Health Care.

NPR’s Nina Totenberg reports that Supreme Court Justice David Souter, 69, plans on retiring at the end of the current court term:
Factors in his decision no doubt include the election of President Obama, who would be more likely to appoint a successor attuned to the principles Souter has followed as …

[This is a content summary only. Click the headline to visit Our Bodies, Our Blog for the full post, links, other content and more!]

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NPR’s Nina Totenberg reports that Supreme Court Justice David Souter, 69, plans on retiring at the end of the current court term:
Factors in his decision no doubt include the election of President Obama, who would be more likely to appoint a successor attuned to the principles Souter has followed as …

[This is a content summary only. Click the headline to visit Our Bodies, Our Blog for the full post, links, other content and more!]

Tags: rates for non medical home health care, french health care, maricopa county special health care district, holistic health care, obama health care plan, hispanic health care marketing, aarp health care options, home health care products, health care cash plan, health care management

We write all the time about the economic and moral imperative for covering all Americans. Today, we’d like to address the public-health we’re-all-in-it-together pandemic flu imperative for covering all Americans.

We don’t yet know how bad the outbreak will become, and it goes without saying that along with everyone else on the planet, we hope it is mild. But the fact that we have 46 million (probably more given the recession) people who are uninsured and don’t have easy access to care, outside the emergency room, is making us nervous. The border States have particularly high rates of insurance. One-in-four Texans lack insurance, nearly as many New Mexicans, one-in-five Arizonans and Californians, (and that’s 2007 data, it may well be higher now). And think about all the people who do have some insurance but may still postpone going to the doctor because they have a bare bones or high-deductible insurance policy. Times are tough, and they’ll try to ride it out because they can’t afford the co-pay or deductible. Delayed care can mean more serious illness—and more spread of disease. 

We know we don’t have a good enough primary care system in this country, and people are going to flock to emergency rooms in an epidemic or a pandemic. But think of how much WORSE that could be because people are already flocking to overcrowded emergency rooms because they don’t have any place else to go. And we wonder, are our ultra-specialized specialists going to help take care of flu patients? Will they know how? Maybe the answer to this is some part of an emergency plan we haven’t read yet. Comment, please, if you know—and no, we don’t mean specialists are heartless or don’t care about patients, we just don’t know how well someone who’s only done cornea transplants or rotator cuff surgery for 30 years can deal with patients with severe respiratory distress. We did see that AHRQ has resources for hospitals to plan surge capacity and to train more non-respiratory therapists to run respirators, and USA Today reported that many communities are activating their emergency plans.

Then there’s the whole sick pay problem. President Obama told us to stay home if we’re sick, and think about what to do if our kids’ schools close. That’s easy enough for those of us who can telecommute or who have paid sick days. But as our colleague, Julie Barnes, pointed out long before the current flu outbreak, we don’t all have paid sick days. Or paid days to take care of sick kids. As the National Partnership on Women and Families has reminded us, nearly half the private sector workers don’t have paid sick leave, and nearly 100 million workers don’t have a paid sick day they can use to care for a sick child.  

We know that in the past few years (partly because Sen. Edward Kennedy and former Sen. Bill Frist, who wisely seized a bipartisan post-anthrax moment and figured out how to use bio-terror defense legislation to beef up the weakened public health infrastructure for natural disease outbreaks as well, and partly because of the response to SARS and bird flu) we began improving public health capacity that had severely eroded. But the recession has taken its toll, draining "hundreds of millions of dollars and thousands of workers from the state and local health departments" the New York Times reports.

We know that some of the response to a severe flu outbreak will be via public health channels and emergency capacity and clinics, not through our everyday health infrastructure. (And the emergency response is going to have to take illegal immigrants—the third rail of health politics—into account, because no matter what you think about our nation’s immigration policy, having an untreated contagious disease among illegal immigrants isn’t good for any of us)  But a public health crisis superimposed on a tattered health safety net and a broken delivery system makes the job harder. Even if this flu is contained, or turns out to be relatively mild, there will be another crisis. And another one after that. So reforming health care and covering everyone isn’t just the morally correct and economically sensible thing to do. It’s the self-interested healthy thing to do. So let’s do it. 

Tags: obama’s health care plan, british health care system, health care economics, cigna health care, dog health care, united health care provider directory, problems with universal health care, health care ethics, health care costs, health care logistics

Much like the Jupiter 2 in the campy ‘60s TV series Lost In Space, the Senate Finance Committee is risking going off course into Deep Space on the topic of care management. It released a 52 page paper two days ago describing ‘policy options’ designed to ‘set forth’ ideas on ways to revise payment systems and policies in the Medicare program. It has 5 sections on 1) improving quality and promoting primary care, 2) fostering care coordination and provider collaboration, 3) health care infrastructure investments, 4) Medicare Advantage and 5) combating fraud.

The Disease Management Care Blog zeroed in on the topic of fostering care coordination. While this section also addressed bundling payments to reduce inpatient readmissions as well as transitioning from fee-for-service to ‘accountable care,’ it was a loopy option to create a ‘Chronic Care Management Innovation Center’ (‘CMIC’) that caught the DMCB’s eye. CMIC? Another acronym? Another Department in an already sprawling bureaucracy?

Recall that CMS can test potential reforms under a mechanism called ‘demonstrations’ and that there are about thirty of them currently underway. This option would enshrine perpetual demos under a permanently established Center. This CMIC would be charged with conducting a continuous quest for models of care that include patient centeredness, focusing on ‘in-person contact’ with beneficiaries, self care and teaming around primary care providers. In addition, a ‘Rapid Learning Network’ (RLN) consisting of a network of providers that would participate in these demos would be created on a competitive basis.

Ayyy carumba. The DMCB thinks this is a lousy idea. While demonstrations under a CMIS are one important tool that enables CMS to examine the merits of a care approach, they:

a) are inefficient and time-consuming, often resulting in the reporting of results long after continuous medical innovation has rendered the original approach obsolete

b) are unable to address the multiple social, cultural and regional dimensions of care management,

c) render opaque complex data that are prone to endless picayune interpretations that fail to disprove instead of succeeding to prove,

d) centralize the conduct of scientific investigation under a Federal entity that, despite the RLN, will be aligned with the interests of large academic institutions that stifle alternative points of view, research methods, audience needs and market demand

e) presuppose that demos are the best, if not only, route to testing chronic care models and finally

f) suggests that the patient centeredness, teaming with non-physician providers, and patient self care are still topics of research.

According to the paper, ‘the Committee is seeking input from members, CBO, and CMS on the design, score, and implementation of the options proposed in this section.’ While it is disappointed that it wasn’t also asked for input, the DMCB nonetheless hopes that someone with the ear of the Committee includes the catch phrase ‘Danger, Will Robinson!’

