My colleagues at Doctors for America have collected 10,000 signatures on a very simple petition:
Declaration to America’s Politicians
We, the undersigned, demand our politicians put Patients Over Politics. We must work together to build on the Affordable Care Act with further reforms and commit to a future where everyone can get health care when they need it.
We believe in an America where everyone has quality, affordable health care and where doctors and the public work together to build a health care system that works for all.
We took a critical first step toward this vision when we passed the Affordable Care Act, a law supported by the largest physician organizations in the country. We must now ensure the Affordable Care Act is implemented so millions of Americans can realize the full promise of the law.
Among those 10,000 signers, one finds some of America’s most distinguished leaders in academic medicine and public health, award-winning health economists, clinicians, and health services researchers. Oh yeah. I’m on there, too.
| Donald Berwick, MD MPP
Former Administrator, Center for Medicare and Medicaid Services Howard Hiatt, MD Former Dean, Harvard School of Public Health Jonathan Gruber, PhD Professor of Economics David Cutler, PhD Otto Eckstein Professor of Applied Economics Linda Rosenstock, MD, MPH Dean Emeritus, UCLA School of Public Health Paul Cleary, PhD Dean, Yale School of Public Health Jack Lewin, MD Former CEO, American College of Cardiology Lori Heim, MD Past President Cedric Bright, MD FACP 112th President, National Medical Association Morris Brown, MD Chair Elect, National Medical Association Nancy Oriol, MD Dean of Students, Harvard Medical School Irwin Redlener, MD Clinical Professor, Mailman School of Public Health Linda Fried, MD, MPH Dean, Columbia University Mailman School of Public Health Greg Evans, MPH, PhD Dean, Georgia Southern College of Public Health Donald Burke, MD Dean, University of Pittsburgh Graduate School of Public Health Eli Adashi, MD, MS Immediate Past Dean of Medicine and Biological Sciences, Brown University Harry Selker, MD Dean, Tufts Clinical and Translational Science Institute Mark Henderson, MD Associate Dean Molly Cooke, MD William G. Irwin Endowed Chair Jeffrey Levi, PhD Executive Director, Trust for America’s Health Ned Helms, MA Director, New Hampshire Institute for Policy and Practice Valerie Brown County Supervisor, Sonoma County, California Judy Norsigian Executive Director, Our Body, Ourselves Norbert Goldfield, MD Medical Director Jonathan Oberlander, PhD, MD Professor of Social Medicine and Health Policy & Management Peter Ubel, MD John O. Blackburn Professor of Marketing Sara Rosenbaum, JD Harold and Jane Hirsh Professor Kenneth Warner, PhD, MPhil Avedis Donabedian Distinguished University Professor of Public Health Lawrence P. Casalino, MD PhD Livingston Farrand Associate Professor of Public Health Elizabeth Wiley, MD, JD, MPH President, American Medical Student Association Terry O’Neill, JD President, National Organization for Women Joanne Tosti-Vasey, PhD National Board Member, National Organization for Women Brian Moench, MD President, Utah Physicians for a Healthy Environment Cynthia Cross, MD Medical Director, LeBonheur Children’s Hospital Bill Bentley, MSW President and CEO, Voices for America’s Children Steve Ondra, MD Senior Vice President and Chief Medical Officer Vineet Arora, MD, MPP Assistant Dean for Scholarship and Discovery S. Balasubramaniam, MD Past President, American Association of Physicians of Indian Origin Joel Alpert, MD Assistant Dean and Professor Emeritus, Boston University Robert Keimowitz, MD Former Dean, George Washington School of Medicine Paul V. Holland, MD Past President of the International Society of Blood Transfusion Dan Morhaim, MD Maryland State Delegate Jan Tillisch, MD Executive Vice Chairman Nancy Berliner, MD Chief, Division of Hematology Nilesh Kalyanaraman, MD Vice President of Medicial Affairs Olveen Carrasquillo, MD Chief, General Medicine Patrick Lee, MD Director, Global Primary Care Program Paul Sinkhorn, MD Vice-Chairman, Women’s Health Paul Moulinie, MD Chief of Cardiology Peter DeGolia, MD Director of Geriatric Medicine Philip Pollner, MD Chair, Delaware Alliance for Health Care Randy Wertheimer, MD Chair of Family Medicine Robert Hatch, MD MPH Professor and Director of Medical Student Education Scott Corlew, MD MPH Chief Medical Officer Susan Spalding, MD Medical Director Tom Ellison, MD PhD Medical Services Director Tory Meyer, MD Division Chief, Pediatric Surgery Warren Matthews, MD Chairman, Department of Family Medicine Richard Harvey, MD Chief Public Health Officer, Alpine County, California Spencer King, MD MACC Past President of the American College of Cardiology Ralph Brindis, MD, MPH, FACC Past President of the American College of Cardiology |
