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Best of Psychopharmacology: Stimulants, ketamine, benzodiazapines
In this episode we go back to the summer for two master classes on ketamine and stimulants, respectively and we drop in on two conversations between Lorenzo Norris, MD on anxiety and comorbid ADHD as well as a conversation on benzodiazapines. The Psychcast will be back with new content in 2019.
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In this episode we go back to the summer for two master classes on ketamine and stimulants, respectively and we drop in on two conversations between Lorenzo Norris, MD on anxiety and comorbid ADHD as well as a conversation on benzodiazapines. The Psychcast will be back with new content in 2019.
Amazon
Apple
Google
Spotify
In this episode we go back to the summer for two master classes on ketamine and stimulants, respectively and we drop in on two conversations between Lorenzo Norris, MD on anxiety and comorbid ADHD as well as a conversation on benzodiazapines. The Psychcast will be back with new content in 2019.
Amazon
Apple
Google
Spotify
ICYMI: EP 01 Lorenzo Norris
Gut bacteria distinguish IBD and IBS
Also today, evidence is still scant for weight-loss apps, there could be a ruling on the ACA on New Year’s Eve and the U.S. Surgeon General takes on vaping among America’s Youth with the support of physician groups.
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Apple Podcasts
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Also today, evidence is still scant for weight-loss apps, there could be a ruling on the ACA on New Year’s Eve and the U.S. Surgeon General takes on vaping among America’s Youth with the support of physician groups.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
Also today, evidence is still scant for weight-loss apps, there could be a ruling on the ACA on New Year’s Eve and the U.S. Surgeon General takes on vaping among America’s Youth with the support of physician groups.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
Healthcare.gov activity surged in last week of open enrollment
A surge in activity during the last week of open enrollment at Healthcare.gov more than doubled the number of plans selected for the season, according to the Centers for Medicare & Medicaid Services.
Over 4.32 million plans were selected during week 7 (Dec. 9-15) of enrollment for the 2019 coverage year, exceeding the 4.13 million selected over the previous 6 weeks and bringing the total to 8.45 million, the CMS reported. During week 6 (Dec. 3-9), which was previously the busiest week of the year, 943,000 plans were selected by residents of the 39 states that use the Healthcare.gov platform.
This year’s week 7 total also topped the comparable number from last year’s enrollment period for the first time and closed the gap in cumulative selections from 11.7% after 6 weeks to 4.2%. Last year, a total of 8.82 million plans were selected for the 2018 coverage year, CMS said, while also noting that the data for this year “are preliminary and do not represent final 2019 Exchange Open Enrollment figures.”
CMS Administrator Seema Verma addressed the drop from 2018 to 2019: “With the lowest unemployment rate in 50 years, it’s possible that more Americans have employer based coverage, and don’t need exchange plans.” The CMS also estimated that “approximately 100,000 current exchange enrollees in Virginia will be eligible for” Medicaid now that the state has expanded its Medicaid population.
A surge in activity during the last week of open enrollment at Healthcare.gov more than doubled the number of plans selected for the season, according to the Centers for Medicare & Medicaid Services.
Over 4.32 million plans were selected during week 7 (Dec. 9-15) of enrollment for the 2019 coverage year, exceeding the 4.13 million selected over the previous 6 weeks and bringing the total to 8.45 million, the CMS reported. During week 6 (Dec. 3-9), which was previously the busiest week of the year, 943,000 plans were selected by residents of the 39 states that use the Healthcare.gov platform.
This year’s week 7 total also topped the comparable number from last year’s enrollment period for the first time and closed the gap in cumulative selections from 11.7% after 6 weeks to 4.2%. Last year, a total of 8.82 million plans were selected for the 2018 coverage year, CMS said, while also noting that the data for this year “are preliminary and do not represent final 2019 Exchange Open Enrollment figures.”
CMS Administrator Seema Verma addressed the drop from 2018 to 2019: “With the lowest unemployment rate in 50 years, it’s possible that more Americans have employer based coverage, and don’t need exchange plans.” The CMS also estimated that “approximately 100,000 current exchange enrollees in Virginia will be eligible for” Medicaid now that the state has expanded its Medicaid population.
A surge in activity during the last week of open enrollment at Healthcare.gov more than doubled the number of plans selected for the season, according to the Centers for Medicare & Medicaid Services.
Over 4.32 million plans were selected during week 7 (Dec. 9-15) of enrollment for the 2019 coverage year, exceeding the 4.13 million selected over the previous 6 weeks and bringing the total to 8.45 million, the CMS reported. During week 6 (Dec. 3-9), which was previously the busiest week of the year, 943,000 plans were selected by residents of the 39 states that use the Healthcare.gov platform.
This year’s week 7 total also topped the comparable number from last year’s enrollment period for the first time and closed the gap in cumulative selections from 11.7% after 6 weeks to 4.2%. Last year, a total of 8.82 million plans were selected for the 2018 coverage year, CMS said, while also noting that the data for this year “are preliminary and do not represent final 2019 Exchange Open Enrollment figures.”
CMS Administrator Seema Verma addressed the drop from 2018 to 2019: “With the lowest unemployment rate in 50 years, it’s possible that more Americans have employer based coverage, and don’t need exchange plans.” The CMS also estimated that “approximately 100,000 current exchange enrollees in Virginia will be eligible for” Medicaid now that the state has expanded its Medicaid population.
Next legal ruling on ACA could come on New Year’s Eve
As Democratic governors scramble to appeal a Dec. 14 ruling that essentially struck down the Affordable Care Act, a reprieve keeping the law intact could come by the end of the year.
The ACA remains in effect until Dec. 31 after Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas ruled that the 2017 tax law that zeroed out penalties beginning in 2019 for not carrying health insurance effectively rendered the entire ACA unconstitutional.
On Dec. 17, a group of Democratic attorneys general “asked Judge O’Connor to clarify that his ruling does not presently affect any rights or responsibilities under the ACA until appellate review is complete, or alternatively to stay his ruling,” Timothy S. Jost, emeritus professor at the Washington and Lee School of Law, in Lexington, Va., said during a Dec. 18 press teleconference hosted by the Commonwealth Fund. “They also asked him to certify the case for an immediate appeal and to do so by the end of this week.”
Mr. Jost noted that Judge O’Connor asked the plaintiffs and the U.S. Department of Health & Human Services to respond to this request by Dec. 21.
“I expect him to rule, probably, on New Year’s Eve on what happens next,” Mr. Jost said.
If Judge O’Connor refuses to stay his order, the group of Democratic attorneys general is expected to appeal to the Fifth Circuit Court of Appeals for such a stay, Mr. Jost said. He noted that the Fifth Circuit is one of the more conservative courts – with five Trump administration appointees and five judges appointed by previous Democratic administrations.
In general, Mr. Jost said that he does not expect Judge O’Connor’s ruling to stand.
“The decision is so clearly wrong, however, that I believe there is a good chance that it will be reversed,” he said. “If the Fifth Circuit does, I think it is very unlikely the Supreme Court take the case.” He added that if the Fifth Circuit upholds Judge O’Connor’s ruling, the court would take the case and “very likely reverse at least 5-4 and quite possibly 6-3 on at least the issue of severability.”
Mr. Jost added that he expects the case to drag into 2020 and possibly 2021.
Democrats – with their new majority in the House of Representatives – are likely to intervene legislatively in early in 2019 but are unlikely to be successful at getting the Republican-led Senate to pass “feel-good” legislation that would protect those with preexisting conditions, something Mr. Jost said “cannot be re-created” short of reenacting the entire ACA given the complex processes and subsidies that make coverage of preexisting conditions possible.
Both chambers of Congress could work together on something as simple as reinstating the penalty – even if it were set at just $1 – to coming up with something more comprehensive, but that would be extremely challenging to make happen and to get President Trump to sign off on, he said.
As Democratic governors scramble to appeal a Dec. 14 ruling that essentially struck down the Affordable Care Act, a reprieve keeping the law intact could come by the end of the year.
The ACA remains in effect until Dec. 31 after Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas ruled that the 2017 tax law that zeroed out penalties beginning in 2019 for not carrying health insurance effectively rendered the entire ACA unconstitutional.
