Health Care.

Tags: medical health care, health care economics, health care ethics, oklahoma health care authority, canadian health care, health care reform, mental health care, health care management, dog health care, cardinal health care

A public health insurance option won’t stand between you and your doctor, straight from the doctors’ mouth. That’s 450,000 physicians for real, strong health care reform with a public health insurance option:

Tags: health care crisis, health care, united health care provider directory, health care in vietnam, outline of american health care system, health care web site development, united health care insurance, essay on single payer health care, oklahoma health care authority, hispanic health care in the us

As the wheeling and dealing of getting a health reform bill passed takes center stage in news coverage, one aspect of the debate is not getting the attention it deserves: the affordability of health care. To keep the cost of the bill and of health insurance down, Congress seems to be moving toward more cost sharing by patients even though mountains of research shows that higher out-of-pocket costs lead people to forego medically necessary care. That leads us further from the goal of guaranteeing everyone has access to quality, affordable health care when they need it.

Read more…

Tags: health care plan, against universal health care, cardinal health care, health care power of attorney, health care logistics, universal health care, health care promotion, philippine health care delivery system, united health care, alberta health care

Tina Dupuy makes a good point:

Let’s look at this reasonably: Firefighting used to be a private for-profit industry. In the 1800’s, the early days of urbanization, in cities like New York and Baltimore, there were private “clubs” or “gangs” who were in charge of putting out fires. The infamous Boss Tweed started his illustrious political career at a volunteer fire company. The way it functioned was the first club at the scene got money from the insurance company. So, they had an incentive to get there fast. They also had an incentive to sabotage competition. They also often ended up getting in fights over territory and many times buildings would burn down before the issue was resolved. They were glorified looters. It was corrupt, bloated and expensive – but at least it wasn’t the much maligned “government controlled.”

Around the time of the Civil War, firefighting in big cities was reformed and taken over by the government. Currently firefighters in most major metropolises are trained by the government, employed by the government and given health care – wait for it – by the government.

Yet if we had to have the “conversation” about the firefighting industry today, we’d have socialism-phobic South Carolina Sen. Jim DeMint on the TV every chance he could get saying things like, “Do you want a government bureaucrat between you and the safety of your home?”

Rep. John Boehner of Ohio would hold press conferences and ask, “Do you want your firefighting to be like going to the DMV? Do you want Uncle Sam to come breaking down your door every time some Washington fat cat says there’s a fire?”

There would be 30-second TV spots paid for by the powerful firefighting lobby featuring stars and stripes graphics and the national anthem playing softly in the background with a booming voice-over trumpeting, “Founding Fathers George Washington and Thomas Jefferson were volunteer firefighters. Support traditional values and oppose government waste. Tell your representative you want a bi-partisan solution to fire reform.”

News programs would be interviewing sobbing people whose homes fell through the cracks and burned to the ground. “I don’t want to see the government take-over firefighting, but I sure miss Momma’s oil paintings.”

And President Barack Obama would relay his childhood experience with a fire then point out the failure of the for-profit firefighting industrial complex that “threatens to bankrupt this country.” And then those most in need of firefighting services would foam about his birth certificate and confuse Karl Marx with Charles Darwin on misspelled protest signs at events put on covert firefighting lobbyists.

But instead, today firefighters are national heroes. They’re organized, quick, competent and with few exceptions pillars of the community. Their duty is to protect people and their property and they do it. They make no profits, are part of the government and they help people 24-hours a day. They even let seniors live. No debate necessary. What started out as a shady gaming of the system where the general public’s welfare was at risk is today something of national pride.

The private health insurance industry today is much like the private firefighting industry of the 1800s. Their incentives don’t align with the purpose they ostensibly exist to serve. Private firefighters fought with each other instead of putting out fires. Private insurance companies throw bureaucrats at you to deny you care and to save their shareholders money instead of keeping you healthy.

Now, why again does the private industry not deserve a little competition from an entity that has only one goal in mind – your health?

Tags: health care web site development, essay on single payer health care, intermountain health care, health care cash plan, problems with universal health care, alberta health care, health care problems, kerry and health care, health care statistics, health care supplies

The insurance industry, its business allies and its shills in Congress are doing their best once again to scare us away from real health care reform, just as they did 15 years ago. Using the same tactics and language they did then, insurers and their cronies are warning us that America will be sliding down a slippery slope toward socialism if the federal government creates a public insurance option to compete with the cartel of huge for-profit companies that now dominate the health insurance industry.

One of the false images they try to create in our minds is of long waits for needed care if our reformed health care system resembles in any way the systems of other developed countries in the world–systems that don’t deny a single citizen access to affordable care, much less 50 million of them.

Here is a real image, and a very scary one, that I wish those overpaid insurance executives and members of Congress could have witnessed before dawn a few days ago: a thousand men, women and children standing for hours, in the dark, in a line that seemed to be endless, waiting patiently for a chance — a chance because the need is so great many are turned away — to get much-needed care from a volunteer doctor.

read more

Tags: holistic health care, cardinal health care, intermountain health care, non medical in home health care services, franciscan health care, apria health care, mercy health care east, health care issues in america, obama health care, french health care

Birther Roy Blunt has been on a rampage against Medicare, saying the other day the patent lie that “Medicare has never done anything to make people more healthy,” despite the millions of healthy seniors on Medicare.

The anti-Medicare argument has been taking hold in other corners, with Rep. Tom Price, chairman of the Republican Study Committee, authoring an op-ed that mostly attacks Medicare as a reason the new Republican tax health care plan is a good idea:

Going down the path of more government will only compound the problem. While the stated goal remains noble, as a physician, I can attest that nothing has had a greater negative effect on the delivery of health care than the federal government’s intrusion into medicine through Medicare. Because of Washington’s one-size-fits-all approach, its flawed coverage rules and broken financing mechanisms, seniors are increasingly having care rationed while federal health spending spirals out of control.

This is, as we say in Washington, bull. Medicare covers virtually the entirety of our senior population, and does it at lower cost and higher quality.

And, that bull is just about the entirety of the Republican argument against health reform it seems: No health reform, because Medicare is awful.

Of course, the plan Price is pushing isn’t so much of a plan and more of a John McCain retread, with lots of talk about taxes and no new ideas for how to lower our health care costs or provide more coverage at an affordable price.

But it’s good to know Price hates Medicare. That puts him at odds with 86% of seniors, people who are actually on Medicare.

