Two of my favorite organizations, Massachusetts Health Quality Partners (MHQP) and Consumer Reports, have teamed up for an innovative new project to help consumers find physicians who best fit their own preferences.  Based on a new MHQP survey of over 60,000 adults and parents, and nearly 500 practices, Consumer Reports today is releasing its first ever Patient Experience Ratings of primary care physician groups in Massachusetts.

The good news: according to the report, every Bay State resident lives close to a high-scoring practice, with no region scoring higher than any other.

"The flip side: there are probably some low scoring practices near you, too."

And "nearly every practice has room for improvement." 

And while Massachusetts health reform increased the demand for doctors, people who already had providers found no issue getting the needed care.

So what? So Massachusetts residents have a new resource to help choose the best primary care practices. It's a milestone in providing consumers with valid, reliable, and useful health information. Let's hope consumers take advantage of it.

For nearly 20 years, MHQP has been doing meticulous work to make medical care in Massachusetts more transparent in order to improve quality. Teaming up with Consumer Reports, the world's largest product-testing organization, takes their abilities to a new level. Consumer Reports is also producing a special version of the magazine for distribution to its subscribers and newsstands in Massachusetts.

The Physician Ratings Report is now available online at www.mhqp.org.  Check out your own physician practice to see how they rank.

(Research assistant: Gideon Duke-Cohan.)

Let's be clear.  June 2012 may be one of the most consequential months in U.S. health care policy history ever. This is the month the U.S. Supreme Court (SCOTUS) is expected to hand down its ruling on the Affordable Care Act (ACA/ObamaCare). Some expect the ruling in the first ten days of June, and some expect it in the final ten days, and nobody seems to expect it in the middle ten days.

By my count, there are eight possible Supreme Court outcomes, ordered from less to most impactful -- SCOTUS could:

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It's a truism in public health that when their job is done well, no one notices. No one notices water that isn't dirty, air that's clean, poisonings that don't occur, diseases and infections that don't emerge.

Well, not always.

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I just finished reading the recently published autobiography of Dr. Joseph B. Martin MD, former Dean of Harvard Medical School (1997-2007) and Dean of Medicine and Chancellor of the University of California, San Francisco, Medical School. He has written a compelling personal history of U.S. academic medicine since the 1970s that honestly confronts many of the controversies and conflicts afflicting our medical system, especially the conflicts of interest between American medicine and the industrial medical complex.

Dr. Martin was born into a Mennonite farm family in depression era Alberta Canada in 1938. One of his many compelling stories involves his uncle Sam who went to prison rather than violate his religious objections to military service in World War II. In spite of a lifetime career in the cathedrals of American medicine, he never lost that common sense approach to difficult decisions.

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Here's something worthy of notice: 30 Massachusetts business leaders this week urged House and Senate leaders to include in their health care cost control legislation a provision to eliminate the exemption from food taxes for soda and candy. Here are the 30 names and their companies who were organized by the Alliance for Business Leadership.

• Andrew Tarsy, President & Executive Director, The Alliance for Business Leadership
• J.J. Bartlett, President, Fishing Partnership*
• Robert Beal, Partner and President, The Beal Companies
• Josh Boger, Founder & CEO (retired), Vertex Pharmaceuticals
• Nicolas Boillot, CEO, HB Agency
• Howard Brick, CEO & Director, MedPanel, LLC
• Jeff Bussgang, General Partner, Flybridge Capital Partners
• Geoff Chasin, President, New England Retail Express
• Tom Clay, CEO, Xtalic Corporation
• Bob Crowe, Partner, Nelson Mullins
• Betsey Dalbeck, Owner/President, Fresh Tracks
• Jeff Dorigan, Global Head, Professional Development Program, State Street Corporation
• Phil Edmundson, Chairman & CEO, William Gallagher Associates
• Israel Ganot, President, Co-Founder & CEO, Gazelle
• Norm Gorin, Chairman & President, Instinct Health Sciences, Inc
• Mark Herman, Vice President, Goldman Sachs
• Diane Hessan, President & CEO, Communispace Corporation
• Kip Hollister, Founder & CEO, Hollister Staffing
• Trish Karter, Founder & Chief Deer, Dancing Deer Baking Company
• Ed Krapels, CEO, Anbaric Transmission
• Janet Kraus, Senior Lecturer, Harvard Business School
• Charles Lord, Senior Project Manager, CQuest Capital LLC
• Jack Manning, President & CEO, Boston Capital
• George Matouk, President & CEO, John Matouk & Co., Inc
• Linda Moulton, CEO , Ceralta Technologies
• Mari Ryan, Founder & CEO, Advancing Wellness
• Tedd Saunders, President, EcoLogical Solutions, Inc
• David Schechter, Managing Partner, Perspective Global Management, LLC
• Ron Shaich, Founder, Chairman & Co- CEO, Panera Bread Company
• Bill Sullivan, CEO, Hub Healthcare Management Services