Tags: clinton’s health care reform, free health care, elderly health care, primary health care, harvard pilgrim health care, canadian health care, obama health care plan, problems with universal health care, health care supplies, health care crisis

We write all the time about the economic and moral imperative for covering all Americans. Today, we’d like to address the public-health we’re-all-in-it-together pandemic flu imperative for covering all Americans.

We don’t yet know how bad the outbreak will become, and it goes without saying that along with everyone else on the planet, we hope it is mild. But the fact that we have 46 million (probably more given the recession) people who are uninsured and don’t have easy access to care, outside the emergency room, is making us nervous. The border States have particularly high rates of insurance. One-in-four Texans lack insurance, nearly as many New Mexicans, one-in-five Arizonans and Californians, (and that’s 2007 data, it may well be higher now). And think about all the people who do have some insurance but may still postpone going to the doctor because they have a bare bones or high-deductible insurance policy. Times are tough, and they’ll try to ride it out because they can’t afford the co-pay or deductible. Delayed care can mean more serious illness—and more spread of disease. 

We know we don’t have a good enough primary care system in this country, and people are going to flock to emergency rooms in an epidemic or a pandemic. But think of how much WORSE that could be because people are already flocking to overcrowded emergency rooms because they don’t have any place else to go. And we wonder, are our ultra-specialized specialists going to help take care of flu patients? Will they know how? Maybe the answer to this is some part of an emergency plan we haven’t read yet. Comment, please, if you know—and no, we don’t mean specialists are heartless or don’t care about patients, we just don’t know how well someone who’s only done cornea transplants or rotator cuff surgery for 30 years can deal with patients with severe respiratory distress. We did see that AHRQ has resources for hospitals to plan surge capacity and to train more non-respiratory therapists to run respirators, and USA Today reported that many communities are activating their emergency plans.

Then there’s the whole sick pay problem. President Obama told us to stay home if we’re sick, and think about what to do if our kids’ schools close. That’s easy enough for those of us who can telecommute or who have paid sick days. But as our colleague, Julie Barnes, pointed out long before the current flu outbreak, we don’t all have paid sick days. Or paid days to take care of sick kids. As the National Partnership on Women and Families has reminded us, nearly half the private sector workers don’t have paid sick leave, and nearly 100 million workers don’t have a paid sick day they can use to care for a sick child.  

We know that in the past few years (partly because Sen. Edward Kennedy and former Sen. Bill Frist, who wisely seized a bipartisan post-anthrax moment and figured out how to use bio-terror defense legislation to beef up the weakened public health infrastructure for natural disease outbreaks as well, and partly because of the response to SARS and bird flu) we began improving public health capacity that had severely eroded. But the recession has taken its toll, draining "hundreds of millions of dollars and thousands of workers from the state and local health departments" the New York Times reports.

We know that some of the response to a severe flu outbreak will be via public health channels and emergency capacity and clinics, not through our everyday health infrastructure. (And the emergency response is going to have to take illegal immigrants—the third rail of health politics—into account, because no matter what you think about our nation’s immigration policy, having an untreated contagious disease among illegal immigrants isn’t good for any of us)  But a public health crisis superimposed on a tattered health safety net and a broken delivery system makes the job harder. Even if this flu is contained, or turns out to be relatively mild, there will be another crisis. And another one after that. So reforming health care and covering everyone isn’t just the morally correct and economically sensible thing to do. It’s the self-interested healthy thing to do. So let’s do it. 

Tags: health care supplies, health care occupations, ethical issues in health care, france has long wait times for health care, assurant health care, health care software, dog health care, health care management, long term health care, rates for non medical home health care

We write all the time about the economic and moral imperative for covering all Americans. Today, we’d like to address the public-health we’re-all-in-it-together pandemic flu imperative for covering all Americans.

We don’t yet know how bad the outbreak will become, and it goes without saying that along with everyone else on the planet, we hope it is mild. But the fact that we have 46 million (probably more given the recession) people who are uninsured and don’t have easy access to care, outside the emergency room, is making us nervous. The border States have particularly high rates of insurance. One-in-four Texans lack insurance, nearly as many New Mexicans, one-in-five Arizonans and Californians, (and that’s 2007 data, it may well be higher now). And think about all the people who do have some insurance but may still postpone going to the doctor because they have a bare bones or high-deductible insurance policy. Times are tough, and they’ll try to ride it out because they can’t afford the co-pay or deductible. Delayed care can mean more serious illness—and more spread of disease. 

We know we don’t have a good enough primary care system in this country, and people are going to flock to emergency rooms in an epidemic or a pandemic. But think of how much WORSE that could be because people are already flocking to overcrowded emergency rooms because they don’t have any place else to go. And we wonder, are our ultra-specialized specialists going to help take care of flu patients? Will they know how? Maybe the answer to this is some part of an emergency plan we haven’t read yet. Comment, please, if you know—and no, we don’t mean specialists are heartless or don’t care about patients, we just don’t know how well someone who’s only done cornea transplants or rotator cuff surgery for 30 years can deal with patients with severe respiratory distress. We did see that AHRQ has resources for hospitals to plan surge capacity and to train more non-respiratory therapists to run respirators, and USA Today reported that many communities are activating their emergency plans.

Then there’s the whole sick pay problem. President Obama told us to stay home if we’re sick, and think about what to do if our kids’ schools close. That’s easy enough for those of us who can telecommute or who have paid sick days. But as our colleague, Julie Barnes, pointed out long before the current flu outbreak, we don’t all have paid sick days. Or paid days to take care of sick kids. As the National Partnership on Women and Families has reminded us, nearly half the private sector workers don’t have paid sick leave, and nearly 100 million workers don’t have a paid sick day they can use to care for a sick child.  

We know that in the past few years (partly because Sen. Edward Kennedy and former Sen. Bill Frist, who wisely seized a bipartisan post-anthrax moment and figured out how to use bio-terror defense legislation to beef up the weakened public health infrastructure for natural disease outbreaks as well, and partly because of the response to SARS and bird flu) we began improving public health capacity that had severely eroded. But the recession has taken its toll, draining "hundreds of millions of dollars and thousands of workers from the state and local health departments" the New York Times reports.

We know that some of the response to a severe flu outbreak will be via public health channels and emergency capacity and clinics, not through our everyday health infrastructure. (And the emergency response is going to have to take illegal immigrants—the third rail of health politics—into account, because no matter what you think about our nation’s immigration policy, having an untreated contagious disease among illegal immigrants isn’t good for any of us)  But a public health crisis superimposed on a tattered health safety net and a broken delivery system makes the job harder. Even if this flu is contained, or turns out to be relatively mild, there will be another crisis. And another one after that. So reforming health care and covering everyone isn’t just the morally correct and economically sensible thing to do. It’s the self-interested healthy thing to do. So let’s do it. 

Tags: rates for non medical home health care, health care economics, primary health care, against universal health care, health care supplies, health care issues, health care issues in america, latino health care marketing, health care, genesis health care

We write all the time about the economic and moral imperative for covering all Americans. Today, we’d like to address the public-health we’re-all-in-it-together pandemic flu imperative for covering all Americans.

