I went to the Ohio Democratic Convention and met this great physician who has a new organization, so I’ll tell you about that, but before I do that I wanted to talk about health insurance.
I supported the health care law here, and I’ve written about it a lot, but the truth is I’ve been fairly lucky with health. I have insurance now, I haven’t in the past, it’s a long convoluted story, but the one time I really, really needed affordable health care and didn’t have insurance was for a pregnancy. I got it, through a county clinic in Toledo where they had a sliding scale fee based on income, and I got great care. That was 22 years ago. County, state and federal funding. I’ve never forgotten it, and I (partly) modeled my approach with my clients on the doctor who cared for me at that clinic, during that difficult time. She was relentlessly practical and kind and non-judgmental. Just a great, great doctor for that group of patients.
Since that crisis, we’ve had private-market health insurance that we purchased, we’ve had insurance through my former employer (the postal service) we’ve had health insurance through my husband’s former employer (he was a county prosecutor) and now we have health insurance through my husband, again, due to contract work he does for the state. I talk to a lot of people in the course of operating a small town law practice and my insurance insecurity saga is not unusual. People don’t work for the same company from ages 19 to 65 anymore. They don’t have the sort of job security of, say, a Mitt Romney, where they can insist on a “soft-landing” cushy contract if the company goes belly-up.
What the health care law offers, if it survives lobbyist attacks and media attacks and Republican attacks and judicial challenges is some measure of security. If your situation changes you will be able to afford the same health insurance that members of the US Congress will get. It won’t be “free”, so the Romney donors can quit fretting that we’re all buying t-bones with our food stamps, but it will be affordable and available to middle class or working class people if it survives what seem to be some very powerful forces who are bound and determined to kill it.
So I met this physician, at the convention, Donald Nguyen, MD, FAAP, he’s a pediatric urologist from Dayton and this is the bumpersticker he was giving out:
Announcing . . . Patients Over Politics Bus Tour
On August 26-September 6, we are mobilizing this summer on a historic journey from the Republican Convention in Tampa to the Democratic Convention in Charlotte – to make sure politicians and the public get our message. We need a system where everyone can get health care when they need it and where patients and health care providers are leading the way.
Sign up for the campaign today, and we will bring your name and story on the road with us. Better yet, join us on the road!
This is part of our broader 2012 campaign – the One Million Campaign – where we are working together to educate 1,000,000 people about the facts of the Affordable Care Act. Engage. Educate. Empower.
They’re recruiting doctors and medical students for the cause, and I think I got them one, a family practice physician in my town who admitted he supports Obamacare. He said when he saw me, out and about, “ah, the Democrat! I want to tell you I like Obamacare!” I’m not the only Democrat, but people here like to make that joke. I have to laugh every time, which is exhausting. A reckless statement, “I like Obamacare!” and one he may regret because I now consider him an “activist”. Hah! Too late! He said it. No backsies, Dr. Mike. You’re practically Saul Alinsky now, in my book. Get on the bus. I’m sending him a bumpersticker and Dr. Nguyen’s card.
Here’s the website where you can learn more.
Dr. Nguyen is intense and a little intimidating. He’s quick and he leans in and speaks rapidly, no-nonsense, he’s not screwing around with this, which will probably serve him well at the GOP Convention among the “let them DIE!” crowd.
If the bus goes anywhere near where I live I’ll go out and see them, and get my blood pressure checked while I’m at it.
Valdivia
what a great story Kay. And I hope his tour recruits a lot of people.
Did you see the testimony of the PA official in charge of the voting law saying she doesn’t know what is in the law?
Are these people for real?
kay
@Valdivia:
Yeah. I did. She should be fired for the sneering and joking and refusal to answer.
She’s in a court and she’s a state employee. I watched an assistant prosecutor get totally humiliated by a local magistrate when she couldn’t recite a statute. He sent her out to find it, gave her ten minutes.
What nerve.
Valdivia
@kay:
To me it is inconceivable that this woman is supposed to be in charge (!) and yet has no clue what the law says. If that doesn’t invalidate the law I have no idea what does.
