OP-ED

OP-ED

A Practicing Doctor’s Prescription for Health Care Reform

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Our national healthcare system needs a ‘step-change’, not incremental change. We are facing a vast and complex problem. Let’s use it as an opportunity; rather than blaming our nation’s health problems solely on corporations, providers, insurers, or the government, let’s also think constructively about individual behavior and incentives.

Why do we stop at a red light? Why do we pay our grocery bill when we check out? Why are we compelled to ‘service’ our car when the red indicator light starts to flash? The simple answer is that if we don’t we know we will incur a penalty. Either we have to pay to get things fixed later, or we pay extra financial fees, or we get nasty looks from our neighbors.

A behavioral sociologist would offer a more complex answer: such contracts form the heart of a civic society. We behave in accordance with laws and a sense of civic duty (we abide traffic signals) because we understand that preserving the community is ultimately self-preserving. We act in ways consistent with financial incentives, or disincentives (we service our cars) because it is immediately self-preserving.

Op-Ed: Health in All Policies

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At the heart of current health care reform discussions – which focus on expanding access to care and  establishing mechanisms to finance broader coverage as well as reduce rapidly escalating costs – must be the promotion of good health and the prevention of disease.
 

Good health is essential to the economic prosperity and wellbeing of the American people. Individually, we are less productive when we become ill; collectively, our nation is less secure when burdened with the high cost of disease. Today, with 45 percent of Americans suffering from a chronic condition and a national fiscal crisis, both our nation’s health and economic security are in peril.

Deteriorating health is a major driver of this crisis. One in five Americans smoke and 66 percent of adults are obese or overweight, fueling a chronic disease epidemic and skyrocketing health care costs. As childhood obesity rates dramatically rise, American children may, for the first time ever, live shorter lives and be less healthy than their parents.

Just as Americans are ailing, so too is our health care system. The U.S. health care system suffers from considerable fragmentation, inefficiencies and inequities. The United States spends nearly twice as much on health care, per person, as any other nation, and the health sector constitutes one sixth of our economy. Yet this significant investment delivers shockingly poor results. America ranks 49th on life expectancy worldwide, 37th on overall health status and performs the worst among industrialized countries at avoiding premature deaths through timely and effective medical care.

Op-Ed: Sustainable Healthcare Reform

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President Obama made a risky wager when he decided to let Congress take the lead on crafting health care legislation, rather than presenting his own reform package. Congress is not known for taking bold, decisive leadership on tough issues. Normally, it reacts and gridlocks; it doesn’t lead.

As Congress takes its usual August recess without acting, it appears that Obama’s strategy has failed. But, has it? Is there a deeper strategy? What’s really at stake here?

Obama reportedly reasoned that Congress will do better in the long-run if it protects its institutional prerogative as law maker and doesn’t take on the appearance of being the President’s rubber stamp. This is a plausible calculation. The last time Congress was asked to respond to a President’s health care reform proposal during the Clinton years it did so by throwing the whole package in the trash can.

Op-Ed: The Payoff from Preventative Healthcare: How disease screening saves lives and money

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To understand and effectively navigate the current healthcare debate, every U.S. CEO must now be a healthcare leader.

From the health, well being and productivity of employees and their families to the impact on a company’s bottom line, healthcare is a major business concern for everyone. Five consecutive years of double-digit health insurance premium increases have hit the business community hard.

If we don’t identify new efficiencies in the way we administer employee-based healthcare programs, the negative impact of these costs on businesses will only grow. Healthcare spending currently accounts for 18 percent of U.S. economic output. It could reach 34 percent by 2040, according to a June 2, 2009 report by the White House Council of Economic Advisers, if the current rate of cost growth continues.

Op-Ed: Reform- Why have our objectives been abandoned?

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In the campaign of 2008 and the first six months of 2009, the call for healthcare reform has been a refreshing and important theme.  It has been widely recognized that

1.    Healthcare costs are out of control.  You cannot have healthcare expenses inflating at 8% in an economy that is growing in the best of times at 4%.  (today, the current inflation rate is negative 1.3%)

2.    47 million Americans need coverage

3.    14,000 Americans lose their insurance everyday

4.    Medicare is in peril, and along with Medicaid, the combination of ever-increasing costs are the main drivers of this government’s budget deficits that threaten our economic future.

Op-Ed: The Unintended Consequences of “No Pay for Errors”

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Hospital_bedsMedicare’s policy to withhold payment for “never events” – the first effort to use the payment system to promote patient safety – remains intriguing and controversial. To date, most of the discussion has focused on the policy itself at a macro level (including two articles by yours truly, here and here).

In the past month, experts on two of the adverse events on the “no pay” list – hospital falls and catheter-associated urinary tract infections – have chimed in. Interestingly, while agreeing that the overall policy has upsides and risks, they came to strikingly different conclusions about the wisdom of including their pet peril on the list.

Let’s begin with UTIs. Last month’s Annals of Internal Medicine article by Michigan’s Sanjay Saint and colleagues begins, quite cleverly, with a quote from Ben Franklin: “By failing to prepare, you are preparing to fail.” Turns out that among Franklin’s many inventions was the flexible urinary catheter (so who the hell was Foley?). The piece nicely reviews the “no pay” policy and describes the epidemiology of catheter-associated UTI (CAUTI).

Op-Ed: Forward thinking health plans? Look for the guys with the white hats

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The public noise about health care reform has painted the parties involved in broad brush strokes that tell  consumers which in the fray are the good guys and bad guys. News reports have for so long vilified health insurers that they’re overlooking the forward thinkers who are actively seeking the white hat role and using their heft for real and positive change.

With the near-term incentives to spur adoption of EMRs and subsequent implementation of clinical decision support to make those EMRs “meaningful”, health plans have a perfect opportunity to improve their value. I already see that happening with our health plan customers who have used additional means to improve their populations’ health, such as personal health records, disease management, and other strategic initiatives.

Op-Ed: Health Care Re-invention and Personal Responsibility More Critical to Reform than Government Intervention

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Stephen Kardos

President Obama should be commended for addressing the challenge that’s facing our nation’s health care system. While Democrats and Republicans agree that the health system is broken (since 1975, per person annual health spending has grown 2.1 percent faster than overall economic growth per person¹), there is no clear agreement on the next steps that need to be taken to fix the problem.

President Obama has offered the idea of implementing a national health care plan; however, in its current iteration, his plan doesn’t address what’s broken with the system. Instead of flooding the system with 46 million more insured persons and spending $1.2 trillion over the decade, Obama should look to the hard evidence that indicates a third of all health dollars currently spent each year (more than $750 billion) are wasted. That lump sum should be brought back into the system to care for the uninsured and reduce the national deficit at the same time.

The Message Is The Medium

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GooznerEmory University psychologist and political consultant Drew Westen in the weekend Washington Post offers a troubling view of the public’s role in health care reform. While reform’s reality involves complicated technical issues like insurance exchanges, public plan governance, physician and hospital payments and who will pay higher taxes, the public’s understanding of these issues is virtually non-existent, Westen assumes.

It’s Not Just Doctors in Short Supply

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Policy-makers involved in healthcare reform are making a mistake in disproportionately emphasizing ourWartman current doctor shortage while neglecting serious shortages of care providers in other fields of health.  Rather than continuing a failed, piecemeal approach, the nation needs to establish a multi-professional, multi-disciplinary, national planning body charged with carrying out a comprehensive and coordinated national health workforce policy.  National healthcare reform cannot be realized without effective national health workforce reform.