The Patient Protection and Affordable Care Act Official Government Website

Dr. Obama

Patient Protection and Affordable Care Act
From Wikipedia, the free encyclopedia


The Patient Protection and Affordable Care Act (PPACA) is a United States federal statute that was signed into law by President Barack Obama on March 23, 2010. The law (along with the Health Care and Education Reconciliation Act of 2010) is a product of the health care reform agenda of the 111th United States Congress and the Obama administration. The PPACA reforms certain aspects of the private health insurance industry and public health insurance programs, including increasing insurance coverage of pre-existing conditions and expanding access to insurance to over 30 million Americans. Read more here

FRONTLINE | Sick Around America | PBS
Introduction March 31, 2009

As the worsening economy leads to massive job losses—potentially forcing millions more Americans to go without health insurance—FRONTLINE travels the country examining the nation's broken health care system and explores the need for a fundamental overhaul. Veteran FRONTLINE producer Jon Palfreman dissects the private insurance system, a system that not only fails to cover 46 million Americans but also leaves millions more underinsured and at risk of bankruptcy. Read more here

Health care reform in the United States
From Wikipedia, the free encyclopedia


Health care reform in the United States has a long history, including two federal statutes enacted in 2010: the Patient Protection and Affordable Care Act (PPACA), signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010 (H.R. 4872 ), which amended the PPACA and became law on March 30. Read more here

Rick Ungar

Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798
Forbes
by Rick Ungar
January 17, 2011

The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court. The pleadings, in part, read -

The Constitution nowhere authorizes the United States to mandate, either directly or under threat of penalty, that all citizens and legal residents have qualifying health care coverage. State of Florida v. US Department of HHS

It turns out, the Founding Fathers would beg to disagree.
In July of 1798, Congress passed – and President John Adams signed - "An Act for the Relief of Sick and Disabled Seaman." The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insurance.


Keep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitution. Read more here

John Adams

Newsflash: Founders favored "government run health care"
The Washington Post
By Greg Sargent
January 20, 2011

Forbes writer Rick Ungar is getting some attention for a piece arguing that history shows that John Adams supported a strong Federal role in health care. Ungar argues that Adams even championed an early measure utilizing the concept behind the individual mandate, which Tea Partyers say is unconsittutional.

I just ran this theory past a professor of history who specializes in the early republic, and he said there's actually something to it. Short version: There's no proof from the historical record that Adams would have backed the idea behind the individual mandate in particular. But it is fair to conclude, the professor says, that the founding generation supported the basic idea of government run health care, and the use of mandatory taxation to pay for it.

Here's the background. Ungar points out that in July of 1798, Congress passed "An Act for the Relief of Sick and Disabled Seaman," which was signed by President Adams. That law authorized the creation of a government operated system of marine hospitals and mandated that laboring merchant marine sailors pay a tax to support it.

Ungar argues that this blows away the argument made by many opponents of the individual mandate: That it's unconstitutional to mandate that all citizens purchase health coverage, or that this violates the founding fathers' view of the proper role of government. Read more here

FRONTLINE

Sick Around The World

United Kingdom

Percentage of Gross Domestic Product (GDP) spent on health care: 8.3

Average family premium: None; funded by taxation.

Co-payments: None for most services; some co-pays for dental care, eyeglasses and 5 percent of prescriptions. Young people and the elderly are exempt from all drug co-pays.

What is it? The British system is "socialized medicine" because the government both provides and pays for health care. Britons pay taxes for health care, and the government-run National Health Service (NHS) distributes those funds to health care providers. Hospital doctors are paid salaries. General practitioners (GPs), who run private practices, are paid based on the number of patients they see. A small number of specialists work outside the NHS and see private-pay patients.

How does it work? Because the system is funded through taxes, administrative costs are low; there are no bills to collect or claims to review. Patients have a "medical home" in their GP, who also serves as a gatekeeper to the rest of the system; patients must see their GP before going to a specialist. GPs, who are paid extra for keeping their patients healthy, are instrumental in preventive care, an area in which Britain is a world leader.

What are the concerns? The stereotype of socialized medicine -- long waits and limited choice -- still has some truth. In response, the British government has instituted reforms to help make care more competitive and give patients more choice. Hospitals now compete for NHS funds distributed by local Primary Care Trusts, and starting in April 2008 patients are able to choose where they want to be treated for many procedures. Read more here

Japan

Percentage of GDP spent on health care: 8

Average family premium: $280 per month, with employers paying more than half.

