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Do doctors really hate Obamacare?

Do doctors really hate Obamacare? | Healthcare and Technology news | Scoop.it

Anti-Obamacare critics often claim that “every” physician they know hates Obamacare. For instance, pediatric neurosurgeon and GOP Presidential candidate Dr. Ben Carsontold Fox News that “he’s spoken to hundreds of doctors throughout the country about the Affordable Care Act, and not one of them ‘liked’ President Barack Obama’s signature health care law.”

Doctors hate Obamacare, it’s alleged, because it authorizes government to “control” the practice of medicine and impose “rationing” of care, thereby harming patients.  The conservative Examiner website quotes a New Jersey family physician, Dr. John Tedeschi as saying, “Just as a guitar string has to be tuned, so does a person’s health to get the right tone. The government has taken away, or refocused the intelligence part of the tuning, and has just about destroyed the creative, or compassion component. Now, with Obamacare, we are left with an incompetent mechanism that does not have the best interest of the patient in mind.”  An ER physician quoted in the articles said that the “storm of patients [created by Obamacare] means when they can’t get in to see a primary care physician, even more people will end up with me in the emergency room.”

There is no question that some doctors (mainly conservatives) hate Obamacare, and if they were the only ones you talked to (like the ones who apparently talked to Dr. Carson), you might think that all doctors feel the same way. But the reality is that — surprise, surprise! — primary care physicians’ views are just like the rest of us, split by their partisan leanings.


A new survey by the respected Kaiser Family Foundation found that 87 percent of Democratic-leaning physicians view Obamacare favorably, while the exact same percentage of GOP-leaning physicians view it unfavorably. Independent doctors split 58 percent unfavorable to 42 percent favorable.  Because there were more GOP and independent physicians among the survey respondents, the overall breakdown of primary care physicians’ views on the ACA is  52 percent unfavorable to 48 percent favorable.  Yet only 26 percent of all primary care physicians viewed the law “very unfavorably. “  So it might be said that just one out of four primary care physicians “hate” Obamacare.

And a deeper dive into the survey results directly refutes the contention of anti-Obamacare doctors that the law is leading to poorer quality, physicians turning away patients, or longer waits for appointments:


  • Most primary care physicians say that quality has stayed the same: 59 percent said that their ability to provide high-quality care to their patients has stayed about the same, while 20 percent said it has improved, and 20 percent said it has gotten worse.
  • More primary care physicians report that Medicaid expansion has had a more positive impact on quality than a negative one: “When asked more specifically about the expansion of Medicaid under the ACA, nearly four of 10 providers (36 percent of physicians and 39 percent of nurse practitioners and physician assistants) said the expansion has had a positive impact on providers’ ability to provide quality care to their patients. About two of 10 said it has had a negative impact, and the remainder said it has not made a difference, or they are not sure.”
  • Ease of getting same-day appointments is about the same as before the ACA: “Overall, about four of 10 primary care providers said almost all their patients who request a same- or next-day appointment can get one; another quarter said most of their patients can get such appointments” which is largely unchanged from 2009 and 2012.
  • Most continue to accept new patients: “A large majority of primary care providers (83 percent of physicians, 93 percent of midlevel clinicians) said they are currently accepting new patients . . . A survey conducted in late 2011 through early 2012 found that 89 percent of primary care physicians were accepting new patients and 52 percent were accepting new Medicaid patients.  This indicates that while physicians’ rates of accepting new patients overall may have declined slightly since the ACA coverage expansions went into effect, acceptance rates for Medicaid have remained about the same.”


When asked specifically about their views on the impact of the Affordable Care Act on five dimensions, the ACA fared well, with one exception (costs to patients).


  • Access to health care and insurance in the country overall: 48 percent positive, 12 percent no impact,  24 percent negative, and 14 percent not sure.
  • Overall impact on practice: 31 percent reported no impact, 23 percent a positive  impact, 36 percent negative  and 9 percent not sure.
  • Quality of care their patients receive: 50 percent reported no impact, 18 percent positive, 25 percent negative, and 6 percent not sure.
  • Ability of the practice to meet patient demand: 44 percent no impact, 18 percent positive, 25 percent negative, and 10 percent not sure.
  • Cost of health care for their patients: 17 percent no impact, 21 percent positive, 44 percent negative, and 16 percent not sure.


However, “physicians’ responses to questions that mention the ACA by name are deeply divided along party lines. For example, by a three-to-one margin, physicians who identify as Democrats are more likely to say the ACA has had a positive (44 percent) rather than a negative (15 percent) impact on their medical practice overall. Republican physicians break in the opposite direction by about seven-to-one (57 percent negative, 8 percent positive).”

The survey also does not support the contention that the ACA is contributing to primary care physician dissatisfaction with practice and burn-out:


“Even though providers with different political affiliations do not share views about the Affordable Care Act, a large majority of primary care providers (83 percent of physicians and 93 percent of nurse practitioners and physician assistants) — both Republicans and Democrats — reported they are very or somewhat satisfied with their medical practice overall. The changing environment does not appear to be affecting overall provider satisfaction even among providers who see a larger share of Medicaid patients or work in Medicaid expansion states. Indeed, current satisfaction levels are slightly higher than what was reported by primary care physicians before the ACA. In 2012, 68 percent of primary care physicians reported they were very satisfied or satisfied with practicing medicine.”