We don’t yet know how bad the outbreak will become, and it goes without saying that along with everyone else on the planet, we hope it is mild. But the fact that we have 46 million (probably more given the recession) people who are uninsured and don’t have easy access to care, outside the emergency room, is making us nervous. The border States have particularly high rates of insurance. One-in-four Texans lack insurance, nearly as many New Mexicans, one-in-five Arizonans and Californians, (and that’s 2007 data, it may well be higher now). And think about all the people who do have some insurance but may still postpone going to the doctor because they have a bare bones or high-deductible insurance policy. Times are tough, and they’ll try to ride it out because they can’t afford the co-pay or deductible. Delayed care can mean more serious illness—and more spread of disease. 

We know we don’t have a good enough primary care system in this country, and people are going to flock to emergency rooms in an epidemic or a pandemic. But think of how much WORSE that could be because people are already flocking to overcrowded emergency rooms because they don’t have any place else to go. And we wonder, are our ultra-specialized specialists going to help take care of flu patients? Will they know how? Maybe the answer to this is some part of an emergency plan we haven’t read yet. Comment, please, if you know—and no, we don’t mean specialists are heartless or don’t care about patients, we just don’t know how well someone who’s only done cornea transplants or rotator cuff surgery for 30 years can deal with patients with severe respiratory distress. We did see that AHRQ has resources for hospitals to plan surge capacity and to train more non-respiratory therapists to run respirators, and USA Today reported that many communities are activating their emergency plans.

Then there’s the whole sick pay problem. President Obama told us to stay home if we’re sick, and think about what to do if our kids’ schools close. That’s easy enough for those of us who can telecommute or who have paid sick days. But as our colleague, Julie Barnes, pointed out long before the current flu outbreak, we don’t all have paid sick days. Or paid days to take care of sick kids. As the National Partnership on Women and Families has reminded us, nearly half the private sector workers don’t have paid sick leave, and nearly 100 million workers don’t have a paid sick day they can use to care for a sick child.  

We know that in the past few years (partly because Sen. Edward Kennedy and former Sen. Bill Frist, who wisely seized a bipartisan post-anthrax moment and figured out how to use bio-terror defense legislation to beef up the weakened public health infrastructure for natural disease outbreaks as well, and partly because of the response to SARS and bird flu) we began improving public health capacity that had severely eroded. But the recession has taken its toll, draining "hundreds of millions of dollars and thousands of workers from the state and local health departments" the New York Times reports.

We know that some of the response to a severe flu outbreak will be via public health channels and emergency capacity and clinics, not through our everyday health infrastructure. (And the emergency response is going to have to take illegal immigrants—the third rail of health politics—into account, because no matter what you think about our nation’s immigration policy, having an untreated contagious disease among illegal immigrants isn’t good for any of us)  But a public health crisis superimposed on a tattered health safety net and a broken delivery system makes the job harder. Even if this flu is contained, or turns out to be relatively mild, there will be another crisis. And another one after that. So reforming health care and covering everyone isn’t just the morally correct and economically sensible thing to do. It’s the self-interested healthy thing to do. So let’s do it. 

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Howard Markel and Alexandra Minna Stern are, respectively, the Director and the Associate Director of the Center for the History of Medicine at the University of Michigan. Both serve as historical consultants on pandemic preparedness planning for the Division of Global Migration and Quarantine, which is part of the U.S. Centers for Disease Control.

The first question to President Obama during Wednesday’s press conference was about whether he’d consider closing the border with Mexico. If you listen to cable television or check around the Internet, you’ll hear that same question–along with some nastier insinuations and conpsiracy theories about Mexicans and their government.

This is all very predictable. And counter-productive.

Epidemics always have scapegoats. In 1892, Eastern European Jews were blamed for outbreaks of typhus and cholera in New York City. In 1900, the Chinese were excoriated for a plague outbreak in San Francisco. Gays were singled out for for HIV/AIDs in the 1980s, Asians for SARS in 2003.

The scapegoating is even worse during economic downturns. And this isn’t the first time that’s made it tough on Mexican-Americans–the majority of whom, documented and undocumented, have come to this country seeking jobs at times of labor market distress. During the Great Depression, up to 30 percent of the Mexican-origin population in the United States was forcibly repatriated.

The U.S. isn’t the only country that reacts to epidemics this way. Russia has banned all Mexican pork products from its grocery stores, despite definitive evidence that humans do not contract swine flu from eating pork. In Israel, the health officials re-named the disease "Mexican flu.”

As it happens, Mexico itself has a history of blaming foreigners for epidemics. During the early 20th century, Mexicans focused blame for disease outbreaks on the Chinese, whom they called a pestilent race. This Sinophobic fever peaked in 1930 with the mass expulsion of Chinese residents from the northern state of Sonora.

Seven decades later, some of those same sentiments remain. Just days ago, the governor of Vera Cruz denied that swine flu had come from his state, declaring that the virus actually originated from “Asia, in China; it came from there, from American visitors and surely from Mexico City and the state of Mexico. It is not associated with the pork industry in the Perote Valley.”

Not only is such behavior a reflexive exercise in racism. It is, quite simply, a huge detriment to the public health. When groups start getting blamed for epidemics, members of those groups will start to fear–sometimes legitimately–that they will be stigmatized, mistreated, or punished if they seek medical attention. So they simply don’t go to the doctor or hospital, at least not until it’s too late for treatment and too late for detection to have done the most good. Taking care of these people, and containing the outbreak, becomes a great deal harder.

This isn’t mere conjecture. It’s been documented in numerous public health studies. And we’re already seeing anecdotal evidence of this phenomenon. There are stories of mistreatment–real or not–circulating in the immigrant press. According to the Associated Press, some Mexican-Americans in California say that medical professionals are turning them away.

In the coming weeks, we have a lot of work to do–and little time for this sort of scapegoating. Blaming the victim of an epidemic is akin to using lancets for bloodletting: sharp, painful, and counter-productive. And, like bloodletting, it should belongs in a museum–as a historical relic.

–Howard Markel and Alexandra Minna Stern

Tags: health care administration, problems with universal health care, flaws of universal health care, united health care insurance, dog health care, home health care, elderly health care, health care, ethical issues in health care, health care crisis

We write all the time about the economic and moral imperative for covering all Americans. Today, we’d like to address the public-health we’re-all-in-it-together pandemic flu imperative for covering all Americans.

We don’t yet know how bad the outbreak will become, and it goes without saying that along with everyone else on the planet, we hope it is mild. But the fact that we have 46 million (probably more given the recession) people who are uninsured and don’t have easy access to care, outside the emergency room, is making us nervous. The border States have particularly high rates of insurance. One-in-four Texans lack insurance, nearly as many New Mexicans, one-in-five Arizonans and Californians, (and that’s 2007 data, it may well be higher now). And think about all the people who do have some insurance but may still postpone going to the doctor because they have a bare bones or high-deductible insurance policy. Times are tough, and they’ll try to ride it out because they can’t afford the co-pay or deductible. Delayed care can mean more serious illness—and more spread of disease. 