On Dec. 17, a group of Democratic attorneys general “asked Judge O’Connor to clarify that his ruling does not presently affect any rights or responsibilities under the ACA until appellate review is complete, or alternatively to stay his ruling,” Timothy S. Jost, emeritus professor at the Washington and Lee School of Law, in Lexington, Va., said during a Dec. 18 press teleconference hosted by the Commonwealth Fund. “They also asked him to certify the case for an immediate appeal and to do so by the end of this week.”
Mr. Jost noted that Judge O’Connor asked the plaintiffs and the U.S. Department of Health & Human Services to respond to this request by Dec. 21.
“I expect him to rule, probably, on New Year’s Eve on what happens next,” Mr. Jost said.
If Judge O’Connor refuses to stay his order, the group of Democratic attorneys general is expected to appeal to the Fifth Circuit Court of Appeals for such a stay, Mr. Jost said. He noted that the Fifth Circuit is one of the more conservative courts – with five Trump administration appointees and five judges appointed by previous Democratic administrations.
In general, Mr. Jost said that he does not expect Judge O’Connor’s ruling to stand.
“The decision is so clearly wrong, however, that I believe there is a good chance that it will be reversed,” he said. “If the Fifth Circuit does, I think it is very unlikely the Supreme Court take the case.” He added that if the Fifth Circuit upholds Judge O’Connor’s ruling, the court would take the case and “very likely reverse at least 5-4 and quite possibly 6-3 on at least the issue of severability.”
Mr. Jost added that he expects the case to drag into 2020 and possibly 2021.
Democrats – with their new majority in the House of Representatives – are likely to intervene legislatively in early in 2019 but are unlikely to be successful at getting the Republican-led Senate to pass “feel-good” legislation that would protect those with preexisting conditions, something Mr. Jost said “cannot be re-created” short of reenacting the entire ACA given the complex processes and subsidies that make coverage of preexisting conditions possible.
Both chambers of Congress could work together on something as simple as reinstating the penalty – even if it were set at just $1 – to coming up with something more comprehensive, but that would be extremely challenging to make happen and to get President Trump to sign off on, he said.
As Democratic governors scramble to appeal a Dec. 14 ruling that essentially struck down the Affordable Care Act, a reprieve keeping the law intact could come by the end of the year.
The ACA remains in effect until Dec. 31 after Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas ruled that the 2017 tax law that zeroed out penalties beginning in 2019 for not carrying health insurance effectively rendered the entire ACA unconstitutional.
On Dec. 17, a group of Democratic attorneys general “asked Judge O’Connor to clarify that his ruling does not presently affect any rights or responsibilities under the ACA until appellate review is complete, or alternatively to stay his ruling,” Timothy S. Jost, emeritus professor at the Washington and Lee School of Law, in Lexington, Va., said during a Dec. 18 press teleconference hosted by the Commonwealth Fund. “They also asked him to certify the case for an immediate appeal and to do so by the end of this week.”
Mr. Jost noted that Judge O’Connor asked the plaintiffs and the U.S. Department of Health & Human Services to respond to this request by Dec. 21.
“I expect him to rule, probably, on New Year’s Eve on what happens next,” Mr. Jost said.
If Judge O’Connor refuses to stay his order, the group of Democratic attorneys general is expected to appeal to the Fifth Circuit Court of Appeals for such a stay, Mr. Jost said. He noted that the Fifth Circuit is one of the more conservative courts – with five Trump administration appointees and five judges appointed by previous Democratic administrations.
In general, Mr. Jost said that he does not expect Judge O’Connor’s ruling to stand.
“The decision is so clearly wrong, however, that I believe there is a good chance that it will be reversed,” he said. “If the Fifth Circuit does, I think it is very unlikely the Supreme Court take the case.” He added that if the Fifth Circuit upholds Judge O’Connor’s ruling, the court would take the case and “very likely reverse at least 5-4 and quite possibly 6-3 on at least the issue of severability.”
Mr. Jost added that he expects the case to drag into 2020 and possibly 2021.
Democrats – with their new majority in the House of Representatives – are likely to intervene legislatively in early in 2019 but are unlikely to be successful at getting the Republican-led Senate to pass “feel-good” legislation that would protect those with preexisting conditions, something Mr. Jost said “cannot be re-created” short of reenacting the entire ACA given the complex processes and subsidies that make coverage of preexisting conditions possible.
Both chambers of Congress could work together on something as simple as reinstating the penalty – even if it were set at just $1 – to coming up with something more comprehensive, but that would be extremely challenging to make happen and to get President Trump to sign off on, he said.
Insulin loses its starting spot
, fewer migraines in women are linked to increased type 2 diabetes risk, the U.S. Preventive Services Task Force looks to prevent opioid abuse in primary care, and there’s an uncomfortable truth in new guidelines for posttraumatic stress disorder.
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, fewer migraines in women are linked to increased type 2 diabetes risk, the U.S. Preventive Services Task Force looks to prevent opioid abuse in primary care, and there’s an uncomfortable truth in new guidelines for posttraumatic stress disorder.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
, fewer migraines in women are linked to increased type 2 diabetes risk, the U.S. Preventive Services Task Force looks to prevent opioid abuse in primary care, and there’s an uncomfortable truth in new guidelines for posttraumatic stress disorder.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
Texas judge strikes down ACA putting law in peril — again
The future of the Affordable Care Act is threatened – again – this time by a ruling Friday from a federal district court judge in Texas.
Judge Reed C. O’Connor struck down the law, siding with a group of 18 Republican state attorneys general and two GOP governors who brought the case. Judge O’Connor said the tax bill passed by Congress in December 2017 effectively rendered the entire health law unconstitutional.
That tax measure eliminated the penalty for not having insurance. An earlier Supreme Court decision upheld the ACA based on the view that the penalty was a tax and thus the law was valid because it relied on appropriate power allowed Congress under the Constitution. Judge O’Connor’s decision said that without that penalty, the law no longer met that constitutional test.
“In some ways, the question before the court involves the intent of both the 2010 and 2017 Congresses,” Judge O’Connor wrote in his 55-page decision. “The former enacted the ACA. The latter sawed off the last leg it stood on.”
The decision came just hours before the end of open enrollment for ACA plans in most states that use the federal HealthCare.gov insurance exchange. It is not expected that the ruling will impact the coverage for those people – the final decision will likely not come until the case reaches the Supreme Court again.
Seema Verma, the administrator of the Centers for Medicare & Medicaid Services, which oversees those insurance exchanges, said in a tweet: “The recent federal court decision is still moving through the courts, and the exchanges are still open for business and we will continue with open enrollment. There is no impact to current coverage or coverage in a 2019 plan.”
The 16 Democratic state attorneys general who intervened in the case to defend the health law immediately vowed to appeal.
“The ACA has already survived more than 70 unsuccessful repeal attempts and withstood scrutiny in the Supreme Court,” said a statement from California Attorney General Xavier Becerra. “Today’s misguided ruling will not deter us: our coalition will continue to fight in court for the health and wellbeing of all Americans.”
It is all but certain the case will become the third time the Supreme Court decides a constitutional question related to the ACA. In addition to upholding the law in 2012, the court rejected another challenge to the law in 2015.
It is hard to overstate what would happen to the nation’s health care system if the decision is ultimately upheld. The Affordable Care Act touched almost every aspect of health care, from Medicare and Medicaid to generic biologic drugs, the Indian Health Service, and public health changes like calorie counts on menus.
The case, Texas v. United States, was filed in February. The plaintiffs argued that because the Supreme Court upheld the ACA in 2012 as a constitutional use of its taxing power, the elimination of the tax makes the rest of the law unconstitutional.
In June, the Justice Department announced it would not fully defend the law in court. While the Trump administration said it did not agree with the plaintiffs that the tax law meant the entire ACA was unconstitutional, it said that the provisions of the law guaranteeing that people with preexisting health conditions could purchase coverage at the same price as everyone else were so inextricably linked to the tax penalty that they should be struck.
