“Spirit of Charity”

The book I have been working on for several years about Grady Hospital and hospitals like it around the country has a new title.

Atlanta's Grady Memorial Hospital
Atlanta’s Grady Memorial Hospital

“A Spirit of Charity”: Restoring the Bond Between America and Its Public Hospitals.

 The title is based on one of my favorite FDR quotes; “Better the occasional faults of a government that lives in a spirit of charity than the consistent omissions of a government frozen in the ice of its own indifference.”

I’m going to keep the Failure to Thrive blog theme here. Originally that was going to be the title of the book too, but there are already too many books out there with that name or something like it. Still,  I like it for the blog, mostly because of my strong feeling that our nation still hasn’t created a health care system that allows the poor the same kind of access to needed care that the rest of us have. You need only look to Georgia and neighboring southern states to see how we have left millions of working poor people and their families behind to fend for themselves. It is impossible for these folks to thrive in the face of such icy indifference. And public hospitals like Grady shoulder the burden of this fundamental failure. That’s what I’ll be talking about in the book.

Last weekend The New York Times and Enroll America provided a revealing map of the counties around the country where the highest concentrations of people without health insurance live. You can look at it here.

http://nyti.ms/1HgsMjf

Meanwhile, watch this space. “Spirit of Charity” will be coming soon to a bookstore near you, or  to the digital device that you may now be holding in your hand.

Coming Soon: The Unfinished Business of Health Care Reform

Failure to Thrive: Hope and Reality at Grady Memorial and America’s Great Public Hospitals

Expected publication: Early 2016

Henry W. Grady Memorial Hospital is a fixture in Atlanta, built and chartered by the city in 1892 to provide care to anyone who needs it. Over the years Georgia’s largest public hospital has earned a reputation as one of the nation’s best teaching hospitals. But it also was a place so rife with political mismanagement that it nearly had to close its doors in 2007.

Many of Grady’s counterparts around the country – iconic places we know by their first names like County in Chicago, Parkland in Dallas, Jackson in Miami – have been through similar turning points and survived. Yet how these hospitals operate, who pays for them and how they fit into the nation’s $3 trillion-a-year health care system, is a mystery to most of us.

Through the prism of Grady, Failure to Thrive explains the unique history of America’s large public hospitals, as well as their continuing challenge. More importantly, it is story about how the poor are cared for in the United States.

In a country that has yet to determine whether access to basic medical care is a right or an earned privilege, these hospitals bear the burden of that indecision. Indeed, their very existence makes it easy to avoid the discussion altogether.

That’s because the people who show up in the emergency rooms and clinics of America’s public hospitals represent the gaping holes, the ill-conceived compromises and the unintended consequences resulting from decades of attempts to reform health care in our country.

Even now. Even after the Affordable Care Act, the latest contentious effort to make health insurance more available to Americans without it. The 2010 law – subject to so much litigation at the federal level and ideological obstruction at the state level – still leaves millions of Americans behind when it comes to getting the health care they need, especially among residents of the South, where state leaders have a history of eschewing federal programs aimed at helping the poor. These patients will continue to turn to Grady and Parkland and County and Jackson and dozens of other beleaguered last-resort providers for the care they need and deserve.

Failure to Thrive makes the case that these hospitals represent more than a frayed safety net for the poor; they have become a safety valve for the nation’s highly profitable health industrial complex.

They exist, not just to take care of the poor but to relieve others from the challenge to profits that poor people represent. And because they exist – indeed, many, like Grady, have been around for more than a century – we seem content to take them, and the essential services they provide, for granted.

Public indifference toward large public hospitals can be understandable for nearly all of them have had years where they failed badly in their mission. Many, like Grady, have had to overcome financial improprieties and political interference. Others have been scandalized by horrific treatment of the very patients they were chartered to help.

But know this too – America’s public hospitals are remarkable at survival. Some of the best and brightest minds in medicine, public health and administration are committed to the cause of caring for the poor. And, despite the financial constraints under which they are forced to function, many of them are providing state-of-the-art services for indigent and paying patients alike.

These hospitals are sentinels to the future of health care in America and, ultimately, how our country treats the poor. Knowing more about them will improve the ongoing discussion of health care reform as we move forward.

 

Mike King, the author, is a retired health policy reporter, editor and columnist for The Atlanta Journal-Constitution.

Secant Publishing, Salisbury MD, expects “Failure to Thrive” to be available in early 2016.