WereBear
It’s never easy to fight through the fog of lies the right wing employs on every issue. We can’t let them blow off accountability. It’s what every parent tries to teach toddlers for heaven’s sake! Why should wingers get a pass?
Patricia Kayden
Good for Dr. Nguyen. Hopefully, there are many more doctors out there who will get the message out about the ACA. Today, many of its benefits go into effect. The Dems should be shouting this from the rooftops.
CA Doc
Doctors For America is a great group; they arrange some very educational conference calls for docs/med students to learn about health policy issues and the ACA and have done some effective lobbying. Unfortunately they are trying to organize a distracted, hyperbusy group, so it’s an uphill slog (like any advocacy in America). If you are on the Twitter machine you can follow DFA and some of their leadership. They’re a rich source of links to good health policy writing.
Kristine
Following their Twitter, and will spread the links around.
Thanks Kay. Nodding in agreement with all the folks here who tell you how much they appreciate your posts.
Walker
I had a doctor family friend (who has always been a Republican) rail against Obamacare in a way I had never heard before. He is in his 60s and the market in his area is such that he cannot sell his practice; he would have to “walk away” from it. And he feels that the electronic records requirement will force him into retirement early (with an unsellable practice).
We talk so much about the insurance stuff that I was completely in the dark here.
CA Doc
@Walker: the business and practice of medicine has changed dramatically in the past 15 years and that has nothing to do with Obamacare. The younger generation of physicians are just not into the idea of spending the time and effort it takes to run a small business, they just want to practice medicine. They want secure, employed positions in big groups or with hospitals. That’s why there’s no market for “selling a practice”.
NonyNony
@CA Doc:
How much of that do you suppose is because of insurance issues? From all directions – running a small business means that you have to worry about insurance for your own staff, and you need a larger staff because you need lots of people to track insurance paperwork, and you need to worry about insurance for yourself. A “big group” can have a pooled resource for handling paperwork and enough people to get you a decent rate for yourself and your family, while a small practice can’t do that.
Honestly the older doctors have kind of done this to themselves, haven’t they? They fought so hard against any kind of “socialized medicine” of any kind for so long that we ended up with all of the bad parts of socialized medicine (the bureaucratic paperwork nightmares on the doctor’s end, the “fighting with nameless bureaucrats” to get your coverage on the patient end) without the benefits.
Walker
@CA Doc:
I understand that. Which would be fine if he could keep practicing as long as he is able. It was the “electronic records are forcing me out of the business” angle that blindsided me.
General Stuck
OT
Maybe voters are starting to pay attention early with a mindset of decision, at least in some crucial swing states.
Polls are polls, and one is just a snapshot fairly far out from the election. But a couple of curious notes on this one. First, it was conducted by Quinnipiac U., that has traditionally been harder on democrats, or less good for dems than other pollsters. I don’t know why.
And secondly, all three of these state poll numbers breach the very important 50 percent marker, that incumbents need to win, due to the fact that undecided Likely voters usually break a little more toward a challenger, if it’s close to election day and they are still undecided.
Chat Noir
You go, Kay! Thanks again for these excellent updates. I remember how valuable and informative your comments were for me during the entire health care debate in ’09 and ’10. And they continue to be valuable and informative, on this and other issues. I have learned a ton from you.
schrodinger's cat
My cousin’s married to a nephrologist, who is fairly wingnutty of the Randian variety, is always going on and on about trial lawyers and such. So he probably won’t be supporting Obama care, I guess. I avoid talking politics with him, since we see them fairly infrequently. Is that common? Doctors being wingnuts, I mean.
CA Doc
Sure there are many reasons why running an independent practice has become harder and harder. There is a big overhead cost to billing insurance, getting prior auths etc. The switch to electronic records is a huge investment, both in time and money, and not very appealing if you were planning on retiring. The ACA does incentivize the acceleration of computerized records but the bigger carrots and sticks were in the stimulus bill and baked into Medicare rules long before the ACA.
@NonyNony: Yes, the medical profession in the US has mostly focused on fighting for the way it’s always been, rather than leading change. And mad as hell with the results, imagine that!