We know we don’t have a good enough primary care system in this country, and people are going to flock to emergency rooms in an epidemic or a pandemic. But think of how much WORSE that could be because people are already flocking to overcrowded emergency rooms because they don’t have any place else to go. And we wonder, are our ultra-specialized specialists going to help take care of flu patients? Will they know how? Maybe the answer to this is some part of an emergency plan we haven’t read yet. Comment, please, if you know—and no, we don’t mean specialists are heartless or don’t care about patients, we just don’t know how well someone who’s only done cornea transplants or rotator cuff surgery for 30 years can deal with patients with severe respiratory distress. We did see that AHRQ has resources for hospitals to plan surge capacity and to train more non-respiratory therapists to run respirators, and USA Today reported that many communities are activating their emergency plans.

Then there’s the whole sick pay problem. President Obama told us to stay home if we’re sick, and think about what to do if our kids’ schools close. That’s easy enough for those of us who can telecommute or who have paid sick days. But as our colleague, Julie Barnes, pointed out long before the current flu outbreak, we don’t all have paid sick days. Or paid days to take care of sick kids. As the National Partnership on Women and Families has reminded us, nearly half the private sector workers don’t have paid sick leave, and nearly 100 million workers don’t have a paid sick day they can use to care for a sick child.  

We know that in the past few years (partly because Sen. Edward Kennedy and former Sen. Bill Frist, who wisely seized a bipartisan post-anthrax moment and figured out how to use bio-terror defense legislation to beef up the weakened public health infrastructure for natural disease outbreaks as well, and partly because of the response to SARS and bird flu) we began improving public health capacity that had severely eroded. But the recession has taken its toll, draining "hundreds of millions of dollars and thousands of workers from the state and local health departments" the New York Times reports.

We know that some of the response to a severe flu outbreak will be via public health channels and emergency capacity and clinics, not through our everyday health infrastructure. (And the emergency response is going to have to take illegal immigrants—the third rail of health politics—into account, because no matter what you think about our nation’s immigration policy, having an untreated contagious disease among illegal immigrants isn’t good for any of us)  But a public health crisis superimposed on a tattered health safety net and a broken delivery system makes the job harder. Even if this flu is contained, or turns out to be relatively mild, there will be another crisis. And another one after that. So reforming health care and covering everyone isn’t just the morally correct and economically sensible thing to do. It’s the self-interested healthy thing to do. So let’s do it. 

Tags: obama health care plan, clinton’s health care reform, advocate health care, united health care dental, canadian health care system, health care, medical health care, health care power of attorney, universal health care debate, health care administration

We write all the time about the economic and moral imperative for covering all Americans. Today, we’d like to address the public-health we’re-all-in-it-together pandemic flu imperative for covering all Americans.

We don’t yet know how bad the outbreak will become, and it goes without saying that along with everyone else on the planet, we hope it is mild. But the fact that we have 46 million (probably more given the recession) people who are uninsured and don’t have easy access to care, outside the emergency room, is making us nervous. The border States have particularly high rates of insurance. One-in-four Texans lack insurance, nearly as many New Mexicans, one-in-five Arizonans and Californians, (and that’s 2007 data, it may well be higher now). And think about all the people who do have some insurance but may still postpone going to the doctor because they have a bare bones or high-deductible insurance policy. Times are tough, and they’ll try to ride it out because they can’t afford the co-pay or deductible. Delayed care can mean more serious illness—and more spread of disease. 

We know we don’t have a good enough primary care system in this country, and people are going to flock to emergency rooms in an epidemic or a pandemic. But think of how much WORSE that could be because people are already flocking to overcrowded emergency rooms because they don’t have any place else to go. And we wonder, are our ultra-specialized specialists going to help take care of flu patients? Will they know how? Maybe the answer to this is some part of an emergency plan we haven’t read yet. Comment, please, if you know—and no, we don’t mean specialists are heartless or don’t care about patients, we just don’t know how well someone who’s only done cornea transplants or rotator cuff surgery for 30 years can deal with patients with severe respiratory distress. We did see that AHRQ has resources for hospitals to plan surge capacity and to train more non-respiratory therapists to run respirators, and USA Today reported that many communities are activating their emergency plans.

Then there’s the whole sick pay problem. President Obama told us to stay home if we’re sick, and think about what to do if our kids’ schools close. That’s easy enough for those of us who can telecommute or who have paid sick days. But as our colleague, Julie Barnes, pointed out long before the current flu outbreak, we don’t all have paid sick days. Or paid days to take care of sick kids. As the National Partnership on Women and Families has reminded us, nearly half the private sector workers don’t have paid sick leave, and nearly 100 million workers don’t have a paid sick day they can use to care for a sick child.  

We know that in the past few years (partly because Sen. Edward Kennedy and former Sen. Bill Frist, who wisely seized a bipartisan post-anthrax moment and figured out how to use bio-terror defense legislation to beef up the weakened public health infrastructure for natural disease outbreaks as well, and partly because of the response to SARS and bird flu) we began improving public health capacity that had severely eroded. But the recession has taken its toll, draining "hundreds of millions of dollars and thousands of workers from the state and local health departments" the New York Times reports.

We know that some of the response to a severe flu outbreak will be via public health channels and emergency capacity and clinics, not through our everyday health infrastructure. (And the emergency response is going to have to take illegal immigrants—the third rail of health politics—into account, because no matter what you think about our nation’s immigration policy, having an untreated contagious disease among illegal immigrants isn’t good for any of us)  But a public health crisis superimposed on a tattered health safety net and a broken delivery system makes the job harder. Even if this flu is contained, or turns out to be relatively mild, there will be another crisis. And another one after that. So reforming health care and covering everyone isn’t just the morally correct and economically sensible thing to do. It’s the self-interested healthy thing to do. So let’s do it. 

Tags: pros and cons of universal health care, cigna health care, flaws of universal health care, health care economics, obama health care, latino health care marketing, essay on single payer health care, obama’s health care plan, medical health care, coventry health care

We write all the time about the economic and moral imperative for covering all Americans. Today, we’d like to address the public-health we’re-all-in-it-together pandemic flu imperative for covering all Americans.

We don’t yet know how bad the outbreak will become, and it goes without saying that along with everyone else on the planet, we hope it is mild. But the fact that we have 46 million (probably more given the recession) people who are uninsured and don’t have easy access to care, outside the emergency room, is making us nervous. The border States have particularly high rates of insurance. One-in-four Texans lack insurance, nearly as many New Mexicans, one-in-five Arizonans and Californians, (and that’s 2007 data, it may well be higher now). And think about all the people who do have some insurance but may still postpone going to the doctor because they have a bare bones or high-deductible insurance policy. Times are tough, and they’ll try to ride it out because they can’t afford the co-pay or deductible. Delayed care can mean more serious illness—and more spread of disease. 

