InfoViewer: Hybrid Model Combines Concierge With Traditional Practice

InfoViewer: Hybrid Model Combines Concierge With Traditional Practice

Why the Nation Needs a Policy Push on Patient-­Centered Health Care

In the Literature
Highlights from Commonwealth Fund-Supported Studies in Professional Journals
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August 3, 2010
Authors: Ronald M. Epstein, M.D., Kevin Fiscella, M.D., M.P.H., Cara S. Lesser, M.P.P., and Kurt C. Stange, M.D., Ph.D.
Journal: Health Affairs, August 2010 (29)8:1489–95
Contact: Ronald M. Epstein, M.D., professor and director, Rochester Center to Improve Communication in Health Care,
University of Rochester Medical Center, ronald.epstein@urmc.rochester.edu, or Mary Mahon, Senior Public Information
Officer, The Commonwealth Fund, mm@cmwf.org
Access to the full article is available at:
http://content.healthaffairs.org/cgi/content/full/29/8/1489?ijkey=HQf01wE/2r.FA&keytype=ref&siteid=healthaff
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Synopsis
Efforts to improve patient-centered care have focused on infrastructure and information technology
support. However, a true patient-centered approach depends on healing relationships among physicians,
patients, and family, with a strong foundation of communication and shared decision-making. Health
policy should focus on multiple means for improving healing relationships, including training health care
professionals and activating and enabling patients to participate in their care.
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The Issue
Although the phrase “patient-centered care” has been in existence for decades, the term entered the
health policy lexicon in 2001 with the Institute of Medicine’s Crossing the Quality Chasm. That report
identified patient-centered care as one of the six aims for high-quality health care, defining the term as
care that is “respectful of and responsive to individual patient preferences, needs, and values, and ensuring
that patient values guide all clinical decisions.” The authors of this Commonwealth Fund–supported study
in Health Affairs contend that patient-centered care has distinct, identifiable characteristics and has been
shown to control costs and improve quality. Nevertheless, the term is still not well understood in all health
care policy circles and is often conflated with merely providing infrastructure support and information
technology.
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What Is Patient-Centered Care?
Patient-centered care is not, the authors say, “just giving patients what they want, when they want it,
regardless of value or cost.” At its core, patient-centered care is about the healing relationships between
physicians and patients and patients’ families. This relationship is grounded in strong communication and
trust, highlighted by clinicians and patients engaging in a two-way dialogue, sharing information,
exploring patients’ values and preferences, and helping patients and families make clinical decisions.
These interactions strive to achieve a state of “shared information, shared deliberation, and shared mind.”
A “shared information” approach involves more than simple facts and figures. In such an approach, a
physician tailors information to an individual patient’s concerns, beliefs, and expectations, while also
considering his or her level of health literacy. “Shared deliberations” engage the patient in discussions and
decision-making to help arrive at a “shared mind”—that is, consensus on an approach to care that goes
beyond informed consent. Achieving the objectives of patient-centered care, the authors note, often
requires a coordinated team of health care professionals, patients who participate in their own care, and a
health care system that functions smoothly and provides information technology that strengthens patient–
clinician relationships.
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Why the Approach Matters
Patient-centered care is the right thing to do: it places the interests of
patients above all else and respects patients’ autonomy. The approach
has also been shown to:
• improve disease-related outcomes and quality of life;
• increase patient adherence to medications and improve
chronic disease control, without higher costs;
• boost well-being by reducing anxiety and depression, and
promote patient access and self-efficacy;
• address racial, ethnic, and socioeconomic disparities in care
and outcomes; and
• reduce diagnostic-testing costs in primary care and decrease
lawsuits against clinicians.
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How to Achieve Patient-Centered Care
Patient-centered care depends on informed and involved patients, receptive and responsive health
professionals, and a supportive health care environment. While investments in infrastructure and health
information technology can facilitate an environment for such a care approach, these two ingredients
alone are not sufficient to produce healing relationships and effective communication. Multiple players
must work to advance the goal of patient-centered care: policymakers must set specific performance
targets; educators must teach and assess interpersonal skills; consumer advocates must encourage greater
patient involvement in shared decision-making; and health care organizations must foster a culture of
patient-centeredness.
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The Bottom Line
Patient-centered care has been shown to improve outcomes and quality of life, while reducing costs and
health care disparities. Investing in infrastructure and health information technology is important, but not
sufficient, for creating a patient-centered health system.
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Citation
R. M. Epstein, K. Fiscella, C. S. Lesser, and K. C. Stange, “Why the Nation Needs a Policy Push on
Patient-Centered Health Care,” Health Affairs, Aug. 2010 (29)8: 1489–95.
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This summary was prepared by Christopher J. Gearon and Deborah Lorber.