Update:

A friend reminds me it’s Medicare and Medicaid’s birthday today, too! On July 30, 1965, President Johnson signed Medicare and Medicaid into law, providing a lifeline to millions of elderly Americans and low-income families who would otherwise not have been able to afford health care.

I’m sure Blunt isn’t celebrating, but millions or seniors and low-income Americans are.

Tags: health care promotion, health care logistics, long term health care, home health care, against universal health care, home health care products, advocate health care, france has long wait times for health care, united health care insurance, health care administration

NEWS

Family Research Council Ad: Fear, Not Facts – Media Matters

One of the several emerging misleading arguments against health insurance reform is that the reform legislation will allow taxpayer dollars to fund abortion. Now, the Family Research Council has released an ad that implies that Planned Parenthood’s funding of reproductive services will somehow prevent another individual from undergoing surgery.

A look at health care plans in Congress – Associated Press

A look at health care legislation taking shape in the Democratic-controlled House and Senate as President Barack Obama pushes to overhaul the system, cover nearly 50 million uninsured Americans and contain rising costs. Many of the details are still being negotiated and any final health care bill would have to meld proposals from the House and Senate.

House Democrats End Impasse on Health Bill – New York Times

Efforts to pass sweeping health care legislation took a big step forward on Wednesday as House Democratic leaders reached an agreement with fiscally conservative party members that would cut the bill’s cost and exempt many small businesses from having to provide health benefits to workers.

Health deal sparks fury on the left – The Hill

A House leadership deal with Blue Dogs and an aggressive marketing push by Sen. Max Baucus (D-Mont.) shifted the healthcare debate sharply toward centrist positions Wednesday, sparking threats of rebellion from the left.

OPINION

Health Care Reform Coming Out of Senate Finance? – The Health Care Blog

And, as I have posted here before, I am concerned that in their efforts to find compromise they are headed for a health care bill that is based on a formula of cost containment “lite,” minor paring of Medicare and Medicaid provider payments, and at least $500 billion in new taxes. I don’t see much changing fiscally if that is the final result in a health care system that is already unsustainable and on the way to spending upwards of $35 trillion to $40 trillion over the next ten years as it goes to 22% of GDP by 2018.

What Does The Blue Dog Compromise On Health Care Say About The Blue Dogs? – Think Progress

After arguing that the House health care bill did not do enough to lower long term health care spending, Blue Dog Democrats hijacked the House Energy and Commerce Committee and promised to vote down the bill unless Chairman Henry Waxman (D-CA) heeded their concerns.

The Deal With the Blue Dogs – The New Republic

The big news on health reform is a deal that will allow the House Energy and Commerce Committee to pass legislation. As you may recall, nearly identical bills have already moved through two other House committees, Education and Labor along with Ways and Means. But it’s gotten hung up in Energy and Commerce, where the Blue Dog Democrats have kicked up a fuss, protesting everything from the bill’s size to the inclusion of a public insurance option.

The Public Plan You Won’t Have Access To – Matt Yglesias

Ezra Klein defends his longstanding contention that the public plan isn’t the most important aspect of the health care debate by noting that as currently envisioned in even the liberal House version of legislation the public plan is available only to people in the Exchange and most people aren’t in the Exchange.

Tags: health care plan, united health care provider directory, health care web site development, role of an advocate in health care, france has long wait times for health care, mental health care, health care problems, free health care, health care issues in america, mercy health care east

by Morgan Clark
Our Bodies Ourselves intern

The first day of my internship with Our Bodies Ourselves began with a fascinating web conference on reproductive and environmental health, organized by Reproductive Health Technologies Project. Presenters from Planned Parenthood of Connecticut, Asian Communities for Reproductive Justice, and MomsRising spoke about their …

[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: exploring health care careers, primary health care, alternative health care, holistic health care, health care crisis, health care problems, mental health care, franciscan health care, health care administration, united health care dental

The internet, social media, web 2.0 etc have changed how important health care issues are discussed. So, it is not surprising that big health care organizations are trying to use these new media to promote their messages. New media, however, are no more immune from the effects of conflicts of interest than are old media.

An article from corporate communications company Ragan.com about how the American Heart Association (AHA) is using bloggers to get people interested in a heart-healthy diet and exercise program illustrates how even “civilian” bloggers can get caught up in the web of conflicts of interest that pervades health care. The background is:

Keeping track of the conversations on the array of social media networks can gobble up your workday. So why not find someone else to do it for you?

The American Heart Association did just that, approaching four established bloggers with a proposal: Write about our new campaign, Go Red For Women: BetterU, and we’ll link to your blog from our site. BetterU is a 12-week online nutrition and fitness program to improve heart health among women.

The blogs appear to be working. They’ve helped drive traffic to Go Red/BetterU since the program’s June 1 launch.

It did seem that the AHA went to considerable effort to make sure they had recruited just the right bloggers.

The AHA researched potential candidates with the help of agencies Edelman PR and Edelman Digital. After a month-and-a-half, they settled on four bloggers: Joshilyn, Nyasha, Stacey, and Nadia.

The criteria: The bloggers had to be female, have an enthusiastic following, be diverse in age and ethnicity, and have a high Technorati rating. Most important, their content and advertising had to align with the association’s values, says Director of Marketing Anu Gandhi.

‘You’re really ultimately picking a spokesperson for Go Red for Women and the larger American Heart Association,’ [senior manager for cause communications Megan] Lozito says. ‘That’s a really important process for us — that it be correct and that it be the right people. So we spent a lot of time getting to know those ladies and making sure our mission would be aligned.’

More interesting was the values with which the bloggers were supposed to align, particularly those relating to the program’s corporate sponsors (see the logos at the bottom right of the BetterU web-site).

From there, the association brought the bloggers to the Dallas headquarters for a full health screening at The Cooper Institute, a photo session, a preview of the BetterU program, and some message training.

Although the BetterU bloggers got some message training in Dallas, Gandhi says AHA has been hands off when it comes to what they can and can’t say about the program.

The bloggers are asked to post once a week about BetterU and follow basic guidelines—no profanity, no defamation, no writing about nor condoning any medications or treatments. She says they also ask bloggers not to talk about competitors of AHA’s two national sponsors: Macy’s and Merck Pharmaceuticals.

I would suspect that the explicit instruction not to favor Merck’s competitors would also remind the bloggers not not do say anything that might make the giant pharmaceutical company unhappy.

Eight weeks into the program, they haven’t had any problems.

