The Missed Opportunities of the Affordable Care Act

Despite the optimistic statements of those who passed the Affordable Care Act who have been designated left wingers, the truth is far different from what is published and stated. Obamacare was and remains a shortcut with no ending, and certainly does not bring us any closer to the stated goal (affordable and accessible). It is neither, nor is it a universal health care system.

Much of our health system remains mired in old ideas and institutions, such as the Veterans Administration, Community Clinics, private practice, university centers, and military medicine. Networks and managed care have grown into another barrier to access care, rather than simplifying it has made it more difficult to negotiate. Health Networks are far from uniform for accessibility largely due to institutional selectivity based upon which system is less onerous, with either reduced reimbursement, increased bureaucracy, and patient accessibility.

The primary care provider remains a gatekeeper in most managed care settings. A cafeteria system of benefits and premiums offer differing copays, deductibles, and scope of services. The relationship is inverse between premium and copays and deductibles. The current version of Obamacare has overall made premiums rise. As we progress lower and lower in income into the population that is close to the poverty level the system deteriorates further.

Those on the edge of subsidy land often have a subsidy which is inadequate for them to purchase a policy. Those who fall into the range of medi-caid face greater obstacles,sometimes making medical care unobtainable except in a life threatening emergency, in which the old system already provided  a safety-net.

Health care has become even more politicized and one is identified by which side of the argument you are on. As physicians we have always ballked at being politicized, for obvious reasons. Political actions will always threaten the quality and consistency of health care. Medical care is not obtained by voting. No one can restore health by voting one way or another. Health care can not be legislated, it can be funded, sometime.

The California Health Care Foundation tracks population health statistics.

Republicans and a few Democrats are using "Repeal Obamacare" as part of their political platform and campaign agendas.

Unwinding Obamacare will be a challenge. The Affordable Care Act created new self interest groups, for HIT, Accountable Care Organizations, and many others in additon to overriding legal costs and new contracting arrangements for insurers, and hospitals.

If Obamacare is repealed or amended, then what ?

Perhaps the most beneficial aspects of the Affordable Care Act is the elimination of pre-existing causes  as a reason for denial.  Standardization of the profit margin ceiling removes some of the profiteering by insurers,  however it is no guarrantee that will remain true. Large institutions have a way of 'cooking the books' transferring any visible profits to another category.  The motive is financial survival and lowering risk of losing assets.  Those are powerful incentives.

The CHCF outlines the Uninsured in California,
The Private Insurance Market in California, 2013, many insurers are in perilous financial condition
While Obamacare has gone into effect, valid long range statistics are still a wild guess. 
If you are still a proponent you can find reasons to state it is successful. A more neutral opinion would state 
otherwise.

Design Challenge: Decision Aid Upgrade

The necessity of communications between health providers and developers has evolved since the explosion of uses for H.I.T. New tools are evolving to manage patient and physician cooperation in management of their disease, alternative treatments and ongoing care. The driving force in studies of American cancer patients, most prefer learning detailed information about their disease and prognosis in a direct and honest manner. Studies also show patients from different cultural backgrounds differ in their need for a prognosis and how they would like to receive it. Despite the vital importance of prognostic information for decision making, many patients today have very little understanding of their prognosis, treatment options, or sources of support. In fact a 2014 study found that only 16% of patients with metastatic cancers had an accurate awareness of their prognosis. Decision aids address this information gap by providing a framework to help patients understand their disease trajectory and consider what is important to them when deciding among different treatment options. Providing treatment and supportive care options, expected outcomes, possible side effects, and success rates empowers patients to align their choices with their values and goals. Decision Aids offers a format for physicians and patients to collaborate on diagnosis, treatment and prognosis. Decision aids address this information gap by providing a framework to help patients understand their disease trajectory and consider what is important to them when deciding among different treatment options. Providing treatment and supportive care options, expected outcomes, possible side effects, and success rates empowers patients to align their choices with their values and goals. However, in the context of advanced lung cancer, decision aids inadequately demonstrate the limitations of multiple rounds of chemotherapy and overlook the benefits of palliative care and other supportive services. Also, current decision aids often lack opportunities for patient engagement and are mostly used by providers in a didactic or instructive fashion. To find better ways to express data and statistics about survivability and sources of support, CHCF partnered with Mad*Pow (a user-centered design studio) and Health 2.0 (a catalyst for the advancement of new health technologies) to present a unique challenge. Designers with skills in user experience, human-centered design, and rapid prototyping are asked to take a set of clinical information and create an experience that promotes shared decision making between patients and physicians. Read more: http://www.chcf.org/rfps/2015/decision-aid-upgrade#ixzz3X3pyxa1w To find better ways to express data and statistics about survivability and sources of support, CHCF partnered with Mad*Pow (a user-centered design studio) and Health 2.0 (a catalyst for the advancement of new health technologies) to present a unique challenge. Designers with skills in user experience, human-centered design, and rapid prototyping are asked to take a set of clinical information and create an experience that promotes shared decisionmaking between patients and physicians. Entries are due by Friday, May 29. More information is available, including challenge submission requirements and evaluation criteria, at the Health 2.0 Developer Challenge website >http://www.health2con.com/devchallenge/chcf-decision-aids-upgrade-challenge/

COMPARISON TOOL:

Those in the digital health space have many opportunities to chose from applications, hardware and the cloud to make the most of their IT investments.  The challenge is made that much harder by the seemingly overwhelming number of choices available.

Step number 

1. Focus and narrow your objectives. 2. Establish your budget  3. Find an efficient source for comparing objects of desire.

4. Enjoy the hunt....it is almost as much fun as catching your prey.

5. When looking for hardware try Engadget's Shopping Tool.

Compare products

The sign of a true geek is not the pencil holder in his shirt, but the list of gadgets he uses.

Ever feel like seeing all the specs stacked up at once? The engadget comparison tool's got you more than covered. Save, sort, highlight, and share your comparisons of up to five products in each category! Add to your comparisons whenever you see a product around the site, or start a comparison by clicking any category below. And don't worry about losing your place, we've got all your stuff stored for later, accessible from the menu bar.

Engadget now has a tool for comparing all sorts of geekology, ranging from computers to cameras, and home audio, and right down to those 'thumb drives'.

Make your choice

2015-03-25 - Centers for Medicare & Medicaid Services

2015-03-25 - Centers for Medicare & Medicaid Services