Co-payments: 30 percent of the cost of a procedure, but the total amount paid in a month is capped according to income.

What is it? Japan uses a "social insurance" system in which all citizens are required to have health insurance, either through their work or purchased from a nonprofit, community-based plan. Those who can't afford the premiums receive public assistance. Most health insurance is private; doctors and almost all hospitals are in the private sector.

How does it work? Japan boasts some of the best health statistics in the world, no doubt due in part to the Japanese diet and lifestyle. Unlike the U.K., there are no gatekeepers; the Japanese can go to any specialist when and as often as they like. Every two years the Ministry of Health negotiates with physicians to set the price for every procedure. This helps keeps costs down.

What are the concerns? In fact, Japan has been so successful at keeping costs down that Japan now spends too little on health care; half of the hospitals in Japan are operating in the red. Having no gatekeepers means there's no check on how often the Japanese use health care, and patients may lack a medical home. Read more here

Germany

Percentage of GDP spent on health care: 10.7

Average family premium: $750 per month; premiums are pegged to patients' income.

Co-payments: 10 euros ($15) every three months; some patients, like pregnant women, are exempt.

What is it? Germany, like Japan, uses a social insurance model. In fact, Germany is the birthplace of social insurance, which dates back to Chancellor Otto von Bismarck. But unlike the Japanese, who get insurance from work or are assigned to a community fund, Germans are free to buy their insurance from one of more than 200 private, nonprofit "sickness funds." As in Japan, the poor receive public assistance to pay their premiums.

How does it work? Sickness funds are nonprofit and cannot deny coverage based on preexisting conditions; they compete with each other for members, and fund managers are paid based on the size of their enrollments. Like Japan, Germany is a single-payment system, but instead of the government negotiating the prices, the sickness funds bargain with doctors as a group. Germans can go straight to a specialist without first seeing a gatekeeper doctor, but they may pay a higher co-pay if they do.

What are the concerns? The single-payment system leaves some German doctors feeling underpaid. A family doctor in Germany makes about two-thirds as much as he or she would in America. (Then again, German doctors pay much less for malpractice insurance, and many attend medical school for free.) Germany also lets the richest 10 percent opt out of the sickness funds in favor of U.S.-style for-profit insurance. These patients are generally seen more quickly by doctors, because the for-profit insurers pay doctors more than the sickness funds. Read more here

Taiwan

Percentage GDP spent on health care: 6.3

Average family premium: $650 per year for a family for four.

Co-payments: 20 percent of the cost of drugs, up to $6.50; up to $7 for outpatient care; $1.80 for dental and traditional Chinese medicine. There are exemptions for major diseases, childbirth, preventive services, and for the poor, veterans, and children.

What is it? Taiwan adopted a "National Health Insurance" model in 1995 after studying other countries' systems. Like Japan and Germany, all citizens must have insurance, but there is only one, government-run insurer. Working people pay premiums split with their employers; others pay flat rates with government help; and some groups, like the poor and veterans, are fully subsidized. The resulting system is similar to Canada's -- and the U.S. Medicare program.

How does it work? Taiwan's new health system extended insurance to the 40 percent of the population that lacked it while actually decreasing the growth of health care spending. The Taiwanese can see any doctor without a referral. Every citizen has a smart card, which is used to store his or her medical history and bill the national insurer. The system also helps public health officials monitor standards and effect policy changes nationwide. Thanks to this use of technology and the country's single insurer, Taiwan's health care system has the lowest administrative costs in the world.

What are the concerns? Like Japan, Taiwan's system is not taking in enough money to cover the medical care it provides. The problem is compounded by politics, because it is up to Taiwan's parliament to approve an increase in insurance premiums, which it has only done once since the program was enacted. Read more here

Switzerland

Percentage of GDP spent on health care: 11.6

Average monthly family premium: $750, paid entirely by consumers; there are government subsidies for low-income citizens.

Co-payments: 10 percent of the cost of services, up to $420 per year.

What is it? The Swiss system is social insurance like in Japan and Germany, voted in by a national referendum in 1994. Switzerland didn't have far to go to achieve universal coverage; 95 percent of the population already had voluntary insurance when the law was passed. All citizens are required to have coverage; those not covered were automatically assigned to a company. The government provides assistance to those who can't afford the premiums.