We know we don’t have a good enough primary care system in this country, and people are going to flock to emergency rooms in an epidemic or a pandemic. But think of how much WORSE that could be because people are already flocking to overcrowded emergency rooms because they don’t have any place else to go. And we wonder, are our ultra-specialized specialists going to help take care of flu patients? Will they know how? Maybe the answer to this is some part of an emergency plan we haven’t read yet. Comment, please, if you know—and no, we don’t mean specialists are heartless or don’t care about patients, we just don’t know how well someone who’s only done cornea transplants or rotator cuff surgery for 30 years can deal with patients with severe respiratory distress. We did see that AHRQ has resources for hospitals to plan surge capacity and to train more non-respiratory therapists to run respirators, and USA Today reported that many communities are activating their emergency plans.

Then there’s the whole sick pay problem. President Obama told us to stay home if we’re sick, and think about what to do if our kids’ schools close. That’s easy enough for those of us who can telecommute or who have paid sick days. But as our colleague, Julie Barnes, pointed out long before the current flu outbreak, we don’t all have paid sick days. Or paid days to take care of sick kids. As the National Partnership on Women and Families has reminded us, nearly half the private sector workers don’t have paid sick leave, and nearly 100 million workers don’t have a paid sick day they can use to care for a sick child.  

We know that in the past few years (partly because Sen. Edward Kennedy and former Sen. Bill Frist, who wisely seized a bipartisan post-anthrax moment and figured out how to use bio-terror defense legislation to beef up the weakened public health infrastructure for natural disease outbreaks as well, and partly because of the response to SARS and bird flu) we began improving public health capacity that had severely eroded. But the recession has taken its toll, draining "hundreds of millions of dollars and thousands of workers from the state and local health departments" the New York Times reports.

We know that some of the response to a severe flu outbreak will be via public health channels and emergency capacity and clinics, not through our everyday health infrastructure. (And the emergency response is going to have to take illegal immigrants—the third rail of health politics—into account, because no matter what you think about our nation’s immigration policy, having an untreated contagious disease among illegal immigrants isn’t good for any of us)  But a public health crisis superimposed on a tattered health safety net and a broken delivery system makes the job harder. Even if this flu is contained, or turns out to be relatively mild, there will be another crisis. And another one after that. So reforming health care and covering everyone isn’t just the morally correct and economically sensible thing to do. It’s the self-interested healthy thing to do. So let’s do it. 

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We write all the time about the economic and moral imperative for covering all Americans. Today, we’d like to address the public-health we’re-all-in-it-together pandemic flu imperative for covering all Americans.

We don’t yet know how bad the outbreak will become, and it goes without saying that along with everyone else on the planet, we hope it is mild. But the fact that we have 46 million (probably more given the recession) people who are uninsured and don’t have easy access to care, outside the emergency room, is making us nervous. The border States have particularly high rates of insurance. One-in-four Texans lack insurance, nearly as many New Mexicans, one-in-five Arizonans and Californians, (and that’s 2007 data, it may well be higher now). And think about all the people who do have some insurance but may still postpone going to the doctor because they have a bare bones or high-deductible insurance policy. Times are tough, and they’ll try to ride it out because they can’t afford the co-pay or deductible. Delayed care can mean more serious illness—and more spread of disease. 

We know we don’t have a good enough primary care system in this country, and people are going to flock to emergency rooms in an epidemic or a pandemic. But think of how much WORSE that could be because people are already flocking to overcrowded emergency rooms because they don’t have any place else to go. And we wonder, are our ultra-specialized specialists going to help take care of flu patients? Will they know how? Maybe the answer to this is some part of an emergency plan we haven’t read yet. Comment, please, if you know—and no, we don’t mean specialists are heartless or don’t care about patients, we just don’t know how well someone who’s only done cornea transplants or rotator cuff surgery for 30 years can deal with patients with severe respiratory distress. We did see that AHRQ has resources for hospitals to plan surge capacity and to train more non-respiratory therapists to run respirators, and USA Today reported that many communities are activating their emergency plans.

Then there’s the whole sick pay problem. President Obama told us to stay home if we’re sick, and think about what to do if our kids’ schools close. That’s easy enough for those of us who can telecommute or who have paid sick days. But as our colleague, Julie Barnes, pointed out long before the current flu outbreak, we don’t all have paid sick days. Or paid days to take care of sick kids. As the National Partnership on Women and Families has reminded us, nearly half the private sector workers don’t have paid sick leave, and nearly 100 million workers don’t have a paid sick day they can use to care for a sick child.  

We know that in the past few years (partly because Sen. Edward Kennedy and former Sen. Bill Frist, who wisely seized a bipartisan post-anthrax moment and figured out how to use bio-terror defense legislation to beef up the weakened public health infrastructure for natural disease outbreaks as well, and partly because of the response to SARS and bird flu) we began improving public health capacity that had severely eroded. But the recession has taken its toll, draining "hundreds of millions of dollars and thousands of workers from the state and local health departments" the New York Times reports.

We know that some of the response to a severe flu outbreak will be via public health channels and emergency capacity and clinics, not through our everyday health infrastructure. (And the emergency response is going to have to take illegal immigrants—the third rail of health politics—into account, because no matter what you think about our nation’s immigration policy, having an untreated contagious disease among illegal immigrants isn’t good for any of us)  But a public health crisis superimposed on a tattered health safety net and a broken delivery system makes the job harder. Even if this flu is contained, or turns out to be relatively mild, there will be another crisis. And another one after that. So reforming health care and covering everyone isn’t just the morally correct and economically sensible thing to do. It’s the self-interested healthy thing to do. So let’s do it. 

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We write all the time about the economic and moral imperative for covering all Americans. Today, we’d like to address the public-health we’re-all-in-it-together pandemic flu imperative for covering all Americans.

We don’t yet know how bad the outbreak will become, and it goes without saying that along with everyone else on the planet, we hope it is mild. But the fact that we have 46 million (probably more given the recession) people who are uninsured and don’t have easy access to care, outside the emergency room, is making us nervous. The border States have particularly high rates of insurance. One-in-four Texans lack insurance, nearly as many New Mexicans, one-in-five Arizonans and Californians, (and that’s 2007 data, it may well be higher now). And think about all the people who do have some insurance but may still postpone going to the doctor because they have a bare bones or high-deductible insurance policy. Times are tough, and they’ll try to ride it out because they can’t afford the co-pay or deductible. Delayed care can mean more serious illness—and more spread of disease. 

