How to Spell Health Care Without R-E-F-O-R-M
Healthcare News first published this article How to Spell Health Care Without Reform on January 8, 2019.
“God gives the nuts, but he does not crack them.” – Franz Kafka
The Federal Bench
There are more than 850 justices and judges (excluding magistrates and administrative law judges) in the United States federal court system, spread out over 94 judicial districts, 13 appellate courts and one Supreme Court. In 2017, there were 274,547 cases filed in the District Court, 295,956 cases terminated, while another 338,013 cases remained. For the same time period in the U.S. Court of Appeals, 49,816 cases commenced, 53,756 terminated, yet still 38,876 remained.
Any dispute involving (1) the United States government, (2) the U.S. Constitution or a federal law, or (3) a controversy between states or between the U.S. government and any foreign government, falls under the jurisdiction of the federal court system. Additionally, 30,000 more judges oversee another 90 million state court lawsuits filed each year in America’s 50 states and 3 districts (District of Columbia, Guam and Puerto Rico).
Federal and state courts share the burden in resolving domestic health care disputes, although the federal system bears the heavier load when it comes to Medicare and the 2010 Patient Protection and Affordable Care Act (ACA), also known as “Obamacare.” Still, it is neither plausible nor prudent for less than 0.12 percent of the federal judiciary to effectively “veto” a system so important as health care. In 2017, approximately 294.6 million Americans had health insurance coverage to rest in one of the 894,575 beds in any of the 5,534 United States hospitals, or see one of 953,000 actively licensed allopathic and osteopathic physicians, still leaving room for the other 31 million people in the United States without health insurance. While the ACA qualifies as landmark legislation, historical hindsight may someday place health care reform’s success in its first decade on par with President Lincoln’s Emancipation Proclamation. … Read more →
What To Do About Broken
California Healthcare News first published this article “What To Do About Broken” on October 9, 2018.
“All of our reasoning ends in surrender to feeling.” – Blaise Pascal
An adjective, the word “broken” encompasses a multitude of meanings, most of which identify a magnitude of concern, while very few provide comfort. Recognizing that which is broken often remains elusive, creating a daunting challenge when facing this dangerous combination. Even when a solution presents itself, the ability to surrender remains a most formidable foe. Navigating through this labyrinth, individually and as a society, is also sometimes referred to as “life.”
It is no coincidence that life usually starts and ends in a hospital. With almost 5,500 hospitals in the United States today, only by the middle of the twentieth century did these institutions become symbols of hope, slowly creating an inextricable dependence upon which the sick and infirm rely. Nearly a score into the twenty-first century, the hospital represents the primary solution when there is a threat to health. What would happen if the basket holding all of society’s proverbial eggs breaks (assuming this container is not already broken)? … Read more →
Repealing the Affordable Care Act – What Could Possibly Go Wrong?0
California Healthcare News first published Repealing the Affordable Care Act — What Could Possibly Go Wrong? on January 9, 2017.
“Necessity is not an established fact, but an interpretation.” – Friedrich Nietzsche
Evolution or Devolution?
In a constant state of flux, the American health care system has struggled to exist in the present since the introduction of Medicare in 1965. Both in terms of medical care and its delivery, our nation’s health care system must continually evolve if it is to keep up with advances in science, technology and the treatment of disease, as well as the way we access these advances. As a result, each generation’s health care must balance providing that which has come to be expected with the need to expand coverage and modern methods of care. As a nation, we depend upon those in highest office to monitor such changes, adding provisions where applicable and paring down what is no longer practical. Much of the divided nation fears that come January 20, 2017, Barack Obama’s legacy, the Affordable Care Act, may find itself vulnerable to a single stroke of the pen, potentially leaving millions of Americans without meaningful access to medical care. Others will celebrate as Donald John Trump accepts the role of 45th President of the United States. The only immediate certainty for modern American health care is that both sides will continue to argue whether the Affordable Care Act is a frivolous luxury or a social necessity. … Read more →
PBS’s ‘This Emotional Life’: Mental Health and the Family Tree0
The Huffington Post first published this article on September 20, 2010.
“The two most powerful warriors are patience and time.”— Leo Nikolayevich Tolstoy
Thanks to the recent closing of many mental health facilities as a result of today’s tough economic times, the subject of mental illness has been getting a lot of attention lately. The National Institute of Mental Health estimates that 26.2 percent of Americans aged 18 and older — that’s one in four adults — suffer from a diagnosable mental disorder in a given year. Though no one likes to think of the possibility, the chances that a family will at some time face the specter of mental illness within its ranks are all too real.
While concern for those directly plagued by psychiatric issues is certainly a priority, surprisingly little information is geared toward the effect such an illness has on the loved ones and friends of the sick patient. Unlike cancer or heart disease, whose conditions can be qualified, psychiatric disorders continue to stand as an enigma to much of the modern world. This often leaves those closest to the patient wondering both how to feel and what to do when dealing with the ramifications that are sure to present themselves.
Why We Must Care About Medicare0
California Healthcare News published this article, Why We Must Care About Medicare, on October 11, 2016.
