Going back to iPhone

In one of my first posts (click here), I commented on my frustrations with my new Microsoft Windows Mobile "smartphone". I even went out on a limb and likened my anxiety with the emotional roller coaster patients sometimes experience in our complex and frequently disconnected health care system. I described the iPhone as the perfect example of when everything comes together just so. The various parts (applications, operating system, hardware) work together. Simply. Reliably. Even beautifully.

Well, it's weeks later and the frustrations remain. Actually, it's worse as the phone increasingly has a habit of freezing right when a call comes in. I'm sure I don't need to tell you that that can be... disrupting. But, thanks to the some good work by our IT Department, relief is on the horizon. Blackberries are coming, and soon. Next week. I jokingly tell our CIO that my present phone has a date with the hard surface below the Lenny Zakim (if you're from Boston, you understand).

So, even with this... I must tell you that I've returned to the iPhone. I'll be one of those guys you see carrying two cellphones. On my Bat Belt, I'm sure. Why? I miss the functionality of the apps I once used. I miss the ability to quickly look information up on-line and to communicate easily with people I work with and family members. I miss being able to see when movies are playing at the local theater, getting walking directions to a downtown restaurant and being able to to jot down notes that will mysteriously, automatically and reliably synchronize over the air (Evernote) with the software I run in the office. The Blackberry is great, but it too is no iPhone. This is a costly move for me, I know. Maybe too costly and one I'll regret. But I don't think so. The iPhone, obviously, has got me and good.

If you're interested in this topic, you might find this article (click here) to be interest. The author details how Microsoft has really missed the boat when it comes to handheld technology and how the future will come down to an Apple vs. Google battle.

Worthwhile

According to the Family Violence Prevention Fund:

• On average, more than three women a day are murdered by their husbands or boyfriends in the United States. In 2005, 1,181 women were murdered by an intimate partner.
• In 2008, the CDC published data showing that women experience two million injuries from intimate partner violence each year.
• Nearly one in four women in the U.S. reports experiencing violence by a current or former spouse or boyfriend at some point in her life.
• There were over 248,000 rapes/sexual assaults in the U.S. in 2007, more than 500 per day, up from nearly 191,000 in 2005.
• The U.S. Justice Department's Bureau of Justice Statistics estimates that 3.4m persons were victims of stalking during a 12-month period in 2005 and 2006.

I'd like to introduce you to an organization that has worked hard to educate the general public, policy makers and government officials on the impact and prevalence of intimate partner violence. It's the Family Violence Prevention Fund. Their website is here.

This is a great time of year to remember this organization and to consider making a donation. Perhaps you can make a gift in someone's name. More information here.

The time is now. Right now!

From an email I just sent to our staff and board members:

On Tuesday, Sens. John Kerry (D-MA), Debbie Stabenow (D-MI), Susan Collins (R-ME), Olympia Snowe (R-ME), Blanche Lincoln (D-AR), Ron Wyden (D-OR), Arlen Specter (D-PA), Tim Johnson (D-SD), and Kirsten Gillibrand (D-NY) filed a bipartisan amendment to reduce the home health cuts in the Senate health care reform bill by nearly $5 billion. This comes on the heels of another amendment by Sen. Kerry — which passed the Senate by a vote of 96 to 0 — to prohibit any reductions in Medicare home health benefits.

National Association for Home Care & Hospice (NAHC) members are encouraged to contact their Senators to urge them to cosponsor the Kerry-Stabenow-Collins-Snowe-Lincoln-Wyden-Specter-Johnson-Gillibrand-Nelson amendment to reduce the home health cuts in the Senate's health care reform bill. Note that additional cosponsors can be added after the amendment is filed; Sen. Ben Nelson (D-NE) has just agreed to add his name as a cosponsor.

We’re fortunate to have Sen. Kerry’s support and leadership in this effort. Soon enough, we’ll have a new Junior Senator in Massachusetts… but in the mean time, interim Senator Paul Kirk will likely have an opportunity to weigh in as well.

Please call or email each of our senators, noting the following:

> Tell them that you work for the Visiting Nurse Association of Boston

> Thank them (particularly, Sen. Kerry) for their longstanding support and leadership in protecting home health benefits

> Urge him to continue the fight on behalf of the many thousands of patients we serve in and around the Boston area

Their contact information:

Kerry, John F. - (D - MA)
Class II
218 RUSSELL SENATE OFFICE BUILDING WASHINGTON DC 20510
(202) 224-2742
Web Form: kerry.senate.gov/contact/email.cfm

Kirk, Paul G., Jr. - (D - MA)
Class I
317 RUSSELL SENATE OFFICE BUILDING WASHINGTON DC 20510
(202) 224-4543
Web Form: kirk.senate.gov/contact/

It will take maybe 3 minutes … but the time to act is right now. You can make a difference!

Thanks very much,

Rey

Public option no more

The "Boston Globe" is reporting that the public option has not survived the latest flurry of Senate negotiations. Fearing that the loss of moderate Democrat votes could topple reform efforts, party leadership has given in on one of the last remaining contentious issues in the debate: the public option. Majority leader Reid suggested that passage is near.

Instead of a true public option, the Democrats have agreed to form a new Federal agency that would oversee private insurers. Additionally, the arrangement calls for Medicare to become available to unsureds over age 54; this marks a critical expansion of the program currently available to those over age 64.

Saving home care?

From a press release by Senator Mitch McConnell (R):

"In voting to cut a half trillion dollars from the Medicare program for seniors, our Democrat friends undercut not only the roughly 40 million seniors who depend on Medicare. They also undercut their own promises about reform." U.S. Senate Republican Leader Mitch McConnell made the following remarks on the Senate floor Saturday regarding the importance of getting it right on health care reform: “The U.S. health care system is in serious need of reform. Costs are too high, they’re rising, and if we do nothing they’ll continue to consume a larger and larger share of federal dollars and of the budgets of millions of middle class American families, of young workers trying to get their start in life, and of seniors.

