Archive for the ‘Policy’ Category

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October 29, 2009

Create Health Workforce Jobs for U.S. Economic Recovery

We all know that the employment picture in the U.S. continues to be dark. One in 10 Americans who wanted a job last month were unemployed. What many do not know is that private sector employment growth fell short of the number of new people entering the labor force by more than 500,00 jobs each year throughout the 1990s! The bottom line: Economists say the U.S. job creation engine has been stalled for the better part of a decade.  New enterprises are not coming on line. As older industries die, established industry and entrepreneurs are not entering the market place and using capital to create jobs.

 So where will jobs come from? Health care is an obvious choice. It’s time for a public policy to support this growth industry with a Jobs Bill for Health Care (similar to the post World War II GI bill). The bill would provide funds to train all comers – from the returning war vets to the unemployed, from the dying manufacturing industries to the recent high school graduates. This will produce not only the health workforce that the U.S. so desperately needs in the near and long term but also create a “product” that can be exported overseas – trainers for other countries’ healthcare challenges.

 In addition to direct investment, the government should ensure funding from the insurance industry and providers who do not now train health professionals but depend on the health workforce . Let’s ensure the health and economic future of the United States with a public-private partnership that makes sense.

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Posted in Health Reform, Policy, U.S. Economic Growth, health economics, health professions education, health workforce | No Comments »

October 22, 2009

Interprofessional Education and Practice: Infrastructure Needed to Go From Rhetoric

For years there is talk about interprofessional teams.  For more than 20 years, educators and policymakers have put this forth as part of the health care vision for the 21st century.  It is also directly and indirectly referred to in health reform legislation before the Congress.  Policymakers are enamored of the idea of an interprofessional team of caregivers providing patient centered care (whatever that means).

 I learned about some of the latest innovations in  interprofessional programs in academic health centers throughout the nation.  Students from two or more health professions are educated together and/or engage in practice together and, in so doing, are not only improving the learning environment but also patient care and outcomes.

 

Rural practitioners tend to embrace interprofessional practice more fully than practitioners anywhere else in the country for obvious reasons.  However, in the last decades, interprofessional education has not gone mainstream and been fully embraced by health professions schools and academic health centers.  Interprofessional activities have been person directed (by a passionate advocate), thus remaining at the margins of health professions education.  Passion on the part of institutions is not quite as evident.

 What’s the problem.  Money is always an issue.  With universities and hospitals waiting for the next budget cut, institutions are hampered from creating new programs so needed for the future.  In addition, we still don’t have enough evidence that such practices make a difference.  There has not been enough study of the long-term impact of interprofessional initiatives.  Research is needed.  And that also cost money. Regulations don’t support it.  State licensing boards and accreditation agencies often inhibit innovation within institutions. Scope of practice laws are barriers to interprofessional practice.  Faculty incentives are still based on what makes a difference to the “profession,” whichever that may be—thus making it hard to engage appropriate teachers in the process. Finally, the current health care delivery system—specifically the reimbursement system—does not support interprofessional practice—and may not support it for the future. 

 The bottom line:  Interprofessionalism lacks focus.  There is no standardization, no uniformity anywhere in the nation.  There is no framework for programs, policy or practice.  There is no infrastructure and no guidelines for establishing the infrastructure that is needed within institutions, particularly academic health centers where most of health professions education takes place.    To fill this void, leaders of academic health centers are engaging on the issue—not only to mainstream interprofessional education and practice but to educate policymakers about the best way to deliver care for the future.

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Posted in Policy, health professions education, health workforce | No Comments »

October 20, 2009

Challenges for the Health Care Sector

I recently returned from the World Health Summit in Berlin, a large substantive meeting dealing with many aspects of health and well-being.   On one of the meeting’s many panels, I was asked to address what the health care sector needs in order to thrive.  In thinking somewhat about this topic, I decided to focus on the serious challenges that health care, from a global perspective, faces, and chose to comment on five of them.

1. Increasing Dualism.  By this I refer to the growing health disparities that exist within and among countries, as well as the significant gap between what we know scientifically and what we practice clinically.

2. Overextension of the health system, such as in needed responses to pandemics, wars, natural or man-made disasters, emerging diseases, behavioral and planetary changes, and so forth.

3. Loss of Focus on the Patient and the Community.  Here the concern relates to growing economics of health care and the delicate balance between seeking profit and good health.

