A few words mustered on AHCA

A few words mustered on AHCA

I want to credit the journalists, academics, and my fellow healthcare providers who continue to write in this inhospitable-to-truths environment. I don’t know how you do it.

I’m hotter than a billy goat in a pepper patch. I can’t put it together. I can barely speak.

On this blog I’ve made the turn from facts to feelings in the last 100+ days, likely because facts seem to have suffered a fatal blow in this unrecognizable version of the world.

Here’s my feeling: I just left CancerCon (post in process), a group of many hundred sparkling, talented, mutually supportive young adults with cancer. Every last one of them contributing and (this is my bottom line) not any less human than before they got sick. THROUGH NO FAULT OF THEIR OWN. I’m one of those hundreds.

The Affordable Care Act was my civil rights legislation. Its “replacement” is the repeal of my and my legion of patients hard fought and nightly worried over civil rights. To adequate care. To freedom from unnecessary physical suffering and premature death and disability. Freedom from fear of sinking ourselves and those who love us into destitution to pay for our care. That’s all I have for now.

Am I less than my healthy counterpart? Is my humanity so easily disregarded by my country?

Advertisements

Last week in health care

Last week in health care

As far as health news for Americans last week was, much like a circus fire, INTENSE. Here in the Capital “Thunder” Dome there was the braying of donkeys, the stampeding of elephants, the crunching sound of every member of the health care community beating their skulls against the walls, and the immense heat of electronic devices tripping breakers over and over as the grid (and I, via bourbon) experienced rolling blackouts.

I stayed up late and got up early and skipped all my meals in an attempt to stay current, but unlike our president I will not make assertions that that means I’m functioning. Hm, maybe he’s just tired and cranky?

Things of importance from this week:

#1 Healthcare Triage short video on understanding the AHCA. You can see that Aaron Carroll is about 85% of the way to his breaking point here. And good god there were still two more days to go in the week.

#2 Paul Ryan shows he’s a bit shaky on what insurance is (we all pay for fire insurance so that if you have the terrible fortune of your house catching on fire, you are not financially devastated). BUT MR. RYAN WHY SHOULD I BUY FIRE INSURANCE WHEN MY HOUSE IS NOT AT PRESENT ON FIRE?

#2 Emma Sandoe, quickly becoming my favorite voice on the internet, expert in Medicaid, with this tweet (Poor people were once human people like me? No…)

https://twitter.com/emma_sandoe/status/839877905882759168

#3 In response to the question: what mandates do the Republicans object to? “Men paying for prenatal care.” Buh..uh..wha..wait. Since no man has ever been born or engaged in an act that might conceive a child.

#4 The AMA, ANA, AHA, and any lobbying association representing direct patient care declare the American Health Care Act to be one hot unsustainable mess. For the uninitiated, this is lions laying with lambs stuff. The orgs are not friends, and we seem to be arguing into a void at this point.

#5 The Washington Post editorial section posts a satire that would make Alexander Pope holler “SWEET BURN” in his grave. Per the Dems response to the AHCA:

“Mr. Gorbachev,” as Reagan so stirringly said, “This wall desperately needs revision.”

#6 Our collective desire to continue living is affirmed by a BBC Asia expert in his home office in Korea when his children pull back that hollow-core door veneer that keeps us believing that what we say and do is suit-and-tie worthy and crucial to the survival of humanity. From his IDAF toddler in her you’re-not-going-to-miss-this-dance yellow shirt to the younger sibling in the most successful comedy vehicle since the American Pie movies. It had to be the mom, btw. That was a woman bolting off the toilet to save her family.

Cheers to this week! Hope you’re well rested.

 

Insurers Can Reduce Drug Prices, If Policymakers Let Them…

Insurers Can Reduce Drug Prices, If Policymakers Let Them…

Source: Insurers Can Reduce Drug Prices, If Policymakers Let Them

Wading into the waters of prescription drug pricing. Interesting article, but I’ve got some counterpoints. Health consumers are not the same as, say, durable goods consumers. You want a kitchen remodel, but you won’t unexpectedly wake up in a home store having purchased a Viking range. God forbid you pass out at the home store and wake up having blown a kitchen’s worth of cash on a high dollar antibiotic to treat your MDRO infection. Apply capitalist principles sparingly.

As a patient who had the unfortunate occasion to met her max-out-of-pocket ($6000) after a cancer diagnosis, I want to keep policies that limit an individual’s financial liability should something devastating happen to their health. Even with that protection I was a hair’s breadth from becoming a medical bankruptcy statistic.

We also need the policy that mandates insurers cover drugs that fall into six therapeutic classes: “anti-retrovirals; immunosuppressants when used for organ rejection; anti-depressants; anti-psychotics; anti-convulsant agents; and anti-neoplastics.” BTW, this began as Bush II era Medicare Part D policy.

