Category Archives: access & costs

Health Reform and the Orphan Called the Individual Health-Insurance Market

Last week, the buzz in Washington, D.C., where I heard numerous lectures and personally talked to two U.S. representatives and two U.S. senators, was about impending health-care legislation in the Senate and particularly focused on the imminent crisis in Iowa, where there probably will be no insurers for the individual insurance market in 94 of its 99 counties in 2018.

Seventy thousand Iowans may not have health insurance next year in a state that prides itself as an insurance state. Iowa is the poster child for the deficiencies in the individual insurance market. Across the nation, only a few counties in Tennessee have that known potential for 2018, though several potential fixes are being discussed at the federal and state levels.

Continue reading →

Health Reform and Pre-Existing Conditions

I was tempted to titled this blog entry Health Reform and “I Won’t Let People Die in the Streets.” I also was tempted to describe the November 8 election as the day health reform died. One retort could be that the Republicans are now in charge of health reform. They need to play offense as opposed to only playing defense. And we should move forward.

For starters, let’s discuss the dual action of repealing the Affordable Care Act (ACA) and maintaining the Republican pledge not have individuals with pre-existing conditions be excluded from health insurance in the post-ACA world.

Continue reading →

Health Reform and Uber and Food Trucks

Recent economic trends nationally and in Iowa include the proliferation of Uber contract-driver taxi services and owner-operated food trucks. Both of these services rely on individuals starting a small private business in the competitive world of commerce.

My brother, my father, and my grandfather have all been owners of their own small businesses. The gumption and personal sacrifices needed to take on all the requirements necessary to run a successful small business have always humbled me. From advertising and marketing to hiring and personnel management, to municipal, state and federal regulations, to eventual retirement, a small-business person needs to consider every aspect of their business. Despite this, many individuals crave the freedom and independence that running their own businesses or being independent contractors allows. Given the other options of being someone else’s employee in a large business or a government worker, I sympathize with and support individuals who are willing to risk their time, resources, and self in these challenging endeavors.

Continue reading →

Health Reform and ACO Incentives – Getting It Right

We need to get this right. As I have said last month, I continue to be dismayed by the evidence that health-care costs are not being controlled. For example, in Minnesota, one of nation’s top health-care managed states, Blue Cross and Blue Shield announced that it would not sell individual insurance policies next year due to concerns over cost. Skyrocketing health-care costs will affect the affordability of private insurance and the existence of public health-care programs such as Medicare, Medicaid, and subsidized insurance sold under the Exchanges.

Continue reading →

Health Reform and Wrapping Up

I should wrap up this blog with this post. This was to be the last entry. I said at the beginning, two and a half years ago, that I would chronicle the first two years of progress for health-care reform and the Affordable Care Act (ACA) in Iowa. Now, at the end of the second year of the ACA, we are able — to some extent — to count the successes, some sad outcomes, and end the blog.

Continue reading →

Health Reform and Janet Huston

This is a Halloween horror story. It is short but not at all sweet.

Janet Huston and I participated in a panel discussion sponsored by the Campaign for Sustainable Rx Pricing on Thursday, September 29, at Drake University in Des Moines, Iowa. Also participating were John Rother, executive director of the Campaign, and Les Nichols, a health economist from George Mason University. The Campaign chose Iowa because of its caucus notoriety. There were approximately 50 in the audience, and the local press took notice.

We all discussed our concerns regarding the high prescription-drug prices in the United States, but it was Janet’s story that was poignant, revealing, and so very incriminating.

Continue reading →

Health Reform and Hillary’s Ideas Regarding Prescription Drugs

Adam Smith, the Scottish economist and moral philosopher of the 18th century, in his book An Inquiry into the Nature and Causes of the Wealth of Nations, generally referred to by its shortened title, The Wealth of Nations, introduced the analogy of an invisible hand working within capitalism to promote the social good, by which he meant, according to many sources, a “process by which market competition channels individual greed toward socially desirable ends.” That invisible hand has failed “socially desirable ends” with the current pricing of prescription drugs in the United States.

Continue reading →

Health Reform and Family Medicine

On Thursday, July 22, I said goodbye to a University of Iowa third-year medical student. The student had been with me for a month.

One of my favorite professors while I was a student at the University of Notre Dame always said that the best way to learn something is to teach it. This was the seventh medical student I have had in my practice in eight years. I have learned so much about my belief in family medicine by teaching these students and sharing my patients with them.

Continue reading →

Health Reform and Quid Pro Quo

This week, a high-ranking politician left a phone message for me at my clinic. He asked that I call him. The purpose of his call, according to the note from my receptionist, was “politics.” I did return his call and left a message. He called me back while I was out at a movie. Stepping out of the movie to look at my phone, I found that the purpose of his call was direct and to the point: He asked for money for his political campaign fund. Another politician currently running for office has called me at various times during my work hours. He called once just as I prepared to do a knee injection for a patient and again while I was making rounds at the hospital. During each call, this politician asked for campaign money.

Continue reading →

Health Reform and Aligned Incentives

In further discussing the now-dissolved CoOportunity Health, as well as Governor Branstad’s proposed plan to turn over the Iowa Medicaid program to a private managed-care company or set of companies, I was going to title this blog entry Health Reform and the Need for Nonprofit Entities, which may, in the end, be what the readers of the blog may feel is my conclusion. Instead, I chose the current title to reflect a refinement of my views over the years. To understand this refinement, I want to start this post by going back to 1993.

Continue reading →