Brent Nyitray
Fairlington Blade
Let the mutherfuker burn!
jnc4p
Kevin S. Willis
Michigoose
lmsinca
markinaustin
Arcanaut
novahockey
quarterback
ScottC
yellojktHealth Affairs published a retrospective on Massachusetts Health care.
http://content.healthaffairs.org/content/early/2012/01/24/hlthaff.2011.0653.full
Some highlights: Coverage is broader than it was in 2006, outcomes are better, costs are still increasing. However, what I found most encouraging yet most problematical for ACA was that the use of ERs for non-emergency treatment has been reduced, but only in the last couple of years.
If ACA is to obtain a savings for the taxpayer, IMHO its best opportunity will be to remove non-emergency treatment from the ER. I will be the among first to suggest that could have been done, years ago, without federal intervention, and there are examples of this around the nation. For example, the @45 neighborhood clinics in SF, funded cooperatively by major employers, the City, UCSF, and the two large insurers in the state, have been successful at this. Now Massachusetts has proven successful at the state level.
However, the fact that there was no relief for the ERs for 3 years in Massachusetts indicates to me the lag time to spread the knowledge of “where to go” to those who need treatment. That lag time would seemingly be, under ACA, a dependent variable upon other functions. Is the state, responsible for the make-up of the “essential” package, disseminating information or remaining silent? Does the locality actually offer alternate choices? [There are huge areas of the Big Empty in TX that don’t offer any choice but a 90+ mi drive to an ER, or to an unknown alternate facility].
NoVAH, could you please address this aspect of ACA – how it is to be implemented re: moving non-emergency patient care out of the ERs?
Thanks, in advance,
Mark
Filed under: aca, health insurance, movies |
All Things in Moderation 
Purely my view after reading a few books is that the state requirements were set with little wiggle room so that they would not make ACA like Medicaid.
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Mark
Excellent and informative post! I notice you mentioned San Francisco. Do you know much about their system. Don’t San Franciscan’s have universal coverage? I may be mistaken but I thought I heard Gavin Newsom make that claim on TV.
Of course San Francisco has some of the highest priced real estate in the nation which means they have a very affluent property tax base. That is one difference between S.F. and other cities. But I’m wondering how they determine eligibility. Does one have to establish residency of some form. What happens to the homeless?
Just curious. Wonder if the nation as a whole could learn anything from S.F. The clinic models you point out are probably one things and as NOVA has pointed out we need to face the fact that we’re going to see a sharp increase in the use of P.A.’s and other nursing specialties to alleviate the pressure on doctors if we ever truly get to universal coverage. I’m not terribly upset by this. Do we really need to see a doctor to treat a common cold or the flu?
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RUK, that is how SF achieved “universal coverage” – NOT with insurance, but with the clinics, and with cooperation from all the “stakeholders”. I do see that ACA changes their program a bit – about 10K people will now have federal subsidies paid into the program.
I like “Healthy SF” as an initiative for a mid sized city. Austin could do it, with 750K people, or the city and county [1.3 M] could do it. I think it is actually the change of delivery mechanism that does the cost saving, not the tinkering with the insurance. So I actually think it is counterproductive to have federal tax money subsidizing a local cooperative venture that is working, although I think there is no way around it, once you federalize an idea.
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Mark,
Thanks for that informative response. And I tend to agree with your points about the SF model and mid sized cities like Austin. How would you do it in Tampa Bay. Let the municipalities split them up…St. Petersburg has 250,000 but Pinellas Country which is more like Austin’s 750,000. Tampa and HIllsborough County are much larger.
I’m always torn by the question of economies of scale versus the increased inefficiency of larger bureaucracies, public or private.
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Mark: I wonder if ARC is still working toward that model.
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I think you’re right Mark. I don’t have time right this second to read the piece you linked, jeebus I’m still working like a rabid dog, but the fact that ER’s are being used as what almost borders on a Primary Care facility is killing health care dollars. I was at the ER with my daughter on New Year’s Eve, we were sent over from Urgent Care, and besides her, a woman who was obviously really sick with something so bad that I made sure I sat on the other side of the room, and another woman with some sort of diabetic event, the other 20 or so people easily looked and sounded like they could have waited until Monday or managed on their own. It’s been a long time since I’ve been in an ER waiting room, but it was pretty discouraging.
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Totally OT for the movie fans:
If Friedrich Nietzsche is your favorite philosopher, you might like The Grey a lot.
Otherwise, you might not want to pay to see this ode to the futility and meaninglessness of life. I am so sorry I paid good money to see it.
(Edited to try to avoid any possible spoilers.)
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QB:
That is probably the most pithy movie review I have ever read. Sounds like I will avoid The Grey.
As long as we’re OT, I just got my first mailer from Winning Our Future (Newt’s SuperPAC). Romney is called a “Massachusetts moderate” compared to Gingrich’s “true Reagan conservative,” trying to reinforce the doubts some may have about Romney’s conservative credentials. It has a poorly Photoshopped pic of Romney with Ted Kennedy and also uses a pic of Reagan that looks suspiciously like Kevin’s gravatar.
