King v. Burwell and Obamacare

If you're at all concerned with the possibility that the Supreme Court may shortly deprive tens of thousands of people of their (recently-acquired) federally-subsidized health insurance, you should look at this post by Timothy Jost on Balkinization, detailing the contents of the amicus briefs that put the anti-Obamacare forces (I think) to shame. And then look at this Wall Street Journal story, and this one, and this amazing piece from Mother Jones, about the four "plaintiffs" in the case, who have little to no idea of the position "their" lawyers are taking on their behalf, and in at least one case don't seem to even know that they're plaintiffs. The plaintiff's legal theory is pathetic, the lawyer's supposed named plaintiffs are frauds--and yet it's actually possible that the Supreme Court might endorse the theory to protect those plaintiffs.

John Roberts can work as hard as he wants to protect the reputation of the Supreme Court as non-political, but if they decide against the US on this one, they will have no credibility left at all.  

Our Voting Public: Uninsured revolt against the Anti-Christ behind the climate hoax edition

An April survey from Kaiser Family Foundation found that four in ten Americans (42%) are unaware that "Obamacare" is actually the law of the land. 12% thought the health reform measure had been repealed by Congress, 7% thought it had been overturned by the Supreme Court (which actually upheld the law in June of 2012), and 23% didn't know enough to say whether the law was in force or not. Overall, 49% of Americans didn't know enough to say whether the law will impact their own families--but, depressingly, the percentage of people lacking that knowledge was highest in the two groups the law is likely to benefit most: the uninsured (of whom 58% said they didn't know how the law would affect them) and the poor (56%).

Another poll--from PublicMind at Farleigh Dickinson University--shows that 29% of all Americans (18% of Democrats, 27% of Independents, and a whopping 44% of Republicans) believe that an armed revolution might be necessary in the next few years, in order to protect our liberties. An armed revolution. In the next few years. Another 5% of Americans aren't sure about that. Well, that's good, I guess; one doesn't want to decide these things too precipitously.

And in other polling news from what appears to be this planet, Public Policy Polling (a well-respected polling firm known for asking the occasional oddball or controversial question) has found (among many other amusing and/or scary things) that 58% of Republicans think global warming is a hoax, while 77% of Democrats disagree; and that 20% of Americans think vaccines cause autism, while 34% aren't sure.

And 20% of Republicans believe that President Obama is the Anti-Christ. Well, I guess we know why they think armed revolution might be necessary. Hope your health insurance covers gunshot wounds.  

Emanuel on Accountable Care Organizations

Zeke Emanuel and Jeffrey Liebman are predicting that health insurance companies will vanish by 2020, to be replaced by the Accountable Care Organizations (ACOs) being called into being by President Obama's Affordable Care Act. ACOs, they predict, will practice more efficient medicine than the current fee-for-service system can generate, and will also replace insurance companies' risk-spreading function by pooling the risks of their higher- and lower-cost patients.

I can't share their optimism. Data from the five-year Medicare Physician Group Practice demonstration project casts doubt on the ability of ACOs to extract major savings from care-coordination. This Health Affairs Health Policy Brief on ACOs raises that question, and others as well: will ACOs form only in wealthier regions of the country, thus worsening already-existing health disparities? Could alliances among healthcare providers result in higher prices? Will ACOs run afoul of antitrust laws?

Of course we should do a better job of coordinating care; of course we should incentivize our doctors and hospitals to work on keeping people well rather than on intervening with expensive procedures after they're sick; of course we should use our better information technology to cut costs without cutting quality. Can ACOs do all of that? I sincerely hope so. But I'm not willing to bet that they'll be so successful as to make private health insurance obsolete in the next eight years.

Insurance Reform Successes

This report from the Centers for Disease Control shows that provisions of the Obama health insurance reform law which went into effect in 2010 have resulted in an additional 2.5 million young adults (19- to 25-year-olds) having insurance coverage. And while we're talking about provisions of the health reform law that are already helping people, let's not forget the reduced Medicare Part C premiums and the Medicare "doughnut-hold" drug rebates for the over-65 set; the no-copay, no-deductible preventative care; the low-rate "pre-existing condition" insurance pools that have allowed some seriously-ill people to find coverage; the tax credits for small businesses who insure their workers; the restrictions on insurance-company limits on what they'll spend on the seriously-ill; and the limits on health plans' ability to spend premium dollars on marketing and administration. All of these benefits are already flowing from Obamacare. If people knew what was in it, they might be less anxious to ask judges to strike it down.

Supreme Court to Rule on Health Reform

I'm a few days late with this, but here's the irreplaceable Timothy Jost's take on the US Supreme Court's grant of certiorari on a number of legal and constitutional issues related to Obama's health-insurance reform law.

DC Circuit on Health Reform

Can't have a bioethics blog in America without at least noting this very important appellate opinion upholding the constitutionality of the Obama's health reform. It comes on the eve of the Supreme Court's decision whether to grant cert and hear appeals from earlier-decided cases on the same issue. For unbeatable analysis, see Tim Jost's post here.

Friday Frivolity, Health Reform Implementation Edition

Evidently this healthcare executive hasn't been reading his Health Affairs. Or his JAMA. Or his NEJM....