 

 

 

 

 

The Myth of Defensive Medicine Costs

From MIKE KING

The standard refrain of opponents to comprehensive health care reform efforts, like Obamacare, is that one of the major drivers of escalating medical cost is defensive medicine practices caused by fear of lawsuits. Fix that and you’ll move a long way toward keeping health costs from escalating, or so the theory goes. The science to back up this claim has never been borne out.  Yet Red State legislatures — including Texas and Georgia — dutifully bought the wisdom of conservative think tanks in recent years and enacted tort reforms making it more difficult to file, as well as limiting the amount of damages plaintiffs can win in medical malpractice lawsuits. Now we have some additional studies that these news laws haven’t really made much of a difference in terms of controlling costs. Today’s New York Times Upshot reports about it.

When you talk about rising health care costs you have to deal with, among other things: an aging population in need and demanding care for chronic illnesses;  new, more sophisticated medical technologies that replace cheaper, less expensive diagnostic tools;  the high-cost of recovering research expenses by overcharging for new drugs to the market; a reimbursement system that pays physicians more for ordering tests and procedures than it does for keeping patients well; and the 20-25 cents on the premium dollar that goes to profit, marketing and administration of commercial health insurance plans. The fear of malpractice, no doubt, is another factor. But it is chump change. And when you hear it come up in serious policy discussions, it is more than likely just a way to distract you from the serious issues this country still faces in making health care affordable.

Mike King is a retired health policy reporter, editor and columnist for The Atlanta Journal-Constitution. He is the author of “Diversion,” a book about how large public hospitals have become the safety valve for the nation’s highly profitable $3 trillion a year health care economy. The book — as viewed through the experience of Atlanta’s Grady Memorial Hospital — is expected to be published next year.

Back in the game with some interesting reading

Been gone a while. But now that the dust is settling on the Obamacare rollout — we’re still a long way from being able to talk about cost control and whether access to affordable plans has been greatly expanded (or just good enough to be happy about year one) — I thought you might be interested in a couple of good reads I saw recently on Vox.com.

This first one deals with why Republicans always choke on a viable alternative to Obamacare. (Hint: It was because it was THEIR plan to begin with.

http://www.vox.com/2014/4/29/5663554/fauxbamacare-obamacare-replacement

Speaking of a plan that many thoughtful people long ago concluded is the only way to truly get universal access and have a real shot at controlling costs, Sara Kliff of Vox offers this lengthy explanation of what’s going on in Vermont.

http://www.vox.com/2014/4/9/5557696/forget-obamacare-vermont-wants-to-bring-single-payer-to-america

And lastly, my favorite website since the first of the year is this one. It shows how we Georgia taxpayers, since the first of the year, have been sending our hard-earned federal taxes to New Jersey, Kentucky, California and other states to help subsidize their expansion of Medicaid enrollment for the working poor while we sit here listening to our elected state leaders say they are proud to give up those dollars and let our working poor fend for themselves. Consider, for a moment, whether they would be willing to give up federal highway funds? Or public safety funds? Wouldn’t it be great if we had one of those billboards — like the one on Peachtree that used to roll out the ever increasing Atlanta population — that showed how much money (about $100 per second, by my count) Georgia’s hog-tied and Tea Party bound GOP leadership is purposefully throwing away for our state. Within the next few days, this number will reach $1 billion (billion, with a “b”) since the first of the year.

http://progeorgia.org/medicaid-counter/

We got our guvment back. And blog too

From Mike King

 

The confederacy of extreme right wingers of the Republican House caucus — aided by their new bestest buds Ted Cruz and a Mike Lee in the Senate — got what they have been begging for the last couple of years — a government shutdown and a chance to make even wilder-than-usual, fact-challenged claims about Obamacare, which they failed to repeal, shutdown or even significantly alter as a price for their ransom of the U.S. economy. But enough about that now. Because these folks long ago detached themselves from rationality, we might have to go through the whole thing again after the first of the year. So no need to waste time about who won and who lost, as the media is likes to do. Mostly, that’s because the media doesn’t have the stomach to actually analyze whether one side was really right and the other side was really wrong to think that sucking $24 billion out of the economy with the shutdown, and putting the credit of the country on the block by threatening not to pay some of our bills, was worth it.

Let’s return instead to some of the discussion points that got lost — as John Boehner may say — while the hot air was still in the room during the shutdown. There are many that need more airing, like whether the individual mandate should be delayed; whether the faulty, horribly-rolled out sign-up process for the exchanges is indicative of other problems administering the new law as it is implemented; whether Congress really did “exempt” itself from the law by providing staffers a special subsidy when they sign up for insurance on the exchange, and whether some of the taxing mechanisms for paying for the insurance subsidies should be repealed.

We’ll deal with one of those — the medical device tax — today. It’s worth a closer look, not because it is all that controversial — although the K Street lobbyists in Washington would have you believe it is — but because it almost got included as part of the ransom demand for Obamacare changes during the shutdown. Thankfully, the White House help firm on it, despite some weak-kneed Senate Democrats who wanted to repeal or delay it and justified their position by claiming they and the White House had to give the House hostage-takers something to claim as a win.

