Tuesday, January 31, 2012
Senator Marco Rubio of Florida has intoduced a bill that would repeal a provision that requires certain religiously affiliated organizations to offer health plans that include co-pay free contraception.
In the actual text of the bill, Rubio and his staff used some rather what I would refer to as inappropriate language better left for a speech or press release, not the text of a major piece of legislation up for debate. Leaving that aside and just talking about the merits of the objection, this proposal just leaves me scratching my head.
The provision included in the rule promulgated by the Department of Health and Human Services leaves an exemption for churches and other places of worship so as to avoid a conflict of religious freedom. The provision does not exempt many religiously affiliated institutions however, such as schools (post-secondary), hospitals, and other organizations with a religious affiliation. This would mean that large employers who in many cases control significant pluralities if not majorities of labor markets in certain geographic areas could control access to contraceptives at affordable rates, leaving women without options to seek these drugs.
I find this very troubling. So, a hospital, who probably gets a significant portion of its revenue from fedeeral or state budgets in both clinical dollars and support for researchers, as well as in many cases tax-exempt status, could then choose not to offer basic contraceptive products as part of their health plan, which is a fundamental aspect of women's health? Maybe if these institutions want to write their own rules, we should cut of funding for them and see how well they respond.
It is amazing to me how ridiculous this bill is. It is one thing to allow a Church to decide what it gives its employees based on some supposed moral teaching. It is another to allow a large employer who has significant market share of the employment market in certain geographic areas to do the same. Especially when they are all to eager to suck on the government teet themselves.
Religious organizations and religious people cannot claim persecution and discrimination every time government does something without thinking about the actual consequences and realities of of their actions. In this case, they won--with exemptions for churches and other places of worship. What they ask for now is simply too much.
As I sit with my glass(es) of wine and my MSNBC Florida election returns on in the background, I cannot help but marvel at the absolute stupidity of the Republican party and this circus of a primary.
Let's remember what we have seen over the last few months:
1) Donald Trump led the polls. Donald Trump. I cannot make a joke about this beyond saying, Donald Trump.
2) Then came Michelle Bachman, the walking talking point about something she did in Congress that never actually happened. This is a woman who takes anything that she hears on the streets and uses it the next day as political fodder, as evidenced by her ridiculous and quite dangerous assertion that the HPV vaccine causes mental retardation. Verbal diarrhea.
3) Oh Rick Perry. We had such high hopes for you! But you smiled at the number of people you killed on death row as governor, compared gays serving in the military to the assault of secularism on Christianity, and couldn't count to three. So so sorry.
4) Herman Cain. The walking pizza jingle! "9-9-9 and feeling fine!". That's all I have to say.
5) Ricky Santorum. At least your kids are all growed up and aren't sobbing on television anymore. But you thought about gay people more than, well, gay people and that is just creepy. Plus, you lost your last election by 18 points. That's not very good.
6) Newt and Mitt. The final two. One thinks if you don't agree with him, you are envious. And the other one thinks if you don't agree with him, you are a radical Kenyan colonialist (still not sure what that means). These two are absolutely destroying each other's chance to win in November. They have abandoned the issues and have decided to engage in purely character attacks that are simply doing Obama's dirty work for him. This race is going on after tonight. Likely for some time.
The longer these attacks go on and the fundamental shift away from what truly are significant policy differences, the probability of an Obama reelection simply grows. Protracted primaries are fine, when the attacks and debates are centered on the issues (see Obama v. Clinton in 2008). But when the attacks are centered on character and personal lives, and the rhetoric, well, spiteful, the process only hurts. Of course as an Obama supporter, I welcome that prospect. But as an American, I can only fear what American democracy has become.
Monday, January 30, 2012
I don't really like to talk about my job outside of work, because well, it is work. But my passion for what I do sometimes bleeds over when people ask me about healthcare in day to day conversation. Especially when people ask, "What is wrong with our healthcare system?".
I am not a doctor. I am not a nurse. I have never worked in a hospital. But I do understand the organizational dynamics of the healthcare delivery system, and the way that system is paid for, from both a public and private (commercial) perspective. I also understand the (sometimes unfortunate) politics of healthcare. Those three things combined--the way healthcare is delivered (ie. how you as a consumer of healthcare interacts with the system), how it is paid for (public and private insurance), and politics tell us all we need to know about why our healthcare system doesn't work so well (or to use my term, sucks quite a bit). The fact is we don't actually have a healthcare system. Rather, we have a highly sophisticated, technologically advanced, fragmented, and expensive disease management system. It isn't Obamacare...it's ObamaDiseaseManagememt.
Three comments. First, on how healthcare is delivered: in pieces. You see "the doctor", you may be a PCP, a cardiologist, a surgeon, or an ER doctor. You never see a "team" when you interact with the healthcare system. If you happen to be relatively healthy, and perhaps see your PCP once year and the occasional specialist, this is quite fine. The system works relatively well for people like you. But if you suffer from multiple chronic conditions, or have a serious specific episodic illness for which you see multiple providers, this system is absolute hell. The infrastructure of healthcare was not set up to allow for coordination, and communication between the different people who care for you. Your endocrinologist has no idea what your cardiologist is doing, and because you use two different pharmacies, pharmacists cannot reconcile medication properly to ensure you are not in danger. Breakdowns in communication and a lack of transparency across the set of providers you interact with creates redundant and/or unnecessary treatments that not constitute 50-60% of the healthcare costs that plague our country, and also put you at greater risk of complications or death.
