Zeke Emanuel: Scrapping Health Care System

Zeke Emanuel, brother of Rahm and therefore one degree away from the President, recently spoke to the Commonwealth Club of California and laid out his 10-point plan for health care reform (really, revolution).

Here are the basics:

1. Citizens get a government voucher to pay for standard basic insurance.
2. Everybody is covered, people have a choice of plans.
3. Funded by a value-added tax dedicated for this purpose.
4. Supplemental insurance available for those who want it.
5. Private sector organizes and delivers health care.
6. Tax deduction for employer insurance is phased out.
7. Phase out Medicare and Medicaid; no new enrollees.
8. Administration by a health board similar to Federal Reserve.
9. Create and institute to evaluate technology and outcomes.
10. Malpractice reform and centers for patient safety.

To watch the whole speech and Q and A in high quality video, go to

http://fora.tv/2009/01/08/Zeke_Emanuel_Scrapping_the_Health_Care_System

You can also access a four-minute version of the 10 points.

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Reporter explains series on insurance companies vs. physicians and patients

Reporter explains Toledo Blade series on how insurance companies compromise physician's ability to deliver care.

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Patients suffer as care, coverage limits collide

‘Most doctors don’t start people on medications because they like to start medicines,’ says Dr. Jack Brunner, a Toledo endocrinologist. ‘They have specific reasons and goals for the patient.’

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The Toledo Blade's investigative team set out to examine whether patients are getting the care their doctors ordered. No doctor or practice manager will be surprised. Take this series of articles to your local newspaper and show them how to tell the story about current health care.

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A nationwide survey of doctors by the Toledo Blade shows they increasingly feel that insurance companies erode the doctor-patient relationship and often prevent patients from getting necessary care by second guessing doctors' decisions.

The rising costs of health care procedures has led insurers to constrain treatment options available to doctors in an attempt to hold costs down, according to the majority of doctors surveyed. Doctors said the motive is a drive for profits, while the insurers said it's necessary to hold down the costs for businesses that usually pay the majority of health care premiums.

### link to Toledo Blade below

Article 1:

http://www.toledoblade.com/apps/pbcs.dll/article?AID=/20080824/NEWS32/106232155/-1/ARCHIVES30

Article 2:

http://www.toledoblade.com/apps/pbcs.dll/article?AID=/20080825/NEWS32/106231964/-1/ARCHIVES30

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Dollars and cents of health care

One of the challenges to everyone in health care is to explain the dollars and cents. But most physicians, hospitals, nursing homes and other providers hold to the traditional view that their books, operating expenses, etc., are proprietary.

Which means nobody understands because nobody effectively explains.

A powerful exception is a story in the Nantucket Independent newspaper.

http://www.nantucketindependent.com/news/2008/0820/front_page/003.html

This story explains how a publicly funded nursing home is going broke. Because it's owned by a municipality, the books are open. This story makes a compelling case for better reimbursement.

This is the way to tell the story and win a better system.

xxx

More health care professionals running for office?

Not sure, but I get a sense that a lot of physicians and other health care professionals are running for political office. Probably because they see and feel the pain.

One of the most interesting is Judy Baker, who is mounting a strong campaign as a Democrat in a usually Republican district, Missouri 9th.
She is trained as a practice manager.

From her campaign site: She joined MU’s University Physicians practice plan, first serving as director of operations at Capital Region Medical Group in Jefferson City during the University’s management of the facility and then as interim executive director of the entire practice plan until 2002. She left the University at that time and found her own consulting firm, now Cura Advantage. In addition to operating her business, she has served as part-time administrative director for ACTS International, a not-for-profit, humanitarian organization dedicated to building partnerships that benefit the country of Georgia, and as an adjunct professor teaching managerial economics at Columbia College.

She served in the MO House for three years. Her campaign has been added to the Democratic Party's Red To Blue effort, which means she has raised enough money and support to possibly win.

The 9th District stretches from the Iowa state line to the Lake of the Ozarks and from Columbia to the western fringe of the St. Louis area.

Her site:

http://judybakerforcongress.com

OP-ed pieces: very effective, if...

Here's an excerpt from an excellent op-ed (opposite the editorial page) article in Long Island Newsday by a hospice volunteer. The full article is personal, detailed and local, full of restrained and powerful emotion.