The best analysis of the medical device tax issue is presented in this op-ed in today’s NYT. 

I can only add with 20 to 30 million more Americans now eligible for insurance coverage — and presumably a bigger market for their wares —  it’s a little disingenuous for these manufacturers to be crying wolf that a small tax on their profits will kill the industry.

And lastly, there’s this: Anyone who has ever dealt with filing claims or purchasing a needed piece of equipment directly from device manufacturers or suppliers — from sophisticated, implantable, life-sustaining devices like insulin pumps to simple technology like CPAP –has figured out the incredible markups they get on these devices. Moreover, they understand how manufacturers collude with doctors and insurance companies to limit choices of what kinds you can purchase or lease if you want to claim coverage.

So don’t expect a lot of sympathy for these health care providers. They don’t deserve it.

 

A red state that can’t adopt Obamacare fast enough

From Mike King

I used to live in Kentucky. It’s a great state. I’d be hard pressed to say that most of the state is any more or less conservative than Georgia. It is, after all, home to the Senate Majority Leader (Mitch McConnell) and an up-and-coming tea party favorite who may be a presidential candidate in 2016 (Rand Paul). On the political color spectrum, it’s very red.

But it isn’t a one-party state. Steve Beshear, the governor, is a Democrat. He’s a former Attorney General for the state and a long-time political figure in Kentucky. And he was smart enough to understand, quickly, how Obamacare can help his state economically while at the same time improving the health and welfare of Kentucky residents by moving thousands of them from no insurance to Medicaid. He also quickly signed Kentucky up to manage its own health insurance exchanges and, by doing so, seemed to generate enough competition in the bluegrass to help keep policies affordable.

Here’s Beshear’s explanation of his decision in today’s New York Times

Contrast that with Georgia, a similarly red state. Unfortunately one-party domination (and the accompanying fear of tea party tail wagging that now controls that party) will leave Georgians to fend for themselves on the federal insurance exchanges. Meanwhile, 650,000 of the state’s residents who could have qualified for Medicaid will be left out altogether.

Georgia’s claim is the state can’t afford it. The state has a $20 billion annual budget. It is much healthier than Kentucky. Georgia can afford it. Kentucky has a visionary governor. Georgia has an intimidated governor who probably, deep down, knows it would have been the right thing for the state to expand Medicaid and set up its own exchanges. But he lacked the political fortitude to do it.

 

 

 

 

About those companies dropping insurance…

From MIKE KING

UPS, Delta, now Home Depot. There’s a lot going on in the employer-based insurance market. And because the changes these companies are enacting come at the same time Obamacare is rolling out, it’s easy to connect them to the new law.

Today’s story is just the latest

But, as these stories unfold, it’s important to keep a few things in mind before jumping to conclusions:

* This is the time of year all large companies, including those that are self-insured, make changes in their employee benefit plans. Changes like dropping spouses from the employee plan if the spouse qualifies for a plan because he/she works for another company that offers group health benefits have been accelerating in recent years. There’s nothing new about this change, but with health insurance about to become much more widely available it may make sense for some companies to do this.

* Go back over the last 10-12 years and think about how often during open enrollment employees were shocked to read about higher premium costs, higher deductibles and higher co-pays, just to keep the plans they had. Then consider that for many workers those costs continued to rise year after year while wages stayed stagnant, and in many cases (because of furloughs and other cost-cutting measures), were cut. It was during those years that momentum began to build for major reforms in the system.

* Keep in mind that the employer-based insurance market has fluctuated widely in the plans available to part-timers. They go from bare-bones plans that don’t cover much and don’t cost much (for employees, as well as their employers) to more traditional plans that can come with a hefty price tag for both. Again, with the insurance exchanges about to open up, it only makes business sense for companies to think about whether they want to continue to offer a plan to their part-timers that may not be as good, or even as affordable, as one the employee will be able to buy on the exchange.

*Speaking of part-timers, it’s important to remember that if the job at Home Depot, or Wal-Mart, or anywhere else that hires a huge volume of part-timers is the only job the employee has — for whatever reason he or she can’t find full-time work — then these employees will more than likely qualify for a subsidy to help pay for their insurance. And because these plans must meet basic minimum benefit standards — paying for preventive care, prescription drugs, etc. — the employees could be much better off buying on the market than having to re-enroll in the plan they now get on the job. Unfortunately, because some states have decided they would rather try to obstruct the new law by any legal means necessary, Home Depot workers in California will more than likely find a more affordable plan on their state exchange than Home Depot workers in Georgia. That’s why it was important for states to create their own exchanges, so they could negotiate with insurers on behalf of consumers for a more competitive marketplace. Georgia didn’t do that. State officials couldn’t muster up even that little amount of political courage to help the state’s residents get a better deal. So Georgia consumers will have to take the prices Ralph Hudgens and his friends in the insurance industry stick them with. Still, it’s better than nothing…but, wait, I digress, that’s another post on another day.