The administration urged the court to declare those provisions invalid beginning Jan. 1, 2019. That is the day the tax penalty for not having insurance disappears.
The protections for people with preexisting conditions was one of the top health issues in the midterm elections in November. While the issue mostly played to the advantage of Democrats, one of the Republican plaintiffs, Missouri Attorney General Josh Hawley, defeated Democratic incumbent Sen. Claire McCaskill. Another plaintiff, West Virginia Attorney General Patrick Morrisey, lost to Democratic incumbent Sen. Joe Manchin.
President Donald Trump was quick to take a victory lap, and pressed Senate Majority Leader Mitch McConnell (R-Ky.) and presumed incoming House Speaker Nancy Pelosi (D-Calif.) to fix the problem. He tweeted Friday night that “As I predicted all along, Obamacare has been struck down as an UNCONSTITUTIONAL disaster! Now Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions. Mitch and Nancy, get it done!”
But congressional leaders were quick to point out that the suit is far from over.
“The ruling seems to be based on faulty legal reasoning and hopefully it will be overturned,” said a statement from Senate Minority Leader Chuck Schumer (D-N.Y.).
Many legal experts agreed with that. “This is insanity in print, and it will not stand up on appeal,” tweeted University of Michigan Law School professor Nicholas Bagley, an expert in health law.
Even some conservatives were left scratching their heads. “Congress acted last year to repeal the mandate, but leave everything else in place and the courts should have deferred to that,” tweeted former congressional GOP aide Chris Jacobs.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
The future of the Affordable Care Act is threatened – again – this time by a ruling Friday from a federal district court judge in Texas.
Judge Reed C. O’Connor struck down the law, siding with a group of 18 Republican state attorneys general and two GOP governors who brought the case. Judge O’Connor said the tax bill passed by Congress in December 2017 effectively rendered the entire health law unconstitutional.
That tax measure eliminated the penalty for not having insurance. An earlier Supreme Court decision upheld the ACA based on the view that the penalty was a tax and thus the law was valid because it relied on appropriate power allowed Congress under the Constitution. Judge O’Connor’s decision said that without that penalty, the law no longer met that constitutional test.
“In some ways, the question before the court involves the intent of both the 2010 and 2017 Congresses,” Judge O’Connor wrote in his 55-page decision. “The former enacted the ACA. The latter sawed off the last leg it stood on.”
The decision came just hours before the end of open enrollment for ACA plans in most states that use the federal HealthCare.gov insurance exchange. It is not expected that the ruling will impact the coverage for those people – the final decision will likely not come until the case reaches the Supreme Court again.
Seema Verma, the administrator of the Centers for Medicare & Medicaid Services, which oversees those insurance exchanges, said in a tweet: “The recent federal court decision is still moving through the courts, and the exchanges are still open for business and we will continue with open enrollment. There is no impact to current coverage or coverage in a 2019 plan.”
The 16 Democratic state attorneys general who intervened in the case to defend the health law immediately vowed to appeal.
“The ACA has already survived more than 70 unsuccessful repeal attempts and withstood scrutiny in the Supreme Court,” said a statement from California Attorney General Xavier Becerra. “Today’s misguided ruling will not deter us: our coalition will continue to fight in court for the health and wellbeing of all Americans.”
It is all but certain the case will become the third time the Supreme Court decides a constitutional question related to the ACA. In addition to upholding the law in 2012, the court rejected another challenge to the law in 2015.
It is hard to overstate what would happen to the nation’s health care system if the decision is ultimately upheld. The Affordable Care Act touched almost every aspect of health care, from Medicare and Medicaid to generic biologic drugs, the Indian Health Service, and public health changes like calorie counts on menus.
The case, Texas v. United States, was filed in February. The plaintiffs argued that because the Supreme Court upheld the ACA in 2012 as a constitutional use of its taxing power, the elimination of the tax makes the rest of the law unconstitutional.
In June, the Justice Department announced it would not fully defend the law in court. While the Trump administration said it did not agree with the plaintiffs that the tax law meant the entire ACA was unconstitutional, it said that the provisions of the law guaranteeing that people with preexisting health conditions could purchase coverage at the same price as everyone else were so inextricably linked to the tax penalty that they should be struck.
The administration urged the court to declare those provisions invalid beginning Jan. 1, 2019. That is the day the tax penalty for not having insurance disappears.
The protections for people with preexisting conditions was one of the top health issues in the midterm elections in November. While the issue mostly played to the advantage of Democrats, one of the Republican plaintiffs, Missouri Attorney General Josh Hawley, defeated Democratic incumbent Sen. Claire McCaskill. Another plaintiff, West Virginia Attorney General Patrick Morrisey, lost to Democratic incumbent Sen. Joe Manchin.
President Donald Trump was quick to take a victory lap, and pressed Senate Majority Leader Mitch McConnell (R-Ky.) and presumed incoming House Speaker Nancy Pelosi (D-Calif.) to fix the problem. He tweeted Friday night that “As I predicted all along, Obamacare has been struck down as an UNCONSTITUTIONAL disaster! Now Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions. Mitch and Nancy, get it done!”
But congressional leaders were quick to point out that the suit is far from over.
“The ruling seems to be based on faulty legal reasoning and hopefully it will be overturned,” said a statement from Senate Minority Leader Chuck Schumer (D-N.Y.).
Many legal experts agreed with that. “This is insanity in print, and it will not stand up on appeal,” tweeted University of Michigan Law School professor Nicholas Bagley, an expert in health law.
Even some conservatives were left scratching their heads. “Congress acted last year to repeal the mandate, but leave everything else in place and the courts should have deferred to that,” tweeted former congressional GOP aide Chris Jacobs.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
The future of the Affordable Care Act is threatened – again – this time by a ruling Friday from a federal district court judge in Texas.
Judge Reed C. O’Connor struck down the law, siding with a group of 18 Republican state attorneys general and two GOP governors who brought the case. Judge O’Connor said the tax bill passed by Congress in December 2017 effectively rendered the entire health law unconstitutional.
That tax measure eliminated the penalty for not having insurance. An earlier Supreme Court decision upheld the ACA based on the view that the penalty was a tax and thus the law was valid because it relied on appropriate power allowed Congress under the Constitution. Judge O’Connor’s decision said that without that penalty, the law no longer met that constitutional test.
“In some ways, the question before the court involves the intent of both the 2010 and 2017 Congresses,” Judge O’Connor wrote in his 55-page decision. “The former enacted the ACA. The latter sawed off the last leg it stood on.”
The decision came just hours before the end of open enrollment for ACA plans in most states that use the federal HealthCare.gov insurance exchange. It is not expected that the ruling will impact the coverage for those people – the final decision will likely not come until the case reaches the Supreme Court again.
Seema Verma, the administrator of the Centers for Medicare & Medicaid Services, which oversees those insurance exchanges, said in a tweet: “The recent federal court decision is still moving through the courts, and the exchanges are still open for business and we will continue with open enrollment. There is no impact to current coverage or coverage in a 2019 plan.”
The 16 Democratic state attorneys general who intervened in the case to defend the health law immediately vowed to appeal.
“The ACA has already survived more than 70 unsuccessful repeal attempts and withstood scrutiny in the Supreme Court,” said a statement from California Attorney General Xavier Becerra. “Today’s misguided ruling will not deter us: our coalition will continue to fight in court for the health and wellbeing of all Americans.”
It is all but certain the case will become the third time the Supreme Court decides a constitutional question related to the ACA. In addition to upholding the law in 2012, the court rejected another challenge to the law in 2015.
It is hard to overstate what would happen to the nation’s health care system if the decision is ultimately upheld. The Affordable Care Act touched almost every aspect of health care, from Medicare and Medicaid to generic biologic drugs, the Indian Health Service, and public health changes like calorie counts on menus.
The case, Texas v. United States, was filed in February. The plaintiffs argued that because the Supreme Court upheld the ACA in 2012 as a constitutional use of its taxing power, the elimination of the tax makes the rest of the law unconstitutional.
