September 23, 2009

Health Reform Update: Baucus releases the new bill!

2 Quick Updates,

First, on Health Care Reform:

Senator Baucus just released the new bill with more than 500 amendments (including all of the ones offered by Senator Snow, potentially the only Republican who will vote for it). The bill purportedly includes an amendment to cut the fine for not having health insurance, and increases the threshold for taxation of high cost insurance plans (tax to insurer, not person). These changes were made to try to increase affordability for low- and middle income people. The mandate still stands and is unlikely (and hopefully) not something that the Committee will budge on. Like Speaker Pelosi has (and many others have) said, we need to make sure everyone is included so that the risk is dispersed among all of us.

Read more at the NPR Health Blog and from the Wall Street Journal article.

Thoughts on health reform that have come up in recent conversations (and aren't really being addressed by this bill...yet):

- should people with expensive-to-treat illnesses have to pay more for health insurance (e.g. someone with cystic fibrosis or type 2 diabetes, who is much more likely to use the services of a hospital)

-Does it make a difference if the illness is hereditary, accidental, or behavior-related? (Type 2 diabetes from obesity v. type 1 diabetes, which is hereditary; or cystic fibrosis, which is inherited, versus cancers from smoking?)

-Should we be able to tax behaviors, such as drinking pop (aka soda, if you're not from the midwest), smoking, alcohol, even fast food - to pay for health care to try to compensate for these costs?

-For the economists out there: would they ever actually compensate for the costs of these behaviors to the health care system?

Second update on med students and lack of professionalism:

We physicians-in-training are not doing a great job of assuring our future patients that we are worth trusting. JAMA just released a paper citing a huge lack of online decorum by medical students. This may seem like nothing compared with the very public trial earlier in the year for a second year medical student at BU who was arrested for murders of women who he met on Craigslist (read more on Boston Globe website)

We had a lot of lectures during orientation and our first block about professionalism - and while many of the topics discussed could seem minor compared to the vast amount of scientific knowledge we're trying to learn - I think it may be the most important.

One of our greatest professors here said that his friend's father was a physician and every time he would leave the house, he would put on a tie. He said that there was always a chance he would run into a previous patient, a current patient, or a future patient - and he wanted them to know that there doctor took his profession seriously. I clearly won't be wearing a tie every time I leave my house (in fact, I'm just embracing wearing jeans again), I do think that you are allowed to have higher expectations for someone to whom you are telling your most intimate life details, who you are letting examine your naked body, and who you are trusting to help you make the best decisions you can about your health.

That said, medical school is quite hard - and incredibly time consuming. The commitment that the path to medicine requires is near total and by embarking on it, you are choosing to have less free time for people and fun - which is not to excuse these students but to provide a framework for understanding the need for a comedic release. But no one tells you medical school will be easy - if anything, they tell you it will be the hardest thing you have done yet. As medical students and future physicians, we really have to consider that even though it may be an arduous path, if we want our patients to trust us, if we want society to continue to hold doctors on such high moral ground, we have to honor this profession, tie or no tie.

“The greater danger for most of us lies not in setting our aim too high and falling short; but in setting our aim too low, and achieving our mark.”

No comments:

Post a Comment