The President Elect Faces Hard Work On Health Care

So history has now been made. On January 20, 2009, our 44th President will take his place as Commander-in-Chief. That man will be Barack Obama. With the vast majority of health care organizations backing his plan, and a seeming mandate from the people, he should be in a position to rapidly enact change, correct? Well.....no. Not really.

You see, like everything in life, health care reform is going to cost. With $700 billion recently allocated to the financial bailout, I would be willing to wager that purse strings are going to be a bit tight. Then you add in the $455 billion budget deficit. To be blunt, I think it could be a fight for every penny. Of course, the one thing that is a huge variable, as his winning campaign has shown all along, is President Elect Obama's seeming mandate from the people. How much leverage will that give him with Congress?

Maggie Fox, Health and Science Editor over at Reuters shares some optimism from the Senate floor:

But Senate Majority Leader Harry Reid predicted the momentum for change would be there. "We have no alternative," Reid told National Public Radio on Wednesday morning. "A wave of hope has swept the country."

Reid said Republicans would not dare to block legislation, given Tuesday's voter mandate.

The next few months are going to be very interesting....

SOURCE: "ANALYSIS-Even with mandate, Obama faces health care pain" 11/05/08
photo courtesy of EricaJoy, used under its Creative Commons license

Is More Comprehensive Health Care Reform Actually Cheaper?

Ezekiel Emanuel thinks it is, and he says he has got a plan. Starting from the premise that incremental changes involve more fees which mount up to an overall higher cost, sweeping changes and fundamental reforms can be made for substantially less.

In his piece on The Huffington Post last Tuesday, Emanuel goes into detail, reviewing the proposals and expected costs of each presidential candidate's health care platform in detail. That alone makes it a good read; however, that is not where it ends. He then goes on to make the case for the affordability of universal coverage.

The biggest surprise is that even more comprehensive reform, not only achieves universal -- true 100% -- coverage of all Americans but does so while controlling costs. Prof. Victor R. Fuchs and I have proposed Guaranteed Healthcare Access Plan. It phases out employer-based insurance, Medicaid, and Medicare. Instead each American would receive a voucher to buy a standard benefits package modeled on the federal employee health benefits plan through regional insurance exchanges in which private health plans would compete. Workers would receive a pay increase from their employers who no longer pay for health care; state taxes decline because states no longer have to devote 32% of their budgets to health care. The plan is financed by a value-assed tax.

Emanuel continues in this vein for quite some time, elaborating on their approach and reasoning. All-in-all, a fascinating perspective and one that is well worth looking at as we enter the last two weeks of the election. It bears many similarities to the Wyden-Bennett plan I have written about in earlier posts in that it assures Americans portability, guaranteed enrollment, and precludes exclusions for any pre-existing conditions. Follow the source link below to read his entire article.

SOURCE: "More Reform is Cheaper: The Paradox of Health Care Reform" 10/21/08
photo courtesy of a.drien, used under its Creative Commons license

Economics and Health Care in Utah

In the first of what I feel sure will be many articles examining this topic, The Salt Lake Tribune looks at some of the ramifications the current economic crisis is already having on American health care. This particular piece looks at the increasingly dire situations faced by the residents of Utah.

From the obvious implications such as people skipping routine care to conserve finances to the not so blatant ones like the fact that low income residents who rely on Medicare or Medicaid are also skipping these procedures because they are unable to afford the costs of transportation. If you add in the increase in health problems caused by stress and bouts of economy-induced depression amongst the populace, the picture gets more and more grim.

Heather May and Lisa Rosetta report:

Scrimping Utahns are skipping preventive checkups and forgoing needed dentures and crowns. More are seeking treatment for depression and anxiety. They're lining up for nearly free health care or heading to emergency rooms.

Or they simply suffer until they can afford to care for their out-of-control diabetes or festering wounds.

"It takes a lot on one's body and soul even," said Shawna Zink, of Magna. "I'll be 45 this month and I feel like sometimes I'm 60."

The article in question provides a disturbing view of the trends that seem to be beginning to take hold, showing why the need for immediate reform of American health care is essential. It is an unsettling read, but one that I advise. Let us hope that the incoming administration is able to implement substantive reform in time to avert more stories like this one.

SOURCE: "Cash woes bruise health" 10/13/08
photo courtesy of Kugelfish, used under its Creative Commons license

Economy vs. Health Care

Everything that happens lately does so to a back beat of economic fear. As the DOW plummets and venerable banking institutions fall to pieces, there is little that is not infected in some way or other by the watchful unease (and yes, outright fear) of American eyes watching the economy as it seems to spiral down the drain.