Health Reform: Summary of New Requirements for Tax-exempt Hospitals and Health Systems

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA) (Pub. L. No. 111-148). PPACA imposes four new substantive requirements that a hospital must satisfy to maintain its tax exemption:
• Conduct a community health needs assessment once every three years and adopt an implementation strategy to meet the identified needs
• Needs assessment must “take into account” input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge or expertise in public health
• Assessment may be based on current information collected by a public health agency or nonprofit organization
• Assessment must be made widely available to the public
• Two or more related or unrelated hospitals may jointly conduct a needs assessment
• Failure to comply results in an excise tax penalty of up to $50,000
• Adopt, implement, and publicize a financial assistance policy that must include:
• eligibility criteria for such assistance, and whether it includes free or discounted care
• the basis for calculating the amounts charged to patients
• the method for applying for financial assistance
• collection actions that will be taken in the event of nonpayment (including reporting to credit agencies)
• measures to widely publicize the policy within the hospital community
Also, the hospital must adopt a written policy to provide emergency medical care to all individuals regardless of their ability under the financial assistance policy
• Limit charges for those qualifying for financial assistance:
• Hospitals must limit charges for emergency or “other medically necessary care” provided to individuals who qualify for financial assistance to “the amounts generally billed” to individuals with insurance
• Hospitals may not use gross charges (i.e., charge master rates)
• The amounts billed may be based on the best ( or an average of the three best) negotiated commercial rates, or Medicare rates
• Refrain from extraordinary collection actions before making reasonable efforts to determine whether a patient qualifies for financial assistance
• Examples of “extraordinary collection actions” includes lawsuits, liens on residences, arrests, body attachments or other similar collections practices
In addition, PPACA imposes three new mandates that will increase the flow of data from tax-exempt hospitals to the IRS, and from IRS/Treasury to Congress:
• Tax-exempt hospitals must include and disclose additional information on Form 990 Schedule H (community needs assessment implementation and financial audits)
• IRS must review every exempt hospital’s community benefit activities as reflected on its Form 990/Schedule H at least once every three years
• Treasury Secretary must report annually to Congress on comparative levels of hospital charity care, and complete a Congressional study on emerging trends after five years
Organizations subject to the new requirements include:
• Any 501(c)(3) organization which operates a facility which is required by State to be “licensed, registered or similarly recognized as a hospital”
• Any other organization which the Treasury Secretary determines “has the provision of hospital care as its principal function or purpose constituting the basis” for its tax status
Also, organizations that operate more than one hospital facility must meet the requirements “separately with respect to each such facility”
These new provisions are generally effective for taxable years beginning after the date of enactment.
• E.g., if a hospital’s fiscal/tax year begins on July 1, the new requirements go into effect at that time
• Effective date for completion of community needs assessment is delayed (consistent with the “once-every-three-years” requirement) to taxable years beginning two years after the date of enactment
In summary, the new health reform law imposes significant additional requirements on tax-exempt hospitals and health systems. The Treasury Department is expected to issue implementing regulations soon.

Written by: VHA Inc. is a nationwide cooperative owned and governed by community-owned health care systems and their physicians.

Premiums for new 'high risk' pool could be steep

By RICARDO ALONSO-ZALDIVAR
The Associated Press
Thursday, July 1, 2010; 12:18 AM

WASHINGTON -- President Barack Obama's new health coverage for uninsured people with health problems won't be cheap - monthly premiums as high as $900, administration officials said Wednesday.

Prices will vary by state and type of coverage from a low of $140 a month to as much as $900, said Richard Popper, deputy director of a new insurance office at the federal Health and Human Services department. Officials provided details of the plan, which starts enrolling people Thursday.

The price range is so wide because premiums will be keyed to standard individual health insurance rates in each state, which can differ dramatically because of medical costs and the scope of coverage. Independent experts estimate premiums will average around $400 to $600 a month. Younger people will pay less.

"There are going to be meaningful premiums that are going to be required to stay in this plan ... in the hundreds of dollars," said Popper, with the Office of Consumer Information and Insurance Oversight.

Despite the cost, consumer advocates are urging uninsured people with health problems to sign up soon, because they cannot be turned away for medical reasons. Family members may be able to help with premiums.

The Pre-Existing Condition Insurance Plan will start taking applications Thursday in many states, the rest by the end of the month. Coverage will be available as early as August 1.

Consumers can go to a new government website, HealthCare.gov, to find out about the program and other coverage options in their state. Twenty-nine states and Washington, D.C., will administer their own plans. The federal government will run the program in the remaining 21 states.

The new plan is a stopgap for vulnerable people locked out of the private insurance market because of medical problems. It's intended to remain available until 2014, when core health care overhaul provisions take effect. At that time, insurers will be barred from turning away people in poor health, low- and middle-income households will get subsidized coverage, and most Americans will for the first time be required to carry health insurance.

To qualify for the pre-existing condition plan, people must be uninsured for at least six months and have been turned down for coverage by a private insurer because of a medical problem. U.S. citizens and legal residents are eligible.

The biggest question hanging over the program is whether the $5 billion allocated will be enough.

Millions of people meet the basic qualifications for coverage, and technical experts who advise Congress and the administration have warned the funds could be exhausted as early as the end of 2011.

HHS officials sidestepped questions about what would happen if the money runs out. One option is for the government to limit enrollment.

Popper estimated about 200,000 people would be enrolled in the program at any one time, but other HHS experts estimated that 375,000 would sign up this year, and the Congressional Budget Office says the total could reach 700,000 in 2013.