Elizabelle
@NonyNony:
Doctors fighting against universal healthcare; no markets for their sole practice.
Poetic justice, is it not?
shortstop
Great stories, Kay.
It’s not just the older Luddite doctors complaining about electronic recordkeeping under the ACA. My dermatologist, a young, urban, Harvard-trained African American who loves Obama and has been supportive of the ACA, spent 20 minutes last month railing to me about the costs of compliance. Unlike Walker’s doc, her beef is not with the concept, but with how much it will cost her to revise her existing electronic system.
Dan
,a href=”#comment-3528364″>Walker:
Well, converting to electronic records is a real expense, and it takes time to do it. I suppose it’s unfortunate for your friend, but anyone who was paying attention to the way the field was going in the past fifteen years would have known that we were moving to a point where electronic records would be something that patients just expected.
Elizabelle
@NonyNony:
Doctors fighting against universal healthcare; no markets for their sole practice.
Poetic justice, is it not?
Elizabelle
@NonyNony:
Doctors fighting against universal healthcare; no markets for their sole practice.
Poetic justice, is it not?
shortstop
Great stories, Kay.
It’s not just the older Luddite doctors complaining about electronic recordkeeping under the ACA. My dermatologist, a young, urban, Harvard-trained African American who loves Obama and has been supportive of the ACA, spent 20 minutes last month railing to me about the costs of compliance. Unlike Walker’s doc, her beef is not with the concept, but with how much it will cost her to revise her existing electronic system.
a hip hop artist from Idaho (fka Bella Q)
@kay: I could not initially believe it was an authentic story. The nerve and arrogance of her insistence that 99% possess sufficient ID, while admitting she doesn’t know what the statute reads. Don’t even get me started on the sneering.
It is inconceivable to me that we (in general) will tolerate a governmental official who proudly admits her ignorance of the statue defining procedures for a process she is legally required to oversee. It’s a disgrace, to put it mildly.
I’ll try to recruit some doctors for the trip.
Abijah L.
@schrodinger’s cat: No, most of us are not wingnuts. Remember that professional/doctoral level were the subgroup of white people that voted most heavily for O in 2008. However, just like there are wingnuts in Hollywood, we have our share. The AMA skews southern, white, male, and specialist and they still support the ACA by a pretty wide margin. Those of us in primary care are even more supportive (>70% in one poll).
Linda Featheringill
@General Stuck:
I saw that. Looking good!
Over at TPM at their electoral college graphic, Obama is given 310 EC votes and Romney 191. That is really good to see. [538 is the magic number, yes?]
And if 90% of folks have already made up their minds . . . .
R-Jud
@Linda Featheringill: 270 EV to win. 538 is the total number.
General Stuck
That cool tingly feeling is not trickle down economics, it’s a plutocrat pissing down the back of the middle class. Many of which will vote for Mitt Romney regardless. Peachy
Elizabelle
echo
Abijah L.
@shortstop: We spent $2M to buy an EHR system to replace our homegrown system. Then we had to buy a server farm to run it and beef up the support staff. Sadly, the software is so crappy (I was a software engineer for a decade before going to medical school — I have written my share of crappy code) that we’re giving up on it and replacing it with another big name and expensive package. However, we now belong to a giant hospital system, so we don’t have to bear the entire cost again. Hopefully it will run on the current hardware. The IT department is dwarfed by the size of the department that interacts with the insurance companies, though.
I hate that EHR with a passion and yet, Luddite that I am, I have 8 computers at my house running various flavors of 3 different OS. I’m kind of a Linux-loving “Luddite”.
SFAW
@a hip hop artist from Idaho (fka Bella Q):
Where the hell have you been since the Rethugs took over? They’re proud of their ignorance in all things not providing them an immediate benefit. Her ignorance is a feature, not a bug.
@Linda Featheringill:
You might say that. It would be the USA equivalent of Saddam’s or QKHaddafi’s or Ahmadinejad’s margin of victory.
shortstop
@Abijah L.: I’m hearing you. The requirement is a legitimate concern that’s causing all kinds of otherwise open-to-reform physicians to pull their hair out. Will be watching this as it unfolds.