How does it work? The Swiss example shows that universal coverage is possible, even in a highly capitalist nation with powerful insurance and pharmaceutical industries. Insurance companies are not allowed to make a profit on basic care and are prohibited from cherry-picking only young and healthy applicants. They can make money on supplemental insurance, however. As in Germany, the insurers negotiate with providers to set standard prices for services, but drug prices are set by the government.

What are the concerns? The Swiss system is the second most expensive in the world -- but it's still far cheaper than U.S. health care. Drug prices are still slightly higher than in other European nations, and even then the discounts may be subsidized by the more expensive U.S. market, where some Swiss drug companies make one-third of their profits. In general, the Swiss do not have gatekeeper doctors, although some insurance plans require them or give a discount to consumers who use them. Read more here

Medicare (United States)
From Wikipedia, the free encyclopedia


Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other special criteria. Medicare in the United States somewhat resembles a single-payer health care system, but is not. "Original Medicare" plans (when Medicare Advantage has not been elected) cover 80% of the Medicare-approved amount of any given medical cost; the remaining 20% of cost must be paid by either a Medicare Supplement plan, which is a "supplemental insurance" from a private health insurance company (normally requiring a monthly insurance premium paid to that company by the holder), or out-of-pocket via the patient's own personal funds (check, money order, cash, etc.). Medicare Advantage plans are not Medicare Supplements, but take the place of "Original Medicare". In return for a premium, these plans share costs and cap out of pocket expenses.

The Medicare program also funds residency training programs for the vast majority of physicians in the United States.

The Social Security Act of 1965 was signed into law on July 30, 1965, by President Lyndon B. Johnson as amendments to existing Social Security legislation. This legislation included the establishing of the Medicare program. At the bill-signing ceremony, Johnson enrolled former President Harry S. Truman as the first Medicare beneficiary and presented him with the first Medicare card, and Truman's wife Bess, the second. Read more here

Letter: The real value of Medicare
Memphis Commercial Appeal
by Arthur J. Sutherland III, M.D.
January 9, 2012

Gerald Friedman, a professor of economics at the University of Massachusetts-Amherst, made this comment last summer on the Dollars & Sense: Real World Economics website:

"America's broken health care system suffers from what appear to be two separate problems. From the right, a chorus warns of the dangers of rising costs; we on the left focus on the growing number of people going without health care because they lack adequate insurance. ... But the division between the problem of cost and the problem of coverage is misguided. It is founded on the assumption ... that the current market system is efficient. Instead, however, the current system is inherently inefficient; it is the very source of the rising cost pressures. In fact, the only way we can control health care costs and avoid fiscal and economic catastrophe is to establish a single-payer system with universal coverage." Read more here

Blue Cross Blue Shield Association
From Wikipedia, the free encyclopedia

The Blue Cross Blue Shield Association (BCBSA) is a federation of 39 separate health insurance organizations and companies in the United States. Combined, they directly or indirectly provide health insurance to over 100 million Americans. The history of Blue Cross dates back to 1929, while the history of Blue Shield dates to 1939. The Blue Cross Association dates back to 1960, while its Blue Shield counterpart was actually created in 1948. The two organizations merged in 1982, forming the current association. The company has its headquarters in the Michigan Plaza complex in the Chicago Loop area of Chicago, Illinois. Read more here

Public health-care in China
From Wikipedia, the free encyclopedia

China is undertaking reform of its health-care system. The New Rural Co-operative Medical Care System (NRCMCS) is a 2005 initiative to overhaul the healthcare system, particularly intended to make it more affordable for the rural poor . Under the NRCMCS, the annual cost of medical coverage is 50 yuan (US$7) per person. Of that, 20 yuan is paid in by the central government, 20 yuan by the provincial government and a contribution of 10 yuan is made by the patient. As of September 2007, around 80% of the rural population of China had signed up (about 685 million people). The system is tiered, depending on the location. If patients go to a small hospital or clinic in their local town, the system will cover roughly 70-80% of their bill. If the patient visits a county clinic, the percentage of the cost being covered falls to about 60%. If the patient requires a specialist in a modern city hospital, the plan would cover about 30% of the bill. Read more here

