New Health Dialogue
Everyone's talking about health reform after the elections. How do we get there?
First, health care has to figure big in the November election. If Iraq, the economy or other issues eclipse health in the mind of voters, the odds of progress are diminished. (Yes health care and economic anxiety are related, but it's too soon to know how they will be linked in voters' minds come November )
Second, we'll need presidential leadership. For health reform to stand a chance "a new president will have to make it an early and top priority and exercise real leadership," Altman writes. The temptation might be to focus on unfinished business, such as the State Children's Health Insurance Program. That would be a step (or two or three) forward, but it isn't comprehensive national reform.
Left, right and center know that more than 80 percent of small businesses owners say finding affordable health care is a challenge. But lawmakers have been stalemated for years about a solution. Four senators took a bipartisan step forward today offering a bill called SHOP - the Small Business Health Options Program.
Senators Richard Durbin (D-Il), Olympia Snowe (R-ME), Blanche Lincoln (D-AR), and Norm Coleman (R-MN) introduced the latest policy proposal designed to increase access to affordable, quality health insurance for small businesses. Just 59 percent of small businesses offered any health coverage to their workers in 2007, and fewer than half of very small businesses (9 workers or less) did.
Under the Small Business Health Options Program or SHOP:
Ten years ago we couldn't even agree on the ultimate goal for health reform. Just a day ago, at the American Medical Association's National Advocacy Conference, I heard a whole lot of agreement on where we want to be -covering all Americans, providing better care, and reducing costs. Two very interesting perspectives on how to get there came from from Senators Ron Wyden (D-OR) and Tom Coburn, M.D. (R-OK).
Wyden and Coburn are of course far apart ideologically. But as I listened to them give their separate speeches, I was struck by how similarly they viewed our health reform challenges (if not how to achieve solutions). In particular:
The terms "concierge medicine" "Palm Beach" "poverty" and "free medical care" don't necessarily go hand in hand but a group of Florida "VIP" physicians are starting an interesting initiative aimed at showing that close doctor-patient collaborations with an emphasis on wellness and good management of chronic disease can work for the poor and sick, not just the rich and healthy.
Now we aren't advocating charity as the solution to the nation's 47 million uninsured (although we sure don't object to helping people out until we get a comprehensive national solution) but we do like good management of chronic diseases before they become acute crises. The pilot program described by the South Florida Sun Sentinel and brought to our attention by Health Leaders Media is intriguing.
The newspaper reports that Project Access, a Palm Beach County Medical Society program that connects patients to free care, is teaming up with MDVIP, a concierge practice, to take care of 25 very low-income people, and they hope to expand it to cover several hundred. It's being paid for by a mix of volunteer labor and subsidies from the medical society.
Increasing financial strains are pushing Level I and II trauma centers to the point of breaking, according to a recent article on Grady Memorial Hospital— the only Level I trauma center serving Northern Georgia, which loses over $40 million a year on trauma care. The problem is simple: the trauma services rendered to the uninsured are uncompensated, and the revenue generated from treating the insured is not enough to cover the deficit. The solution is clear: we must cover all Americans to financially stabilize our trauma care services in this country.
Call us optimistic cheerleaders if you must, but our mission is to preach hope and dispel fears about the possibility of national health care reform. We took this message to hundreds of health care journalists at their recent conference—Health Journalism 2008—knowing that our friends in the media are sharp about spotting the problems but focus less on reporting the solutions.
While we are optimistic about the chances of health reform, we are not stupid—we are preparing for the battles that will inevitably come. Our preparation, however, includes facilitating a conversation among divergent interests in the health care community—and pointing out just how many things we can agree upon.
Some of the areas of agreement (as well as the battleground) were apparent in our health care reform discussion with Karen Davis, President of The Commonwealth Fund, David Himmelstein, M.D., associate professor of medicine, Harvard Medical School, and Tom Miller, resident fellow, American Enterprise Institute, on Friday, March 28. Indeed, there was common ground on several core issues:
People are not getting the health care they need in America. They aren’t getting enough of the treatments that we know work and they may be getting too much of treatments with questionable value. This problem and how to resolve it is at the heart of reforming our health care delivery system, which is why we were glad it came up at last Friday's Alliance for Health Reform briefing on the topic of "Improving Care for Chronic Conditions."
Nora Super from Kaiser Permanente zeroed in on this issue after listening to Harvard's David Cutler present his last slide: "Implications: Under-utilization of effective, cost-efficient therapies continues to be a major public health challenge." She asked Dr. Cutler if he would agree that many patients are receiving unnecessary treatments, and more robust comparative effectiveness research is needed to examine what is over-utilized and what is under-utilized.
Medical tourism is no longer just the province of the uninsured and desperate. As health care costs soar in the United States, it is also the insured and their insurers who are scouring the globe for quality at a bargain. This is further evidence that one of our main tenets is true: reforming our delivery system to increase the value of our health care dollar is just as important as covering all Americans.
Medical tourism, or as some prefer to call it "Global Health Care," could become a $150 billion market, according to Wouter Hoeberechts, CEO of WorldMed Assist, a company that assists Americans in accessing overseas care. He was among the experts who took part in a panel on the topic at the recent Association of Health Care Journalists conference just outside Washington.
Going overseas for health care makes sense, he argued, if the care is not urgent, if it doesn't require a lengthy foreign stay or prolonged follow-up care, and if it's relatively expensive, say $15,000 or more. Hoeberechts sees patient demand for orthopedic and spinal surgery, weight loss surgery, cosmetic and dental procedures, some cardiology and even transplants. Heart bypass surgery, for instance, can cost $149,000 in the U.S. (although insurers usually negotiate steep discounts) compared to $10,000 in India including airfare and lodging.
Health care, like baseball, is in many ways a game of numbers. And so, in honor of Opening Day festivities across America, we've taken the liberty of drafting our own roster of the starting nine numbers you need to know to understand what's driving health reform in the U.S.
The World Series isn't won in April, and nine numbers won't tell you everything you need to know about health reform, but the following measures will give you a sense of health policy's "inside baseball." Like a good baseball team built on the fine balance of pitching, hitting, fielding, we chose our starting nine to reflect the three interrelated issues of cost, coverage, and quality that must be addressed by any sustainable health reform plan.
Imagine if your newborn twins, already hospitalized with an infection likely acquired at another hospital, were given two potentially fatal overdoses of a blood thinner. Imagine if your pediatrician (now your former pediatrician) did not call to tell you. Imagine if the night nurse told you everything was fine when you phoned to check on the babies. Imagine if you learned the truth when you arrived at the hospital at 6 a.m. to see your kids and were met by Risk Management.
That's what happened to Dennis Quaid last winter. His babies survived. His story has been told. But Quaid hasn't forgotten the 41-hour ordeal, when his tiny children nearly bled to death, their blood "squirting on the walls." He has joined the ranks of "cause celebrities," knowing that his fame can bring national attention to medical errors that usually occur in isolation. He has set up a new foundation to address patient safety, particularly regarding medication errors.