In June, the Justice Department announced it would not fully defend the law in court. While the Trump administration said it did not agree with the plaintiffs that the tax law meant the entire ACA was unconstitutional, it said that the provisions of the law guaranteeing that people with preexisting health conditions could purchase coverage at the same price as everyone else were so inextricably linked to the tax penalty that they should be struck.
The administration urged the court to declare those provisions invalid beginning Jan. 1, 2019. That is the day the tax penalty for not having insurance disappears.
The protections for people with preexisting conditions was one of the top health issues in the midterm elections in November. While the issue mostly played to the advantage of Democrats, one of the Republican plaintiffs, Missouri Attorney General Josh Hawley, defeated Democratic incumbent Sen. Claire McCaskill. Another plaintiff, West Virginia Attorney General Patrick Morrisey, lost to Democratic incumbent Sen. Joe Manchin.
President Donald Trump was quick to take a victory lap, and pressed Senate Majority Leader Mitch McConnell (R-Ky.) and presumed incoming House Speaker Nancy Pelosi (D-Calif.) to fix the problem. He tweeted Friday night that “As I predicted all along, Obamacare has been struck down as an UNCONSTITUTIONAL disaster! Now Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions. Mitch and Nancy, get it done!”
But congressional leaders were quick to point out that the suit is far from over.
“The ruling seems to be based on faulty legal reasoning and hopefully it will be overturned,” said a statement from Senate Minority Leader Chuck Schumer (D-N.Y.).
Many legal experts agreed with that. “This is insanity in print, and it will not stand up on appeal,” tweeted University of Michigan Law School professor Nicholas Bagley, an expert in health law.
Even some conservatives were left scratching their heads. “Congress acted last year to repeal the mandate, but leave everything else in place and the courts should have deferred to that,” tweeted former congressional GOP aide Chris Jacobs.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
Class-action suit filed against ABIM over MOC
A group of internists is suing the American Board of Internal Medicine over its maintenance of certification (MOC) process, alleging that the board is monopolizing the MOC market.
The lawsuit, filed Dec. 6 in Pennsylvania district court, claims that ABIM is charging inflated monopoly prices for maintaining certification, that the organization is forcing physicians to purchase MOC, and that ABIM is inducing employers and others to require ABIM certification. The four plaintiff-physicians are asking a judge to find ABIM in violation of federal antitrust law and to bar the board from continuing its MOC process. The suit is filed as a class action on behalf of all internists and subspecialists required by ABIM to purchase MOC to maintain their ABIM certifications. The plaintiffs seek damages and injunctive relief, plus lawsuit and attorney costs arising from ABIM’s alleged antitrust violations.
In a statement, ABIM expressed disappointment at the lawsuit and said the organization will vigorously defend itself, adding that doing so will “consume resources far better dedicated to continuous improvement of its programs.”
ABIM declined to answer questions addressing specific accusations from the lawsuit. However, in an interview, ABIM President Richard Baron, MD, said that “ABIM board-certified physicians have taken the initiative to distinguish themselves. This is a credential that physicians earn. We offer certified physicians the opportunity to demonstrate to the medical community, their peers, and the public that they are current and have special expertise.”
ABIM has not yet filed a formal response to the lawsuit, which was due by Jan. 6. Court documents show that in January, ABIM entered the appearances of four attorneys that will represent the board in the case. From there, discovery and evidence gathering in the case will begin.
Katherine Murray Leisure, MD, an infectious disease specialist based in Plymouth, Mass., is one of the plaintiffs. While she said that she could not comment specifically on the lawsuit, she has written publicly about her ABIM concerns in the past.
In a 2015 letter to Dr. Baron and posted on an anti-MOC website, Dr. Murray outlined a litany of complaints against ABIM’s MOC process and called on the U.S. Congress to investigate ABIM’s financial, legal, and ethical conduct.
“[The American Board of Medical Specialties] and ABIM collected more than $10,000 in fees and lost practice hours every decade from each [diplomate] doing MOC,” Dr. Murray Leisure wrote. “MOC took weeks away from our offices, clinics, patients, families, specialty societies, and individual research. ABMS MOC removed hundreds, perhaps thousands … of America’s best, once board-certified physicians from full hospital careers and earnings whenever [diplomates] did not complete these high-stakes MOC programs. … The righteous and fast solution to such moral, ethical, scientific, and constitutional problems is to end MOC now.”
Plaintiffs Glen Dela Cruz Manalo, MD; Alexa Joshua, MD; and Gerard Kenney, MD, did not return messages seeking comment. When contacted, attorneys for the plaintiffs declined to comment.
The doctors’ 32-page lawsuit characterizes ABIM as an organization motivated by money that has made its MOC process increasingly more burdensome for physicians over the years without evidence that MOC has any beneficial impact on doctors, patients, or the public. Complying with ABIM’s MOC costs internists an average of $23,607 in financial cost and time lost over 10 years, and costs up to $40,495 for some specialists, according to the suit.
The physicians allege that ABIM controls in excess of 95% of the market for MOC of internists, in violation of federal antitrust laws, and that the organization has unlawfully obtained and maintained monopoly power for MOC services.
The board’s illegal tying of its initial certification to its MOC results in burdensome conditions, including “raising the cost of the practice of medicine, constraining the supply of internists thereby harming competition, decreasing the supply of certified internists, and increasing the cost of medical services to patients and consumers,” the suit claims.
The legal challenge details how MOC has personally and professionally impacted each of the four plaintiffs. Dr. Manalo, a gastroenterologist, lost his privileges at St. Vincent Healthcare in Billings, Mont., and was subsequently terminated after he declined to maintain his ABIM certification as a gastroenterologist. In a letter to ABIM, Dr. Manalo wrote that it was “unfair and outright discriminatory that practitioners certified on or after 1990 are the only ones required to certify,” according to the lawsuit. Dr. Manalo later took a position as staff gastroenterologist at Jonathan M. Wainwright Memorial Veterans Affairs Medical Center in Walla Walla, Wash., at a substantially reduced salary. He became unemployed in 2017.
Dr. Murray Leisure obtained an initial and lifelong board certification in internal medicine from ABIM in 1984 and an infectious disease certification in 1990. ABlM terminated Dr. Murray’s infectious diseases certification after she failed her MOC examination in 2009, which led to lost privileges at Jordan Hospital in Plymouth, Mass. The loss caused significant damage to Dr. Murray, including lost income, a tarnished reputation, and the lost opportunity to help patients, according to the lawsuit. Jordan Hospital restored her privileges after Dr. Murray passed her MOC examination in 2012.
Dr. Kenney lost a job opportunity with Mount Nittany Physicians Group in State College, Pa., after he declined to renew his ABIM certification in gastroenterology. He is currently a physician with the University of Pittsburgh Medical Center in Seneca, Pa.
That the ABIM website lists him as “not certified,” is misleading, and makes it appear that his initial certifications were revoked due to failure to pass a MOC examination or misconduct, rather than because the certifications lapsed, according to the suit. The description makes Dr. Kenney appear less qualified to patients, hospitals, insurance companies, medical corporations, other employers, and others, he claims.
Dr. Joshua could not renew her consulting and admitting privileges at Detroit Medical Center after she failed an MOC examination in 2014 and became uncertified in internal medicine, according to the suit. In addition, Blue Cross Blue Shield informed Dr. Joshua it would no longer cover her because it required ABIM certification for coverage. She unsuccessfully appealed based on her certification with the National Board of Physicians and Surgeons. As a result of her certification termination, Dr. Joshua can only practice outpatient medicine at Detroit Medical Center.
In an interview, Dr. Baron emphasized the number of modifications made to its MOC process in recent years after responding to physician concerns. This includes an overhaul of the organization’s governance structure to include more than 200 practicing physicians and opening new avenues for physicians to engage in the creation of assessment content that more closely reflects what they see in practice, he said. In addition, ABIM now surveys all specialists to contribute to the exam blueprint review and the creation of the new Item Writing Task Force.
“We take all suggestions from physicians seriously, and have used it to launch many new initiatives including: the Knowledge Check-In, a new Physician Portal, partnerships to give physicians dual credit for CME and MOC, and exploration of alternative assessment models with medical societies,” he said.