Health care in Canada
From Wikipedia, the free encyclopedia

Health care in Canada is delivered through a publicly funded health care system, which is mostly free at the point of use and has most services provided by private entities. It is guided by the provisions of the Canada Health Act. The government assures the quality of care through federal standards. The government does not participate in day-to-day care or collect any information about an individual's health, which remains confidential between a person and his or her physician. Canada's provincially based Medicare systems are cost-effective partly because of their administrative simplicity. In each province each doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses health care to be involved in billing and reclaim. Private insurance is only a minimal part of the overall health care system. Competitive practices such as advertising are kept to a minimum, thus maximizing the percentage of revenues that go directly towards care. In general, costs are paid through funding from income taxes, although British Columbia is the only province to impose a fixed monthly premium which is waived or reduced for those on low incomes. There are no deductibles on basic health care and co-pays are extremely low or non-existent (supplemental insurance such as Fair Pharmacare may have deductibles, depending on income). Read more here

The New England Journal of Medicine
Private Health Care in Canada
by Robert Steinbrook, M.D.
N Engl J Med 2006; 354:1661-1664

The hallmarks of Canada's government-funded universal health care system include the public provision of core physician and hospital services and the absence of copayments and other patient charges.1 The system is often championed as a reflection of Canadian values and as an alternative that the United States might emulate. In 2003, Canada's health care spending per capita was $3,003 — higher than that of some European countries and Japan but about half that of the United States (see tableHealth Care Statistics for Canada and Other Countries.). Canada's spending as a proportion of gross domestic product has remained steady, while many other countries have been spending an increasing proportion on health care. Now, however, Canada's system, called Medicare, is under attack for inefficiency, insufficient funding, and failure to meet some patients' needs in a timely fashion. Read more here

Canada's Supreme Court Chips Away at National Health Care
The New York Times
By CLIFFORD KRAUSS
Published: June 9, 2005

TORONTO, June 9 - The Canadian Supreme Court struck down a Quebec law banning private medical insurance today, dealing an acute blow to the publicly financed national health care system.

The court stopped short of striking down the constitutionality of the country's vaunted nationwide coverage, but legal experts said the ruling would open the door to a wave of lawsuits challenging the health care system in other provinces.

The system, providing Canadians with free doctor's services that are paid for by taxes, has generally been supported by the public, and is broadly identified with the Canadian national character. Read more here

Health care in Mexico
From Wikipedia, the free encyclopedia

Health care in Mexico is provided via public institutions, private entities, or private physicians. Health care delivered through private health care organizations operates entirely on the free-market system, i.e., it is available to those who can afford it. This is also the case of health care obtained from private physicians at their private office or clinic. Public health care delivery, on the other hand, is accomplished via an elaborate provisioning and delivery system put in place by the Mexican Federal Government. Read more here

Healthcare in Cuba
From Wikipedia, the free encyclopedia

The Cuban government operates a national health system and assumes fiscal and administrative responsibility for the health care of all its citizens. There are no private hospitals or clinics as all health services are government-run. The present Minister for Public Health is Roberto Morales Ojeda.

An overall improvement in terms of disease and infant mortality rates was observed in the 1960s. AIDS is only one-sixth as common on a per-capita basis as in the United States. Like the rest of the Cuban economy, Cuban medical care suffered following the end of Soviet subsidies in 1991; the stepping up of the US embargo against Cuba at this time also had an effect. Cuba has one of the highest life expectancy rates in the region, with the average citizen living to 77.7 years old (in comparison to the United States' 77.4 years). Read more here

Supreme Court to Hear Challenge to Health-Care Law; Case Arrives ‘On a Winning Streak’ for US
ABA Journal Law New Now
by Debra Cassens Weiss
November 14, 2011

The court granted cert today in three cases and allowed extra oral argument time when the case is heard in March, SCOTUSblog reports. As a result of the schedule, the case will be decided only months before the presidential elections, USA Today reports. The court gave the parties a total of 5 1/2 hours to argue the cases, apparently setting a modern record, SCOTUSblog says.

According to the Los Angeles Times, the law has arrived at the court "riding a surprising winning streak and carrying a constitutional stamp of approval from prominent conservative judges."

Only three out of 12 federal appeals judges who considered the law voted to overturn it. The rulings provide arguments for upholding the law that could appeal even to some conservatives on the court, the newspaper says.

The major issue: whether Congress can require individuals to buy health insurance or pay a penalty. Two leading conservative judges—Jeffrey Sutton of the 6th U.S. Circuit Court of Appeals and Laurence Silberman of the U.S. Court of Appeals for the District of Columbia Circuit—wrote opinions upholding the law.

Both relied on a 2005 Supreme Court opinion, Gonzales v. Raich, upholding the federal government’s authority to regulate pot. The court held in Raich that the federal government had commerce clause authority to ban medical marijuana, even when the drug doesn’t cross state lines.