“It’s kind of fun to do the impossible.” – Walt Disney
A Federal Circuit Court of Appeal recently commented, “Medicare is, to say the least, a complicated program.” United States health insurance for people 65 and older has 37,000 separate guidance documents online at the Centers for Medicare & Medicaid Services (CMS), myriad federal regulations expounding upon 50 years of statutory direction, and a legion of Federal Court decisions adding even more detail. To be sure, health care providers should exercise great caution before sharing in Medicare’s $650 billion annual fund. Unfortunately for those ambivalent about Medicare with all of its complexities, not to mention anyone who outright hates the program, resistance is probably futile. … Read more →
Health Care’s Unfinished Bridge0
This article, Health Care’s Unfinished Bridge, was first published in California Healthcare News on April 5, 2016.
“We must be willing to let go of the life we planned so as to have the life that is waiting for us.” – Joseph Campbell
Every era relies on the intuition of a talented few in its search for scientific breakthroughs. Herodotus rejected the notion the Earth was flat, and in particular its description on the Shield of Achilles in Homer’s Iliad. Some 29 centuries later, science has reduced the labors of Homer to little more than myth, though philosophy still honors the epic, from its very first word (“μῆνῐν” or “wrath”) to its lesson addressing the value of balancing excessive pride with the fear of anonymity. Similarly, advances in technology have greatly benefited medicine in recent generations, as doctors increasingly approach diseases of the body from a tangible perspective. However, the treatment of diseases of the mind continues to be far more speculative in nature, serving to highlight the chasm between these two seemingly similar but ultimately disparate fields. This in turn presents a complex issue for both medical practitioner and mental health provider. … Read more →
The Decay in Regulating California’s Corporate Practice of Medicine0
This article, The Decay in Regulating California’s Corporate Practice of Medicine, first appeared in the Business Law News (Issue 2, 2015) of the State Bar of California on June 24, 2015.
“There is nothing worse than a sharp image of a fuzzy concept.”
In the 1990s, dentists in North Carolina began to whiten teeth. A decade later, nondentists across the state began to provide the same services, but at a lower price. In 2006, the North Carolina State Board of Dental Examiners (the “N.C. Dental Board”) responded by issuing more than 47 cease-and-desist letters to parties whitening teeth without degrees in dentistry, and in 2007 the N.C. Dental Board enlisted the aid of the North Carolina Board of Cosmetic Art Examiners to issue similar warnings, specifically to cosmetologists Their combined efforts were successful, and North Carolina nondentists soon stopped offering teeth whitening services.
The United States Federal Trade Commission (the “FTC”) took exception to the actions by the N.C. Dental Board, and in 2010 the FTC filed an administrative complaint, alleging the N.C. Dental Board acted deliberately for the benefit of North Carolina dentists and to the detriment of North Carolina nondentists. According to the FTC, these anticompetitive and unfair tactics violated the Federal Trade Commission Act, and in particular Section 5.
After multiple hearings before an administrative law judge, followed by the FTC’s internal oversight and a review by the Court of Appeals for the Fourth Circuit in February 2015, the United States Supreme Court agreed with the FTC’s 2010 allegations, namely that the anticompetitive conduct of the N.C. Dental Board violated antitrust law, and in particular the Sherman Act. The Supreme Court also held that sovereign immunity did not protect the actions of the N.C. Dental Board.
In its 6-3 decision referring to the roles of dentists and nondentists in North Carolina, the Supreme Court reached a far greater audience than those concerned with tooth color in the Tar Heel state. In point of fact, the Court’s ruling did much to undermine most if not all authority held by professional organizations in California, including in particular the Medical Board of California (“MBC”). This article explores how and why such change came about. … Read more →
CMS Quality Measures0
This Health Law e-Bulletin, published on March 20, 2015, summarizes the 2015 National Impact Assessment of CMS Quality Measures Report (the “2015 Impact Report”) (as mandated by section 3014(b), as amended by section 10304, of the Affordable Care Act (the “ACA”)).
What if one day the Internal Revenue Service (“IRS”) changed the ways in which the Federal Government taxed individuals? For example, rather than assessing tax liability on the basis of income, what if the IRS assessed taxes on the basis of an individual’s contribution to society, or on his or her general demeanor or overall perception as “good” or “bad”? Under the ACA, Medicare has started to transform in such an historical manner, reimbursing hospitals now (and physicians soon) on the basis of performance, efficiency, and patient satisfaction, gradually replacing the previous system that structured reimbursement on the costs involved in the delivery of health care. The 2015 Impact Report represents the second assessment by CMS since the ACA became the law in 2010, this time focusing on 25 CMS reporting programs and nearly 700 quality measures (using data from 2006 to 2013).
The ACA mandated a push toward high-quality, evidence-based care for patients, with top priorities including (1) making care safer, (2) ensuring that each person and family are engaged, (3) promoting effective communication and coordination of care, (4) promoting the most effective prevention and treatment practices, (5) working with communities to promote wide use of best practices to enable healthy living and (6) making quality care affordable. The 2015 Impact Report provides a 262-page scorecard for those who may be interested in the ACA’s success during its first few years.
CMS is committed to quality measurement as it transforms the very nature of modern American health care. The 2015 Impact Report illustrates how providers, private payers, and communities can work together to achieve the greatest impact on quality. As stated in the 2015 Impact Report: “Everyone receiving healthcare in the nation is likely to benefit from CMS programs and initiatives, as healthcare professionals engage in delivery system reform to achieve better care for patients, better health for the U.S. population and lower costs through quality improvement.” The complete 2015 Impact Report can be found here.