We know we don’t have a good enough primary care system in this country, and people are going to flock to emergency rooms in an epidemic or a pandemic. But think of how much WORSE that could be because people are already flocking to overcrowded emergency rooms because they don’t have any place else to go. And we wonder, are our ultra-specialized specialists going to help take care of flu patients? Will they know how? Maybe the answer to this is some part of an emergency plan we haven’t read yet. Comment, please, if you know—and no, we don’t mean specialists are heartless or don’t care about patients, we just don’t know how well someone who’s only done cornea transplants or rotator cuff surgery for 30 years can deal with patients with severe respiratory distress. We did see that AHRQ has resources for hospitals to plan surge capacity and to train more non-respiratory therapists to run respirators, and USA Today reported that many communities are activating their emergency plans.

Then there’s the whole sick pay problem. President Obama told us to stay home if we’re sick, and think about what to do if our kids’ schools close. That’s easy enough for those of us who can telecommute or who have paid sick days. But as our colleague, Julie Barnes, pointed out long before the current flu outbreak, we don’t all have paid sick days. Or paid days to take care of sick kids. As the National Partnership on Women and Families has reminded us, nearly half the private sector workers don’t have paid sick leave, and nearly 100 million workers don’t have a paid sick day they can use to care for a sick child.  

We know that in the past few years (partly because Sen. Edward Kennedy and former Sen. Bill Frist, who wisely seized a bipartisan post-anthrax moment and figured out how to use bio-terror defense legislation to beef up the weakened public health infrastructure for natural disease outbreaks as well, and partly because of the response to SARS and bird flu) we began improving public health capacity that had severely eroded. But the recession has taken its toll, draining "hundreds of millions of dollars and thousands of workers from the state and local health departments" the New York Times reports.

We know that some of the response to a severe flu outbreak will be via public health channels and emergency capacity and clinics, not through our everyday health infrastructure. (And the emergency response is going to have to take illegal immigrants—the third rail of health politics—into account, because no matter what you think about our nation’s immigration policy, having an untreated contagious disease among illegal immigrants isn’t good for any of us)  But a public health crisis superimposed on a tattered health safety net and a broken delivery system makes the job harder. Even if this flu is contained, or turns out to be relatively mild, there will be another crisis. And another one after that. So reforming health care and covering everyone isn’t just the morally correct and economically sensible thing to do. It’s the self-interested healthy thing to do. So let’s do it. 

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One of the easy areas of agreement across the political spectrum is that primary care providers need to be paid more from both Medicare and private insurance. It’s such a strong consensus that the Senate Finance Committee includes multiple proposals to address the problem in the “policy options” document it released yesterday. The most straightforward of these proposals would be a 5% payment bonus for primary care providers and general surgeons through Medicare. It sounds pretty good – but in reality, it won’t even come close to solving the problem.

Let’s wrap our head around the payment problem by means of an analogy. Let’s imagine you’re fresh out of college or some other postgrad higher education program, with all the attendant student loans that implies. You’re offered two jobs. One of them is the Platonic ideal of the job you always wanted to have, and is a job that you know desperately needs to be done. The other is similar and in the same field, but isn’t exactly everything you dreamed it could be and, although important, isn’t as urgently filled. Job A pays $45,000. Job B pays $73,000. This is a scenario faced by recent graduates all the time. Plenty of people will go for the dream job at $45,000, but it should be obvious that, over time, more and more grads will gravitate to the $73,000 job.

Now what if some people decided to restructure the payment process for Job A to make it more competitive with Job B, particular since the number of people interested in Job A is dwindling and the need for more people doing that job is critical? Great idea – but they only make it “more competitive” by raising Job A’s salary to $47,250 a year. Does that make your decision easier? Not at all! They’ve raised it a measly $187.50 per month, or $43 per week. This isn’t a change – it’s a tinker.

I’m using lower dollar figures because what a physician in private practice gets paid is deceptively high, considering the doctor’s reimbursement pays for his/her salary, but also for nurses, bookkeepers, people to be on the phone fighting insurance companies who want to deny claims, etc. Not to mention that in order to become a doctor, they have to go through 8 years of higher education, 3-7 years of a residency where they’re working up to 80 hours a week for an average salary, and only making decent money post-residency. Plus, since most doctors work on a fee-for-service basis, their “salary” is entirely dependent on the question of how many patients they see and how many procedures they perform – hardly a set figure year-to-year. So to make the problem more relatable, for Job A, I substituted the $131,417 median salary for Family Practice doctors for the median income for households in the U.S. — $45,000. Job B is the median salary for an Anesthesiologist — $212,734 a year. Someone in Job B is, yes, still a doctor, still saving lives, still vital to our health care system and with a specialized set of skills worth much of that extra salary. But not a specialty that’s in an urgent shortage as primary care doctors or general surgeons.

Suddenly, that 5% bonus doesn’t look that great.

Here’s the other knock against it – it’s going to be a massive fight to put this into action. On pg. 10 of the Finance Committee’s document, right under discussing the 5% bonus, we get this humdinger of a problem:

MedPAC recommended in June 2008 that Congress enact a budget-neutral bonus for primary care services. For this reason, the cost of the bonuses in this option would be offset by an across-the-board reduction in payments for services under all other codes. Alternatively, the increases could be paid for through funding from other sources. However, this approach would require finding new offsets.

Danger! Danger!

Essentially, Sens. Baucus, Grassley et al. are saying this bonus must be budget-neutral. The money from it either has to come from cutting payments to other specialties (something they’re prepared to fight tooth and nail, in an all-physician civil war) or from coming up with completely new money out of thin air. Suffice to say, even getting this measly bonus will be a fight.

Look, we need to do a much better job of compensating primary care, particularly because if we succeed in extending coverage, we don’t have the doctors we need. There’s an argument to be made that we’ve lost a sense of parity in how we pay our doctors (anesthesiology is a rather tame example of what we pay even more specialized doctors – the median salary for neurosurgeons is almost $300,000). But it’s not going to be solved with giving primary care docs a 5% bonus. If we’re going to have this fight, let’s have it over a meaningful solution.

(Photo credit:  chego101 on Flickr.)

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We write all the time about the economic and moral imperative for covering all Americans. Today, we’d like to address the public-health we’re-all-in-it-together pandemic flu imperative for covering all Americans.

We don’t yet know how bad the outbreak will become, and it goes without saying that along with everyone else on the planet, we hope it is mild. But the fact that we have 46 million (probably more given the recession) people who are uninsured and don’t have easy access to care, outside the emergency room, is making us nervous. The border States have particularly high rates of insurance. One-in-four Texans lack insurance, nearly as many New Mexicans, one-in-five Arizonans and Californians, (and that’s 2007 data, it may well be higher now). And think about all the people who do have some insurance but may still postpone going to the doctor because they have a bare bones or high-deductible insurance policy. Times are tough, and they’ll try to ride it out because they can’t afford the co-pay or deductible. Delayed care can mean more serious illness—and more spread of disease. 