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Catching up on some late reading, and something from the April 21 National Journal jumped out like a rocket and demands attention:

"The Other Jobs Bill: Mitt Romney lionizes entrepreneurship. His health care law -- and possibly the national version based on it -- helped more than he knew."

Margot Sanger-Katz starts her article by describing Laura Fitton who launched a social media marketing company in 2009. Laura didn't have a lot of money to pay employees, though she found herself able to lure out-of-state talent because of ... Massachusetts health reform. "I absolutely was able to get better people," says Fitton.

Here are extended excerpts from the article which deserves a lot more attention and discussion:

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We now have initial legislative proposals from both the House of Representatives and the Senate to create new mechanisms to control the rising growth of health care costs. After reading both of them, I agree with MIT economist Jon Gruber who notes that the similarities vastly outweigh the differences. Even though the co-chairs of the Joint Financing Committee, Senator Dick Moore (D-Uxbridge) and Representative Steve Walsh (D-Lynn) were unable to agree on a common proposal in committee, their two versions are mighty close.

And that's not a bad thing at all if you would like to see something happen in the short amount of time that remains between now and the end of the legislative session on July 31st.

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Message to the smart people in the Massachusetts House of Representatives who are getting ready to debate legislation to reform the health care financing/payment system: if you want to save real money and add real value to our society, emphasize prevention and public health, and prioritize it.

Here's the latest, just in time for the House debate, from the U.S. Centers for Disease Control and Prevention:

Reduce the rate of growth of obesity by one percent a year over the next two decades, and slice the nation's health care costs by $85 billion.

Keep obesity rates at current rates -- well below the 33 percent projected increase, and save the nation $550 billion during the same period.

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Yesterday, Massachusetts House leaders released their first version of legislation to reform the state's health care financing system in order to bring health care costs under control. For rookie Health Financing Co-Chair Steve Walsh (D-Lynn), it is an impressive debut for his first major health proposal, advanced with the backing of House Speaker Robert DeLeo (D-Winthrop) and 11 health economists. Read the coverage in today's Globe and on WBUR's Commonhealth blog.

Two reasons this is good news.

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Yesterday's Washington Post op-ed column by Norman Ornstein of the American Enterprise Institute and Thomas Mann of the Brookings Institute deserves wide discussion. Ornstein and Mann are widely respected political centrists, not aligned (unlike yours truly!) with either end of the political spectrum. That makes their insights all the more powerful:

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I observe a tendency in both human nature and public policy to see progress in a difficult situation and to declare victory prematurely. Often it turns out that the early victory signs were ephemeral and an opportunity to secure more enduring change gets missed.

Two related examples of that are happening right now, both involve national and Massachusetts health policy choices. One involves rising health care costs, and the other the obesity epidemic and sugar sweetened beverages.

Let's first look at costs.

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Apropos the previous post on the repeated delays in legislative consideration of Governor Patrick's health care cost control proposals, here is some smart reporting from the State House News Service:

Fourteen months after Gov. Deval Patrick filed a proposal on the issue, Senate President Therese Murray said Wednesday she expects the Senate to take action in mid-May on a bill making major changes to the way health care is delivered and paid for in Massachusetts.

"Probably the week before budget," Murray told the News Service, referencing the fact that the Senate intends to consider its annual budget plan the week before Memorial Day.

The bill, with multi-billion-dollar implications for an industry that also ranks as Massachusetts largest employer, has been sitting idle in the Legislature's Health Care Financing Committee since Patrick filed it in February 2011. On Wednesday, the committee decided to discharge Patrick's bill unchanged and send it to the Senate budget committee, a step that signals the bill is nearing consideration in the full Senate.