David Feinberg, MD, MBA
CEO and President JudyAnn Bigby, MD Massachusetts Secretary of Health and Human Services Kimberlydawn Wisdom, MD, MS Former Surgeon General, State of Michigan Gilbert Omenn, MD, PhD Former Dean, School of Public Health at University of Washington Robert S. Lawrence, MD Center for a Livable Future Professor Timothy Jost, JD Robert L. Willett Family Professor of Law Len Nichols, PhD, MS, MA Director, Center for Health Policy Research and Ethics Michael Grossman, PhD Distinguished Professor of Economics Philip Nasca, MA, PhD Dean of the School of Public Health Randall P. Ellis, MS, PhD Professor of Economics, Boston University Harold Pollack, PhD Helen Ross Professor at the School of Social Service Administration Howard Forman, MD, MBA Director of the MD / MBA Program Vivian Ho, PhD James A. Baker III Institute Chair in Health Economics Peter Van de Water, PhD Senior Fellow, Center for Budget and Policy Priorities Alan Monheit, PhD Professor of Economics L. Toni Lewis, MD International Vice President, Service Employees International Union Desmond Runyan, MD, DrPH Jack and Viki Thompson Professor of Pediatrics James P. Evans, MD, PhD Bryson Distinguished Professor of Genetics and Medicine Don Mathis President and CEO, Community Action Partnership Kathy Majzoub, BSN, MA Northeast Director of Prevent Blindness America Joseph Majzoub, MD Chairman, Division of Endocrinology Barbara Otto CEO, Health Disability Advocates Juanita Lynn Taylor, MD Chief of Child and Adolescent Psychiatry Warren Siegel, MD, MBA Chairman, Department of Pediatrics, Coney Island Hospital John Wong, MD Chief, Division of Clinical Decision Making Michael Bennick, MD, MA Associate Chief of Medicine Dennis Davidson, MD, PhD, MDiv Past President, American Society of Preventive Cardiology David Bor, MD Chair of Medicine Larry Churchill, PhD Stahlman Chair of Medical Ethics Mark Vrahas, MD Chair of Orthopedic Trauma Laura J. Esserman, MD MBA Director, Carol Franc Buck Breast Care Center Rick Foster, MD Senior VP, Quality and Patient Safety Beverly Neyland, MD Professor and Interim Chair of Pediatrics Col. Katherine Scheirman, MD Former Chief of Medical Operations, Ramstein Air Force Base Gary LeRoy, MD Associate Dean of Student Affairs and Admissions Teresa W. Zryd, MD, MSPH, FAAFP Family Practice Residency Program Director Ann Burke, MD, FAAP Associate Professor of Pediatrics Aaron Waxman, MD, PhD Director, Pulmonary Vascular Disease Program Ajoy Kumar, MD, FAAFP Chair, Department of Family Medicine Anne Fabiny, MD Chief of Geriatrics, Cambridge Health Alliance David Teitel, MD Chief, Division of Pediatric Cardiology Emalee Flaherty, MD Section Head, Child Abuse Pediatrics Gitte Larsen, MD MPH Medical Director of Clinical Quality Improvement Jay Gold, MD, JD, MPH Senior Vice President / Chief Medical Officer Juan Dumois Director, Pediatric Infectious Disease Kathryn Florio, DO Co-Director, Neurocritical Care Kathyrn Brandt, DO MS Chair, Primary Care Keith Rafal, MD, MPH Chief of Rehabilitation and Restorative Care Laura Koenigs, MD Program Director, Pediatric Residency Program Mark Greenberg, MD Division Chief, Community Pediatrics Matthew Levy, MD MPH Division Chief, Community Pediatrics Julian Harris, MD Massachusetts Medicaid Director Nancy Hardt, MD Senior Associate Dean for External Affairs Don Nguyen, MD Director of Pediatric Urology Gregory Hayes, MD MPH Associate Professor of Public Health, Emeritus Jagat Narula, MD PhD Philip J. and Harriet L. Goodhart Professor of Medicine and Cardiology |
If these people truly wanted affordable healthcare for everyone they would be shunning the idea of government involvement. I’ll put it in the language they seem to understand:
Government is not a warm-fuzzy, its jail, war, police, destruction. There is no civilized place for it in healthcare.