Six-Month Medicare Patch Slows Medicare Meltdown for Now

Statement Attributable to:
Cecil B. Wilson, MD [1]
President, American Medical Association

"The six-month Medicare patch Congress passed today is a very temporary reprieve for seniors and baby boomers who rely on the promise of Medicare. Delaying the problem is not a solution. It doesn't solve the Medicare mess Congress has created with a long series of short-term Medicare patches over the last decade - including four to avert the 2010 cut alone.

"Seniors are already experiencing access problems as a result of the complete congressional mismanagement of Medicare over the years. About one in four Medicare patients looking for a new primary care physician are having trouble finding one. About one in five physicians are already limiting the number of Medicare patients they treat because of the instability and uncertainty of Medicare payment.

"In December, the Medicare physician payment cut will be a whopping 23 percent, increasing to nearly 30 percent in January. Congress is playing a dangerous game of Russian roulette with seniors' health care. Sick patients can't wait. Congress must replace the broken payment system before the damage is done and cannot be reversed.

"The baby boomers begin entering Medicare in six months, and if the physician payment problem isn't fixed, these new Medicare patients won't be able to find a doctor to treat them.

"End the political posturing and fix the problem: Health care for America's seniors hangs in the balance. Congress needs to fix the broken Medicare physician payment system so physicians can continue to do what they love - care for patients."

Let the AMA open the door for foreign medical students and physicians to work in primary care today.

The affordable care act today created a stimulus package for creating new primary care physicians, physician’s assistance, nurse practitioners, and nurses. A new generation of health professional to help in the shortage of primary care doctors as projected by the AMA.

So by the year of 2016, we will have an influx of health professions to serve today’s 47 million uninsured. This is a major step for the future of this nation healthcare but I can’t help to wonder about today.

Today we still need access to healthcare. Hospitals emergency rooms are still the only recourse for the uninsured, and the numbers of uninsured continue to rise. Small businesses continue to offer no benefit or with large deductibles policies. The working individuals continue to take the risk of not buying insurance and depending on the emergency room, since they cannot be turned down.

Yet the AMA continues to make it difficult for foreign medical students and foreign physicians to get into an AMA-approved residence program in the US. The success rate is 25%, if you attend medical school in another country to be able to practice medicine in the US. At a time when the AMA projects a shortage of 21,000 primary care doctors, they have not changed their policy in how they view foreign medical student and physicians. Why not make it easier an open the door for these foreign medical student and physicians to work in a community residency program in the primary care field today.

Each community Dept of Health Services should evaluate alternative in sponsoring a foreign medical student and foreign physician to get AMA to approve and license these Doctors to work to provide care for the uninsured in their own community.

Unlike self-insured, fully-insured employers must decide old vs. new with their current plans

Well the regulations are finally out on the "grandfather plans". Large corporations who are self insured can continue their current plan designs without any fear of CHANGE. They can change administrator, reinsurers, and other vendor they choose. So to be self insured under the Affordable Care Act on March 23, 2010 is where all large corporations should have been to have the greatest flexibility of choice. Just keep your present benefit design, modify the plan document and negotiate, negotiate, and negotiate with every vendor to lower cost or change them.
The large corporations who are fully insured are not so fortunate. The modifications of the plan, to keep in compliance with the Affordable Care Act will create increase in the premium with very little negotiating power, flexibility or choice. They are at the mercy of the insurance carrier, only able to negotiate premium. If they elect to change to another carrier, this automatically makes them lose the grandfather status. Fully -insured companies must decide to stay or not stay with their current plan. The renewal rate of the current plan vs. the new rate of the new plan will tell the story. This also applies to midsize and small companies as well.

The Pre-Existing Condition, is now a thing of the past

The Health care reform Act, allocates five billion by April 30th to each State for creating a Temporary High Risk Pool Program. HHS requirement and amount listed below.

The creation of a high risk pool program was proposed by Congressional Republicans and included in the historic new health reform law to help provide affordable health insurance coverage to people who are uninsured because of pre-existing conditions. States may choose whether and how they participate in the program, which is funded entirely by the Federal government.

Eligibility
In order to receive insurance through the temporary high risk pool program, an individual must meet the criteria established in the law. Eligible individuals must:
Be a citizen or national of the United States or lawfully present in the United States; Not have been covered under creditable coverage (as defined in Section 2701(c)(1) of the Public Health Service Act) for the previous 6 months before applying for coverage; and Have a pre-existing condition, as determined in a manner consistent with guidance issued by the Secretary.

Premiums
Premiums in the high risk pool will be affordable for participants to ensure that those who have been locked out of the insurance market have access to high-quality insurance. Premiums must be set so that they: Equal a standard rate for a standard population (that is, not exceed 100 percent of the standard non-group rate); and
Do not vary by age by more than 4 to 1.

State Role
HHS’s goal is to grant the flexibility needed to permit successful and expeditious implementation of the program by interested states. There are different avenues for states to carry out the statutory requirements for a high risk pool program. A state could consider the following options:
Operate a new high risk pool alongside a current state high risk pool;
Establish a new high risk pool (in a state that does not currently have a high risk pool);
Build upon other existing coverage programs designed to cover high risk individuals;
Contract with a current HIPAA carrier of last resort or other carrier, to provide subsidized coverage for the eligible population; or
Do nothing, in which case HHS would carry out a coverage program in the state.
HHS has asked states to declare how they intend to participate in the program by April 30, 2010.
Regardless of whether or how a state participates, all Americans who meet the eligibility criteria will have the opportunity to join a high risk pool.

