Pat McNees

Writer, editor, ghostwriter, personal historian

"America is at that awkward stage. It's too late to work within the system, but too early to shoot the bastards." ~ Claire Wolfe

"No nation would be so dumb as to say that we all want to go to one point, we just don't know how to get there. What we are finding is some want to go to San Diego, some to Seattle. We are ashamed to admit this so we pretend we all want to go to San Francisco." ~attributed to Uwe Reinhardt

"Eat food. Not much. Mostly plants."~Michael Pollan


"Rule-based behavior (when it’s raining, take an umbrella) is important in medical training. Using mnenomics, we train physicians in rule-based behaviors with code algorithms, said Weingart. “The trick is to apply it in the correct setting.” Rule-based mistakes occur when we apply the wrong rule — for example, going down a code algorithm but choosing the wrong arm."

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Health Care Reform and Medical Error
and the Affordable Care Act


The Affordable Care Act (ACA)
Sweet-industry lobbying vs. the public interest
Industry lobbying vs. the public interest
Do you (can you) trust your doctor?
Complementary and alternative medicine (CAM) and treatments

These sections have been expanded and moved to a sister site:
The medical use of marijuana
REFORMING THE U.S. HEALTHCARE SYSTEM
Understanding the issues health care reform should address
Improving healthcare practices
The costs of neglecting the mentally ill
Organizations serious about improving the U.S. healthcare system

Why U.S. medical costs are so high and where the system needs fixing
Taking the mystery out of health care prices
(was Pricing transparency: Doctors, patients, and insurance companies on the same page)
Reforming the U.S. health care system
Drugs, Big Pharma, conflicts of interest, and why U.S. patients pay too much for medication
Pros and cons of a single-payer system and related insurance issues
Retainer or concierge medicine and other new payment models
Dealing with shortages of physicians and other healthcare professionals
Medicare and Medicaid
Planning for long-term care and end-of-life preferences
What you need to know about long-term care insurance
Long-term care, long-term care insurance, and public policy
Organizations focused on long-term care and long-term care insurance
End-of-life care and planning for pets

Vaccines and vaccinations
HIPAA, electronic health records, and patient privacy
Resolving issues with electronic health records (EHRs) (especially privacy, safety, and security)
Medical errors and quality control
Will you die from medical error? Will they know that's why you died?
The anatomy of medical error
Reducing medical errors
Improving end-of-life care (part 1)
Improving end-of-life care (part 1)
Alzheimer's disease and other forms of dementia
Autism spectrum disorders
Coping with cancer
Coping with chronic, rare, and invisible diseases and disorders
(and disabilities)

Treating depression and other forms of mental illness
Managing your pain, health, and health care costs
Medicare, Medicaid, and health insurance
Social Security and veterans benefits
Substance abuse, treatment, and recovery
Vaccines and vaccinations

