Obama on Letterman and Healthcare Reform

Check out Obama on Letterman talking healthcare reform. The health care reform talk is near the end and includes Obama's take on racism as a main cause of all the dissent, anger and town hall madness or even the most Rep. Joe Wilson behavior during his address.

I find it interesting and frankly, quite striking, that Obama is using popular media like the media to advocate for health care reform. That's meant to be a good comment by the way. Talk about getting out there and promoting the cause. I guess in terms of convincing people, you gotta give the guy credit for taking the road less travelled. I think this goes back to some of the comments that were brought up at the health care reform workshop and in some ways points back to the idea in policy that the President has a national constituency and in that sense has a unique leverage.

I don't necessarily know if Letterman's audience are in some ways biased or if Letterman himself is biased, it is New York afterall and maybe the optimist in me would still like to believe that using this new form of advocacy by the President would reach a wider audience. In 200c, Oprah was noted to be one of the most effective health educators around.

In that case, Mr. President, has your staff been talking with Oprah's people? After all, she does have a new season and most likely a new couch.

"My question, then, is what you all think about whether people can really be convinced either that things aren't as great as they seem, or that what they think they like really won't change. Or is it even necessary to convince people of either?"

Hmmm - Andrea, convincing people is always so difficult. If it were to happen, I feel like this is an instance where we need to somehow get the little penguins to join together to tell their parents that they should buy into this. Maybe Obama should start a nationwide college tour to build momentum/support and show people that there are supporters out there. It's great trying to bring everyone together, but I think that when you hold multiple town halls/joint sessions of congress (okay, so maybe that couldn't be helped :P ) where there are loud, angry dissenters, supporters might begin to feel as if they're on the fringe.

for your health...and your entertainment?

While flipping through the channels earlier tonight, I was taken by surprise when the face of none other than Professor Art Reingold appeared on the TV screen. It was the CBS5 news, and he was addressing...you probably guessed it...swine flu. In an example of true public health epidemiology, he was making an announcement to the public that, contrary to common belief, hand washing is not enough to protect you from the swine flu, or any flu for that matter.

Since stopping breathing isn't really an option...time to get vaccinated? Tang Center's flu shot schedule: (http://www.uhs.berkeley.edu/home/news/pdf/FluShotFlier09.pdf)

You can read the article and watch his interview here:
http://cbs5.com/health/hand.washing.h1n1.2.1194097.html

Most insured Americans at least say they're happy

I just came across this study by the Kaiser family foundation that found that, of all insured Americans, the majority say they are happy with their plan. Deeper digging revealed that different groups of people, including those in lower socioeconomic groups, were not so pleased. Furthermore, more questions showed that even those people who said they were pleased with their plans really did have quite a few gripes. I think this data gets at part of the challenge of convincing US citizens that health reform is necessary. Most of the time, people will be relatively happy with the status quo. In many cases, if people are the ones who have chosen the status quo (i.e. people feel as though they're choosing their health insurance), they're even more likely to say they're happy with it, if only to justify their choice. When you start asking more questions, you may find, as this study did, that people are unhappy with most aspects of something, but they're still, overall, going to be convinced they mostly like it, if only because it's familiar and they know they don't hate it. If the majority of Americans are insured (which they are), and if the majority of the uninsured claim to like their insurance provider (which this study claims), and if many people believe that the public option (or, more broadly, health care reform of any sort) will change their insurance (which people do), then it will be very hard to convince people to change. By that logic, there are 2 options: convince people that all those things they said they didn't like about their insurance are actually large enough problems for them to admit they're dissatisfied overall with their insurance, or convince them that the public option won't affect their own choices. Obama has clearly been trying to do the latter in his speeches, and the former seems time-consuming and complicated (pointing out the faults of these enormous insurance companies will not be a politically-popular move). My question, then, is what you all think about whether people can really be convinced either that things aren't as great as they seem, or that what they think they like really won't change. Or is it even necessary to convince people of either?

Special Interest Groups: What's their role in the reform?

Hey guys.

I'm going to respond to Patrick's post, and then pose a couple (somewhat-rhetorical) questions. I found it very interesting that while the AMA's position is one against the public option, the majority of physicians belonging to AMA are in favor of the public option, in some shape or form. Off the bat, I just have to throw the fact out there that the majority of physicians sign up for the AMA because it's "what you do", you get your little purple ID card, keep it in your wallet (or the back of your desk drawer), and conspicuously arrange your free subscription to JAMA on your desk as to assure your patients will see it. Somewhat of a cynical exagerration, but you catch my drift. That being said, I guess it's not too hard to conceptualize how the majority of the group's members feel one way, yet the official position of the group fails to reflect the majority vote. The average doc out there, "working 75+ hours per week, trying to please a million masters, attempting to keep his head above water in the sharktank" is about as invested in the AMA as schoolchildren are in classwork on the day before Christmas vacation. In fact, this lack of leadership and interest has been a topic of concern for the AMA for decades. And it's sad, because as much as the reform (in whatever form it eventually takes) is going to effect patients, insurers, etc...it's going to rock the worlds of physicians.

