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.
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.
Health Reform and “Under Duress”
I was quoted in the Des Moines Register on Friday, November 27, regarding the Medical Assistance Advisory Council (MAAC) meeting that I attended on Wednesday, November 25. The topic is familiar in this blog: Medicaid managed care. The federally mandated council advises the state of Iowa on Medicaid issues and is one of the major overseers of the upcoming Medicaid managed-care “modernization” that is currently scheduled to begin on January 1, 2016 — four short weeks from today. The approximately 30 other members of the council and I spent two hours raising questions and concerns with the Iowa Department of Human Services and representatives from the four managed-care organizations (MCOs) that will divide 550,000 Medicaid patients and more than $3.5 billion in state and federal monies.
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.
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.
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.”
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.
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.”
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.
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.