Four federal appeals courts have considered the health-care law. Two upheld it, one struck it down, and one found the state of Virginia had no standing to challenge it.

The New York Times also has a story on the pending constitutional questions. Read more here

The Constitutionality of the Individual Mandate
The New England Journal of Medicine

Since the Affordable Care Act was passed, numerous lawsuits have been filed arguing that the federal mandate that individuals obtain health insurance is unconstitutional. Three appeals courts have issued mixed rulings, and the matter will probably ultimately be decided by the Supreme Court. In this video roundtable, Wendy Mariner moderates a discussion between legal scholars Jack Balkin and Ilya Somin focusing on the relevant constitutional issues. Read more here

Eleventh Circuit Rules Individual Mandate is Unconstitutional
The BLT: The Blog of Legal Times
August 12, 2011

Setting up a circuit conflict over the most controversial part of the health care reform law, a divided panel of the U.S. Court of Appeals for the 11th Circuit has just ruled that the "individual mandate" feature exceeds the authority of Congress to legislate under the Constitution.

"This economic mandate represents a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them re-purchase that insurance product every month for their entire lives," the ruling states.

That judgment runs counter the decision in late June by the U.S. Court of Appeals for the 6th Circuit that upheld the mandate as a justifiable exercise of congressional Commerce Clause power. The mandate requires most individuals to obtain at least a minimum of insurance coverage, as a way of spreading health care costs to a larger pool of individuals.

The likelihood that the Supreme Court would ultimately decide the issue was never in much doubt, but today's decision makes that prospect even more certain, because the most common justification for Supreme Court review is now met: a conflict between two circuits. It also makes it more likely that the battle will be joined at the high court in the coming term, before next year's presidential election. Read more here

Most Physicians Will Be Sued for Medical Malpractice, Though Payouts Are Few, Study Finds
ABA Journal Law News Now
August 18, 2011
by Debra Cassens Weiss

Most physicians and virtually every surgeon will face a medical malpractice claim at least once in their careers, a study has found.

But only one claim out of five results in a settlement or other payout, the Associated Press and the Boston Globe report. Neurosurgeons and heart surgeons are sued the most, while pediatricians and psychiatrists are sued the least. Across specialties, the average indemnity payment was about $275,00 and the median was about $112,000.

The study, published in the New England Journal of Medicine, analyzed medical malpractice data from a national insurer for the years 1991 to 2005. "Our study uncovered an important aspect of malpractice liability: the high likelihood of claims that do not result in payments to a plaintiff," the authors write. Yet physicians consistently report concerns about malpractice claims, "suggesting that the risk of being sued alone may create a tangible fear among physicians."

One of the study authors is economist Amitabh Chandra, a public policy professor at the Harvard Kennedy School of Government. He said the study highlights the need to resolve med-mal disputes before litigation. "In some sense, the payment is the least important part, because you can insure against it, but you can’t insure against the hassle cost," Chandra told the Globe.

Read more here

Malpractice Risk According to Physician Specialty
The New England Journal of Medicine
August 18, 2011
N Engl J Med 2011; 365:629-636

Background: Data are lacking on the proportion of physicians who face malpractice claims in a year, the size of those claims, and the cumulative career malpractice risk according to specialty.

Results: Each year during the study period, 7.4% of all physicians had a malpractice claim, with 1.6% having a claim leading to a payment (i.e., 78% of all claims did not result in payments to claimants). The proportion of physicians facing a claim each year ranged from 19.1% in neurosurgery, 18.9% in thoracic–cardiovascular surgery, and 15.3% in general surgery to 5.2% in family medicine, 3.1% in pediatrics, and 2.6% in psychiatry. The mean indemnity payment was $274,887, and the median was $111,749. Mean payments ranged from $117,832 for dermatology to $520,923 for pediatrics. It was estimated that by the age of 65 years, 75% of physicians in low-risk specialties had faced a malpractice claim, as compared with 99% of physicians in high-risk specialties. Read more here

Remarks by the President to a Joint Session of Congress on Health Care
September 9, 2009

"Now, finally, many in this chamber -- particularly on the Republican side of the aisle -- have long insisted that reforming our medical malpractice laws can help bring down the cost of health care. (Applause.) Now -- there you go. There you go. Now, I don't believe malpractice reform is a silver bullet, but I've talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. (Applause.) So I'm proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. (Applause.) I know that the Bush administration considered authorizing demonstration projects in individual states to test these ideas. I think it's a good idea, and I'm directing my Secretary of Health and Human Services to move forward on this initiative today. (Applause.)"