Dr. Baron acknowledged past criticism of the MOC process, but said he is proud of the work ABIM has done to address physician concerns about the choice, relevance, and convenience of its MOC program.
*This story was updated on Feb. 6, 2019.
A group of internists is suing the American Board of Internal Medicine over its maintenance of certification (MOC) process, alleging that the board is monopolizing the MOC market.
The lawsuit, filed Dec. 6 in Pennsylvania district court, claims that ABIM is charging inflated monopoly prices for maintaining certification, that the organization is forcing physicians to purchase MOC, and that ABIM is inducing employers and others to require ABIM certification. The four plaintiff-physicians are asking a judge to find ABIM in violation of federal antitrust law and to bar the board from continuing its MOC process. The suit is filed as a class action on behalf of all internists and subspecialists required by ABIM to purchase MOC to maintain their ABIM certifications. The plaintiffs seek damages and injunctive relief, plus lawsuit and attorney costs arising from ABIM’s alleged antitrust violations.
In a statement, ABIM expressed disappointment at the lawsuit and said the organization will vigorously defend itself, adding that doing so will “consume resources far better dedicated to continuous improvement of its programs.”
ABIM declined to answer questions addressing specific accusations from the lawsuit. However, in an interview, ABIM President Richard Baron, MD, said that “ABIM board-certified physicians have taken the initiative to distinguish themselves. This is a credential that physicians earn. We offer certified physicians the opportunity to demonstrate to the medical community, their peers, and the public that they are current and have special expertise.”
ABIM has not yet filed a formal response to the lawsuit, which was due by Jan. 6. Court documents show that in January, ABIM entered the appearances of four attorneys that will represent the board in the case. From there, discovery and evidence gathering in the case will begin.
Katherine Murray Leisure, MD, an infectious disease specialist based in Plymouth, Mass., is one of the plaintiffs. While she said that she could not comment specifically on the lawsuit, she has written publicly about her ABIM concerns in the past.
In a 2015 letter to Dr. Baron and posted on an anti-MOC website, Dr. Murray outlined a litany of complaints against ABIM’s MOC process and called on the U.S. Congress to investigate ABIM’s financial, legal, and ethical conduct.
“[The American Board of Medical Specialties] and ABIM collected more than $10,000 in fees and lost practice hours every decade from each [diplomate] doing MOC,” Dr. Murray Leisure wrote. “MOC took weeks away from our offices, clinics, patients, families, specialty societies, and individual research. ABMS MOC removed hundreds, perhaps thousands … of America’s best, once board-certified physicians from full hospital careers and earnings whenever [diplomates] did not complete these high-stakes MOC programs. … The righteous and fast solution to such moral, ethical, scientific, and constitutional problems is to end MOC now.”
Plaintiffs Glen Dela Cruz Manalo, MD; Alexa Joshua, MD; and Gerard Kenney, MD, did not return messages seeking comment. When contacted, attorneys for the plaintiffs declined to comment.
The doctors’ 32-page lawsuit characterizes ABIM as an organization motivated by money that has made its MOC process increasingly more burdensome for physicians over the years without evidence that MOC has any beneficial impact on doctors, patients, or the public. Complying with ABIM’s MOC costs internists an average of $23,607 in financial cost and time lost over 10 years, and costs up to $40,495 for some specialists, according to the suit.
The physicians allege that ABIM controls in excess of 95% of the market for MOC of internists, in violation of federal antitrust laws, and that the organization has unlawfully obtained and maintained monopoly power for MOC services.
The board’s illegal tying of its initial certification to its MOC results in burdensome conditions, including “raising the cost of the practice of medicine, constraining the supply of internists thereby harming competition, decreasing the supply of certified internists, and increasing the cost of medical services to patients and consumers,” the suit claims.
The legal challenge details how MOC has personally and professionally impacted each of the four plaintiffs. Dr. Manalo, a gastroenterologist, lost his privileges at St. Vincent Healthcare in Billings, Mont., and was subsequently terminated after he declined to maintain his ABIM certification as a gastroenterologist. In a letter to ABIM, Dr. Manalo wrote that it was “unfair and outright discriminatory that practitioners certified on or after 1990 are the only ones required to certify,” according to the lawsuit. Dr. Manalo later took a position as staff gastroenterologist at Jonathan M. Wainwright Memorial Veterans Affairs Medical Center in Walla Walla, Wash., at a substantially reduced salary. He became unemployed in 2017.
Dr. Murray Leisure obtained an initial and lifelong board certification in internal medicine from ABIM in 1984 and an infectious disease certification in 1990. ABlM terminated Dr. Murray’s infectious diseases certification after she failed her MOC examination in 2009, which led to lost privileges at Jordan Hospital in Plymouth, Mass. The loss caused significant damage to Dr. Murray, including lost income, a tarnished reputation, and the lost opportunity to help patients, according to the lawsuit. Jordan Hospital restored her privileges after Dr. Murray passed her MOC examination in 2012.
Dr. Kenney lost a job opportunity with Mount Nittany Physicians Group in State College, Pa., after he declined to renew his ABIM certification in gastroenterology. He is currently a physician with the University of Pittsburgh Medical Center in Seneca, Pa.
That the ABIM website lists him as “not certified,” is misleading, and makes it appear that his initial certifications were revoked due to failure to pass a MOC examination or misconduct, rather than because the certifications lapsed, according to the suit. The description makes Dr. Kenney appear less qualified to patients, hospitals, insurance companies, medical corporations, other employers, and others, he claims.
Dr. Joshua could not renew her consulting and admitting privileges at Detroit Medical Center after she failed an MOC examination in 2014 and became uncertified in internal medicine, according to the suit. In addition, Blue Cross Blue Shield informed Dr. Joshua it would no longer cover her because it required ABIM certification for coverage. She unsuccessfully appealed based on her certification with the National Board of Physicians and Surgeons. As a result of her certification termination, Dr. Joshua can only practice outpatient medicine at Detroit Medical Center.
In an interview, Dr. Baron emphasized the number of modifications made to its MOC process in recent years after responding to physician concerns. This includes an overhaul of the organization’s governance structure to include more than 200 practicing physicians and opening new avenues for physicians to engage in the creation of assessment content that more closely reflects what they see in practice, he said. In addition, ABIM now surveys all specialists to contribute to the exam blueprint review and the creation of the new Item Writing Task Force.
“We take all suggestions from physicians seriously, and have used it to launch many new initiatives including: the Knowledge Check-In, a new Physician Portal, partnerships to give physicians dual credit for CME and MOC, and exploration of alternative assessment models with medical societies,” he said.
Dr. Baron acknowledged past criticism of the MOC process, but said he is proud of the work ABIM has done to address physician concerns about the choice, relevance, and convenience of its MOC program.
*This story was updated on Feb. 6, 2019.
A group of internists is suing the American Board of Internal Medicine over its maintenance of certification (MOC) process, alleging that the board is monopolizing the MOC market.
The lawsuit, filed Dec. 6 in Pennsylvania district court, claims that ABIM is charging inflated monopoly prices for maintaining certification, that the organization is forcing physicians to purchase MOC, and that ABIM is inducing employers and others to require ABIM certification. The four plaintiff-physicians are asking a judge to find ABIM in violation of federal antitrust law and to bar the board from continuing its MOC process. The suit is filed as a class action on behalf of all internists and subspecialists required by ABIM to purchase MOC to maintain their ABIM certifications. The plaintiffs seek damages and injunctive relief, plus lawsuit and attorney costs arising from ABIM’s alleged antitrust violations.
In a statement, ABIM expressed disappointment at the lawsuit and said the organization will vigorously defend itself, adding that doing so will “consume resources far better dedicated to continuous improvement of its programs.”
ABIM declined to answer questions addressing specific accusations from the lawsuit. However, in an interview, ABIM President Richard Baron, MD, said that “ABIM board-certified physicians have taken the initiative to distinguish themselves. This is a credential that physicians earn. We offer certified physicians the opportunity to demonstrate to the medical community, their peers, and the public that they are current and have special expertise.”
