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Daily Archives: December 21st, 2016


 

Here again the failure of the GOP to fully understand and assist in the creation of the Affordable Care Act (Obamacare), The GOP effectively denied coverage for many due to their political goals being put ahead of the public good.MA
Rita Numerof, PhD, president of Numerof & Associates
22 Hours Ago
CNBC.com

As Republicans in Washington get set to reshape national health-care policy, it is critical that the surrounding debate distinguishes between two related but distinct issues: access to coverage and access to care.
In other areas of policy, we understand this distinction. We know that the issues of homelessness and affordable housing are linked, but not the same. Solutions for one are not automatically fixes for the other. We see the same thing with other basic health issues like food security and nutrition.
Only in health care do we consider the decades-long challenge of delivering high-quality and cost-efficient care “solved” once everyone nominally has access to some sort of insurance.

But real health-care reform is not just about coverage. Getting people into exchange plans they can barely afford, with heavy (and increasing) deductibles and taxpayer-funded subsidies, is a “homeless shelter” fix. It’s better than being on the streets — for sure — but a homeless shelter isn’t a home any more than a high-deductible “bronze” plan is a real health-care solution for a family that can barely afford to pay the rest of its bills.
If we want to fix this system, it’s time to get serious about replacing fee-for-service provider reimbursement with approaches that link costs to outcomes, like bundled payments and population health.

Health care in a post-Obamacare world: Centene CEO
Thursday, 15 Dec 2016 | 7:15 AM ET | 04:50
“If we are serious about reform, we need to move beyond the current obsession with coverage to a real debate about accountability, transparency, cost and quality.”
The Obama administration has pushed forward on several value-based care initiatives, but one of the most striking success stories we’ve had occurred under the previous Republican administration.
In 2008, the Centers for Medicare & Medicaid (CMS) announced it would no longer pay for so-called never events — preventable incidents like hospital falls or objects left in patients after surgery that should never happen in modern health-care delivery organizations.
This first meaningful connection between payment and outcomes led directly to a 17 percent decline in hospital-acquired conditions from 2012 to 2013. Notably, it took financial incentives/consequences before this happened.
Unfortunately, there are worrisome signs that the incoming Trump administration is less committed to the idea of value-based care. It will be important to differentiate between the baby (payment reform) and the bathwater (onerous regulations and reporting requirements) if we’re ever going to get to true value in health care.
A second key goal for reform is more in keeping with Trump’s campaign messages. Unwinding the existing incentives for consolidation would help preserve the competitiveness of many local markets, and thereby protect working-class families. The Affordable Care Act (ACA) established a bureaucratic labyrinth of new organizational structures, regulations and incentives.
Rather than focusing on the capabilities and culture needed to move toward better outcomes at lower cost, providers and payers have been compelled to invest in new staff and technologies to comply with all these new regulations.
On the provider side, this effort spawned a flood of consolidation, with health-care delivery systems buying or affiliating with other systems, and physicians seeking refuge in employment from proliferating bureaucracy. A grave danger we face as a nation is that all these systems become too big to fail — and, more importantly, too big to care.
Finally, it is past time to require transparency of cost and outcomes, so consumers can make informed choices about their care. Having awareness that not every hospital is performing equally well allows consumers to make judicious decisions, an important first step toward a true market-based health-care system.
Health care is an issue that affects all Americans. It costs too much, it is piecemeal, there is little accountability for outcomes, and it is not consumer-centered.
In virtually every other industry, consumer demand drives service providers and product manufacturers to improve quality and compete on price. In contrast, the approach in health care has always been to try to reduce costs by manipulating organizational structures — as with HMOs or Accountable Care Organizations — while leaving in place the original sin of fee-for-service provider reimbursement.
This will always incentivize volume-driven care decisions, not a focus on outcomes.
If we are serious about reform, we need to move beyond the current obsession with coverage to a real debate about accountability, transparency, cost and quality.
Commentary by Rita Numerof, PhD, president of Numerof & Associates, a firm that helps businesses across the health-care sector define and implement strategies for winning in dynamic markets.