Funding
The law appropriates $5 billion of federal funds to support the new temporary high risk pool program.
It will be available beginning on July 1, the start of many state fiscal years, until the program ends on January 1, 2014. The program is funded entirely by the federal government.

HHS has proposed allocating funds for the program by using a formula almost identical to what was used for the Children’s Health Insurance Program (CHIP). Specifically, funds would be allotted to states using a combination of factors including nonelderly population, nonelderly uninsured, and geographic cost as a guide. This combination of factors has been refined over time in the CHIP context, and the CHIP formula has broad Federal and State support. As under CHIP, HHS intends to reallocate allotments after a period of not more than 2 years, based on an assessment of state actual enrollment and expenditure experiences. This proposed reallocation aims to ensure that the capped amount of Federal funding is allocated to states based on both the
initial formula and performance. A list of proposed allocations by state for the four year period is included below.

The attached table presents the estimated state allotments based on the above methodology. Potential Allocation of High-Risk Pool Funds Dollars in Millions*

State Funds
Alabama 69
Alaska 13
Arizona 129
Arkansas 46
California 761
Colorado 90
Connecticut 50
Delaware 13
Dist of Columbia 9
Florida 351
Georgia 177
Hawaii 16
Idaho 24
Illinois 196
Indiana 93
Iowa 35
Kansas 36
Kentucky 63
Louisiana 71
Maine 17
Maryland 85
Massachusetts 77
Michigan 141
Minnesota 68
Mississippi 47
Missouri 81
Montana 16
Nebraska 23
Nevada 61
New Hampshire 20
New Jersey 141
New Mexico 37
New York 297
North Carolina 145
North Dakota 8
Ohio 152
Oklahoma 60
Oregon 66
Pennsylvania 160
Rhode Island 13
South Carolina 74
South Dakota 11
Tennessee 97
Texas 493
Utah 40
Vermont 8
Virginia 113
Washington 102
West Virginia 27
Wisconsin 73
Wyoming 8
Total United States = 5 Billion

*Preliminary: Final allotments may increase or decrease by +/- 1%.
Data sources: ACS State Population 2008; BLS Wage Data 2008.

Actuary Report Reaffirms that Affordable Care Act will Strengthen Medicare, Extend Coverage to Millions of Americans

Yesterday, the Office of the Actuary released an analysis of the new health insurance reform law. Here is Secretary Sebelius on the report:
"Congress and the President have enacted landmark legislation that puts American families and businesses back in control of their own health care. The analysis by the independent Office of the Actuary reaffirms what the Congressional Budget Office has already said: the Affordable Care Act will cover more Americans and strengthen Medicare by cracking down on waste fraud and abuse, modernizing payment systems and improving benefits by providing free preventive services, supporting innovations that help control chronic disease and closing the prescription drug donut hole. The Actuaries also find that under the new law, the life of the Medicare trust fund is extended by 12 years while reducing annual Medicare premiums by nearly $200 per senior in the coming years. The Affordable Care Act will improve the health care system for all Americans and we will continue our work to quickly and carefully implement the new law."

Posted April 23, 2010
By Jessica Santillo, Communications Director for Strategy and Policy

New innovative solution is our commitment to offer access to healthcare to all Americans at affordable cost.

The battle will continue in the healthcare reform arena for the next four years and beyond. The efforts to appeal it, stop it, or threats to the Congressman and Senators who voted for it, does nothing to change it. And if anything comes out of it, is more taxpayers’ money wasted. The number of uninsured will continue to increase since insurance premium will becomes more and more expensive. So being able to qualify for coverage was half the battle, buying it is still a problem we face today.

The time has come to assure that the efforts of this change whether we agree or disagree, will never be bottled neck again for 50 years. This change can only be obtained by how we vote. If we continue to vote by party lines we will guaranteed ourselves another 50 years will pass before we can address change again. If we vote as Americans and only elect young innovative minds who want the best for America, and be willing to serve two term limits we will never experience a 50 years delay for change.

Healthcare is a growing concern and this passage of the bill is only the beginning, the peak of the iceberg, of the real issues we are and will be facing today. So American should begin to be the watchdog of healthcare, the first line of defense to make sure insurance companies, hospitals, providers, doctors, and government do away with their wasteful spending habits and charge the proper fees for service.

47 Million Reasons will continue to oversee this reform, overseeing spending, and offer solutions on how to reduce the cost of healthcare. We will continue to ask our politicians to change what is wrong and to create a policy which benefits all Americans.

And we will continue to fight for the government to change the bill to offer community center funding to all center not only those that serve up to 133% of poverty level.

We will continue to seek funding and educate businesses to show them how our 47MR model is the future and the solution to lower their cost, and create a healthier nation.

So continue to let your friend and families know more about 47 Million Reasons and continue to offer our RX cards to everyone who needs one in your community.

