Mind The Gap: The Insurance Gap

Michelle Singletary shares her perspective on why the plight of the American uninsured affects all of us in her column for The Courier-Journal in Louisville, KY:

The cost for those with coverage is escalating in part because the number of uninsured Americans keeps rising, said Ron Pollack, executive director of Families USA, a nonprofit organization that advocates high-quality, affordable health care for all Americans.

Using data from the Census Bureau, the federal Agency for Healthcare Research and Quality, and the National Center for Health Statistics, Families USA determined that the unpaid expenses for the uninsured added an average of $922 in 2005 to the premiums for employer-provided family health insurance. That extra cost could rise to $1,502 in 2010.

Increasingly, employers are shifting a larger portion of their health premiums to employees. You may be able to afford your policy today, but it's possible you may not in the future.

In pure and simple terms, the unpaid balances do not disappear. Instead, they get added to the balances paid by those with insurance. It is not exactly a slow process either. Singletary reports an increase of 78% in family premiums just since 2001!

She also explodes the myth that the uninsured are mostly poverty stricken. According to her reports, eight out of ten are employed, often at multiple jobs just trying to make ends meet. They are workers who fulfill important roles in our communities as caregivers and in small businesses.

The plight of the uninsured does not occur in a vacuum. Its economic impact alone touches every American in every socio-economic strata.

SOURCE: "Health-care insurance gaps affect all of us" 03/30/08
Photo courtesy of fabio, used under its Creative Commons license

The Healthy Internet

Over the course of this blog's existence, I have often touted the need for intelligent application of technology as an important part of health care reform. Usually when I do so, I am speaking of electronic medical records, e-prescriptions, or online payment systems. Today, let's take a look at the other side of the coin: public use of the Internet as a tool for mobilization and sharing of information.

Kyla King at The Houston Chronicle (via Newshouse News Service) brings us round one in the form of a story about a Michigan family who used an email campaign to apply leverage to their insurance provider:

The first e-mail arrived at 12:36 p.m. The next one followed two minutes later.

Then came the flood: More than 50 e-mails came in the first hour, and more than 300 over two days filled inboxes of executives at a health insurance company and media outlets.

That's how a father — and hundreds of friends and relatives — used the power of the Internet to keep his health insurer paying for his recently disabled daughter to stay in Mary Free Bed Rehabilitation Hospital rather than be sent home for outpatient care.

Maia Moore, 2, has been rehabilitating since an aneurysm in September nearly ended her life.

Her father, Jeremy Moore, of Grand Rapids, claims moving the toddler home goes against recommendations from Maia's doctors at Mary Free Bed.

The Information Age is certainly having an impact on the health care discussion. Social media and Web 2.0 applications are making it easier than ever for concerned citizens to mobilize, share information, and facilitate debate on the subject.

The case of Maia Moore shows how Internet tools, even basic ones like email, can make it easier to mobilize the public. Let us now take a look at a good example of information sharing, the federal Agency for Healthcare Research and Quality's (AHRQ) 2007 State Snapshots:

“This year’s State Snapshots do more than illustrate the wide variations in health care quality among states,” said AHRQ Director Carolyn M. Clancy, M.D. “They also show a handful of the important challenges that states face as they work to improve the quality of care.”
.
As in previous years, the 51 State Snapshots – every state plus Washington, D.C. – summarize health care quality in three dimensions: type of care (such as preventive, acute or chronic care), setting of care (such as nursing homes or hospitals), and by clinical areas (such as care for patients with cancer or diabetes). The evaluations are expressed in simple, five-color “performance meter” illustrations that rate performance from “very weak” to “very strong.” Users may explore whether a state has improved or worsened compared to other states in several areas of health care delivery.

The tool itself is located here, and is very revealing. A quick glance at my home state of Louisiana yielded the unsurprising statistics of being weak in all metrics used.

These are only two of many examples available. Many more abound if you do a little digging. Just as technology impacts all aspects of our lives, it now also impacts all levels of discourse on any given subject. Since health care reform is one of the American public's highest priorities, a wealth of Internet resources is a mere Google search away.

SOURCE: "Dad wins e-mail fight over daughter's health care" 03/26/08
SOURCE: "2007 State Snapshots Provide State-by-state Health Care Performance" 03/26/08
photo courtesy of meyshanworld, used under this Creative Commons license

American Insurance Sends Patients to....Tijuana??

The cost of health care is a constant refrain these days. Just take a look at the wide variety of studies, news articles, and blog posts that are generated on the topic daily. Hardly surprising in an era where, as George C. Halvorson points out in his book Health Care Reform Now!, there are over 9,000 billing codes for procedures but not one for a cure.

Many solutions have been proposed, although the one embraced by a growing group of providers is novel: ship the patients to Mexico for treatment to cut costs.

Bloomberg's Thomas Black brings us the details as he reports from Monterrey, Mexico:

Yielding to pressure from employers, health insurers such as Health Net, Aetna Inc. and Blue Cross Blue Shield of South Carolina are offering cost savings to policy holders who take their ailing backs, hips and knees to foreign countries for non- emergency medical treatment. Mexico has emerged as a favored place for American medical tourists because of its proximity and U.S. insurer incentives.

