Page 1 of 2 12 LastLast
Results 1 to 10 of 17

Thread: Health Care Reform: The Missing Piece of the Puzzle

  1. #1

    Health Care Reform: The Missing Piece of the Puzzle

    By Laurie H. Glimcher, M.D.

    Amid the deafening rhetoric around health care reform there's a silence that should concern all of us. While the Supreme Court considers challenges to the Affordable Care Act (ACA) on a variety of grounds, no one is talking about what health care reform will mean for medical education and biomedical research, an essential element in the quest for more efficient and effective care. It's a critical piece of the reform puzzle that has fallen off the table.


    Health care reform as currently conceived doesn't pay much attention to supporting the mission of academic medical centers, but it does put in place financial incentives and organizational innovations (such as accountable care organizations) that may be good for the health care system as a whole but harmful to academic centers.When it comes to providing care at as low a cost as possible, academic medical centers are at a considerable disadvantage compared to hospitals and medical groups that are not responsible for educating new physicians or for making groundbreaking research discoveries. The mission of the academic medical center is unique. Training physicians and scientists with modern techniques and tools is costly, and its impact is not always immediately measurable. An investment in a medical student's experience today might result in the creation of a skilled practitioner or elegant clinical investigator decades hence.


    Consider, for example, the costs of training a medical student. Data from the American Association of Medical Colleges show that only a small percentage of medical school revenues come from tuition. For all 126 fully accredited medical schools in the U.S. only 3.6 percent of revenue comes from tuition and fees. The remaining funding for education, patient care and research — all necessary for the training of students — comes from clinical practice, grants and philanthropy. As grants and patient revenue decrease, cost-shifting for education of students becomes increasingly challenging.
    Weill Cornell public health professor Lawrence Casalino, M.D., Ph.D., and other researchers have shown that financial incentives aimed at improving the quality and controlling the cost of care may have the unintended consequence of harming organizations with special missions and/or special patient populations.
    In thinking about stewardship of the academic medical center, I consulted with Joseph J. Fins, M.D., chief of medical ethics at Weill Cornell, and he reminded me of the late Daniel Patrick Moynihan's consistent, stalwart defense of academic medicine. During an earlier round of health care reform, the senator reminded Washington's elite of "…the manifest fact that American medicine is in a heroic age of discovery" and that these discoveries "are taking place in our academic health centers and in our pharmaceutical industry, as well."
    Moynihan warned that, "Whatever we do, we are under a solemn obligation to do no harm to, indeed to facilitate, these centers." We would hope that present-day leaders would take note and appreciate the danger that narrow market-based reforms pose for academic medicine and its broader humanitarian mission.
    It is a critical time for academic medicine. Making health care leaner will fundamentally change the financial structures that make medical education and research possible. Experts suggest that even the most efficient of centers will see reduced funding under President Obama's Patient Protection and Affordable Care Act. This financial shift, coupled with a National Institutes of Health (NIH) budget, projected to be flat or reduced in real dollars, will place academic medicine under considerable strain.
    This needs to be fixed. In the past, Senator Moynihan sponsored the Medical Trust Fund Act, so as not to "…bring a premature end to a great age of medical discovery, largely made possible by America's exceptionally well-trained health professionals and superior medical schools and teaching hospitals."
    This generation of leadership must do the same. Funding must remain in place for the complex training of physicians as well the research that leads to improved clinical therapies. We must preserve that unique combination of training, research and patient care that inspired Moynihan to call academic medical centers the "jewels in the crown" of the health care system — a "public good" that "everyone benefits from."
    But much of this is at risk. Dr. Fins importantly cautioned that metrics that quantify the success of the new models of health care delivery mandated by the ACA do not factor in the latency of a superb medical education. Nor do they account for the "unproductive" years of medical research that typically precede an important discovery. Neither can be measured by the fiscal year, and holding academic medical centers to account — as if one could — is to ignore a critical part of their mission.
    I am not suggesting that the new financial incentives and organizational innovations being introduced via health care reform should be abandoned because they are not well-suited to academic medical centers. Nor do I suggest that academic centers should be free from accountability, that nothing should change, and that policymakers should give us lots of money and leave us alone. But I do believe that academic medical centers are a crucial element of U.S. society — an area where the U.S. has an important comparative advantage over other countries. Policymakers should seek to provide a stable source of revenue to these centers to support their special missions, and policymakers and academic medical center leaders should work together to seek ways that academic medical centers can demonstrate accountability.
    Both tasks will require a good deal of creativity. The tasks are urgent. These great institutions took a century to create, but they could be eviscerated in a decade if we do not act.
    Altruism need not be the motivation for action. Support of academic medical centers is also highly cost-effective and good for a flagging economy. A recent report by the Association of American Medical Colleges noted that in 2009, research funds awarded to academic medical centers and teaching hospitals generated approximately $45 billion for the U.S. economy and that each NIH dollar invested yielded a return of $2.60.
    Moynihan's voice, and those of other proponents for biomedical science like Senators Edward Kennedy and Arlen Specter, is sadly absent from the current debate over health care reform. But their historic and enduring advocacy reminds us that responsible health care reform must also be accountable to the future.As we strive for present-day value, our leaders must ensure a bright future for academic medical centers — uniquely American medical institutions, which have done so much to foster human good. It is simply a question of stewardship. The President and the Congress should emulate the bi-partisanship of the past and work together to ensure their continued strength and viability.
    Our academic medical centers are the envy of the world; let's not place them at risk. To replace these "jewels in the crown" would be beyond our means, and entail a societal and moral cost no nation could ever afford