* From the perspective of recent history anyway, it’s also important to remember that many of these large, part-time-employee-based companies were pretty damn late to the notion that while they were fat and happy they ought to be providing decent benefits to this huge volume of workers. They may have been good about providing those benefits to supervisors and full-timers, but it wasn’t that long ago that workers advocates and others shamed these companies into providing at least something to part-timers. In other words, if it took them years to start offering their employees a health plan, it shouldn’t surprise us when they choose the first opportunity they can to get out of it. Only this time, with the new law in place, their employees won’t be left out in the cold. In fact they could be better off.

So read these and future stories about employer changes in health care plans carefully. No doubt, with the market about to change so dramatically, some of the decisions being made by companies are being implemented because of the new law. But more than likely they are the result of accountants showing executives how the bottom line can be improved by diminishing — if not eliminating altogether — the continuing cost of insuring some of their employees. Come to think of it, when hasn’t it always been that way?

 

 

 

A lot of info to cram into a video

Sister Rose Patrice, a Dominican nun who was principal at my elementary school, once told me while she was preparing me for a speech, “Michael, even if you don’t have much to say, say it with vigor.” This guy has a lot to say, and he says it with vigor — maybe a little too much vigor. But, as we used to say in the newspaper business, he can back up more than half of what he reports. This video has been making the rounds on Facebook. It deals with why medical costs are so high and challenges some of the usual talking points on the issue. I recommend giving it eight minutes or so of your time. Here’s the link:

A helpful look at Georgia’s priorities

My friend, and former AJC reporter/editor Tom Baxter has a great column discussing the difference in how Georgia’s political leaders think about spending money on a project like deepening the Port of Savannah versus expanding the Medicaid program to cover an additional 650,000 uninsured Georgians. It’s on the Saporta Report website. The standard brush off line that the governor’s office gives to reporters asking about why Georgia won’t take advantage of Obamacare’s offer to pay the full cost of the expansion for the first three years and at least 90 percent of the costs after that is “the state can’t afford it.” Georgia has a $20 billion annual budget. The “cost” to the state to expand Medicaid would run about $200 million a year. Do the math. It ain’t much. But can we afford a lot more than that to expand the port? Sure we can. An expanded port provides jobs, right? (Well, hopefully, although the promised benefit is pretty much a best, most optimistic guess.) Whereas the Medicaid expansion results in more Georgians being covered, a revitalized health care sector and, more than likely saved lives that might actually help the state improve its dismal health rankings. We could probably afford to do both. But you won’t hear that from the state’s leaders. It’s a matter of priority. What Nathan Deal and Ralph Hudgens mean to say about the Medicaid expansion is not that “the state can’t afford it,” it’s that we don’t think its worth spending any more money on poor people. They ought to at least be honest about that.

Here’s the link to Tom’s column.

Welcome to Comment on Health

This site is devoted to helping understand all the changes happening in our nation’s health care and insurance system. It is open to thoughtful, serious, sometimes comical and, hopefully, always engaging commentary. Opinions are welcome. Made up stuff isn’t. Nor is re-posting unverified and/or demonstrably false “facts” about health care reform.  Don’t be bringing that crap here. Do your homework. If you want to spew unchallenged, non-factually based opinions, take them back to your respective campfires and discuss it among yourselves. They won’t be posted here. (Yeah, yeah, I’m elitist and old school about this.) Having said that, all informed opinions that challenge conventional wisdom and common narratives about the subject of health care are otherwise welcomed. Still, part of what we want to do here is some helpful myth-busting. That means, from time to time, I will dissect some of the misinformation that makes its way into the mainstream, on Facebook, Twitter and other venues. I apologize in advance for even referencing some of these whoppers — putting anything on them World Wide Internets nowadays, even the blatantly false stuff — can sometimes result in extending the very life of the lie itself, despite the best effort to lay it to rest. (Think “death panels,” and “government takeover of health care.”) So I promise to do this with only  the most despicable of these claims, and only then with the aim of explaining who created it and why they want to mislead you.

 

Here’s what you need to know about me. I spent nearly 40 years in the daily newspaper business, much of it covering science, health and health care policy. I still write a lot about it, mostly as a freelance journalist. I don’t consider myself an expert on policy, but I know something about how the system works for real people and how to help people understand the issues connected to it. I am unabashed proponent of expanding both government and private programs so that all Americans are covered by an affordable, quality health insurance plan. It is not only good for the nation’s economy, it is — bottom line — the right thing to do. I consider it a sad commentary on our nation’s standing in the world that we have yet to come to grips with this basic societal need. One day we will. Until then, let’s talk about how best to get there. See you around the blog. — mike king