Black reports about 180,000 Americans make a run for the border when they need health care each year, and spent approximately $2 billion with foreign providers last year while doing so. Why is this happening? Cost is the main factor, although Black's article reports some people stating they received better quality care in Mexico than in the United States.

A hip replacement in Mexico or Thailand costs $12,000 compared with $43,000 to $63,000 in the U.S., according to a study by Christus Health published last year. Angioplasty, in which a surgeon uses a tiny balloon to open a blocked coronary artery, costs $10,000 in Mexico, compared with $57,000 to $82,000 at an American hospital.

So that addresses the cost factor, how about that quality of care? Let's take a look at the case of Antonia Siguenza, who needed treatment for a cyst.

[In the U.S.] Her portion of the bill was $800, she said. When the incision failed to heal after several months and her U.S. doctor advised her to give it more time, she drove two and a half hours to get another opinion in Tijuana and elected to have a second procedure there.

Her cyst cleared up a few weeks after the surgery, she said.

Ana Andrade, vice president of Latino programs at Health Net says that approximately 20,000 customers have the Mexican coverage plan and also that they save roughly 40% on premiums by doing so.

While the pricing is vastly better across the border there are justifiable quality of care concerns. Follow-up care can be complicated to near impossibility, safety of the blood supply is sometimes suspect, and possible lack of legal options in the face of malpractice are valid concerns.

Black's article contains two pages of analysis as well as brief interviews with both patients and providers on this subject. He demonstrates the impact our inflated and inflating health care costs are having by demonstrating how many are opting to go outside of the American system because of finances.

SOURCE: "Mexico Gets Medical Tourists as Health Net Sends U.S. Patients " 03/26/08
photo courtesy of omar omar, used under this Creative Commons license

Health Care: Do Your Footwork Online!

Joe Light at CCN Money has consolidated a nice little list of online tools that consumers can use to make informed decisions about their health care expenditures.

It takes five minutes of Web surfing to compare prices and features and to check out customer reviews on, say, a digital camera.

But for health care? "We just haven't evolved to that level," says Jean Chenoweth, a senior vice president at Thomson Healthcare, a division of the giant information services company.

Clarity seems to be forthcoming. Many companies are launching online tools and websites geared towards this trend towards transparency. According to Light, some of the best available are run directly by the insurers themselves.

He provides a step-by-step research program for finding info about prospective providers and hospitals, including web addresses for a variety of tools and info on how to properly implement them. A few of the resources he point to include:

• ABMS.org- A site for researching whether your practitioner is board certified or not.


• Vitals.com- This site allows you to see how many times a provider has performed a certain procedure, as well as documentation of sanctions and malpractice suits.


• Leapfroggroup.org/cp- For checking to see if your hospital has proper staffing and equipment.


• HealthGrades.com- provides survival rates for patients, both while they are in the hospital and for six months following discharge.
  

There are several more tools on his list, along with explanations of how to use them, what their limitations seem to be, and what info they can provide. All in all, there is a wide ranging array of sites that should prove invaluable to someone trying to pierce the veil of medical mystery that surrounds health care in modern America.

SOURCE: "Click here for the best health care" 03/25/08
photo courtesy of barnoid, used under this Creative Commons license

Cost of Care: It'll Get You Coming and Going

Affordability is one of the big bugaboos of health care in modern America -- one that is getting steadily increasing amounts of media coverage as the serious part of the Presidential campaign ramps up. Michael A. Fletcher of The Washington Post takes a look at at the impact of these skyrocketing cost on the average working class citizens of the United States:

"The way health-care costs have soared is unbelievable," said Katherine Taylor, a vice president for Local 1199 of the Service Employees International Union. "There are people out here making decisions about whether to keep their lights on or buy a prescription."

Since 2001, premiums for family health coverage have increased 78 percent, according to a 2007 report by the Kaiser Family Foundation. Premiums averaged $12,106, of which workers paid $3,281, according to the report.

Fletcher goes on to examine the cost outlay businesses must factor in when providing health care is part of their equation, and why this is making many businesses cease offering it altogether. All in all, his opening sentence offers an encapsulated view of the issue, "Recent history has not been kind to working-class Americans, who were down on the economy long before the word recession was uttered."

So, if you manage to survive your working career without going bankrupt from health care related costs you should be in good shape, right? Wrong. If you do some digging you can find this informative little gem on Investment News (co-authored by Alicia H. Munnell, Mauricio Soto, Anthony Webb, Francesca Golub-sass and Dan Muldoon) about the National Retirement Risk Index (NRRI):

The results show that once health care is considered explicitly, the percent-age of households that will be "at risk" [of being unable to maintain their standard of living in retirement] rises from 44% to 61%. As always, the percentage "at risk" is greater for those at the low end of the income distribution. And later cohorts show more "at risk" than earlier ones due to the combined effect of a contracting retirement income system and continually rising health-care requirements.[...] Because health-care costs are rising rapidly and the income system is contracting, a much larger percentage of later cohorts will be "at risk" than earlier ones. The NRRI rises from 50% for early boomers to 68% for Generation Xers.