Another Halocene Human
@Walker: Well, he’s barking up the wrong tree–electronic records was coming anyway, generally with support from the industry. They needed a uniform standard because hospitals were all switching over to different systems that weren’t interoperable.
Even had ACA failed Congress most likely would have taken that issue up.
So he can blame the rest of the industry for wanting it and Silicon Valley for making it possible and These Modern Times for creating patients who move from place to place and provider to provider.
Oh, and the #1 reason a doctor can’t sell a practice now is that new doctors have no capital. They’re massively in debt to the medical schools who “charge what the market will bear”. Something Obama has his sights on as a former professor. Maybe we ought to help him do something about that.
Linda Featheringill
@R-Jud:
Ah, right! 538 is the total number and that would make 270 the “magic number.”
I’ll bet Axelrod already knew that. :-)
[And yes, Axelrod & Co. are very, very good at counting.]
SFAW
@General Stuck:
“Your Mittjesty is like a stream of bat’s piss”
(and I’m gonna copyright or trademark or whatever that name, before some whiny Rethug beats me to it.)
Another Halocene Human
@NonyNony:
Ding ding ding. AMA fought Medicare tooth and nail. Now look where they’re at.
AMA has always, always been run by the white hairs so it’s tough for the majority of younger doctors to really be properly represented by them, hence the springing up of alternative doctor advocacy groups.
Oh yeah, AMA also got that law passed in the 1930s blocking doctors immigrating with German medical licenses (superior to US at the time) to keep Teh J00z out. I’m sure all the people that died because of that were worth it so they could save some of their profits.
Another Halocene Human
@shortstop: This situation was foreseeable. Our government doesn’t know how to develop software (seen this from the inside), but neither does most of the private sector. They just know how to grift (believe me I’ve seen this). This is easy because the people in charge of purchasing don’t know code, and the people who would are either grifters themselves in the org or got laid off eons ago. The whole industry was debased by the Windows 95 debacle and the Gates system of selling directly to the top. Made Gates a very, very, very, very, very wealthy man. Probably cost the US billions in lost productivity.
Had there been a strong enough non-profit force out there, a consortium of hospitals and software engineers, a really great open-source product could have happened, but in this country hospitals are seen as cash cows. Hence, I’m sure they were lobbied heavily by the usual suspects.
Another case of We Can’t Build Anything Right.
And there are expenses every time anything is upgraded. I’m glad the gov put its foot down and required the change now instead of putting it off endlessly like most federally mandated improvements, because there are major costs to not upgrading as well.
Speaking of upgrades, the US gov lost a court case that mandated that we change our paper bills to different sizes for different denominations (Euro style) for the blind. And Congress did… fuck-all. There seems to be a persistent lobby for “NEVAR CHANGE ANYTHING EVAR” that quite frankly other developed countries would laugh at. Changing that shit would not be a GDPocalypse, not even close. Heck, eliminating the $1 bill would not even require a change in money tray for most cashiers using standard money trays, just a rearrangement. GAH!!!
Linda Featheringill
There is an essay on dkos that seriously looks at the possibility that Romney has dementia of some sort, possible Alzheimer.
http://www.dailykos.com/story/2012/08/01/1115628/-Does-Romney-Have-Alzheimer-s-Seriously-Does-He
Maybe you docs could have a look at this?
ETA:
Yes, I know that a diagnosis made at this distance is not worth the paper it’s written on. But still . . .
Another Halocene Human
@schrodinger’s cat: It used to be typical.
Doctors wouldn’t have to worry so much about trial lawyers if the medical boards were more aggressive about yanking medical licenses from the worst 3%. I think lawyers are actually much better about policing their own ranks than doctors. And according to those lawyers, it’s less than 5% of doctors who are responsible for over 90% of the medical malpractice awards. Yeah, lots of patients like to sue but the real expense is WHEN THEY FIND YOU GUILTY OF MALPRACTICE.
If you can’t take out the trash, you’ll have to cough up the cash… malpractice insurance is EXPENSIVE. They are all paying big time to protect a few bums (and their image that all MDs are gods by virtue of being an MD).
