Category Archives: Medicare

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.

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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 “Yuge”

Former Vermont Governor Howard Dean speaking this week at the 2016 Democratic National Convention quoted Donald Trump. According to Governor Dean, Donald Trump said that he’s going to replace the Affordable Care Act (ACA) with “something so much better” — something “‘Yuge,’ no doubt.”

In researching this “something so much better,” I could find only a mismatched set of random ideas such as buying health insurance across state lines, establishing Medicaid block grants for each state to administer, allowing Americans to import medications, eliminating the individual mandate but still preventing insurance companies from excluding patients based on pre-existing conditions, and expanding tax exemptions for corporate health insurance to individuals.

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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.

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Health Reform and Medicare for All … Seniors

One of my favorite movies is White Christmas, which starred Bing Crosby and Rose Mary Clooney. In one scene, Rose Mary Clooney’s character sings a song in a nightclub about her unhappiness with Bing Crosby’s character. She sings, “Love, you didn’t do right by me … you planned romance that just hadn’t a chance, and I am through.”

In a fashion similar to that Irving Berlin song, after years of touting private health insurance by helping to create the Healthy and Well Kids in Iowa (HAWK-I) — Iowa’s CHIP program, and working with CoOportunity Health — Iowa’s health-care co-op that went bankrupt, I have come to the conclusion that the private health-insurance market under the Affordable Care Act (known as the ACA or Obamacare) has not done “right by me.” More importantly, it has not “done right”  the citizens of the country. For reasons that I will clarify later, I now support expanding Medicare to individuals 55 years of age in a graduated, voluntary enrollment process.

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Health Reform and Enhancing Patients’ Lives

Family medicine is creating and maintaining relationships with patients in order to enhance their lives.That is the definition I gave to the University of Iowa’s family-medicine residents at their resident retreat on Saturday. During my talk with this group of young physicians, I described my family-medicine team and how we help our patients to maintain their health, recover, and become healthy from an illness or improve their quality of life if diagnosed with chronic illness or a terminal disease. My team includes a head nurse, two health coaches who share a full-time position, a “roomer” nurse who seats patients in examination rooms and charts their vitals signs, and a “shot” nurse. Together, we are responsible for the family-medicine needs of 2,100 patients. I have described the use and value of health coaches in a previous entry.

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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.

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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.

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Health Reform and Public Service

The world became a lesser place on Friday, August 28. My mother-in-law died. I had known her for 41 years and never once heard her speak a cross word. She died three months short of her birthday. She would have been 90 years old. She worked her entire professional life in public service. Her first position was as a Head Start teacher in the first year of the Head Start Program in Alabama at the time of the Selma march. Her major role, once she returned to Iowa, was as a county home economist, initially in Kossuth County, then for more than 20 years in Crawford County. She added Ida County toward the end of her career. She taught rural families how to survive and thrive in the changing world of the 1960s, ’70s, and into the 1980s. At her retirement dinner, her supervisor said, “In many ways, Norma has been in the vanguard. When you look to see what Norma is doing and, in two or three years, all Iowa counties will be doing it.”

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Health Reform and Patient-Centered Health Goals

Every other Wednesday morning, I attend our hospice interdisciplinary team meeting. This meeting is one of the highlights of my week. Four years ago, we began introducing each discussion of new and current patients with that patient’s stated goals. I always make notes directly on the printed list of patient names provided at this meeting when certain facts and information about a patient catch my interest. Often, it is the patient’s goals that I write down. The goals are many and varied. A common goal is for patients to stay in their own homes. Other goals include family events, such as attending a wedding or awaiting an upcoming birth in the family. I have heard goals including finishing a scrapbook, continuing to work on a classic car, taking a grandson to a basketball game, or traveling to see relatives. The personal nature of this way of starting the discussion of a patient’s status at the hospice-team meeting places the focus precisely where it should be — on the patient.

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