    http://weill.cornell.edu/news/deans/2012/03_26_12.shtml


    Dr. Glimcher was on CNBC this morning and was really pessimistic about support with ACA. She was using the word DIRE about ACA. Usually later that day or the next they'll put the interview on their page if anyone wants to see it.

  2. #2
    If Obamacare is fully implemented the quality and quantity of health care is going to nosedive.
    If you're a bright young kid who wants to be a doctor or a research scientist or a developer of medical technology are you going to invest 300-500 k in education millions or billions in r&d
    to get into a business where some government schmuck is going tell you how to do your job and how much you can make doing it.Sorry sick folks I don't think so.

  3. #3
    If Obamacare is fully implemented the quality and quantity of health care is going to nosedive.
    If you're a bright young kid who wants to be a doctor or a research scientist or a developer of medical technology are you going to invest 300-500 k in education millions or billions in r&d
    to get into a business where some government schmuck is going tell you how to do your job and how much you can make doing it.Sorry sick folks I don't think so.

  4. #4
    Quote Originally Posted by ctoom91 View Post
    If Obamacare is fully implemented the quality and quantity of health care is going to nosedive.
    If you're a bright young kid who wants to be a doctor or a research scientist or a developer of medical technology are you going to invest 300-500 k in education millions or billions in r&d
    to get into a business where some government schmuck is going tell you how to do your job and how much you can make doing it.Sorry sick folks I don't think so.
    And the alternative to ACA is???????? I certainly dont have the answer. Imagine if the gop really cared about the people and came to the table with ideas that benifit all Americans and just the wealthy corporations. Corporations are not people my friend.
    "I'm manic as hell-
    But I'm goin' strong-
    Left my meds on the sink again-
    My head will be racing by lunchtime"

    <----Scott Weiland---->

  5. #5
    Quote Originally Posted by ineedmyelin View Post
    And the alternative to ACA is???????? I certainly dont have the answer. Imagine if the gop really cared about the people and came to the table with ideas that benifit all Americans and just the wealthy corporations. Corporations are not people my friend.

    Romney has stated he would like to redo it and keep the pre existing in it as well as boehner. He talked about litigation clause and free over the state line compitition for insurance companies.

  6. #6
    Senior Member lunasicc42's Avatar
    Join Date
    Oct 2004
    Location
    Lutz, Fl USA*********C456
    Posts
    2,334
    corporations are not people? What are they made up of?
    "That's not smog! It's SMUG!! " - randy marsh, southpark

    "what???? , you don't 'all' wear a poop sac?.... DAMNIT BONNIE, YOU LIED TO ME ABOUT THE POOP SAC!!!! "


    2010 SCINet Clinical Trial Support Squad Member
    Please join me and donate a dollar a day at http://justadollarplease.org and copy and paste this message to the bottom of your signature

  7. #7
    Quote Originally Posted by lunasicc42 View Post
    corporations are not people? What are they made up of?
    What do you mean?

  8. #8
    Senior Member lunasicc42's Avatar
    Join Date
    Oct 2004
    Location
    Lutz, Fl USA*********C456
    Posts
    2,334
    I mean that in the end, corporations ARE people
    "That's not smog! It's SMUG!! " - randy marsh, southpark

    "what???? , you don't 'all' wear a poop sac?.... DAMNIT BONNIE, YOU LIED TO ME ABOUT THE POOP SAC!!!! "


    2010 SCINet Clinical Trial Support Squad Member
    Please join me and donate a dollar a day at http://justadollarplease.org and copy and paste this message to the bottom of your signature

