OP-ED

OP-ED

Op-Ed: Patients first. Doctors second.

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Arun As part of the recently enacted stimulus bill the federal government is spending $19 billion to promote the adoption of electronic medical records by physicians.  Yet, with all the focus on doctors, lawmakers have forgotten the most critical piece of the puzzle — patients.

Take the case of Joe (not his real name), a patient who came to see one of us recently. Joe is a thirty-something year-old with type 1 diabetes. After a rebellious few decades that included dozens of hospitalizations, he was finally re-engaged in his care. His most recent request — to access his electronic medical record. Joe wanted to track his hemoglobin A1c, an important marker of his diabetes, follow his blood pressure and take a closer look at his cholesterol. After all, it is his information in the clinic's commercially available electronic medical record.  Sadly, his request couldn't be honored. Patient-access features simply hadn't been built in.

Health information technology offers great promise to patients. Patients can access their medical information online, communicate with doctors by email, schedule appointments through the web and take advantage of numerous tools to manage their own illnesses. They can become equal partners in their care.

Op-Ed: Seven Strategies to Address the Nation’s Health Care Crisis

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Susan_Blumenthal_SOH_Photo1 America's health crisis does not have either a single cause or a silver bullet solution. Yet previous attempts at reform have often focused too narrowly on the financing and delivery of health care. In a report released last week, a Commission of national health experts convened by the Center for the Study of the Presidency and Congress (CSPC) emphasizes a wide spectrum of actions needed to become the healthiest nation in the world. The Commission on U.S. Federal Leadership in Health and Medicine: Charting Future Directions that we co-chair has identified seven strategies to mobilize all sectors of American society to help put "health" into our nation's health care system.

The report, New Horizons for a Healthy America: Recommendations to the New Administration, adopts a comprehensive perspective in framing its seven recommended strategies for a high-performance health care system and a healthier nation. These recommendations include:



Issue a Presidential Call to Action for a "Healthy U.S." The
Administration, working with Congress, should set a bold framework for
action for improving health in the United States (Healthy U.S.),
mobilizing all sectors of society and emphasizing comprehensive health
promotion, disease prevention, and the delivery of high quality medical
care .

Establish "Health in All Policies."  Marshal the leadership and
resources of the more than 40 federal agencies that address health into
a coordinated, synergistic effort.

Op-Ed: Health care reform is within reach

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-1In recent weeks, President Obama has gotten flack for insisting that, despite the nation’s urgent economic  problems, “health care reform
cannot wait.”

On this point, though, he’s absolutely right. But that doesn’t mean we
need more government programs. What we need is a focus on chronic
disease.

Chronic diseases are among the most serious public health threats
facing the American people today. These conditions, which include
diabetes, chronic kidney disease, cardiovascular disease and cancer,
often last for years, requiring frequent treatment throughout a
person’s life. The toll they exact on American patients is appalling,
accounting for 70 percent of all deaths in the United States.

America’s exorbitant health care spending is also linked to these
destructive illnesses. In fact, 75 percent of the more than $2 trillion
spent on health care in the United States goes toward caring for those
with chronic conditions. Heart disease and strokes alone cost the
American people $448 billion in 2008.

Op-Ed: Dropping Cancer Death Rates and the Role of Radiation Therapy

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Mackie_rockRadiation therapy is the most overlooked of cancer therapies. While attention has primarily been given to  chemotherapy and immunotherapy, the truth is that for every 100 people who survive cancer, about 50 can principally thank surgery, 45 are alive because of radiation therapy and perhaps 5 survive due to all other therapies. As cancer death rates continue to decline, we must recognize and support the critical role that radiation therapy plays in this trend.

Of the $2.2 trillion spent by the U.S. economy on healthcare, less than one percent (about $800 million) is spent on radiation therapy equipment—this, despite the fact that radiation therapy serves as our safest, most convenient and cost-effective method of treating cancer.

