Archive for the ‘Policy’ Category
August 25, 2009
The emotional and sometimes angry discourse seen at some health care reform town hall meetings reflects a disturbing combination of politics, fear, and misunderstanding. On one hand, there are the deep divisions within our country concerning the role of government. On the other, there is fear that something as intensely personal as health care might be made “less personal” and more bureaucratic. And lastly, there is confusion as to how our current health system actually works. So far, this combination is proving to be an important obstacle to health reform and perhaps lethal to a bipartisan effort.
Given the huge part of the economy represented by the health care sector, the interplay of economics and health reform is intense on many levels. Yet, I think many of these reactions speak to another aspect of the debate: the basic issue as to whether health care is perceived as a social entitlement that is part of citizenship or as a commodity that can be purchased if desired. There is a deeply reflexive reaction to what are perceived as handouts, and a strongly held sense of one’s just rewards for hard work. Against this backdrop, it is not that surprising that the U.S. is alone amongst highly developed nations in not having a system of universal health care. I would like to see the health reform debate focus more on the meaning of health care to American society and less on the paranoia of change.
Tags: American ethos, health economics, Health Reform, societal values
Posted in Health Reform, Policy | No Comments »
August 13, 2009
I hit a deer the other day. Bambi is not supposed to gallop out of nowhere on a busy street and land on the hood of your car. Bambi got up and ran away but my car needed major repair. Which leads me to the Ford Focus, the only rental car available from the vendor used by my insurance company. One only has to drive two minutes in this car to realize why Detroit went under. What a piece of tin, I kept saying. From the design to the operation to the flimsy sunshade, the car is a disaster.
We blinded ourselves for years to the fact that American cars were terrible by blaming industry troubles on unions, high wages, environmental controls and lots of other diversionary issues. Many of us wanted to buy American but American design was no good.
Which brings me to health care. The design of the system—employer based coverage—is not good. It is not working because it is a model of a bygone era. We have to admit it—and move on to something better. All the hoopla at recent town meetings is diversionary from the real issue of health reform. It’s not a question of who pays for abortions; it’s not a question of death bed counseling or pulling the plug on granny. Wake up America. Think about cars. It’s a design issue.
Many in Congress—like the CEOs of the automotive industry–continue to promote a bad product–a health system that cannot fulfill current or future needs. What’s the answer? Stop the shouting. Americans are confused. They want to buy that American car but know that something is wrong with it.
The answer is to go back to the drawing boards. Mr. President– Take back control and call on Congress to create a special new committee for health care. Why are we using the old committee system for something that crosses the boundaries of so many committees? Start with a new structure and put out one plan from one committee—a plan that is understandable and creates a new delivery system. It has to be a new design for health care for the future.
Tags: Bambi, Ford Focus, health policy, Health Reform, new congressional committee, President Obama town meetings
Posted in Health Reform, Policy | No Comments »
August 6, 2009
For all those Americans worrying about health reform and fearing they will lose their current insurance, think about this. Sixty percent of all U.S. bankruptcies are attributable to medical problems, according to a study by Dr. David Himmelstein and his colleagues at Harvard and Ohio University, published this month in The American Journal of Medicine. The share of bankruptcies attributable to medical problems rose by 49.6 % between 2001 and 2007. “Medical” was based on debtors’ stated reasons for filing, income loss due to illness and the magnitues of their medical debts.
Here’s the kicker–Many families with continuous coverage found themselves under-insured and responsible for thousands of dollars of out-of-pocket costs (averaging almost $18K for all medically bankrupt families). Because almost all insurance is linked to employment, a medical event can trigger loss of coverage, say the authors. Nationally, 25% of firms cancel coverage immediately when an employee suffers a disabling illness (so much for your employer taking care of you); another 25% cancel coverage within a year.
The fear mongering currently underway to make Americans believe they will be losing the security of their current insurance coverage if the government steps into the act is truly intended to cover up the real threat. It seems to me that a real fear is the potential actions of employers (look at GM over the years–or how about the steel or airline industries) vis-a-vis health insurance. There’s no security there–and often they too are the victims of economic decline.
Finally, where do those people without insurance go? Answer: to the emergency rooms at academic health center hospitals throughout the country. How do policymakers think these institutions can survive? The Association of Academic Health Centers found in 2008 that AAHC institutions, on average, provided almost $44 million in uncompensated patient care each year, with one in seven institutions providing more than $100 million. It is not clear how the reform packages will help these institutions.
