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Ten reasons why we need Congress to pass health care reform now:

1)        Discrimination based on pre-existing conditions would end.
2)        No one would lose insurance because they get sick.
3)        No more lifetime limits on benefits.
4)        31 million uninsured would gain affordable health coverage.
5)        Medicaid (a public plan) would cover 15 million additional 
          people who are currently at risk.
6)        Low- and moderate-income families would get subsidies for 
          insurance and co-pays.
7)        No more discrimination in premium costs based on gender.
8)        New limits on insurance company profits and administrative  
          costs.
9)        Losing your job would not mean losing your health care.
10)       All insurance policies would be required to provide 
          preventive care without co-payments.

All of these points are already in the health reform bills passed by
both the House and the Senate.

Call your Congressional Representatives and Senators and tell them
giving up on health care reform is not an option. Pass comprehensive
health care reform now!

Senate Switchboard: (202) 224-3121
House Switchboard: (202) 225-3121

Outstanding issues between the House and Senate should be resolved
through budget reconciliation (51 votes) and the House should pass the
Senate bill.


(Original alert authored by Donna Mandel and Ken Jacobs on January 26,
with permission to re-post, pass along by email, blog, tweet, call,
etc.  We can do this!) 
  

    
And now, the question for anybody participating in this discussion.
Are you pushing for the health bill at this point, or is it not good
enough as-is, or have you given up on getting it through? Where are you
in this fight today?
  

    

I am never sure, on any given day, what the health care bill contains on 
that day, so I don't feel comfortable pushing it, because maybe that day 
is the one that kills everything if I do.

I get e-mails from many organizations and politicians urging me to call or 
sign petitions or have a meeting, but I worry about the agenda of each and 
how well it matches my own.

I have never been so confused.  I want to take a firm stand.  But: how?  
  

    
> I am never sure, on any given day, what the health care bill contains

Actually, that's not so since the Senate passed its version a month ago. 
There is a Senate version and a House version, and at this point they 
are dickering behind the scenes trying to figure out what the heck they 
can do to pass something, but they are not producing new bills right and 
left like they were in October in the House and December in the Senate.

The list above is a least common denominator of what shows up i both 
bills. The differences are in details, such as whether there is one 
national insurance exchange or 50 state ones, how abortion is dealt 
with, whether the biggest things phase in by 2013 or 2014, whether we 
tax rich people or "Cadillac plans" or both or none, and so forth.

I certainly still advocate passing something, anything. At the same 
time, though, the process seems to have passed beyond the public 
advocacy stage.
  

    
I guess some of the organizations who are following are hoping that people
will keep pushing the dems to make this as good as possible and to not
listen to those who say it will be worse than nothing becuase it has no 
Public Option.  Which some are saying.  That looks like the old problem of 
the perfect versus the pretty good that can be better if public pressure
keeps alive.

And getting it passed now seems important because coporations are now able 
to start amassing war chests like never before seen to buy candidates from  
both parties.   Slowing anything down now probably favors business interests.
Curious if anybody knows more about that.

Shifting back to empowered patients, does anybody know if this movement has 
reached medical schools in terms of training the next generation?  Do 
doctors need to learn a little about teaching various kinds of learners?

Or do patients teach doctors this kind of craft?
  

    
Particpatory medicine is just getting legs, I think. It hasn't been
formalized in any way, as in some kind of instruction in med schools.
Our purpose in launching the Journal of Participatory Medicine was to
facilitate the kind of evidence-based research you'd need to build
participatory medicine programs and initiatives.

I've done social media work for hospital systems and pharma companies,
and they were very aware of the Internet's impact on healthcare,
patient communities, etc. It's relevant to their marketing and
community engagement practices.

I have a friend whose wife is in ER physician, and he was telling me
second-hand her position - that patients who've investigated their
conditions online can be led down a rabbit hole of misinformation and
misunderstanding. I understand the concern - patients don't have the
context of medical discipline, they don't necessarily know how to take
the information that's increasingly available online. But you don't
address that sort of issue by wishing it would go away. Better
education and information is better than less information; engaged
patients are better than passive patients. Those are the assumptions,
anyway - we need to gather evidence to make the case, and to point to
best practices and possible insitutional responses.
  

    
this looks like it's been a great conversation so far, and I wish I
had been able to be more engaged during this last week and a half.  I
have much to say about the recent comments on healthcare reform that
I'll try to jot down later tonight.