Reforming the U.S. health care system


Health policy issues (Association of Health Care Journalists, or AHCJ)
Health Reform reading list (Joanne Kenen, AHCJ, resources for journalists) ****
Diagnosing Health of the Healthcare System (animated video, Peterson-Kaiser Health System Tracker, measuring the performance of the U.S. health system). See more Peterson-Kaiser charts, tracking health care trends.
What we know about how health insurance affects health (Carolyn Y. Johnson, Washington Post, 9-8-15) "The real question now may not be how big the effect of insurance is on health, but how to structure insurance so that it gives people the best chance of staying healthy. There is also growing interest in comparing insurance coverage to other ways that money could be spent to improve health, for example by reducing poverty, which is associated with poor health outcomes, spending on food stamps, or structuring insurance plans differently. 'We know we improve health care coverage, but .... what are some of the other strategies to improve health?' Long said."
What being overwhelmed by rules and regulations looks like (Fred N. Pelzman, KevinMD, 8-31-14)
What do we do when antibiotics don’t work any more? Public health journalist Maryn McKenna's excellent TED talk, recounting the often terrifying stories behind emerging drug-resistant diseases that medical science is barely keeping at bay. "We've squandered the advantages of penicillin and the antibiotics that followed. New, drug-resistant bacteria mean we're entering a post-antibiotic world -- and it won't be pretty. There are, however, things we can do ... if we start right now."
Where Does Rationing Fit Into Healthcare Reform? (Trisha Torrey, About Health, 11-24-14) Rationing is not new, nor will it be any better or worse under healthcare reform. Private insurers too often deny care based on cost -- a form of rationing. Care is also rationed denial of coverage and care for people with pre-existing conditions. See What Is Healthcare Rationing?
In a State of Denial (Norman Bauman, New Scientist, 10-7-95). Thousands of Americans will die of AIDS because politicians refuse to believe scientists who say needle exchanges make good sense
Politicians need to get over their squeamishness about needle exchange programs (Christopher Ingraham, Wash Post, 3-24-15) There's widespread evidence going back decades that needle exchange programs are effective at preventing the spread of HIV and other blood-borne diseases, that they encourage drug users to seek treatment for their addictions, and that they do not promote or encourage drug use overall.
Older people risk losing access to health information if services move online and to the phone (UK) (press release, International Longevity Centre, UK, 2-12-15)
Controversies in Hospital Infection Prevention (Stopinfections.org)
Finding the full story behind hospital mergers, consolidations (Joanne Kenen, Health Journalism blog, 3-10-15) "Across the country, health systems are getting larger, gobbling up community hospitals or smaller chains. Some of this has to do with payment incentives in Obamacare, but just as much has to do with changes to Medicare, Medicaid and providers’ desire for leverage as they negotiate payments with insurance companies." See New York’s leading health systems differ on growth strategy (Dan Goldberg, Capital Magazine, 3-10-15). Goldberg explains how the old model (fee for service, which meant chronically ill patients were good for business), differs from the new model (paying a set amount per patient or per service, encouraged by ACA, state Medicaid reforms, shifting demographics, and Medicare's ACO models and payment penalties), which provides an incentive to treat more patients but also provide less in-patient service. These five NY systems represent two camps: one "believes in aggressive upsizing"; the other, wary of affiliation with other hospitals, "made strategic investments and focused on ambulatory care and their traditional role as teaching hospitals. They have steered well clear of the insurance business." Excellent explanations.
Unnatural Causes....is inequality making us sick? (an important PBS series).
---In Sickness and in WealthWhat connections exist between healthy bodies, healthy bank accounts, and skin color? Four individuals from different walks of life demonstrate how one’s position in society – shaped by social policies and public priorities – affects health. Read transcript here
---When the Bough Breaks (“When the Bough Breaks” examines the mystery of the Black-white infant mortality gap, while “Becoming American” sheds light on the shifting health status of newly arrived Latino immigrants. Read the transcript here.
---Bad Sugar explores the causes and effects of diabetes within two Native American communities. “Place Matters” connects the dots between health, wealth and zip code. Read the transcript here.
---Collateral Damage traces the health challenges of Marshall Islanders from the South Pacific to Springdale, Arkansas, while “Not Just a Paycheck” explores the toll taken by layoffs and job insecurity in western Michigan. Read the transcript here.
Bill Moyer Journal (12-18-09) Amidst fading hopes for real reform on issues ranging from high finance to health care, economist Robert Kuttner and journalist Matt Taibbi join Bill Moyers to discuss Wall Street's power over the federal government. You can read transcript here.
Reform by the Numbers (Robert Wood Johnson Foundation, RWJF)), a source for timely and unique data about the impact of health reform. For example: Eight Million and Counting (RWJF, May 2014). A deeper look at premiums, cost sharing and benefit design in the new health insurance marketplaces. And Health Insurance Exchange Compare (RWJF, May 1, 2014) Benefit design and cost sharing information for health plans in all 50 states.
HELP Is on the Way (Paul Krugman on why universal health coverage is affordable)
Reach of Subsidies Is Critical Issue for Health Plan (Robert Pear, NY Times, 7-26-09—on another important issue: where the money comes from to cover the costs of the formerly uninsured)
The Republican Case for Waste in Health Care (Phillip Longman, The Health Care Blog, explains why the Republican funders don't want cost-effectiveness research, 3-8-13). "Conservatives love to apply “cost-benefit analysis” to government programs—except in health care. In fact, working with drug companies and warning of 'death panels,' they slipped language into Obamacare banning cost-effectiveness research." Longman explains how that happened and why it can't stand. "[O]verthrowing the ban on cost-effectiveness research now must move high on the agenda, and it requires clearly and forthrightly explaining what it really is and why it’s essential to everyone getting the best care possible."
Health Insurance Consumer Information (news you can use), with blogs that follow the health care debate and discuss news of health insurance coverage around the country, and a Consumer Guide for Getting and Keeping Health Insurance for each state and the District of Columbia. The American Cancer Society and the Robert Wood Johnson Foundation and other organizations provide support for this research by The Georgetown University Health Policy Institute. Worth checking out.
Health Insurance Woes: My $22,000 Bill for Having a Baby (And I had coverage for maternity care!) by Sarah Wildman, DoubleX, 8-3-09). "Our insurer, CareFirst BlueCross BlueShield, sold us exactly the type of flawed policy—riddled with holes and exceptions—that the health care reform bills in Congress should try to do away with. The “maternity” coverage we purchased didn’t cover my labor, delivery, or hospital stay. It was a sham."..."The individual insurance market is like that old joke about the food being terrible and the portions too small; it’s expensive, shoddy, and deeply unsatisfying. Those of us who buy into it are not protected by the federal and state laws that govern employer-based health care. In fact, there’s no one looking out for us at all."
