OP-ED

Op-Ed: Health care reform is within reach

-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.

It’s for these reasons that combating chronic conditions must be a
central goal of health care reform. Fortunately, unlike some public
health crises of the past, the challenges posed by chronic conditions
are hardly insurmountable. That’s because a large majority of them can
be prevented simply through healthier lifestyle choices.

As a practicing primary care physician specializing in treating the
elderly, I understand better than most how unhealthy habits can, over
time, lead to debilitating chronic conditions.

But before any effort to reduce the incidence of these diseases can be
effective, we need to rethink the way medicine is practiced in the
United States. In short, health care in this country needs to be more
patient-focused.

For doctors, this means practicing a more personalized kind of care
that aims at keeping patients healthy, and not simply on treating
illnesses when they arise.

Toward this end, experimenting with new health care delivery models may
prove effective. In the “medical home” model, for instance, a single
personal physician coordinates all of an individual’s medical care over
the course of that person’s life. This allows for a more comprehensive
approach to medicine that stresses healthy living and disease
prevention over stopgap treatment solutions.

In other words, the government doesn’t have to step in and incentivize
us to take better care of ourselves. The truth is that the government
isn’t equipped to do such a thing. And that’s not a proper role for
government, either.

Lawmakers can, though, create a system where both patients and
physicians are incentivized to prevent chronic illnesses before they
develop. Moving closer to a health care model where patients are
rewarded for living healthier lives and physicians are compensated
based on outcomes rather than volume of service would go a long way
toward reducing health care costs.

Just look at breast cancer, an illness that killed more than 40,000
women in 2004. According to Researchers at the Centers for Disease
Control and Prevention, regular mammograms could reduce that number by
up to one-third.

The same goes for hypertension, a leading cause of stroke and heart
attack. If caught early, high blood pressure can be effectively treated
with prescription medication before it evolves into something worse.

In fact, a recent study published in the journal Health Affairs found
that blood pressure medication reduced the number of heart attacks and
strokes in 2002, saving Americans more than $16 billion. That same
study found that properly using antihypertensive therapies could reduce
the number of premature deaths from heart disease in America by 89,000
and the number of hospital admissions for strokes by 287,000.

Recognizing the urgency of this issue, leaders of key health care
institutions – from AARP to pharmaceutical companies – have united
behind the goal of making chronic illnesses far less common.

Our health care system is ripe for reform. Not because it is
irreparably broken, but rather because the reforms we need are well
within our grasp. It’s crucial that we all work to reduce the
prevalence of chronic illness.

Gary Applebaum is a senior fellow at the Center for Medicine in the Public
Interest, which is known best for the usually pro-big pharma leanings of Peter Pitts. He is the former executive vice president and chief medical officer of Erickson Retirement Communities. This opinion piece first appeared in the San Diego Union Tribune.

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19 replies »

  1. Naturally, prevention is the ideal solution to ballooning costs. Unfortunately, such a methodology is hard to convey to people when they are healthy and stable. Treating problems only after they arise is our nature. It is the speed, level of efficiency and efficacy with which we treat them that is most important.
    http://www.hometelemed.com – Stroke Rehabilitation At Home

  2. Exercise has been really a very important factor for the people of today’s generation. And especially exercise really helps heart patient more than anything. I have got an enlarged heart because of inability of pumping. I was also having a defective valve, which led me to be a sinus tachycardia patient. I got to know at my medical checkup at my campus. And being very young to face all this, I was really frightened regarding all these health issues. I need someone to monitor my health and keep an eye on my health as well as daily health issues. Getting an internist hired was just not the solution to the problem. I got to know about some kind of wellness program from elite health (www.elitehealth.com) Medical Service Provider Company. I got enrolled in it, as they were providing me 24/7 access to the doctors. Especially, I got one unexpected and quite a surprising opinion from their health executive who used to monitor my health and guide me the appropriate dietary solutions. He told me to have a regular exercise daily. I thought he is really mad, or planning to kill me. Ha Ha. .. But my regular exercise! Not so heavy, the results came out to be positive. I was really feeling better and healthier as compared to previous conditions. So, indirectly, exercise has really helped me suppress my health issues, especially the problems we generally face while having heart failure.

