March: The National Convention Edition of Health Policy and a Pint

This month, we're discussing the role of medical students in the upcoming health care reform. As part of the convention's theme, "Win Back our Profession", we want to know what YOU think about medical professionals as political advocates.

Questions to Consider:

• Is this a part of the new medical professionalism?
  
• Is it appropriate for physicians to "take sides" in politics? How might this affect our patients who disagree with us politically?
  
• When, if ever, does political involvement constitute an abuse of our influence as physicians?
  
• What is the power of medical students to enact political change?
• How can we best unite medical students behind a common goal?
  
• What skills do we have? What are our resources?
  
• How can we best use our power and skills to support meaningful reform?

If you missed convention this year, I hope you can discuss these topics at your home institutions. Check back for discussion from convention attendees!

I say AMSA
You say power

OCTOBER Topic: Special Election-Themed HP&P

OBAMA vs MCCAIN: Who will deliver quality, affordable healthcare for all?

With all the back-and-forth about health care in this year's presidential election, sometimes it can be hard to know what to think about the candidate's plans. Having a discussion with fellow medical students can be a great way to find out more about the plans and debate their relative merits.

The AMSA scorecard on the candidate's plans is a great place to start your discussion. Find it on the AMSA website at http://www.amsa.org/election/scorecard.cfm

Questions to consider as you think about each candidate's plan:

1) How does a private health insurance system work? What are the fundamental failings of such a system, and how might they be corrected with market incentives or industry regulation? What other models for health insurance exist, and would it be feasible to use these in America?

2) Is health care a right? Do Americans have to choose between equality, efficacy, and efficiency in our health care system, or is there a way to get all three? Do the plans of either candidates offer substantial progress towards achieving this goal?

3) Under McCain's Plan: What are the advantages to buying health insurance on an open market, across state lines? What are the disadvantages? How might this affect the system as a whole?

4) Under Obama's Plan: Will healthy individuals purchase health insurance without mandates, or will they "free-ride" the system until they get sick, knowing they will not be denied coverage due to a pre-existing condition? What are the advantages and disadvantages to requiring mandates?

5) What do the two plans have in common? Where are the areas of greatest disparity?

6) Imagine you are running for president. How would your own health care platform differ from that of Senators Obama or McCain? How might your opponent criticize your plan, and how would you frame your argument to defend your plan to the American people?

Don't forget to vote!
...and as always, here's to your health!

SEPTEMBER Topic: Health Savings Accounts

In elections all over the country, candidates are raving about Health Savings Accounts. But what are Health Savings Accounts, and are they really the silver bullet for American health care reform?

Questions to Ponder

1) In what ways is competition good for health care? In what ways is it bad?
2) Do Americans overuse health care? Is this overuse supply-driven (by doctors and hospitals) or demand driven (by patients)? Can this overuse be controlled by Health Savings Accounts?
3) In what ways do Health Savings Accounts affect the rest of the insurance market? What is the reason for the insurance function, and how can insurance markets fail?
4) What information do patients need in order to be rational, efficient consumers of health care services? What tools are available to help patients become better informed? What are the information problems and uncertainty intrinsic to health care?

Background and Resources

The Promise and Pitfalls of Health Savings Accounts

Wall Street Journal - To Your Health

NYT Op-Ed - The Health of a Nation

NYT Editorial - The Lopsided Bush Health Plan

RAND Health Insurance Study

AMSA Health Savings Accounts Primer

NEJM - Health Savings Accounts: The Ownership Society in Healthcare

Health Affairs - Medical Savings Accounts: Lessons from Singapore

JULY Topic: Medicare Payment Cuts to Physicians

Just before the Fourth of July recess, the House passed a bill to prevent Medicare a pay cut of 10.6% by a vote of 355 to 59. In the Senate, Republicans blocked efforts to take up the bill, so the cut took effect on July 1. But the Bush administration has delayed processing of new claims to give Congress time to come up with a compromise.

Core Concepts (will open in new window):

• Physician Reimbursement
  
• Provider Reimbursement
• Medicare Structure
  

KaiserNetwork.org, 7/16.08
Congress Overrides Veto of Medicare Bill To Delay Physician Payment Cut

New York Times, 7/13/08
Long-Term Fix Is Elusive in Medicare Payments
Congress has blocked a cut in payments to doctors but has not solved the problem that caused the cut, experts say.

KaiserNetwork.org, 7/10/08
Senate Votes 69-30 To Approve Legislation That Would Halt Medicare Physician Payment Cut

New York Times, 7/7/08
Doctors Press Senate to Undo Medicare Cuts:
Ads by the American Medical Association blame Senate Republicans for a 10.6 percent cut in payments to doctors who care for older Americans.

New York Times, 7/5/08
The Senate Stalls on Medicare
A sensible new Medicare bill must pass so that Congress can wring subsidies from inefficient private Medicare plans.

KaiserNetwork.org, 7/8/08
Medicare Physician Pay Patch Bill Might Gain Enough Votes for Cloture in Senate, Baucus Says

Questions to Ponder

- How do you think physician payments should be set?

- Should Medicare Advantage programs exist? Why or why not?

- Why has no meaningful reform occurred regarding physician payments through Medicare?

- Are medical students at your school informed about Medicare payments? Do they think what happens with Medicare will impact their future careers?

JUNE TOPIC: How is Massachusetts Mandated Insurance Working?

A study from the Commonwealth Fund that analyses mandated insurance in Massachusetts one year on.

An article from the Boston Globe about costs.

- Do you think mandated insurance is the most cost-effective insurance system?

- What do you think are the advantages and disadvantages of mandated insurance vs. Obama's plan vs. publicly funded insurance?