Category Archives: culture of coverage

Health Reform and Continuity of Care

In the chaos of health-care efforts both nationally and in Iowa, today I seek to go back to two basic beliefs: 1) the hope of future generations to learn from past generations’ mistakes and 2) the value of continuity of care for primary health care and, ultimately, health care in general.

The U.S. Senate is now debating a tax-cut bill that includes eliminating the Affordable Care Act (ACA) individual mandate for health-care coverage — a basic tenet for true health-care reform — and, in Iowa, the for-profit, managed-care Medicaid fiasco now has one managed-care organization (MCO) leaving the state and another MCO not able to take new patients. These actions leave the state with only one MCO left to serve Medicaid patients. Given these realities, I shift gears by presenting to you a guest blogger.

She is a third-year medical student who recently spent a month with me in my clinic. She plans to be a pediatrician. I choose not to provide her name. Although she would allow it, I am not sure her medical school would.

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Health Reform and Motive

My dad — whom I admire, respect, and love dearly — for my taste, watches too much Fox News. He criticized the Affordable Care Act (ACA) for years. He talked exclusively about its shortcomings. He talked about the 3,000 pages of the Act that none of the members of Congress had read. After listening to him for a while, I rebutted him on only one point. I said you could never criticize the ACA’s authors’ motive — to improve health-care coverage for Americans. With my comment, he quickly changed the topic of discussion. During many conversations with him over several years, he never changed the topic as quickly as he did that time. My rebuttal hit home. We can argue over method, but it is far more difficult to argue over motive.

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Health Reform and Incremental Primary Care through the Eyes and Experience of Atul Gawande, MD

Wading through the onslaught of presidential executive orders in search of a future of health reform in our country, I became weary and disheartened. Then, two people reached out to me regarding a feature article in the January 23, 2017, issue of The New Yorker by Atul Gawande, a surgeon, public-health researcher, and staff writer for The New Yorker. The article is titled The Heroism of Incremental Care. Dr. Gawande is the premier medical thinker and writer of our time. He has produced an excellent summary of my thoughts regarding Primary Care — both in theory and in how I seek to practice. A sincere thanks to Chris, my friend from Connecticut, and David, a patient and reader of my blog, for this remarkable find. I will defer this blog with the recommendation to read Dr. Gawande’s article, which is linked below with sincere appreciation and credit to The New Yorker.

 

The Heroism of Incremental Care, by Atul Gawande, as published in The New Yorker.

Next month I will return refreshed and invigorated and attempt humbly to carry out the spirit of Atul Gawande and his insightful article in the context of health reform.

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.

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Health Reform and the “Vulnerables”

In the health insurance industry, young adults are known as the “invincibles.” Like the superheroes that inhabit movies and TV now, these young men and women believe they are impervious to illness, disease, and injury. Therefore, they do not acquire health-care coverage, believing they are invincible. It is human nature to create groupings of individuals and name that grouping. We commonly talk about “baby boomers” and “millennials.” Tennessee Williams said that he wrote about the “incomplete.” Studs Terkel, in his book, Working, said he interviewed and wrote about the “uncelebrated.” Today for this blog, I create my own grouping. Here’s why.

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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.

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Health Reform and the Letter of the “Court”

June 25, 2015, was a banner day for many reasons. The U.S Supreme Court decision in King v. Burwell allowing 6 million Americans (more than 40,000 in Iowa) to maintain federal subsidies to help pay for individual health-insurance premiums that were purchased under the Affordable Care Act (ACA) federal Exchange was uplifting. The decision will allow the ACA to become a permanent part of our lives and our culture. In Iowa, Republican Governor Terry Branstad responded to the decision saying the ACA was “unaffordable” and “unsustainable.” I would respond to his comments here, but Paul Krugman’s commentary in The New York Times published same day as the decision is a far better response than anything I could write.

In concluding his commentary, Krugman wrote, “Put all these things together and what you have is a portrait of policy triumph — a law that, despite everything its opponents have done to undermine it, is achieving its goals, costing less than expected, and making the lives of millions of Americans better and more secure. … And it’s a beautiful thing.”

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Health Reform and Numbers

60. I start and end this blog post with selected lines from poems. Dylan Thomas began his Poem in October with: It was my thirtieth year to heaven. Today marks my sixtieth year to heaven (I hope), and, instead of Dylan Thomas describing the beauty of Wales in October on his birthday, I am witnessing six months and thirty birthdays later the beauty of Iowa in April. April brings the brightest green grass of the year, the snow-white blossoms of the pear tree in my back yard, and the soon-to-be-red blossoms of my crabapple tree in the front yard. Colors seem to explode from every flower and bush.

Birthdays also mark time in relationship to other events, including the anniversary of the Oklahoma City bombing. Albert Einstein died 60 years ago yesterday. Sixty years ago this month, Churchill left office as the prime minister of Great Britain. The American Revolution started 240 years ago on this date. For me, dates give a sense of one’s location in both the positive and negative swings of history. Correspondingly, numbers can give us perspective and relative significance of the people, events, and details of our lives. Today, I review some numbers that I have heard over the past several months, numbers that cause me to reflect on health reform, both positively and negatively.

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Health Reform and Reminiscences of Hospice Patients

This blog is dedicated to a good friend and patient of mine who died last month in hospice. I had taken care of her for 15 years. We had many remarkable and enjoyable conversations regarding her growing up in a home where her father was a physician. She thought very highly of her father and the profession of medicine. She knew the value of good medical care and how much it means to all of us, even physicians and their families. She had seen the human side of medicine in its effects on her father and her family.

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Health Reform: Healing vs. Cattle Trading

In one of the most profound lectures that I have heard in my life, Dr. Eric Cassell, New York City internist and author, discussed at a Harvard conference on hospice the “Nature of Healing.” His concept regarding spirituality moved me. He said, “Function reaches from the cellular to the spiritual. Something is spiritual when it transcends the individual. Relationships are spiritual. Religion is spiritual. Spirituality is a human function.” As a family physician, I fully subscribe to this spiritual aspect of my relationship with my patients.

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