The ACO is a Child of the ACA

By Gregg A. Masters, MPH

Only another battle has been won, (tho’ an effing big one at that), yet the war to re-engineer America’s healthcare borg remains intact and the Act at risk to the outcome of November’s elections. In perfect world 100% of our resources are committed to implementation of the vision, yet in a perfect world we do not dwell.

The SCOTUS decision notwithstanding the opposition has seemingly only upped the ‘repeal and replace’ ante if nothing other than symbolically, see: ‘House Gears Up to Repeal Obamacare (Again).’

Yet on the replace front the vocal opposition has precious little to offer in terms of substance, see: ‘Republicans Plan To Replace Obamacare With Obamacare‘.

Want to test your knowlege of what’s in the Act, take the quiz below courtesy of the good folk at The Kaiser Health Fondation:

So today we start a new series to educate the grossly misinformed American public with a campaign and the associated hashtag of #ACA101, where ACA = the Affordable Care Act and 101 = a primer or ‘just the facts’ ma’am.

The intention is to convey the essence of the Affordable Care Act, ‘one tweet at a time.’ While the attention span of the average American is somewhere south of 8 seconds, we hold the possibility that a 2,471 page document set might be digestible via 160 characters at a time.

Join us, tag your tweets with #ACA101 if your intention is to educate, not confuse.

The Affordable Care Act: What’s Changed Post SCOTUS Ruling?

By Gregg A. Masters, MPH

Found over at the Healthcare Blog, a post SCOTUS Affordable Care Act conversation hosted by Eliza Corp and led by noted healthcare futurist and consultant Jeff Goldsmith. This is well worth a view and even note taking. Among Goldsmith’s many insights is the following:

A stunning lack of understanding of what’s in the law [Affordable Care Act] – Jeff Goldsmith

From fictional ‘death panels’ to the none existent ‘public option’ the the American people are completely mis-informed on the nature and value proposition of the Affordable Care Act.

Be Afraid, Be Very Afraid

By Gregg A. Masters, MPH

Watching the ensuing theater unleashed by SCOTUS’ ruling on the Affordable Care Act, I came across some similar sound bytes from a ‘by gone era’ – or so we thought.

Since we are not likely to see these disingenuous, ‘don’t confuse me with the facts, my mind is already made up’ foes fold their tents and go home defeated, we can expect a re-grouping of the troops around a yet to be crafted all out ‘Citizens United‘ fueled offensive to pick away at and then ultimately attempt it’s repeal.

Inside this earlier media enabled public discourse we find the usual suspects [or their predecessor organizations], but then again some rather unsuspecting foes of what was then an emerging and rather compelling societal and public health concern. Perhaps best framed by an actor turned politician, forecasting the threats to freedom from a Government takeover of medicine:

The doctor begins to lose freedoms; it’s like telling a lie, and one leads to another. First you decide that the doctor can have so many patients. They are equally divided among the various doctors by the government. But then the doctors aren’t equally divided geographically, so a doctor decides he wants to practice in one town and the government has to say to him you can’t live in that town, they already have enough doctors. You have to go someplace else. And from here it is only a short step to dictating where he will go. – Ronald Reagan, 1961.

One of the traditional methods of imposing statism or socialism has been by way of medicine….If you don’t do this, one of these days you and I are going to spend our sunset years telling our children and our children’s children what it was like in American when men were free. – From Ronald Reagan’s 1961 taped anti-Medicare message, “Ronald Reagan Speaks Out Against Socialized Medicine” paid for by AMA and AMPAC.

Not unlike today, there was a rather determined campaign to inject the fear of tyranny associated with an alleged Government take over of Medicine into the hearts and minds of the American public. We see many if not all of the same ‘talking points’ in the political diatribes before our very eyes and ears.  Yet, the surprises [back then] were from several usual allies of progressive thought leadership in the organization and financing of US healthcare, including:

[The Medicare bill would] set up a health care program which served little or no necessary social purpose and which would be a direct, unwarranted and completely unfair intrusion in private enterprise. – Dr. Clifford H. Keene, Kaiser Foundation Health Plan.