Defensive medicine
From Wikipedia, the free encyclopedia

Defensive medicine is the practice of diagnostic or therapeutic measures conducted primarily not to ensure the health of the patient, but as a safeguard against possible malpractice liability. Fear of litigation has been cited as the driving force behind defensive medicine, however even critics of the litigation system have found that a more fundamental motive may be a deliberate increase of services to create revenue. Defensive medicine is especially common in the United States of America, with rates as high as 79% to 93%, particularly in emergency medicine, obstetrics, and other high-risk specialties. Read more here

Medical malpractice
From Wikipedia, the free encyclopedia

Medical malpractice is professional negligence by act or omission by a health care provider in which the treatment provided falls below the accepted standard of practice in the medical community and causes injury or death to the patient, with most cases involving medical error. Standards and regulations for medical malpractice vary by country and jurisdiction within countries. Medical professionals may obtain professional liability insurances to offset the risk and costs of lawsuits based on medical malpractice. Read more here

Lawsuit-wary docs drive up costs with unnecessary tests
Tampa Bay Times
by Susan Taylor Martin
October 3, 2009

Ed Homan, an orthopedic surgeon in Tampa, often sees patients complaining of knee pain. Based on a $40 X-ray and his 40 years of experience, he can usually tell if it is only a sprain.

But there's also a remote chance the pain is caused by a malignant tumor. Rather than risk being sued for a wrong diagnosis, Homan may order an $800 CT scan.

"You want to make sure you don't make any mistakes," he says. "There's a question of where the line is between very thorough, good medicine and where it becomes defensive medicine."

Concern over the nation's soaring health care costs has increasingly focused on defensive medicine — unnecessary tests, procedures, referrals and consultations ordered by physicians who are afraid of being slapped with lawsuits.

"I've talked to enough doctors," President Barack Obama said in his recent speech to Congress, ''to know that defensive medicine may be contributing to unnecessary costs." Read more here

Female-Owned Personal Injury Law Firm Sparks Billboard Battle in Detroit
ABA Journal Law News Now
by Martha Neil
August 8, 2011

Television is still a major advertising medium for personal injury lawyers in and around Detroit. But a relatively new and unusual competitor has sparked a growing billboard battle in recent years.

Operating what she says is the first PI firm in the state headed by a woman, 47-year-old Joumana Kayrouz promoted her law practice on dozens of billboards, forcing male competitors to do the same, reports the Free Press.

"She came out of nowhere with a very unique idea," says prominent PI attorney Vernon Johnson of Kayrouz. "Because of her success, you see the big hitters doing the same. She's done a great job."

Local billboard companies say their business has increased as a result of all the attorney faces and catchy phone numbers plastered around town, although some of the principal competitors, including Kayrouz, deny they're advertising in reaction to one another.

Typical billboards include a lawyer's name, photo and a catchy phrase to help viewers remember the phone number to call. But one attorney has become so well-known from his "call Sam" television commercials that his billboard simply shows his photo in place of the final digits of his phone number. Read more here

Infographic: America, The Lawsuit-Happy Nation
Zero Hedge
by Econmatters
August 27, 2011


According to the latest BLS national wage estimate through May 2010, the mean annual salary for lawyers was around $129,440, which partly accounts for the fact that the U.S. has one of the highest number of lawyers per capita in the world.
Based on data from the American Bar Association, there are over 1.2 million lawyers in the United States. That's one attorney for every 254 Americans, which also makes some of the stunning statistics (and what a waste of resources) illustrated in the infographic below somewhat "logical":

• 15 million lawsuits will be filed in 2011 across the U.S.
• A new lawsuit every 2 seconds
• One lawsuit for every 12 adults
• 21 U.S. states are facing a medical liability crisis
• $248.1 billion = the cost to the U.S. tort system (personal injury) in 2009, or $808 per person
• The cost per capita of tort related lawsuits has increased 800% between 1950 to 2009

The Great Recession may have diminished the ability of lawyers to command a higher salary, but probably at the same time also has increased the likelihood of frivolous litigation, as the odds are good for some kind of settlement to avoid an even more costly trial, particularly when insurance companies are involved.

Read more here

Chefs, Butlers, Marble Baths: Hospitals Vie for the Affluent
The New York Times
By NINA BERNSTEIN
January 21, 2012

The feverish patient had spent hours in a crowded emergency room. When she opened her eyes in her Manhattan hospital room last winter, she recalled later, she wondered if she could be hallucinating: "This is like the Four Seasons — where am I?"

