Health Wonk Review Is Up: A Superb Summary of Provocative Healthcare Posts

The latest edition of Health Wonk Review is now up on Wing of Zock.

 Sarah Sonies and Jenifer Salopek have done a superb job of summarizing some of the most provocative healthcare blog posts of the past two weeks. 

Here are just a few of the questions these posts  raise:

—   Should states mandate nurse staffing ratios in acute care hospitals?

— What can we learn about early Medicaid expansion in some states?

—   Why do we need more research into the value of colonoscopies?

I won’t try to summarize the posts. Just go to Wing of Zock                    

2 COMMENTS SO FAR -- ADD ONE

Expanding Medicaid Is Not Enough–Making Medicaid A Federal Program

 Note to readers—please read the post below, “Pulse—More Stories from the Heart of Medicine” (which includes “One More Child Left Behind”) before you read this post.

When I read “One More Child Left Behind,”  all I could think of was how much Aaron’s arm must have hurt during the more than 24 hours that he didn’t receive treatment. I also imagined how frightened and bewildered the six-year-old must have been as he heard his mother and grandmother talk, and realized that they couldn’t persuade a doctor to help him.

This story was published in 2009—one year before the Affordable Care Act was passed.  The ACA extends Medicaid to millions. But even under reform legislation, many children like Aaron will not receive care. This is because Medicaid now pays an average of 34% less than Medicare for exactly the same treatment.

Why on earth would we pay doctors and hospital less to care for poor patients than we would pay them to care for the elderly?

Lower Medicaid fees are part of the legacy of racism. (I write about this in Money-Driven Medicine.)  When the Medicare and Medicaid laws were passed in 1965, Southern Congressmen refused to agree to laws that would pay doctors who treated the poor as much as they reimburse physicians who care for older patients.

At the time, relatively few African-Americans living in the South were over 65.  Most died long before they would be eligible for Medicare. Yet many African-Americans were poor, and would qualify for Medicaid. This is what disturbed Southern legislators. They wanted to make sure that healthcare remained segregated.    

Even under Reform, Specialists Who Treat the Poor Will be Under-Paid   

Medicaid rates vary widely by state, but on average, according to the Kaiser Family Foundation, the new program will offer PCP’s a 73 percent raise This should open doors for millions of Medicaid patients. In some states that have been paying the lowest rates, the hike will be much higher. (See this map) The ACA guarantees raising Medicaid reimbursements for primary care for just two years (2013-2014). But I expect this program will be extended, although increases may be modified. Once begun, it will be very hard to justify ending it.

At the same time, specialists who care for Medicaid patients will continue to receive about 1/3 less than when treating seniors.  As a result, even under the ACA a great many Medicaid patients will be hard-pressed to find a specialist willing to see them.
Continue reading

7 COMMENTS SO FAR -- ADD ONE

More Stories from “Pulse—voices from the heart of medicine”

Every Friday, thousands of readers smile when they see an e-mail from Pulse: voices from the heart of medicine in their in-box. Pulse is a free, online magazine  that publishes riveting, often moving, sometimes controversial, and occasionally hilarious first-person stories and poems about medicine.  (Click on “hilarious” for a story that will astound you, and, if you share my sense of humor, make you laugh. )

All of these tales are true, and the authenticity of the writers’ voices helps explain their power.  Written by patients and doctors, nurses, caregivers, and students, these unblinkingly honest stories and poems bear witness to the suffering that patients endure, and to the compassion of caregivers — as well as their doubts.  

                                        Some of My Favorites

Long-time readers may remember poems and stories from Pulse that I have cross-posted in the past. 

 —  “Useless (But Needed), A Doctor’s Constant Companion”  — one of my favorites

 — “First Do No Harm,”  a story about how we train doctors that drew thoughtful and provocative comments from both doctors and nurses; 

— “Broken”– a controversial story about what happens when a trauma surgeon overrules an obstetrical resident. The question:  should they have tried to save the baby or the mother? Could either be saved?                                       

                A Stairwell Conversation, And a Unique Magazine is Born

Pulse founder Paul Gross, practices family medicine at Montefiore hospital in the Bronx, New York.  He recalls how Pulse was conceived:

 “What would it be like, I wondered, if there were a magazine that told about health care the way it really is? What if patients and health professionals alike got to tell their stories? 

“Around the same time, I had a stairwell conversation with a hospital director of nursing. It stopped me short. ‘For the first time in my long career,’ she said, ‘I’m ashamed to be in this business.’

“To me, this sounded like a cry for help; it sounded like a system in crisis,” Gross adds. “And yet, for the most part, popular magazines and medical journals seemed oblivious.

“It occurred to me that if we found a way to share our stories—the difficult moments along with the glorious ones—perhaps we could jump-start a national conversation about health care. Maybe this exchange could lead us toward a better health system.”
Continue reading

2 COMMENTS SO FAR -- ADD ONE