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

When billionaire Jeff Bezos—the founder of 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.

Flawed AHCA passes House despite outcry from physicians, patients

The U.S. House of Representatives today passed an amended version of the American Health Care Act without an official estimate of the bill’s costs or its impact on the insurance coverage that more than 20 million people have gained in recent years. The 217–213 vote came after a deal that was struck early this week to capture wavering Congressmen added $8 billion in funding over five years to provide assistance to individuals who may be subject to increased premiums because of a pre-existing condition.

My latest. The whole shebang.

Critical treatment gap seen in effort to stem opioid epidemic

Confronted by the gravity of an opioid epidemic that contributes to the deaths of 91 Americans daily, the nation’s physicians are making much greater use of state prescription drug-monitoring programs, reducing opioid prescriptions, and increasing prescriptions for the life-saving antidote naloxone. Tens of thousands of physicians nationwide are now certified to provide office-based medication-assisted treatment for opioid-use disorders, yet there remains a treatment gap that leaves too many patients who want help unable to get it.

My lede. The whole shebang.

New changes don’t fix AHCA shortcomings, threaten key protections

The most recent effort to broaden support for the American Health Care Act, which comes in the form of an amendment proposed by New Jersey Rep. Tom MacArthur, does not address the most serious flaws in the bill and would also undermine critical health insurance consumer protections. For these reasons, the AMA “remains opposed to passage of this legislation,” the Association’s CEO and Executive Vice President, James L. Madara, MD, said today in a letter to House Republican and Democratic leaders.

My lede. The whole shebang.

Appeals court should uphold decision blocking Anthem-Cigna merger

Giant health insurance company Anthem is appealing a federal judge’s February ruling that blocked its proposed acquisition of fellow health insurer Cigna, arguing that the merger would result in $2.4 billion in “efficiencies” that would benefit consumers. But in an amicus brief filed with the U.S. Court of Appeals for the District of Columbia, the AMA Litigation Center strongly disputed that argument and urged a three-judge panel to uphold the lower court’s ruling to protect patients and physicians.

My latest in AMA Wire. Read the whole shebang.