Longer Looks: For Doctors, Breaking Up Is Hard To Do

Every week, reporter Jessica Marcy selects interesting reading from around the Web.

Economist: A Person Already?
One evening in late September John Perkins, a veteran of the civil-rights movement, attended a rally at a Baptist church in Jackson in support of what he called "a total justice issue," … It was concerned with Amendment 26, a measure on Mississippi’s ballot this November that defines a person as being "every human being from the moment of fertilisation, cloning or the functional equivalent thereof". The reason for the measure is straightforward; its consequences less so. The Supreme Court, in its landmark Roe v Wade ruling in 1973, held that the right of a woman to terminate her pregnancy in the first trimester was guaranteed by her constitutional right to privacy. … The measure is expected to pass. … But what happens once the measure passes is unclear. … Would embryos be counted as people for the purposes of a census? Could a pregnant woman be charged with child abuse if she smokes, or be denied chemotherapy if it might hurt the fetus? From Mississippi’s tiny unborn people come strange legal questions (10/8).

The Economist: A New Prescription For The Poor
Medicaid, America's health programme for the poor, is in the process of being transformed. Over the next three years, New York will move its entire Medicaid population into "managed care", paying companies a set rate to tend to the poor, rather than paying a fee for each service. New York is not alone. States from California to Mississippi are expanding managed care. It is the culmination of a steady shift in the way most poor Americans receive their health-care treatment. Medicaid is America's single biggest health programme. This year roughly one in five Americans will be covered by Medicaid for a month or more. It gobbles more federal and local money than any state programme, other than education. ... Most Americans with private insurance are still horrified by thoughts of health-management organisations and prefer to pay fees for each medical service. For the poor, managed care is becoming the norm (10/8). 

The Atlantic: The Quiet Health-Care Revolution
CareMore, through its unique approach to caring for the elderly, is routinely achieving patient outcomes that other providers can only dream about: a hospitalization rate 24 percent below average; hospital stays 38 percent shorter; an amputation rate among diabetics 60 percent lower than average. Perhaps most remarkable of all, these improved outcomes have come without increased total cost. Though they may seem expensive, CareMore's "upstream" interventions—the wireless scales, the free rides to medical appointments, etc.—save money in the long run by preventing vastly more costly "downstream" outcomes such as hospitalizations and surgeries. As a result, CareMore’s overall member costs are actually 18 percent below the industry average (Tom Main and Adrian Slywotzky, November 2011).

Mother Jones: Herman Cain: Alive Because He's Rich
Last month, during a GOP presidential debate, former Godfather's Pizza CEO Herman Cain scored major points when he spoke about his personal experience surviving stage IV cancer. Cain claimed that if he'd been covered under President Barack Obama's health care plan, he'd be dead by now. He suggested that if bureaucrats had been involved, his treatment would have been delayed and probably would have led to an early death. It was a compelling story, but an incomplete one. As Cain makes clear in his new book, This is Herman Cain! My Journey to the White House, he is probably alive today because he's rich. And that's not something Obamacare would have affected one way or another. … The sort of treatment Cain received would have put many people into bankruptcy, even if they had health insurance, thanks to caps and co-payments and other tricks insurance companies use to shift costs onto patients. Cain has never mentioned just what sort of health insurance he had during his cancer treatment, or what he has now. Multiple calls and emails over several weeks requesting information about his health care coverage went unreturned. These omissions are glaring because as a 65-year-old stage IV cancer survivor, Cain would be all but uninsurable if he tried to get insurance now on the private market (Stephanie Mencimer, 10/11).

American Medical News: Pain Management For Practice Breakups
Attorney John Fanburg likes to say that medical partnerships are "marriages without love." He should know, as part of what keeps him busy is helping medical practices divorce as peacefully as possible. There may not be love, but there is plenty of emotion embedded in a medical practice partnership, whether the practice is made up of two or two dozen doctors. When the partnership fails, there is much at stake: Professional reputations, health insurance contracts, vendor relationships, employees' livelihoods -- and, most important, patients' health and happiness -- are at risk. Even a relatively amicable split can be emotionally and professionally draining (Emily Berry, 10/10).

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