  9. #9
    When President Obama was selling health reform, he often talked about providing universal coverage. But a Congressional Budget Office report out this week finds that goal getting more elusive.
    The report found that despite ObamaCare's $1.2 trillion price tag, it would only cut the ranks of the uninsured in half, leaving 30 million without coverage. That's seven million more uninsured than the CBO first projected in March 2010.
    The latest downgrade comes in the wake of the Supreme Court ruling, which gave states the freedom to reject ObamaCare's massive expansion of Medicaid. Since then, governors in more than 25 states have said they will refuse to expand Medicaid or are leaning in that direction, despite the generous federal contributions.
    But the uninsured problem under ObamaCare could be much worse than the CBO projects.
    What the report doesn't cover is the fact that the other legs of the ObamaCare stool designed to expand insurance coverage — the individual mandate, the employer mandate and the state insurance exchanges — are also buckling.
    As a result, ObamaCare will likely cover far fewer uninsured than advertised. There's even a chance that, if all goes wrong, it could actually make the uninsured problem worse.
    The individual mandate, for example, is a cornerstone of ObamaCare's effort to expand coverage. But tax experts who've studied how the IRS will enforce the mandate conclude that it's likely to be ineffective, because the law makes it virtually impossible for the IRS to collect the tax penalty from those who don't pay it.
    Under normal circumstances, the IRS has broad powers to collect taxes from those who don't pay what they owe. It can charge civil and criminal penalties, impose liens, and seize assets and bank accounts.
    But ObamaCare specifically blocks the IRS from using these enforcement tools when it comes to collecting any unpaid ObamaCare tax penalties.
    These restrictions "make it unlikely the IRS can effectively enforce the individual mandate," according to a detailed analysis of the tax penalty by Jordan Barry and Bryan Camp, law professors at the University of San Diego and Texas Tech University, respectively.
    "The individual mandate," they conclude, "may not actually be mandatory after all."
    The problem is that if the mandate doesn't work, ObamaCare could make the uninsured problem worse, at least in the individual insurance market.
    That's because ObamaCare's insurance market reforms — called "guaranteed issue" and "community rating" — force insurers to cover anyone, regardless of their health status, while forbidding them from charging the sick more than the healthy.
    ObamaCare's designers knew that without an effective individual mandate, these market reforms could cause a "death spiral" as healthy people dropped coverage knowing they could get it — guaranteed — whenever they got sick. This death spiral, in fact, is just what happened in states that tried those market reforms without imposing a mandate.
    ObamaCare backers say that generous subsidies offered through the ObamaCare "exchanges" will more than make up for a neutered mandate.
    But Obama's solicitor general, Donald Verrilli, admitted before the Supreme Court that without an effective individual mandate, "guaranteed issue and community rating will, as the experience in the states showed, make matters worse, not better. There will be fewer people covered; it will cost more."
    In addition to problems with the individual mandate, there are increasing concerns about the effectiveness of the employer mandate at maintaining the employer-based system of coverage, through which 154 million get insurance.
    Studies consistently predict that around four million people will lose workplace coverage as a result of ObamaCare, despite the fines imposed on businesses that don't offer insurance. But the most recent analysis from the Congressional Budget Office says the number could be as high as 20 million.
    And a study out this week by Deloitte finds that almost one in 10 businesses expect to drop coverage, with another 10% saying they weren't sure. A 2011 McKinsey & Co. survey found that 30% of companies "definitely or probably" would drop health benefits under ObamaCare.
    Finally, there's a potentially fatal flaw in ObamaCare's insurance exchanges, which are designed to let individuals pick from a variety of government-approved health plans and get subsidies if their incomes are below certain levels.
    As written, the law only allows state-run exchanges to offer subsidies, according to an analysis by Jonathan Adler and Michael Cannon published by Case Western Reserve University School of Law. Federally run exchanges, they concluded, aren't allowed to.
    If federal exchanges can't provide subsidies, that would dramatically undermine ObamaCare's efforts to cover the uninsured, since as many as half the states might leave it to the feds to set up their exchanges.
    The lack of subsidies at federally run exchanges would mean far fewer could afford coverage. The CBO expects 25 million to join the exchanges, assuming all of them can offer subsidies to the 80% who would be eligible. It would also mean that businesses in those states would be exempt from the employer mandate.

    Under the law, that mandate only kicks in if an employee is eligible for subsidized coverage through an exchange.
    As a result, the "mandate is effectively unenforceable in states that decline to create an exchange," Adler and Cannon conclude.
    To be sure, the topic is the subject of fierce debate, and the IRS has written rules assuming federal exchanges can offer subsidies.
    Whether all these worst-case scenarios actually come to pass is impossible to predict. States could all decide to expand Medicaid, people might respond to the mandate even without IRS enforcement, businesses could end up keeping their insurance benefits, and courts could decide that the federal ex

    http://news.investors.com/articlepri...uninsured.aspx

  10. #10
    Quote Originally Posted by TheRainman View Post
    Romney has stated he would like to redo it and keep the pre existing in it as well as boehner. He talked about litigation clause and free over the state line compitition for insurance companies.
    Also the reinstatement of tax deductible medical savings plans,allowing private groups form their own co-ops to purchase group insurance.For example the Elks,K of C,trade organizations
    could use the power of their numbers to by cheaper insurance.High deductible catastrophic
    care plans for young people.If you're single and healthy and live in states like NY,NJ or CAL you're forced to buy all kinds of services you may not want or need.Drug rehab,abortion even
    podiatry ffs.When the govt.begins to ration care and they will have to ration care to do all they want to do the elderly,severely disabled(us) and people with advanced disease are going
    to pay the price for this monstrosity.The ideas are out there they just don't get a lot of airplay.

Similar Threads

  1. Health Care Reform
    By Vike in forum Funding, Legislation, & Advocacy
    Replies: 0
    Last Post: 09-03-2009, 05:13 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •