American Medical Association is again led by a Lexington doctor

June 30, 2015

Steven Stack, a 43-year-old Lexington emergency room physician, recently became the youngest president of the American Medical Association since 1854.

He will need all of the youthful energy he can muster.

The nation’s largest physician organization has some ambitious challenges, from helping sort out health care reform laws to rethinking medical education and trying to stem epidemics of diabetes and high blood pressure.

Stack is the second Lexington doctor to head the AMA in three years. Ardis Hoven, an infectious disease specialist, was AMA president in 2013. She now chairs the council of the World Medical Association.

“We live in the same Zip code,” Stack said. “But we never see each other in Lexington.”

Dr. Steven Stack, a Lexington emergency room physician, recently became the youngest president of the American Medical Association since 1854.  Photo provided

Dr. Steven Stack. Photo provided

Stack and his wife, Tracie, a physician and University of Kentucky graduate, moved to Lexington in 2006 to be closer to family in Ohio. He is from Cleveland and got his education from Holy Cross and the Ohio State University.

He is director of emergency medicine at St. Joseph East and St. Joseph Mt. Sterling hospitals. Before moving here, he directed emergency medicine at Baptist Memorial Hospital in Memphis.

When I caught up with Stack by phone Monday, he was relieved that the U.S. Supreme Court had rejected a technical challenge to the Affordable Care Act, popularly known as the ACA or Obamacare.

“If it had come out the other way,” he said, “there was the risk of over 6 million Americans losing their health insurance that they had just recently gotten and throwing the entire delivery system into a whole new type of chaos with no clear path forward.”

The AMA has been generally supportive of the ACA, especially its goal of increasing insurance coverage. That doesn’t mean doctors don’t think the law needs improving.

“But you have to be willing to want to correct it and make it better as opposed to just ripping apart and destroying it,” he said. “If we want to make some things better about it, then we need to focus on those things and not on trying to cut the whole law.”

The ACA has both good and bad aspects, Stack said. A bigger issue is how it and other health-reform laws do or don’t work together. Insurance companies also have regulation and bureaucracy that makes doctors’ jobs more difficult and interferes with patient care.

“We spend too much to provide care to too few people with results that are not as good as they need to be,” he said.

In 2012, the AMA identified several broad areas where it hopes to have an impact over the next decade.

One is medical education. Stack said the AMA has invested $11 million in 11 medical schools around the country to pioneer ways of incorporating new technology, new learning methods and new leadership skills in the training of doctors.

Another big initiative is addressing the diabetes and hypertension (high blood pressure) epidemics through early diagnosis and prevention.

About 86 million Americans are thought to be pre-diabetic, “and nine out of 10 of them do not know they are,” Stack said. With better diet and more exercise in proven intervention programs led by partner organizations such as the YMCA, many pre-diabetic people can be prevented from developing Type 2 Diabetes.

Early diagnosis and disease management also are critical for hypertension, which affects 70 million Americans, or 1 in three adults.

“Those are two of the most prominent and prevalent conditions of chronic health in the United States, and they cost over a half-trillion dollars a year in healthcare expenditures,” Stack said.

“If we can improve the care of those conditions … then we could profoundly improve the health and wellness of the nation, improve their capacity for work and fulfilling lives, and improve the economy of the nation all at the same time.”

Kentucky’s diabetes and hypertension rates are some of the nation’s highest, but Gov. Steve Beshear’s embrace of the ACA, by creating a state insurance exchange and expanding Medicaid, has helped get more Kentuckians treatment for a variety of health problems, Stack said.

Another AMA goal is to help “restore the joy to the practice of medicine,” he said.

Doctors “have so much intrusion from governments and private payers and other regulators in their lives,” he said. “If we want to have a healthier, happier nation, we have to have healthier, happier physicians to partner with patients to make that possible.”

GOP extortionists offer no credible alternative to health care law

October 7, 2013

Any discussion of the Affordable Care Act cannot ignore the elephants in the room.

Republicans fought passage of what they call Obamacare in Congress and were outvoted. They challenged its constitutionality before the Supreme Court and lost. They made it their central issue in last year’s elections and lost again.

Having exhausted all legitimate means for getting their way, Republicans resorted to extortion. Demanding that the nation’s new health care law be “defunded,” they forced a shutdown of the federal government. The shutdown put hundreds of thousands of people out of work, inconvenienced millions more and stopped vital services to some of America’s most vulnerable people.

The GOP insisted that President Barack Obama “negotiate” to sabotage his proudest achievement, a 3-year-old law that a Supreme Court dominated by conservatives ruled was constitutional.

If Obama doesn’t cave in, Republicans threaten to not raise the federal debt ceiling — in other words, refuse to pay bills that they already have rung up. The last time they did that, the economy suffered. If they do it this time, economists say, the results could be catastrophic.