We need your support and are offering incentives to those who want to make a difference and have a 47 MR Community Resource Center in their town.

New innovative solution is our commitment to offer access to healthcare to all Americans at affordable cost.

Now that the political war is over, let’s get back to the task at hand, access to ‘Health Care’, not ‘coverage.’

The Health Care Reform Bill (Senate Bill) has passed along with the amendments and is now pending final approval so the President may sign it into law. So now, the challenges begin in implementing the most widespread Health Care reform in this country since Social Security and Medicare were passed. So the fight is over for those 32 million uninsured and every American will now have access to comprehensive coverage as result of this bill. Now the issue will be execution and the cost. So congratulations to President Obama, Pelosi, Reid and the Democratic politicians who voted for the bill. This was a mission worth fighting for and we can take heart in that all those with pre-existing conditions will no longer need worry about being denied coverage. The President said it well: it is time to reclaim health care from the insurance interests.

That being said, and with the political war over, we must now hold the President stringently to his word: yes, the task at hand is now to get Americans access to Health Care – NOT insurance. To those who celebrate the victory, remember there are fifteen million Americans left behind to deal with the aftermath of knowing they can get access to coverage with no assistance or subsidies and that they will be faced with the increases in premiums, and no such recourse for quality Health Care. And if insurance is still not affordable, and a penalty will need be paid for not complying with the new law, this is a recipe for disaster which the American people will doubtfully tolerate and which the insurance industry could easily initiate in order to blow up this bill as it goes into practice.

So by no means is this crisis over. Now we just have to deal with premium increases to 283 million Americans of which 15 million are uninsured, and 32 million now insured under the Health Care bill (via subsidies) at the price tag of $940 billion. So if the economy does not change for the better, we may be faced owing China $.87 of every $1.00 spent in America.

Given this understanding our mission has clearly just begun. We need to show how the 47MR model can offer the solution now for those 15 million left behind, as well as how a simple approach of a “community resource center” can solve the problem of access to Health Care in America without insurance for primary care, wellness, dental, prevention, etc. and all at a fraction of the cost with no insurance or government bureaucracy.

Let’s focus then on the change we need, and not just simply change – we needed and still need access to ‘Health Care’ and it seems that now, all we’ve gotten out of healthcare reform is access to ‘coverage.’

Why is health care reform so difficult?

Yes, we were the first to talk about it! Well, maybe not THE first, but pretty close in recent history. In our desire to encourage values-based dialogue among people of faith, Faithful Reform in Health Care has offered insights into our century-long struggle over health care for all. Our Seeking Justice in Health Care Guide, PowerPoints, workshops, and adult study materials, have helped thousands of people understand why health care reform is so contentious. Now, in the wake of the Health Care Summit, the columnists and pundits are answering the same question we addressed long ago: Why is health care reform so difficult? Our answers are framed as five challenges, hoping that they are not a permanent indictment on our ability to move forward.
Challenge #1 - Moral Vision. The underlying challenge is the absence of a strongly articulated moral vision. Do we want a health care future that includes everyone and works well for all of us -- or not? Without a clear answer to that question, reform efforts remain locked in conflict over competing views of who we are as a nation and where our responsibilities lie in caring for those who live here.

Over the years, we have accepted a collective moral responsibility for our most vulnerable populations -- those with the lowest incomes, our elderly, our veterans, and our Native American and indigenous populations. The crisis facing us now is what to do about the 123 persons who die unnecessarily each day, and the millions more who risk that possibility, for lack of health insurance.
While most members of Congress would likely profess a commitment to health care for all, the lack of a national moral vision becomes evident as proposals are developed. Deliberations are informed by questions that focus on how much money is saved or what industry is protected, rather than on those who are left out as a result of the negotiations. Whether our goal is everybody in (or just some people) impacts how all other questions are answered and how challenges are overcome.
Challenge #2 - Access or Costs. Is our goal to improve access inspite of costs, or to restrain the growth of costs by reducing access and/or quality? Historically and currently, because these goals are often seen as contradictory, legislative efforts usually have polarized around one or the other. And because we don't start with a commitment to include everyone, we argue over just how many/few more can be covered, and at what cost. If money were no object, increasing access would be much less troublesome. But resources, though abundant, are finite, which means we have to practice faithful stewardship in using them. The difficulty lies in how to distribute these resources equitably and in how to determine who will bear the burden for controlling the costs.
In spite of the politics that might suggest otherwise, the truth is that successful reform will encompass both goals: improving access and containing costs while maintaining a high quality of care. Neither goal can be fully achieved by itself; comprehensive reform will be impossible without a commitment to both. All other industrialized democracies have found ways meet both goals, and so must the United States.
Challenge #3 - Marketplace or government. The moral dilemma informs differing perspectives around the relative roles of competition and regulation. Are human needs better served by markets, individual ownership, competition and profits, or by governments and laws that guarantee access and a fair distribution of costs and services?
Extreme ideologies in our country have failed to recognize that modern health care systems actually exist somewhere between unfettered free markets and complete government responsibility. A system that consumes one-seventh of our economy yet fails millions of us would benefit from both increased public accountability to protect the common good and improved private initiatives to encourage quality, innovation, and efficiency in covering 300 million people. The most reasonable voices for reform understand the need for partnerships among all sectors to make this system work. The attempts by both sides to polarize the debate must be transformed into expectations that lawmakers will find solutions that demonstrate a creative mix of effective government regulation and fair market incentives.
Political Partisanship. The three previous challenges and how legislators respond to them feed the political partisanship that paralyzes our efforts to achieve major reform. In spite of an initial goal to make health care reform bipartisan, the decline in cooperation between the two major political parties has limited their willingness to seek consensus for the common good. In spite of broad and deep public support for reform, and in spite of numerous bipartisan agreements and compromises in the bills, legislators continue to fall into the usual and comfortable circles of partisanship. Party loyalty helps guarantee upward mobility, leadership and membership on key committees, funding for upcoming electoral bids, and campaign contributions from powerful stakeholders.
Ultimately, it will be dialogue around shared values, rather than debate over competing ideologies, that will lead to the possibility of transforming the public concience and creating the legislative priorities for successful and sustainable reform.
Challenge #5 - Economic Self-interest of Key Players. Almost everyone in the United States would benefit from health care reform. Some groups -- low-middle income workers, persons with pre-existing medical conditions, the uninsured, racial and ethnic minorities, people living in under-served areas -- stand to gain a lot. But a number of well-financed, tightly organized health care industries and trade associations fear what they could lose. In spite of concessions to keep them engaged as supporters, in the end, they are now using their influence and affluence to derail reform.
As long as the discussion is dominated by those who fear the loss of their profits, the rest who have so much more to lose will continue to be crushed by the inequities and injustice of U.S. health care. Ultimately, strong public demands for change, coupled with substantial campaign finance reform, will be needed to promote the common good as a benefit to everyone's self-interest and to prevent special interests from blocking progress.

