010 was the deadliest year of the 9-year Afghanistan War and less than 1% of the American population was asked to sacrifice in ways we can’t even begin to comprehend.)

All of these events are related. Slowly but surely they are defining the character of our country. Will we be able to come together as a nation to solve the many challenges we face, or will we remain partisan and divided and only expect others to sacrifice instead of ourselves. All Americans are going to need to sacrifice in some way if we’re going to pull ourselves out. It’s a new mindset for most. Time will tell whether we will.

Kaiser Foundation determined the uninsured in America grew by nearly 4 million people in 2009. Now, over 50 million Americans are without health insurance to finance the health care they may need. The number of Americans without access to some type of health care financing/insurance support now exceeds the population of Spain. This number will likely increase when the study is repeated for 2010.

Uncompensated care for the uninsured reached $57 billion in 2008 with the state and federal governments footing three-fourths of the tab. This number will continue to add to the strains of federal and state budgets as the number without health insurance increases.

The Employee Benefits Research Institute concluded that a couple will require $170,000 in savings for a 50% chance of covering their health care expenses during their retirement- including what would be paid through Medicare. Considering the average savings is only around $50,000 today, it doesn’t take a math wizard to conclude there are challenges ahead. Twenty-seven percent of those uninsured already used all of their savings to pay for the health care they need and many are delaying treatment simply due to cost. Sixty-percent of all bankruptcies are now related to health care expenses.

Only 20% of the Baby Boomers now beginning to flood the Medicare system believe it is financially stable and nearly half believe they will live longer than Medicare itself. The influx of Baby Boomers is going to put a strain on a system that is already strained and adding daily to our national debt.

Something has got to give.

As we enter 2011 and begin to argue again about reforming our health care system let’s not delude ourselves into thinking everything is ok. These numbers are only going to grow if we do nothing or just continue to tinker around the edges. We’ve tinkered around the edges for long enough.

And, yes, it will require sacrifice; sacrifice from everyone this time. Whether you are Republican, Democrat, Tea Party or any of the other variations, and no matter what demographic or economic class you are in, it is how we accept and address these challenges will define us in 2011 and beyond.

“For unto whomsoever much is given, of him shall much be required: and to whom men have committed much, of him they will ask the more.”

A good verse to keep in mind for 2011.

Happy New Year

Just Continuing To Kick the Can Down The Road

It's almost Christmas.

Last year, Congress was frantically putting the pieces together on the health care legislation- which wasn't pretty. This year they are frantically trying to put together the pieces for the omnibus spending and tax bills- even less pretty. At a cost of over $850 billion and loaded with over 6,000 earmarks, this legislation is once again an example of cramming together what is politically viable instead of what is needed for the country. Before signing the omnibus spending bill in 2009, President Obama stated, "This piece of legislation must mark the end of the old way of doing business and the beginning of a new era of responsibility and accountability that the American people have every right to expect and demand." I guess he feels one more time won't matter. We'll really, really make this one the last time. I doubt it.

Last week the House passed the Medicare and Medicaid Extenders Act of 2010 avoiding the 25% cut in Medicare physician payments and freezing provider reimbursement at the current levels until the end of 2011. Physicians breathed a sigh of relief- the Medicare budget was blown to hell. This marks the fifth time we have set aside the sustainable growth rate (SGR) model this year and the fifteenth time it has been set aside since 2001 accruing a liability of another $300 billion. Do you think the SGR model might need to be changed instead of continuing to simply push dealing with Medicare cost increases off in the future?

A few days ago the first judge ruled against the individual mandate included in the health reform legislation signed earlier this year. Republicans celebrated as they felt this supported their calls for repeal. Democrats simply ran (or continued running- they have been running from this for a long time). In the meantime, the $2 trillion spent on health care costs continues to climb and our life expectancy compared to the rest of the world (one measure of how effective our system is) declined.

The Debt Commission report released a few weeks ago stressed we are nearing the edge of the cliff. We heard it, we know it, but we simply continue to put our hands over our ears and yell, "I'm not listening, I'm not listening, I'm not listening," hoping it will all just magically go away and we can return to the way things were. Ain't going to happen.

While stabilizing the economy in the short-term is important, considering the long-term impact of all of this on our debt is more important than ever. We all know we're in a very precarious situation as a nation; we just don't like to sacrifice anything if we don't have to. We're big into "screw-avoidance." Whenever sacrifice is mentioned, we think we're getting screwed. A hint; fixing our financial and health care structure is going to require some shared sacrifice from everyone whether we like it or not.

Or, we can just continue to kick the can down the road as we've always done and enjoy the scenery as we're falling off the cliff. We don't have very far to reach the edge.

Happy Holidays.

Health Care Consumers- An Enigma For Health Care

Last week I sat in on one of the webinars hosted by the Institute for Health Improvement (http://www.ihi.org/). The topic was "bending the Cost Curve" and was intended to continue the never-ending discussion of how to address the health care cost crisis in this country (if you get a chance, sit in one one of these- some of the topics are pretty decent). There were over 600 health care professionals listening in to this one.

We heard all the usual numbers. We heard the usual descriptors; crisis, unsustainable, breaking-point. We listened as one of the speakers discussed the methods used to contain hospital costs in Maryland with propspective payment and bundling approaches. Then, there was one slide that seemed to create a stir with most of the audience (I've posted it here).

When discussing how to get consumers involved- the group was at a loss. When discussing the creation of "discernable health care consumers," changing consumer behaviors, and changing the expectations of individuals, the group honestly did not know what to do. Most in the audience are used to controlling, incentivizing, and directing. When realizing they may need to begin a real dialogue with the general population, this audience simply didn't know how to go about it.

Health care needs to change its image. It needs to realize that consumers are not simply a herd of cattle that needs to be driven in the right direction. With the right relationships and context, consumers (for the most part), know what they need to do. They just need some trust and guidance sometimes. Health care needs to realize that the individual consumer is not simply a component that needs a clinical fix that can be directed by free gifts an money- but an important part of the solution that needs to be part of the dialogue, discussion, and relationship.

If we're ever going to fix the problem we have, health care is going to need to communicate better with the general population. It is going to need to break down the clinical and technical communication approaches it has relied on in the past and begin a dialogue and discussion with the "Joe the Plumbers" of the world. It needs to regain some semblance of trust, relevance, and context for the average individual before they are ever going to get engaged and participate.

Only then will we be able to begin to address the issues with "Bending the Cost Curve." And, hopefully, we won't have 600 health care professionals wondering how to get consumers involved.

We'll have solutions to discuss already making it happen.