4. Shortage and Maldistribution of Healthcare Workers.  Readers of this Blog should not be surprised by this one.  These shortages range from a general lack of practitioners to specific kinds of medical specialties, and include ethical issues of the international migration of health workers.

5. Support of Research.  Research is a critical engine of progress for health care delivery.  Continuing the flow of these dollars and directing them to areas with the highest yield remain substantial challenges.

There has never been a more relevant opportunity for those institutions educating the next generation of health professionals, conducting biomedical and clinical research, and caring for patients to work together collaboratively.  In response, AAHC International has been created to foster the concept of an international academic health center community driven by the ideal of improving the public good.

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Posted in Health Reform, Policy, health workforce | No Comments »

October 15, 2009

Olympia Snowe’s Trigger Will Shoot Americans in the Foot.

What qualifies Olympia Snowe to be the arbiter of health reform?  Her health reform option is nothing to write home about.   Snowe would have states get a government-run plan–a public option– if at least five percent of residents lack access to affordable care.  Congress should not create a subpar Medicaid option–something only for the poorest in our society–rather than a true health plan for all Americans.  

What is “affordable access to care,” according to Olympia Snowe?  How will states decide that they have  more than five percent of the population who qualify?  Who decides how much a health plan will cost?  Who decides what the plan will cover–and for how long?  What about the middle class people–with coverage–who are now going bankrupt because of their medical bills?  Will they be in the five percent?  

Who decides at what point premiums get raised–or that certain conditions will no longer be covered?  What about the family with the 17 pound baby who was denied health insurance coverage and deemed to have a pre-existing condition–obesity– by the health insurers?  Will his family be counted? Maybe it takes 17 pounds to pull the trigger?

Here’s the bottom line: With a true public option, Americans would not have to ask those questions–or worry now about what a public option means.  Olympia Snowe’s “trigger” is just another way of shooting ourselves in the foot!  It’s time to stop playing games and have a real public option as an American right.

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Posted in Health Reform, News, Policy, health insurance | No Comments »

October 8, 2009

Include Health Workforce Planning Entity in Health Reform Legislation

It’s still not too late to put a national workforce planning entity into health reform legislation (or I am supposed to say health insurance reform).  This would neither be a commission nor a short-term advisory or research group. This would be a permanent entity–perhaps a quasi-governmental organization that has some clout–not only to bring constituencies together but also to get things done that change the shape of health workforce policy in this nation.  The goal–plan so that the health workforce can care for the American people now and in the future.

Academic health center CEOs said as much this week when they told congressional staff and representatives of national health care organizations at a congressional briefing that pending health reform legislation(including the Senate Finance Committee proposal) does not yet reflect the strategic emphasis on health workforce needed to implement successful health system reform.

  “Pending bills include numerous important workforce-related provisions, but they lack sufficient means to effectively coordinate workforce policy among federal, state, and private laws, regulations, and standards,” said Dr. Steven A. Wartman, President and CEO of the Association of Academic Health Centers (AAHC).

Dr. Wartman was joined in the panel discussion by: Dr. Nancy Dickey, President, Texas A&M Health Science Center, and Vice Chancellor for Health Affairs, Texas A&M University System, and past chair of the AAHC Board of Directors; Dr. Philip A. Pizzo, Dean, School of Medicine at Stanford University, and chair of the AAHC Board of Directors; and Dr. M. Roy Wilson, Chancellor, University of Colorado Denver, and a member of the AAHC Board of Directors.

 Dr. Wilson told the group that the nation must have a national agenda for the workforce.  Without such an effort, federal, state and local governments and agencies will continue to work in isolated silos as they attempt to solve workforce issues.

 Dr. Dickey emphasized that health workforce reform has to start today so the nation can build a viable infrastructure and rationalize our health workforce policy.  With a permanent national workforce planning body, the nation can address the full range of workforce issues — from shortages and geographic disparities, to regulatory and policy conflicts that prevent health professionals from practicing to the full extent of their training, to the paucity of reliable data on the workforce — in a comprehensive and coordinated manner.

 Dr. Pizzo cautioned that when policymakers consider changes in health care reimbursement, they must take account of the unique academic health center education and research missions, which in part are dependent on clinical revenues.  The nation must ensure that reimbursement reform does not financially undermine these academic health center missions that are so vital to the nation’s economy and its preeminence in education and research worldwide.

