Sunday, November 15, 2009

Witnessing History

By coincidence, the Virginia Academy of Family Physicians (VAFP) Board of Directors' (BOD) meeting on November 7 was the same day that the United States House of Representatives (HOR) was due to debate and vote upon H.R. 3962—Affordable Health Care for America Act. This act has been at the center of much of the political debate all summer, and includes significant overhauls of our health care system as well as providing for the establishment of a public health care insurance plan. As we were waiting to enter the Capitol for a tour, we saw a long line of people waiting to enter the HOR gallery to witness the debate on this important piece of legislation.

Following the tour of the Capitol, my wife Janet and I came back to the hotel to meet up with other members of the BOD. While we were mingling, Jan Ragland (the current VAFP President) mentioned that Sterling Ransome (one of the VAPF’s previous Presidents) had received tickets to visit the HOR gallery and we could check with him if we were interested. We deferred, considering that it was already after 7:30 pm and we didn’t want to head back over and wait in line. However, when Sterling showed up and offered the tickets directly, we figured that we really should go and sit in on some of the debate.

When we walked back to the Capitol, we realized that the lines were gone and we were able to proceed directly to the gallery. There we saw the introduction of the Stupak Amendment (which extended the Hyde Amendment restricting federal funding of abortion to the insurance plans purchased on the health insurance exchanges proposed by H.R. 3962) as well as the introduction of House Minority Leader John Boehner’s substitute amendment that would replace the proposed legislation with new legislation put forward by the GOP. As expected, the debate on this was energetic and long, and after being in the gallery for nearly 2 hours Janet and I decided to look for a cup of coffee.

It took a little while to find an open restaurant where we could get coffee and a snack, and we decided that we would head back to the Capitol. I didn’t expect there to be a vote of any consequences for some time—I expected something to happen in the early hours of the morning, but we felt that this was a historic moment (whichever side won) and we wanted to see how long we could last.

As we approached the HOR visitor’s entrance, it was clear that something was happening. People were streaming across the plaza outside of the Capitol, which was now filled with cars where it had previously been empty. We hurried through the security stations and into the line waiting to reach the gallery. As luck would have it, the Capitol security was in the process of moving current gallery occupants out to make room for new visitors and we were able to move forward right away and were soon seated in the gallery.

The floor of the HOR, which previously had only 30 or 40 people scattered in the seats, was packed and standing-room-only. Janet and I realized that the vote was underway on Boehner’s substitution amendment, which was voted down 258-176. Suddenly we realized that this was THE vote—that H.R. 3962 was going to be voted on directly.
Before the bill itself came to a vote, Minority Whip Eric Cantor (of Virginia’s 7th Congressional district) rose with a motion to recommit the bill to committee with instructions to add language regarding tort reform. This motion was voted down 247-187, and the bill itself came to a vote.

In the gallery, I was sure that the bill would pass without difficulty. After all, the two previous votes showed less than 190 votes that would likely also be votes against the bill. As the clock started counting down the time to vote, however, it became evident that the vote was closely matched. The “nays” reached 187, then 190, then 200 as the “yeas” stayed just 3 or 4 votes ahead. Each side increased little by little until, with approximately 3 or 4 minutes left in the vote, the “yeas” reached 218—the number needed to ensure a majority in the 435-member chamber. A loud cheer went up from the Democratic side of the HOR, and from many in the galleries—even as security sought to enforce the no-clapping rule for visitors. The final minutes of the vote expired, with the final count being 220-215 for passage. Whatever your perspective on the debate, it was dramatic and terribly important moment.

I support the bill, and after the vote Janet and I walked over to our Congressman’s office to see if we could thank him for his vote in favor of the bill. Bobby Scott’s office was open, and his aides mentioned that he was due back in a few minutes and if we would like we could wait and meet him. We waited—after all, what were a few more moments when it was already after midnight—and were able to speak with Rep. Scott for a few moments and thank him for his work in support of this bill.
When I went to college, Government was the other major I was considering other than Biology. It was a great chance to see the process at work—ugly and convoluted as it can be—and an opportunity to walk in and meet our representative. Health care reform has a long road ahead of it and, whatever side of the argument you find yourself on, I urge each of us to become active and engaged in the process. If we choose not to, rest assured that someone else will be speaking their mind to our representatives.

Wednesday, November 11, 2009

Anthem's Response

So, apparently I annoyed Anthem/WellPoint, Inc with my Op/Ed. My reply might not be posted in the paper, so I'll post it here.


I am writing to clarify claims I made in my Op/Ed dated October 30, 2009. On November 8, a WellPoint, Inc. spokesman called into question some of the claims I made in my Op/Ed, and alleged that I had been dishonest. I would like to take the opportunity to reply to these comments, and to show why I believe I have accurately represented some of WellPoint, Inc.’s business practices.