As far as the last question goes: 

 " does anybody know if this movement has reached medical schools in
terms of training the next generation?  Do doctors need to learn a
little about teaching various kinds of learners?" 

I  get to teach medical students at Harvard with frequent visitors
from other medical schools. My impression is that there is not an easy
answer to the question.  The concept of the truly empowered patient, as
some of us here use it, has probably not been integrated into any
medical school curriculum.  However, there is a lot of emphasis on
changing the way doctors and patients interact.  Medical schools
attending to the teaching and modeling of empathy, and are emphasizing
the fine arts of observation and listening.  And, while medical schools
recognize that no one can know everything, the doctor continues to be
trained as the "expert"  of the online tools and computer-aided
clinical decision-support that keep us all healthy in the information
age.  Not Exactly a "participatory" model.
  

    
My experiences when I was first dealing with cancer were that my
doctors were not interested in what I was doing in addition to the
chemo and radiation. I did amazingly well (My oncologist said I made
chemo and rad look easy). I was doing all sorts of alternative things
and none of them were interested in hearing about any of the additional
treatments I was doing (accupuncture, Chinese herbs, various
supplements). It was annoying and a bit sad. Is this because of their
training that Western Medicine is king and everything else is silly? 
  

    
Um, yes?
  

    
Would either of the current versions of healthcare reform legislation
be helpful? And if we pass nothing, are we going to see a meltdown? 

An observation: I've been privy to discussions for years about how
modern medicine will double, or better than double, life spans. I know
we already have technologies that can make a huge difference for many.
But I'm also aware that prices are going up, way up. I've seen patients
unable to buy prescriptions because the insurance policy wouldn't pay
the full cost (and the patient would have to come up with hundreds of
dollars for a month's Rx). My observation is that, while we might
create healthcare innovations that can prolong life, and quality of
life, unless we have an intervention in healthcare, only the rich will
be able to afford them. I can imagine a future where any kind of
quality healthcare is a luxury, only for the rich. I'm wondering how
this looks from a physician's perspective?
  

    
If you're not on the WELL, you can still send comments and questions
that moderators will post here. Just email to inkwell@well.com
  

    
In this physician's practice, I am already disturbed by the disconnect
between the availability of treatment for various conditions and my
ability to prescribe them, or not, for patients based on their ability
to pay.  It's not simply about who has the most money, or the most
expensive all-inclusive insurance plans:  sometimes we can offer the
best care to those with nothing but MediCal, because MediCal doesn't
fight us as much as some of the private insurers do. This is true
especially when it comes to the often rare conditions we treat--too few
patients for there ever to be the kind of large, controlled trial the
FDA requires to create an approved indication for a drug.  I see
patients with the best insurance who have great care, patients with
MediCal who have great care, and patients who have so-so insurance who
really get stuck in between.
  

    
During the course of this two week discussion, we lost our health
insurance because of a job change. 

And Cheryl is tough to insure because she beat such a serious breast
cancer. We've already had one rejection this week, even though she beat
it cleanly 14 years ago with no signs whatsoever of recurrence.

I agreed passionately with Gail before. I feel it in my bones now. We
need this:

Ten reasons why we need Congress to pass health care reform now:

1)        Discrimination based on pre-existing conditions would end.
2)        No one would lose insurance because they get sick.
3)        No more lifetime limits on benefits.
4)        31 million uninsured would gain affordable health coverage.
5)        Medicaid (a public plan) would cover 15 million additional 
          people who are currently at risk.
6)        Low- and moderate-income families would get subsidies for 
          insurance and co-pays.
7)        No more discrimination in premium costs based on gender.
8)        New limits on insurance company profits & administrative  
          costs.
9)        Losing your job would not mean losing your health care.
10)       All insurance policies would be required to provide 
          preventive care without co-payments.
  

    
I'm so sorry to hear that you guys are going through this with
insurers now, Alan.

We've got to improve health care in this country, inch by inch if
necessary, from all directions.  Legislative, working within the
healthcare field, as informed patients and advocates for family
members.  I've got pre-existing concerns too, and for those who don't,
I wish you good luck in not being in those shoes in the future, but
please remember that you or a loved one could be.

Thanks for contributing to this online roundtable.
  

    
Thanks, Gail. Your quote is now a post-it note on my (very cool
treadmill) desk:

"We've got to improve health care in this country, inch by inch if
necessary, from all directions."