A Glimpse Into
The Present
Arie Friedman, M.D.
Physicians Council for Responsible Reform
“Unless we put medical freedom
into the constitution the time will
come when medicine will
organize into an undercover
dictatorship and force people
who wish doctors and treatment
of their own choice to submit to
only what the dictating outfit
offers.”
Benjamin Rush
Patient Protection and Affordable Care
Act of 2010
Health Care and Education Reconciliation
Act of 2010
Regulatory Process
Centers for Medicare and
Medicaid Services
• Directly manages Medicare
• Partners with states in managing Medicaid
• Writes the guidelines for all medical billing
• Controls much of medical education
• Will innovate new delivery systems
• Will innovate new payment systems
• Will innovate new guidelines and protocols
• Will incentivize providers to provide quality care
Donald Berwick, M.D.
Cynics beware, I am a romantic about the [UKs]
National Health Service; I love it. All I need to do
to rediscover the romance is to look at health
care in my own country.
Berwick DM, 2008
“We believe, and refuse to be dissuaded, that the
National Health Service, with its moral intent,
commitment to equity, and store of knowledge,
has the inherent capability to become the
greatest healthcare system of any nation.”
Berwick DM, 2006
“As Americans, we know dependence on market
forces for constructive change is playing
with fire.”
Berwick DM, 2006
“Young doctors and nurses should emerge from
training understanding the values of
standardization and the risks of too great an
emphasis on individual autonomy.”
Berwick DM, 2005
“An immense resource for progress in improving
the NHS—the key resource, in my view—has
been the consistent focus of government,
emanating from the Prime Minister personally, on
raising the bar for NHS performance.”
Berwick DM, 2004
“The modernization process sought to establish
accountabilities, structures, resources, and
schedules in the NHS that no one at all is in a
position to establish in the pluralistic, chaotic,
leaderless US healthcare system.”
Berwick DM, 2004
“The UK can decide, as an entire nation, to
improve its cancer care outcomes... Indeed, the
recent NHS Plan proposes exactly those
improvements and backs up the strategy with
specific plans, accountable management
structures, and major infusions of money.”
Berwick DM, 2000
UK Cancer Outcomes
• Breast Cancer – 88% worse than U.S.
• Prostate Cancer - 604%
• Worse in literally every other major form of
cancer
People are policy
What are we talking about?
• Guidelines
• Incentive payments
• Penalties in ratings and payments
• Outcomes payments
• Hospital ratings combined with bundling
• State mandates for medicaid
• Etc, etc, etc...
Privacy
SEC. 4302.
UNDERSTANDING HEALTH
DISPARITIES: DATA COLLECTION
AND ANALYSIS.
Data Collection
• Begins within 2 years
• All federally funded or supported:
– Health care, public health program, activity or
survey
– Includes Dept. of Labor and Census surveys
• Measures sex, primary language, disability
status
• Includes anything else deemed apropriate
by the Secretary of HHS
...sufficient data to generate statistically reliable
estimates by racial, ethnic, sex, primary language,
and disability status subgroups for applicants,
recipients or participants using, if needed, statistical
oversamples of these subpopulations
...any other demographic data as deemed appropriate
by the Secretary regarding health disparities.
Sources of Data
• Reported by applicant, recipient, or
participant
• Reported by parents of above
• Health care providers
– How many have disability compliant equpment
– How many employees have been trained in
“disability awareness”, etc.
• Will include at a minimum info on race,
ethnicity, sex, primary language, and
disability status
Who gets it?
• Office of Minority Health
• National Center on Minority Health and Health
Disparities
• Agency for Healthcare Research and Quality
• Centers for Disease Control and Prevention
• Centers for Medicare and Medicaid Services
• Indian Health Service and associated studies
• Office of Rural Health
• Anyone else the Secretary of HHS wants
‘‘(2) REPORTING OF DATA.—The Secretary shall report data
and analyses described in (a) and (b) through—
‘‘(A) public postings on the Internet websites of the
Department of Health and Human Services; and
‘‘(B) any other reporting or dissemination mechanisms
determined appropriate by the Secretary.
‘‘(3) AVAILABILITY OF DATA.—The Secretary may make data
described in (a) and (b) available for additional research,
analyses, and dissemination to other Federal agencies, non-
governmental entities, and the public,
SEC. 4203. REMOVING BARRIERS AND IMPROVING
ACCESS TO WELLNESS FOR INDIVIDUALS WITH
DISABILITIES.
SEC. 5306. MENTAL AND BEHAVIORAL
HEALTH EDUCATION
AND TRAINING GRANTS.
• B.A.s, M.A.s, Ph.D.s, in social work
• Develop social work teaching faculty
• Higher learning degrees in all aspects of
behavioral health
• Preservice or in-service training of
paraprofessional child/adolescent professionals
Eligibility
(1) participation in the institutions’ programs of individuals and groups from
different racial, ethnic, cultural, geographic, religious, linguistic, and class
backgrounds, and different genders and sexual orientations
(2) knowledge and understanding of the concerns of the individuals and groups
described in subsection (a)
(3) any internship or other field placement program assisted under the grant will
prioritize cultural and linguistic competency
(4) the institution will provide to the Secretary such data, assurances, and
information as the Secretary may require
INSTITUTIONAL REQUIREMENT.—For grants authorized under subsection
(a)(1), at least 4 of the grant recipients shall be historically black colleges or
universities or other minority-serving institutions.
“And finally, don't complain—I have visited
settings in Rwanda, Mozambique, Peru, and
Palestine where every person I met had 100
times more reasons to complain than I do. And
none did. Complaint is waste.”
Berwick DM, 2004
Controversy is only dreaded by the advocates
of error.
Benjamin Rush