Another Halocene Human
@Abijah L.: Today’s doctors to me have a much better image but they are stuck with the decisions of the past. Path dependence.
It’s so bad now that it’s hard to even imagine how a better way to deliver medicine would look like. And doctors have tarnished their reputation with the public for generations.
Another Halocene Human
@General Stuck: Ahahaha. Wow.
Another Halocene Human
@Linda Featheringill: OMG this comment:
SBJules
according to the L.A. Times this morning, nearly 2 million Californians will receive refunds as part of the federal healthcare law. Also too…Have you heard about the great socialized medicine system in Israel?
shortstop
@Another Halocene Human: Or he could just be a lying, disconnected asshole who never had to pay the price until now for being one.
Thanks for the info above re recordkeeping changes. I do understand that it was foreseeable and am nodding my head at the problems of coordination/resistance to change you documented. Right now I’m concerned about the fallout from angry healthcare providers who are otherwise sympathetic to the ACA — you are right that the AMA has traditionally been opposed to any and all change, but Abijah is correct that a dramatically increasing number of physicians, especially younger ones and non-specialists, are on our side. It’s going to be interesting to see how this particular issue shakes out.
debg
@Kristine: I second the nodding in agreement. You do great work, Kay.
Another Halocene Human
IANAMD,
But couldn’t Romney’s “odd gait” just be the result of him favoring one leg or the other because of pain?
He looks really bad, though. (Looked a video from the Polish gaffe.)
SFAW
@shortstop:
I’m sorry, but I must have just dropped in from another dimension/reality. Because in MY reality, His Mittjesty has yet to pay any price for being a lying, disconnected asshole. (I cannot speak to any consequences he may have received when he was George’s-little-boy-Mittens, however.)
liberal
@Another Halocene Human:
This, although I’m not all that impressed with lawyers either.
shortstop
@SFAW: He’s about to pay the price, SFAW — he’s going to lose the election and not get a job he thought was owed to him.
Mnemosyne
@Walker:
@shortstop:
Make sure those physicians know that the government is offering financial incentives for making the switchover early (they probably got some mailings about it, but I suspect that doctors get a whole lot of mail from Medicare).
They need to move fast, though — the program has already started and the last day for individual practicioners to start reporting is October 3rd.
shortstop
@Mnemosyne: Thanks; mine knows. She’s quite well informed and still pissed. Sigh.
SFAW
@shortstop:
I hope you’re right, but I am less convinced of the wisdom of the electorate.
I realize I’m ignoring reality: if the electorate were really as stupid as I fear, then we’d be worrying about Congress trying to do such insane things as kill Medicare, kill Social Security, and so forth, and the voters would not make them pay for such insanity.
Fortunately, our Congressional leaders are focusing are focused like laser beams on JOB JOB JOBS, and their efforts have restored the robust US economy.
And so President Obama can just coast into Election Day, so I shouldn’t worry.
terraformer
My wife and I are lucky in that we both work for companies that have health care plans. She just started working for them, and as we were spending hours digging through the 300+ page plan for each company to determine which plan to go with – I recognize this is a nice problem to have if one doesn’t have health insurance – I began to think “it’s ridiculous that we have to wade into this mess: co-pay this, co-pay that; generic prescription this, “preferred” prescription that.
Especially when I think, “other first-world countries don’t have to do this, why should we?” I then I think about the powerful greed machine that is the current state of health care, the determined lobbyists and their paymasters, and the all-to-willing dunderheads who buy into the scare tactics and resentment politics who keep universal health care from becoming reality. One day, I hope, we’ll look back on this time period, what with all the evident greed from healthcare companies, the banks, etc., and shake our heads in shame about how far down the rabbit hole we were. I hope.
shortstop
@SFAW: Stay calm. Congress’ treachery and the realities of the electoral college are two different issues. Mitt Romney is not going to win this election, so save precious angst for stuff like current Congressional races and future presidential campaigns when the GOP candidate isn’t so ludicrously bad that CU can’t save him.
