Monday, April 14, 2014

Obamacare Schadenfreude - The Sebelius Pity Party Continues

One more warm, breezy day here, before the advance of a spring storm system (what, no naming scheme, Weather Channel?), bringing rain, we hope, along with severe storm warnings and cooler temperatures.

What Obamacare Schadenfreude there is today, and it's thing gruel at that, continues to mostly focus on the long hoped for, conveniently timed, totally unexpected ousting resignation of Kathleen Sebelius at HHS

Sebelius: I wasn’t pushed out — staying just “wasn’t an option”
A normal post-first term career change deferred until the the president’s crowning legislative achievement became operational, or the least inopportune moment possible to shove out an incompetent manager after a disastrous performance? The world may never know.
I made a decision at the election that I couldn’t leave along with a lot of my colleagues who left at the end of the first term. That did not seem to be even a topic to consider since there was still one more chapter in this Affordable Care Act that needed to roll out and that had been one of my responsibilities as the secretary of Health and Human Services, so staying on made good sense to me. I also thought that at the end of open enrollment was a logical time to leave. There is never a good time — there’s going to be another open enrollment, there are changes down the road. But the president and I began to talk, you know, after the first of the year, and I went back to him in early March and said, you know, I’m really optimistic that we’re going to meet the targets, and the enrollment is going well. The site is working well. I think once we finish this first chapter, you really should begin to look for the next secretary who can be here through the end of your term. And that really wasn’t a commitment I was willing to make, and he knew that.
Ah, well. I think it’s probably safe to say that her political career has come to a close — but no matter, right? K Street awaits with open arms, I’m sure.
Cruz: ‘Scared Senate Democrats Demanded Sebelius’ Head’
On America’s News HQ this afternoon, Republican Senator Ted Cruz (TX) said her resignation highlights the disaster of ObamaCare, but said she should’ve stepped down a long time ago.

The timing of it is political, Cruz said. “[Senate Democrats] are running scared because every one of them in their races across the country, they’re underwater, they’re losing because ObamaCare has hurt so many millions of people.”
Probably as close to the truth as we're going to get.

Sebelius’s Slow-Motion Resignation From the Cabinet
WASHINGTON — Everyone knew it was a disaster. After Kathleen Sebeliusappeared on “The Daily Show with Jon Stewart” last October, she and her staff at the Department of Health and Human Services felt she had been sandbagged by Mr. Stewart. At the White House, President Obama’s top aides were aghast at her wooden performance.

The White House frustration with Ms. Sebelius crystallized by Thanksgiving, as it became clear in Washington that she would eventually have to go. Republicans were brutalizing her at congressional hearings. The health care website’s problems were consuming the White House. Under mounting pressure from congressional Democrats panicking about the fallout from the health care debacle on their fall campaigns, Mr. Obama had already brought in Jeffrey D. Zients, a management guru, to take control of the crisis from Ms. Sebelius.
. . .
But three things put off Ms. Sebelius’s departure: Mr. Obama’s fear that letting people go in the middle of a crisis would delay fixing the website; his belief that ceremonial firings are public concessions to his enemies; and the admiration and personal loyalty that Mr. Obama still felt for Ms. Sebelius and her advocacy for his chief domestic legacy.
Clearly then, not making public concessions to his enemies is more important than doing the right thing.

A bit of pointed humor from Ann Althouse: Andrea Mitchell asks Kathleen Sebelius: "Along the way, what was your low point?"
On "Meet the Press" this morning. And Sebelius said:
Oh, Andrea, it would have to be the time I curled up into a little ball and cried all day. If it weren't for all the ice cream... people say I wasn't good at planning for all the things that could go wrong, but I did have the foresight to load the freezer with chocolate-chip Haagen Dazs... I cried and cried and consoled myself with ice cream and I tell you, Andrea, if it weren't for all that ice cream, I would have committed suicide.Actually, that's not what Sebelius said. That's what I said watching "Meet the Press" and thinking Andrea Mitchell had resorted to an absurdly girlie question.
What Sebelius actually said was: "Well, I would say that the eight weeks where the site was not functioning well for the vast majority of people was a pretty dismal time. And I was frankly hoping and watching and measuring.... " etc. etc.Pretty dismal, but not emotional in any personal way.
More from the "Soon we'll be longing for the good old days of healthcare" Dept: ACA Threatens Promise of Concierge Medicine
Doctors in Texas are showing us what a medical system without comprehensive insurance might look like. The NYT profiles the rise of Texan “direct primary care” practices that don’t accept insurance. Instead, patients pay flat fees out-of-pocket. In return, doctors save both time and money that they can then pass on to patients. By not having to process reimbursements through third party payers, fill out convoluted forms, or hire administrative staff, they can charge their patients less and spend more time with them. Here’s some examples of how different practices are implementing this approach:
In Austin, Drs. William and Mason Jones — a father-son team — practice “concierge medicine,” treating patients under a membership model in which patients pay annual fees for access to a variety of services, including unlimited office visits, routine vaccinations and round-the-clock medical assistance by phone.
Mason Jones said his office was a “low-volume practice” that gives him the “luxury of time” to spend with patients. “This works out great for preventive medicine,” he said [...]
But there’s a catch here, as the article points out. Concierge medicine isn’t a new trend—we’ve covered it here before. But now that Obamacare is swelling the ranks of the comprehensively insured, doctors who don’t take insurance are increasing the pressure on the system. There’s a hint in the NYT piece that other doctors think it’s irresponsible for their colleagues to stop taking insurance just as the Obamacare rollout promises to strain practices and hospitals past capacity. This bias against innovators is what happens when federal legislation cements a dysfunctional system in place. Doctors who want to experiment with new models of payment face social pressure to abandon these experiments because of policy choices made in Washington.

Concierge medicine is part of our medical life as well.  Georgia has problem with what would commonly be written off as "chronic fatigue",  a garbage diagnosis, and went through all the available medical options available under our medical plan.  She heard of another Dr. an internist who runs a private, no-insurance practice.  We started off with a 2 hr appointment to start with (can you imagine a 2 hr appointment with the internist on your plan?) to review the issues, and develop a plan to attack the problem on several fronts.  Although progress is slow, it has been positive, and the cash out of pocket was well worth it.

No comments:

Post a Comment