by Tim Size on August 1, 2010
On the way to my office, there is a very busy intersection by our local high school. It has four roads coming together at odd angles. It has no stoplight, just stop signs. In thirty years, I have only seen one fender bender. Somehow the setup works–people figure it out and the traffic keeps moving.
I hope that the health insurance exchanges required by the new federal health reform law will work as well. These virtual market places open for business in 2014. Until then there will be much speculation, pro and con. The promise is that individuals and small businesses will gain access to better health insurance. We do know a fair amount about how they will be constructed. We can only guess how individual consumers will react.
The hope is that insurance exchanges will offer more reasonably priced premiums that vary less year to year. Individuals and small employers will have a choice among health plans on a more level playing field.
Near full participation in these markets is necessary for the exchanges to work. Participation will be “encouraged” through an array of federal subsidies and penalties, that may or may not be strong enough.
But it is a mistake to focus only on the law and the expected regulations. The benefits from this health reform will not come mostly from the government’s action but from the decisions of those using the exchanges. In other words, this reform is less about stop and go lights and more about an intersection with stop signs that requires people to make a choice of when and where to go. [click to continue…]
by Tim Size on June 2, 2010
As someone with a lifetime gladly spent promoting rural health, managing the uncertainty of health care reform has all the appeal of a root canal. Add in the joys of raising teenagers and you begin to get the picture. My hair turned gray helping to raise four teenagers, so I’m not sure what I have left to let go of this time around. But I know I’ll soon find out.
Make no mistake, whether or not you call it “reform,” health care must and will change in some very basic ways. We, and our country, can’t afford not to change. I have yet to meet a healthcare leader who disagrees with this, although I am sure there is someone somewhere. We all know this, regardless of where we stand in the endless political posturing.
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by Tim Size on March 21, 2010
The healthcare legislation that looks headed to the President’s desk is not ideal. It couldn’t be otherwise given our country’s deeply held and contradictory values. But the fact that tens of millions of Americans are uninsured and most of the rest of us are just one lost job from the same dilemma, drove this train. A majority in the Senate, and now the House, have decided they couldn’t lose another generation in pursuit of the perfect bill.
I studied with George Bugbee, (the American Hospital Association’s first non-physician executive director) to become a hospital administrator just a few years after the creation of Medicare and Medicaid in 1965. Assuring universal coverage for the rest of America was widely believed to be right around the corner. It has been a long corner.
It took us the greater part of twenty years to work through challenges caused but not anticipated when the Medicare Prospective Payment System began in 1983. It will take at least that long for all of us to digest this new change. From a rural perspective, here are some of the priority areas that will need our attention: [click to continue…]
by Tim Size on March 15, 2010
For quite a few years, I have been recording myths about rural health care. I think of myths as something easily proven false but too often assumed to be true. My list started when an urban-based executive told me, with a straight face, “Pay them less, they grow their own vegetables.” But it has been over half a century since most rural Wisconsinites lived on a farm.
I have come to recognize “they grow their own vegetables” as “rural as Lake Wobegone” myth. For my friends who never stray off of Fox News to National Public Radio, Lake Wobegone is Garrison Keillor’s fictional hometown where “all the women are strong, all the men are good looking, and all the children are above average.” Not anywhere I’ve seen.
The opposite of an overly idealized version of rural America is the equally extreme view of “rural as backwater.” Unfortunately I hear a lot more of these myths than the possibly less harmful Wobegone variety.
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by Tim Size on March 8, 2010
Wisconsin State Journal Special Report: Rural Health. This first ever series at <http://host.madison.com/special-section/rural_health/> was launched Sunday, March 7th, 2010 with an in-depth array of articles, photos, videos and graphics. “Wisconsin State Journal reporter David Wahlberg is undertaking a special project this year examining rural health care challenges. Installments on related issues will follow in the coming months. Joining Wahlberg on the project is State Journal photographer Craig Schreiner. To contact them, e-mail dwahlberg@madison.com or cschreiner@madison.com or call Wahlberg at 608-252-6125. The project is partly supported by the nonprofit, nonpartisan Kaiser Family Foundation, which awarded a fellowship to Wahlberg.” Comments welcome here, pro or con.
by Tim Size on January 27, 2010
Not a front row seat, but I had the good fortune to be in the Visitor’s Gallery for President Obama’s first State of the Union address. Regardless of one’s politics, it is a rush to be in the House Chamber to be a part of history and political pageantry.
The President spoke to the country in the shadow of the irony of the Massachusetts election. The irony isn’t what happened to the seat long held by Ted Kennedy but that the one state that has, and to all accounts appreciates, universal health care might block the rest of the country from gaining something similar.
The President took a share of the responsibility for a process that has been too partisan and pork laden for most of us. He challenged both Democrats and Republicans to stop making every day and every issue about the next election. For my part, it is clear that America does not like watching sausage being made. This doesn’t make us all vegetarians but he spoke for most of us when he said the people want fewer sound bites and more of the job getting done.
The President strongly believes in the ethical imperative of reform as well as believing it is a fundamental building block of having a strong economy and sustained job creation. Contrary to the pundits, it didn’t sound to me like he was backing away from health reform. He is not quitting.
by Tim Size on January 6, 2010
The health-care reform bill pending in Congress will help rural communities by more people having health insurance, beginning to address some rural payment inequities and continue some important protections for rural providers that were expiring.
The bill needs to be seen as only a really important first step on long over due changes for our country. This is not a criticism of Congress but a statement of reality when a country goes about trying to fundamentally improve a huge part of itself, like its healthcare system. [click to continue…]
by Tim Size on November 3, 2009
In 40 years working in and studying health care, I have never seen a more challenging time. I’m not suggesting that you need to hug a healthcare worker, or even your hospital administrator, yet.
On a typical day, they are working to protect their patients and community from the effect of not one storm but a plague of once in a generation storms. You see or hear about these events every day but you may not know how they pile up on your local hospital or clinic. Think of the uncertainty on the ground around federal healthcare reform, of state budget shortfalls, of physician and healthcare workforce shortages, the effects of the global recession, and of course, H1N1. Each one of the five is a big challenge. All five at one time would cause any of us to do more than lose sleep.
Let me be clear, I am not whining on behalf of friends and colleagues who work in the front lines of health care; just the opposite– I stand in amazement at their calmness.
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by Tim Size on September 9, 2009
The President made it clear he stands on common ground for our country by “building on what works.” A new government run plan that undermines the private sector now seems less likely. A major shift of patients into a plan paying Medicaid and Medicare type rates would harm rural patients’ access to local health care. Reform affecting rural communities must and can be built on quality outcomes and efficiency while delivering care locally. As the President concluded, I “believe we can replace acrimony with civility, and gridlock with progress.”
by Tim Size on August 23, 2009
The shouting heads on the talk shows recently sunk to a new low in their ongoing mission to misdirect the American people. One of the national health reform bills proposed encouraging doctors to discuss end of life options with patients and families. Radicals with their own agendas twisted this into a Government plot to set up “death panels.” But it is lemonade out of lemon time. We now have the long overdue opportunity to talk about what it means to our health care when we joke “none of us gets out of here alive.”
Martians may land here tomorrow. Congress may start listening to the larger number of us who don’t shout for a living. So yes, trying to help patients and families deal with tough end of life questions can be twisted into something sinister. But when each of our time comes, most of us don’t want end of life heroics. We want to be treated with respect, to be embraced and to die free of pain. [click to continue…]