ABIM has not yet filed a formal response to the lawsuit, which was due by Jan. 6. Court documents show that in January, ABIM entered the appearances of four attorneys that will represent the board in the case. From there, discovery and evidence gathering in the case will begin.
Katherine Murray Leisure, MD, an infectious disease specialist based in Plymouth, Mass., is one of the plaintiffs. While she said that she could not comment specifically on the lawsuit, she has written publicly about her ABIM concerns in the past.
In a 2015 letter to Dr. Baron and posted on an anti-MOC website, Dr. Murray outlined a litany of complaints against ABIM’s MOC process and called on the U.S. Congress to investigate ABIM’s financial, legal, and ethical conduct.
“[The American Board of Medical Specialties] and ABIM collected more than $10,000 in fees and lost practice hours every decade from each [diplomate] doing MOC,” Dr. Murray Leisure wrote. “MOC took weeks away from our offices, clinics, patients, families, specialty societies, and individual research. ABMS MOC removed hundreds, perhaps thousands … of America’s best, once board-certified physicians from full hospital careers and earnings whenever [diplomates] did not complete these high-stakes MOC programs. … The righteous and fast solution to such moral, ethical, scientific, and constitutional problems is to end MOC now.”
Plaintiffs Glen Dela Cruz Manalo, MD; Alexa Joshua, MD; and Gerard Kenney, MD, did not return messages seeking comment. When contacted, attorneys for the plaintiffs declined to comment.
The doctors’ 32-page lawsuit characterizes ABIM as an organization motivated by money that has made its MOC process increasingly more burdensome for physicians over the years without evidence that MOC has any beneficial impact on doctors, patients, or the public. Complying with ABIM’s MOC costs internists an average of $23,607 in financial cost and time lost over 10 years, and costs up to $40,495 for some specialists, according to the suit.
The physicians allege that ABIM controls in excess of 95% of the market for MOC of internists, in violation of federal antitrust laws, and that the organization has unlawfully obtained and maintained monopoly power for MOC services.
The board’s illegal tying of its initial certification to its MOC results in burdensome conditions, including “raising the cost of the practice of medicine, constraining the supply of internists thereby harming competition, decreasing the supply of certified internists, and increasing the cost of medical services to patients and consumers,” the suit claims.
The legal challenge details how MOC has personally and professionally impacted each of the four plaintiffs. Dr. Manalo, a gastroenterologist, lost his privileges at St. Vincent Healthcare in Billings, Mont., and was subsequently terminated after he declined to maintain his ABIM certification as a gastroenterologist. In a letter to ABIM, Dr. Manalo wrote that it was “unfair and outright discriminatory that practitioners certified on or after 1990 are the only ones required to certify,” according to the lawsuit. Dr. Manalo later took a position as staff gastroenterologist at Jonathan M. Wainwright Memorial Veterans Affairs Medical Center in Walla Walla, Wash., at a substantially reduced salary. He became unemployed in 2017.
Dr. Murray Leisure obtained an initial and lifelong board certification in internal medicine from ABIM in 1984 and an infectious disease certification in 1990. ABlM terminated Dr. Murray’s infectious diseases certification after she failed her MOC examination in 2009, which led to lost privileges at Jordan Hospital in Plymouth, Mass. The loss caused significant damage to Dr. Murray, including lost income, a tarnished reputation, and the lost opportunity to help patients, according to the lawsuit. Jordan Hospital restored her privileges after Dr. Murray passed her MOC examination in 2012.
Dr. Kenney lost a job opportunity with Mount Nittany Physicians Group in State College, Pa., after he declined to renew his ABIM certification in gastroenterology. He is currently a physician with the University of Pittsburgh Medical Center in Seneca, Pa.
That the ABIM website lists him as “not certified,” is misleading, and makes it appear that his initial certifications were revoked due to failure to pass a MOC examination or misconduct, rather than because the certifications lapsed, according to the suit. The description makes Dr. Kenney appear less qualified to patients, hospitals, insurance companies, medical corporations, other employers, and others, he claims.
Dr. Joshua could not renew her consulting and admitting privileges at Detroit Medical Center after she failed an MOC examination in 2014 and became uncertified in internal medicine, according to the suit. In addition, Blue Cross Blue Shield informed Dr. Joshua it would no longer cover her because it required ABIM certification for coverage. She unsuccessfully appealed based on her certification with the National Board of Physicians and Surgeons. As a result of her certification termination, Dr. Joshua can only practice outpatient medicine at Detroit Medical Center.
In an interview, Dr. Baron emphasized the number of modifications made to its MOC process in recent years after responding to physician concerns. This includes an overhaul of the organization’s governance structure to include more than 200 practicing physicians and opening new avenues for physicians to engage in the creation of assessment content that more closely reflects what they see in practice, he said. In addition, ABIM now surveys all specialists to contribute to the exam blueprint review and the creation of the new Item Writing Task Force.
“We take all suggestions from physicians seriously, and have used it to launch many new initiatives including: the Knowledge Check-In, a new Physician Portal, partnerships to give physicians dual credit for CME and MOC, and exploration of alternative assessment models with medical societies,” he said.
Dr. Baron acknowledged past criticism of the MOC process, but said he is proud of the work ABIM has done to address physician concerns about the choice, relevance, and convenience of its MOC program.
*This story was updated on Feb. 6, 2019.
Time for single payer? ColdironCare
At a New Year’s Eve party a few years back, I noticed a man sitting nearby clutching his left upper arm. He was ashen and obviously uncomfortable. Acute coronary insufficiency, I thought, and I asked him if I could call the life squad for him. “Oh no,” he said, “I have these spells several times a day, the nitro will kick in after a minute, and this will ease off.” I listened as he explained he had a “widow maker,” a 90% plus left main occlusion, but “I am Canadian, and my government is going to pay for my bypass,” he said. “I just have to wait 6 more weeks.” The irony? He was the son of our host, and we were sitting in his mothers’ multimillion dollar home in the Florida Keys. He could be in a Miami hospital’s operating room in an hour or 2.
Wow. Click. Got it.
Fast forward to a lobbying discussion on Capitol Hill: A sympathetic U.S. senator tossed me this softball: ‘What do you think about Medicare reimbursement?” I expect he thought I was going to complain about how bad Medicare is, about its failure to keep current with inflation (currently about 30% behind), and the obtuse quality metrics it now requires. Instead, I found myself saying, “Medicare is my most reliable payer, paying on time – in 2 weeks for clean claims – and the private insurers have beaten me up badly. Medicare is one of my best payers.”
Wrong answer, but true statement.
There is much talk these days about , particularly considering all the barriers to care. (See my recent column, “Produce and Promises.”) Physicians and patients endure a mutual misery inflicted by private insurance companies.
What to do about health care in America?
First, let’s deal with the extraordinary costs of health care in the United States – 19% of our gross domestic product. About 3%-4 % of this figure is an accounting gimmick, since it includes nursing home care, which is considered “domiciliary” care rather than health care in Europe. In addition, drug costs are higher in the U.S., largely to cover the development of new drugs that cost less in the rest of the world. Wait lists are largely unheard of in the United States, and if you have such ready capacity, that means you incur the costs of idle capacity. Also, rarely is a new miracle drug flatly denied for coverage in the United States. If you persist, you will usually get your drug.
We are a commodity-driven society, and that is the real reason that health care costs so much in this country. Hence, we come to the real debate, the “R” word. How do we ration access to care? (See my 2017 column, “Why the Affordable Care Act will be Greatly Modified.”)
There are a plethora of proposals to fund single payer out there, none of which address rationing. And while single payer affords free universal coverage, it does not assure better care. As health economist Devon Herrick, Ph.D., wrote in his health care blog in 2016: “A single payer is not some magical entity that rains down savings from Heaven by being unconcerned about profit. Rather, an efficient single payer operates more like a predatory HMO with no competition. It is currently in vogue for hipsters to matter-of-factly announce the simple solution to health reform is single payer. Be careful what you wish for; you may end up with Medicaid for All.”
In fact, if you try to ferret out how physician income will be affected by universal health care, there would be an estimated pay cut of 11%-40%, depending on how the numbers are manipulated.