For a walk down memory lane, and there are some gems from the likes of American Medical Association, and the International Association of Health Underwriters, as well as context if not a score card of the sound bytes yet to come, click here.

The Affordable Care Act in Historical Context: Lead, Follow or Get Out of the Way

By Gregg A. Masters, MPH

As I have penned over at XanateMedia in The Triple Aim Sets the Agenda for Healthcare Social Media Community,’ while the aftermath of the SCOTUS ruling is predictably lining up along straight partisan lines, the net takeaway for healthcare social media peeps is to get behind the ‘triple aim’.

Yet we seem to be in an unending loop of ‘Kubler-Ross moments‘ at least inside the conservative media bubble machine and their media partners including select voices in the blog-o-sphere. For those unfamiliar with the psycho-emotional journey Elizabeth Kubler-Ross and the ‘DABDA’ acronym (aka denial, anger, bargaining, depression and acceptance) she codified the predictable stages of ‘death and dying’ which can be generalized to all forms of loss – including those of the financial, legislative and even judicial variety.

This clip places the legislative accomplishment in context and should serve as a reminder that ‘the Act’ is law, call it a ‘tax’, ‘penalty’ or whatever, the reality is it has been and remains law. Let’s get on with it. There is much to do!

Summary of SCOTUS Affordable Care Act Rulings

By Gregg A. Masters, MPH

This provided courtesy of Deloitte’s ‘Special Edition Health Care Reform Memo: June 29, 2012′ where long term healthcare industry advisor and wonk Paul Keckly opines:

The decision was a bit of a surprise: I expected the law to be upheld; I did not suspect the mandate would be upheld, nor its legal standing as a “tax” the foundational justification for the ruling.

On the questions before the court:

To read complete Deloitte letter, click here.

Meanwhile, in the Day +1 of the post SCOTUS ACA ruling, I opined somewhat on ‘This Week in Accountable Care‘ discussing my take as well as the near term plans for the radio show. Suffice it to say there is an impressive line-up of some top talent who are slated to make guest appearances on the show. From health plans to medical groups, ACOs and even the consulting domain we have some informative sessions in store for you!

Maggie Mahar, Robert Reich, Michael Cannon and Grace Marie Turner on SCOTUS ACA Ruling

By Gregg A. Masters, MPH

Courtesy of a tweet via Gary Levin aka @glevin1 we note the following  @Google+ Hangout post SCOTUS ruling discussion. NOTE: there is a slight delay in the clip.

The chat is facilitated by David Firestone aka @fstonenyt and includes an eclectic mix of the academic, think tank and ideological spectrum including Maggie Mahar, aka @Maggie Mahar, @UCBerkeley Professor Robert Reich, aka @RBReich, Michael F. Cannon, aka @MFcannon of @CatoInstitute, and Grace Marie Turner of @GalenInstitute aka @GraceMarieTweet!

Considering all the noise from peeps who know little to nothing about healthcare, it’s oh so ‘tender underbelly’ and fundamentally flawed if not schizophrenic financial incentives and resulting business models, but are none-the-less convinced that anything Obama puts his name to must be bad, this is a breath of fresh air in the thoughtful exchange about the realities of the Act and it’s challenge to be more broadly embraced by a confused American public.

SCOTUS and the ACA: Livestreaming via @TakeActionNews

By Gregg A. Masters, MPH

It’s here! Watch as we get the historic decision of SCOTUS on the Affordable Care Act. David Shuster aka @DavidShuster, and Mark Levine aka @MarkLevineTalk report from the plaza of the Supreme Court of the United States. Watch as social media delivers the decision, first and accurately via a historic live streamed video feed from two veteran legal observers, reporters and social media aficiandos David and Mark. That’s more than can be said for CNN and Fox News.


Live feed is courtesy of Take Action News.