Murray and House Speaker Robert DeLeo have pledged to act on a health care payment reform proposal this spring, but have offered no concrete timetable, even as the Legislature nears its last three months of formal business for the session.

The release of the governor's bill without changes suggests that the House and Senate were unable to forge agreement on a unified, pre-negotiated proposal, one that could help speed consideration and limit disagreement as lawmakers head toward their five-month campaign and holiday season recess. ...

Murray and DeLeo have both signaled they intend to set long-term goals for health care cost increase, with DeLeo saying he believes limiting health care cost growth to the level of "gross state product" is achievable.

In this case, any news is good news.  Still, the fact that the Health Care Financing Committee chose to discharge the legislation to the Senate without making its own report is an indication of significant differences between the House and Senate leadership on the matter.  That could be problematic because of the short amount of time left until formal legislative business ends on July 31st.  Had the Committee been able to settle on a common framework, prospects for passage would be far more favorable. 

Still, any news is good news -- in this case.  The nation is watching -- let's not let them down.

I confess, it feels strange.

And in Massachusetts, it feels doubly strange.

Just a month ago, the Supreme Court of the United States (SCOTUS) heard oral arguments on the constitutionality of the Affordable Care Act (ACA/ObamaCare). Defenders of the law greeted the arguments with confidence, and then left the Chamber despondent that the incompetent representation of our position was an omen for a disastrous decision to be. Could the conservative SCOTUS majority that selected George W. Bush as president and concocted the Citizens United decision be readying a triple-header?

Hate to say it, beats me.

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I spent a healthy part of this afternoon at the Canary Square Restaurant in Jamaica Plain at a fundraiser for NAMI Massachusetts, organized by their board member Steve Rosenfeld. NAMI is the National Alliance on Mental Illness, the largest advocacy group in the nation for adults with mental illness -- perhaps the most important organization in the state or nation to you, if you have or know someone with mental illness.

NAMI's prime mission is addressing the stigma faced by those with mental illness and their families and loved ones. They are an indispensable resource for individuals and families facing mental illness, and provide "free mental health family-based education, family and peer support and grassroots advocacy." Currently, one of their projects is training on mental illness for local police departments across the Commonwealth.

This afternoon's event was intended to raise $20,000, and by the end of the event, more than $40,000 had been collected. The main speakers were Michael and Kitty Dukakis who began grappling with Kitty's depression in the late 1980s. After 17 years, they found relief in electro-convulsive therapy (ECT) and Kitty is now an author and speaker on mental illness. They are both passionately open about their experiences in order to help others.

NAMI Massachusetts will host its annual NAMI Walks fundraiser on Saturday, May 12th. Their executive director, Laurie Martinelli, notes that of the 85 NAMI chapters across the nation, the Massachusetts Walk is the most successful. Here's to their continued success!

Today's announcement by the Massachusetts Medical Society and six other major health care organizations of a new approach to medical liability/malpractice is a welcome event and breakthrough.

Patients harmed by medical errors at Mass. General Hospital, three Baystate hospitals in western Mass., and three Beth Israel Deaconess hospitals will be offered an apology and financial compensation as an alternative to litigation. This program is modeled on a ten-year successful model in Michigan. Development of the program was supported by a $300,000 federal grant from the Obama Administration. Michelle Mello, my colleague at the Harvard School of Public Health, will be the principal evaluator.

It is rare when I give a talk on health reform or the Affordable Care Act that the topic of malpractice does not come up. The ACA does not include the kind of liability changes promoted by Republicans, though it does include support for a demonstrations of new liability alternatives -- though the Obama Administration found alternative funding for the demos when Congress could not agree on how to appropriate the funding.

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It's not winning much attention, especially from the Wall Street Journal which loves to print anything negative about Massachusetts health reform, but the new report from the Massachusetts Taxpayers Foundation on the cost of reform after six years of operation, is important:

"The gains of health reform have been achieved without placing an unexpected or unmanageable burden on the state's budget. Annual spending for programs affected by Chapter 58 grew from $1.041 billion in fiscal 2006 to $1.947 billion in fiscal 2011, an increase of approximately $906 million (Table 1). The state's share of this spending increase is $453 million, or 50 percent of the total. While critics periodically claim that health reform has been a 'budget buster,' additional state spending attributable to the health reform law accounted for only 1.4 percent of the Commonwealth's $32 billion budget in fiscal 2011."