‘There are things we don’t want them to write, like profanity, but that’s also part of the vetting in the beginning,’ Lozito says. ‘We wanted to find people who believe in our mission, who speak to the same type of audience, but at the same time we want them to have their own flavor and own tone, because it’s a blog.’

So the bloggers recruited by the AHA may be happy, since they now have a big organization’s web-site driving traffic to their blogs. The AHA may be happy, since the bloggers can spread the word about their BetterU program. I imagine the marketers at Merck may be happy too, since the bloggers have been warned about the need to keep the corporate sponsors happy. However, what may be good for all the parties in this transaction may not be so good for the general public, as another opportunity for uninhibited, honest discussion of health care issues has been lost.

This is an explicit example of the adverse effects of commercial funding of not-for-profit disease advocacy groups. Corporate sponsors may not expect anything as gross as advertising in return for their money. However, they may expect something more subtle, a generally favorable attitude toward the sponsor, at least the disinclination to say anything that might put the sponsor in a negative light. After all, politeness requires that we be nice to the people who are nice to us. But being nice to sponsors may not be so nice for the people that a health care not-for-profit organization is supposed to serve.

PS – for those who like science fiction, see the preview of the new version of “V,” in which Anna, the leader of the Visitors, an invasion force disguised as human-appearing, benign aliens, warns her television interviewer,

Just be sure not to ask anything that would put us in a negative light.

Tags: home health care jobs, united health care provider directory, obama on health care, health care supplies, pet health care, aarp health care options, health care issues in america, health care administration, cardinal health care, canadian health care

While in the UK recently, I met Michael Balle, the author of the Shingo Prize winning book The Gold Mine: A Novel of Lean Turnaround. He has a new book (published by LEI, my employer) just out this week called “The Lean Manager.”

Michael has offered to take questions from Lean Blog readers that he’ll answer here in written form. If you have questions about The Gold Mine, lean transformation, or lean leadership, you can submit the questions in one of three ways:

1. Email me at leanpodcast (at) gmail dot com
2. Call the “Lean Line” and leave a voice mail — 817-776-LEAN (5326)
3. Leave a comment here on this blog post.

Here is an intro to Michael via the Evolving Excellence blog.

Subscribe via RSS | Lean Blog Main Page | Podcast | Twitter @leanblog

Tags: united health care dental, ethical issues in health care, health care statistics, health care occupations, health care ethics, medical health care, mental health care, hispanic health care in the us, assurant health care, cigna health care

By Andy Wagner:

The New York Times recently published an essay by Matthew Crawford, based on his new book “Shop Class as Soulcraft: An Inquiry Into the Value of Work“. In his inquiry into the value of work, Crawford takes on Taylorism’s separation of thinking from doing in a way that only a philosophy PhD with his own classic motorcycle repair shop can:

The dichotomy of mental versus manual didn’t arise spontaneously. Rather, the twentieth century saw concerted efforts to separate thinking from doing. Those efforts achieved a good deal of success in ordering our economic life… Yet to call this “success” is deeply perverse, for wherever the separation of thinking from doing has been achieved, it has been responsible for the degradation of work.

He goes on to argue that it is in the crafts and trades that thinking and doing are permitted to exist in their natural state, and work to retain its full dignity. He doesn’t think much of the new “creative class” and includes continuous improvement under that name:

The rhetoric of freedom pleases our ears. The simulacrum of independent thought and action that goes by the name of “creativity” trips easily off the tongues of spokes people for the corporate counterculture… The term invokes our powerful tendency to narcissism, and in doing so greases the skids into work that is not what we had hoped.

Freedom to be creative means nothing if a worker, blue or white collar, hasn’t first mastered his trade and mastery itself is not possible without a physical and mental connection. Deming highlighted this in Point 12, “Remove barriers that rob workers of pride in workmanship” and he applied this message to managers as well as the hourly worker.

I think most lean thinkers relate well to what Crawford and Deming have to say in terms of engaging the minds of hourly workers. It’s the first thing that we think of when we say “Respect for People”. It’s Crawford’s critique of the “cubicle class” that strikes much deeper, into the heart of some problems with corporate America:

Corporations portray themselves as results-based and performance-oriented. But where there isn’t anything material being produced, objective standards for job performance are hard to come by. What’s a manager to do?

He compares this with the shop floor, where a foreman uses a micrometer to check a workpiece and rule in unambiguous terms whether a worker has done his job correctly or not.

At issue in the contrast between office work and manual trades is the idea of individual responsibility, tied to the presence or absence of objective standards.

The subjective standards to which Crawford refers remind me of Bill Waddell’s ever enjoyable rants against Standard Cost Accounting. What could better epitomize Crawford’s point that managers, out of touch with the objective “doing” of the shop floor, find themselves frustrated by chasing metrics that stray from reality, metrics that they are rarely able to influence in a meaningful way.

And so it began for me: my first week on the floor, one of the more senior union workers took me aside and with one of the most dire serious faces I’ve ever seen said: “Whatever you do with these people, don’t ever lie to them.”

Management doesn’t so much lie, as Crawford points out, as they double talk and hedge to avoid responsibility for things they lack objective ability to control:

When a manager’s success is predicated on the manipulation of language, for the sake of avoiding responsibility, reward and blame come untethered from good faith effort. He may then come to think that those beneath him in the food chain also can’t be held responsible in any but arbitrary ways… It is in this… system of language… that the world of managers resembles that of Soviet bureaucrats, who had to negotiate reality without public recourse to language that could capture it, obliged to use instead language the whole point of which was to cover over reality.

More to the point:

Given the moral maze inhabited by managers, we can understand why those higher in the hierarchy must absent themselves from the details of the production process: such abstraction facilitates non accountability.

Is it any wonder Enron, Fannie, Freddie, and AIG are household names?

In Crawford’s conclusion, he suggests that the most satisfaction comes in work that we understand objectively, with our hands and with a satisfied customer customer close by to help us to appreciate the result. He gets this by helping people to restore old motorcycles, watching their faces when the motor turns over and they drive away smiling. His “gemba” is riding with friends in the Blue Ridge Mountains, feeling what is and isn’t a well tuned suspension. He thrives on the brotherhood of excellence that exists between perfecting their skills and intuition for their craft.

I think his “Soulcraft” piece is off the mark in one respect. He doesn’t think to much of manufacturing, in that he views it as a unredeemed Taylorist institution. It’s not a trade or craft to build a new motorcycle because the screws are not stripped–they always turn, and the castings are not covered in grease or dirt. It’s repetitive, the same every time, or so he perceives it. The lean thinker, however, sees it differently. Our trade–our craft–and our brotherhood of excellence, is the pursuit of continuous improvement of each task, every time, thinking and doing.