Seems like the cost factor has got you both coming and going. This is a clarion call for systemic reform.

SOURCE: "Rising Health Costs Cut Into Wages: Higher Fees Squeeze Employers, Workers" 03/24/08
SOURCE: "Health-care costs drive up the National Retirement Risk Index" 03/24/08
photo courtesy of Carlos Madrigal, used under this Creative Commons license

From Oregon to Pennsylvania: Quality of Care Data is Going Online

The third week of March 2008 may well be remembered for the debut of online access to quality of care info simultaneously on both the east and west coasts of the United States.

On the west coast, Kaiser Permanente* stepped up to plate as the first provider in the Oregon areaa to issue a public report on quality of care at its outpatient medical offices using nine different measures. The results are available online and debut roughly a year ahead of a regional effort of a similar nature.

The Portland Business Journal reports:

"This report is just the beginning of our plan to share our quality story with our members and the public," said Dr. Maureen Wright, assistant medical director for Quality Management and Systems. "Each year we will add more measures. For 2008, we will also be reporting scores on screening for colorectal cancer and controlling high blood pressure."

The Kaiser report uses nationally recognized quality standards called the Healthcare Effectiveness Data and Information Set (HEDIS). More than 90 percent of U.S. health plans use the HEDIS yardstick. You can access the report and look up Kaiser clinic scores at kp.org/medicalofficequality or kp.org/qualityscores.

Meanwhile on the east coast, the Pennsylvania Health Care Quality Alliance (PHCQA) launched a website on March 19 that contains similar data for all of the state's acute care hospitals. The Pittsburgh Business Times brings us the news:

The site contains information gathered from Medicare, the Pennsylvania Health Care Cost Containment Council, and the Joint Commission. Visitors to the Web page are able to search hospital quality measures in four major clinical areas: heart attack, heart failure, pneumonia and prevention of health care-associated infections.

Additional clinical areas will be added over time.

"While hospital quality data has become more available on the Internet, consumers are at a disadvantage when they must search out multiple sites, each with its own measurement standards," said Gerald Miller, chairman of the alliance. "PHCQA has developed, and is continuing to refine, a consistent and uniform approach that makes it easier for consumers to access, understand and use the data."

These bicoastal efforts are far from the whole picture. There are many significant initiatives around the country to shine a spotlight on the details of our health care transactions. As more and more people become agitated about the costs of their health care, I predict this much needed trend will sweep the nation.

The question before us is this: how will these systems interact when the areas they cover meet and overlap? At what point will we achieve the uniform standards of quality measurement necessary to enact true and lasting reform?

* Disclosure for new readers: This blog is a companion to Kaiser CEO George C. Halvorson's newest book: Health Care Reform Now!.

SOURCE: "Kaiser publishes quality data for clinics" 03/20/08
SOURCE: "Pennsylvania quality-of-care data available online" 03/19/08
photo courtesy of Unhindered by Talent, used under this Creative Commons license

Dropping the Ball in 21st Century Health Care

Today I'd like to direct your attention to an article in the Health and Wellness section of AlterNet by Niko Karvounis. Karvounis is a Program Officer with The Century Foundation in New York City where he works on issues of socioeconomic inequality and health care. He is also a regular contributor to the Foundation's health care blog.

In his article, he examines a chronic health issue, but not diabetes or obesity, instead he casts his eye upon the mistakes made when a patient is transitioned from one health care provider to another.

Even the most common hand-off -- your standard referral from primary care physician to specialist -- is not risk-free. As Dr. Bob Wachter recently noted in his blog, "in more than two-thirds of outpatient subspecialty referrals, the specialist received no information from the primary care physician to guide the consultation." Sadly, the radio silence goes both ways: "in one-quarter of the specialty consultations," Wachter says, "the primary care physician received no information back from the consultant within a month."

These missteps are indicative of what can go wrong during the hand-off, such as, according to QSHC, "inaccurate medical documentation and unrecorded clinical data." Such misinformation can lead to extra "work or re-work, such as ordering additional or repeat tests" or getting "information from other healthcare providers or the patient" -- a sometimes arduous process that can "result in patient harm (e.g., delay in therapy, incorrect therapy, etc)."

In the era of our nations "non system" of health care, the discontinuous and fragmented nature of treatment poses many opportunities for mistakes to enter the process, often to the detriment of the patient.

Kourvanis delineates a pattern in which most of the gaps in care are communications failures and most of those are on the part of primary care physicians. To provide context, he does examine the plight of primary care doctors, doctors whose workload is mammoth and pay miniscule by comparison to others in their profession. Combined with the fee for service system currently in place, these inequities are a recipe for disaster.

He examines a variety of possible changes that could improve the system, in the end reaching this conclusion:

But for all that these ambitious changes hold promise, the hand-off will always exist -- which means reformers need to dig deeper and develop protocols at the operational level. Luckily, they're doing just that. Kaiser Permanente, for example, has created a procedure meant to formalize communication between health care teams when a patient is transitioning from one provider to another.