As Patrick mentioned, the medical community is widely split on the reform issues. So much so, in fact, medical schools host debates (tactfully-advertised around campus as "expert panel discussions on health reform") between physicians from the two camps: mainly the AMA and PNHP (Physicians for a National Health Plan.) Med students pile into auditoriums to listen to middle-aged docs battle it out over reimbursement, treatment of the uninsured, and how there are more billers in their office than physicians due to the headaches involved with billing several different insurance companies. In general, primary care physicians side with PNHP, and specialists side with AMA--but this is a gross overgeneralization (as the statistics in Pat's article illustrate.) I guess I'm having a hard time reconciling how the AMA, whose vision is to "help doctors help patients by uniting physicians nationwide to work on the most important professional and public health issues", can publicly take a stance on such a massive issue as national reform, with an opinion that does such a mediocre job of capturing the best interests and feelings of so many (the majority!) of its constituents. Sure, there will always be a few dissidents in every interest group...but this is more than that. In this case, with so much on the line, and such a massive discrepancy of opinion amongst its constituents, is the AMA justified in publishing any official stance on health reform? That's what an "interest group" is supposed to do, right? Attempt to influence policy, in some way, by at least taking some official stance on the issue. Or is this a classic example of the squeaky wheel speaking inappropriately on behalf of the silent majority?

New survey in NEJM finds that, overall, doctors support a public option

Hi all,

I found this interesting article published by NPR in my daily read. In it, the authors describe that physicians as group have traditionally had difficulties giving an official stand on health care reform. As a medical student, I can definitely see this as being true. From my personal experience, doctors in primary care tend to prefer a public option and those in high-paying specialties tend to be content with the status quo. However, in this article, a recently published survey in the New England Journal of Medicine has found that 63% of doctors favor a mixed system that includes both private and public insurance; an additional 10% favor a single-payer only system. When the public was polled, about 50-70% said that they are in favor of a public option.

What else is interesting is that the majority of the doctors who are members of the American Medical Association (AMA) are in favor of a public option, though the organization itself is opposed to it. The AMA has historically been opposed to health care reform as one of its main objectives is to protect the interests of physicians, not improving patient access or care. Also, I've heard that the AMA only represents about 20% of physicians; in the NPR article, the authors state that less than one-third of physicians belong to the AMA. Most physicians join their own specialty groups. If this is true, then here we have a very powerful lobbying group against a public option who does not actually represent the opinions of its constituents.

Instead of looking to the AMA as the voice of physicians, one can find differing opinions from other medical groups. The American Medical Student Association (AMSA) represents the future physicians of America and has a very firm commitment to universal health care and enstating a single-payer system. However, not every medical student is involved with AMSA.

Just the other day, massive protests against federal spending took place in Washington DC. Given this NPR article stating that the majority of both doctors and the general population actually favor a public option, one has to wonder who exactly these protesters are. Are they simply the loud minority? How do these statistics fit in with what we discussed in class -- that most Americans are happy with their own health coverage?

I have included both the NPR and NEJM articles below:

http://www.npr.org/templates/story/story.php?storyId=112818960

http://healthcarereform.nejm.org/?p=1790&query=home

Let's discuss!

"Socialized Medicine"

Hey everyone, I thought this would be a great article to share:

http://www.nytimes.com/2009/09/03/opinion/03kristof.html?_r=1&em

Here's a small excerpt:

"Until the mid-19th century, firefighting was left mostly to a mishmash of volunteer crews and private fire insurance companies. In New York City, according to accounts in The New York Times in the 1850s and 1860s, firefighting often descended into chaos, with drunkenness and looting. So almost every country moved to what today’s health insurance lobbyists might label “socialized firefighting.” In effect, we have a single-payer system of public fire departments.

Throughout the industrialized world, there are a handful of these areas where governments fill needs better than free markets: fire protection, police work, education, postal service, libraries, health care. The United States goes along with this international trend in every area but one: health care."

The article also discussed how the government run health care systems (VA, Medicare) are what people actually like, has better performance and is cost-efficient. I just find it intriguing that other systems in America--like fire-fighting--are okay to be set up with a single-payer system but health care is constantly faced with extreme opposition and fear of reform. Granted, health care is a different area, even creating/proposing small incremental changes exerts a lot of effort and time. Maybe, like this article points out, when put into the context of looking at the spectrum of activities/positions in the US that are so-called "socialized" people can begin to understand the positive implications the single payer system or public option could potentially have. What do you think?