Subscribe via RSS | Lean Blog Main Page | Podcast | Twitter @leanblog

Tags: exploring health care careers, pros and cons of universal health care, free health care, health care ethics, health care cash plans, cardinal health care, humana health care, health care logistics, elderly health care, holistic health care

Tags: health care web site development, ethical issues in health care, health care cash plans, free health care, canadian health care system, health care proxy, health care supplies, health care in vietnam, united health care provider directory, obama on health care

More than a month ago, the mainstream media’s coverage of health care reform turned sour. I’m not sure why, but that negativity has extended to the way the press is reporting on the president himself.

Today, the New York Times reported that a new poll reveals that “Americans are concerned that revamping the health care system would reduce the quality of their care, increase their out-of-pocket health costs and tax bills, and limit their options in choosing doctors, treatments and tests. The percentage who describe health care costs as a serious threat to the American economy — a central argument made by Mr. Obama — has dropped over the past month.”

I fear that the way the media has been reporting on reform has played a significant role in shaping the public’s perception of both the president and what some like to call “ObamaCare,” personalizing the issue, as if reform were merely the president’s favorite hobby-horse.

Begin with the coverage of health care reform. Over the past month,,Media Matters has done an excellent job of tracking how “the media continues to spread conservative misinformation on health care reform.” Here are just a few examples:

 “Despite clear progress, media declare health care reform nearing "life support"

 “On health care reform, networks highlight perceived setbacks far more than progress” July 22 

 “Politico ignores contradictions in calls by “moderates” for lower costs, limits on public plan” July 20 

 “CBS' Smith advanced falsehood that Dems are taxing small businesses to fund health bill” July 19 

 “NY Times ignores House health bill's exemption protecting small businesses” 

 “Wash. Post column cites inapplicable CBO assessment to claim public plan option has ‘huge cost, minor benefit’” July 07 

 “CNN.com joins Republican fear-mongering about Canadian-style health care” July 07 

And  I’m not even including the over-the-top distortions of the truth that have become regular fare on Fox News, and in the pages of some decidedly conservative newspapers.

The Press Fails to Analyze the Arguments

In light of the compromises that Senate Democrats are making, one could argue that the press was correct earlier this month, when it declaried that health care reform was headed for trouble. But I can’t help but wonder: to what degree did the headlines become a self-fulfilling prophecy?

Less than two weeks ago, it seemed that Senator Baucus’ political capital was falling, and that the Senate HELP committee bill, along with the House bill, might well define the terms for reform. But the media continued to “highlight setbacks far more than progress.”

Moreover, Media Matters is right in pointing out that the press failed to analyze the contradictions in the Blue Dog’s arguments as they simultaneously criticized progressive Democrats for creating reform bills that “did not include enough cost savings,” and at the same time, insist that any public plan should pay doctors and hospitals more than Medicare pays. The Blue Dogs seem to be winning on that last point (As I have explaind in the past, while the Blue Dogs press for across-the-board increases for all rural providers,  the .House  bill would hike Medicare paymetns for treatments that provide greater  benefit to patients–including primary care, while lowrering very lucrative paymetns for some treamens that are far less effective.)  

How then would the Blue Dogs save money? In the House, legislators have now agreed to reduce the federal subsidies designed to help lower-income families afford insurance. As I have pointed out in the past, if they are going to be able to afford mandated insurance, middle-income families also will need help from the government. And now it appears that the the subsidies may not be sufficient—certainly not not if a family wants comprehensive insurance.

What I find most disappointing is that when the 1,018 page House Plan was made public, even progressive newspapers failed to give readers much-needed, solid information on the strengths of the plan. How many Americans know that, under the plan approved by three House committees: insurers would not be able to charge co-pays for preventive care—including eye and foot exams for diabetics; insurers would not be allowed to “cap” coverage, either annually, or over the course of a customer’s lifetime; adult children would be able to remain on their parents’ insurance plan through age 26, or that Medicare would pay doctors for the time that it takes to explain the continuum of end-of-life services available to critically ill patients, including palliative care and hospice care?

What all of this adds up to is security. No family would ever again go bankrupt because a child suffering from cancer had blown through their insurance plan’s life-time cap on reimbursements. No parent would have to worry that her twenty-something might be in a car accident—and then find himself in a situation where he received subpar care– because he didn’t have insurance. No one would have to fear watching a loved one die in screaming pain because the doctor never explained that “palliative care” was available. (Palliative care specialists aretrained to control pain–this is not easy.. They also counsel critically ill patients, explaining treatment options.)

“Either We’ll Have to Tax Health Care Insurance, Or Ration Care”—Not True

Last week, I attended a conference where Dr. Donald Berwick, founder of the Institute for Health Care Improvement,  noted that: “Both politicians and the media have been stressing that health care reform is going to be very difficult. Either we are going to have to ration care” denying care to 80-year-olds “or we are going to have to tax employer-based insuracne.”

“This just isn’t true,” Berwick told an audience who understood what he was saying. They had just spent the day discussing ten U.S. communities that have succeeded in reducing health care spending and improving the quality of care—without rationing and without taxing. “There is a third way,” Berwick declared, “reforming the health care system.”

This is just what the House bill would do, funding half of the needed savings by making structural changes in our bloated system while raising the other half with a modest tax increase for Americans at the very tip-top of the income ladder. I’ve written about the structural changes here , the tax hike for the top 1 percent here.

“What’s In It for My Family?”—The NYT Finally Gives a Fair Answer

Rather than offering accessible analysis of the text of the House bill, too many newspaper articles reverted to spreading fears in unsettling “What’s In It For Me?” stories like this one. This piece ends: “In recent weeks, polls have shown that a solid majority of Americans support the stated goals of health reform government-run insurance plan. Most want the uninsured to be covered and want the option of a government-run insurance plan. Yet the polls also show that people are worried about the package emerging from Congress.

“Maybe they have a point,”  the writer added.

To its credit, on Sunday the New York Times finally ran an editorial headlined “Healthcare Reform and You”  that tackled the question: “How does my family stand to benefit from health insurance reform?” and then answered it, showing how reform will  help virtually every American family, even if you already have good group coverage.

The editorial does an excellent job of addressing fears that reform means we will all wind up paying more: “If President Obama and House Democratic leaders have their wa, the entire tax burden would be dropped on families earning more than $250,000 or $350,000 or $1 million a year, depending on who’s talking.”