The Politics of Healthcare (Claire Topal, an interview with Tadataka "Tachi" Yamada, of Takeda Pharmaceuticals, formerly of Gates Foundation, for National Bureau of Asian Research, 9-23-13). " The Affordable Care Act in the United States is meant to provide extended basic healthcare to millions of people, but it still uses a system of fee for service. So as you increase the number of people accessing healthcare, you are actually increasing the costs of healthcare, collectively as a nation, unless each episode of healthcare is somehow reduced in cost. " Read this for insight into how in the U.S. we are locked into an inefficient system of care. As co-pay increases and we pay more directly for our medical care, there will be a demand for change. "[S]ome countries are thinking in a very different way about how to deliver care to the masses . . .the most cost-effective solutions often come out of poorer countries that are not locked into an orthodoxy of past-practices."
Health Care In Transition: Fee For Service Vs. Pay For Performance (listen to Kojo Nnandi show, WAMU-FM, or read transcript, 6-4-13) Many health innovators and reformers believe the current "fee for service" system, which rewards doctors and hospitals based on volume, is outdated and unsustainable. Instead, they are experimenting with new "pay for performance" models with a focus on preventive care, coordination between doctors and ways to lower readmission rates. Kojo explores how hospital systems and providers are adapting to the changing health care environment. Guests Bob Kocher and Toby Cosgrove.
Are Price Controls the Answer? (Martin Gaynor, Compassionate Economics, 2-24-13). A few observations about the effects of rate-setting.
Healthcare and the profit motive—do they work well together? Columbia Journalism Review on Eduardo Porter's article Health Care and Profits, a Poor Mix (NY Times, Business, 1-8-13)
The Cost Conundrum: What a Texas town can teach us about health care (Atul Gawande, New Yorker, 6-1-09). Overuse of medical care (over-testing, over-medicating, often performing unnecessary procedures)--both to avoid lawsuits and to increase the bottom line--are increasing costs without improving outcomes.
As medical providers consolidate, questions about effects on costs, quality of care (Phil Galewitz, Washington Post 4-18-14) “Consolidation has not been an effective way of reducing costs or providing more effective care,” [Zelda Geyer-Sylvia] said. “People here have all the best intentions, but once you eliminate competition it’s gone.”
Letting Go Abraham Verghese's review of Katy Butler's book, Knocking on Heaven's Door: The Path to a Better Way of Death . "Although most of us claim no desire to die with a tube down our throat and on a ventilator, the fact is, as Katy Butler reminds us in Knocking on Heaven's Door: The Path to a Better Way of Death, a fifth of American deaths now take place in intensive care, where 10 days of futile flailing can cost as much as $323,000, as it did for one California man." ... "Much of what ails health care, as Butler discovers, revolves around reimbursement issues. Doctors are paid to do things to people, not for people." "My hope is that this book might goad the public into pressuring their elected representatives to further transform health care from its present crisis-driven, reimbursement-driven model to one that truly cares for the patient and the family."
Resource Links on Health Reform (Association of Health Care Journalists)
Post Supreme-Court Health-Care Decision Symposium (SCOTUS BLOG, varying opinions on what happened and what it may mean --between them, you get some sense of what the issues are and were and what Justice John Roberts' swing vote was about )
Health Care and the Court: Who Won? (Clive Crook, The Atlantic, 7-4-12)., You must read this.
Excluded Voices. Trudy Lieberman's penetrating series of interviews on health care reform, in Columbia Journalism Review. Start with her interview with Wendell Potter, who "didn’t want to be part of another health insurance industry effort to shape reform that would benefit the industry at the expense of the public." You can also listen to Bill Moyers interview Potter or read the transcript and Potter's testimony before Congress.
C-Span's programs on health care a good place to find various town hall discussions, hearings, wonderful links. C-Span, you're wonderful!
DrSteveB's blogroll (helpful Daily Kos blogger--and check his blogroll for other resources)
Expert Interviews from CEO's of America's Healthiest Companies, wellness experts, and business leaders (Wellness Council of America, or WELCOA) Several free reports available after one-time registration.
Consumer-directed health plans: Do they deliver? (PDF of report brief, M. Kate Bundorf, The Synthesis Project. Robert Woods Johnson Foundation)
Cost-sharing: Effects on spending and outcomes (PDF of report brief, Katherine Swartz, The Synthesis Project, Robert Woods Johnson Foundation)
Health Affairs (excellent issues on health care reform, in this important policy journal about health care)
Health Reform Source *Kaiser Family Foundation (many excellent resources, including The States (a state-by-state view of health care reform implementation and news--click on a state for state-specific information)
Medical Progress, Social Progress, and Legal Regression (Andrew Solomon, New Yorker, 4-13-13). If we want people to stop terminating pregnancies, we might start by providing better services for people with disabilities; our neglect of decent care is a national disgrace. Solomon has written a wonderful book about how people with disabilities benefit from peer groups with those disabilities (except for individuals with schizophrenia): Far From the Tree: Parents, Children and the Search for Identity . He writes about families coping with deafness, dwarfism, Down syndrome, autism, schizophrenia, or multiple severe disabilities; with children who are prodigies, who are conceived in rape, who become criminals, who are transgender.
What ‘Dallas Buyers Club’ got wrong about the AIDS crisis (Dylan Matthews, Washington Post, 12-10/​13). The movie isn't the "story of a man who got the treatment he needed despite a government that tried to stop him. It's about a man who tried whatever he could in hopes of extending his life as long as possible, and in the process often rejected helpful treatments and embraced harmful ones."
Dallas Buyers Club-inspired “right to try” laws: Good movies don’t make good policy (Orac, Science Blogs, 3-6-14) Analysis of Right to Try laws.
Income, Poverty, and Health Insurance Coverage in the United States: 2012 (by Carmen DeNavas-Walt, Bernadette D. Proctor, Jessica C. Smith, released September 2013 by U.S. Census Bureau, P60-245). 88-page PDF. Real median household income and the poverty rate were not statistically different from the previous year, but the percentage of people without health insurance coverage decreased. Some additional links to census data:
---Income data
---Poverty data
---Health insurance data
---Current Population Survey (CPS) table creator (gives you the ability to create customized tables from the Current Population Survey's Annual Social and Economic Supplement)
Employers Must Offer Family Care, Affordable or Not (Robert Pear, Health, NY Times, 12-31-12)
[Back to Top]