Because healthcare is exactly synonymous with jail & war.
Sheesh, and the full moon doesn’t arrive for three more days.
Nor, presumably, in the maintenance of roads, sewers, parks, and schools, the provision of civil courts for the settlement of disputes, the advancement of science, the relief of poverty …
These millionaire doctors ought to put their money where their mouth is and donate. Give a kidney, save a life. It’s easy to support socialized medicine from the inner sanctum of a million dollar home.
The rich worry least about health care. Your logic is severely flawed.
Finally, the professionals respond: quit playing politics with our nation’s health.
All things considered, Medicare has worked well. Not perfect, but well. Mercurus is obviously still working and doesn’t need protection from the high costs of medical care. Reaching Medicare age comes none too soon for many of us who are retired and rely on expensive, poor coverage health insurance policies. Tweak Obamacare, remove the wasteful spending in Medicare and raise our taxes to help retirees and the disabled maintain some dignity in their old age. You too will be old one day.
Thank you for standing up and not only supporting the many people who need affordable care, but for ensuring the stability of our health care system. If people truly understood how dangerous it is to ALL of us. I have insurance, but i have already seen one trauma center shut down near my home. ER’s and trauma centers have to take uninsured people are care for them. Not only is it the law, no moral person could allow someone to die due to being poor. But this puts us all at risk. To those who talk against the affordable care act. It does not matter how rich you are or how well insured you are. If all the trauma centers in your area shut down due to too many uninsured patients, and you get in an accident that requires the services only available at a trauma center, you are going to die due to lack of care, just like the poor people. Weather you like it or not hospitals have to continue to be profitable(or at least not loseing money) to stay open. But with so many uninsured it is getting harder and harder.
The sad truth is the GOP gets more WELFARE than anyone else. MEDICAID is CORPORATE WELFARE. Corporations have an obligation to provide their employees with health care. Instead they rob their employees by keeping them part time, and they depend on Medicaid to provide for the employees and families to cut their costs. If corporations provided insurance for all their employees and families at a reasonable cost, it would cut medicaid by billions. But instead they deny their employees, what they truly have a right to, and force the tax payers like my self to shoulder the cost. That is welfare for the businesses NOT THE PEOPLE. I worked as a Medicaid worker for years. I saw billions of dollars in Medicaid spending going out TO HARD WORKING AMERICANS who worked 1 and sometimes 2 part time min wage jobs. While employers hired two people at part time instead of one at full time, so they would never have to pay insurance and the employees were so poor they had no choice but to apply for assistance. Business just do not want to pay their fair share.
Part time employment is only going to increase when business have to start paying $2,000 per year tax for each full time employee.
The only solution to that is universal health coverage funded through government. It’s the healthcare system that has to be funded, and that only happens when everyone who needs health care is guaranteed to be covered so that health care providers don’t have to hire expensive financial departments to fight insurance companies and collect on bad debts.
Companies have to pay the cost of their labor, not shift that cost off to the workers themselves the way Walmart does. They are either going to have to pay for health care insurance for their employees or pay a tax to cover the health care costs. Since buying the private insurance means also paying taxes to cover the uninsured while having large sums siphoned off for insurance company executives and investors to waste, the private insurance system will always be more expensive and much less efficient in financing health care delivery.
The core problem is, in fact, not providing health care to individuals. The core problem is funding the overall system of health care providers on a regular, routine and profitable basis. Private insurance will always skim the most profitable clients off and leave the most expensive patients to die.
Anyone who thinks there is nothing new to be done in managing the delivery of health care needs to look at the Pioneer Accountable Care Organizations which have been initiated by the Centers for Medicare and Medicaid (CMS) under the auspices of the Affordable Care Act. These are 32 organizations established across the nation to propose and test new ways to deliver health care across multiple providers and coordinate the care so that patients get the care they need instead of being artificially cut off (released from the hospital early to save money) or prevented from getting care (Humana recently refused to pay for a cancer patient to be sent to MD Anderson Cancer Care Center in Houston because the care there was too expensive.)
All of the Republican proposals for saving money (HMO’s & PPO’s especiallly) save money by limiting care without regard to the patient outcome. The ACO’s are managed, not by financial managers and insurance companies, but by health care practitioners who are researching best care models of care.
One big difference between the older financial models and the new health care focused models is that any financial rewards from saving money go to health care providers rather than to financial managers and insurance company executives.
