policy

An Update on Healthcare Reform

In March, Republicans failed to repeal Obamacare and replace it with the American Health Care Act (AHCA). It was a troubling moment for a new Republican regime that, for years, had promised to repeal Obamacare.   The AHCA was a flawed bill. It attempted to appease varied conservative interests, but it ended up being a convoluted mess that only alienated hard-line and moderate Republicans. Far-right conservatives thought the bill was Obamacare-lite, while moderates were concerned the bill failed to protect the interests of both their lower-income and sicker constituents.   According to Politico, Republicans have come to a tentative agreement that would appease the conflicting interests of their party. The conservative Republicans have agreed to reinstate Obamacare’s Essential Health Benefits, which was stricken from the original AHCA. According to this provision, all health plans must provide health benefits such as mental health and addiction treatment, preventive services, ambulatory care, and more—all with no limit. This appeases moderate Republicans who were worried about their constituents, as the provision prevents insurers from providing bare-bones coverage. In exchange for this, moderate Republicans have agreed to permit states to opt out of Obamacare’s community rating provision—this means that insurance companies can charge higher premiums to individuals with pre-existing conditions. This is a win for fiscally conservative Republicans because it’ll theoretically lower health insurance prices, at least for healthy individuals.   The compromise does...

Can Punishing Medical Errors Make Hospitals Safer?

In January, Medicare cut federal payments to 769 hospitals, continuing a program of punishing hospitals for errors and avoidable complications, such as blood clots, falls and bed sores. For the first time these penalties also included hospital-acquired antibiotic-resistant infections. Mandated by the Affordable Care Act, Medicare is required to penalize the bottom 25% of the worst performing hospitals, even if they’ve shown a reduced rate of incidents from year to year. In the years since the penalties took effect, they had the unintended consequence of disproportionately reducing funding in teaching hospitals and for patients in low-income areas with limited access to services. This prompted congress to legislate a socioeconomic adjustment when evaluating hospital performance.   While the federal Agency for Healthcare Research and Quality (AHRQ) estimates that hospital-acquired conditions have declined 21% from 2010 to 2015, there were still an estimated 3.8 million hospital injuries in 2016: 115 injuries for every 1,000 patient stays. Specialized hospitals, such as those for children, rehabilitation, cancer, veterans and psychiatric treatment are exempt from the financial penalties.   Reporting by the Kaiser Family Foundation has found that readmission rates started falling in 2012 and have continued, suggesting that more hospitals have taken up preventative measures for hospital acquired infections and preventable readmissions, and that overall the impact of the penalties is less than 1% of the reimbursable amount for a re-admission.   Image:...

Would You Google a Patient?

With social media permeating our lives, the lines between professional life and personal life often become blurred. Going on a first date? A quick Google search can give you a glimpse into your date’s life and potential conversation topics. Taking a class with a new professor? Google will give you a heads-up as to his or her professional interests or recent publications. Have an appointment for a check-up with a new doctor? Many websites will give you patient reviews and ratings of the practice.   …But what if your doctor is Googling you right back?     Researchers have had the better part of two decades to figure out if doctors could use social media to the benefit of their patients, but there still seems to be a wary skepticism among med school students and practicing physicians of all ages that prevents investigation of potential benefits. After all, knowledge is power, but it often comes with an ethical dilemma.   Research from James Brown et al at the University of Sydney found that 1 in 5 doctors surveyed had received a “friend request” from a patient. A similar survey from Bosslet et al found that 93.5% of medical students surveyed used social media in their everyday lives, but it was practicing physicians who were more likely to have looked up the profile of a patient or patient’s family members...