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The election of 2015 has brought so many twists and turns as to be quite dizzying to most of us and with that in mind too many have gone back to the mindset that that is the end of that. However this is just the beginning. Mr. Trump has allowed the rise of prior administration workers, former (and disgraced) legislators. These backgrounders who have seized on the Trump outbursts and election are the same people who  have created some of the worst legislation in our history. Newt Gingrich has appointed himself as explainer in chief for Donald Trump along with Kelly Anne  Conway, et al.  The tweet fest that has become the apparent norm for this President seems to indicate an inability to construct a coherent sentence. I expect we may see more campaign type speeches  herein from this administration. The worry is more about the Neer do well Congress who will do less for us since there is an expectation of being able to manipulate the President and his actions (maybe). If Mr. Binks (Trump) continues as is, the swamp may be drained along with loss of the necessary parts of that swamp that helps maintain our way of life. Some offshoots of the Trump win: re-emergence of Klan activity, Nazi like groups and anti-Jewish, black, and catholic rhetoric. It should be noted that  even Glenn Beck is appalled at the Trump emergence and has spoken out against it. The way to regain control of the Government by the people is to pay attention to who you put in Congress as these are the people who have and can do us the most harm! As an example: The ACA-the Congress doesn’t have the concern about your lack of coverage as they are completely covered with the Government medical system which they pay into. Any changes in the ACA that affects you has no affect on their coverage. Forget the rhetoric and pay attention to who you put in Congress and be prepared to in elect them if necessary. Remember those we elect are only your friend when running for the office.

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Mitch the Turtle is again refusing to do his job, aside from his failure to denounce his President elect’s antics, he has in the past allowed his constituents (coal miners) to die without lifting a finger and not telling the truth about the future of coal and coal related diseases . This is just another mealy mouthed politician milking the system.MA

By MATTHEW DALY, Associated Press
4 hrs ago

WASHINGTON — Senate Majority Leader Mitch McConnell is rejecting bipartisan calls for a special committee to investigate Russian interference in the U.S. election, which American intelligence says was aimed in part at helping Republican Donald Trump defeat Democrat Hillary Clinton.
The likely meddling by Russia “is a serious issue, but it doesn’t require a select committee,” said McConnell, R-Ky. The Senate intelligence committee is able to investigate the matter, he added.
CIA Director John Brennan has said the intelligence community is in agreement that Russia tried to interfere in the U.S. presidential election, although there’s no evidence Moscow succeeded in helping Trump win.
“There’s no question that the Russians were messing around in our election,” McConnell told Kentucky Educational Television on Monday night. “It is a matter of genuine concern and it needs to be investigated.”
Still, McConnell said the issue should be investigated in “regular order” by the Senate intelligence panel, which is “fully capable of handling this.”
McConnell’s comments put him at odds with Arizona Sen. John McCain and other Republicans who have joined with incoming Senate Democratic leader Chuck Schumer in calling for a special committee to investigate efforts by Russia, China and Iran to interfere in U.S. elections.
A select committee is a high-profile panel created by congressional leaders that taps lawmakers from a variety of committees to focus on a single issue, such as Watergate or the Iran-contra arms deal.
McCain, chairman of the Senate Armed Services Committee, said Russian interference in the election threatens to “destroy democracy,” adding that a select committee is needed to find out exactly what Russia did and what effect it had on the election.
“We need to get to the bottom of this,” McCain said. “We need to find out exactly what was done and what the implications of the attacks were, especially if they had an effect on our election.”
He said: “There’s no doubt they were interfering and no doubt that it was cyberattacks. The question now is how much and what damage and what should the United States of America do? And so far, we have been totally paralyzed.”
Trump has called reports of Russian hacking “ridiculous,” and his transition team dismissed the CIA assessment, saying it was the work of the same people who claimed Iraq had weapons of mass destruction before the U.S. invaded.
Schumer, D-N.Y., said in a statement that the investigation must be bipartisan.
“We don’t want this investigation to be political like the Benghazi investigation,” he said. “We don’t want it to just be finger pointing at one person or another.” Schumer added: “We want to find out what the Russians are doing to our political system and what other foreign governments might do to our political system. And then figure out a way to stop it.”
McCain, Schumer and other senators say a select committee is needed to “reconcile contradictory information” and give the issue needed focus.
In the interview with KET’s Bill Goodman, McConnell spoke of his surprise at the election’s outcome.
“I thought we’d come up short” in the Senate, McConnell said. “And I didn’t think President Trump had a chance of winning.”
Trump won in part because he was able to connect with rural voters in states such as Michigan, Pennsylvania and Wisconsin that had previously voted for Democrats, McConnell said.
“Trump was able to convey — oddly enough a message from a billionaire who lives in Manhattan — a genuine concern for people who felt kind of left off, who felt offended by all the political correctness they see around them,” he said.

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