Godwin's Law: ""As a Usenet discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches"
~ Mike Godwin, creator of Godwin's Rule of Nazi Analogies, fearing glib use of the term will dilute the meaning of "Never Again"

[Go Top]

The Affordable Care Act (ACA)
(often called Obamacare, originally by its opponents)


On March 23, 2010, President Obama signed comprehensive health reform, the Patient Protection and Affordable Care Act, into law. The eight basic consumer protections the Obama White House wants health care reform to cover:
(1) No discrimination for pre-existing conditions,
(2) No exorbitant out-of-pocket expenses, deductibles or co-pays,
(3) No cost-sharing for preventive care,
(4) No dropping of coverage if you become seriously ill,
(5) No gender discrimination,
(6) No annual or lifetime caps on coverage,
(7) Extended coverage for young adults,
(8) Guaranteed insurance renewal so long as premiums are paid.
For more about the White House plans for health care, see
http:/​/​www.whitehouse.gov/​healthreform .

Various sites, articles, judicial arguments (etc.) of interest:
Summary of the Affordable Care Act (Kaiser Family Foundation). Many other ACA-related resources here, too.
Affordable Care Act (Commonwealth Fund). Many more ACA-related resources.
Wrong Prescription? (Trudy Lieberman, Harper's, July 2015) The failed promise of the Affordable Care Act. "The A.C.A. was sold to the public on the pledge of “affordable, quality health care....The A.C.A.’s greatest legacy may finally be the fulfillment of a conservative vision laid out three decades ago, which sought to transform American health care into a market-driven system. The idea was to turn patients into shoppers, who would naturally look for the best deal on care — while shifting much of the cost onto those very consumers. In other words, Rooney and his G.O.P. allies (with, it should be said, Democratic acquiescence) moved American health insurance in a direction contrary to that taken by most every other nation in the developed world. It is also contrary to the needs of those unlucky enough to get sick."
Dead Man Walking (Michael Stillman and Monalisa Tailor, New England Journal of Medicine 2013) 'Mr. Davis had had an inkling that something was awry, but he'd been unable to pay for an evaluation. As his wife sobbed next to him in our examination room, he recounted his months of weight loss, the unbearable pain of his bowel movements, and his gnawing suspicion that he had cancer. “If we'd found it sooner,” he contended, “it would have made a difference. But now I'm just a dead man walking.”'
Equitable Access to Care — How the United States Ranks Internationally (Karen Davis and Jeromie Ballreich, NEJM, 10-23-14) "The United States has been unusual among industrialized countries in lacking universal health coverage. Financial barriers to care — particularly for uninsured and low-income people — have also been notably higher in the United States than in other high-income countries. As more Americans become insured as a result of the Affordable Care Act (ACA), differences in access to care between the United States and other countries — as well as among income groups within the United States — may begin to narrow."
Mississippi, Burned (Sarah Varney, Political magazine, Nov./​Dec. 2014). " In Mississippi, America’s most down-and-out state, a full 20 percent of the population doesn’t graduate from high school, 22 percent lives in poverty—and even more than that, a quarter of the state, goes without health care coverage. In a state stricken by diabetes, heart disease, obesity and the highest mortality rate in the nation, President Barack Obama’s landmark health care law has barely registered, leaving the country’s poorest and most segregated state trapped in a severe and intractable health care crisis. ...Why has the law been such a flop in a state that had so much to gain from it? ...bumbling errors and misinformation; ignorance and disorganization; a haunting racial divide; and, above all, the unyielding ideological imperative of conservative politics."
Landmark: The Inside Story of America's New Health-Care Law—The Affordable Care Act—and What It Means for Us All (Public Affairs Reports, staff of Washington Post)
Health Insurance Marketplace Calculator (Subsidy Calculator) (Kaiser Family Foundation) provides estimates of health insurance premiums and subsidies for people purchasing insurance on their own in health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA). With this calculator, you can enter your income, age, and family size to estimate your eligibility for subsidies and how much you could spend on health insurance. You can also use this tool to estimate your eligibility for Medicaid. Here's an explanation of how it works (KFF)
Deciphering The Health Law’s Subsidies For Premiums (Julie Appleby, Kaiser Health News, 7-24-13)
• The Kaiser Family Foundation's summary of the law (pdf), and of changes made to the law by subsequent legislation, focuses on provisions to expand coverage, control health care costs, and improve health care delivery system. Kaiser also posts the implementation timeline for health reform , an interactive tool designed to explain how and when the provisions of the Affordable Care Act will be implemented over the next several years.
Frequently Asked Questions about Health Reform (Kaiser Family Foundation)
HHS basic information on the coming health insurance marketplaces.
HHS interactive state-by-state map.