More importantly, the Times observes: Many Americans reflexively reject the idea of any new taxes — especially to pay for others’ health insurance. They should remember that if this reform effort fails, there is little hope of reining in the relentless rise of health care costs. That means their own premiums and out-of-pocket medical expenses will continue to soar faster than their wages. And they will end up paying higher taxes anyway, to cover a swelling federal deficit driven by escalating Medicare and Medicaid costs.”

The editorial disposes of conservative fear-mongering about reform “rationing” care: “Critics have raised the specter that health care will be ‘rationed’ to save money. The truth is that health care is already rationed. No insurance, public or private, covers everything at any cost. That will not change any time soon.”

What will be different uned heath-care reform,  is that care would be rationed, not by for-profit insurance companies, but by physicians and other health experts looking at medical evidence to determine which treatments work best for particular patients. The “bills call for research and pilot programs to find ways to both control costs and improve patients’ care,” the Times explains.

“The bills would alter payment incentives in Medicare to reduce needless readmissions to hospitals, the Times'  editorial continues. "They would promote comparative effectiveness research to determine which treatments are best but would not force doctors to use them."

The editors do acknowledge that not everyone will be happy. “Healthy young people who might prefer not to buy insurance at all will probably be forced to by a federal mandate.” But, “That is all to the good,” the Times argues. “When such people get into a bad accident or contract a serious illness, they often can’t pay the cost of their care, and the rest of us bear their burden.Moreover, conscripting healthy people into the insured pool would help reduce the premiums for sicker people.”

 I would add that, under the House bill, insurers are allowed to charge older customers twice as much as they charge younger enrollees for the same plan–which means that, in effect, younger Americans will receive a 50 percent discount on their premiums.

The editorial dispels fears that seniors will be the losers, pointing out that Medicare beneficiaries will receive discounts on brand name drugs. The House plan also phases out the “doughnut hole” which forces seniors to begin paying the full cost of their drugs out of pocket once their insurer has paid out a certian amout..

The piece concludes: “The AARP, the main lobby for older Americans, has praised the emerging bills and thrown its weight behind the cause. All of this suggests to us that the great majority of Americans — those with insurance and those without — would benefit from health care reform.”

(Kudos also to the Washington Post which ran an article yesterday that included some helpful bullet points explaining provisions in the House plan.)  I wish we had seen more pieces like this when the plan was first released.

The Press Waffles

Yet, after publishing an encouraging editorial on Sunday, yesterday the Times reverted to stirring up fears in a news story headlined: “Democrats Push Health Care Plan While Issuing Assurances on Medicare.”

The article itself is far from reassuring. It states: “Democrats in Congress plan to finance about half the cost of the legislation by squeezing savings from Medicare. The White House says benefits will not be cut and beneficiaries will not be hurt.”

That’s it—no explanation that Democrats would squeeze savings from Medicare by trying to eliminate ineffective care that provides no benefit for the patient in question. As a result, the White House assurance that “beneficiaries will not be hurt” sounds hollow.

Then the Times repeats the conservative lie that healthcare reform will promote “euthanasia for the elderly”: “A provision of the House bill would provide Medicare coverage for the work of doctors who advise patients on life-sustaining treatment and “end-of-life services,” including hospice care. “Conservative groups have seized on this provision as evidence that the bill could encourage the rationing of health care. The Family Research Council, for example, said the bill would ‘limit end-of-life care.’ The House Republican leader, Representative John A. Boehner of Ohio, said, ‘This provision may start us down a treacherous path toward government-encouraged euthanasia.’”

Again, that’s it. No rebuttal. The article just moves on to another topic, without explaining that the House bill would pay doctors to explain palliative care to patients, making it clear that that palliative care is all about giving patients options– by providing full infromatinon about the the benefits and side effects of various treatments. With that knoweldge, patients (or families) can play a role in deciding which treatments to pursue. Palliative care is not about abandoning hope. Patients continue to receive potentially life-prolonging treatments as long as they want them.  Why didnn't the Times spell that out? It just takes two senteneces.

It’s one thing to tell both sides of the story, another to repeat canards without deconstructing them. I  fact, even if a reporter tries to expose the lie, unless his argument is quite powerful, a phrase like “government-encouraged euthanasia” may well linger in the reader’s mind.

The Times' story  ends by explaining that President Obama wants to “eliminate billions in unwarranted subsidies to insurance companies in the Medicare Advantage program” and then gives Robert E. Zirkelbach the final word. He is , spokesman for America’s Health Insurance Plans, a trade group for insurers. The Times tells us: "Zirkelbach says “that if Congress made those cuts, ‘beneficiaries would face higher premiums and reductions in benefits, and in some parts of the country, they might lose access to their Medicare Advantage plans.’ When Congress cut Medicare payments in the past, he said, insurers withdrew from some counties.”

Meanwhile the  Washington Post, like the Times, continues to see-saw on reform, explaining it one day, slamming it the next day.  Tuesday it published an Op-ed by CBO director Douglas Elmendorf’s mentor, Martin Feldstein. (I have written about Elmensdorf and his Feldstein here.  Fedlstein’s piece is jam-packed with misinformation—and just plain silliness.  Referring to the Dartmouth Research, Feldstein offers no argument, but simply writes: “I just don’t believe it.”

Oh, okay, I guess that settles that.

Clearly, an economist with no particular expertise in healthcare is in a better position to judge more than two decades of research done by physicians at Dartmouth than the thousands of physicians and medical researchers who have endorsed Dartmouths's  findings. In the early 1990s, many in the medical community were still trying to poke holes in the Dartmouth research. That was nearly 20 years ago. Now, both the cognoscenti of medicine, and the mainstream press have reached a conclusion:  Dr. Jack Wennberg and the Dartmouth team were right.

The only question that remains: what do we do about the waste in our system?

Many would argue that papers like the Washington Post should publish OP-eds by writers representing a wide spectrum of political views. I completely agree. But that doesn’t mean that a newspaper should publish Op-eds by people who know nothing about the subject that they are writing about.

 Princeton economist Paul Krugman likes Feldstein personally. In the past he has praised him. But this Op-ed was too much, and earlier this week, Krugman’s criticism was scathing:

“Pundits don’t have to be right about everything . . . They do, however, owe it to the public to make enough effort to get basic facts right  . . . One possibility is that Feldstein really is that ignorant of the health-care basics; if so, he has no business writing an op-ed on the subject, just as he had no business writing an op-ed on climate change policy (Yes, I write about subjects on which I’m not an expert — but I do my homework first.)