We know we don’t have a good enough primary care system in this country, and people are going to flock to emergency rooms in an epidemic or a pandemic. But think of how much WORSE that could be because people are already flocking to overcrowded emergency rooms because they don’t have any place else to go. And we wonder, are our ultra-specialized specialists going to help take care of flu patients? Will they know how? Maybe the answer to this is some part of an emergency plan we haven’t read yet. Comment, please, if you know—and no, we don’t mean specialists are heartless or don’t care about patients, we just don’t know how well someone who’s only done cornea transplants or rotator cuff surgery for 30 years can deal with patients with severe respiratory distress. We did see that AHRQ has resources for hospitals to plan surge capacity and to train more non-respiratory therapists to run respirators, and USA Today reported that many communities are activating their emergency plans.

Then there’s the whole sick pay problem. President Obama told us to stay home if we’re sick, and think about what to do if our kids’ schools close. That’s easy enough for those of us who can telecommute or who have paid sick days. But as our colleague, Julie Barnes, pointed out long before the current flu outbreak, we don’t all have paid sick days. Or paid days to take care of sick kids. As the National Partnership on Women and Families has reminded us, nearly half the private sector workers don’t have paid sick leave, and nearly 100 million workers don’t have a paid sick day they can use to care for a sick child.  

We know that in the past few years (partly because Sen. Edward Kennedy and former Sen. Bill Frist, who wisely seized a bipartisan post-anthrax moment and figured out how to use bio-terror defense legislation to beef up the weakened public health infrastructure for natural disease outbreaks as well, and partly because of the response to SARS and bird flu) we began improving public health capacity that had severely eroded. But the recession has taken its toll, draining "hundreds of millions of dollars and thousands of workers from the state and local health departments" the New York Times reports.

We know that some of the response to a severe flu outbreak will be via public health channels and emergency capacity and clinics, not through our everyday health infrastructure. (And the emergency response is going to have to take illegal immigrants—the third rail of health politics—into account, because no matter what you think about our nation’s immigration policy, having an untreated contagious disease among illegal immigrants isn’t good for any of us)  But a public health crisis superimposed on a tattered health safety net and a broken delivery system makes the job harder. Even if this flu is contained, or turns out to be relatively mild, there will be another crisis. And another one after that. So reforming health care and covering everyone isn’t just the morally correct and economically sensible thing to do. It’s the self-interested healthy thing to do. So let’s do it. 

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We write all the time about the economic and moral imperative for covering all Americans. Today, we’d like to address the public-health we’re-all-in-it-together pandemic flu imperative for covering all Americans.

We don’t yet know how bad the outbreak will become, and it goes without saying that along with everyone else on the planet, we hope it is mild. But the fact that we have 46 million (probably more given the recession) people who are uninsured and don’t have easy access to care, outside the emergency room, is making us nervous. The border States have particularly high rates of insurance. One-in-four Texans lack insurance, nearly as many New Mexicans, one-in-five Arizonans and Californians, (and that’s 2007 data, it may well be higher now). And think about all the people who do have some insurance but may still postpone going to the doctor because they have a bare bones or high-deductible insurance policy. Times are tough, and they’ll try to ride it out because they can’t afford the co-pay or deductible. Delayed care can mean more serious illness—and more spread of disease. 

We know we don’t have a good enough primary care system in this country, and people are going to flock to emergency rooms in an epidemic or a pandemic. But think of how much WORSE that could be because people are already flocking to overcrowded emergency rooms because they don’t have any place else to go. And we wonder, are our ultra-specialized specialists going to help take care of flu patients? Will they know how? Maybe the answer to this is some part of an emergency plan we haven’t read yet. Comment, please, if you know—and no, we don’t mean specialists are heartless or don’t care about patients, we just don’t know how well someone who’s only done cornea transplants or rotator cuff surgery for 30 years can deal with patients with severe respiratory distress. We did see that AHRQ has resources for hospitals to plan surge capacity and to train more non-respiratory therapists to run respirators, and USA Today reported that many communities are activating their emergency plans.

Then there’s the whole sick pay problem. President Obama told us to stay home if we’re sick, and think about what to do if our kids’ schools close. That’s easy enough for those of us who can telecommute or who have paid sick days. But as our colleague, Julie Barnes, pointed out long before the current flu outbreak, we don’t all have paid sick days. Or paid days to take care of sick kids. As the National Partnership on Women and Families has reminded us, nearly half the private sector workers don’t have paid sick leave, and nearly 100 million workers don’t have a paid sick day they can use to care for a sick child.  

We know that in the past few years (partly because Sen. Edward Kennedy and former Sen. Bill Frist, who wisely seized a bipartisan post-anthrax moment and figured out how to use bio-terror defense legislation to beef up the weakened public health infrastructure for natural disease outbreaks as well, and partly because of the response to SARS and bird flu) we began improving public health capacity that had severely eroded. But the recession has taken its toll, draining "hundreds of millions of dollars and thousands of workers from the state and local health departments" the New York Times reports.

We know that some of the response to a severe flu outbreak will be via public health channels and emergency capacity and clinics, not through our everyday health infrastructure. (And the emergency response is going to have to take illegal immigrants—the third rail of health politics—into account, because no matter what you think about our nation’s immigration policy, having an untreated contagious disease among illegal immigrants isn’t good for any of us)  But a public health crisis superimposed on a tattered health safety net and a broken delivery system makes the job harder. Even if this flu is contained, or turns out to be relatively mild, there will be another crisis. And another one after that. So reforming health care and covering everyone isn’t just the morally correct and economically sensible thing to do. It’s the self-interested healthy thing to do. So let’s do it. 

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Republican music to our ears: "Will health reform require an upfront investment? Yes. But will that investment pay off in the long-term? Yes it will."

That’s former HHS Secretary Tommy Thompson, who served under President  George W. Bush, writing in the Politico, arguing for comprehensive reform. He didn’t spell out precisely how he defines comprehensive reform, and he didn’t explicitly endorse any of the main Democratic approaches, but he sure extended a warm fiscal handshake, a welcome note of bipartisanship as Congress grapples with how to finance expansion of coverage and an overhaul of the system.

Thompson wrote that sustainable, affordable health care reform is an important investment in the future, but Congress must heed the estimates of the Congressional Budget Office. In the past, when CBO calculated the cost of health care reform, he said, it didn’t adequately assess the savings that will come from changing the health care system to provide more value and promote wellness in the long run. Thompson writes:

…the CBO price tag for health care reform, on which legislators will base decisions, will not capture the future savings, because it underestimates the value of investment in health care as a means to achieving a healthier, more productive and, ultimately, more prosperous America.

Thompson identifies the cost of chronic disease as a source of significant financial difficulties for the health care system (and therefore our whole national economy), stating that "treatment of patients with chronic illnesses accounts for 75 cents of every health care dollar, or $1.65 trillion in 2007." He wrote that chronic disease accounts for  83 percent of Medicaid spending, and 96 percent of Medicare. He’s right—and the real tragedy of chronic disease is that much of it can be prevented, controlled or delayed. An emphasis on prevention and wellness, which many lawmakers are currently calling for, will have an important impact on lowering costs over time and making the utilization of care more efficient.