The bed linens were by Frette, Italian purveyors of high-thread-count sheets to popes and princes. The bathroom gleamed with polished marble. Huge windows displayed panoramic East River views. And in the hush of her $2,400 suite, a man in a black vest and tie proffered an elaborate menu and told her, "I’ll be your butler."

It was Greenberg 14 South, the elite wing on the new penthouse floor of NewYork-Presbyterian/Weill Cornell hospital. Pampering and décor to rival a grand hotel, if not a Downton Abbey, have long been the hallmark of such "amenities units," often hidden behind closed doors at New York’s premier hospitals. But the phenomenon is escalating here and around the country, health care design specialists say, part of an international competition for wealthy patients willing to pay extra, even as the federal government cuts back hospital reimbursement in pursuit of a more universal and affordable American medical system.

"It’s not just competing on medical grounds and specialties, but competing for customers who can go just about anywhere," said Helen K. Cohen, a specialist in health facilities at the international architectural firm HOK, which recently designed luxury hospital floors in Singapore and London and renovated NewYork-Presbyterian’s elite offerings in the McKeen Pavilion in Washington Heights. "These kinds of patients, they’re paying cash — they’re the best kind of patient to have," she added. "Theoretically, it trickles down."

A waterfall, a grand piano and the image of a giant orchid grace the soaring ninth floor atrium of McKeen, leading to refurbished rooms that, like those in the hospital’s East 68th Street penthouse, cost patients $1,000 to $1,500 a day, and can be combined. That fee is on top of whatever base rate insurance pays to the hospital, or the roughly $4,500 a day that foreigners are charged, according to the hospital’s international services department.

But in the age of Occupy Wall Street, catering to the rich can be trickier than ever, noted Avani Parikh, who worked for NewYork-Presbyterian as in-house project leader when the 14th floor was undertaken. She pointed to the recent ruckus at Lenox Hill Hospital, where parents with newborns in the intensive-care unit complained that security guards had restricted their movements and papered over hospital security cameras in their zeal to please Jay-Z (real name Shawn Carter) and Beyoncé Knowles, whose daughter was born on Jan. 7 in a new "executive suite."

Read more here

More Physicians Say No to Endless Workdays
The New York Times
by GARDINER HARRIS
April 1, 2011

HONESDALE, Pa. — Even as a girl, Dr. Kate Dewar seemed destined to inherit the small-town medical practice of her grandfather and father. At 4, she could explain how to insert a pulmonary catheter. At 12, she could suture a gash. And when she entered medical school, she and her father talked eagerly about practicing together.

But when she finishes residency this summer, Dr. Dewar, 31, will not be going home. Instead, she will take a job as a salaried emergency room doctor at a hospital in Elmira, N.Y., two hours away. An important reason is that she prefers the fast pace and interesting puzzles of emergency medicine, but another reason is that on Feb. 7 she gave birth to twins, and she cannot imagine raising them while working as hard as her father did.

"My father tried really hard to get home, but work always got in the way," Dr. Dewar said. "Even on Christmas morning, we would have to wait to open our presents until Dad was done rounding at the hospital."

Dr. Dewar’s change of heart demonstrates the significant changes in American medicine that are transforming the way patients get care.

For decades, medicine has been dominated by fiercely independent doctors who owned their practices, worked night and day, had comfortable incomes and rarely saw their families.

But with two babies, Dr. Dewar wants a life different from her father’s and grandfather’s. So instead of being an entrepreneur, she will become an employee of a large corporation working 36 hours a week — half the hours her father and grandfather worked. Read more here

High-end medical option prompts Medicare worries
Yahoo/Associated Press
April 2, 2011

Every year, thousands of people make a deal with their doctor: I'll pay you a fixed annual fee, whether or not I need your services, and in return you'll see me the day I call, remember who I am and what ails me, and give me your undivided attention.

But this arrangement potentially poses a big threat to Medicare and to the new world of medical care envisioned under President Barack Obama's health overhaul.

The spread of "concierge medicine," where doctors limit their practice to patients who pay a fee of about $1,500 a year, could drive a wedge among the insured. Eventually, people unable to afford the retainer might find themselves stuck on a lower tier, facing less time with doctors and longer waits.

Medicare recipients, who account for a big share of patients in doctors' offices, are the most vulnerable. The program's financial troubles are causing doctors to reassess their participation. But the impact could be broader because primary care doctors are in short supply and the health law will bring in more than 30 million newly insured patients.

