The Health Care Blog – Page 680 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Can We Design a Heart Healthy Home?

Dec 9, 2011• 7

By SANJAY BASU, MD

There is increasing evidence that the quality of our homes and cities is a critical determinant of cardiovascular disease, diabetes and lung conditions. As urbanization and economic change occur globally, whether we live in a house free of dust in a city with open parks and traffic regulations, or in a dusty tenement building next to a major road, seems critically correlated with our likelihood for having shortened life expectancy, poor nutrition, heart disease and lung problems. In this week’s blog post, we look at some of the mechanisms relating the “built environment”—our human-made surroundings of daily living—to the risk of illness. We ask the question: can we do for our hearts and lungs what the Bauhaus movement did for functional design?

Indoor air quality

If Dwell Magazine had a feature edition on designing a healthy home, they’d have to tackle the major issue of indoor air quality. Much research on the built environment’s impact on health was revealed through a series of studies on asthma among children living in low-income public housing units in the United States. Poor indoor air quality resulting from dust and dirt in public housing units was a major cause of emergency room visits during the 1980’s and 90’s among these children, leading to new programs for housing quality checks and maintenance, which we featured in a previous post.Continue reading…

Obamacare to the Rescue

Dec 8, 2011• 82

By Spike Dolomite Ward

I want to apologize to President Obama. But first, some background.

I found out three weeks ago I have cancer. I’m 49 years old, have been married for almost 20 years and have two kids. My husband has his own small computer business, and I run a small nonprofit in the San Fernando Valley. I am also an artist. Money is tight, and we don’t spend it frivolously. We’re just ordinary, middle-class people, making an honest living, raising great kids and participating in our community, the kids’ schools and church.

We’re good people, and we work hard. But we haven’t been able to afford health insurance for more than two years. And now I have third-stage breast cancer and am facing months of expensive treatment.

To understand how such a thing could happen to a family like ours, I need to take you back nine years to when my husband got laid off from the entertainment company where he’d worked for 10 years. Until then, we had been insured through his work, with a first-rate plan. After he got laid off, we got to keep that health insurance for 18 months through COBRA, by paying $1,300 a month, which was a huge burden on an unemployed father and his family.

By the time the COBRA ran out, my husband had decided to go into business for himself, so we had to purchase our own insurance. That was fine for a while. Every year his business grew. But insurance premiums were steadily rising too. More than once, we switched carriers for a lower rate, only to have them raise rates significantly after a few months.
Continue reading…

Free the Vets

Dec 7, 2011• 17

By John Goodman

Don’t you think our military veterans deserve decent health care? I certainly do. That’s why I like Mitt Romney’s idea of setting the veterans free. Give them the opportunity to choose private health care alternatives to the Veterans Health Administration (V.H.A.), a system that too often fails them.

Why can’t we do for veterans what we do for seniors? About one in every four Medicare beneficiaries is not actually in Medicare. They have enrolled instead in private health insurance plans operated by such entities as Aetna, United Health Care, Cigna, etc. Why can’t we give people who risked their lives for the rest of us similar options?

You would think this idea is a no-brainer. But, just like the Grinch at Christmas time, you can always count on Paul Krugman of The New York Times to argue that being trapped is good, free to choose is bad, and government medicine is all anyone should ever have or need.

According to Krugman, “the V.H.A. [is] providing better care than most Americans receive” and it does so at a lower cost. He doesn’t stop there. Here is Krugman’s view of health care, worldwide:

The most efficient health care systems are integrated systems like the V.H.A.; next best are single-payer systems like Medicare; the more privatized the system, the worse it performs.

In other words, in the best of worlds we all would be getting veteran’s care, courtesy of the U.S. government!

Cameron’s Law

Dec 7, 2011• 1

By Richard Hoey

British Prime Minister David Cameron is a man who likes to get his PR right.

In the summer, he used all his experience as a former head of corporate communications at Carlton TV to steer a path through the anger and acrimony generated by his reforms to the National Health Service (NHS).

He whisked up a listening exercise and an independent report, spoke some conciliatory words, and persuaded first MPs and then the House of Lords to wave through his Health and Social Care Bill to its current position on the brink of becoming law.

But just as the debate over the NHS appeared to be calming down, it has been abruptly reignited by a leaked policy document critics of the reforms describe as a ‘smoking gun’, demonstrating the Government’s intention to dismantle the state health system.

The document doesn’t sound a great deal. It is called ‘Developing commissioning support: towards service excellence’.

But its contents are explosive enough that the British Medical Association, which until now had been prevaricating over its response to the Government’s bill, has come down on the side all all-out opposition, with a series of attack ads planned soon.

A Litmus Test For Elected Officials

Dec 7, 2011

By BRIAN KLEPPER AND DAVID KIBBE, MD

Six months ago, who could have imagined that a large percentage of rank-and-file Americans would support the Occupy Wall Street (OWS) against special interests’ rigging of the American dream? So why not go to the next step? Why not pointedly ask political candidates, “Will you take money from lobbyists?” and “If elected, what will you do to stop special interest influence?”