“For months, the Administration and its allies in Congress promised a solution to these problems, a solution they said would lower costs and help the economy. They assured us that under their proposal anyone who likes the health care plans they have would be able to keep them. And they said their proposal would save Medicare.

“But, in the end, what matters isn’t what we say. It’s what we do. And this week, the proponents of this plan did more with a single vote than they did all year in talking about all the things that their health care plan would do. How? Because in voting to cut a half trillion dollars from the Medicare program for seniors, our Democrat friends undercut not only the roughly 40 million seniors who depend on Medicare. They also undercut their own promises about reform.

“As I said, the President and Congressional Democrats have noted again and again that under their measure those who like the plans they have will be able to keep them. After Thursday’s vote, even Democrats are admitting that’s no longer true. Here’s how one of our Democrat colleagues put it: “We’re not going to be able to say that ‘If you like what you have, you can keep it.” And then he added, “… and that basic commitment that a lot of us around here have made will be called into question.”

“As for the oft-repeated pledge to save Medicare, well, nobody buys that one after Democrats voted Thursday to cut it by half a trillion dollars. These Medicare cuts will impact the quality of care for millions of American seniors. Nearly 11 million seniors on Medicare Advantage will see a reduction in benefits. Hospice care will see massive cuts. Hospitals that treat Medicare patients will see massive cuts. Nursing homes are cut. And more than $40 billion is cut from home health agencies — agencies that provide an appealing alternative to seniors who would rather receive the care and attention they need in the comfort and privacy of their own homes.

First Snow... from Bird Park in Walpole

Boston After Hours

A filibuster? Almost.

Republican senators aren't filibustering, formally, just yet. But you can feel it in the air. Budget Committee member Judd Gregg (NH), in a published letter to his GOP colleagues, has instructed that the party must, "use the tools we have under Senate rules to insist on a full, complete and fully informed debate on the health care legislation...." Gregg notes that the Republican senators much be prepared to claim "certain rights before measures are considered on the floor as well as certain rights during the actual consideration of measures." One wonders what exactly "certain rights" means.

The Democratic response? Senate Majority Leader Harry Reid noted that rather than offering their own comprehensive plan, "the first and only plan Senate Republicans bothered to draft is an instruction manual on how to bring the Senate to a screeching halt."

As the Senate considers amendments, the critical question is whether the process can serve to strengthen the bill... or merely delay it.

The President's Two Wars

Republicans have been unable to slow the health reform momentum largely created by the President's insistence that a package be prepared before the end of the year (and the beginning of the next year, an election one). The recent Get-In-Big, Get-Out-Fast announcement regarding the war in Afghanistan may have given reform opponents just the opportunity they were looking for. Already, Senate Republican leader Mitch McConnell has stated that there's too much on the agenda to wrap up a unified health reform proposal this year. Citing the 30,000 troop build-up (no one is using the word "surge" for obvious political reasons), Senate Republicans are noting that there's no need to rush the reform package. Behind that logic comes a hope that slowing the bus could ultimately halt the bus... thus leaving the President with two important wars on his hands.

"You're going to die sooner..."

So says Senator Tom Coburn, a former obstetrician. Yesterday's Senate debate was heated as proponents and opponents of the health reform proposal clashed over the likely impact of the proposed changes. Describing comments such as Coburn's as merely "scare tactics", Senator Max Baucus argued that the cuts would strengthen the Medicare program's ability to secure lower fees for services provided to seniors.

Senator John McCain, an active tweeter on the subject, has proposed an amendment that would eliminate $400b in Medicare cuts to hospitals, hospices and home care providers. U.S. Seniors are clearly concerned that expanding coverage to the presently uninsured will result in reduced coverage for them. Any and all suggestions of "rationing" are being rebuffed by those who cite the bill's long-term positive impact on cutting costs.

Another amendment has been introduced that would cover expanded preventive services for women, clearly designed to quell fears prompted by the recent recommendation that mammograms could begin for most at age 50.

The good news here seems obvious, but the bad news? The bill's already shaky financial footing is beginning to feel even more shaky.

New York to Boston?

A couple more from the NYC B&W series. Thanks for the comments/emails on these pictures. A few have asked why I've not posted any photos of Boston, aka "the most photogenic city on the planet." Fair enough. Stay tuned.

Health reform budget neutral?

The Congressional Budget Office has said that the net effect of health reform, based on their analysis, will be budget neutral. Many, upon hearing this, are raising their eyebrows and saying "seriously?"

Paul Levy wrote about this yesterday (click here), speculating that the implementation delay is intentional by the Obama administration... pushing the politically charged work out past the next Presidential election cycle. Here are a few other items worth considering:

• The proposed independent Medicare Advisory Board will recommend changes in Medicare reimbursement with limited Congressional oversight. Recommendations impacting hospitals or physicians are off the table through 2019. Expect other providers to be hit hard.
• Between 1 and 2% of hospital Medicare payments will be subject to quality and efficiency targets. Will the savings generated here be enough to offset the higher costs of the overall program? Payments to physicians could be altered based on utilization patterns, but the potential for that will be impacted by the usual process and it will take more political will than government leaders have been able to muster thus far.
• Accountable Care Organizations (ACOs) are introduced, but the currently fragmented system makes implementation difficult. If ACOs become hospital dominated systems, one has to wonder whether hospital systems will be able to effectively take the lead in driving costs down.

There's plenty to like about the proposed health reform legislation... and plenty to be worried about as well.