Category Archives: universal coverage

Health Reform and High-Risk Pools

United States House of Representatives Speaker Paul Ryan is right. High-risk pools could be the solution that solves some of the current problems with our health-care system.

Even though high-risk pools have not worked in the past (most immediate for me is the example of my home state, Iowa); even though I believe that states have neither the expertise, the competency, nor the will to run high-risk pools; even though I have railed time and again against high-risk pools as being anti-universal coverage, I now propose a new concept for high-risk pools.

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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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A Culture of Coverage and Health Reform

(This month’s blog post is the text of an article that I was asked to write for a professional publication.)

As chair of the Iowa Tobacco Use Prevention and Control Commission, I was responsible for helping to guide Iowa’s anti-smoking efforts by following a mission statement created by the Iowa Legislature that read, “to foster a social and legal climate in which tobacco use becomes undesirable and unacceptable.” In this same vein of using legislation to create social change, I will review the actions derived from the Affordable Care Act (ACA), also known as Obamacare, in Iowa. From this family physician’s reading of the ACA, I submit that the underlying social change goal is to create a “culture of coverage,” which  means that, within certain constraints, the citizens of the United States, and residents of Iowa in particular, will have the expectation that they have health coverage and that they will, in part, be responsible for securing that health coverage.

Obviously this 2,000-page law has many more elements, approaches, and objectives, but for me, this “culture of coverage” is the overarching goal. It is with this goal in mind that I discuss what I perceive as the unfolding of the ACA in Iowa.

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Health Reform and the Economy

My premise for this blog is that the basic tenets of health-care reform found in the Affordable Care Act (ACA) are sound. I have for years advocated for universal coverage, an individual mandate, care coordination as a way to improve the quality and cost of health care, an employer mandate (as limited by the ACA), improved private-insurance competition, Medicaid expansion for adults below the poverty level, and improved insurance regulation. I will not categorically support every action found in the 2,000 pages of the law, but, by and large, I think it provides a framework that can produce positive, significant change and that, over time, can be improved as necessary.

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