I would like to start by acknowledging my misstatement regarding WellPoint’s profit. This error was pointed out to me by one of the Richmond Times-Dispatch readers, and the newspaper printed a correction on October 31. I apologize for this error, and am glad that it was addressed.

I would also like to note that my Op/Ed represents my personal opinion. I do not speak for VCU Health Systems, and VCU Health Systems has not requested, endorsed or approved of my comments. My employment there was mentioned only because I understood the Richmond Times-Dispatch required it to be noted.

Moving forward, I would like to demonstrate some examples of why I believe that WellPoint’s business model actively seeks to deny care to patients. Mind you, in my Op/Ed I never accused individual employees of improper conduct or of refusing care for patients. Rather, I draw attention to corporate policies that I believe harm patients. Some examples of these policies are:

• During a June 16, 2006 hearing of the Oversight and Investigations Committee of the House Energy and Commerce Committee, subcommittee Chairman Rep. Stupak noted that the committee's investigation has "found that at least one insurance company, WellPoint, evaluated employee performance based in part on the amount of money its employees saved the company through retroactive rescissions of health insurance policies. According to documents obtained by the committee, one WellPoint official was awarded a perfect score of five for exceptional performance based on having saved the company nearly $10 million through rescissions." Therefore, it is not only me but also a subcommittee of the U.S. House of Representatives that asserts that Anthem rates employees based on their ability to retroactively deny care to policyholders. It is also striking that Anthem’s representative at this hearing would not commit to ending rescissions and stop retroactively canceling patients' insurance--even if the reasons for revoking the policy had nothing to do with any intentional fraud on patients' parts or any connection with the patients' insurance claims. I could provide numerous examples included in this subcommittee's report, but do not have the space to do so. The transcript of the hearing and its supporting documents can be viewed at

• An article in the Los Angeles Times (February 13, 2008) reports on Blue Cross of California’s decision to stop asking physicians to search through patients’ medical records to seek information that might be used to cancel patients’ insurance coverage. To quote from the article:
Blue Cross sent physicians copies of insurance applications filled out by new patients, along with the letter advising them the company had a right to drop members who failed to disclose “material medical history.” That could include “preexisting pregnancies.”

The letter asked physicians to “immediately” report any discrepancies between their patients' medical condition and the information in the applications.
Again, this sounds like a practice designed to find patients whose health insurance can be terminated—after they have applied for the policy and paid premiums. At least some of those interviewed in this article raise concerns whether these letters violated privacy laws.

In closing, allow me to make it clear that I did not accuse Anthem’s associates of any wrongdoing. Instead, I believe that a great deal of what is wrong with our current health insurance system is related to the activities of for-profit companies and the steps they take to ensure that profits are made. It is WellPoint’s and Anthem’s corporate policies that I am critical of. Considering the information I have provided above, I believe that I have good reason to be critical.

A public option would provide a counterbalance to policies such as these described—although it would still face fraud and abuse, it would at least be answerable to the people and not to stockholders seeking profit. Once WellPoint and other for-profit insurance companies choose to engage in an honest public discussion, we should welcome it. We should also ask them to explain the harmful policies I have outlined above.


Mark H. Ryan, M.D., F.A.A.F.P.

Sunday, November 1, 2009

The American Medical Association's Position on Healthcare Reform

I was at meeting recently where a representative of the American Medical Association (AMA) spoke about the organization's perspective on the current healthcare reform proposals under debate in the congress.

The AMA's template for reform includes:

1. Provide coverage for all

2. Insurance market reforms to expand affordable coverage, address pre-existing conditions, etc.

3. Assure health care decisions will be made by physicians (not insurers or government agencies)

4. Invest in prevention, wellness, and quality improvement.

5. Repeal Medicare's Sustainable Growth Rate.

6. Medical liability reform.

7. Reduce administrative burdens.

The AMA's perspective is that physicians generally agree on these ideas, but differ on the proportions that each of these ideas should contribute toward reform.

My main disappointment is that during the conversation, the issue of universal coverage was discussed very little in proportion to issues of physician payment and such. I guess that shouldn't be a surprise considering that this was a physician's meeting, but I guess I expected more.

There was a representative on the panel discussing these issues who is a member of the "Coalition to Protect Patients' Rights." This person seemed pretty set that the only right reform was to give tax breaks to individuals and allow them to negotiate with their providers regarding the costs of care. I'm going to try and review this group a little more--I don't think this proposal has any validity, but I want to check into it before I criticize it.

Initial Reaction to the Op/Ed

As I noted a couple of days ago, the Richmond Times-Dispatch posted my Op/Ed. The discussion has been interesting, to say the least. A few personal attacks, some half-formed arguments, but a lot of honest and concerned people sharing their opinions on this incredibly complicated issue.

My point of view is that, without a national public alternative to the for-profit plans, reform will not amount to much. It will be interesting to see how the debate continues over the next few days.