Living into Our Health Care Future. Good people with good hearts and moral grounding sit on both sides of the aisle in Congress, seemingly unable to recognize the value in one another's perspectives. In spite of agreement that health care is a people, not partisan, issue, the ideologies embedded in a two-party system make differences appear to be insurmountable.
Faith communities, however, with members representing the full spectrum of political views, are uniquely positioned to create the opportunities for dialogue and collaboration. In fact, in these moments, it is our calling to help move the debate surrounding health care reform from what is politically prudent or economically feasible to dialogue which embraces compassion and justice and the common good. It is our task to transform these challenges into opportunities for moving forward by identifying the shared values that bridge the partisan differences.
In doing such work, it is in hopeful expectation that we will touch the hearts and minds of the American people so that together we may envision a health care future that fully embraces health, wholeness, and human dignity. It is in transforming our collective conscience on the issue of health care that we eventually will make comprehensive, compassionate and sustainable reform a reality.

Written by Faithful Reform in Health Care www.faithfulreform.org

America deserves to know exactly what it all means

I have reviewed Obama’s healthcare proposal and am led to believe, like every other American, that the government is going to do all these wonderful things for us. However, it is not mentioned once what the actual cost of healthcare will be for the individual and for the family. Although his proposal makes some very clear and valid points, there are some points that need to be clarified.

Obama introduces several ideas but never thoroughly explain what he means. I found some key points confusing.

He stated:

“The most expensive health plans”

According to the summary of Obama’s proposal the standard for healthcare will have no limits or caps, no maximums, no exclusions and no pre-existing conditions. His plan will also provide major medical coverage and 100% prevention coverage. This plan is no different than the proposal made by the Senate and the House of Representatives. The only major difference is increasing the threshold for the excise tax on the most “expensive health plans”. Yet, there is only one plan. So, in essence Obama is increasing the tax for everyone once cost exceeds $27,500.

“Lower Premiums”

In the summary under the category Policies to Improve the Affordability and Accountability it states Increase Tax Credits for Health Insurance Premiums as a perk of the proposal. It goes on to state, “The House and Senate health insurance bills lower the premiums through increased competition, oversight, and new accountability standards set by insurance exchanges.” This statement is quickly followed by, “the President’s proposal lowers premiums for families with income below $44,000 and above $66,000. Relative to the house bill, the proposal makes premiums less expensive for families with income between roughly $55,000 and $88,000.” I, however, am suspicious of such a generous offer. In the house bill the control of the insurance companies was barely mentioned, so I am led to believe that in the President’s Proposal the insurance companies would not be lowering their premiums at all. In fact the premiums would be increased and off set by the lowering of subsidies and tax credits, creating a false sense of security between the American people and the insurance companies.

“New accountability standards”

His proposition for tax Credits are fine. Obama states that the maximum percentage of income paid for premiums is 9.5% for a family income of $88,000 a year. However, according to his chart any family that earns over $88,000 a year will not receive a tax credit. Those families will have to resume responsibility for the premiums that must be paid and will not receive any reduced cost sharing from Obama’s health insurance plan.



“Invest in Community Centers”

I am in complete accordance with the President’s proposal to invest $11 billion in these centers. My one contention is that community centers should not be limited to the underserved communities. These centers can be the future of healthcare in all communities. The 47 MR Model for these centers are self sustained and only would require funding for setup cost and professional staffing for the first year.