  3. The government screwed up the system. We had great primary care until 1983. Now no one in their right mind will go into it except midlevel providers and FMG’s.

  4. There is absolutely nothing new being discussed here-must be a slow blog day. Amen to Tim, who shares my view that nothing meaningful in healthcare reform will occur until and unless the payment system is used to shape whatever the “reform” prescription. I think medical home as a concept has legs, but in most states and locations would require significantly more consolidation among hospitals and physicians–but could be accomplished via either govt or private insurance, or a mixture. The trick is reallocating professional payments from producers of medical widgets to primary care, and increasing the primary care physician numbers.

  5. You are assuming everyone has access to a private, long term doctor. What about those with mobile lives or that live in urban centers? How about the uninsured? How about some unethical for-profit practices that make money from unnecessary prescription and testing sales? What about the good private practices that have become overburdened by the inefficiency of the insurance companies? How about nurse understaffing and lack of access to quality Heath IT data? The government must have a role in the system. It, after all, is paying for it.

  6. In other words, you get what you pay for. American doctors are paid by CPT code, so CPT codes are what they produce. As the government becomes a larger and larger payer through the years, the likelihood that the system will change decreases, unless the payment system is utterly remodeled.
    A reform in payment methodology would solve the coordination of care problem, which would do much to reduce costs — and this reform could be done by CMS today, using their present clout, with no new legislation. Simply put more money in the coordination of care codes. Expenditures will bump up at first, then other CPT codes will drop as fragmented care reduces.

  7. hi i like your blog and i see alot people would like to be healthy the rest of there life who doesn’t if you guys like info and advice on health and fitness check out my blog

  8. It seems that many of the changes in access to health care and the provision of services have indeed been driven by government programs. What Medicare does is often followed by private insurers, so it seems to me. Medicare part D has driven much competition among insurers in the area of prescription drugs, for instance.
    From these historical facts I believe that the adoption of the Wagner Chronic Care Model in the Patient-Centered Medical Home by Medicare will drive a great deal of change in chronic care practices at primary care sites. Patient–Centered Medical Home pilots have demonstrated the improved efficiency of the delivery of care at a lower cost with this model. This has been well documented at the TransfoMED web site.

  9. Dr Applebaum’s comments are well taken. We cannot afford to give everyone everything in the way we now deliver medical care in America. That said, America is the only country that has not figured out a way to assure all of its citizens have access to required medical care. After I wrote “The Future of Medicine – Megatrends in Healthcare” I was repeatedly asked about healthcare delivery as well. This led to interviewing over 150 thought leaders across the country. What comes through loud and clear is this. We have a medical care not a health care system. We do not focus on prevention in large part because providers are not paid for the time to do so. We are seeing a rise of complex chronic illnesses such as heart failure, diabetes with complications, cancer, and autoimmune diseases that last a life time and require many different specialists over time. Yet we have a system that does not encourage coordination of care. The result is extra doctor visits, extra procedures, tests and X-rays and even extra hospitalizations than would have been necessary with well coordinated care. Unfortunately, this is the way medicine is practiced today and it is a real problem. It means that care is not as good as it should be or could be, not as safe as it should or could be, not as customer [patient] friendly as it should be or could be, and it means that it costs far too much. So, health care reform needs to address not only access but also the costs of care, the coordination of care and the prevention of illness. What Applebaum did not mention was his role in developing an effective approach to care coordination for residents of a retirement community. Each primary care physician managed the care of about 400 of residents rather than the typical 1800 or so for most PCPs in practice. They found that the care became better, the residents were more satisfied, and the number of hospital admissions and overall costs of care came down substantially, well more than offsetting the extra cost of the PCPs . The problem is that current insurance – government or commercial – just does not pay for that type of time commitment by providers.

