Wednesday, May 30, 2012

Hump Day Already?

Big appeal hearing this afternoon -- a young girl with reactive attachment disorder with multiple psychotic breaks and her insurance company doesn't think she needed inpatient treatment, even after she was arrested and after more conservative treatment failed.  Unreal, the world I live in.  Let's see if the news gives us any larger perspective.

I have to put this first even though it's only a small trend right now.  A new program called Hospital at Home for patients with complex chronic illnesses who prefer to remain home when they need more intensive treatment.   What a great prospect for patients, being able to receive the treatment they need without hospitalization.  Of course, the hurdle is Medicare and insurance companies.  I have to think, though, that when such a program is set up right, it may actually save money.  In any event, innovation in care delivery is essential if we are going to figure out how to reform health care in America -- so I think we should be trying anything that makes sense to see how it works.  And insurers and Medicare should support such innovation.

Conservatives are campaigning against health insurance exchanges.   Now, let's look at this.  The exchanges are where people will be able to go to comparison shop for health insurance.  For each plan, there will be a summary of benefits and coverage in an identical format, allowing  side-by-side comparisons.  Every plan will have to contain "essential health benefits," and this is estimated to require the beefing up of about 50% of individual plans.  Who's against these common sense, consumer oriented reforms?  The Cato Institute and ALEC.  You know ALEC -- the conservative group that's been losing supporters (retailers like Amazon, for example) as they've been exposed as a tool of the GOP?  Exchanges in and of themselves are not controversial.  How is it not better for consumers to be able to make more informed choices when they buy insurance?  But the exchanges are one of the keys to implementation of health reform.  The opposition is not to exchanges -- Utah has had an exchange for years, and it's hardly a liberal bastion.  The opposition is to health reform and anything that furthers it.  I believe the American people want the sensible parts of health reform, even if they feel some of the other elements -- the individual mandate -- are controversial (and I've explained this one to death -- we need the individual mandate if we're going to cover pre-existing conditions).  The exchanges are a no-brainer, and unqualified good thing.  Indeed, I've heard no argument against them other than the fact that they are key to implementing health reform.  That's no argument for why we shouldn't have exchanges even if health reform is struck down.

The challenge of building exchanges, though, is Information Technology or IT.  Exchanges would have to interface with other systems -- from Medicaid to the IRS (assuming the subsidies survive the Supreme Court decision).  And this is a huge challenge. 

The House GOP plans a series of votes to repeal pieces of health reform this summer, leading up to the election. A tax on medical devices that is opposed by -- you guessed it -- the medical device manufacturers.  Loosening up rules for health savings accounts and flexible spending accounts.  The GOP demanded that health reform pay for itself, and now they want to undo the ways that was accomplished.  Of course, the big deal comes at the end of this month, when the Supreme Court rules and we see what kind of shape we're in.  I'm still hoping.

Massachusetts voters may be deciding whether to add a "death with dignity" law.  This law -- like similar ones in Oregon and Washington -- will allow doctors to prescribe medication that will allow terminal patients to end their lives.  I so totally believe that it is right to give us control of when and how we die, especially if we are suffering and relatively sane, before we become too incapacitated to make the decision ourselves.  Like abortion, it's because the decision is so hard and so complicated that I believe it should be up to each of us, in consultation with our consciences.  What do you think?

More on the dangers of hormone replacement therapy, especially for women who are past menopause and healthy.  This panel found little evidence that HRT can fend off dementia or heart disease, and it carries with it many dangers -- blood clots, urinary incontinence.  I still don't know the right answer on this one.

Want to screen yourself for mental illness?  There's an app for that.

And that's it for this morning.  Have a great day! Jennifer

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