Pros and Cons of the American Health Care Act

The Republican establishment has longed to repeal Obamacare basically since it became law in 2009. Conservative politicians have centered their campaigns around repealing the health care law, while President Donald Trump promised to get rid of “horrible” Obamacare during rallies.   Image: Source   On March 6, House Republicans revealed Obamacare’s potential replacement: The American Health Care Act (AHCA). The bill has quickly passed through three different house committees before many have had time to fully comprehend its implications. So, who benefits from this new bill and who doesn’t? Let’s list some pros and cons.   PROS – Repeals individual mandate Perhaps the most central (and most criticized) proposal of Obamacare is the individual mandate. This mandate requires all individuals to purchase health insurance. Although both Democrats and Republicans lauded the idea of an individual mandate when it was a part of Mitt Romney’s health care plan in Massachusetts, it quickly came under fire when proposed in Obamacare. Opponents described it as an unconstitutional attack on individual freedom—to them, no one should be forced to buy insurance. This criticism does make sense. For example, if you’re a healthy young person, you might not want to spend a lot of money on health insurance that you probably don’t really need. With that said, for these individuals who are passionate about their individual liberties, the AHCA’s repeal of the mandate is...

How Much Medical Education is Actually Necessary?

A common theme to many of my posts here on The Almost Doctor’s Channel is the idea that we are at a point of great change in the medical field. I’ve covered such topics as how our healthcare system falls behind that of other countries, how the match can be improved, and how we can improve science literacy. Another area of my interest (and one that is readily apparent to those of us who are currently in medical school) is the design of medical training – notably its excessive length.     Currently, after four years of undergraduate education, one must complete four years as a medical student followed by three to six years as a resident before being able to independently practice medicine. If no gap years are taken, this puts a person at 29 to 32 years of age when they are first able to contribute to the physician workforce – or even older if their specialty requires further fellowship training. If they decide to go into medicine later or circumstances prolong their education, this pushes them back even more. Because of this, some are hoping to shorten medical education.   As we look to shaping the future of medical education, though, it is important to note that this excessive length is a modern phenomenon, one that arises out of a desire to bring regulation and excellence...

ACA Repeal – Good or Bad for Doctors?

As Trump is sworn in as the 45th President of the United States, the Republican-led Congress is making strategic moves to repeal the Affordable Care Act (ACA), a.k.a. “Obamacare.” Despite their promises to immediately replace the ACA with a new plan, no solid details have been given out by Trump or Republicans.   The effects of the ACA on the lives and practice of doctors has been complex, and opinions as to whether the law has been good or bad for doctors are clearly divided along party lines. There is high anxiety surrounding the proposed repeal from patients and doctors alike. Without a clear plan in place, it’s hard to know how a repeal would affect doctors and the future careers of current med school students.   Image: Source   Here are some concerns when considering the repeal:   Fewer patients in a smaller insurance pool – The ACA has enabled roughly 22 million previously-uninsured Americans to purchase health insurance or obtain it through expanded Medicaid programs. The ACA also has rules in place that end pre-existing condition exclusions for children, allow young adults under the age of 26 to be covered under their parents’ insurance and prohibit arbitrary withdrawals of insurance coverage. If repealed with no immediate replacement, millions of people could be dropped from their plans and left unable to purchase new plans. Fewer people with insurance equals...

What Can Angelina Jolie Teach Us About Gene Patents?

Angelina Jolie’s op-ed in The New York Times about her preventive double mastectomy sent shockwaves through the media. She represents a new generation of patients who are able to use genetic testing to make empowered, evidence-based decisions. While experts agree that her description of the procedure resulting in a breast cancer risk reduction from an 87% to a 5% chance might be an oversimplification, her courage in the face of such a difficult choice is laudable. Jolie now joins a class of “previvors,” unencumbered by the social stigma of these types of preventive procedures.   None of this could be possible without the BRCA1 and BRCA2 test, which helped to identify the mutated genes linked to cancer. But as Jolie so adeptly points out in her piece, “The cost of testing for BRCA1 and BRCA2, at more than $3,000 in the United States, remains an obstacle for many women.”   The simple truth to take away is that while Jolie’s example will inspire many individuals to jump over the social stigma of preventative procedures, there is still one large hurdle to cross: gene patents.    Last November, the Supreme Court heard the case Association of Molecular Pathology v. U.S. Patent and Trademark Office, concerning gene patents for BRCA1 and BRCA2 held by Myriad Genetics. An article in The New York Times explains the company holds patents for “two human genes, which, when mutated, give a woman a high risk of getting breast or ovarian cancer. The patents give Myriad...

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