"I know from my own and others' experience that hospice is an important option for a terminally ill patient and his or her family to be able to choose...

"But this choice is being threatened by the Bush administration, which, as a cost-cutting measure, plans to reduce Medicare reimbursement rates to hospices so severely that some may be forced out of business and others to reduce their services..."
BY JEAN BARBER

Full text of article:
http://www.newsday.com/news/opinion/ny-opbar315782876jul31,0,6538603.story

Just as with letters to the editor (see below), the writer, and as many others as you can muster, need to send a copy to senators and representatives you can vote for and request action and request a response. Fax works best and it's important to call and make sure someone got it. That demonstrates you are serious. Anything less gives elected officials and their staff permission to do nothing.

Remember, your goal with PR techniques like this is to get action from members of Congress. If that doesn't happen, it doesn't matter how many people read and agree with you.

Doctors using letters to editor - very effective, if...

Two letters to the editor make good points in the Baltimore sun July 31:

"If Medicare altered its reimbursement system by rewarding preventive care and giving a smaller financial incentive to tests and procedures, not only would the cost of health care drop without any decline in quality but the altered financial incentives might prompt more medical students to pursue primary care fields."
Dr. Andy Lazris

"Under (the current) system, excess blood tests, EKGs, X-rays, CT scans, MRIs, etc., will be ordered with increasing frequency, no matter what else happens."
Dr. Edmund J. MacLaughlin
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This is an effective tactic to get out your message, but you need to make sure the letters are read by appropriate elected officials. I recommend you cut out the newspaper masthead (that gives the name and date), put it with your letter, copy it, then fax to your representative and senator with a cover letter to them. Call to make sure it got there and -- most important -- ask for action.

Otherwise they may never see it and they will not respond.

Full text of letters at

http://www.baltimoresun.com/news/opinion/letters/bal-ed.le.medicare31jul31,0,1240881.story

Physicians and their associations shift money to Democrats

Insightful look at the politics of medicine from Patrick O'Connor at Politico:

Congressional Republicans are trying to mend an ailing relationship with their once-loyal allies in the medical community after opposing legislation to block an annual pay cut for doctors under Medicare.
In the House, Republican Whip Roy Blunt of Missouri convened a private meeting last week with a handful of top lobbyists for the medical community to make amends after the contentious vote, according to people familiar with that session...

In the run-up to the 2006 midterm elections, doctors and the groups that represent them gave 62 percent of their combined $52.4 million war chest to Republicans, compared with 37 percent to Democrats, according to the Center for Responsive Politics. That breakdown mirrors previous cycles since Bush entered the White House.
But since 2006, doctors and related groups have given Democrats 53 percent of their combined $53 million in campaign contributions, according to the watchdog group.
The switch is even more stark for the AMA.
In the run-up to the 2006 election, the AMA’s political action committee gave Republicans 70 percent of its campaign cash, according to the Center for Responsive Politics. In 2004, the AMA’s PAC contributed 80 percent of its total donations to Republican lawmakers and candidates.
Since 2006, that PAC has directed 53 percent of its contributions to Democrats.

The complete commentary at:

http://www.politico.com/news/stories/0708/12124.html

What it takes to fix Medicare Medicaid reimbursement

Here's an interview with a lobbyist for California Medical Association that explains how powerful -- and easy -- it is for physicians to contact politicians. The first thing he says gives you an indication of why such issues as Medicare and Medicaid reimbursement don't always go the way physicians would like.

Sensible editorial about Medicare reimbursement

Atlanta Journal Constitution gets it right. Here's an excerpt:

The most reasonable approach would be to bundle payments to doctors, or groups of doctors, who care for patients with chronic conditions such as diabetes and congestive heart failure. The healthier the doctors keep their patients, the lower the cost to taxpayers and the higher the reimbursement rate.

Instead, Medicare still pays doctors for more than 7,000 "units of service" — ordering tests, changing medications, requiring more frequent visits from patients — all of which are billed separately. With few exceptions, there is no financial incentive for physicians to keep their per-patient cost under control.

Use this url for the full editorial

http://www.ajc.com/opinion/content/opinion/stories/2008/07/25/medicared_0727.html

Another good shot in the Medicare war

Dr. Robert A. Thompson, President, North Dakota Medical Association
wrote a great letter that is published in The Dickenson Press. Note how it is localized and relevant to the newspaper's readers.