He goes on to look at a variety of situations and programs designed to minimize or eliminate these errors. He looks at post discharge coaching, electronic medical records, Kaiser's SBAR program and more.

Go give it a read. His article is packed not only with food for thought, but also with an amazing a array of data and hyperlinked resources.

SOURCE: "21st Century Medicine Wrought with Miscommunication and Human Error" 03/20/08
photo courtesy of Ninjapoodles, used under this Creative Commons license

Wyden and Bennet: Together Again For The Very First Time!

United States Senators Ron Wyden and Bob Bennett are a pairing most people would not expect. Not at all. Wyden, founder of the Grey Panthers, hails from the so called "Blue State" of Oregon while Bennett calls the "Red State" of Utah home. As Ezra Klein points out in his column for The American Prospect:

Indeed, they appear to have only two things in common. They're both tall. And they want to solve America's health-care crisis. [...] "Isn't this great?" [Wyden] enthused. "A Jesuit university hosting a Mormon fellow and a Jewish fellow to fix health care!"

The bipartisan group coming together around these two looks formidable. The legislation they have co-sponsored now has twelve Senators on board, six from each side of the aisle. A search that Wyden instigated through the Congressional Research Service has declared it the largest bipartisan coalition ever assembled around a concrete piece of universal health care legislation. The reason would probably be the incredibly and fundamentally transformative bill they have co-sponsored.

Rather than patching up the employer-based system and offering alternatives that individuals would maybe migrate toward, as both Clinton's and Obama's plans do, Wyden-Bennett end the employer-based system. They force employers to account for every dime and dollar they spend on employee health care and, the year after the bill's passage, redirect that cash into employee paychecks. So if your employer is spending $7,000 a year for your health insurance, your paycheck gets a $7,000 boost as soon as their bill passes. You have the money they spent on your health care, but you are no longer dependent on them for that health care.

Under the Wyden-Bennett system, health dollars would be controlled by the individual (a long-time conservative goal) and used within a restructured, heavily regulated, totally universal, insurance marketplace (a longtime liberal goal). Each state would create Health Help Agencies, who would provide easy access to insurance products, along with information, guidance, and advice on how to choose. Insurers would have to meet a minimum standard for comprehensiveness (equivalent to the standard Blue Cross/Blue Shield plan currently offered to members of Congress), and they could not discriminate based on pre-existing conditions, occupation, genetic information, gender or age. Nor could they deny insurance to those who ask for it. In return, every American would have to buy health insurance, and there would be hefty subsidies for those further down the income ladder.

According to Klein, the Lewin Group estimates that savings from the plan would amount to $1.4 trillion over the first decade. His analysis continues to look at a variety of aspects of this unheard of coalition. One aspect of the situation that he looks at in particular is the question of how intact this legislation will be at the end of the process.

Citing comments made by Amerihealth executive Dan Hilfery, Klein notes that the most common reaction will probably be: " Your plan sounds great, except for the part that impacts my profit stream." Only time will tell whether or not this dynamic duo can make their plan a reality, but if they do, the next President will have a concrete plan to get on board with -- a plan where most of the legislative jockeying is already over and done with.

No matter what, these two bear watching!

SOURCE: "Health Care's Odd Couple" 02/15/08
photo courtesy of batintherain, used under this Creative Commons license

Health Care by Lottery??

91,000 residents of the state of Oregon are watching the lottery. It is not dollar signs that attract them, but rather the hope that a winning number will provide them with health insurance that they do not currently have. One of those residents is Melvin Trosies, a man whose heart attack of a month ago has resulted in escalating medical bills that currently have exceeded the $200,000 mark. William Yardley of The New York Times reports:

“They said they’re going to draw names, and if I’m on that list, then I’ll get health care,” said Mr. Tsosies, 58, a handyman here in booming Deschutes County. “So I’m just waiting right now.”

Despite the great hopes of people like Mr. Tsosies, only a few thousand of Oregon’s 600,000 uninsured residents are likely to benefit from the lottery anytime soon. The program has only enough money to pay for about 24,000 people, and at least 17,000 slots are already filled.

While the national average is 16% of the population uninsured, on the eastern side of Oregon's Cascade range in Deschutes County the number is roughly 19%. Many of those suffering a lack of coverage are seasonal or service workers, including many construction workers who are suffering from a slowdown within their industry.

Chris Coon, the outreach manager for the Community Clinic of Bend and the two other clinics, is quoted as saying that resorting to health care by lottery is a sign of "profound desperation," in response to the overwhelming need.

The lottery was born out of a consensus among state officials and advocacy groups that small steps can help. As part of the state’s Medicaid program, known as the Oregon Health Plan, the lottery is intended for low-income adults who lack private insurance and do not qualify for Medicaid or Medicare. Although the plan once served more than 100,000 people, budget cuts in 2004 reduced the number to about 17,000.

This situation is quite disturbing when you consider the fact that in the late '80s through early '90s, the state was a leader in health care reform. The Oregon Health Plan had reduced the number of uninsured to 11% of the population by 1996. Everything seemed to going smoothly until a major recession hit the state earlier this decade.