Tags: academic health centers, bankruptcy, David Himmelstein, employer based health insurance, Health Reform, uncompensated care
Posted in Health Reform, Policy | 1 Comment »
August 5, 2009
Mr. David Axelrod , senior advisor to President Obama, may be the greatest strategist when it comes to getting candidates elected to office, but I am not sure about his credentials on strategizing on health reform. He wants Americans to understand that there are insurance market reforms in the legislation before Congress and has boiled the issue down to the following: “If you’re an American with insurance, you’re saying, Where am I in this debate?” He wants Americans to understand that there is “security and stability” in the plan.
Well, I am an American–with insurance—and so are almost all of my friends. A good many of my friends are the senior citizens and women that you say you are targeting, Mr. Axelrod. My friends know exactly where they are in this debate—trapped by the insurance industry. In fact, my friends call and email me every day to tell me this. They don’t want market reforms—they don’t want the insurers at the table. They tell me they want the insurers out of business—the sooner the better. I tell them to write to you, Mr. Axelrod, and the President, and the Congress.
Tags: David Axelrod, Health Reform, insurance industry, public policy
Posted in Health Reform, Policy, health insurance, president Obama | No Comments »
August 3, 2009
Speaker of the House Nancy Pelosi and HHS Secretary Kathleen Sebelius are using their August vacations to try to sell health reform. Unfortunately, no one really knows what they are selling. President Obama was elected in part because millions of Americans wanted health reform. They wanted change and a NEW health care system. What the Congress now has to offer—and Pelosi and Sebelius are trying to sell– is a warmed over version of the dysfunctional system we already have. It’s reasonable to expect that buyers might be leery.
Americans are attracted to all that is shiny, new, high tech, and different. But what are they getting with health reform? The proposed public plan is warmed over Medicaid, not Medicare—and no one is buying that. The insurers still get a big piece of the action—and no one is buying that. The timeline is too long for people out of work now—or fearing a layoff–and no one is buying that. People are wondering why the President is asking them to buy a clunker.
Mr. President, it’s time to take the next exit—turn around– and tell the Congress you want something better to sell on the road.
Tags: Congress, Health Reform, kathleen sebelius, nancy pelosi, president Obama, public policy, United States Secretary of Health and Human Services
Posted in Health Reform, Policy, president Obama | No Comments »
July 23, 2009
Mr. President. The press conference usurped the time slot of So you think you can dance? but you did not command the dance floor. You did not command the attention of the American people by telling them why health care is important to the future security of this nation. You provided no vision last night. You talked about the costs of health care as if you were the director of the Congressional Budget Office. Yes, health care may an important part of the economic recovery –which you are taking extraordinary steps to address. And the costs of health care are a worry for the government. But you forgot to tell the people that there are costs that go beyond the numbers on some CBO balance sheet. There are also the costs of greatness. Without health care, the greatness of the nation is at risk. Health care reform relates to life, liberty ,and the pursuit of happiness for the American people who still believe that the U.S. should be the shining example of what is good in the world.
You did not call upon the nation last night to think about a new and better way to live, as you have done in the past. Where was the orator last night? You are capable of raising the nation’s heart and soul. It is about the economic future that comes from good health care for each individual. You should be telling us how health care is about individual and national security–about freedom from worry about your child’s health or your mom or dad’s Alzheimer’s disease. Tell us that the nation is only secure if the health of its people is secure–that American greatness is built upon caring for each other.
Mr. President, we want you to provide the vision that is so lacking in this health care debate. You talked about insurance premiums, employer coverage, and insurance exchange programs. You talked about passing reform at the “lowest cost.” How can health and security be equated to the “lowest cost”? I am not sure the nation wants to hear that, Mr. President.
What can you do Mr. President? Here is my short list. #1. Give us new vision on health care–one that’s about health–not just money and costs. #2. Reframe the debate by getting some new voices in the mix–including the single payers. Don’t close them out. #3.Make sure the nation knows what health reform will mean for the health workforce–and for biomedical research in this nation. Those are real issues for the future. Open the door to new thinking on all fronts. #4. Take control of the debate. The Congress is pushing many agendas and may not be doing what is best for the nation. #5. Take a stand. Tell the nation that the government is a good guy and can solve this problem. #6. Tell the nation that the bureaucrats making decisions about health services do not work for the government but for the insurance industry. It’s time to get creative to find out how the insurers can contribute in new and different ways to the economy. There may be a new world out there for them in job retraining. #7. Be strong and be confident that the nation is behind you.