 “Comprehensive health workforce reform is necessary for successful health system reform, and the key to health workforce reform is creation of a permanent, ongoing health workforce planning body,” concluded Wartman.

It’s about health care.  It’s about jobs.  It’s about the economic future of the nation.  We can’t make the health workforce a second-class issue.

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Posted in Health Reform, News, Policy, health workforce | 1 Comment »

September 30, 2009

Baucus Tells America: No Public Option, Horatio Alger is Role Model

Long live Horatio Alger, the Congress said yesterday.  The Senate Finance Committee, by its vote against a public option in health reform legislation,  told the American people  that  if you can’t be Horatio Alger–if you can’t suffer and persevere and make it on your own when it comes to health care– tough luck.  Senate Finance Committee Chairman Max Baucus lives too much on the frontier.  He  obviously still believes in the Horatio Alger myth–that is,  that America can be sustained by  rugged individuals who, like the boys glorified by the 19th century dime-store novelist  Horatio Alger,  can go from rags to riches on their own solely by hard work and clean living. 

Without a public option, Baucus is saying that if you get sick, don’t have a job, lost your job, can’t pay your bills, get insurance coverage, figure out the insurance system, there must be something  wrong with you.  You’re not living right. You didn’t follow the Alger rules. The government will not help you.

 Shame on Senator Max Baucus. Shame on the Finance Committee. Shame on President Obama for letting the Congress act on its own on health care.  Shame on  America for not protesting in favor of a public option.

 This is the 21st Century.  Horatio Alger is not the role model we should be admiring. Did Horatio get an inherited form of cancer? Did Horatio lose his job because thieves on Wall Street were “too big to fail?”  There are forces at work beyond the control of any one person.  No one can make it on his  own these days—and no one should be blamed for that.

Horatio Alger  can no more protect his health in the modern world than he can provide for his own defense with a musket in the corner of his room in the boarding house!

 The government should protect its people with a health care program just as Horatio Alger –in the end– was saved from poverty with the help of a wealthy benefactor.

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Posted in American culture, Health Reform, News, Policy | 1 Comment »

September 10, 2009

The Time for Games Has Passed, Says Obama on Health Reform

The President  brought new energy and enthusiasm  to Congress last night as he tried to reignite action on health care reform.  Overcoming my anger at a joint session of Congress during a  BIG GAME –a quarterfinal match at the U.S. Open with 1 of only 2 Americans left in the tournament — the speech showed the President taking a firmer stand on reform, attacking the false claims on reform options, and talking of “my plan.”

Obama exhorted Americans to believe in their power—and the power of government—to do good.  He called on Americans to address health care as a moral issue, emphasizing that social justice and the character of the nation are at stake.

That said, what did we learn?  The President said that if we do nothing to slow the costs of Medicare and Medicaid, they will eat up the entire budget.  On the other hand, Obama made of point of saying that if you’re enrolled in Medicare, Medicaid, or the VA, or have employer based health insurance, nothing will change. Does that mean that the government will not cut Medicare and Medicaid payments? 

 The President’s plan will provide more security and stability to those who have insurance, provide insurance to those who do not, and slow the growth of health care costs.  His plan is to “make insurance work better for you.”  Will the insurers just pay for less (especially since they will have to cover pre-existing conditions)? How much will insurers change their pricing with academic health centers?

For those individuals without insurance, they will be required to get insurance (like auto insurance, said the President). The interesting thing is that some states do not make motorists show proof of insurance on routine traffic stops. Insurance is required, but only in the event of an accident. While fines can run to $5000, most are in the $500 range and only a few states impound your car—or send you to jail.  How will the government enforce the mandate?

As for the new insurance exchanges to be established, “customers will have leverage with the insurers,” said the President, who added that he will hold insurers accountable. The President did not say how that would happen.  I hope you’re right, Mr. President, but it sounded a bit like Shangri-la.  

Most importantly, the President will end fraud and abuse in Medicare.  While a worthy goal, it raises concern for academic health centers. The government does little now to evaluate providers (many fraudulent) who apply for a Medicare provider ID and run off with millions of dollars in payments for services never rendered.  So where is there money to be found?  The government is able to collect money by establishing Recovery Audit Contractors and other vehicles to search for supposed billing errors by academic health centers.  Is this the “fraud” the President is talking about?  Will we see some RAC clones established or a new wave of billing regulations? 