Most Americans are deeply disturbed by this issue. In a recent Time Magazine poll of people familiar with the OWS protests, 86 percent thought that “Wall Street and its lobbyists have too much influence in Washington.” Gallup found that 68 percent of Americans think corporations should have less political influence.

These trends didn’t just happen. They resulted from special interests’ vigilant attention to legislative possibility, lubricated by the exchange of money for votes. Influence peddling is now so accepted in American politics that the Center for Responsive Politics (CRP) has established a lobbying data base, Open Secrets. But making lobbying contributions transparent hasn’t slowed the torrent of money that re-shapes law and wealth distribution.

Since 1952, the percentage of gross domestic product (GDP) represented by corporate taxes has plummeted from 6.1 to 1.0 percent, while the percentage represented by employment taxes has skyrocketed from 1.8 to 6.3 percent. Meanwhile, a just released Congressional Budget Office study confirmed that the top 1 percent of earners more than doubled their share of the nation’s after tax income over the last 30 years.Continue reading…

Leavitt ACO Report: Overstating or Understating Accountable Care Activity?

Dec 7, 2011• 6

By Vince Kuraitis

Accountable Care Organizations (ACOs) have been likened to:

A unicorn — a fantastic creature that is vested with mythical powers. But no one has actually seen one.

A camel — a horse designed by a committee, one that already has its nose in the tent

With this background, you can begin to appreciate the difficulty of conducting an accurate census of ACO animals in the wilderness. Yet, this is exactly the task undertaken in the excellent Leavitt Partners report measuring ACO activity in the US.

As I will explain, the Leavitt report has the potential both to overestimate and underestimate ACO and accountable care-like activities. In my judgment, however, it’s far more likely to be understating just how much accountable care activity actually is going on.

Findings in the Leavitt Report

The Leavitt researchers “identified ACOs from news releases, media reports, trade groups, collaborations and interviews through the beginning of September 2011. Also included were entities that either self-identified as being an ACOs or specifically adopted the tenets of accountable care.”

The report counts 164 ACOs — 99 that are primarily sponsored by hospital systems, 38 by physician groups, and 27 by insurers.

Here’s how Leavitt summarized their results:

Justice Kagan Should Recuse Herself from Obamacare Case

Dec 6, 2011• 6

By Carrie Severino

This spring the U.S. Supreme Court will decide what may well be the case of the century — the constitutional challenge to Obamacare. But will the case be heard by eight or nine justices?

Before the health care law was even passed, the Department of Justice had been meeting to develop a strategy for defending the law from constitutional attack. Involved in this effort was none other than Elena Kagan, now the newest Obama appointee to the Supreme Court.

Federal law requires Supreme Court justices to recuse from a case if they had earlier “participated as counsel” in the case. Justice Kagan did just that when she was Obama’s solicitor general, but has never explained why she believes she is nevertheless justified in sitting on the case under this standard.

One simply can’t be the coach and referee in the same game. At best, knowing the playbook will color your judgment, and at worst, you’ll be on the lookout for chances to give your former team an advantage.

Here are the facts. It took two lawsuits to get “the most transparent administration in history” to release emails detailing Kagan’s involvement in the Obamacare defense. Those emails show that, in a highly unusual move, she ordered her staff to become involved in the defense before the law was even passed.

Why Three Hospitals Didn’t Hurt My Wife

Dec 6, 2011• 2

By Michael L. Millenson

My wife was lying in the back of an ambulance, dazed and bloody, while I sat in the front, distraught and distracted. We had been bicycling in a quiet neighborhood in southern Maine when she hit the handbrakes too hard and catapulted over the handlebars, turning our first day of vacation into a race to the nearest hospital.

The anxiety when a loved one is injured is compounded when you know just how risky making things better can get. As a long-time advocate for patient safety, my interest in the topic has always been passionate, but never personal. Now, as Susan was being rushed into the emergency room, I wanted to keep it that way. “Wife of patient safety expert is victim” was a headline I deeply hoped to avoid.

In the weeks after the accident, we spent time at a 50-bed hospital in Maine; a Boston teaching hospital where Susan was transferred with a small vertebra fracture at the base of her neck and broken bones in her left elbow and hand; and a large community hospital near our suburban Chicago home. There were plenty of opportunities for bad things to happen – but nothing did. As far as I could tell, we didn’t even experience any near misses.

What went right? After all, though our health care system knows how to prevent errors that kill 44,000 to 98,000 people in hospitals each year, that death toll has remained stubbornly constant. Based on personal and professional observations, I’d simplify the formula that kept Susan safe into three variables: consciousness, culture and cash.

The Promise of Electronic Healthcare Records

Dec 6, 2011• 18

By JOHN HALAMKA, MD

Last week, Don Berwick completed his 17 month tenure as administrator of Medicare and Medicaid. The nation should be grateful that such a visionary was at the helm. The nation should frustrated that he was never confirmed.

In his parting interview with the press, he noted that 20 percent to 30 percent of health spending is “waste” that yields no benefit to patients.

Berwick listed five reasons for the enormous waste in health spending:
*Patients are overtreated
*There is not enough coordination of care
*US health care is burdened with an excessively complex administrative system
*The enormous burden of rules
*Fraud

Certainly regulatory reform is needed, but electronic health records can go far to addressing each of these issues.