“Improve Individual Responsibility”

In our opinion there should be no requirement to pay for insurance as the only option. The insurance argument of lowering costs by mandating that all Americans must pay, is what the insurance experts been stating for years, the supply and demand rules. The industry will raise the rates regardless and the people will be paying more from the onset. This is what we are told to believe from the insurance companies. We believe we should allow each individual to have the freedom to choose where to direct his money? In the 47MR Model the consumer would pay a flat fee directly to a community center on monthly base.

“Hardship exemption”

Under the 47MR model there will be no need for such a clause. Everyone is contributing via government programs, private insurance, or the community center approach.

“Can purchase a low-cost catastrophic plan”

According to the Presidents proposal an exemption can exist if you purchase a catastrophic policy. All Americans would be happy to have this option. A catastrophic policy is a high deductible policy specifically used by large employers who self insure. We should be able to purchase this type of policy. We should be able to select the deductible according to what we can afford. Being able to choose whether we would like to receive a deductible of 10,000, 25,000, 35,000, 50,000 or higher would eliminate the worry of “What if” a catastrophic situation occurs. In the 47MR Model each community center will offer this type of policy to its members. Each consumer would have peace of mind knowing there primary care, preventive needs, and catastrophic needs are being satisfied.


Now the “assessment” for the individuals and businesses who choose to participate in a community center is eliminated. The assessment for businesses with 51 employees proposed by the President proposal is greater then what it would cost to directly support the community centers.

The “comprehensive database” should be solely for claim filing activity. The 47MR Model would eliminate claim-filing activities since new technology would create a database for enrolling, eligibility, and billing.

Standardized funding for the 47MR community health centers would be the model for community mental health centers. In addition, standardized funding for basic medical fee services within the Medicare and Medicaid programs would be beneficial as well.


“Access to Generic drugs”

With the 47MR Model Rx would be provided in each community center in addition to education programs where patients can learn about alternative forms of medicine. Eastern and western philosophies would become an integral part of our center and would allow patients a wide variety of sources for good health.

“Unjustified coding patterns”

There are several coding systems available. Too often Doctors are faced with choosing codes that do not properly diagnose the patient. This is due to a lack of code systems being used. This can correct the patterns if we determine these systems based on the more extensive diagnosis coding.

If we must increase revenue lets have more than one industry. We should offer incentives to the manufacturers of natural herbs--and those of Rx--which have proven to lower health risks as an alternative to prescription medication. They should be included and monitored to avoid abuse.

“Uniform 100% Federal support”

Under Obama’s proposed health bill each state will be uniformly supported for Medicaid services. The federal government is taking 100% responsibility and subsidizing the states. The 47MR Model would be offered nationwide as well and would benefit all communities, not just the underserved.

“67 Billion Assessment on health insurers over 10 years to offset some of the cost of enrolling millions of Americans in their plans”

This statement does not provide any clarity as to who will be paying who. It does, however, seem to suggest that the insurance industry will receive an assessment for enrolling all Americans, now eligible under mandate, into the plan. So what is being said is that the government will pay them another $67 billion just for enrolling all Americans, who have been mandated by the government to join the plan. We are already paying premiums, which include up to 30% of administrative fees which includes enrollment. It doesn’t end here though. In his proposal it goes on to state, “another $1 billion is for the administration.” Am I then correct for assuming that the insurance companies will receive 30% of premium, a $67 billion assessment, and an additional $1 billion for administration, all in the name of healthcare?

With the 47 MR Model projects the cost for an individual to be a member of the community center would average around $20.00 per week. This membership would include an inclusive primary care, preventive, wellness, and educational facility. Each community can help their citizen who are uninsured by having this 47MR model.

In order for America to agree with this proposal we need to know the cost of the premiums, and the rates. America deserves to know exactly what it is that the Americans are being asked to pay before passing any healthcare bill. The cost charged by the insurance companies should be negotiated first to be reasonable and affordable for all Americans before any subsidy is applied. If not we are paying too much for insurance.

Let’s not ask if it’s broken, but rather how do we fix it?

There was a survey by CNN and the Opinion Research Corp and release February 21, 2010 asking if “our system of government is broken” and published in The Swamp Tribute’s Washington Bureau. Let’s not ask if it’s broken, but rather how do we fix it? This question requires introspection of ourselves, as to who are we "the people". Are we a nation of parties, Democrats, Republicans, Independents and now Tea Party? Equally locked in their beliefs of their own party? If so we have seen and are living the results of our party actions.

Big business understands this so they support both sides and buy the votes they need to win. The problem is we feed into this party game, by solely voting on party lines. Its time to place party lines aside and do what our forefather would do and vote American first. Let’s stop the corruption by voting in the young politician who want to make a difference for America and will vote for what best for Americans. If big business can buy votes on all parties lines to benefit themselves. Then we should elect candidates who are best for America regardless of their party. We as Americans have allowed big business to control our government because of party lines. Now is time for us to change our thinking and make America first again. Our votes must be for the candidates who have the best interest for our nation. It’s about him serving the American public, not the American public serving him syndrome we have today.