The President said the details of the plan are yet to be worked out.  The coming days will show the true impact of the speech and whether we see any change in attitude or action on Capitol Hill.

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Posted in Health Reform, Policy, health insurance, president Obama | No Comments »

September 8, 2009

Baucus to Uninsured: Pay Up or Face Fines

According to reports about  Sen. Max Baucus’ latest plan for health reform, fines would be imposed on those individuals and families who do not buy health insurance–$950 for individuals and up to $3800 for families.  Senator Baucus, what kind of reform is this?   Talk about wasting resources.  How will the plan be monitored and enforced?  Maybe the U.S. Department of Homeland Security and the Transportation Security Administration can add insurance surveillance  to their duties.  As you are screened at airports, you have to show your insurance card.  Will Senator Baucus create the insurance police or just ask the OIG to create a new department?  Will neighbors be asked to report on neighbors and become insurance spies with some incentive program for reporting?  What happens  if you pay the fine and still don’t buy insurance?  Will you just pass GO and head directly to jail?

I can’t understand such a proposal.   Is Baucus worried about not throwing enough business to his backers–the insurance companies?  Reform should be so good that everyone wants “in.”   Something tells me that Baucus is not offering much if he has to fine the non-participants.   Sounds like our current system where people, mostly for financial reasons, do not buy insurance.   Today, many people say, “OK, I’ll pay the medical bills for my post-college age kid because health insurance premiums are either too high or don’t provide decent coverage.”

In Baucus’ plan, we see he penalizes the victim–adding insult to injury to those people who cannot afford insurance–even with a government subsidy, which will amount to peanuts.  So we make the non-insured pay a fine–and then what?   Do they still go the emergency room of an academic health center hospital to get care?  Will Senator Baucus pay for that?

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Posted in Health Reform, Policy, health economics, health insurance | No Comments »

September 3, 2009

Obama Trying to Salvage Match Point in U.S. Health Reform Open

What should have been a “love game,” with Obama easily cruising to victory in the U.S. Health Open, has now turned  into a grueling last set, last game battle, with the President having to save match point.  The President will address a joint session of Congress next Wednesday night to add specifics to his vision of health reform, according to media reports.   If conversations with White House health advisors are any indication, it is difficult to discern anything new in the messaging.  If the President tells the nation we need more primary care, health IT, and research to find out what treatments work and don’t work, America will not be enthused.

 America wants to know what systemic changes the President wants in a health reform bill. Will he stand for a strong public option?  Will he provide the roadmap and transition time for changing the current health insurance industry? Will he ensure that the health workforce is a priority and address workforce issues now—not later?  Will he go beyond primary care—and provide a new vision for how to deliver primary and specialty care to all segments of society or will he be satisfied with a 19th century view of the primary care doc going off alone to the rural regions of the country to solve the workforce crisis? 

Will the President explain to the nation that whatever happens in the delivery of services will ultimately affect  the nation’s research enterprise because of the unique  role that academic health centers play in the nation’s health system?  Will he explain how health reform must take account of how the clinical monies help to support the nation’s biomedical research through these institutions?  If the answers to these questions are what is meant  when the White House says  “specifics,” then America will listen.  If not,  the  President will be forced to make a quick exit from Center Court.

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Posted in Health Reform, News, Policy | 1 Comment »

August 27, 2009

Kennedy Believed in Government and the People

Senator Edward Kennedy came from wealth and privilege but believed in the obligation to serve the public—to give back to society and make it better.  He will be remembered as the champion for the little guys–the people without a voice. But he spoke and acted for all Americans.  He raised our consciousness. He channeled our outrage against injustice into solutions to help people live better lives. He reminded us of duty.  He showed us the positive role that government can and must play in the lives of all Americans. He believed in equality and fought and won battles for social justice, health care, higher education, and labor.   That was Edward Kennedy.   There is talk of naming the health reform bill for him.  He would not want the honor without substance—without health care legislated as a right for all.  To remember one of the greats of history with a health care bill that does not live up to the ideals he fought for more than 50 years would be shameful.  Kennedy wanted what was right for the little guy—not the rich, powerful, or corporate interests.

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Posted in Health Reform, News, Policy | 1 Comment »

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