“Oregon was way ahead of everyone else,” said Charla DeHate, the interim executive director of Ochoco Health Systems. “And then we went broke.”

SOURCE: "Drawing Lots for Health Care" 03/13/08
photo courtesy of St A Sh, used under this Creative Commons license

The Mayo Clinic Health Care Symposium

If you were unable to make it to the Mayo Clinic's Health Care Symposium earlier this week, fear not. Thanks to the efforts of Lee Aase, the Mayo Clinic's Social Media Manager, you can time shift the proceedings and listen to many of the good parts online.

Not only has Aase launched a blog that acts as a companion to the Symposium, but he has also made sure to record and podcast many of the juicier bits for our listening and researching pleasure.

The Keynote Address by Tom Brokaw is a perfect introduction to the proceedings and is an erudite and moving speech. In it, he reminds us that while our current problems may seem insurmountable, they are tiny compared to the ones faced by prior generations. He frames his comments in the dual context of our responsibility and our legacy as a society:

"It is said that medicine took a dramatic turn at the beginning of the 20th century when it began to do more good than harm to the patient. A hundred years from now what will be the judgment of historians about the delivery of health care at the beginning of the 21st century? Will we do more good than harm to the system and, by extension, to the patient? That is the charge and the battle now has been joined. "

In addition to the esteemed Brokaw, there are several other podcasts available. MP3s can be downloaded, included the following:

• Helen Darling, President of the National Business Group on Health brings us the business perspective


• Robert Smolt, Executive Director of the Mayo Clinic Health Policy Center provides an overview of the Symposium's goals.


• Symposium Co-Chair Pat Mitchell's welcome message


• Denis Cortese, President and CEO of the Mayo Clinic's opening remarks
  

I am sure we will be seeing more (or hearing more) as they get the rest of the audio digitized. Thanks to podcasting, we may not have been there, but we did not miss out. If listening to any of these inspires you, please leave a comment here or on the Mayo Clinic's blog.

SOURCE: "The Mayo Clinic Health Policy Blog"
SOURCE: "PODCASTS: The Mayo Clinic Health Policy Blog"
photo courtesy of 2008 Mayo Clinic National Symposium on Health Care Reform

Health Care: This Time It's Personal!

Eric Stoner is writer for The Huffington Post. He also suffers from cystic fibrosis (CF), a genetic disease that attacks the digestive and respiratory systems. Despite major advances in medicine, most CF sufferers do not live far past 40, often dying from everyday infections that become life-threatening.

There are roughly 30,000 documented cases of CF in the United States. Since it is a relatively uncommon ailment, the market for treatments and medication is quite small. Stoner quotes his annual prescription costs at $60,000 per year! As he points out, this makes him a dream customer for the pharmaceutical companies and a nightmare client for the insurance companies:

I'm the worst kind of member to have on the rolls: someone with a chronic illness whose medical expenses, as long as a cure remains elusive, will always be exorbitant. I show no profit potential.

Not surprisingly, then, navigating the health care system has never been easy for me. Even when the system is working as smoothly as it can, I have had to jump through countless hoops. Those are an unavoidable and exhausting part of this tortuous circus. But my experience in insurance company hell reached a new low last year. Last November, I spent weeks politely jostling my inept doctor's office and insurance provider to get one of my prescriptions filled. Nobody seemed to take me seriously or put any priority on my case, even as I stressed that I was quickly running out of my medicine. To my disbelief, I began to realize that I did not have intrinsic value in their eyes, but had effectively been reduced to a "member number" and data on their seemingly endless medical forms. And when your needs become too expensive -- since the price of life apparently can now be calculated -- the companies find every possible way to dodge their obligation, playing the role of absentee landlord or deadbeat dad to perfection.

Stoner then goes on to share his disturbing and demoralizing adventures navigating the byzantine bureaucracy of insurance and health care. His experience resonates with many who have been subject to the "non system" of American health care.

He recounts the extensive phone calls with his provider, including a four-day stretch where he was on the line literally all day each day. As each obstacle was overcome, it was replaced with another, a seemingly endless stream of complications, requirements, and red tape. On several occasions, he was told to go to the emergency room.

After reaching the point of desperation, Stoner got in touch with a lawyer friend who agreed to apply pressure on his behalf. Oddly enough, the very next day he was contacted by the suddenly helpful provider with full approval for his treatment.

There was no explanation. The extensive documentation that they had been demanding was, in the end, unnecessary, as I suspected. I rushed to the pharmacy. But by the time I was able to fill the prescription, I had already gone three days without it.

My fragile health was put at risk because some faceless suit wanted to save a buck and was testing to see how much of a fight I would put up. (I was told more than once by people who had their own horror stories with health insurance that companies hope you'll just give up. Whether it's true or not, that is definitely how it feels.) It was an emotionally exhausting process that I hoped I would never have to endure again.

The unfortunate part is that this only covers the beginning of his outlandish odyssey. A mere few weeks later, the same provider once again refused to authorize medication prescribed by Stoner's doctor. Only the threat of legal action was able to cut through the red tape involved.