Interestingly, Democratic physicians (56 percent) are more likely to recommend a career in primary care than Republicans (39 percent)  or Independents (40 percent).


I know that many conservative primary care doctors have a strong and principled objection to Obamacare, believing  passionately that it gives the government too much power and the physicians, and their patients will be hurt as a result.  I (and ACP) may not agree with them, but I respect their views, and their right to make their case to their colleagues and to the public.


But the Kaiser Family Foundation survey shows us that the anti-Obamacare doctors do not represent the views and experience of most primary care doctors on the front lines, never mind “all” of them.  Doctors (at least those in primary care, who knows about surgeons?) clearly don’t “hate” Obamacare.  Rather, more of them see Obamacare as doing some good things, like improving access; and doing not as well on other things, like lowering costs to patients.  Much of what they do and see in their practices remains unchanged by it, for good or bad.


And that strikes me about right, Obamacare is making many things better, but there is a lot more that needs to be done to improve quality and access, lower costs to patients, and sustain and support primary care.  Of course, such nuances do not make for as good a headline or political talking point as “Doctors Hate Obamacare.”

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Americans' Risk of Dying From Cancer Is Falling, CDC Finds

Americans' Risk of Dying From Cancer Is Falling, CDC Finds | Healthcare and Technology news | Scoop.it

The risk that any one American will die from cancer -- thecancer death rate -- is going down, regardless of sex or race, a new government study reports.

However, because the United States has a growing aging population, the overall number of people dying from cancer is on the rise, officials from the U.S. Centers for Disease Control and Prevention reported.

"While we are making progress in reducing cancer death rates, we still have real work to do to reduce cancer deaths among our aging population," said lead researcher Mary White, a scientist in the CDC's division of cancer prevention and control.

Between 2007 and 2020, cancer deaths are expected to rise more than 10 percent among men and black women, the report found. Among white women, the number of cancer deaths will start to stabilize, increasing less than 5 percent during this period, according to the CDC researchers.

"Further declines in cancer deaths might be achieved if we can reach other national targets for addressing risk factors," White said.

These include cutting exposure to tobacco and UV radiation, increasing cancer screening for early detection, and improving access to health care to increase early treatment and survival, she said.

White said that a decline in cancer death rates -- even as the actual number of cancer deaths rises -- is not a paradox.

"Death rates are calculated by dividing the number of cancer deaths by the number of people in the population," she explained.

The number of older adults continues to grow, White explained. "Because death rates for many cancers increase with age, the number of people who die from cancer is also predicted to grow, even while death rates decline," she said.

Dr. David Katz, director of the Yale University Prevention Research Center in New Haven, Conn., agreed that reducing cancer deaths and reducing cancer are not the same.

"Cancer death rates are declining markedly, which is excellent news and testimony to the power of early detection and improving treatments," said Katz, who was not involved with the study.

And Dr. Rich Wender, the chief cancer control officer at the American Cancer Society, said, "We have made substantial progress for many of the common adult cancers. The key to that progress is applying research about how to prevent cancer, how to detect it early and treat it effectively."

According to the study findings, between 1975 and 2009, the number of cancer deaths increased 45.5 percent among white men, 56 percent among white women, 53 percent among black men and 98 percent among black women.

These increases are primarily attributed to an aging white population and an increasing black population, White said. This pattern is likely to continue, she added.

The government's Healthy People 2020 initiative set a goal of reducing the rate of cancer deaths by 10 to 15 percent for some cancers by 2020. This target was met for prostate cancer in 2010, the study authors said.

Researchers expect to meet the goal for breast, cervix, colon and rectum, lung and bronchus cancers in 2015. The death rates for cancers of the oral cavity and pharynx seem to be stabilizing, the report said.

However, the goal for melanoma is not expected to be achieved. "It's discouraging to find out that we aren't reducing deaths from melanoma, the most deadly form of skin cancer," White said.

"We know that most cases of melanoma are preventable," she said. "To lower your skin cancer risk, protect your skin from the sun and avoid indoor tanning."

White suggested the people can lower their own risk of dying from cancer by learning about screening tests and other steps they can take to prevent cancer.

"While we have seen improvements to lower cancer deaths, everyone can learn about screening tests and the cancer prevention steps that are right for them," she said.

Katz pointed out that "back in 1981, researchers first highlighted the substantial preventability of cancer by changing one's lifestyle. Most authorities remain convinced that 30 to 60 percent of cancers could be prevented by avoiding tobacco, having a healthy diet, routine activity and weight control."

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Ebola-stricken nations need $700 mln to rebuild healthcare

Ebola-stricken nations need $700 mln to rebuild healthcare | Healthcare and Technology news | Scoop.it

Guinea, Liberia and Sierra Leone need a further $696 million in donor funding to rebuild their battered health services over the next two years in the wake of the deadly Ebola epidemic, senior World Health Organization (WHO) officials said on Monday.


