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 a $10,000 Neighborly Visit

A friend of mine, a family physician, told me about a visit he had with his 93-year-old neighbor recently. This neighbor had known my friend for more than 20 years and was my friend’s patient. His neighbor is a wonderful man and a big basketball fan. He grew up on a farm in northeast Iowa and remembers when his farm received electricity in the 1930s. He was the electric power supervisor for the district that included downtown Chicago in the 1960s and remembers the riots following the 1968 Democratic Convention there.

The neighbor had a heart-valve procedure earlier this year and, because of complications, had an evaluation with his cardiologist the day before my friend’s visit. At the cardiologist’s evaluation, the neighbor’s cardiac drug regime was significantly changed. My friend was called by the neighbor’s wife and asked to come over to her home when her husband, the neighbor, was having chest pressure and nausea. The wife had called First Nurse, a 24-hour nurse hotline, and was told to call for an ambulance. My friend, knowing the patient’s previous workup and having been told of the change in the cardiac meds, evaluated the neighbor. Based on the evaluation, my friend had the neighbor lower his cardiac meds and, by the next day, the neighbor was back to the baseline of his cardiac status.

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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 Confusion

It should be so easy: A patient should receive his or her needed and entitled health care.  Medicaid should be the conduit that connects the patient and the physician and then pays the physician or other health-care provider for services rendered.

Furthermore, if Medicaid contracts with a for-profit managed-care organization (MCO) to provide care to patients, there should be adequate state oversight to ensure the safety and well-being of these patients. As the 2016 Conference Report for the Health and Human Services, passed this week by the Iowa House and Senate, states, “The primary focus of the general assembly in moving to Medicaid managed care is to improve the quality of care and outcomes for Medicaid members.”

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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 Oversight, Ombudsmen, and Obfuscation

“Iowa has two ombudsmen to investigate and advocate for the 560,000 poor or disabled recipients on the (Medicaid) program.”

— The Des Moines Register, February 28, 2016

I salute Jason Clayworth, the reporter who wrote the Des Moines Register article from which the above quote is taken, as well as Tony Leys, another Register reporter, and the Des Moines Register editorial staff. Their tireless efforts to investigate and comment on the upcoming transformation of the Iowa Medicaid program to a for-profit managed-care model has brought some clarity to the issue, as well as exposed some potential flaws. Iowa is only the fourth state in the country to completely adopt this new model across its various Medicaid programs.

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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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