Not only is this an important view of the incredibly convoluted processes involved in attempting to get health care, but Stoner's blog entry also has a very interesting set of reader comments that further amplify discussion of the issue. Go give it a read and let us know your thoughts.

SOURCE: "Criminal Health Care" 03/10/08
Artwork: "Red Tape Machine" by Dustin McGahan, courtesy of grifray, used under this Creative Commons license

Ethnicity and American Health Care

The concept that different ethnicities view their health care experiences in very different ways is one that just keeps surfacing. Less than a month ago, I was posting about the inadequacies of American health care as seen from the perspective of our country's Asian and Pacific Islander communities. Now Kevin Freking of the Associated Press examines the issue.

Before he digs down into the hard numbers, Freking notes that there has long been the view amongst researchers that improved patient perception of care is extremely important and can influence the outcome of health care issues. The reasoning is that if someone has a bad experience with their provider, they will tend to spend less time with that provider. Negative interactions can also contribute to poor communication between the patient and their medical professional (a subject I addressed in my post a month ago).

The foundation of the article is a survey done by researchers from Harvard University and the Robert Wood Johnson Foundation. 4,334 adults were interviewed last year and asked a variety of questions such as how quickly were they able to get appointments when injured and whether the doctor explained things to them in a way they could understand.

The results show an average of 10 - 20% percent lower positive responses from ethnic minorities.

When it came to getting an appointment, about 63 percent of whites were able to get an appointment on the same day or the next day after they became sick or injured. That percentage dropped to 42 percent for Cuban-Americans and 39 percent for African-Americans born in the Caribbean.

One major difference in how this particular study was conducted is that it used much more detailed categories. Prior studies of ethnic disparity in health care looked at the major ethnic groups, even though there can be marked differences between members of the same group due to country of origin. The Harvard study aimed a microscope at these groups, breaking them down into smaller cultural subsets. Instead of surveying all African Americans as a single ethnicity, the study broke them down into three sub groups based on country of birth: Caribbean, African, or American born.

Dr. Anne Beal, assistant vice president at the Commonwealth Fund, said the latest study results are consistent with previous research of how minority patients view the quality of their health care. She said perception is reality when it comes to patients being treated with respect.

"Because the findings are so consistent, it's not something where we can say it's just about the patients," Beal said. "They are reporting their experiences and the results should be taken seriously."

SOURCE: "Health Views Differ Along Ethnic Lines " 03/10/08
photo from Louisville African American Think Tank's Health Summit (Feb 8-10, 2008) courtesy of Sprigley, used under this Creative Commons license

Massachusetts Health Care: The Country is Watching

James Roosevelt, Jr., is a man who knows health care fairly well. He is President and CEO of the Tufts Health Plan, and when not engaged with that, he acts as the chairman for the Massachusetts Association of Health Plans. Roosevelt was kind enough to share his opinion of the current state of health care affairs in Massachusetts with Boston's WBUR 90.9 recently:

When the topic turns to access to health care, we should prepare ourselves to hear Massachusetts’ efforts for health care reform referenced as either visionary or as a cautionary tale of misguided public policy. While I continue to be unwavering in my support of health care reform, the true answer on its success is really yet to come.

In order to succeed, what we must do next is grapple with health care costs in a manner that hasn’t been done before. Massachusetts is the perfect laboratory in which to create real change.

He exhorts the provider community, the Commonwealth's Quality and Cost Council, and many other groups to come together in an effort to "leverage their common goals for the greater good."

He also speaks highly of the efforts of Senate President Therese Murray for taking decisive action in that regard. Her focus on funding electronic medical records and pledge of $25 million per year to implement them is only the beginning. He applauds her efforts to bring transparency to both providers of health care and insurance in order to identify the segments of health care that truly drive cost increases.

Using wellness programs enacted in the Tufts Health plan as illustrations he calls for individuals to take a more active role in their own health. Wellness programs are an important factor, he states, in reducing overall health care costs.

While many of these points are familiar to readers of this blog and to those who have been following the health care debate, Roosevelt presents them as part of a clarion call to the citizens of Massachusetts. After all, as he correctly states it, "The country is watching."

SOURCE: "HEALTH REFORM SUCCESS DEPENDS ON OUR WILLINGNESS TO GRAPPLE WITH HEALTH CARE COSTS " 03/10/08
photo courtesy of altemark, used under this Creative Commons license

Critical Condition: Tom Daschle Speaks Out on American Health Care

On the AFL/CIO's Blog is a very interesting piece about former Democratic Senator Tom Daschle who was a speaker on March 5 at the Center for American Progress in Washington, D.C.

At $2 trillion per year, the United States has the most expensive health care system in the world (16% of our economy and rising), but the results it produces are poor when compared to other nations.

Although Sen. John McCain (R-Ariz.) claimed on Tuesday night that the United States has “the world’s best medical care,” Daschle said that what we actually have are “islands of excellence in a sea of mediocrity,” with the highest-quality options for those who can afford it and inadequate or inconsistent service for millions more.