“The alternative possibility is that Feldstein knew that he was saying something false, but did it anyway in the hope of scaring his readers.

Krugamn concluded: “I don’t know which is worse.” 

The Media Turns on the President Himself

What is perhaps most troubling is that the negative spin is not confined to coverage of health care reform. At times, is seems that the mainstream media is turning on President Obama himself, in a free-floating critique that isn’t directly connected to the issues.

Here’s one small but telling example: In a story about the recent press conference where the President argued for health care reform, the New York Times wrote: “he sounded cerebral as he delved into policy specifics for nearly an hour and tried to link them to the concerns of ordinary Americans."

Yes, now, at long last, we have a “thinking president.” Health Care reform is a very complicated topic. The President was using his intelligence to describe reform—and the alternative—as clearly as possible. Yet the Times’ writer must know that in our society, “cerebral” is, without question, a pejorative term.

The.Dictionary.com definition of the word is telling: “betraying or characterized by the use of the intellect rather than intuition or instinct: His is a cerebral music that leaves many people cold.” The American Heritage dictionary definition is even more damning:” to or requiring the use of the intellect; intellectual rather than emotional: "His approach is cerebral, analytical, cautious" Appealing to or requiring the use of the intellect; intellectual rather than emotional.”

The knock on Obama is that “he’s too intelligent”? Would we rather have a leader who appealed to our instincts and emotions? Didn’t we just see that movie? And this criticism of Obama is coming from the New York Times, supposedly the nation’s paper of record, a thinking-man’s newspaper.

Still some observers suggest that the president needs to reach out to people where they live—in their hearts, not in their heads. But today, the Washington Post criticized the President for trying to follow that advice. First, the Post quoted Obama pollster Joel Benenson saying: "I believe the more we know about underlying values and attitudes, and those deeply held attitudes that shape what people think, what they bring to the table, the more we can fine-tune a message. The more you understand what they are bringing to the table, the better you can connect with them." 

"That's one of the things we are very conscious of," he aded, " really kind of using language that reflects the language that people actually use."

Then Washington Post staff writer Michael Shear felt a need to editorialize: “That admission opens Obama up to the charge of pandering, of telling people what they want to hear rather than what they need to hear.” Shear then turned to “Gail Gitcho, the press secretary for the Republican National Committee” to finish the job, repring hat Gitcho “says the reliance on polling proves that Obama ‘is running a PR machine’ out of the Oval Office.” The headline on the story: “Poll Results Drive Rhetoric of Obama's Health-Care Message.”

Finally, of course, the re isthe press response to Gates-Gate. The president was surprised by the  reaction , and I was too.

 I wasn't 'shocked that the press blamed Havard professor Henry Louis Gates. The media doesn't  see distinguished schoarls as celebbirites. . But I was caught off guard by the way reporters blamed President Obama for what he said at his press confrence, suggesting that the police made a misake, by arresitng Gates in his own home, after they had determiend they he hadn't broken in and wasn't a burglar. Gates  was arrrested for being disrespectful to a police officer.

 Consider what Washington Post columnist Chris Cillizza had to say: “the media swirl that has developed in the wake of Obama's comments last night reveals just how critical message discipline is when you sit in the White House. “The Administration wanted today's message to be about the urgent need for health care reform — but instead saw much of the coverage focused on whether Obama stepped too far out on a limb in his defense of Gates.

"Again, the long-term impact of the Gates story is minimal,” Cillizza added. “But, for every minute of press coverage it draws is a minute not being spent pushing the idea of the necessity of health care reform.”

Whoa . . . Anyone who has watched President Obama over the past fifteen  months realizes that he does not need to be lectured about the need for “discipline.” This is not a man who lacks impulse control. Moreover, Cillizza, like many in the press, seems to be blaming Obama for the fact that the media was “distracted” from healthcare reform. The truth is that the president could only watch, as the media itself leaped on a story with racial overtones and ran with it.

Tuesday night, I happened to catch Cillizza on television, keeping the narrative going as he once again declared the president “wrong.”

When I think of the amount of ink that has been spent on Gates-Gate. . . Certainly the fact that African Americans are “profiled” is worth comment –as is the question of how a policeman should respond if a citizen who has not committed a crime shouts at him. (I tend to think the motto: “Sticks and Stones Will Break My Bones, But Names Will Never Hurt Me” should be posted in all police academies. But this is only  a mother’s personal opinion.)

In any case,what is certain is that the  the Gates-Gate story has gone on for far too long. In the meantime, as the Times noted today, most Americans seem to have forgotten that out-of-control health care spending represents “a serious threat to American economy.”

Perhaps the media  might begin using some of those Gates-Gates space and minutes to remind us of what will happen if Congress does not  pass legislation that calls for deep, structural health-care refrom.

We need editorials and news stories that drive the point home: if health care spending continues to climb by 8 percent a year, not only does that guarantee that your health care costs will double in nine years, it also means that the deficit spiralls and other nations become increasingly skeptical about the dollar. The cost of imports will climb, and at some point oil-producers will no longer price oil in dollars. If that happens energy costs will skyrocket, and you can  expect a decline in the U.S. standard of living. As for healthcare—without reform, in ten years only the wealthiest 5 percent of the nation will be able to afford decent care. The rest of us will be lucky if we have Medicaid.

If this sounds apocalyptic, ask yourself this: Two year ago did you think that we were heading toward the deepest recession/depression that this nation has seen in eighty years?

Tags: health care costs, health care ethical issues, pros and cons of universal health care, obama’s health care plan, health care administration, rates for non medical home health care, united health care dental, canadian health care, franciscan health care, health care software

The road to health care reform is peppered with landmines that threaten to derail passage of truly comprehensive legislation. Some of these landmines are predictable: cost projections that go beyond $1.6 billion; controversy over new taxes and a public plan; worries about rationing and a government-takeover of health insurance.

There are other, less obvious, issues that conservatives can use to ignite controversy. Abortion, which I’ve written about here, is one divisive issue that could delay progressive reform. Another potential deal-breaker is health coverage for immigrants—an issue that has simmered just below the surface for a while now. A recent move by legislators in Massachusetts to drop some immigrants from that state’s health care roll could be a harbinger of what’s to come in federal health reform efforts.