SFAW
@shortstop:
I’m calm. But I’m also rational (no, I’m not slamming you).
It’s three months until the election. A lot can happen between now and then, and a lot of it can/could work to His Mittjesty’s benefit. Unless he’s caught with an eight-year-old altar boy, his floor is probably 45 percent. Given the low-information-ness-itude of the typical “Independent” voter, there’s no reason he can’t get close-to-or-over the 50 percent mark. (Yes, I understand how the Electoral College works.) Added to that will be a bunch of Rethugs following the McConnell Doctrine.
Obama’s personal favorability rating is significantly higher than His Mittjesty’s, but Mitt’s has probably bottomed-out, and there’s a lot that can be done to damage Obama’s. And there are probably still a bunch of purity trolls who will go-Naderite on Election Day.
Three months is a long time. I’m not lighting the victory cigar just yet.
karen marie
This is such good news, it literally brought a tear to my eye. There are good people in America.
shortstop
@SFAW:
I didn’t think you were slamming me. I know you know my own comments are meant in friendliness, too.
Do you think so? Failing some catastrophic event, I think they’ve done about all they can do and are recycling old gambits that didn’t work the first time. The guy’s been in office for four years and people’s minds are fairly firmly made up at this point, so we’re dealing with a scant few percentage points of persuadable folks. I don’t think the purity trolls are as plentiful as a lot of you guys here tell me they are — they are loud, though, which sometimes gives the impression of larger troops.
Me neither, though I’m more confident than you are in the results of this particular race. I’m more of a chocolate person anyway. On November 7, you’ll smoke and I’ll munch sweet deliciousness companionably.
ETA: (At least, we’ll celebrate regarding the results of the presidential race. Not happy at how the various Senate races are going.)
a hip hop artist from Idaho (fka Bella Q)
@SFAW: They haven’t generally been so blatant about flaunting their ignorance of laws controlling the tasks their governmental jobs require them to perform. It was the context of the pride that was striking. They usually just boast of general ignorance.
SFAW
@shortstop:
Of course, never doubted it.
Or we could have chocolate cigars.
SFAW
@a hip hop artist from Idaho (fka Bella Q):
OK, I guess I can get on board with that sentiment.
accidentalfission
@Abijah L.: No chance of an open source EHR system then? Just a money pump out to some amalgamated software giant that requires its product to run on Microsoft platforms?
Shame. Integrated Library Systems have had significant success with open source ILSs.
shortstop
@SFAW:
Genius.
dww44
Question for Kay or whomever wishes to provide info and/or links. My ultra conservative brother (from another more northern state) sent me the piece from the NYTimes 2 days ago about the ACA will worsen the doctor shortage. I’ve not yet delved into this, but mostly my brother only sends me political stuff when a nominal liberal media outlet says something negative about a liberal passed law. I am obliged to respond and not to ignore and I’d appreciate any quick links or info that would help me refute or put into better context this piece.
shortstop
@dww44: One thing that piece (incredibly) fails to mention is the artificially restricted supply of doctors created by the AMA and certain other professional groups in the last couple of decades of the last century. Quite simply, keeping the number of doctors low keeps physicians’ salaries higher. In 2006, the American Association of Medical Colleges responded to the coming super-shortage by recommending that U.S. med schools up their enrollment by almost a third by 2015, as well as accredit new medical schools. Here’s some info on how they’re going about doing that.
dww44
@shortstop: Thanks for this info and I had long known that the AMA has kept the supply of physicians low for quite some time. Anyone in my region who’s gone to a hospital or a “doc-in-the box”. or an ER in the last decade or so is very much aware that those places are almost entirely staffed by doctors who got their medical training elsewhere, either in Central America, or South America, and particularly India. Thanks for the links as well.
Pokey
I just heard about them too! They seem pretty great and I think Obamacare is definitely a step in the right direction, so I signed up for the virtual tour ( http://www.patientsoverpolitics.org ). Opponents can still do a lot to hurt Obamacare by either refusing to fund it, governors refusing to do the Medicaid expansion, and if enough opponents are elected in November, they can vote to repeal it. So that’s why I signed up.