Tags: biomedical research, health policy, Health Reform, health workforce, Obama's press conference, president Obama, So you think you can dance
Posted in Health Reform, Policy, president Obama | No Comments »
July 16, 2009
I read that countless numbers of people are worried about being regulated by government in any reformed health system. But no one, especially policymakers, seems to be addressing the regulatory infrastructure and the costs of regulation, which might open up a pandora’s box and really shed light on the extent to which the public is benefiting from the regulations developed to protect the American people (which is an issue for a longer discussion). No one is asking whether the agencies mandated to regulate, including the Centers for Medicare & Medicaid Services, have the resources to address implementation and enforcement of current and new regulations. Policymakers should be addressing those resources now. Policymakers would also do well to look at the costs of compliance for the government and for health care providers. A 2005 study by the Association of Academic Health Centers found that the costs of compliance increased up to 300% in the previous decade and often more than 70% a year at academic health centers throughout the nation. We are hearing of even greater increases at the present time. No one is denying the need for accountability and protecting quality, safety, and privacy in the health care arena. But it may be time for the government to ask about the costs and benefits of regulation along with addressing the need for rational and ”smart” regulations. There is also an urgent need for harmonization within the regulatory environment. Interagency task forces have done little to ensure there is no contradiction and confusion between regulations coming out of the many government agencies. If we really want to ensure safety and quality for the public as well as savings in health care delivery, reform of the regulatory world must be addressed now.
Tags: association of academic health centers, centers for medicare & medicaid services, costs of regulation, Health, Health care, health policy, Health Reform, Patient safety, regulation
Posted in Health Reform, Policy | No Comments »
July 14, 2009
It’s well known that the practice of medicine is not completely evidence-based; in fact, it is estimated that less than 25% of typical medical practice is supported by rigorous evidence, such as controlled clinical trials. So it is very welcome that, in considering health care reform, the administration wants to enhance the evidence-base for medical care. Already, there have been some funds from the stimulus package devoted to this, and the Institute of Medicine has a Round Table on this topic.
This is certainly a good thing, but merely producing the evidence isn’t enough. The findings then have to become part of everyday clinical practice. It is a reality that many guidelines and best practices have yet to be fully adopted into clinical practice, or that it takes an unacceptably long time for this to happen. I suggest, as we move to build up the evidence base for medical practice, that we concurrently develop strategies to link this research directly and meaningfully to the actual delivery of health care. A guideline is, after all, just a guideline.
- SW
Tags: clinical effectiveness, evidence-based practice, guidelines, health care quality
Posted in Health Reform, Policy, guidelines | No Comments »
July 10, 2009
Michael Jackson is being remembered for his extraordinary talent, vision, and courage. He changed music, dance, and culture in the U.S.–and around the globe. He understood new technology, had a new vision for the entertainment world, and had the courage to take on a music giant, MTV, forcing the playing of the Billie Jean video and ultimately music by black artists. He was not satisfied with tradition and the status quo. His courage resulted in amazing transformations in the entertainment industry–and American society. Which brings me to health care. Who on Capitol Hill will be remembered for courage, vision, and talent when it comes to health reform? Where is the vision? Where is the courage? Isn’t everyone trying to preserve tradition–employer based coverage and the insurance industry? What will be the achievement that will reshape the nation?Aren’t we seeing a complicated mix and match game built on the current dysfunction in the system. Is there a Michael Jackson on health reform? I don’t see one. Do you?
Tags: Billie Jean, Capitol Hill, health policy, Health Reform, Insurance, Michael Jackson
Posted in Health Reform, Policy | No Comments »
July 7, 2009
I recently learned that a large metropolitan health care institution is offering a “summer special” on coronary calcium CT scans at a reduced price of $99 from the regular price of over $400. These scans determine the amount of calcium in the coronary arteries. The result, known quantitatively as the Agatston score, is said to be predictive of the risk for heart disease, although this still needs to be fully worked out. Since this test is often not covered by insurance, patients who are offered the test must pay out of pocket.
The fact that certain, discretionary medical tests are being offered on “special,” should not be surprising as this is a natural progression of the growing role of market forces in health care. Some would argue that this is a good example of how market forces positively impact health care by enabling patients and their doctors to make more cost effective health care decisions, rather than relying on passive decisions made by insurance companies.
However, I find it a troubling example as health care becomes increasingly commercialized. Do we really want the practice of medicine to look like a late night infomercial: “The first 30 people to sign up for the test will also get a set of Ginsu Knives.” I recognize that there needs to be a balance between medical professionalism and the free play of market forces. But that balance is inexorably becoming skewed in the direction of the market.
The patient-provider relationship should be kept at arms-length from market forces so as to ensure that the care delivered is in the patient’s best interest. The market does not necessarily have the patient’s best interests in mind: its goal is to seek profit wherever it can be found. In some cases it does work in the patient’s interests; in some it does not. But special deals and price incentives for medical tests and procedures by their very nature undermine effective medical care decision making by substituting financial motivation for effective patient care decisions. Do medical infomercials and their equivalents really have a place in a reformed health care system?
Tags: Health Reform, medical decision making, medical tests, money and medicine
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