WHO Assistant Director General for Health Systems and Innovation Marie-Paule Kieny said that donors had pledged $1.4 billion of an estimated $2.1 billion required by the three countries before December 2017.


U.N. Secretary-General Ban Ki-moon will host an international Ebola recovery conference in New York on Friday to raise additional funds for reconstruction.


More than 500 healthcare staff are among the over 11,200 people killed in West Africa by the worst recorded outbreak of the hemorrhagic fever, which erupted in Guinea in December 2013 and continues to claim lives.


"Full recovery in the three countries will not happen if we don't strengthen the health system," Kieny told a conference call with journalists. She said additional funding would also be required after 2017.


Even before Ebola struck, Guinea, Liberia and Sierra Leone had some of the poorest healthcare systems in the world, but the damage inflicted by the outbreak has left them more vulnerable than ever, officials say.


In Guinea, WHO officials have reported a drastic increase in deaths from malaria and measles. Before the crisis, the country's annual healthcare spending stood at just $7 per person in 2013, one of the lowest rates in the world.


Pre-Ebola healthcare expenditure in Liberia and Sierra Leone was little better at $14 and $11 per person respectively, well below the WHO's recommended minimum of $84 per person per year.


The re-emergence of Ebola in Liberia last week, nearly two months after it was declared free of the virus, has stoked fears that it may take longer than expected to defeat the epidemic.


Kieny said it was too soon to say how the three new cases in Liberia - one of whom has died - became infected. Tests are being carried out by the Liberian government and international health agencies.


The European Union on Monday approved 1.15 billion euros in aid for West Africa through to 2020, nearly doubling its previous commitment to a region that is a major source of migrants seeking to enter Europe.

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Three years on, U.S. Chief Justice Roberts rescues Obamacare again

Three years on, U.S. Chief Justice Roberts rescues Obamacare again | Healthcare and Technology news | Scoop.it

The healthcare law conceived by President Barack Obama and passed by Congress was by no means perfect, U.S. Chief Justice John Roberts said on Thursday. The law, for instance, had "three separate Section 1563s."


“The Affordable Care Act contains more than a few examples of inartful drafting,” the country's top jurist quipped as he announced the court's ruling from the bench preserving the law.


But the imperfections were not the point, he said.

Simply put, the 60-year-old chief justice said, the law was written to make healthcare insurance widely available, and the disputed tax subsidies at the heart of the case were crucial to keeping the cost of premiums down and enrollment up.


It was the second time in three years that Roberts had authored an opinion rejecting a conservative challenge to the 2010 law known as Obamacare.


If a law was ambiguous, it was the job of justices to provide a fair interpretation, he said, as he read from his majority opinion in the marble-columned chamber before some 300 spectators.


His corporate legal experience before joining the bench might have informed his understanding of insurance markets. But the man who cut his teeth in Washington as a lawyer in the government's executive branch also voiced understanding of the messy compromises that accompany bills taken up by the legislative branch.


'TOO COMPLICATED TO UNDERSTAND'


He referred to a cartoon described in 1947 by the late Justice Felix Frankfurter, “in which a senator tells his colleagues, ‘I admit this new bill is too complicated to understand. We'll just have to pass it to find out what it means.’"


Curtailing the subsidies, Roberts said, would lead to an economic "death spiral," with premiums rising and the number of people with insurance dropping.


Unlike three years ago, when Roberts was the only conservative joining the four liberal justices on the nine-member bench to uphold the law, fellow conservative Justice Anthony Kennedy, 78, a 1988 appointee of Republican President Ronald Reagan, signed on with Roberts.


The vote three years ago was 5-4; this time it was 6-3.

In 2012, Roberts drew the wrath of Kennedy, Republicans and other conservatives. Some right-wing advocates beyond the court deemed the 2005 appointee of Republican President George W. Bush a traitor.

Three years ago Roberts confronted a multi-faceted constitutional challenge and stitched together various rationales to uphold the law. His approach on Thursday was straightforward interpretation of statute.


SCOTUSCARE?


In the case decided on Thursday, the challengers, financed by the libertarian Washington-based Competitive Enterprise Institute, had argued that tax-credit subsidies should go only to people who bought insurance on marketplace exchanges "established by the state," as stated in one part of the law.


That reading would dramatically curtail the availability of subsidies because most of the low and moderate income people who qualify live in the nearly three dozen states with exchanges run by the federal government and not the states.


That interpretation also would conflict with the court's usual approach to ambiguous statutes, Roberts said. "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," he said.


Spectators laughed along with Roberts when he quoted Frankfurter, but Antonin Scalia, a 79-year-old justice appointed by Reagan in 1986, was not amused.


Given a Roberts majority had now twice preserved Obamacare, the law might as well be called "SCOTUScare," said Scalia, one of the three dissenters, using the six-letter acronym for the Supreme Court of the United States.

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