Obamacare’s Secret Success (Paul Krugman, NY Times Opinion page, 11-28-13) The law establishing Obamacare was officially titled the Patient Protection and Affordable Care Act. And the “affordable” bit wasn’t just about subsidizing premiums; t was also about “bending the curve” — slowing the seemingly inexorable rise in health costs. Follow the bending cost curve and you will find that the slowdown in health costs has been dramatic.
Obama's Deal, long, fascinating transcript of Frontline special on the deal-making that went into health care reform. You can also Watch the Frontline program. "Those deals can be pretty smelly."
Why Republicans can't come up with an Obamacare replacement (Ezra Klein, Vox, 1-16-15) Making "sure poor people have health insurance is politically popular, at least in the abstract. But the plans that achieve it tend to be in tension with both broad tenets of conservatism — it raises taxes, it redistributes wealth, and it grows the government — and with key factions of the conservative coalition....It is ironic that the law Republicans loathe most is actually based on ideas they developed, and that their most recent presidential nominee actually implemented."
Supreme Court Case May Be A Wake-Up Call For Republicans (Julie Rovner, KHN, 2-23-15) About Obamacare: "“Republicans are united around repeal. And they’re united around replace. But obviously they’re not united around ‘replace with what...’”
Obamacare: The Rest of the Story (Bill Keller, Opinion Page, NY Times, 10-13-13) "You realize those computer failures that have hampered sign-ups in the early days — to the smug delight of the critics — confirm that there is enormous popular demand. You have probably figured out that the real mission of the Republican extortionists and their big-money backers was to scuttle the law before most Americans recognized it as a godsend and rendered it politically untouchable. What you may not know is that the Affordable Care Act is also beginning, with little fanfare, to accomplish its second great goal: to promote reforms to our overpriced, underperforming health care system. " An interesting account of "accountable care organizations" (ACOs), which are springing up all around the country.
Medicaid Expansion in Red States (Drew Altman, WSJ's Think Tank, 12-18-14) "In the struggle between pragmatism and ideology over Medicaid expansion in red states, pragmatism may slowly be winning."
Majority Favors the Affordable Care Act’s Employer Mandate, But Opinion Can Shift When Presented With Pros and Cons (Kaiser Family Foundation, 12-18-14) Recent news stories on the health law did not attract most Americans’ attention, and many are unaware of details and implications of the developments
Three Words and the Future of the Affordable Care Act (PDF, Nicholas Bagley, draft accepted for publication in Journal of Health Politics, Policy and Law, 2014, open access)
Medicine’s Top Earners Are Not the M.D.s (Elisabeth Rosenthal, Sunday Review, NY Times 5-12-14) The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries. (There are more doctors than administrators, so she's talking about individual, not total, salaries for a group.)
Feds Target Health Law Loophole That Allows Large Employers To Offer Plans That Don’t Cover Hospitalization (Kaiser Health News, 11-4-14) The administration intends to disallow plans that “fail to provide substantial coverage for in-patient hospitalization services or for physician services,
Medical Loss Ratio (MLR) Information "The medical loss ratio is a calculation that divides the total dollars a plan spends on health care by the total dollars a plan receives in premiums. The result is the medical loss ratio or MLR." The ACA requires that health insurers "spend specific target amounts of the premiums they receive on payments for the health care members utilize, as well as for projects that improve the quality of care members receive. When insurance companies spend less than those target amounts, the Affordable Care Act requires that those companies refund the difference between the amount that was spent and the specific target amount."
A death blow for Obamacare? (Laurence H. Tribe, Boston Globe, 7-18-14) "The moment the Affordable Care Act was enacted in 2010, it became a litigation magnet. The lawsuits threatening to derail it were initially dismissed as ridiculous but became deadly serious by the time Chief Justice John Roberts’s decisive fifth vote two years later barely upheld the law’s individual mandate, while the Court’s decisive 7-2 vote left the health law’s Medicaid expansion in tatters. Last month, the court struck a second blow to the ACA by allowing some for-profit corporations to opt out of offering contraceptive coverage they deemed religiously offensive. And even House Speaker John Boehner is joining in the litigation..."
The Piecemeal Assault on Health Care(NY Times editorial, 11-22-14) "Now that they will dominate both houses of Congress, Republicans are planning to dismantle the Affordable Care Act piece by piece instead of trying to repeal it entirely....All of the provisions they are targeting should be retained — they were put in the reform law for good reasons."
Hospitals and health law (Opinion, NY Times, 12-7-14) "The American people aren’t the only ones who will suffer from the systematic dismantling of the Affordable Care Act. It’s also bad news for America’s hospitals."
Another Baseless Attack on Health Law (NY Times editorial, 12-12-14) A suit filed by the "Republican-dominated House aims to block another important subsidy: federal payments to insurance companies to keep deductibles, co-payments and other cost-sharing low for the poor. ... If the federal government cannot assist, a lot of other individual policyholders may have to pay more."

