I don’t know how many of you linked over to Lawrence Brown’s perspective piece “The Amazing,
Non-Collapsing US Health Care System” in the January 24th issue of the New England Journal of  Medicine
(buried in Mathew’s “Whisper it quietly. . .” post), but it’s the most useful piece of political analysis of the  health reform conundrum I’ve seen in a long time.   

What Brown argues, convincingly, is that we really have three healthcare systems: public and private health FINANCING systems (which operate in the lucrative fantasy land of “reimbursement”) and a public CARE system (the safety net urban hospitals, community health centers, public health clinics, the VA, etc.) that serve the rural and urban poor and uninsured. 

Other than a few isolated outposts like Kaiser, the third health system that Brown discusses is the only place in the United States where population health is actually practiced. And, most important, it is also is the mysterious resource that prevents the 47 million uninsured, including a very large number of our 12 million undocumented people, from dying in our streets, and causing a huge political crisis. It is invisible to much of the voting public, but thank God we have a safety net healthcare system.

This latter system has been a political stepchild of state and federal governments, and lurches from financial crisis to financial crisis, living off the land. But it has successfully propped up the other two, and, I think, helped prevent a revolution.  Precisely because it has succeeded in reaching its target populations and helping them, albeit “too late” in the disease process, it has drained both political urgency (and funding) from making the first two “reimbursement” systems universal.

Continue reading…

Wendy Everett is president of the New England Healthcare Institute. She thinks that the candidates for President from both parties agree on the important stuff for health care–dealing with chronic care prevention. I can’t say that I’m totally in agreement with her political analysis, but her ideas about chronic care and prevention for the basis of bipartisan action are interesting (and as Wendy used to be my boss at IFTF I thought that it would be polite of me to let her have shot on THCB!)

The presidential candidates are doing a disservice to the voters and to themselves when they emphasize their differences over how to fix the broken health care system. They can argue all they want about the likes of universal coverage, tax incentives and employer mandates, but that cacophony obscures the fact that the candidates, regardless off party, actually share a major position on health reform. Though little-noticed to date, there is a breakthrough bipartisan consensus that the key to health reform is to redirect the system to prevention and management of chronic illnesses.

This unanimity is huge. Chronic diseases – including conditions such as diabetes, asthma and hypertension – are a major threat to both our health and our economy. More than half of all Americans already suffer from one or more chronic ailments, and the rate is rising as the population ages.And the price tag is staggering. Some 80 percent of the more than $2 trillion in annual health expenditures already goes to taking care of patients with chronic diseases. A recent Milken Institute study found that in 2003, chronic care cost the country $277 billion for treatment and another $1 trillion in lost worker productivity. If nothing is done to halt the rise of chronic illness, the Milken Institute projects that treatment and lost economic output will rise to $4.2 trillion by 2023.

And yet much of this cost is completely avoidable.

Continue reading…