The Foundation is the respected, long-time, business-backed Massachusetts state fiscal watchdog agency, led by the respected Mike Widmer. In my years in the State House, I had loads of agreement and disagreements with MTF.  Yet even in disagreements, they always hold the respect of friends and foes alike.

Across the land, it is accepted wisdom that Massachusetts health reform has been a fiscal nightmare and is driving the state to near bankruptcy. The MTF report will not change that prevailing wisdom because so many don't want the judgment to change. It just happens to be the truth.

Prior to Mitt Romney's 2012 presidential campaign, hardly anyone referred to Massachusetts health reform as "RomneyCare." As with "ObamaCare," it was a term of choice only for critics, most of them out-of-state. The libertarian Cato Institute began using it back in 2006. I recall former Boston Medical Center Chief Elaine Ullian using it early and often because she opposed the law's funding reductions for safety net hospitals. Not many more.

Those of us who worked on the law's passage and implementation never used the term for a simple reason. The law Romney proposed in 2005 differed markedly from the law approved by the Democratic-dominated Legislature in 2006. Romney wanted everyone to have access to flimsy, high-deductible coverage; the Legislature insisted on fuller coverage for those getting access to the subsidized Commonwealth Care coverage, and a choice of skinny or full for everyone else.

Romney was governor for less than nine months into the law's implementation. Most key decisions did not happen until 2007 after his departure and the arrival of Governor Deval Patrick who supported a more expansive version than did his predecessor. We were pleased Romney continued to support the law and promote it as a national model during his 2008 presidential run, though it was no big deal.

And still...

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It's time for me to say something nice about physicians, and the organized kind in particular.

For many years, I've noticed that organized groups/stakeholders/associations have an almost impossible taking public positions that violate their economic self-interest. It happens so rarely, at least in the health space, I can count on one hand the number of notable exceptions I have encountered, for example:

• Dentists who support water fluoridation;

• Pediatricians who support vaccination;

• The Massachusetts Medical Society in the 1990s who led a first-in-the-nation effort to make physician liability records available online.

Perhaps you can think of others. They are few and far between. Individuals, even as members of groups, can part company with the herd. It's just devilishly hard for organizations themselves to do so because self-interest is so engrained in their DNA.

This makes it all the more noteworthy that last week nine U.S. physician specialty societies representing 374,000 physicians released a total of 45 recommendations (5 each) for common medical treatments that should not be done commonly by their members on/to patients. For more information on the campaign, check out the website Choosingwisely.org organized by the American Board of Internal Medicine.

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Lots of folks ask me why I think the Affordable Care Act/ObamaCare is so unpopular. I first assert that it's not as unpopular as popularly characterized (see Kaiser Family Foundation monthly tracking polls) and then I refer to the deliberate and false claims about the law being widely circulated around the nation, particularly aimed at senior citizens. I wrote about one particular falsehood last month. Now, my newfound pals at the GE Retirees Association yesterday sent me another they have been receiving in their email inboxes:

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So, lots of state and local Republican officials have been perseverating over voter fraud by unknown perpetrators, and passing laws and ordinances aimed at making it harder to commit illegal voting. One problem, these same officials have been unable to identify any instances of actual fraud. Meanwhile, their restrictions impede voting and voter registration efforts by population groups more likely to vote in the Democratic direction, leading to charges that their real agenda involves not voter fraud, but voter suppression of those likely to vote in favor of their opponents.

Beats me, I'm just your humble reporter here.

But, there is a real and gigantic case of voter fraud committed just this past week, and for the second known time! And it seems that these perpetrators will get away with it again. And it's not chump change -- it involves more than $500 billion.

Bear with me.

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Some thoughts after three days of oral arguments before the U.S. Supreme Court (SCOTUS) on the Affordable Care Act (ACA).