Daschle critiqued the myths and outright lies spread by opponents of health care reform. Among them, that any change to the system would be “socialized medicine,” which Daschle says creates a false choice. Opponents also claim we “can’t afford” reform, even though the flaws in the system are raising costs.

Among the other topics Daschle addressed were the following:

1. Reform would require "rationing." According to the former Senator, the differences in quality of care, access to care, and a pattern of claims denials under the current system already creates "the worst kind of rationing."


2. The desperate need for true leadership on the issue, especially from the President's office. To illustrate, he referred to the recent Presidential veto of SCHIP by President Bush.


3. The McCain approach, which he refers to as "cost shifting" without any real tangible gains.

All in all, the Senator's views continually stress effective political leadership as the key element needed to enact true and lasting reform. Take a look at what he has to say and let us know your opinion.

SOURCE: "Daschle: America’s Health Care System in Critical Condition" 03/06/08
photo courtesy of NARA/EPA via pingnews, used under this Creative Commons license

400 Thinkers: The Mayo Clinic Symposium on Health Care Reform

Next week, 400 of the leading thinkers in our ongoing health care debate will converge on Lansdowne, VA, to participate in the Mayo Clinic Health Policy Center's Second National Symposium on Health Care Reform. Speakers and panelists at the event will include Former NBC anchor Tom Brokaw, former CNN Anchor Aaron Brown, Ceci Connolly of The Washington Post, Mayo Clinic President and CEO Denis Cortese, M.D., The Commonwealth Fund's Karen Davis, M.D., Joanne Silberner of NPR, and many, many more.

The symposium will run March 10-11 and will include a varied and interesting schedule. Once the welcome and overview portion of the proceedings is finished, they will be diving in with both feet as Brokaw leads discussions about how we, as a nation, can create the needed environment to enact change.

Brokaw will then lead a session examining the Mayo Clinic Health Policy Center's reform principles and approach. Following this session, Silberner, NPR's national health correspondent, will moderate a "real world reality check" of those principles. In my opinion, Silberner's session will be a vital one, as public perception and acceptance of these reform principles is a vastly important metric when looking at their viability.

More panels include one examining and comparing the various reform plans touted by our presidential hopefuls, and one on the creation of action plans for viable reform. All in all, it looks like quite an information-packed two days.

I was quite pleased to see that Lee Aase, the new social media guy over at the Mayo Clinic, has been doing a wonderful job of making sure that this event hits the Internet in a big way. The mere fact that his position exists at the Mayo Clinic speaks well of their awareness of current technology and its impact on the debate.

Aase's Health Policy Symposium Blog is only the first step:

We’re using this blog and other web tools to extend the discussion to everyone who wants to participate. All of the symposium’s general sessions will be made available live via streaming webcast, and also will be archived for later viewing and listening. I will be live-blogging the symposium here, and we will have an open comment thread available during each discussion for anyone to share ideas and opinions.

If you want to engage in the discussion here on this blog, that’s great. If you’d prefer to write on your own blog and link to the relevant posts here, that’s even better. We accept and encourage trackbacks. To help bring the conversation together, please also tag your posts MayoHealthPolicy08, as this one is.

I will certainly be following up on this, despite my inability to make it to the actual event. Watch for follow up commentary early next week!

SOURCE: Mayo Clinic website 03/04/08
SOURCE: "Health Policy Symposium Blog"
photo courtesy of idogcow, used under this Creative Commons license

Health Care: It's All About Access

Access: noun, The right or opportunity to use or benefit from something.

Jeanne M. Lambrew, Senior Fellow at the Center for American Progress and an associate professor of public affairs at the Lyndon B. Johnson School of Public Affairs at the University of Texas, is a specialist in health care and policy. She conducts research on the uninsured, Medicaid, Medicare, and long-term care. On March 5, she delivered a stirring and fact-laden testimony before the United States House of Representatives on the subject of health care access. (Full text of the testimony along with a downloadable PDF version is available on American Progress.)

One wonderful thing about the Lambrew testimony is her ability to put things into realistic terms. For example, we often hear the statistic "47 million uninsured Americans" quoted throughout the media and the web (including here on this blog), but her testimony provides illustrations of just how much of the population that represents:

Nearly one in five of all Americans reports needing health care but not being able to access it due to cost. This largely results from lack of health insurance. About one in six Americans lacks health insurance at any point in time. To put this into perspective, 47 million uninsured Americans is double the number of people with diabetes. It is also more the number of people who live on the entire west coast of the United States or in Canada (Figure 1). This estimate does not capture all the people affected by gaps in coverage. Looking over a two-year period, a government study found that 82 million – one-third – of all non-elderly Americans experienced a gap in coverage (Figure 2). Research suggests that access for people with short gaps in coverage is more similar to the long-term uninsured than insured population.

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The entire testimony is well worth the read. As you can see from the slideshow above, she covers a lot of ground dispelling misconceptions such as the demographics of the uninsured. (Did you realize that four out of five uninsured are not below the poverty line, but rather are from working families?) She covers economic and racial disparities, analyzes trends that have contributed to to these "grim statistics," and examines the differences the issue takes on as you cross state lines.