This can now be reproduced and sent to elected officials and others. No doubt most of them will get it from their clipping service and by sending it in from multiple sources you reinforce the message. Politicians pay careful attention to what their voters pay attention to. While letters to the editor are not read as much as the sports pages, the people who read them are opinion leaders.

This is a time-tested, effective, cheap and easy technique to influence elected officials.

http://www.thedickinsonpress.com/articles/index.cfm?id=16323&section=Opinion

Excellent newspaper coverage of Medicare problems

The Nashville Tennessean just featured a two-part series about how physicians are limiting the number of new Medicare beneficiaries they will treat and how some are charging concierge fees to accept new beneficiaries.

This is a model you might be able to suggest to your local news media and offer to find people to flesh out the story.

Part 1 Medicare cuts take toll on patients, doctors

http://www.tennessean.com/apps/pbcs.dll/article?AID=2008807200408

Part 2 Want to keep your doctor? Pony up $1,500

http://www.tennessean.com/apps/pbcs.dll/article?AID=2008807210342

grassrootsguy

Physician attitudes toward politics, PACs and politicians

In the survey below you get a sense of the cynicism, doubt and discouragement many people feel about our political system. In my own focus group research I found a lot of the same feelings with one important distinction: the people expressing this kind of non specific negativity are usually people who don't know a politician personally, haven't been active lobbying for their association and haven't communicated meaningfully with a politician. People who have gotten engaged in politics, even though they didn't get what they wanted, often feel very positive about the process and politicians.

A parallel finding is that most people get most of their information about politics and politicians through the news media. Most of that information is about campaigns, which are by nature negative, confrontational and contentious and that turns off many people.

To activate volunteer advocates, help them understand the difference between campaigns (before election day) and lobbying (after election day).

When a politician says no...

Mostly when you meet in person, even if they know the answer will be no, they will demur. The don't like face-to-face nos.
But later they will send a letter or make a phone call and say they can't support you in what you want.
They may give a reason such as, "leadership is against this and I can't oppose them."
You can explore their reasoning by asking this question in these exact words:
"You must have some reason for feeling that way, can you tell me what it is?"
Then, and this is important, resolve to find something you can get a "yes" on; you don't want to leave on a "no."
It may be as simple as "I understand you can't help us now, can we send you some more information in hopes of changing your mind?"
Always leave on a positive note.

Question of the week

How do you respond when a politician says "No"? That is, you've made your pitch and your make the ask and you get sorry, I can't help. What do you say next? Send the exact words you would speak or write.

Coming This Fall: New book to help you achieve policy goals

This is the working cover for the new book on advocacy for physicians and staff. This book was developed from Joel's work training physicians through medical societies and specialty organizations. He's available to consult and keynote for your medical group.
Inside the book, and coming up in this blog, you'll find interviews with politicians, physicians, medical staff managers, association execs, lobbyists, medical students, academics and others. You'll see how you can influence public policy, get legislation passed or stopped, raise money to support candidates... all the things needed to have an impact. Stay tuned for practical tips and techniques to help you achieve your policy goals.
You can also ask Joel your questions about what works to influence elected officials (Hint: Money helps, but it's not enough by itself.)
You will learn about three ways to make your money most effective.

Are the Ds and Rs really a "party?"

If you think we have two political parties, or three, try to join one. See if you can find an office. Most of the time you can't because there isn't one. If you can, as in an election season, see what it takes to become a "member." Can you get a card? More importantly, can you use this "party" or "membership" to advance a legislative agenda? Ask how you make your voice heard through this "party" to influence public policy.
That's because what we usually call a "party" is really just a campaign. What the media usually calls a "party" is a caucus of like-minded people in the Congress or legislature. It doesn't really engage you, want you or serve your political interest. It just tries to get power and keep power.
The likelihood that Obama or McCain or anyone else elected president will fix what ails you is almost nonexistent on a specific issue.
For example, if you want to change the law, your best bet is the much aligned special interest group, which performs many functions political parties ought to perform. That is, research issues, write and introduce legislation and advocate for policy.
And the special interest group includes you in the process and reflects your views.
It is more accurate to speak of the Democratic or Republican "campaign" than to call them a party. And more effective to turn to a special interest group to pass or stop legislation.
Why else do you think there are so many?