“Dreamers” bolster physician workforce, should be allowed to stay

To help alleviate the physician shortage and improve access to care, Congress should move quickly to enact legislation that would allow those granted Deferred Action for Childhood Arrivals status—often dubbed “dreamers”—to live and work legally in the U.S. An estimated 5,400 previously ineligible physicians could be introduced into the U.S. health system over the coming decades through a DACA-like legislative fix.

My latest at AMA Wire. Read the whole shebang.

Bridge

Sunlight shimmering on the river water
Leaves me squinty-eyed on a Chicago summer day
The only kind worth a damn in this dreary town
The ladies in their floral dresses
And the men in their short sleeves
Walk briskly toward their midday destinations
While the tourists carefully trace their steps
Speaking in foreign tongues and consulting
Their pocket computers

I take a spot near the Wabash Avenue Bridge
To sip my coffee and let the sun hug my skin
What a lovely day to feel so bereft
An architectural tour boat wades into view
And the guide tells about the building
Where I work, and I wonder whether to wave
It seems like the neighborly thing to be
One more welcoming sight, another
Connection across the skyline

“Yes, I see you down there,” I think, and thrust out my arm
To offer the gentlest, friendliest wave I can conjure
The nonchalant sort that doesn’t beg for notice
Or require any response
But up there go one, two, three hands
Threading the summer wind with their fingers
“Hello,” the hands say as the boat parts the waters
And their owners’ faces become the backs of heads
Yes, they saw me standing up here
With my back to the glass and steel

Genome editing and the AMA “Code of Medical Ethics”

An international team of researchers recently published, in the journal Nature, their study using genome editing to correct a heterozygous mutation in human preimplantation embryos using a technique called CRISPR-Cas9. This bench research, while far from bedside use, raises questions about the medical ethics of what could be considered “genetic engineering.” The AMA “Code of Medical Ethics” has guidance for physicians conducting research in this area.

My latest at AMA Wire. Read the whole shebang.

Senate should reject ACA repeal, replace bills

Ahead of a planned vote in the Senate on Tuesday, AMA Executive Vice President and CEO James L. Madara, MD, made it clear that neither of the bills senators may consider contain the necessary elements to earn the support of America’s physicians.

“We urge the Senate to reject efforts to repeal or replace the Affordable Care Act,” Dr. Madara wrote in a letter to Senate leaders, asking that they “work instead toward improvements that will increase access to affordable, quality health care coverage for all Americans.” He noted further that “recent revisions do not correct core elements that will lead to millions of Americans losing health insurance coverage with a resulting decline in both health status and outcomes.”

My latest at AMA Wire. Read the whole shebang.

Jeff Bezos’ charitable drive and the “Code of Medical Ethics”

When billionaire Jeff Bezos—the founder of Amazon.com Inc.—recently posted to Twitter seeking suggestions on how to make the best charitable use of his vast holdings, he was met with a wealth of responses almost as impressive as his estimated $80 billion fortune. Nearly 50,000 responses have poured in so far.

For physicians seeking to do good through charity, the AMA “Code of Medical Ethics” has guidance for them to keep in mind when soliciting contributions from their patients.

My latest at AMA Wire. Read the whole shebang.

9 battleground states show health reform’s high stakes

Lora Wilkerson does not have to look far to see the potential effect of the Senate’s ongoing efforts to overhaul the nation’s health system. The Charleston, West Virginia, woman needs only peer into the bright eyes of her 3-year-old granddaughter, Ellie.

The girl was diagnosed at 18 months old with rhabdomyosarcoma, a rare cancer that mostly affects children. Wilkerson said Ellie is still alive because of the Medicaid coverage and patient protections available under the current health care law, provisions that the latest version of the Senate’s Better Care Reconciliation Act of 2017 (BCRA) would overturn.

“Ellie would have died,” Wilkerson said at a press event held Thursday in Charleston, West Virginia. “Ellie survives, but continues to have nerve damage in her hands and feet.” The girl receives physical, occupational and speech therapy on a weekly basis.

Little Ellie is just one of more than 180,000 West Virginians now covered by Medicaid expansion under the Affordable Care Act (ACA). Their coverage is threatened by the BCRA provision that would phase out the enhanced rate at which the federal government funds Medicaid expansion between 2021 and 2023. Expanded Medicaid makes coverage available to people who earn too much to qualify for the traditional Medicaid program but earn less than 138 percent of the federal poverty line (that is $28,180 for a family of three in West Virginia).

My latest at AMA Wire. Read the whole shebang.

Revised Senate bill fails to address core AMA concerns

A revised draft of the Senate’s Better Care Reconciliation Act of 2017 (BCRA) was released Thursday, and new spending and coverage estimates from the Congressional Budget Office are expected to be released Monday.

In a statement, AMA President David O. Barbe, MD, MHA, said “the revised bill does not address the key concerns of physicians and patients regarding proposed Medicaid cuts and inadequate subsidies that will result in millions of Americans losing health insurance coverage.” Added funding to address the opioid epidemic “is a positive step,” he said, but “those suffering from substance-use disorder have other health care needs that are not likely to be addressed if they lose coverage through a rollback of the Medicaid expansion.”

My latest at AMA Wire. Read the whole shebang.

Recently …

It has been a hectic time, and so I have let slip on my usual practice of blogging links to my new bylined stories at AMA Wire. Here is a round-up of what was posted in June:

More to come, as always.

The Merest Pleasures

From now on, you say, whenever we come
To this hot-dog restaurant, I will give you
One of the white-and-red round candies that is in my bag
And, you explain, I will always bring two quarters
To buy a very bouncy ball from the machine where
You turn the silver handle really hard and then
Open the little door

There you go again, rewriting the rules
Bending the world to your will
Wrapping us around your sticky little fingers

Oh, for another first taste of peppermint
To feel its sweet sting on my virgin tongue
To twirl the dwindling disc from side to side
And bite off tiny shards that melt in my mouth
Oh, to set my buoyant ball on its maiden
Voyage to the ground with all the force
My little body could muster
Then bounding high into the sky
Taller even than the tree
That is in our front yard

Oh, to believe again that all I could ever want
Is within my grasp
To require the merest pleasures—
A mother’s voice, a father’s hand—
To know no limits, and to have felt
So few of life’s lacerations
Oh, to say a thing and my grown-up makes it so!
And, when crossing, to be warned about letting go

“What a lovely boy you have,” your Papa told me
As he closed the book on story time
You scooched off his lap, careful as you could be
To avoid the tubing from the oxygen tank
When sliding down his swollen, blood-clotted legs

Papa died, I say, because he had the kind of sickness
The doctors do not know how to fix yet
Then a special thing was done to make him so tiny—
It did not hurt, I assure you—
That he fits in a beautiful case up on Nana’s shelf
In the darkness of quiet time
You have asked and so I say
Papa is very small now
You are bigger every day

∞             ∞             ∞

The lawyer felt bad to ask about timing, but he did it anyway
“I’m not a doctor, but I don’t think he’s going to die tomorrow,”
I said, on the day before Papa died

That night we put on a fresh diaper and told him to get some rest
When the nurse went away, we laughed with relief
At another hospice day put to bed

“I love you,” I said, with a kiss on the head
And walked toward the door
The other words that we needed were already said
In the hospital two weeks before

The next morning, Nana called as I stepped in the shower
She said, “He’s not breathing—what do I do?”
I told her that’s what we expected

∞             ∞             ∞

From now on at dinner, you tell me, after four more bites
You will always get two treats from your treat bucket
Not just one, you explain, but two treats from the bucket
That has the lollipops and the chocolate eggs and the M&M’s
And the white-and-red round candies
Always and from now on

Before I was as big as I am now
But not so little as you are today
I thought about always and forever
Being stuck in a darkness that does not end—
I was afraid
Then I grew and grew and grew and grew
And learned that when you are dead
You cannot think or see or hear, taste or touch or smell
Wherever death is, you are not
It is quiet time, always and from then on
And I was pacified

Now I am all grown up (and out)
And I have too many days that bring me back
To what was and can never be
A day in the park, the crack of the bat
A trip down the slide and a shove on the swing
The plink of a piano and the pluck of a guitar string
So much I have is smothered by absence
That is present in every way
Papa is very small now
You are bigger every day

– 30 –

Individual market endangered by uncertainty over subsidies

Health insurers in most states have until June 21 or sooner to decide whether they will participate in the federally facilitated marketplace exchanges in 2018. In several states, that deadline has already passed without any certainty regarding the future of vital federal funding that helps millions of Americans shoulder the burden of deductibles and co-pays.

Billions of dollars in cost-sharing reductions (CSR) that go to an estimated 7 million patients could be affected unless Congress moves quickly to eliminate “the single most destabilizing factor causing double-digit premium increases for 2018,” according to a group of organizations representing America’s physicians, hospitals, businesses, employers and health insurers.

The lede. The whole shebang.

Anthem-Cigna merger threatens innovation, appeals court finds

The U.S. Court of Appeals for the District of Columbia has upheld a lower-court ruling blocking a proposed $54-billion mega-merger between health insurance giants Anthem and Cigna. The appeals court agreed with the trial court’s ruling that this merger would harm patients because it would likely stifle competition and choice, eliminate the existing head-to-head competition between the two insurers, reduce the number of national carriers from four to three, raise premiums, and diminish quality and innovation.

My lede. The whole shebang.