She closes with three comments on approaches to reform which I will summarize here:

1. The paramount importance of addressing coverage and cost issues together.


2. To be effective, any solution must be national in scope. 50 different reform efforts would add hopeless complexity to an already complex situation.


3. The perfect should not be the enemy of the good. Purism should not be stressed over pragmatism.
   

My own summation of this moving and erudite assessment of our current health care "non-system" is that it is well worth the read. Drop us a line and let us know what you think about it.

SOURCE: "Access to Health Care: Testimony Before the House Committee on Appropriations, Subcommittee on Labor, Health and Human Services, and Related Issues" 03/05/08
photo courtesy of Ben Zvan, used under this Creative Commons license

Consensus Among Voters, Candidates Out of the Loop

Regular readers are aware of the efforts of Kathleen O'Connor over at Code Blue Now! The last time we checked in on her efforts was back in January when we shared her efforts to poll the voting public for their input on what would constitute a national health care solution.

Well, she is at it again. Now that the numbers are in from their surveys, CodeBlueNow! has released their findings, many of which agree with George C. Halvorson's proposals in Health Care Reform Now. The Seattle Business Wire brings us the details and information collated for CodeBlueNow! by the Gilmore Research Group of Seattle, WA:

Republicans, Democrats and Independents typically think very differently about many issues. But when it comes to health care, widespread agreement exists among all voters on key issues including:

• Universal coverage
  
• Basic benefit package
  
• Support of preventive care over high-tech cures
  
• Health care as a shared responsibility of employer, individual and government

There was also universal agreement that a basic benefit package should include many licensed health care professionals, not just medical doctors. Ironically, none of the current candidate proposals would gain support from the public because the proposals don’t address concerns across party lines or the concerns of Independents.

To see how the results of this research compare to the plans proposed by our Presidential candidates, you can download a PDF which graphs the results. It's available on the front page of the Code Blue Now! website. It is quite interesting to observe how many times the phrase "no provision," appears next to almost every candidate's name while you go through the data.

Members of the CodeBlueNow! Honorary Board see this data as confirmation that a Voters Health Care Platform of a non-partisan nature could become a reality. If so, that platform could serve as the bedrock for effective reform efforts that cut across the rigid ideological lines of the established parties. Governor Richard Lamm (D-CO), also on the organizations honorary board, said, "It is lack of political courage -- not lack of public support -- that keeps America from Universal Coverage."

[O'Connor] says the findings about Independents are particularly interesting in this election year, because Independents are seen as a key voting group for the presidential candidates.

“The key is Independents. They shift back and forth between Republicans and Democrats depending on the issue. This means we have the chance to have a safe, problem-solving conversation that won’t explode in our faces. We Americans have more in common than we are told. We shine as a people when we toss aside party lines and focus on solving a problem.”

SOURCE: " New Research Commissioned by CodeBlueNow! Finds Surprising Agreement on Health Care Reform But None of the Current Proposals by Either Party Are Supported" 03/03/08
SOURCE: "CodeBlueNow!" 03/03/08
photo courtesy of tsanfranannie, used under this Creative Commons license

Health Care, Pharmaceuticals and Investments

Do you remember the piece I wrote a few days ago about health care costs doubling by 2017? Well, today I am going to revisit that topic by sharing with you an article by Brian Lawler I found on the investment website The Motley Fool.

Why would I share an article on investing here, you might ask? Because it provides a window into some of the economic forces that are driving the health care industry. Lawler references the Centers for Medicare and Medicaid Services (CMS) forecast which shows aging baby boomers creating one of the largest demographic shifts on record. As these boomers begin reaching the age where they will be relying on Medicare/Medicaid, and the attendant prescription drug plans, the pharmaceutical companies will be raking in larger and larger profits. Or will they?

While this forecast for increased prescription-drug spending might be a positive omen for the pharmaceuticals industry, the reality is that if health-care spending does jump to a fifth of GDP, there will be a lot of pushback from government and private health-care payers. For example, as we're seeing now, the leading presidential candidates are agitating to allow prescription-drug importation from less-costly developed countries, or to give Medicare and Medicaid more direct negotiating power over drug prices.

Nonetheless, there are strong demographic trends favoring the pharma industry. With the large dividends that many large-cap drugmakers like GlaxoSmithKline (NYSE: GSK) pay out and the relatively recession-proof nature of the pharma industry, investors should keep a keen eye on the sector in the coming years.

As the citizens of the U.S. push for reform in our health care system, it would be wise to keep in mind that economics and political lobbies are a very large factor in what decisions and legislation actually pass. A quick scan of the dollar amounts donated by pharmaceutical companies and their lobbyists to the current batch of presidential hopefuls speaks volumes about the industry's influence.

I would love to hear some input from anyone with an investment background on this issue. Please leave us a comment if you have views you would like to share.

SOURCE: "Medicare, Health Care, and Megabucks" 02/28/08
photo courtesy of holding.me, used under this Creative Commons license