  10. Oh yes Deron I read all of it, but it’s nothing there but rambling blather with no connecting practical way of instituting the things we all know already – or have been told by our mothers – “eat your vegetables”. And he does not address how we’re going to pay for his “solutions”, except to say government can’t solve this. He’s a Republican who ran in the primary for the GOP.
    He starts with this;
    “It’s for these reasons that combating chronic conditions must be a central goal of health care reform. Fortunately, unlike some public health crises of the past, the challenges posed by chronic conditions are hardly insurmountable. That’s because a large majority of them can be prevented simply through healthier lifestyle choices.”
    “As a practicing primary care physician specializing in treating the elderly, I understand better than most how unhealthy habits can, over time, lead to debilitating chronic conditions.
    “But before any effort to reduce the incidence of these diseases can be effective, we need to rethink the way medicine is practiced in the United States.”
    “Moving closer to a health care model where patients are rewarded for living healthier lives…”
    Great stuff but of course he doesn’t say how we’re going to get there or how docs can “change” poor health lifestyles (any more than they’re already) but here’s his “solutions”;
    “regular mammograms could reduce that number by up to one-third.”
    If caught early, high blood pressure can be effectively treated with prescription medication…
    “blood pressure medication reduced the number of heart attacks and strokes in 2002,”
    “using antihypertensive therapies could reduce the number of premature deaths from heart disease..”
    He doesn’t say whose going to pay for all of this extra intervention (the core problem) and after saying government can’t incentivize he says this;
    “Lawmakers can, though, create a system where both patients and physicians are incentivized to prevent chronic illnesses before they develop.”
    Doctor Applebaum neither understands the problems or the fixes, but watch for him running again for the GOP.

  11. Agree with the importance of chronic diseases and the need for a better approach to preventing and managing them. A systems approach that supports primary care with a team of health care professionals having expertise in care coordination, medication adherence and safety checks, self-management coaching, lifestyle behavior change, gait and balance training, ongoing assessments in the home and community, and other elements of a full-featured care management service is more likely to be effective.

  12. “Heart disease and strokes alone cost the American people $448 billion in 2008.”
    Does Healthcare and high spending on it really “cost” us? What would happen if Wal Mart sold a magic pill for $4 a month that prevented all heart disease and stroke? Would we have $448 billion to play with? Could we buy more oil and Chinese imports?
    Healthcare expenditures are almost 100% domestic. Very little HC spending leaves the country. Elasticity of money would imply our $448 billion in spending on heart disease increases our GDP by trillions. Buying foreign oil or chinese toys draws money out of our economy and thus has no positve impact on GDP.
    Solving the HC “crisis” and spening that savings on imports could easily do more damage to our economy and debt then consuming to much healthcare.

  13. Peter – It’s almost as if you didn’t read a word of what he said. He was actually proposing solutions that hit the biggest cost drivers head on (as opposed to simply addressing the financing structure). I think your question confirms that either 1) you didn’t read what he said (because he answered the question before you asked it) or 2) you are so set on single-payer that you’ve completely closed your mind to anything that isn’t a total government solution.

  14. One easy solution is a model using a web based system for uninsured and under-insured Americans. It saves money for both providers and consumers. Consumers find participating providers and then pay cash for discounted health care. That is a win/win deal. Saves for the patients and no staff needed or waiting for delayed reimbursement. Yahoo posted this press release yesterday for a new compnay called http://www.PriceDoc.com. Here’s the link to the Press Release:
    http://finance.yahoo.com/news/New-Website-Helps-Families-prnews-14974448.html

  15. “In other words, the government doesn’t have to step in and incentivize us to take better care of ourselves. The truth is that the government isn’t equipped to do such a thing. And that’s not a proper role for government, either.”
    Spoken like a true Rebublican. Gary, all of your “solutions” treat AFTER the patient has the disease. In fact Americans WILL need to be “incentivized” with a totally different approach to food production and marketing if we are to reduce cronic disease. Please tell me how you’re going to pay docs for outcomes and how you’re going to make all those tests and drugs for cronic disease affordable for everyone?
    “Our health care system is ripe for reform.”
    No, it’s ripe for profits.

  16. While this is an interesting concept there is a major flaw in the reasoning in my opinion. North Carolina has been on the forefront of the medical home model and it does work well. However, as reported recently by the Washington Post, North Carolina now has approximately 25 percent of its population without health insurance. Reducing chronic illness is certainly possible but not if patients can’t afford to have preventative and follow up care. Insurance coverage needs to be stabilized first and then we can make enormous strides toward decreasing chronic illnesses.
    Kate@ http://aftercancernowwhat.blogspot.com

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