This isn’t just another partisan dispute or Washington gridlock as usual. It is an unprecedented act of hostage-taking by a minority party that doesn’t seem to care who gets hurt.

For four years, Republicans have waged an ideological crusade against the health care reform law based on lies and distortions: death panels! Government takeover! They claim it will explode government deficits, even though nonpartisan analysts predict it will shrink deficits.

Gov. Steve Beshear wrote in The New York Times recently that Obamacare will, for the first time, make affordable insurance available to every Kentuckian. Currently, he said, 640,000 Kentuckians are uninsured.

Beshear also pointed out that a study by PricewaterhouseCoopers and the Urban Studies Institute at the University of Louisville found that expanding Medicaid as part of the reform law would add $15.6 billion to the state’s economy during the next eight years and create almost 17,000 jobs.

The irony, of course, is that the new law is based on conservative ideas.

The philosophy behind Obamacare — requiring everyone to buy coverage from private health insurance companies — was first promoted by the far-right Heritage Foundation as an alternative to government health insurance. It combined market-based solutions with personal responsibility. But once Democrats embraced the idea, Republicans rejected it.

As governor of Massachusetts, Mitt Romney instituted just such a system. One reason Romney lost the 2012 presidential election was that he couldn’t make a logical argument for why the health insurance system that has been good for Massachusetts would be bad for everyone else.

Republicans are desperate to stop the Affordable Care Act not because they are afraid it will fail. If that were the case, they would simply let it fail and then capitalize on that in the next elections.

No, the GOP’s biggest fear is that Obamacare will succeed, just as Social Security and Medicare succeeded. Republicans opposed those programs when Democrats created them, and some factions of the GOP have been trying to undermine them ever since.

Republicans have tried to justify their extortion by claiming that Americans don’t want Obamacare. But when asked about the things the law will do, opinion polls show, most people approve of it. And a substantial majority of Americans tell pollsters they oppose the Republicans’ “defund Obamacare” crusade.

Many Democrats are dissatisfied with the new health care law because it doesn’t go far enough. They think the United States needs a single-payer insurance system, much like Medicare, to provide universal coverage. It works for the elderly; why not Medicare for everyone?

Still, Obamacare is much better than what we have had. It will provide coverage to millions more Americans than were covered before, through more-affordable private insurance and an expansion of Medicaid for the poor (except in states where Republicans refused to accept federal funding for it).

One thing you will not hear from Republicans is a credible alternative to Obamacare for getting this nation closer to universal health insurance coverage. That’s because they don’t have one.

Health care political debate needs solutions

June 28, 2012

The U.S. Supreme Court is expected to rule this week on the constitutionality of the Patient Protection and Affordable Care Act, the 2010 law that is often called “Obamacare” but just as easily could be called “Romneycare.”

America’s health care system — if you can even call it a system — is a convoluted mess. Studies show that Americans pay more for health care and get less overall quality than citizens of most other industrialized nations.

Nobody understands our current health care system, and just thinking about it makes a head hurt. Year after year, you pay more for insurance that covers less. You spend more time fighting insurance companies, and you pay more money out of pocket.

We hate the system we have, but we are afraid of change.

It will be interesting to see what the Supreme Court decides, especially if the verdict splits 5-4 along ideological lines. The court’s public approval ratings have been falling amid a series of rulings by the court’s activist conservative majority. A New York Times/CBS poll this month found that 75 percent of Americans think Supreme Court justices’ personal politics influence their legal decisions.

It will be more important to watch how elected leaders of both parties respond to whatever the court decides. Health care, more than any other issue, illustrates today’s poisonous politics. Special-interest money, political ideology and unwillingness to compromise seem to have left that concept we used to call “the public good” in the dust.

The main issue before the Supreme Court is the law’s “individual mandate.” It requires people to buy health insurance from a private company if they can afford to, or pay a penalty to the government to help cover the costs of uninsured people.

Without an individual mandate, almost everyone agrees, a for-profit universal health insurance system won’t work. But few people like the mandate, for various reasons. President Barack Obama was against it before he was for it. His Republican challenger, Mitt Romney, was for it before he was against it.

The conservative Heritage Foundation first proposed the individual mandate in 1989 as a way to create a free- market alternative to government health insurance. An individual mandate was part of the state insurance law Romney signed as governor of Massachusetts.

Now, though, conservatives call the individual mandate “socialism.” Liberals don’t like it, either, because they think it simply props up a fundamentally flawed private insurance system. Many of them would prefer a government-run “single-payer” system, which they say would provide universal coverage with much lower overhead costs and less paperwork.

One way to create a single-payer system would be to open Medicare to everyone. That federal health insurance program, created in 1965, now covers 48 million Americans, most of whom are elderly.