As far as physicians making a percentage of the cost of drugs administered in their offices, I agree with the author; Conflict of interest much?

I disagree with the author’s concluding statement that insurers must have the ability to restrict access to drugs in order to negotiate lower prices. Patients dying for lack of lifesaving drugs is a thing we should happily put in the past. Regulating the pricing and equitable access mechanisms of the pharma industry (similar to insurance companies and health care providers) would be a more righteous path.

I know, easy for me to say.

Also, the check the author’s note: Dr. Howard has received grant support from Pfizer, Inc. Gotta love those disclosures.

United States Health Care Reform:  Progress to Date and Next Steps | JAMA | JAMA Network

United States Health Care Reform:  Progress to Date and Next Steps | JAMA | JAMA Network

The president got published in JAMA! This is a lovely, academic, chock-full-of line graphs sum up of the past 6 years of changes. Uninsured rates are way down, access and quality measures improving. The economy has responded positively. The health care world is topsy-turvy, and it is undeniably rough in the ranks of hospital management. But in spite of the challenges to the health care industry, the protections that the Affordable Care Act legislation provided make me as a believer in health care as a human right happy. And very frustrated with my home state and others that have declined to expand Medicaid.

It’s strange and sad that I celebrated the upholding of the ACA in the office of a Free Clinic where I volunteered, thinking it might be the end of clinics covering adults below the federal poverty level with a patchwork of volunteer services, state funds, and grants. I’m sorry that virtually nothing has changed for the patients we saw at that clinic. Hospitals in non-expansion states are still going uncompensated for millions of dollars of care. The federal government DSH (disproportionate share hospital) dollars that used to support public hospitals with large numbers of uninsured have declined as that money was plowed into ACA program support. One last insult: if you are paying federal taxes in a non-expansion state, your money is fed into Medicaid for adults in other states, while your health infrastructure is starving. But that is not the main focus of the article. This is a celebration. A statistically-backed victory lap. But don’t take my word, listen to Barack Obama, JD:

The United States’ high uninsured rate had negative consequences for uninsured Americans, who experienced greater financial insecurity, barriers to care, and odds of poor health and preventable death; for the health care system, which was burdened with billions of dollars in uncompensated care; and for the US economy, which suffered, for example, because workers were concerned about joining the ranks of the uninsured if they sought additional education or started a business.

Source: United States Health Care Reform:  Progress to Date and Next Steps | JAMA | JAMA Network

Guns and public health

Firearm deaths are driven principally by availability of firearms. While frequently after these events we link them to mental illness, the evidence is very clear that this is a negligible part of the problem. People with mental illness are much more likely to be victims than perpetrators of firearm violence.

–Sandra Galea, Dean at the School of Public Health at Boston University

Scientific American: Gun researchers say Orlando is a public health emergency

Why the cops don’t get called for campus sexual assaults.

Why the cops don’t get called for campus sexual assaults.

How does it make sense that universities are responsible for adjudicating sexual assaults on campus? Well, Title IX and US Supreme Court rulings dating back to the 1970s. Read the article, it explains the why and makes clear just how short UVA and others are coming up in complying with the mandate. Ugh.

via No, We Can’t Just Leave College Sexual Assault to the Police – Alexandra Brodsky and Elizabeth Deutsch – POLITICO Magazine.

What Alexander helped to establish, then, is that campus rape is not just a crime but also an impediment to a continued education—and to subsequent success in the workplace and public life. That means that Title IX’s protections are necessary for an individual student’s learning opportunities and for gender equality throughout American life. If sexual violence goes unaddressed at universities, women will face unconscionable obstacles to education, professional success and full citizenship.

 

Between Two Lives – Features – Fall 2014 – Johns Hopkins Public Health Magazine

Between Two Lives – Features – Fall 2014 – Johns Hopkins Public Health Magazine

via Between Two Lives – Features – Fall 2014 – Johns Hopkins Public Health Magazine.

Does fleeing family violence and the nation with the world’s highest murder rate qualify Wilter as a refugee?

Though it’s been bobbing in and out of the news cycle, there is still a Central American migrant crisis. I got into the weeds on immigration policy, then deleted it all because jeez it may be the one thing more complicated than health policy. For reference: UNHCR definition of refugee, US Citizen and Immigration Services definition of refugee.

But this current event is germane to public health. By not having a comprehensive policy in place we are unable to mobilize resources to address the health and safety needs of a large group of immigrants, mostly children. The humane thing to do would be to accept and give the best care we can possible to these refugees. At bare minimum, to protect our native population we should ensure screening for infectious diseases (TB, measles, mumps, rubella, Hep A-C, pertussis), treatment, and vaccinations.

If you have the time and the inclination to have your heart broken, watch the film Sin Nombre. It was done more than five years ago and is of course fiction, but by all accounts captures the migrant journey well. What keeps me up at night is thinking of what home must be like if this voyage is the better option.