Tweeting the health care bills line-by-line
It’s an amazing feat: A retired doctor is analyzing the House and Senate bills on Twitter — line-by-line. That’s a total of 1,189 pages of legislative prose stuffed into an epic series of 140-character analyses.
@bringsdogtowork has seen the future of managed care and isn’t breaking out the champagne: “My qualifications to Twitter Obamacare: ten years experience in Indian Health, otherwise known as RATIONING HELL.”
Even if you don’t agree with the interpretations, @bringsdogtowork is worth following: The tweets are crisp, informative and far from predictable. For example, the former emergency room doctor turned rancher and “troublemaker” notes that the Senate bill excludes payments for private hospital rooms. But, she says, many hospitals have eliminated shared rooms and wards to prevent spread of infections. An interesting point, worth researching.
Below, I share two sets of tweets. The first set focuses on a section in the Senate bill (a modest 172 pages long) describing how doctors are rated, acceptable expenses, and the role the federal government would play in medical training. The second set, from the (gulp) 1,107-page House bill, delves into the relationships among drug companies, doctors and patients as well as opportunities for residents to work in inner city settings. She also marvels at the ballooning price tag for the audit costs on Medicare. If you like what you see, but don’t like Twitter, you can follow @bringsdogtowork on the WordPress blog Country Doctor. (NB: At the bottom of this post, you’ll find a guide to the more obscure abbreviations in the tweets.)
From Senate Bill 703:
Nursing home care:
S.B.703 p 50 Docs sign “Participating Agreement” & meet QA stands. incl.”efficiency” & outcome (e.g U look bad if take tough cases)
Sen. Bill 703, p. 48 health providers not paid unless service follows “guidelines” & claim/supporting documents sent in within 30 days
S.B. 703 p 44-45 Exclusions: services in a non-participating facility, nursing home costs unless NH is the “least restrictive” setting
S.B. 703 p Exclusions: Private hospital rooms (FYI most hospitals don’t have shared rooms/wards d/t privacy laws & infection control)
S.B 703 p 39 Amount spent by state on home/community long-term care may not exceed 65% of cost if patients had been in nursing homes
Setting standards:
SB703p127 AHSSBoard will study expansion of practice of midlevel providers || Would U like a midwife to do your C-section?
SB703p125 States must graduate more dentists. Board will tell them how many
SB703p125 States must graduate more midlevel providers (midwives, nurse-practitioners, Phys assistants). AHSSBoard will say how many
SB703 p 126 If Med School does not meet these goals, State (in which Med School is located) will have its health budget cut by Feds
SB703p120-1 AHSSBoard will pay more for services & supplies in medically underserved areas (inner-city & rural)
From House bill 3200:
Reporting conflicts and training standards:
HR3200p634-42 Docs report financial ties 2 companies (makers of drugs, devices etc) to SecH&HS 2 post on Net #tcot Make Congress do it too
HR3200p646 Also pharmacists, insurers, hospitals, med schools, med researchers, etc must report financial ties. Also Companies report #tcot
HR3200p642-3 If Company (drug, med device, etc) knowingly fails 2 report ties, penalties start at $10K-$100K to maximum of $1M/year #tcot
HR3200p653-8 Sec H&HS posts healthcare-associated infections by hospital/facility & recommends how to eliminate them …#tcot
HR3200 Note: That is why they culture your nose for MRSA carriage on admission – because it’s community acquired now #tcot
HR3200p659-70 SecH&HS PREFERS to fund growth in hosp. doc’s RESIDENCY programs that train in Federal centers, underserved areas, etc #tcot
HR3200p670-2 Resident time AWAY from TEACHING hosps (in “nonprovider settings” =clinics, nursing homes, etc) now counts as “teaching” #tcot
HR3200 Note: So Residents can work FREE at inner city clinics! #tcot
HR3200p679 If a hospital closes, its Residency positions go to other State hospitals #tcot Expecting some hospitals to close?
HR3200p682-5 Govt. tells hospitals how to train Residents: Curriculum, Electronic Health Records, etc #tcot
HR3200p685 “Medicare Integrity Program” (fights waste, fraud & abuse) gets $100Million more (on top of current $720Million+) annually #tcot
AHSSB: American Health Security Standards Board
Abbreviations:
AHSSBoard: American Health Security Standards Board
SecH&HS: Secretary of Health & Human Services
#tcot: Top Conservatives on Twitter
MRSA: methicillin-resistant Staphylococcus aureus (MRSA)
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The more I learn, the more dismayed I become. Cookbook, take-a-number medicine, here we come.
Paul, In your experience as an M.D., do you have any thoughts on how health care reform could work (in 140 characters or less -ha!)?
In response to another comment. See in context »Did you happend to research the Twitter posts made by this “doctor”? If you did, you’d see that she’s not interested in healthcare reform at all. But she is all on board to scare the bejesus out of people…S-703 won’t see a vote, and any person that is serious about the subject understands that. But that’s the first Bill that gets worked over, HR 3200 is brimming over with lies and misrepresentation. Ten years working for IHS (which this woman refers to as an Indian Reservation, and leads me to wonder what century she is living in) doesn’t give her any idea as to how everyday Americans are struggling with health care costs or being locked out of a system that is essential to being a human being. You would do yourself a great service to research the information you write about throughly before you post it here.
National health care does not haveto be on the Engish or Canadian model. The Israel model seems to work quite well. Maybe because doctors make a ;ot less money and medications are cheaper.
Are you saying medications are cheaper for patients or are they cheaper for the distributors? Why would drugs be cheaper in Israel? It’s also interesting that you say doctors earn less but provide quality care.
In response to another comment. See in context »Generally meds in other places are cheaper because companies sell them for less, so distributors sell them for less, so patients can pay less at the pharmacy. NOTE: this is only for legitimate, regulated meds – there are a lot more counterfeit meds on the international market vs. US market (we still get some, but not near as many due to our regs).
In response to another comment. See in context »Thank you, of course, that’s right. Drug companies have scaled pricing. First world countries essentially subsidize the cost for everyone else.
In response to another comment. See in context »Nancy,
It’s not first-world countries subsidizing the rest of the world. It’s the U.S. subsidizing the rest of the world.
Canada and other countries are free-riders on drug development, negotiating prices far lower than Americans pay for American drugs.
We should immediately institute re-importation or Most Favored Nation rules in pricing. That would cut our costs and raise the costs to the free-riders, as big pharma would price somewhere in between.
Tort reform and drug pricing are two easy areas to cut costs, but Obama won’t touch them because the trial lawyers and big pharma are campaign contributors.