Thompson points out that now is the time for health care reform—the people want it, health industry stakeholders want it, and health care advocates want it. We couldn’t agree more. The Cost of Doing Nothing
on health care is high. Health care costs are growing faster than wages; by 2016, the cost of the average employer-sponsored health insurance plan for a family will reach $24,000. The already struggling economy will continue to lose up to $200 billion per year because of the poorer health and shorter lifespan of the uninsured. Health care reform that encompasses prevention and wellness will make Americans healthier and save money. We’ll see the payoff, he said, in reduced health care spending and improved work force productivity. And that’s a healthy conclusion that conservatives should like.

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Midland Memorial Hospital

A doctor uses the IT system at Midland Memorial.

As the New England Journal of Medicine reported in a study last month, only 1.5% of U.S. hospitals have adopted “comprehensive” electronic health records throughout their facilities and another 7.6% have basic systems installed in at least some portion of their operations. A key stumbling block to getting boosting such EHRs is cost, which can run $20 million to several times that amount for large hospitals.

But the WSJ’s Laura Landro today details how the government already has invested billions of dollars over two decades to develop a software for a records system that’s available free for any hospital that wants to use it. The system is run by the Veterans Administration and provides electronic services at more than 1,400 VA facilities.

Of course, while the so-called open-source software is free, it still costs money to adapt it for a hospital’s needs as well as to buy hardware and maintain it all. But Landro says the VA’s Midland Memorial Hospital in Texas paid less than $7 million for a full electronic medical-record system.

While there have been some missteps along the way – computers were new to some of the hospital’s staff, for one thing – the system has achieved notable success, Landro reports:

In the 18 months after the system went live hospital-wide in June 2006, the hospital reduced medication errors and patient deaths. Infection rates dropped 88% thanks to guidelines in the record system that prompted nurses to follow infection-control procedures, such as changing a dressing or following correct procedures when inserting a new IV.

PricewaterhouseCoopers consultant Dan Garrett says that while the VA’s software — dubbed VistA for the Veteran’s Health Information Systems and Technology Architecture — holds promise for some hospitals, it hasn’t been widely commercially proven, unlike offerings from for-profit vendors.

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Republican music to our ears: "Will health reform require an upfront investment? Yes. But will that investment pay off in the long-term? Yes it will."

That’s former HHS Secretary Tommy Thompson, who served under President  George W. Bush, writing in the Politico, arguing for comprehensive reform. He didn’t spell out precisely how he defines comprehensive reform, and he didn’t explicitly endorse any of the main Democratic approaches, but he sure extended a warm fiscal handshake, a welcome note of bipartisanship as Congress grapples with how to finance expansion of coverage and an overhaul of the system.

Thompson wrote that sustainable, affordable health care reform is an important investment in the future, but Congress must heed the estimates of the Congressional Budget Office. In the past, when CBO calculated the cost of health care reform, he said, it didn’t adequately assess the savings that will come from changing the health care system to provide more value and promote wellness in the long run. Thompson writes:

…the CBO price tag for health care reform, on which legislators will base decisions, will not capture the future savings, because it underestimates the value of investment in health care as a means to achieving a healthier, more productive and, ultimately, more prosperous America.

Thompson identifies the cost of chronic disease as a source of significant financial difficulties for the health care system (and therefore our whole national economy), stating that "treatment of patients with chronic illnesses accounts for 75 cents of every health care dollar, or $1.65 trillion in 2007." He wrote that chronic disease accounts for  83 percent of Medicaid spending, and 96 percent of Medicare. He’s right—and the real tragedy of chronic disease is that much of it can be prevented, controlled or delayed. An emphasis on prevention and wellness, which many lawmakers are currently calling for, will have an important impact on lowering costs over time and making the utilization of care more efficient.

Thompson points out that now is the time for health care reform—the people want it, health industry stakeholders want it, and health care advocates want it. We couldn’t agree more. The Cost of Doing Nothing
on health care is high. Health care costs are growing faster than wages; by 2016, the cost of the average employer-sponsored health insurance plan for a family will reach $24,000. The already struggling economy will continue to lose up to $200 billion per year because of the poorer health and shorter lifespan of the uninsured. Health care reform that encompasses prevention and wellness will make Americans healthier and save money. We’ll see the payoff, he said, in reduced health care spending and improved work force productivity. And that’s a healthy conclusion that conservatives should like.

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April 30, 2009, Real Clear Politics

Prelude: What follows in an article by Betty McCaughey. McCaughey is a patient advocate and founder of the Committee to Reduce Infection Deaths. She is also a fellow at the Hudson Institute and a former lieutenant governor of New York State. Her point of view directly counters policy makers in the Obama Administration, who believes the government should reserve the right to override doctors’ decisions based on computer evidence of effectiveness.

Patients count on their doctor to do whatever is possible to treat their illness. That is the promise doctors make by taking the Hippocratic Oath.

But President Obama’s advisers are looking to save money by interfering with that oath and controlling your doctor’s decisions.

Ezekiel Emanuel sees the Hippocratic Oath as one factor driving “overuse” of medical care. He is a policy adviser in the Office of Management and Budget (OMB) and a brother of Rahm Emanuel, the president’s chief of staff.

Dr. Emanuel argues that “peer recognition goes to the most thorough and aggressive physicians.” He has lamented that doctors regard the “Hippocratic Oath’s admonition to ‘use my power to help the patient to the best of my ability and judgment’ as an imperative to do everything for the patient regardless of the cost or effects on others.”

Of course, that is what patients hope their doctor will do.

But President Barack Obama is pledging to rein in the nation’s health care spending. The framework for influencing your doctor’s decisions was included in the stimulus package, also known as the American Recovery and Reinvestment Act of 2009.

The legislation sets a goal that every individual’s treatments will be recorded by computer, and your doctor will be guided by electronically delivered protocols on “appropriate” and “cost-effective” care.

Heading the new system is Dr. David Blumenthal, a Harvard Medical School professor, named national coordinator of health information technology. His writings show he favors limits on how much health care people can get.

“Government controls are a proven strategy for controlling health care expenditures,” he argued in the New England Journal of Medicine (NEJM) in March 2001.
Blumenthal conceded there are disadvantages:

“Longer waits for elective procedures and reduced availability of new and expensive treatments and devices.”

Yet he called it “debatable” whether the faster care Americans currently have is worth the higher cost.

Now that Blumenthal is in charge, he sees problems ahead.

“If electronic health records are to save money,” he writes, doctors will have to take “advantage of embedded clinical decision support” (a euphemism for computers instructing doctors what to do).

“If requirements are set too high, many physicians and hospitals will rebel – petitioning Congress to change the law or just resigning themselves to … accepting penalties,” he wrote in NEJM early this month.

The public applauded the new requirement for electronic records, not foreseeing that it would put faceless bureaucrats in charge of your care.

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