The question asked by George Lakoff " Where's The Movement?"

There is a movement. A movement which is for the people and about the people, one which offers a viable solution to get access to healthcare for the hard working Americans who are stuck in the middle and have no insurance. There is Medicaid for the poor and Medicare for those lucky to be 65, private insurance or emergency room for every one else. And if you employed and work for the government or big corporations you too have insurance. Yet the weekly cost is prohibitively affordable, but enough to just get by. So who left? The small to midsize business owner, the sole proprietor, the two job part-time worker, the non-qualified disabled worker, and the pre-existing individual who no one wants is left.

The movement is called 47 Million Reasons Movement for Healthcare Reform. This movement is above party line since we service the uninsured American who see healthcare as an American issue above all political party lines. We are focus on those Americans who need access to care NOW at an affordable cost. Where innovation and quality care comes from the community centers, and where no big business or government is needed to control, dictate, or mandate who, what, or how treatment or care should be provided. The Doctor and the patient should have freedom to decide the treatment and be free from the protocol care physicians are force to practice today. A place where a physician is free to think and diagnose what is best for his patient.

To believe big business and government has a solution, just look at what has happen this past year. The only solutions they presented is greed above all else, hiding behind the party lines and fulfilling the deed of the lobbyist whom has paid them handsomely for creating confusion among us all. So the outcome is clear; nothing changes.

We are first Americans, and then second; conservative, liberal, populist, etc and any name we want to choose. Then thirdly we are democrat, republican, independent, etc. We have forgotten what it is to be American Patriot

.So as Americans, we say we believe in democracy, in our constitution, which gives us freedom, independence, and justice for all, so why is our Congress having a problem? Perhaps they have forgotten what it is to be an American. We know big business has, since profits are valued over what is good for America.

I agree we must stand and bring back our patriotism, values, morals, and be a nation of Proud Americans. When a business becomes too big or too greedy, we better take the time to notice. No one business should have control of our nation’s physicians and consumers concerning healthcare, or any other national resource. When government gives this much control to any one industry, and these industry control our elected politicians, the outcome is clear; A DIVIDED HOUSE IN CONGRESS.

So I support any movement who is willing to help bring our country back. And I challenge any elected politician to address every American in writing "IF ELECTED HE WILL ONLY SERVES TWO TERMS" and support term limits.

Learn more www.47millionreasons.blogspot.com
George L Soria

What we can do as a community, before mandates are imposed on everyone.

This new year is now the time to reexamine our goals and move forward into 2010 with a defined solution as to what will be accomplished in the name of healthcare reform.
The passage of healthcare bill in both houses of Congress now leaves little doubt that a passage of a healthcare bill will ensue. The fact is whether we agree or not agree with all the terms and provision in this bill, this is the first time in over four decades something is being done.

So let’s clearly define the main points and see how these can be improved. This makes more sense that to try to kill the whole bill and return back to the place where we talk about it, which is all we have ever done. The fact there is no pre-existing condition is a real win to those whom been denied coverage all these years- ex. retired football players.

The revaluing of the Medicaid and Medicare system, and creating a check and balance to eliminate waste and fraud which has been a common practice, as well as the government forgiving millions of dollars of overpayments to the insurance industry needs to be fixed.

The subsidization of the insurance industry as well needed to be addressed, since subsidies and outsourcing to the same industry is at best questionable.

So in one hand the government is fixing the long outstanding problem of the healthcare issue but in the other is creating another questionable situation.

Under the healthcare bill, on the one hand we are fixing one problem but in the other creating one as well. We are now mandating all Americans to buy insurances and then subsidizing premiums for 30 Million American. Never mind outsourcing all the government employee benefits to private insurance industry.

Was it not the government which broke ATT due to being a monopoly many years ago, now creating another? It must be said that the government needs to stop reshuffling the same deck of cards and let’s begin playing with a new deck of cards. A deck which bring back the basic elements of governing and helps the community look to solve there own uninsured problems. A free society to think and be creative is what is required than mandates on individuals only benefiting a specific industry with no cost control on that industry.

If we are to mandate anyone it should be the insurance industry to equally share in the risk of those medically impaired conditions. No company portfolio should be able to exclude or overcharge those individuals, and should equally maintain a percentile of those medically impaired individuals on their portfolio of insured.

So in this climate of healthcare reform regardless of the final bill, it is clear there will be a void in the middle class where there will be no assistance. A void where there will be no subsidies or qualification for Medicaid, and too young to qualify for Medicare.

In this New Year, an innovative approach will be introduced on Super Bowl Sunday February 7th, 2010 at Gulfstream Park & Casino, Halladale Beach, Florida. This will specifically be design to bring access to quality health care and bring back control to the provider PCP and the patient, who will benefits both financially and in the quality of care. Let’s look at a viable solution for the remaining American who will not benefit under the healthcare reform bill, and a solution for all communities in America who are facing this problem this year and every year thereafter. We have three years to show the government what we can do as a community, before mandates are imposed on everyone.

Perhaps then the government can see the solutions lies in the hand of the people at the community level and not in big government or lobbyist representing special interest of major insurance and pharmaceutical companies.