A closer look: Did the ACA result in more canceled plans? (Joanne Kenen, Covering Health, AHCJ, 4-29-14)
Warren: It's too soon to call Obamacare — or Obama — a failure (James Warren, Daily News, 12-1-13) There was a lot of melodrama over Saturday's 'sort-of deadline' for repairing HealthCare.gov. Though Obama's approval ratings are tanking and the Obamacare website had early missteps, the President and his health care plan shouldn't be written off so quickly.
Safety Leaders. Actor Dennis Quaid's family is joining forces with the Texas Medical Institute of Technology (TMIT) to raise public awareness about our broken medical system, to eliminate human error, and to make caregivers aware that patients have the right to know all information that could have an impact on their health and well-being, with major focus on increasing awareness of the dangers of medication errors. See also Preventable Medical Malpractice: Revisiting the Dennis Quaid Medication/​Hospital Error Case (Rick Schapiro, The Legal Examiner 8-9-10).
Bringing local, national perspectives to report on ACA in rural Kentucky (Joanne Kenen, Covering Health, AHCJ, 6-17-14)
The AP downplays its Obamacare scoop (Trudy Lieberman, Columbia Journalism Review 4-11-14). AP calls "minor' a change in legislation that shifts costs to consumers by raising deductibles.
Preventive Services Covered by Private Health Plans under the Affordable Care Act (Kaiser Foundation 10-28-14) A key provision of the ACA is the requirement that private insurance plans cover recommended preventive services without any patient cost-sharing. Full discussion.
The Great Cost Shift comes into focus (Trudy Lieberman, CJR, 12-24-14). "Consumers, even consumers who have insurance, are paying a larger share of their healthcare costs. This shift has been in the works for years, but provisions in the ACA have made it more visible."
Rooting for Failure (Timothy Egan, NY Times Opinion page, 11-28-13) It's hard to remember a time when a major political party and its media arm were so actively hoping for fellow Americans to lose. Tim Egan's unvarnished take on the shamelessness of the anti-Obamacare creed.
Challenges For The New Health Insurance Exchanges (transcript for Diane Rehm show, with guests Susan Dentzer of The Robert Wood Johnson Foundation, Louise Radnofsky of The Wall Street Journal, Jon Kingsdale of the Wakely Consulting Group, who led the agency that implemented the Massachusetts health insurance exchange, and David Simas, speaking from the White House, 10-16-13).
Special Investigation: How Insurers Are Hiding Obamacare Benefits from Customers (Dylan Scott, Talking Points Memo, 11-4-13). "By warning customers that their health insurance plans are being canceled as a result of Obamacare and urging them to secure new insurance plans before the Obamacare launched on Oct. 1, these insurers put their customers at risk of enrolling in plans that were not as good or as affordable as what they could buy on the marketplaces."
Middle class families wary of higher premiums Carla K. Johnson, AP story in Portland Press Herald, 9-13-13). "The new Affordable Care Act health exchanges won't offer any bargains for higher-income families, who fear that their current health insurance policies may get more expensive under the new law's requirements. As many as nine in 10 Texans buying health insurance on the new federally run exchange will get a break on costs, according to federal health officials. Steve and Maegan Wolf won't be among them."
Medical Device Industry Fears Health Care Law’s Tax on Sales (Barry Meier, Tracking the Affordable Care Act, NY Times, 10-1-13)
Questionable design blamed for healthcare website woes (Carla K. Johnson and Ricardo Alonso-Zaldivar, AP, 10-8-13)
A decision by the Obama administration to require that consumers create online accounts before they can browse health overhaul insurance plans appears to have led to many of the glitches that have frustrated customers, independent experts say.
How Obamacare’s medical device tax became a top repeal target (Sarah Kliff, Wonkblog, WashPost, 9-28-13). See also:
In Need of a New Hip, but Priced Out of the U.S. (Elisabeth Rosenthal, NY Times, 8-3-13) Paying Till It Hurts: A Trip Abroad. Part of an excellent series on what's wrong with American health care.
How can I get an estimate of costs and savings on Marketplace health insurance? (Healthcare.gov)
Kaiser Family Foundation information site on the Affordable Care Act (extremely helpful)
LocalHelp.HealthCare.gov (for state-specific information)
ACA-Mandated Insurance Quick Tips (Bob Rosenblatt, Aging Today) /ib_marketplace_premiums.cfm"target="_blank">Health Insurance Marketplace Premiums for 2014 (HHS, Assistant Secretary of Planning and Evaluation)
The Affordable Care Act Will Work (Sen. Jay Rockefeller, Reader Supported News, 10-3-13)
Where Poor and Uninsured Americans Live (interactive map, NY Times, 10-2-13). The 26 Republican-dominated states not participating in an expansion of Medicaid are home to a disproportionate share of the nation’s poorest uninsured residents. Eight million will be stranded without insurance.
Little Evidence Obamacare Is Costing Full-Time Jobs (Kaiser Health News' Daily Report, 10-23-13) Roundup of stories from WSJ, NYTimes, Reuters, Wash Post, Politico and others.
States Are Focus of Effort to Foil Health Care Law (Sheryl Gay Stolberg, NY Times, Politics, 10-18-13) In Virginia, conservative activists are pursuing a hardball campaign as they chart an alternative path to undoing “Obamacare” — through the states.
New York State of Health: The Official Health Place
Covered California, the new marketplace for affordable private health insurance
Millions of Poor Are Left Uncovered by Health Law ( Sabrina Tavernise and Robert Gebeloff, NY Times, 10-2-13)
A Nevada Health Plan -- Without The Insurance (Pauline Bartolone, Kaiser Health News, Capital Public Radio, NPR, 9-14-13) An unusual Nevada nonprofit that helps connect 12,000 uninsured residents to doctors and hospitals who are willing to accept a lower-cost, negotiated fee for their services. Giving care to the uninsured before they require urgent care helps lower costs by keeping their members out of the ER.
Health Reform D-Day? Or not for a few more months? (Joanne Kenen, Covering Health, AHCJ, 10-1-13). See also Tracking exchange activity.
Shutdown Din Obscures Health Exchange Flaws (Robert Pear, NY Times, 10-4-13)
What's in a name? Lots when it comes to Obamacare/​ACA (Steve Leisman, CNBC, 9-26-13) In CNBC's third-quarter All-America Economic Survey, we asked half of the 812 poll respondents if they support Obamacare and the other half if they support the Affordable Care Act. And 30% of those polled don't know what ACA is, vs. only 12% when asked about Obamacare; 29% support Obamacare compared with 22% who support ACA; and 46% oppose Obamacare and 37% oppose ACA. "So putting Obama in the name raises the positives and the negatives." Republicans coined the term Obamacare as a pejorative, but not everyone perceives it that way.
A British Woman Spent Three Days in a U.S. Hospital. Here's What She Learned About Obamacare. (Eleanor Margolis, New Republic, 10-18-13. First appeared in New Statesman) "I begin to wonder how the Republicans have managed to convince even those in the very midst of a system that punishes the poor, that the slightest implementation of state-funded healthcare is an evil, communist conspiracy. ...As a foreigner with travel insurance, I’m lucky enough to observe American healthcare from a safe distance. But to someone fully enmeshed, like Carmen, Obamacare is a tiny drop in the murkiest of quagmires."
Health Care Reform: What It Is, Why It's Necessary, How It Works by Jonathan Gruber (clear explanations in graphic novel format of the Affordable Care Act, by an MIT economist, and one of the architects of both RomneyCare and ObamaCare). Here's YouTube version, in short.
C-Span is a good place to find various town hall discussions, hearings, wonderful links. For example: Supreme Court Determining the Constitutionality of Health Care Act and Supreme Court Hears Argument on Individual Mandate Provision
Understanding the Right’s Obamacare Obsession (Joshua Holland, What Matters Today, Moyers.com, 9-2-13) Excellent overview.
Church Insurance Improvements To Obamacare Threatened By Partisan Fighting (Sarah Pulliam Bailey, Religion News Service, 8-9-13)
The Republican party's 'defund Obamacare' disorder (Michael Cohen, The Guardian, 8-25-13) In denial of political reality thanks to its Tea Party fringe, the GOP is revving up for a debt ceiling showdown it can only lose.
How the ObamaCare defunding fight became a political showdown (Sam Baker, HealthWatch, 8-29-13)
Ten Titles: Understanding the Affordable Care Act (pdf, John McDonough, Hunter College, October 2010)