First, we don't know what the full Court will do, and no one does. The air of confidence that ACA supporters brought into the room has evaporated. Some, such as CNN's Jeffrey Toobin, have now gone 180 degrees to pessimism. They may be right, but it's clear that the smart analysts just don't know. The DC Court of Appeals oral arguments on the law were considered a disaster for ACA supporters, and that court's decision ended up as a huge win.

The history of the ACA has been marked by premature death sentences, most notably on January 19 2010 when Republican Scott Brown won the U.S. Senate seat formerly held by Sen. Ted Kennedy, thus ending the Democrats' 60-seat Senate margin. I recall nearly every commentator, right-left-center, saying it was over, and deriding then-House Speaker Nancy Pelosi for her confident statements that health reform would pass. This moment, after the oral arguments, does not come close to the consternation of January 20, 2010.

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So, here we are, the Affordable Care Act (aka: ACA) and the Supreme Court of the US (aka: SCOTUS). For public health law and political junkies, this is the World Series. Six hours, three days. Every move and statement will be parsed and analyzed. It doesn't get better than this.

And while interest is high among non-policy wonks, let's recognize vast confusion among the broader public. Broccoli, home grown wheat, home grown marijuana, car insurance, huh?  So, as a public service to those who might like to get up to speed, I offer a modern day parable on the ACA's biggest controversy, the individual mandate.

Like any good parable, it starts with an oversized metaphor: so, imagine a sailing ship called the S. S. Individual Mandate.

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Readers here may have noticed that I spend a lot of time writing about the Affordable Care Act (aka: ACA/ObamaCare). On the occasion of the second anniversary of the law's signing on March 23, 2010, let me explain, as concisely as possible, why.

First, our beloved U.S. health care system, pre-ACA, is a moral, ethical, humanitarian, and economic disgrace. No other advanced nation on earth permits its citizens to suffer financial ruin because they get sick. No other advanced nation leaves so many citizens with no financial protection from the cost of illness, with as many as 45,000 deaths each year due to lack of health insurance. No other nation spends as much on medical care services as we do, and for such mediocre results.

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Most good lies have a kernel of truth in them, giving them undeserved credibility. Here's a great example of a lie intended to scare senior citizens into opposing both the Affordable Care Act (aka: ACA/ObamaCare) and President Obama as well.

Last week, I spoke to the GE Oldtimers Association, a luncheon group of about 50 older gents (and a few women) who are retired managers and engineers from the GE jet engine plant in Lynn, Massachusetts. They meet at Anjelica's Restaurant in Middleton, MA. They are nice, smart, informed, and attentive. They had lots of questions about the ACA, and we had a great discussion.

Near the end, some of them asked me about unsolicited emails they were getting claiming that the ACA, beginning in 2013, would impose on them a new Medicare tax of 3.8% when they sold their homes. Now, I knew that the ACA creates a new 3.8% Medicare tax on unearned income in excess of $200,000 for individuals and $250,000 for couples. But a tax on principal residences? It didn't sound right. Rather than guess, I asked them to send me the email and I would check it out.

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In honor of this day, I offer a non-health post:

For most of my life, St. Patrick's Day was an eye-rolling, shoulder-shrugging event. Silly leprechauns, gaudy fluorescent shamrocks, bars bulging with beer-drenched braggadocios, plus fingernail scratching renditions of "When Irish Eyes Are Smiling" -- all reasons to race for the door.

It wasn't until mid-adulthood, and thanks to Thomas Cahill's little book, How the Irish Saved Civilization, that I learned a different side to the story. Patrick is a figure for the ages -- an energetic voice in early human history to speak out in opposition to human slavery.

Huh?

See, around the year 401 AD, a 16-year-old middle-class and Romanized Briton boy named Patricius was kidnapped by an Irish war party from his home on the southwestern coast of Britain, taken to Northeastern Ireland and sold into slavery. For six years, Patrick, "chastened exceedingly and humbled in truth by hunger and nakedness and that daily," was the shepherd-slave of local warlord named Miliucc.

On his final night as a slave, a voice in a dream told him that a ship was ready to take him home. He found that ship after a 200-mile walk to the southeastern Irish city of Wexford, convincing a skeptical captain to take him aboard. He reunited with his family after years of wandering, and then pursued ordination as a priest after visions and dreams urged him "walk among" the Irish once more.

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