The corporations at the heart of our current health care industrial complex hate the idea of a single-payer system because its efficiencies would cut into their profits — or put them out of business. Republicans and even many Democrats don’t like it, either, because they get huge amounts of campaign cash from those corporations.

Thanks largely to health care industry lobbying, single-payer proposals have gone nowhere in recent years. Instead, congressional Democrats passed the controversial law now before the Supreme Court over the solid Republican objections.

The Affordable Care Act will greatly expand affordable coverage and curb some of the insurance industry’s worst abuses, such as canceling coverage when people get sick or denying it for pre-existing conditions. But nobody is completely satisfied with the reform law.

In addition to hating the individual mandate, conservatives complain that the law is too complex and won’t do enough to contain rising costs. But they have offered no credible alternatives that would provide universal coverage.

Liberals complain that Obama and congressional Democrats made too many concessions to the drug and insurance companies. They say the law amounts to a huge taxpayer subsidy for industry.

But after years of political posturing, Americans need solutions. More than 750,000 Kentuckians have no health insurance, and the coverage most of the rest of us have loses value every year.

Whatever the Supreme Court decides, this is the question each Kentuckian should ask his or her representative and senators: How will you work with members of the other party to create a system that gives all Americans access to good, affordable health care? How will you provide us with access to insurance coverage as good as what the government provides for you?


Health care reform: a chance to see what works

March 26, 2012

The Patient Protection and Affordable Care Act turned 2 years old last week. This week, it faces a key test in the U.S. Supreme Court, which will hear oral arguments on challenges to its constitutionality.

President Barack Obama’s health care reform law has a curious political history. Originally developed as a conservative proposal and embraced by Republican presidential front-runner Mitt Romney when he was governor of Massachusetts, it is now derided as “Obamacare” by GOP leaders determined to repeal it.

Many aspects of the law have yet to take effect, in part because of uncertainty caused by legal challenges. But, so far, it seems to have been good for people in Kentucky — a relatively poor state with some of the nation’s highest rates of cancer, heart disease and diabetes and lowest rates of private health insurance coverage.

The law forbids insurance companies from discriminating against children with pre-existing conditions, Terry Brooks, executive director of Kentucky Youth Advocates, wrote in an op-ed piece. Adults also will get that protection in 2014.

Insurance companies also can no longer put lifetime caps on coverage benefits, Brooks noted, “so if a child beats leukemia at age 8, she will still be able to get the care she needs if she relapses at age 20.”

Children have received preventive care and immunizations without their parents having to pay out-of pocket costs. Young adults have been able to stay on their parents’ insurance until age 26 while they search for a job that includes health benefits — something that has been hard to find since the 2008 financial collapse.

Kentucky Voices for Health, a broad coalition of more than 250 groups in the state, notes that insurance companies must now cover more preventive care, such as mammograms and other cancer screenings, which results in better health and lower long-term health care costs.

Dr. Gilbert Friedell sees a lot of good potential in the law. The founding director of the University of Kentucky’s Markey Cancer Center started the Friedell Committee for Health System Transformation in 2008 to help facilitate improvements in a fragmented and often dysfunctional health care system.

“My question for those who want repeal is, did you like what we had before?” Friedell said. “What do you want to do instead?”

Friedell said the biggest problem with the health care system is that it isn’t a system at all, but a collection of silos and special interests whose business models are built around fee-for-service. That promotes cost escalation and pays too little attention to prevention, management of chronic conditions and coordination of a patient’s care.

While the Affordable Care Act is far from perfect, Friedell said, it is an important step in the right direction for two important reasons: it provides money and government support for new ideas and methods for improving health care and lowering costs, and it encourages discussion for continuous improvement.

“The key to success will be the active participation of the public and accountability to the public,” Friedell said. “At some point, somebody has to say, ‘How is the system working? How does it benefit the public?’ ”

Too much of the health care debate has focused on costs rather than care and prevention, Friedell said. More investment in prevention would go a long way toward bringing down overall costs.

As an example, he cited figures showing that an increase in colonoscopy exams from 2001 to 2008 among Medicare patients reduced colon cancers and deaths among those seniors by 16 percent. “It shows what we can do,” he said.

Friedell said he thinks the law is flexible enough to help states and communities tailor solutions to local needs as well as to address changes ahead. One such change is the need for more integrated care by a wider variety of professionals beyond physicians, such as nurses, nurse practitioners, physician assistants and even social workers.

That means more teamwork — something that wasn’t happening nearly enough before the Affordable Care Act’s passage two years ago.

“You might as well call it the Affordable Opportunity Act,” Friedell said. “This gives us the opportunity to experiment, to look at new things that might work. Yes, money is a problem. If you focus on quality of care, there’s no question in my mind that it will bring down costs. But it has to be given time.”