Some single-payer proposals use the term “exchange rates,” which for the uninformed means Medicaid rates. In addition, payment is usually given to the local hospital system, or “authority” to dole out. I have a very bad feeling that any small practitioner in an office-based practice would be severely shortchanged in such a system. In fact, if you cut pay for office-based physicians at all, you may begin to see them disappear.
Policy wonks argue for pay cuts for American physicians because European physicians “make less money.” Those numbers are all wrong. U.S. physicians are paid for their work, and for their practice expense. That is, how much it costs to provide the service in their office, which is around 40%-50% of published income. In Europe, almost all procedures are performed in the hospital setting, and the hospital absorbs the practice expense, which is ignored in this current health care reform debate. (See my 2015 column, “Doctor, Why DO you get paid so much?”)
The big selling point of single payer for physicians is that they might have less paperwork and get paid more for seeing Medicaid patients. Yet the paperwork will persist to avoid lawsuits, electronic medical records are now ingrained into the system, and most Medicaid patients are currently seen in the federal or hospital outpatient clinic where higher rates or other subsidies are available. The comically low Medicaid rates paid to physician offices are largely evaded or not even filed for.
Single-payer advocates are basically saying, “Yes, you will be seeing patients at a loss but you will make it up in volume.” This ignores the reality that most physicians don’t need or want more volume.
Here is my plan for single-payer health care. Call it ColdironCare.
- Set payment rates for physicians at 130% of current Medicare, about where we were 30 years ago, considering inflation. Tie the reimbursement rate to the cost of living index, same as social security. If you cut physician pay 11%-40%, you will see mass retirement and the elimination of the most efficient care, office-based practice.
- Remove the practice expense payment from government-reported physician income since this is overhead spent to provide the care.
- Let all physicians participate, and don’t pay site-of-service differentials.
- Enact national tort reform, which would decrease the paperwork, overhead, and much useless defensive medicine.
- Press the generic drug manufacturers (but not the innovators) regarding drug costs. Bite the bullet, and set national coverage standards (ration care) to be revisited every 5 years, which will eliminate step therapy and prior authorizations. Allow individuals to pay out of pocket for additional treatments they want, including that questionable additional 90 days of life they may get from the $250,000 drug for the off-label indication.
- Press the hospitals, and don’t complain when many of them close, especially rural ones.
- Allow individuals, hospitals, and physicians to contract outside of the government plan (in contrast to Canada).
- Downsize the health insurance companies, and have them sell private supplemental insurance to whomever wants it.
Finally, make all of this a constitutional amendment. If not put out of reach, in 15 years we will have the same system we have today. The politicians simply will not be able to resist degrading (reforming, improving, refunding, defunding) the original plan. Or, you could simply increase Medicaid rates to Medicare rates and call it a day.
Oh, by the way, I saw that man from the New Year’s Eve party at the airport the following Christmas. He survived to get his government bypass and is doing well.
The health care system we have is miserable, except compared with all the others.
Dr. Coldiron is in private practice but maintains a clinical assistant professorship at the University of Cincinnati. He cares for patients, teaches medical students and residents, and has several active clinical research projects. Dr. Coldiron is the author of more than 80 scientific letters, papers, and several book chapters, and he speaks frequently on a variety of topics. He is a past president of the American Academy of Dermatology. Write to him at [email protected].
At a New Year’s Eve party a few years back, I noticed a man sitting nearby clutching his left upper arm. He was ashen and obviously uncomfortable. Acute coronary insufficiency, I thought, and I asked him if I could call the life squad for him. “Oh no,” he said, “I have these spells several times a day, the nitro will kick in after a minute, and this will ease off.” I listened as he explained he had a “widow maker,” a 90% plus left main occlusion, but “I am Canadian, and my government is going to pay for my bypass,” he said. “I just have to wait 6 more weeks.” The irony? He was the son of our host, and we were sitting in his mothers’ multimillion dollar home in the Florida Keys. He could be in a Miami hospital’s operating room in an hour or 2.
Wow. Click. Got it.
Fast forward to a lobbying discussion on Capitol Hill: A sympathetic U.S. senator tossed me this softball: ‘What do you think about Medicare reimbursement?” I expect he thought I was going to complain about how bad Medicare is, about its failure to keep current with inflation (currently about 30% behind), and the obtuse quality metrics it now requires. Instead, I found myself saying, “Medicare is my most reliable payer, paying on time – in 2 weeks for clean claims – and the private insurers have beaten me up badly. Medicare is one of my best payers.”
Wrong answer, but true statement.
There is much talk these days about , particularly considering all the barriers to care. (See my recent column, “Produce and Promises.”) Physicians and patients endure a mutual misery inflicted by private insurance companies.
What to do about health care in America?
First, let’s deal with the extraordinary costs of health care in the United States – 19% of our gross domestic product. About 3%-4 % of this figure is an accounting gimmick, since it includes nursing home care, which is considered “domiciliary” care rather than health care in Europe. In addition, drug costs are higher in the U.S., largely to cover the development of new drugs that cost less in the rest of the world. Wait lists are largely unheard of in the United States, and if you have such ready capacity, that means you incur the costs of idle capacity. Also, rarely is a new miracle drug flatly denied for coverage in the United States. If you persist, you will usually get your drug.
We are a commodity-driven society, and that is the real reason that health care costs so much in this country. Hence, we come to the real debate, the “R” word. How do we ration access to care? (See my 2017 column, “Why the Affordable Care Act will be Greatly Modified.”)
There are a plethora of proposals to fund single payer out there, none of which address rationing. And while single payer affords free universal coverage, it does not assure better care. As health economist Devon Herrick, Ph.D., wrote in his health care blog in 2016: “A single payer is not some magical entity that rains down savings from Heaven by being unconcerned about profit. Rather, an efficient single payer operates more like a predatory HMO with no competition. It is currently in vogue for hipsters to matter-of-factly announce the simple solution to health reform is single payer. Be careful what you wish for; you may end up with Medicaid for All.”
In fact, if you try to ferret out how physician income will be affected by universal health care, there would be an estimated pay cut of 11%-40%, depending on how the numbers are manipulated.
Some single-payer proposals use the term “exchange rates,” which for the uninformed means Medicaid rates. In addition, payment is usually given to the local hospital system, or “authority” to dole out. I have a very bad feeling that any small practitioner in an office-based practice would be severely shortchanged in such a system. In fact, if you cut pay for office-based physicians at all, you may begin to see them disappear.
Policy wonks argue for pay cuts for American physicians because European physicians “make less money.” Those numbers are all wrong. U.S. physicians are paid for their work, and for their practice expense. That is, how much it costs to provide the service in their office, which is around 40%-50% of published income. In Europe, almost all procedures are performed in the hospital setting, and the hospital absorbs the practice expense, which is ignored in this current health care reform debate. (See my 2015 column, “Doctor, Why DO you get paid so much?”)
The big selling point of single payer for physicians is that they might have less paperwork and get paid more for seeing Medicaid patients. Yet the paperwork will persist to avoid lawsuits, electronic medical records are now ingrained into the system, and most Medicaid patients are currently seen in the federal or hospital outpatient clinic where higher rates or other subsidies are available. The comically low Medicaid rates paid to physician offices are largely evaded or not even filed for.
Single-payer advocates are basically saying, “Yes, you will be seeing patients at a loss but you will make it up in volume.” This ignores the reality that most physicians don’t need or want more volume.
Here is my plan for single-payer health care. Call it ColdironCare.
- Set payment rates for physicians at 130% of current Medicare, about where we were 30 years ago, considering inflation. Tie the reimbursement rate to the cost of living index, same as social security. If you cut physician pay 11%-40%, you will see mass retirement and the elimination of the most efficient care, office-based practice.
- Remove the practice expense payment from government-reported physician income since this is overhead spent to provide the care.
- Let all physicians participate, and don’t pay site-of-service differentials.
- Enact national tort reform, which would decrease the paperwork, overhead, and much useless defensive medicine.