Op-Ed: Surgeon Shortage Worries Rural Doc

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Now that I’ve reached my mid-50s, I sometimes think about retirement, and to be honest it worries me.
  I’m not talking about the typical things you worry about pre-retirement, such as the loss of income or lifestyle changes.  I worry about what will happen to my patients.

Why?  For the simple reason that it will be hard to replace me. This isn’t my ego talking: there simply aren’t nearly enough new surgeons coming along to replace me – or my other contemporaries, for that matter.

I work in Glasgow, Montana, a town of 3,500 in northeastern Montana that is about as rural as it gets.  I serve more than 20,000 patients in an area that runs 100 or more miles in every direction except north past the Canadian border. I’ve been on call essentially every hour of every day since I came to Montana over 20 years ago.

Op-Ed: No Need for Alarm Over Need for Foreign Nurses

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Recent news coverage (“Amid Nation’s Recession,
More Than 200,000 Nursing Jobs Go Unfilled,” Reuters, March 8th) validly
and vividly calls attention to a nursing shortage in the U.S. healthcare system that
“threatens the quality of patient care even as tens of thousands of
people are turned away from nursing schools, according to experts.”

That article adds, “The shortage has drawn the
attention of President Barack Obama. During a White House meeting on Thursday
to promote his promised healthcare system overhaul, Obama expressed alarm over
the notion that the United States
might have to import trained foreign nurses because so many U.S. nursing jobs are
unfilled.”

Importing internationally-trained nurses is no cause for
alarm.  The fact is, at least in the short term, the U.S.does have to
import these nurses, and plenty more of them, if we are to meet our rapidly
growing healthcare needs.  Don’t understand why?  Consider the
following:

Op-Ed: Pathway for FOBs Should Balance Need for Competition and Need for Innovation

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President Obama's first budget calls for the creation of a regulatory pathway for the creation of follow-on, or biosmiliar, biologics. This is obviously now the most high-profile call yet to move forward with a system that will provide the benefit of biotech drugs to patients who need them the most.

The biotech industry has done an outstanding effort in the last 10 years producing some of the most high-tech but also the most expensive drugs on the market. Some biotech medicines cost hundreds of thousands of dollars each year. Many of these products face no competition, because there is no legal way for a generic version of the product to get on the market. Individual patients as well as the healthcare system generally simply cannot absorb these continually rising costs.

To date, the debate over follow-on biologics has been mostly political posturing between the trade groups that represent the generic drug industry and the pioneering companies. The generic industry wants biotech companies to have only three to five years of market protection after bringing a new drug to market. The industry counters it needs up to 14 years of exclusivity to recapture its investment costs, which can reach over $1 billion for a single product.

Innovation + Economics: Keys to Successful Healthcare Reform

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Now that the economic stimulus package has been negotiated and signed, healthcare is on deck. Not just for Congressional action, but also for the biggest wave of reform the industry has ever experienced. It *could* be a very good thing – not only for patients, providers and payers, but also for innovators and investors who contribute to the “new healthcare economy” that will emerge.

Everyone knows “change” will have to find its way into the hospitals, clinics, labs, doctor’s offices and insurance providers that make up our current healthcare “system” in America. The rate of healthcare inflation – which is currently twice the core inflation rate – can clearly no longer be supported, and changes are required to address the explosion in America’s aging population over the next two decades. Experts estimate that roughly one third of all medical care delivered in the United States is wasted or in error, suggesting there is ample room for improvement.

In spite of the bleak near-term indicators, we predict that the United States is poised to establish a new healthcare economy. Starting in 2009, we expect to see a ten-year transformational cycle that will re-define many dynamics of the American healthcare system. The new healthcare economy will depend on innovation to simultaneously drive down costs and improve quality of care – core criteria cited by President Obama in his inaugural address. It will also require better alignment of economic incentives across payers, providers and patients.

Op-Ed: Why the Senate should be abolished, Parts 34-36

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Irrelevant small states with no people in them that exist by an accident of history are chronically over-represented in this country — both in the electoral college and most obviously in the Senate. And those states are much more conservative than metro areas where people actually live, which means that even if they send Democrats to DC, they’re not exactly raging Trotskyites.