A New “Lesson” From Massachusetts

Here’s the background: Earlier this month, the Massachusetts legislature decided to drop state-subsidized health coverage for 30,000 legal immigrants—those who have green cards but have been residents for less than five years. Dropping the immigrants—non-disabled adults who are 18 to 65 years old—is expected to save the state $130 million next year. 

Some commentators both inside and outside the state tried to portray the immigrants as illegal aliens who were “freeloading” off the state for health benefits. In fact, they are documented, permanent residents who are able to work and live in our country legally. Like American citizens, they pay taxes and can join the military to fight our wars—many go on to become citizens.

In justifying the legislature’s decision to cut coverage for this group, State Treasurer Tim Cahill told the State House News Service (a subscription service) that immigrants may be receiving the message, “Come to Massachusetts and we’ll cover you.” Cahill went on to say, "That's not really protecting our own citizens who have grown up here and spent their lives here and want to either raise a family or keep their family here, like I'm trying to do."

Governor Deval Patrick, facing a budget crisis tied to a $3.2 billion drop in state revenue, but wanting to keep his commitment to universal coverage, proposed restoring $70 million to the $28 billion state budget to cover some of these immigrants. The latest news is that Massachusetts legislators decided to restore about $40 million in funding, but it’s not clear what benefits this will pay for.

State legislators are not willing to budge any more and the public seems to agree. In an editorial in the Boston Globe entitled “Who Comes First in the State,” columnist Joan Vennochi sees cutting coverage for immigrants as a necessary evil:

“The $70 million Patrick wants to restore is a tiny piece of a $28 billion state budget. But if I were being asked to do it, I would first consider the big picture. The Massachusetts healthcare reform law was passed in 2006 without a dedicated revenue stream to support its costs and with the expectation that serious cost containment measures would be implemented.

“Until then, there isn’t enough money to pay for the universal coverage promised by the law. Until then – as cold as it sounds – the most vulnerable Massachusetts citizens should come first.”

Much has been written about the fundamental problems Massachusetts faces in financing its grand scheme to achieve universal health coverage. Trudy Lieberman’s series, “Health Reform Lessons from Massachusetts” for the Columbia Journalism Review is a great resource for learning more about the topic. But besides the lack of cost-control and the lack of a steady source for financing universal coverage, a new lesson from the Massachusetts experience is that, when it comes to health care, apparently immigrants are expendable.

Naturalized Citizens, Legal and Illegal Immigrants Contribute to the Economy

Before we can talk about immigrants and health care reform we need to specify which kind of immigrants we’re talking about. According to the Census Bureau, in 2006 there were 37.5 million immigrants living in the U.S., some 12.5% of the population. About 40% of those who were foreign-born are naturalized citizens (i.e. they fulfilled the necessary requirements for U.S. citizenship). Then there are the illegal immigrants.  Although it’s hard to know for sure, the government estimates that about 11.5 million immigrants are living here illegally. The rest (my math gives me about 13 million) are legal immigrants who have been in the country for varying amounts of time—but work and pay taxes.

Whatever their legal status, our country’s economy depends on immigrants of all types. They comprise some 15.6% of the workforce, many of them employed in lower-paying jobs in the service, agricultural and construction industries. Contrary to charges made by foes of immigration, these newer arrivals contribute more than they take from our economy.

The Massachusetts Immigrant and Refugees Advocacy Coalition, (which opposes the coverage cuts for legal immigrants in Commonwealth Care) points to the recent report “Massachusetts Immigrants by the Numbers: Demographic Characteristics and Economic Footprint,” to highlight valuable contributions immigrants make to the state’s economy:

“The report shows conclusively that the state’s immigrant population ‘countervails the net out‐migration from Massachusetts to other states’ and offsets the aging of our native‐born workforce. Indeed, immigrants represent a larger percentage of the workforce (17 percent) than they do of the general state population (14 percent). The report also shows that ‘immigrants pay into the state income tax system at a higher rate than their percentage of the population.’”

Although they clearly contribute to our economy, immigrants are more likely to be uninsured than any other segment of the population. Approximately 47% of non-citizens lack health insurance, compared to 15% of U.S. citizens. While undocumented immigrants are the least likely to be insured because they do not receive coverage through their employers and do not qualify for any public programs,  legal permanent residents—those we’ve admitted into the country on a permanent basis who work, pay taxes, serve in the military, become U.S. citizens—are also ineligible for federal programs (like Medicaid) for at least 5 years.

Immigrants Are Not a Drag On Our Health Care System

Immigrants are often portrayed as being a huge drain on our health care system. Conservatives write about emergency rooms overflowing with undocumented aliens, clamoring for free care that hospitals must provide under EMTALA laws. They spin scary stories about “medical tourists,” sick immigrants who come to America specifically to get treatment once they are admitted through the ER.

It is true that certain hospitals in border states like Texas and Florida provide uncompensated care to many immigrants, and the federal government never fully pays them for that care. A court decision in Florida handed down earlier this week illustrates the problem, while pointing to the public’s increasingly hard stance on immigrants. A jury decided that a hospital in Stuart, Florida did not act unreasonably when it chartered a plane and sent a severely brain-injured patient who was an illegal immigrant back to Guatemala without the consent of his legal guardian.

The saga began when the man was hit by a drunk driver and brought to the emergency room in dire shape. Months later, after he was stabilized, the hospital tried to transfer him to a nursing home, but because he didn’t qualify for Medicaid, none would take him. The Guatemalan man ended up “boarding” in the hospital for several years at a cost of more than $1 million. By comparison, the $30,000 the hospital spent to send him back to live in a village with his ailing mother was chump change.

But despite these anecdotes from over-stretched hospitals, and rants from legislators who call for sealing the borders to new arrivals, immigrants are actually not exacting a heavy toll on our health care system.
In a study published in July’s American Journal of Public Health,  Leighton Ku, director of the Center for Health Policy Research at George Washington University’s School of Public Health, found that recent immigrants (those who have been in the U.S. for fewer than 10 years) were responsible for only about 1% of public medical expenditures even thought they constituted 5% of the population.

This is not surprising because, as noted before, undocumented and legal immigrants who have been in the U.S. for fewer than 5 years are not eligible for Medicaid (except for emergency coverage or in a few states that mostly provide coverage for pregnant women and children.)

More surprising is that Ku found that recent immigrants who were fully insured over a 12-month period had medical costs that were half the size of their U.S. born counterparts. Established immigrants had medical costs that were two-thirds the size of U.S.-born citizens. Lu and others have found that immigrants are less likely to have chronic health problems like diabetes, heart disease, hypertension or arthritis and are much less likely to report being in fair or poor health.Finally, as well as seeing doctors far less frequently, recent immigrants have lower rates of hospital admissions and emergency medical visits than native-born Americans.