If concierge medicine goes beyond just a thriving niche, it could lead to a kind of insurance caste system. Read more here

Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy
The New York Times
by GARDINER HARRIS
March 5, 2011

DOYLESTOWN, Pa. — Alone with his psychiatrist, the patient confided that his newborn had serious health problems, his distraught wife was screaming at him and he had started drinking again. With his life and second marriage falling apart, the man said he needed help.

But the psychiatrist, Dr. Donald Levin, stopped him and said: "Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate."

Like many of the nation’s 48,000 psychiatrists, Dr. Levin, in large part because of changes in how much insurance will pay, no longer provides talk therapy, the form of psychiatry popularized by Sigmund Freud that dominated the profession for decades. Instead, he prescribes medication, usually after a brief consultation with each patient. So Dr. Levin sent the man away with a referral to a less costly therapist and a personal crisis unexplored and unresolved.

Medicine is rapidly changing in the United States from a cottage industry to one dominated by large hospital groups and corporations, but the new efficiencies can be accompanied by a telling loss of intimacy between doctors and patients. And no specialty has suffered this loss more profoundly than psychiatry.

Trained as a traditional psychiatrist at Michael Reese Hospital, a sprawling Chicago medical center that has since closed, Dr. Levin, 68, first established a private practice in 1972, when talk therapy was in its heyday.

Then, like many psychiatrists, he treated 50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each. Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart. Then, he knew his patients’ inner lives better than he knew his wife’s; now, he often cannot remember their names. Then, his goal was to help his patients become happy and fulfilled; now, it is just to keep them functional.

Dr. Levin has found the transition difficult. He now resists helping patients to manage their lives better. "I had to train myself not to get too interested in their problems," he said, "and not to get sidetracked trying to be a semi-therapist." Read more here

The Franciscan Sisters of Mary arrived in St. Louis in 1872 and later took on ministering to patients in hospitals

Nuns, a ‘Dying Breed,’ Fade From Leadership Roles at Catholic Hospitals
The New York Times
by KEVIN SACK
August 20, 2011

ST. LOUIS — When Sister Mary Jean Ryan entered the convent as a young nurse in 1960, virtually every department of every Catholic hospital was run by a nun, from pediatrics to dietary to billing. After her retirement on July 31 as the chief executive of one of the country’s largest networks of Catholic hospitals, only 11 nuns remained among her company’s more than 22,000 employees, and none were administrators.

For SSM Health Care, a $4.2 billion enterprise that evolved from the work of five German nuns who arrived here in 1872, Sister Mary Jean’s departure after 25 years as the company’s first chief executive marks a poignant passing. The gradual transition from religious to lay leadership, which has been changing the face of Catholic health care for decades, is now nearly complete.

In 1968, nuns or priests served as chief executives of 770 of the country’s 796 Catholic hospitals, according to the Catholic Health Association. Today, they preside over 8 of 636 hospitals. With Sister Mary Jean’s departure, only 8 of 59 Catholic health care systems are directed by religious executives.

SSM, which is now led by William P. Thompson, a Catholic layman and longtime company executive, had been the largest Catholic health system still managed by a nun. Formed in 1986, the St. Louis firm consolidated the management of 15 Catholic hospitals and two nursing homes in Missouri, Illinois, Oklahoma and Wisconsin.

As with other healing orders that have ceded control, the Franciscan Sisters of Mary prepared for their inevitable detachment from SSM with more planning than sentiment.

"We can’t be maudlin about this," said Sister Mary Jean, 73, who still presides over the company’s board. "I mean, yes, we are a dying breed. We are disappearing from the face of the earth and all of that. That being said, perhaps this is a moment for people to acknowledge the contribution that has been made by women religious throughout our history in the United States."

The leadership shift has stirred angst in many Catholic hospitals about whether the values imparted by the nuns, concerning the treatment of both patients and employees, can withstand bottom-line forces without their day-to-day vigilance. Although their influence is often described as intangible, the nuns kept their hospitals focused on serving the needy and brought a spiritual reassurance that healing would prevail over profit, authorities on Catholic health care say.

In the case of SSM, that has meant turning away business arrangements with doctors who decline to accept Medicaid. It has meant discounting treatment for the poor and offering charity care to the uninsured, just as the order’s founders did. The St. Louis nuns’ earliest ledgers denoted patients unable to pay as "Our dear Lord’s." Read more here