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Do you trust your doctor? Can you?

What doctors can do to regain the trust of their patients
and what patients can do in their own interests

How to Fight Fear and Restore Trust in Medicine (Leana Wen, MD, Huff Post, 10-17-13). "With my disclosure, I am holding myself publicly accountable to my patients. I am saying that I don't have anything to hide from you. I know you are vulnerable, but I'll be vulnerable with you. This is a partnership. We're in this together."
Patient Advocacy in Patient Safety: Have Things Changed? (Helen Haskell, Perspective, June 2014, AHRQ, Agency for Healthcare Research and Quality). An important historical overview of patient safety efforts.
When More Medicine Isn't Better (Leana Wen, HuffPost, 8-11-13) "More tests and better technologies are not the solution to improving clinical care. Patients: Insist on being an equal and active partner in your care. Ask "why" and "how." Why is this test ordered? How will this test change my management? Make sure you know your diagnosis. Assure your doctor that it's OK if she is not 100 percent sure; you don't demand certainty, but you do expect transparency."
(Sabrina Rubin Erdely, Self, 5-22-07) PDF version. Certain laws give physicians and hospitals the right to refuse women's requests for the best care, even in emergencies. In medical offices and hospitals around the country: Catholic and conservative Christian health care providers are denying women a range of standard, legal medical care, allowing their religious beliefs to compromise patient care.
Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care by Marty Makary
Dollars for Docs: How Industry Dollars Reach Your Doctors (Jeremy B. Merrill, Charles Ornstein, Tracy Weber, Sisi Wei and Dan Nguyen, ProPublica updated 6-24-13)
The Right Care Alliance (Lown Institute). A major new initiative of the Lown Institute that is designed to change the culture of American medicine from “more is better” to the right care for the right patient.
Who's My Doctor? The total transparency manifesto
Why Is It Important for a Doctor to Be Board Certified? (Trisha Torrey, About.com)
How Doctors Think by Jerome Groopman
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Complementary and Alternative Medicine (CAM) and Treatments


Health Law Boosts Status Of Alternative Medicine -- At Least On Paper (Ankita Rao, Kaiser Health News, 7-26-13)
Academic Consortium for Complementary and Alternative Health Care (ACCAHC, a vehicle for shifting medicine toward a system which focuses on health)
Natural Disaster (James Pitkin, Willamette Week, 5-30-07). Out-of-court settlement resolves what's believed to be Oregon's first naturopath-caused death--through chelation therapy, "in which amino acids are administered intravenously to suck metals out of the blood....chelation also withdraws metals the body needs, including calcium, which can lead to heart failure."
Human Body Microbes Make Antibiotics, Study Finds (National Center for Complementary and Alternative Medicine, or NCCAM, 9-11-14)
Cochrane Summaries Cochrane has a sterling reputation for evaluating the evidence of health care studies, including CAM studies.
Death by Natural Causes (Nina Shapiro, Seattle News, 10-9-06). The circumstances of a teenager's medical emergency are in dispute. But her case raises important questions about the line between increasingly popular naturopathic health care (in this case for asthma) and standard medical treatment. See also Naturopathic, Negligence Asthma, Wrongful Death (Perey Law Group. Result: $400,000). Thanks to Norman Bauman for these citations.
But where is the evidence? (Platelet Disorder Support Association). That's the question many physicians ask when patients mention complementary and alternative medicine (CAM) It is the very question PDSA's medical advisors asked. Unless the treatment has a large profit potential, a placebo-controlled, phase III trial or even a smaller trial is prohibitive for many wanting to study complementary treatments. (And by the way, the negative results from Big Pharm studies rarely get published.)
Location bias in controlled clinical trials of complementary/​alternative therapies. (Pittler MH et al. Journal of Clinical Epidemiology. May 2000, Volume 53, Issue 5, Pages 485-489)
"Black Hole" of Medical Research--Negative Results Don't Get Published (VH Sharav, JAMA, WSJ Alliance for Human Research Protection. June 5, 2004)
Impact Factor (Wikipedia)

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The anatomy of medical error


by Pat McNees
This piece has migrated. Click on

The anatomy of medical error
with links to stories about
Medical Errors as Third Greatest Cause of Death in U.S.


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Reducing Medical Errors

(Institute of Medicine report)

In 1999 the Institute of Medicine published its report, To Err Is Human:Building a Safer Health System, which presented a strategy by which government, health care providers, industry, and consumers could reduce preventable medical errors. This report led to several others, which an educated consumer could use as a checklist on how not to be the victim of hospital-caused medical problems (above all, make sure whoever does a procedure on you washes their hands first).

In February 2000, the Quality Interagency Coordination Task Force (QuIC) issued a report, Doing What Counts for Patient Safety: Federal Action to Reduce Medical Errors and Their Impact, listing more than 100 activities needed to:
1. Create a national focus on reducing errors.
2. Develop a knowledge base for learning about errors' causes and effective error prevention.
3. Ensure accountability for safe health care delivery.
4. Guarantee that patient safety practices are implemented.

The Institute for Healthcare Improvement (IHI) announced the 100k lives Campaign, through which healthcare organizations, by implementing one or more of six specific evidence-based practices, could join a campaign to potentially prevent 100,000 avoidable deaths. Six interventional measures were identified as crucial to improving patient safety:
* Deploying rapid response teams at the first sign of patient decline.
* Delivering reliable, evidence-based care for acute myocardial infarction (AMI) to prevent deaths from heart attack (for example, give patient an aspirin).
* Preventing adverse drug events (ADE) by implementing medication reconciliation.
* Preventing central line infections by implementing a series of scientifically grounded interdependent interventions.
* Preventing surgical site infections by reliably delivering appropriate antibiotics and other specific steps.
* Preventing ventilator-associated pneumonia by implementing a series of scientifically grounded interdependent interventions.