These figures point to the fact that 1) immigrants are generally healthier than their U.S.-born counterparts, 2) they use fewer medical services and emergency visits and, therefore 3) those that are able to purchase private insurance, end up subsidizing the care of U.S.-born citizens.

In their report, “Health Care: Sharing the Costs, Sharing the Benefits,”  the folks from the Immigration Policy Center try to correct some of the major misconceptions Americans have about immigrants and their perceived drag on our overburdened health care system:

“The majority of the growth in the number of uninsured individuals between 2000 and 2006 consisted of U.S. citizens. Citizens made up approximately 80% of the increase, while noncitizens accounted for approximately 20%.”

“Millions of immigrants want the opportunity to purchase affordable health insurance so they can stay healthy, work, and care for their families. Allowing millions of immigrants to purchase affordable health care will result in the payment of billions of dollars in insurance premiums, helping to pay the cost of health reform in America.”

Will Health Care Reform Include Recent Legal Immigrants?

So far, Congress has managed to avoid a confrontation over immigrants and health care reform by maintaining that they comprise two entirely separate, and arguably—equally difficult—issues for legislators. In fact when asked about it directly, Senate Finance Committee Chair Max Baucus answered;

"[W]e're not going to cover undocumented workers. That's too politically explosive.”

President Obama also does not support providing government health coverage for illegal immigrants; except, he told CBS’ Katie Couric, in the case of children who should be offered vaccinations and basic care to prevent the spread of infectious disease.

But Obama did say that he wanted legal residents to be eligible for coverage under a new health care plan. So far, he hasn’t defined which ones will be eligible.  Will reform include the recent legal residents who, until now, have been denied federal programs until they’ve been here for more than five years?

How do Americans feel about providing immigrants with health coverage? A poll conducted in June by pollster Rasmussen Reports, found that 80% of voters oppose providing government health care coverage for illegal immigrants; only 11% support it as part of health care reform. The poll—like others–failed to ask the question about recent legal immigrants.

In the end, it looks like Congress will continue to avoid the issue of what to do about illegal immigrants and health care. And judging by public opinion, dodging the issue may not be a bad idea right now. The best legislators can do is follow the example of the SCHIP program and allow immigrants to sign up for benefits with just a social security number, without asking for other proof of citizenship.

Excluding Legal Immigrants Puts a Strain on Safety-Net Hospitals

But providing coverage for all legal immigrants is important. By dropping 30,000 legal immigrants from Commonwealth Care, Massachusetts will only shift the cost back to the “safety net” that is currently in place to deal with the small percentage of residents who remain uninsured. These include community health centers and hospitals that are mandated to offer care without concern about payment. Abby Goodnough, writing in the New York Times lays it out this way:

“If the full $130 million cut survives, hospitals that provide free care to the poor will need to spend an additional $87 million this year treating immigrants who lose their coverage, according to the Massachusetts Hospital Association. That would come on top of a $40 million cut in the state’s Health Safety Net, which reimburses such hospitals, said Tim Gens, the association’s executive vice president.”

On a national scale, the problem only grows larger.  The best solution would be for the federal government to reinstate legal immigrants’ eligibility for Medicaid and SCHIP—increasing the number of low-income residents who have health insurance coverage and reducing the strain on safety net services. Meanwhile, if immigrants are allowed the opportunity to purchase insurance through a new health plan, these healthier individuals will end up subsidizing care for the native-born population—further disproving the myth that immigrants represent a drain on our health care system.

Tags: humana health care, universal health care, aarp health care options, health care accounts receivables outsourcing, health care cash plans, home health care, hispanic health care marketing, pros and cons of universal health care, health care promotion, oklahoma health care authority

Yesterday’s national polls, conducted by New York Times/CBS News and WSJ/NBC News, and reported today by their sponsors, The New York Times, “New Polls Finds Growing Unease on Health Plan” and the Wall Street Journal, “Support Slips for Health Plan,” indicate the more President Obama talks up and defends his plan, the more skeptical the public becomes.

This slippage brings to mind two things.

One, the story of the mother who who sent her son out on a stormy day and gave this advice,”Big wind, take small steps.”

Two, one of the main underlying themes of my book Obama, Doctors, and Health Reform (IUniverse, 2009). In the book, I predict incremental reform is likely and big reform will not happen.

Here are passages in the book on the likelihood of incremental versus massive reform.

Page 5

Although President Obama strikes a determined, even combative tone, I place odds for sweeping reform at 30/70 in his first term, but as near slam dunks for immediate incremental changes such as coverage for children, stem cell financing, funding for electronic records, setting in motion a Comparative Effectiveness Institute, and extended Medicaid unemployment benefits.

Page 10

Under President Obama, health reform is coming – fast, ready or not. But in my opinion, reforms will be incremental, but we’ll not see the whole enchilada – universal coverage.

Page 144

What are the ultimate answers to the primary care shortfall? If I knew that, I would be a candidate for a combined Nobel Prize in Medicine and Economics. Here are a few evolving development that may offer incremental solutions.

• Federal, state, and health plan support of medical homes with adequate payments for creating these homes and lowering of bureaucratic barriers for physicians wishing to create medical homes.

•Page 160

I would not bet against significant incremental health reform. What might prevent Obama-style helath reform are the economy, the soaring federal budget deficit, the Department of Health and Human Services current $708 billion budget, and 25% of federal spending going to Medicare and Medicaid. But Obama is not one to let billions, even trillions of dollars in deficitsstand in his way. He will persist, and he will let the government printing presses roll.

Page 221 -

Physicians on the ground prefer incremental changes through expanding coverage through tax incentives and market-driven changes rather than through a single-payer system.

Page 269

Self: Is there any way to fix the system?

Alter Ego: Sure, but it’s going to incremental, it’s going to be painful, it’s going to be by trial and error, it’s going to be by testing and rejecting entrepreneurial innovations, and it’s going to be through an uneasy symbiosis between government and business, with business leading the way in many instances, because its survival is at stake in the global economy and because business can move quickly and decisively. The prospect of bankruptcy in the morning concentrates one’s attention.

To sum up, big wind, take small steps.

Tags: health care reform, french health care system, long term health care, health care reform in the 1990’s, canada health care, maricopa county special health care district, outline of american health care system, france has long wait times for health care, canadian health care, coventry health care