Second, how we pay for healthcare: By volume. Let's say you develop CAD (coronary artery disease), and require a catheter or stent to be placed into an artery to free up the blood flow to prevent a heart attack. A cardiologist (depending on who is paying) can be reimbursed up to $15,000 for about 20 minutes of their time on this procedure. Now let's say that 5 years earlier, your cardiologist spent 1-2 hours with you after noticing some early warning signs of a problem-increased weight, hypertension, elevated cholesterol-and began to lay out a proactive plan to help eliminate your symptoms. She may refer you to a nutritionist to help you map out a healthier diet, refer you to an exercise therapist to help you develop an exercise plan to get you cardiovascular system back in shape, and provide ongoing monitoring/evaluation be a nurse and the team of nutritionist and exercise physiologist to get you into shape, your BP and cholesterol down, and prevent the development of plaque in your arteries and the need for the stent. That cardiologist maybe would have made $100 to go through all of that. What is worse--take the cost of that plan I laid out--ongoing monitoring by a nurse and referall to a team of nutritionists and exercise physiologists to help manage the problem and prevent it from worsening--may cost a a couple hundred bucks initially until the patient can learn to manage on their own, only checking in from time to time. Compare that cost to the average heart attack: $50,000. Seems irrational to pay for the latter, and not the former. But that is what we do.
We pay to fix things, not prevent them from breaking. We have spent trillions of public and private dollars over the last 100 years on medical innovation for the treatment of disease and only a fraction of that on strategies and programs that create the economic incentive to prevent problems from happening. We get what we pay for.
Third: Politics. Republicans, mandating individuals to have health insurance and incensing them to see a primary care doctor once a year is not Marxism, or Socialism, or even Fascism. It is common sense, not just morally, but also economically. Making sure that schools serve healthy foods is not a nanny state, it is working to prevent obesity and diabetes, which constitute $147Billion annually and $174Billion annually in healthcare (unnecessary) spending respectivley. Democrats, health insurance companies are not (all) evil, and most have just as strong of an incentive to work to reduce costs as you do. The free market system is not the cause of the health care crisis we face, and socialized medicine is not in itself the solution. Calm down, every one.
The solution is a system that first incentivizes the right kind of behavior. For doctors and other providers, this means paying for lengthy consultation with patients to drill down to the root causes of problems before they become crises. It means allowing them to coordinate with other doctors when patients have to see multiple people to prevent unnecessary and redundant care. It means prevention programs, education, and patient engagement and empowerment. For patients, it means economic incentives to take care of them selves. Lower premiums for maintaining a healthy weight and blood pressure, incentives to join fitness studios, shorter work hours, and other stress reducing actions.
We then have to pay for it in the right way (actually, this part should come first). We need a payment system that realizes that moderate investments in health upfront, prevents major costs down the road. Focusing on prevention, health education, nutrition and other safe behaviors are proven ways to reduce health expenditures down the road. We cannot continue to rely on a system that simply pays people to fix other people's problems. We need to pay people to help prevent those problems.
It is the ONLY way.
Wednesday, November 23, 2011
Too much time off. New job, new place to live. New everything.
So,I will be back blogging now.
I took a job as a Project Manager and Policy guy at a think tank here in DC. It is truly a dream come true I must say. I work on healthcare, and healthcare reform implementation specifically. That said, forgive what may be a focus on healthcare policy in the blog.
It's Thanksgiving and there is a lot to be thankful for. A great family, an amazing career, the best group of friends (DC and otherwise) that anyone could ask for, and an election season that is already living up to my expectations :).
I will start posting more regularly tomorrow, but consider this another welcome back!
Monday, June 27, 2011
"You get to the point where you evolve in your life where everything isn't black and white, good and bad, and you try to do the right thing. You might not like that. You might be very cynical about that. Well, fuck it, I don't care what you think. I'm trying to do the right thing. I'm tired of Republican-Democrat politics. They can take the job and shove it. I come from a blue-collar background. I'm trying to do the right thing, and that's where I'm going with this." Roy McDonald, (R-NY)
The above quote speaks volumes about where many people in this country have arrived on the issue of same-sex marriage. Many have come to the conclusion that Roy came to as a key player in the New York debate over the legalization of same-sex marriage. That conclusion is rather simple: Unless you are seeking to marry your same sex partner, the issue of same-sex marriage is a complete non-issue. And the litany list of “outs” provided by the anti-same-sex marriage lobby as to why you should oppose it has run its course. It is dry. It has failed.
I think what Roy was getting at with his rather blunt but truly heartfelt quote about the issue is similar to one of the central realities around which I try and center my life. We share one thing and one thing only with each and every person on this planet: we are human. It sounds so basic, but through humanity comes a number of unique elements that bind each of us together. One of those basic elements is indeed marriage. Perhaps it did not always go by that term, or bring with it the litany of legal elements that exists today, but there has always been a human desire to share with another all that we are fully and completely. We have a desire to share our goals, our passions, our experiences, our very lives with someone else who can help us be all that we can be. That is what separates us from other creatures. That is a fundamental element of humanity.
To deny someone that right – the public acknowledgement of that basic human desire and right is simply unacceptable anymore. It is saying to two people that they are not worthy enough to share in one of the most fundamental things that make us human. How can we as a nation claim to be a nation that stands for civil rights and the rights that are given to mankind from God when we say to a group of individuals that for a reason they cannot control, they are denied the right to fully be human? The truth is we cannot. We will never be a nation or society that truly understands what it means to be human as long as we publically and legally keep others from having the right to publically engage in that simple act of sharing oneself completely and openly with another, regardless of who they choose to do it with.
New York took a giant step forward this past week and it came only with the brave voices of people like Roy, who stood not for politics, not for party, but for humanity. It was the winner of the day on Friday. And the march moves on from there. To new states and new challenges. But I fundamentally believe that as long as those who champion this cause keep in their heart that fundamental aspect of what it means to be human, we cannot be stopped.