To this it added new interventions targeted at harm
* Prevent harm from high-alert medications... starting with a focus on anticoagulants, sedatives, narcotics, and insulin
* Reduce surgical complications... by reliably implementing all of the changes in care recommended by SCIP, the Surgical Care Improvement Project (www.medqic.org/​scip)
* Prevent pressure ulcers... by reliably using science-based guidelines for their prevention
* Reduce methicillin-resistant Staphylococcus ureus (MRSA) infection…by reliably implementing scientifically proven infection control practices
* Deliver reliable, evidence-based care for congestive heart failure... to avoid readmissions
* Get Boards on board … by defining and spreading the best-known leveraged processes for hospital Boards of Directors, so that they can become far more effective in accelerating organizational progress toward safe care

Following are links to websites and reports that deal with improving patient safety and hospital staff performance. A quick look at these lists will give you a checklist of things to watch for when you or a loved one checks into a hospital. For one thing, you'll make sure healthcare providers wash their hands between patients and activities!
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More stories about medical error and quality control



Medical Errors Are No. 3 Cause Of U.S Deaths, Researchers Say (Marshall Allen, Olga Pierce, Shots, Health News from NPR, with Pro Publica, 5-3-16). Medical errors rank behind heart disease and cancer as the third leading cause of death in the U.S., Johns Hopkins researchers say. Their study "highlights how shortcomings in tracking vital statistics may hinder research and keep the problem out of the public eye....Medical mistakes that can lead to death range from surgical complications that go unrecognized to mix-ups with the doses or types of medications patients receive....no one knows the exact toll taken by medical errors. [partly] because the coding system used by CDC to record death certificate data doesn't capture things like communication breakdowns, diagnostic errors and poor judgment that cost lives, the study says."



To Err Is Human: Building a Safer Health System (.pdf, Institute of Medicine report, 1999, which emphasizes errors that are “preventable" and lists many types of errors, from medication mistakes to hospital-acquired infections. It warns that the nation is experiencing an “epidemic of medical errors.”
MU leads national initiative to foster a new culture of health care teamwork (Jodie Jackson Jr., Columbia Daily Tribune, 1-20-13). More than a decade after publication of To Err Is Human, the University of Missouri School of Medicine and MU Sinclair School of Nursing are at the forefront the Retooling for Quality and Safety Initiative, a project of the IHI and Josiah Macy Jr. Foundation that could transform health care by changing the way medical and other health care professionals are trained. The aim is to improve quality and safety by developing a team-teaching curriculum for medical, nursing, pharmacy and other health professions students. The schools are introducing “interprofessional learning” as a teaching model — part of a grant-funded initiative sponsored by the IHI Open School at the Institute of Healthcare Improvement.
Reducing and Preventing Adverse Drug Events To Decrease Hospital Costs (Agency for Healthcare Research and Quality, AHRQ)
Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors and Their Impact (Agency for Healthcare Research and Quality, AHRQ)
National Patient Safety Goals Now Available (The Joint Commission)
National Quality Measures Clearinghouse (Agency for Healthcare Research and Quality, AHRQ) A public resource for evidence-based quality measures and measure sets. NQMC also hosts the HHS Measure Inventory.
Teaching Hospitals How to Listen (Susan Okie, Washington Post, 12-12-06)
When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests by Leana Wen and Joshua Kosowsky
CMS Partnership for Patients . Sponsored by the US federal government's Centers for Medicare & Medicaid Services (CMS), the Partnership for Patients initiative aims to make hospital care safer, more reliable, and less costly. The Partnership for Patients has identified ten core patient safety areas of focus. Hosted on site of the Institute for Healthcare Improvement (IHI)
When Good Enough Isn’t…. Good Enough: The Case for Reliability (Institute for Healthcare Improvement, 8-3-11)
The Surgical Care Improvement Project (The Joint Commission)
Specifications Manual for National Hospital Inpatient Quality Measures (The Joint Commission)
ANCC Magnet Recognition Program® (American Nurses Credentialing Center). The Magnet Recognition Program® recognizes healthcare organizations for quality patient care, nursing excellence and innovations in professional nursing practice.

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Books, articles, and more

Writing or telling life stories
Everyone has a story to tell. What's keeping you from telling yours? Become a storykeeper or personal historian or find one.
A loving testament, or legacy letter, sharing your life experiences and lessons with the next generation
Learn to write articles, reports, ethical wills, or life stories (memoirs and beyond).
Mom — hardworking, sassy, and full of surprises
Mutual support and discussion
Social history through the life of an ordinary Midwestern businessman.
Dancing, food, good books, and other diversions
Favorites of several book groups
What is the single lunch-bag item most hated by all children?
What heightens the caviar experience is the price of those little gray or black sturgeon eggs.
Links to dancing venues and calendars for the Washington, D.C. area.
Midlife "first dates"
Did she fall in love with the man or the waltz?
Also related: jive, hustle, hand-dancing.
All the dancing your feet can take
Choosing a school of dance
Contra, English country, international, Irish, Israeli, Scandinavian, Scottish
The big ones, with dirty stems
"A rich, varied, and highly rewarding collection," says Joyce Carol Oates
Ceilis (Irish dancing)
Medical mysteries, patient stories, and practical links
John Travolta played the boy in the movie. The real story ended far differently.
Thin little Marian had a cholesterol problem most people have never heard of.
You've probably never heard of this national research hospital and clinic. But someone you know may be able to benefit from it directly and all of us do, indirectly.
Understanding the Affordable Care Act (ACA) and the debate on health care reform. Avoiding medical errors
Dying, mourning, and other inevitable events
"This remarkable collection, coming from personal experience and wide reading, will help many find the potential of growth through loss." --Dame Cicely Saunders, founder of the hospice movement
For those dying, for caregivers, and for the bereaved
Listen to samples of popular songs and music
Girls and science
Cool science sites
Best practices for teaching science--to strengthen the science workforce.
Some links and a selection
Practical matters
Identify children's learning styles and improve their ability to learn.
Six weeks to hassle-free homework.
Why parents should be concerned.
Public speaking is a craft, not an art. It can be learned.
Can you wash it if it says "dry clean"?
Fact vs. fantasy
One woman's story.
Don't focus on the fabric.
Organizational histories
A frank history of the Young Presidents' Organization.
The little lift truck that could — a story of brilliant marketing in America's heartland.
Online Shopping
Best places to shop online