We've mentioned soaring U.S. health costs many times before, but a recent Commonwealth Fund report puts into perspective '"what we pay for" versus "what we get" from our health system. In comparison to other industrialized nations, according to The Washington Post, the U.S. is one of the top spenders on health care -- $2.4 trillion annually -- but we rank near the bottom in preventable deaths.
The report, Reducing Preventable Deaths Through Improved Health System Performance, found the US had the highest rate of preventable deaths, with 110 out of 100,000 dying in 2002-2003. For example, controlling for age and whether death is preventable from certain conditions, the study found women under the age 75 died from health care-amenable causes at a rate of 96.41 per 100,000 in the U.S., versus 68.15 in Canada and 57.40 in France. Though all countries made progress in lowering rates of preventable deaths between 1997 to 1998 and 2002 to 2003, the United States made the least progress, dropping from 15th overall in preventable mortality to 19th, said a similar study in Health Affairs.
The Hastings Center recently published a series of articles on American values and health reform, including one on stewardship by New America's Len Nichols. Hastings has now created a related web site and blog, The Values and Health Reform Connection to expand the conversation. They invited me to write one of the inaugural essays, "Honest Debate - and Pragmatic Solutions." I wrote about values and politics (not as synonyms) and honesty and quality. (I think working moms by nature and necessity tend to find themselves pondering the practical side of things more than the ethereal and philosophical) I'm cross posting below. Other early contributors include Maggie Maher, "Dr. Val" Jones and William Sage. Hastings also invites your comments and contributions, as do we.
Liberty. Justice, Responsibility, Solidarity.
These are some of the American Values highlighted in the Hastings Center's report on "Connecting American Values with Health Reform."
Watching health reform unfold here in Washington, however, that "Connection" is painfully elusive. The debate is not a careful calibration of competing rights, values and obligations. It's a political moshpit. Instead of values, we have vitriol.
We've written often about misaligned incentives in the US health care system -- we pay for quantity of care instead of paying for quality. We've seen high-performing health systems across the nation work to reverse this trend -- and succeed in bringing down costs and improving quality. It is possible for the U.S. health care system to become a value-based purchaser, to move toward pay for performance (healthier patients getting the right treatment at the right time) rather than fee for service (paying for more and more tests and procedures, regardless of whether or not they help the patient). So we're glad to see states taking steps toward pay for performance by including it in their Medicaid contracts.
Security was tight as NPR's David Kestenbaum entered the inner sanctum. Six staffers hovered around him.
It wasn't the CIA. Or a secret air base. Or Fort Knox. Not even the Playboy mansion. It was the closely-guarded Medicare databank in Baltimore.
The databank is enormous, petabytes of data (a petabyte is a 1 with 15 zeros after it, Kestenbaum explains). The rows and rows of shelves, a half-million cassettes of computer data, so vast that a robot is required to navigate it. The library holds medical records of decades of Medicare patients. And their doctors. It could potentially tell us much about quality and performance and efficiency of just about every physician in the United States.
Except it's a secret. Some researchers and consumer advocacy groups have fought to open it up (not the patient records, but the doctor data). And doctors have fought to keep it closed.
Arnold Milstein, a physician and researcher who has advised the White House on health care economics, wants it open. Doctors don't even know how they stack up against their peers, against standards. The database could tell them.
A growing number of Americans rely on federally qualified health centers for care, reports The Wall Street Journal. Last year, community health centers, as well as migrant and homeless health centers, served approximately 18 million people. That number is expected to hit 20 million this year, according to the WSJ and the National Association of Community Health Centers.
This post appears on the National Journal's Health Care Experts Blog where you can also see what other health policy analysts have to say about ways to promote wellness through health reform.
This is another example for which both God and the Devil are in the details. No one disputes that some behavioral choices -- smoking, diet, regular exercise, age and condition-appropriate screenings -- affect health status, expected health costs, and therefore, our collective average premiums. It seems perfectly reasonable, especially to economists and to those who make good choices already, to use incentives to encourage socially responsible choices and to discourage those that impose costs on others. At the same time, smoking is addictive and extremely hard to quit for some people who really want to, obesity can be caused or exacerbated by genetics and often comes with co-morbidities like depression that make financial incentives ineffective, and some people can only afford to live in neighborhoods with no stores that sell fresh fruits and vegetables and with little safe walking space. So how to reward good behavior without punishing the unlucky?
We talk a lot about how health reform will place a bigger emphasis on preventative care, managing chronic conditions and paying providers based on the quality of care. So much of this means providing necessary medical screenings and diagnostic tests to improve the quality of care. But who will be charged with the task of screening us for cancer? Who will run the CBC (complete blood count) to help a doctor diagnose fatigue or an infection?
Labs. Pathologists. The people in the white coats that shake the test tubes, look under microscopes and mysteriously see things regular people don't see. I spoke at a conference today where more than 1,000 of them were learning about a different mystery -- health reform.
The association that represents clinical labs in Washington (American Clinical Laboratory Association) is fond of saying that lab tests represent only 1.7 percent of Medicare spending but are essential to 70 percent of all clinical decisions. I have no idea if that is an accurate representation, but it is striking what a big player labs are in our health system and yet we only just heard from them recently -- and even then you had to be paying pretty close attention.
Remember that funding for health information technology in the stimulus package? We know, it's been a little while, and when it comes to health reform, we've had a lot on our minds lately. But states haven't forgotten about health IT and the American Recovery and Reinvestment Act of 2009 boosted both their motivation and resources to get health IT programs up and running in two to six years. That states are interested in establishing electronic health information exchanges isn't exactly breaking news, but the recent progress in investment, implementation, and infrastructure is pretty exciting.
The stimulus package included the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act), which lays the groundwork for advances in health care quality. Late in August, the Obama administration announced $1.2 billion of the stimulus funds would be released in the form of health IT grants, reports American Medical News.
"It's hokum," Biden said, "It's bunch of malarkey."
No one, no panel, is going to sit down and tell your doctor or you how to make these decisions, he explained. Health reform is about "giving you more power and your doctor more power" to make the decisions that are best for you.
If the Vice-President's own mother is hearing rumors about death panels, it's no wonder seniors, as a group, are among those most skeptical of health reform.
Helping to dispel these fears and sell the benefits of reform, the Vice President spoke Wednesday at a retirement community in Montgomery County, Maryland. Assisted by Secretary of Health and Human Services Kathleen Sebelius and White House Director of Health Reform Nancy-Ann DeParle, the Vice President laid out how reforms will protect and strengthen senior's Medicare.
Many of the key points from the discussion are outlined in a new report from the White House on Health Insurance Reform and Medicare. The report tackles questions seniors may have such as:
As you know, there's been a ton of argument about whether prevention saves money -- and one of the issues has been how narrowly we define "prevention," whether we treat it as a synonym for "screening for early detection of disease" or whether it's something bigger.
Today, a report by the Trust for America's Health (TFAH) and The New York Academy of Medicine (NYAM) comes down firmly on the side of prevention (broadly defined) as a money-saver.
The report, Compendium of Proven Community-Based Prevention Programs, is a comprehensive review of studies which document community-based disease prevention from all around the world. Specifically, the report looks at programs aimed at decreasing smoking, increasing exercise, and improving healthy eating. The goal of these programs is not just to detect disease early, but to prevent it altogether.