This is the kind of initiative that the financial manager Mitt Romney wants to eliminate by repealing the Affordable Care Act. Romney understands financial statements. It’s all he’s ever done. We really, really, really do not want him screwing over our health care delivery.
Rick B:
The very structure of the Shared Savings Program described in 42 U.S.C. 18 raises significant questions as to how patients will fare not the least of which is that it depends upon the Secretary of HHS to establish and monitor standards of care. The ability of CMS to improve the quality of care and its affordability is highly questionable. For proof of this I advise you to read the GAO reports and testimony given concerning CMS’s $8.5 Billion Quality Bonus Payment Program, starting with its March, 2012 report at http://www.gao.gov/products/GAO-12-964T. That demonstration injects $8.5 Billion into Medicare Advantage plans, thereby blunting the cuts that would have been made by the Affordable Care Act in 2012. The bulk of the $8.5 million goes to mediocre Medicare Advantage plans (rated 3 stars), which is why I believe that the demonstration should be titled as the “Demonstration of Nothing.” The demonstration was so severely flawed that in March, 2012 the GAO recommended that it be shut down immediately, a recommendation that was repeated again in July and in September. One explanation for why the demonstration was performed in the first place and continued despite the GAO’s repeated recommendations was to hide the benefit cuts made by the Affordable Care Act to Medicare Advantage plans in 2012 from the 13 million seniors holding these plans. Another explanation is that CMS is willfully incompetent. Whatever explanation you pick, does not inspire confidence that HHS or CMS will do anything for the quality of healthcare or its affordability.
Thanks for the reference. Did you notice this line in it? “CMS stated that the demonstration’s research goal is to test whether a scaled bonus structure leads to larger and faster annual quality improvement for plans at various star rating levels compared with what would have occurred under PPACA.”
The proposed bonus process was a test to determine the effectiveness of the scaled bonus structure. Once gain financial people are trying to use financial incentives to force others to do their bidding, and it’s my opinion that this is not how medicine should be managed. At least saving money or making money should not be the primary goal of delivering health care. This is a test, however, to determine its effectiveness.
Financial people and insurance people should not be running and controlling health care delivery systems. Physicians should. Insurance, finance and the entire accounting system are tools to accomplish the job of providing health care. The large health care delivery systems today are financial systems which exploit health care to make profits. Look at Florida’s Rick Scott. One result of this focus on making profits (by cutting costs) is to restrict medical judgment using arbitrary policies. An example is a policy that says a patient with a given diagnosis must be released from the hospital after a set period. If he then goes to an extended care facility, gets worse and is readmitted to the hospital the cost to the overall medical system is sky high. But the current payment system pays the hospital for two admissions so the hospital makes money - and so did the extended care system. This could have been avoided by simply trusting the judgment of the physician in the first place and not releasing the patient early.
Medicare advantage is a private enterprise boondoggle created in the same 2003 law that created part D of Medicare. Private organizations - usually insurance companies - take over all Medicare reimbursed services. They are organized into regions with no region having fewer than 2 MA plans. By using insurance cost control techniques (HMO, PPO) the MA companies are supposed to have lowered the cost of care to less than that paid directly by Medicare. For this the MA companies received an initial bonus of 13% over the cost of the same care provided by traditional Medicare. The program started in 2006 and the MA companies were supposed to lower costs with two to three years to less than Medicare costs.
Never happened. The MA companies cannot make a profit without a supplement of at least 10% more than Medicare costs. Until CMS was created this kind of boondoggle was not tested, evaluated or reported on. Now it is. And with greater visibility, expect more failures. That is what research is all about - repeated failures until something works. (The authoritarian management of private enterprise makes the managers directly responsible for those failures, so they become successful managers by avoiding transparency and by not measuring success or failure. This is the “freedom” Mitt Romney demands from government. Freedom to never be exposed as a fraud or a failure, and never to have to test the results he promises.)
One last thing about that GAO report. Note where it was sent. To Darryl Issa’s Committee. One thing I will assure you - nothing touched by Darryl Issa will ever reflect positively on President Obama or on the ACA. You can count on that.
What is not communicated about the “affordable” health care act is the fact that many insurance plans that people already have are “grandfathered” in, meaning they do not have to comply with the new regulations of the plan. In this way, your policy premiums go up and coverage is even more limited than it was before. When inquiries are made of insurance companies about what other little issues may come up, they have NO idea. The response? Contact your government representatives.
Obamacare is not the answer. The problem is no one has the guts to stand up and actually make the changes that can be made in fear of losing a vote.
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