Quality

Our colleagues Joanne Kenen and Sarah Axeen have a front-page story up at The American Prospect explaining how the the cost of doing nothing on health care is even greater now than during the time of Clinton reform effort, making the prospect of real change even more imperative. Building on recent research from the New America Foundation they write:

In 1993-94 we had "fanfare and promise." But proponents of health reform massively bungled the politics, the process and the policy. Foes of reform, expensively and expansively, exploited their errors. The upshot was that we, as a nation, rejected comprehensive health reform. We didn't understand it. We didn't like it. We certainly didn't want to pay for it. We decided that the status quo, however flawed, was better than change.

What we didn't recognize in the 1990s was that the status quo was an illusion. Imperceptibly to most of us, dramatic changes were underway in how we pay for care, how we access care, and in the quality of our care. For the most part, they were not changes for the better.

I just spent two days at the preconference part of IHI's 20^th annual quality forum and the first thing I did when I got home (aside from dealing with my son's now ex-wisdom teeth) was to get right back on the phone to the IHI conference. This post will have two parts based on that conference call with IHI CEO Don Berwick and colleagues. First, we'll tell you about what the Five Million Lives Campaign has achieved and where they go next, and then we'll fill you in on what an Obama administration means for health care quality (keep reading, in Berwick's view it's all very encouraging). In the coming days, I'll post a bit more about what I learned in Nashville.

As the song goes, we don't know much about history—unless you're talking top-20 songs from 1960 later covered by Herman's Hermits. That we got.

So this morning we checked out an event on Change in Turbulent Times over at the Center for American Progress to help put health reform in a historical perspective.

Presidential historian, Robert Dallek began the discussion by laying out the parallels between our current opportunity in health care and previous watersheds of reform. Noting the unifying effect of the economic crisis, Dallek thinks we're again in period of time that can produce the kind of monumental reforms seen during the New Deal and Civil Rights movement. Presidential leadership and early action are key, as is the ability to produce a consensus around reforms that are seen to benefit all Americans and not just specific interest groups. But, the one thing that can kill any reform, Dallek argued, was war. Citing examples from Vietnam back to the Spanish-American War, Dallek worried that escalation in Afghanistan could ruin Obama's chances of achieving major reform at home.

I am attending the pre-conference of the Institute for Healthcare Improvement's 20^th annual National Forum on Quality Improvement in Healthcare (and if my oldest son wasn't having a minor health care crisis of his own later this week—not that he really needs his wisdom teeth—I'd stay for the whole thing). It hasn't really gotten going yet but a few things to share:

This post also appears on the National Journal's Health Care Experts Blog. where you can also see what other health policy analysts have to say.

Instead of asking how much it will cost to reform our health system, we should first remember what failing to fix our health system costs our society.

As a result of the lost productivity stemming from the premature death and prolonged illness of the uninsured, we sacrifice over $200 billion of potential economic value each year. That is more than it would cost to cover the uninsured. This is not just a moral issue (though it surely is one); it is also an economic issue of the first order.

Premiums will continue to rise faster than wages if we do not act, rendering health insurance and timely, high quality health care unaffordable for more and more American families every year. In fact, recent projections by my colleagues at New America suggest that by 2016 half of American households will need to spend more than 45 percent of their income to buy health insurance for themselves and their families.

For anyone still questioning the need for health reform in this faltering economy, Jonathan Gruber, MIT professor and a health care adviser to the Obama campaign, has an excellent op-ed in today's New York Times.

Gruber carefully lays out the potenial role health reform can play in jump starting the economy.

Expanding SCHIP and Medicaid would help free up state budgets to undertake important infrastructure projects that would boost employment. Investing in health IT and primary care will not only improve quality and lower costs but will also create jobs along the way. Providing Americans stable secure health insurance will boost consumer confidence and spending since "previously uninsured families would no longer need to save every extra penny to cover a medical emergency." Gruber should know. He's done the work to prove it, finding that Medicaid raised the consumption of eligible families by $538.

On the challenge of controlling health care cost growth, Gruber argues "cost control would be easier in an environment of universal coverage," noting that the Netherlands and Switzerland have achieved universal coverage with a private health insurance system that is much more adept at controlling costs than ours.

Gruber concludes:

Sitting in traffic Sunday with the rest of those migrating Turkey Day pilgrims, we caught a story by Karen Brown on NPR's All Things Considered. It seems long lines aren’t limited to the highways of Pennsylvania, and that many of those 440,000 newly—covered by health insurance in Massachusetts are having trouble getting access to a primary care doctor.

The story should be familiar to those who have followed closely the developments of Massachusetts. We've written in the past about some of the challenges facing the state's reform efforts.Physician shortages are certainly high on the list.

Kaiser Permanente, the Mayo Clinic and Intermountain Health Care, three health systems known for their emphasis on primary care, care coordination and integrated delivery systems, have collaborated on a five-year vision for improving how we deliver health care. The paper outlines practical steps that would move us from a fragmented, inefficient, and expensive system to one based on teamwork, care coordination and sound medical evidence to guide clinical decision-making. The five-year plan is built around an expanded health information technology infrastructure and an ambitious set of pilot programs, drawing in Medicare, other public programs and private insurers, that would lead us to a system where we pay for good value, and good quality. Hallmarks would include:

Ok, so may be we don't have a non-fatal strain of the hantavirus... In today's New York Times:

If that headache plaguing you this morning led you first to a Web search and then to the conclusion that you must have a brain tumor, you may instead be suffering from cyberchondria.

On Monday, Microsoft researchers published the results of a study of health-related Web searches on popular search engines as well as a survey of the company’s employees.

The study suggests that self-diagnosis by search engine frequently leads Web searchers to conclude the worst about what ails them.

Further evidence that your Google home page is no subsitute for having a medical home to can help guide you through the complex decisions and treatment options of modern medicine.

Can we interest you in some unapproved drugs?

Medicaid is interested. So is the FDA. And Senator Chuck Grassley (R-IA). It seems that from 2004 to 2007, Medicaid spent nearly $198 million paying for prescription drugs that had not gone through FDA safety and effectiveness reviews, according to analysis of federal data by the Associated Press.

Bringing in the bigger picture, the AP notes:

At a time when families, businesses and government are struggling with health care costs and 46 million people are uninsured, payments for questionable medications amount to an unplugged leak in the system.

 The FDA estimates that unapproved drugs account for 2 percent of all prescriptions, or about 72 million scripts per year. (Informative FDA video with great sound track here) Many of these drugs provide little or no benefit to the patient. Some are potentially harmful, even deadly, contributing to the some 1.5 million Americans, killed sickened or harmed by preventable medication errors each year.