Volokh Conspiracy: Final Thoughts on the Eve of the Individual Mandate Decision

By Gregg A. Masters, MPH

In the interest of balance and reflecting the range of thoughtful and credible legal thinking on the ACA in general and the individual mandate in particular, I followed the link attached to this post via @EzraKlein this afternoon:

@ezraklein  If the mandate falls and this proves a key moment in Court history, this post will be very useful to future scholars

To wit the following extract is pasted. The complete blog post appears at the Volokh Conspiracy:

Ilya Somin • June 27, 2012 5:05 pm

Over the last year, I have written an academic article, several amicus briefs, and countless blog posts and op eds about the individual mandate case. Whether I said anything useful or not is for others to judge. But, as a constitutional federalism scholar and one who had long argued for the need to enforce constraints on the scope of federal power, I felt I could not simply sit out what will surely be one of the most important federalism cases of my lifetime.

If the Court ends up striking down the mandate (which I continue to believe is a 50-50 proposition), it will be because the federal government failed to come up with a good explanation of how the law can be upheld without giving Congress nearly unlimited power to impose other mandates. Although both sides in the litigation have come up with numerous interesting points, I continue to think that this is the central issue, and the biggest flaw in the federal government’s position.

I would like to thank Eugene Volokh for inviting me to join the Volokh Conspiracy, without which I might not have been able to be involved in this debate to anything like the same extent. I would also like to thank the Washington Legal Foundation, several members of Congress (at the lower court level), and many of my academic colleagues (including several of my co-bloggers) for giving me the opportunity to represent them by writing amicus briefs on their behalf, including one at the Supreme Court level. It was a great honor to be your advocate in this important case.

Many have commented on the role of the Volokh Conspiracy in promoting the viability of this challenge. Co-blogger Randy Barnett deserves great credit for developing several of the most important arguments underlying the challenge, and especially for his December 2009 paper with Todd Gaziano, which gave an excellent and very influential early explanation of why the individual mandate was unconstitutional, and how it was not authorized by previous precedent. Co-bloggers Jonathan Adler, David Kopel, and David Bernstein also played an important role in developing legal arguments and participating in the resulting public debate.

In my view, the VC was just one of many factors that made this challenge more viable than the mandate’s defenders initially expected. Perhaps our most important role was in challenging the oft-made claim that there was an expert consensus in favor of the constitutionality of the mandate. This helped undermine the emerging narrative that this case was a frivolous no-brainer that only people ignorant of constitutional law could support. But it is important to add that we were not the only legal academics who helped develop the case against the mandate, and discredit the myth of a consensus. Non-VCers who made important contributions include Steve Calabresi (Northwestern), Richard Epstein (NYU), Gary Lawson (BU), Steve Presser (Northwestern), Steve Willis (Florida), and others whom I apologize for omitting.

Outside the academy, enormous credit goes… (click here for original post).

Paul Gigot, SCOTUS and the Affordable Care Act

By Gregg A. Masters, MPH

WSJ Editorial Page Editor Paul Gigot handicaps the highly anticipated SCOTUS ruling following the disgusting ‘silenced majority’ ad copy piece fronting an otherwise informative clip (shame on the WSJ, they know better!). This is more evidence of the real world impact via the triumph of Citizens United and the more recent ‘we know better than you Montana folk’ over-reach of the ‘small government [when it's convenient] crowd’ via the recent American Tradition Partnership, Inc. v. Bullock ruling.

Yet I digress, as Gigot opines:

My ideal outcome would be to overturn the whole law

Inside the Murdoch empire, I’m sure the executive compensation and benefits package from which Mr. Gigot proffers his lofty opinion is a rather attractive and well funded set of tax advanaged [read subsidy] healthcare benefits. Perhaps if he were one of the 50 million plus uninsured, his perspective might be a little different.

SCOTUS Decision: ‘It’s Affirmed’, No It’s a ‘Divided Court’, Nope It’s Bye, Bye ‘Obamacare’

By Gregg A. Masters, MPH

Holey rusted metal, Batman! The ground. It’s all metal. It’s full of holes. You know, holey. – Robin

In ‘Mourdock Prepares for all SCOTUS Outcomes‘ we witness the elasticity and ‘whatever it takes’ determination to position the election-ering agenda of one aspiring Congressman.

Watch as Indiana’s Treasurer Richard Mourdock covers his ‘ass’ in anticipation of the soon to be announced rulings. Gotta give him credit for the ‘strategic thinking’, yet question the wisdom of the social media guru who uploaded all ‘holey‘ contingencies to Youtube.