Only 10 votes in my poll so far. Primary is Tuesday ….
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Why thanks, Mike. No sense mincing words, I thought.
I don’t normally say “don’t see the movie” unless it is really bad in quality. This isn’t bad in quality. It just left us thinking that ole Friedrich could have endorsed it.
I hope my “review” isn’t a spoiler. Perhaps I’ll edit it.
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I probably wouldn’t see the movie anyway but knowing that qb didn’t like it makes it tempting (kidding), and then again, not being a Nietzsche fan, I think I’ll pass. I don’t know much about the movie but which one of Nietzsche’s “themes” did it follow? Anti-Christianity, aristocratic hierarchy and herd mentality, or his diminution of women?
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lms,
Nihilism, God is Dead, faith is false hope–that cheery stuff. It’s bleak, desolate, existential despair. It’s really a movie about death.
It has quite good reviews. So apparently I am a minority. When we walked out, my son said he half expected a message from Nietzche to show up at some point. I was thinking that old Fred would certainly endorse it.
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Yeah, I think I’ll pass. I’m ready for a movie, just to get away from my desk, but maybe I’ll find a good comedy, that’s more along the lines of what I need. Have you ever read this “quotation” though?
Anyone who has declared someone else to be an idiot, a bad apple, is annoyed when it turns out in the end that he isn’t.
For some reason that cracks me up. I was never a fan of existentialism though as there’s no embodiment of hope and it’s just downright depressing to me. Didn’t he believe in the words of Jesus though, just not the way he thought the church altered the history or something? It’s been a long time since I read up on any of this stuff.
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BTW, qb, don’t know if you saw my comment on your new avatar or not. . .
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mcurtis, I think Community Care is public-private and gets tax money from the City and County and the feds, plus private donations. Its got about 20 locations as I recall, and has been around for about 40 yrs. My eldest daughter’s best friend from childhood and her husband are docs there. And we also have the totally private People’s Clinic, and a lawyer friend of mine is Board chair [chief fundraiser]. I don’t know “ARC”.
QB, thanks for the tip on “The Grey”.
Rosanne and I saw “My Week with Marilyn” last night. C+ from me, B- from her. Well acted. Branagh as Olivier. Ms. Williams as Marilyn. Everyone you ever saw on “Masterpiece Theater”, from Derek Jacobi on down, as supporting cast. From events that occurred during the making of “The Prince and the Showgirl” in England in the mid 50s.
Diverting, worth the price of admission, forgettable.
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Austin Regional Clinic is ARC.
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Movies? There really isn’t much on the screen right now. The Descendants is good and a near comedy. _Tinker, Tailor, Soldier, Spy_ is a deep spy thriller. Slow for some.
A foreign movie called _The Darkness_ is very good, but depressing.
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That ARC.
It is a for profit medical practice. A good one, but not to be compared with Community Care or People’s, which have sliding scale and subsidized care for the poor.
When I read “ARC” I think of the old Austin Rehearsal Center facility for our thousands of registered bands down off SoCo.
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Mark–
I got all Utah yesterday and went to see a Sundance Film Festival movie. “Father’s Chair” (Brazilian); well acted, beautiful cinematography, occasional interesting turns in the story but overall cliched and predictable. If you get the Sundance channel on cable/satellite it would be worth seeing if the alternatives are American Idol and/or The Bachelor, but I wouldn’t pay money to see it in a theater (full disclosure: the tickets were a birthday present, so it didn’t cost me anything).
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Michigoose:
The Brazilians are making some excellent films lately. Many of them never get to our shores because of the Region Codes. What is interestng is their VCR’s and DVD machines have the ability to watch any region while ours do not.
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mcurtis:
I suspect that this particular film made it into Sundance based on the reputation of the director (this is his second or third Sundance appearance); the most interesting part of the whole movie yesterday was watching the evolution of the father’s character from a completely unlikable jackass to a man who might just be on the cusp of realizing the worth of personal relationships over work. The combination of a great actor and a great director in order to do that was really impressive. . . I thought the director spoiled his argument for what a good film it is by including his screenwriter for the q&a at the end as, like I said, the story itself wasn’t all that great and her explanations for why she wrote some of the things she did was weak tea. She has done a couple of other movies that I’ve seen in the past which were MUCH stronger pieces of work.
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‘Goose, thanks for the tip. I’m adding “movies” to the categories.
Tonight is the Masterpiece double header of course: “Downton” and “Sherlock”.
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Michi,
Yes, I did. Thanks. I still like Mr. Burns and Dr. Quest, so perhaps I wll use them for proper occasions. Too many avatars, too little blogging time.
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Michi,
Have yu seen a Brazilian documentary _Bus 174_? I have several friends who were not in the bus, but knew people there. It seems it was a day for those in that country that is universally known.
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Mike (Curtis):
No, I haven’t. . . but it’s in my Netflix queue now. Thanks!
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