Wednesday, June 30, 2010

How can you learn what is really in health reform?

Recent polls show that the public remains split on the merits of the health reform law, although the most recent polling shows a modest uptick in support, with a small plurality of Americans now expressing support of the legislation in polls conducted by the Kaiser Family Foundation and USA Today/Gallup; other polls show a narrow plurality of voters continue to view the legislation unfavorably. The overall trend, though, appears to be toward increased support and decreased opposition, based on an aggregation of polls on the website. The shift, though, is modest, and the country remains deeply divided by political affiliation and other characteristics of respondents.

One constant, though, is that a substantial percentage of Americans describe themselves as being "confused" about the law. The latest Kaiser poll has roughly four in ten respondents describing themselves as at least somewhat confused by aspects of the law, although larger percentages describe themselves as being aware (and generally supportive, except for the individual mandate) of key provisions of the legislation.

Who does the public trust most on health reform? A March survey by Gallup shows that 77% of respondents trust in physicians to recommend the right thing for health care reform, the highest of any sector.

The problem is that physicians also are confused. Mark Blumenthal wrote in April's National Journal that "Doctors report on high levels of confusion, panic or anxiety expressed to various physicians, including patients asking if their doctors are "going to be able to keep seeing me" or 'pushing for surgery now' in fear it might be denied in the future. Even more important, many of the doctors are as confused about the new law as their patients. 'Quite honestly,' one doctor told the Times, 'I don't know how to answer their concerns.'"

In my recent talks about health reform with physicians in Massachusetts, Maryland, Wyoming, Mississippi, Washington state, and the District of Columbia, I too have heard from many physicians who are unsure themselves about the specifics of health reform, yet they are being asked (besieged?) by patients asking for help in understanding it.

Here's the good news: today, the American College of Physicians released An Internist's Practical Guide to Understanding Health System Reform; ACP's press release describes the guide "as the single most comprehensive, clear, and objective explanation of the new law, and what it might mean for internists and their patients." The 90 plus-page PDF document is designed to be super-easy to use, allowing readers to navigate to key descriptions of the legislation, organized by date and topic, with a single mouse click. ACP is making the guide generally available for redistribution, free of charge, on a not-for-profit basis with attribution ACP.

The guide was written by the staff for ACP's Division of Governmental Affairs and Public Policy, which I direct, so I recognize that there is a bit of self-promotion on my part in recommending the guide. But I encourage anyone who has an interest in learning about what is actually in the legislation to download it and give it a test run. Whether you agree with the legislation or not, I hope you will agree that the guide fills an urgent need to provide practical, thorough, unbiased information on the "nuts and bolts" of the legislation, and by doing so, can help reduce the rampant confusion that exists among doctors and patients.

Today's questions: Have you downloaded the new ACP guide? What do you think of it?


ryanjo said...

Much ado about nothing. Seeing the summary of how little this "reform" offers to help patients and physicians makes me wonder yet again why ACP spent its efforts supporting it.

A 10% increase in office based primary care pay on Jan 1, 2011, contrasted to the 30% SGR cut we are facing on the same day? How is Medicare going to provide new preventive benefits and still cut half a trillion $ to pay for it?

"The overall trend, though, appears to be toward increased support and decreased opposition." Not in comments from my patients! They're just angry, frustrated and scared.

Even after the embarrassment of the SGR and liability relief failures, the ACP leadership blogs on about needing to support PPACA with or without these pieces. What incredible naiveté about the way our government passes laws. This is a central part of the fix, and ACP leaders dropped the ball by lending support. It appears this lesson has not been learned.

Rich Neubauer MD said...

The guide is a great piece of work and will indeed help those physicians who choose to use it in their efforts to answer questions from patients. Congratulatons are due to the ACP Washington office staff in putting this together.

The larger question of what kind of future PACA will yield is something only time will tell. The reasons that ACP supported the bill have been outlined repeatedly; while imperfect, the bill addressed many priority issues that the college has been advocating for years and was consistent with many of the college's carefully wrought policies and positions.

The Chicken Little syndrome will not be very helpful right now. ACP as a professional organization has maneuvered well through the debate about health care reform and can now help meneuver through implementation in a way that is most beneficial to internists and their patients. The SGR issue is an embarrassment to government; it is not an indictment of ACP or other professional organizations which have worked hard over the years to have this dysfunctional formula repealed and replaced.