Hence we get Max Baucus, representing less than 1 million people, or one-sixth of an average state’s population, pushing moderate reform and saying that single-payer is a political non-starter. He’s right, but it’s only because of the political structure that guarantees him his power. If San Francisco, which has roughly the same population as Montana, sent a Senator to Congress I think the result would be somewhat different.

Saving Health Care, Saving America

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So far, Congress’ response to the health care crisis has been alarmingly disappointing in three ways. First, by willingly accepting enormous sums from health care special interests, our representatives have obligated themselves to their benefactors’ interests rather than to those of the American people. More than 3,330 health care lobbyists – six for every member of Congress – contributed more than one-quarter of a billion dollars in the first and second quarters of 2009. A nearly equal amount has been contributed on this issue from non-health care organizations. This exchange of money prompted a Public Citizen lobbyist to comment, “A person can reach no other conclusion than this is a quid pro quo [this for that] activity.”

Second, by carefully avoiding reforms of the practices that drive health care’s enormous cost growth, Congress pretends to make meaningful change where little is contemplated. For example, current proposals would not rebuild our failing primary care capabilities, which other developed nations depend upon to maintain healthy people at half the cost of our specialist-dominated approach. They fail to advance the easy availability and understandability of information about care quality and costs, so purchasers still cannot identify which professionals and organizations are high or low performers, essential to allowing health care to finally work as a market. They do little to simplify the onerous burden associated with the administration of billing and collections. The proposals continue to favor fee-for-service reimbursement, which rewards the delivery of more products and services, independent of their appropriateness, rather than rewarding results. Policy makers overlook the importance of bipartisan proposals like the Wyden-Bennett Healthy Americans Act that uses the tax system to incentivize consumers to make wiser insurance purchases. And they all but ignore our unpredictable medical malpractice system, which nearly all doctors and hospital executives tell us unjustly encourages them to practice defensively.

Most distressing, the processes affecting health care reflect all policy-making. By allowing special interests to shape critically important policies, Congress no longer is able to address any of our most important national problems in the common interest – e.g., energy, the environment, education, poverty, productivity.

Over the last four years, a growing percentage of individual and corporate purchasers has become unable to afford coverage, and enrollment in commercial health plans has eroded substantially. Fewer enrollees mean fewer premium dollars available to buy health care products and services. With diminished revenues, the industry is unilaterally advocating for universal coverage. This would provide robust new revenues. But they are opposing changes to the medical profiteering practices that result in excessive costs, and which often are the foundation of their current business models. And these two elements form the troublesome core of the current proposals.

Each proposal so far contemplates additional cost. But we shouldn’t have to spend more to fix health care. Within the industry’s professional community, most experts agree that as much as one-third of all health care spending is wasted, meaning that a portion of at least $800 billion a year could be recovered. There is no mystery about where the most blatant waste is throughout the system, or how to restructure health care business practices to significantly reduce that waste.

Make no mistake. A failure to immediately address the deep drivers of the crisis will force the nation to pay a high price and then revisit the same issues in the near future. It is critical to restructure health care now, without delay, but in ways that serve the interests of the nation, not a particular industry.

Congress ultimately must be accountable to the American people. The American people must prevail on Congress to revise the current proposals, build on the lessons gleaned throughout the industry over the last 25 years, and directly address the structural flaws in our current system. True, most health industry groups will resist these efforts over the short term, but the result would be a more stable and sustainable health system, health care economy and national economy, outcomes that would benefit America’s people, its businesses and even its health care sector.

Finally, the American people should demand that Congress revisit and revise the conflicted lobbying practices that have so corroded policymaking on virtually every important issue. Doing so would revitalize the American people’s confidence in Congress, and would re-empower it to create thoughtful, innovative solutions to our national problems.

Brian Klepper is a health care analyst and industry advisor. David C. Kibbe is a family physician and a technology consultant to the industry. Robert Laszewski is a former senior health insurance executive and a health policy analyst. Alain Enthoven is Professor of Management (Emeritus) at the Stanford University Graduate School of Business.