- Press the generic drug manufacturers (but not the innovators) regarding drug costs. Bite the bullet, and set national coverage standards (ration care) to be revisited every 5 years, which will eliminate step therapy and prior authorizations. Allow individuals to pay out of pocket for additional treatments they want, including that questionable additional 90 days of life they may get from the $250,000 drug for the off-label indication.
- Press the hospitals, and don’t complain when many of them close, especially rural ones.
- Allow individuals, hospitals, and physicians to contract outside of the government plan (in contrast to Canada).
- Downsize the health insurance companies, and have them sell private supplemental insurance to whomever wants it.
Finally, make all of this a constitutional amendment. If not put out of reach, in 15 years we will have the same system we have today. The politicians simply will not be able to resist degrading (reforming, improving, refunding, defunding) the original plan. Or, you could simply increase Medicaid rates to Medicare rates and call it a day.
Oh, by the way, I saw that man from the New Year’s Eve party at the airport the following Christmas. He survived to get his government bypass and is doing well.
The health care system we have is miserable, except compared with all the others.
Dr. Coldiron is in private practice but maintains a clinical assistant professorship at the University of Cincinnati. He cares for patients, teaches medical students and residents, and has several active clinical research projects. Dr. Coldiron is the author of more than 80 scientific letters, papers, and several book chapters, and he speaks frequently on a variety of topics. He is a past president of the American Academy of Dermatology. Write to him at [email protected].
At a New Year’s Eve party a few years back, I noticed a man sitting nearby clutching his left upper arm. He was ashen and obviously uncomfortable. Acute coronary insufficiency, I thought, and I asked him if I could call the life squad for him. “Oh no,” he said, “I have these spells several times a day, the nitro will kick in after a minute, and this will ease off.” I listened as he explained he had a “widow maker,” a 90% plus left main occlusion, but “I am Canadian, and my government is going to pay for my bypass,” he said. “I just have to wait 6 more weeks.” The irony? He was the son of our host, and we were sitting in his mothers’ multimillion dollar home in the Florida Keys. He could be in a Miami hospital’s operating room in an hour or 2.
Wow. Click. Got it.
Fast forward to a lobbying discussion on Capitol Hill: A sympathetic U.S. senator tossed me this softball: ‘What do you think about Medicare reimbursement?” I expect he thought I was going to complain about how bad Medicare is, about its failure to keep current with inflation (currently about 30% behind), and the obtuse quality metrics it now requires. Instead, I found myself saying, “Medicare is my most reliable payer, paying on time – in 2 weeks for clean claims – and the private insurers have beaten me up badly. Medicare is one of my best payers.”
Wrong answer, but true statement.
There is much talk these days about , particularly considering all the barriers to care. (See my recent column, “Produce and Promises.”) Physicians and patients endure a mutual misery inflicted by private insurance companies.
What to do about health care in America?
First, let’s deal with the extraordinary costs of health care in the United States – 19% of our gross domestic product. About 3%-4 % of this figure is an accounting gimmick, since it includes nursing home care, which is considered “domiciliary” care rather than health care in Europe. In addition, drug costs are higher in the U.S., largely to cover the development of new drugs that cost less in the rest of the world. Wait lists are largely unheard of in the United States, and if you have such ready capacity, that means you incur the costs of idle capacity. Also, rarely is a new miracle drug flatly denied for coverage in the United States. If you persist, you will usually get your drug.
We are a commodity-driven society, and that is the real reason that health care costs so much in this country. Hence, we come to the real debate, the “R” word. How do we ration access to care? (See my 2017 column, “Why the Affordable Care Act will be Greatly Modified.”)
There are a plethora of proposals to fund single payer out there, none of which address rationing. And while single payer affords free universal coverage, it does not assure better care. As health economist Devon Herrick, Ph.D., wrote in his health care blog in 2016: “A single payer is not some magical entity that rains down savings from Heaven by being unconcerned about profit. Rather, an efficient single payer operates more like a predatory HMO with no competition. It is currently in vogue for hipsters to matter-of-factly announce the simple solution to health reform is single payer. Be careful what you wish for; you may end up with Medicaid for All.”
In fact, if you try to ferret out how physician income will be affected by universal health care, there would be an estimated pay cut of 11%-40%, depending on how the numbers are manipulated.
Some single-payer proposals use the term “exchange rates,” which for the uninformed means Medicaid rates. In addition, payment is usually given to the local hospital system, or “authority” to dole out. I have a very bad feeling that any small practitioner in an office-based practice would be severely shortchanged in such a system. In fact, if you cut pay for office-based physicians at all, you may begin to see them disappear.
Policy wonks argue for pay cuts for American physicians because European physicians “make less money.” Those numbers are all wrong. U.S. physicians are paid for their work, and for their practice expense. That is, how much it costs to provide the service in their office, which is around 40%-50% of published income. In Europe, almost all procedures are performed in the hospital setting, and the hospital absorbs the practice expense, which is ignored in this current health care reform debate. (See my 2015 column, “Doctor, Why DO you get paid so much?”)
The big selling point of single payer for physicians is that they might have less paperwork and get paid more for seeing Medicaid patients. Yet the paperwork will persist to avoid lawsuits, electronic medical records are now ingrained into the system, and most Medicaid patients are currently seen in the federal or hospital outpatient clinic where higher rates or other subsidies are available. The comically low Medicaid rates paid to physician offices are largely evaded or not even filed for.
Single-payer advocates are basically saying, “Yes, you will be seeing patients at a loss but you will make it up in volume.” This ignores the reality that most physicians don’t need or want more volume.
Here is my plan for single-payer health care. Call it ColdironCare.
- Set payment rates for physicians at 130% of current Medicare, about where we were 30 years ago, considering inflation. Tie the reimbursement rate to the cost of living index, same as social security. If you cut physician pay 11%-40%, you will see mass retirement and the elimination of the most efficient care, office-based practice.
- Remove the practice expense payment from government-reported physician income since this is overhead spent to provide the care.
- Let all physicians participate, and don’t pay site-of-service differentials.
- Enact national tort reform, which would decrease the paperwork, overhead, and much useless defensive medicine.
- Press the generic drug manufacturers (but not the innovators) regarding drug costs. Bite the bullet, and set national coverage standards (ration care) to be revisited every 5 years, which will eliminate step therapy and prior authorizations. Allow individuals to pay out of pocket for additional treatments they want, including that questionable additional 90 days of life they may get from the $250,000 drug for the off-label indication.
- Press the hospitals, and don’t complain when many of them close, especially rural ones.
- Allow individuals, hospitals, and physicians to contract outside of the government plan (in contrast to Canada).
- Downsize the health insurance companies, and have them sell private supplemental insurance to whomever wants it.
Finally, make all of this a constitutional amendment. If not put out of reach, in 15 years we will have the same system we have today. The politicians simply will not be able to resist degrading (reforming, improving, refunding, defunding) the original plan. Or, you could simply increase Medicaid rates to Medicare rates and call it a day.
Oh, by the way, I saw that man from the New Year’s Eve party at the airport the following Christmas. He survived to get his government bypass and is doing well.
The health care system we have is miserable, except compared with all the others.
Dr. Coldiron is in private practice but maintains a clinical assistant professorship at the University of Cincinnati. He cares for patients, teaches medical students and residents, and has several active clinical research projects. Dr. Coldiron is the author of more than 80 scientific letters, papers, and several book chapters, and he speaks frequently on a variety of topics. He is a past president of the American Academy of Dermatology. Write to him at [email protected].
Telemedicine not widely used
Also today, you ought to be judicious with empiric antibiotics for febrile neutropenia, home-based exercise is better than supervised treadmill exercise for peripheral arterial disease, and brain injury in sickle cell merits more attention.
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Also today, you ought to be judicious with empiric antibiotics for febrile neutropenia, home-based exercise is better than supervised treadmill exercise for peripheral arterial disease, and brain injury in sickle cell merits more attention.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
Also today, you ought to be judicious with empiric antibiotics for febrile neutropenia, home-based exercise is better than supervised treadmill exercise for peripheral arterial disease, and brain injury in sickle cell merits more attention.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