The question before us in this blog is how does this fear of coming recession -- or if some are correct depression -- affect health care spending by the citizens of America? Simple application of logic dictates that as belts get tightened, essential routine health care expenditures would fall by the wayside. How closely does this train of logic resemble fact?

Via CIGNA press release on MarketWatch:

According to recent CIGNA surveys, about one-third of Americans say yes, the economy has changed the way they take care of themselves. Of those, 55 percent report taking better care of their health by exercising, eating healthier or getting regular check-ups and screenings, while 41 percent say they are taking worse care.

Among those who are taking worse care of themselves, more than one-third (35 percent) say they're not going to the doctor regularly or at all, while 17 percent say they're taking their medications less often or not at all. Ten percent say they can't afford to eat properly or are eating less healthy foods.

The survey goes on to point out long term cost savers built into many policies, things like regular checkups and preventative screenings. I would consider it advised reading, especially if the new austerity ends up lasting awhile.

SOURCE: "The Shaky Economy: Is it Changing the Way People Take Care of Their Health?" 10/08/08
photo courtesy of Epicharmus, used under its Creative Commons license

The Veterans Health Care Budget Reform Act

Even though my father is deceased, I still remember the trials and tribulation he underwent during the years following Viet Nam. Suffering a 100 percent disability, he logged many hours with doctors and even more in attempting to deal with the complexities of the way we handle the health care of our country's veterans. Despite attempts to make sure that I heard none of it, I often overheard discussion between my parents about the troubles they constantly had with delays and shortfalls in the system.

Enter a few courageous U.S. Senators and Representatives and The Partnership for Veterans Health Care Budget Reform.

This partnership, which represents almost 8 million members, came out last Thursday in support of legislation presented in Washington by Senate Veterans' Affairs Committee Chairman Daniel Akaka (D-Hawaii), House Veterans' Affairs Committee Chairman Bob Filner (D-Calif.), and a variety of bipartisan co-sponsors to introduce major and historic reforms in veterans health care. Focusing on budget reform, the goal is to provide "sufficient, timely and predictable funding for veterans' health care programs."

The partnership itself is a group comprised of AMVETS, Blinded Veterans Association (BVA), Disabled American Veterans (DAV), Jewish War Veterans (JWV), Military Order of the Purple Heart (MOPH), Paralyzed Veterans of America (PVA), The American Legion, Veterans of Foreign Wars (VFW), and the Vietnam Veterans of America (VVA).

Via MarketWatch:

The new legislation, called the "Veterans Health Care Budget Reform Act", would authorize advance appropriations for Department of Veterans Affairs (VA) health care programs one year in advance of the start of the fiscal year, an idea favored by more than 80 percent of American voters, according to a survey released today by the Disabled American Veterans.

The Veterans Health Care Budget Reform Act would also require the Government Accountability Office (GAO) to audit VA's budget forecasting model and report to Congress and the public on the integrity and accuracy of the model. With these estimates in hand, Congress would be greatly enhanced in their ability to develop and enact sufficient funding levels for VA health care.

"While funding levels have increased in recent years, particularly over the past two years, Congress has failed to approve a new VA appropriation bill on time for 19 of the past 21 years," said DAV Commander Ray Dempsey. "Our polling results show that the American people overwhelmingly support a proposal to have Congress approve VA's health care funding one year in advance to once and for all end these delays," Commander Dempsey said.

If this works, it should drastically reduce the number of conversation like the ones my parents did not want me to hear. No matter what opinion one may have of the various wars and conflicts in which these men participated, the fact remains that they fought to protect us here at home. We owe them the best we can offer.

SOURCE: "Historic Legislation to End Delays in Veterans Health Care Funding" 09/18/08
photo courtesy of NARA via pingnewsused under its Creative Commons license

Billions in Medical Costs Saved by Tobacco

I smoke. I wish I did not. I've been trying to quit for almost two decades now with pathetic results. I know it is important to my health and increasingly to my wallet as well. Unfortunately, I must admit my addiction. What is really boggling to the mind is a recent study by researchers at the University of California that shows an unexpected way that smoking effects us all financially: health care costs. Now I know everyone is aware that health cost are higher for smokers, but this report brings a whole new perspective to things.

California's state Tobacco Control Program has saved $86 billion dollars (in 2004 dollars, FYI) in individual health care costs during its first 15 years in place.

Via Science Daily:

During the same period, the state spent only a total of $1.8 billion on the program, a 50-to-1 return on investment, according to study findings. The study is the first that has been able to quantifiably connect tobacco control to healthcare savings, say its authors.

The savings come from the 3.6 billion packs of cigarettes that were not smoked as a result of these programs between the beginning of the Tobacco Control Program and the end of the study in '04. While great for health care consumers, I am sure the tobacco industry is not happy. Those lost sales account for $9.2 billion dollars in sales.

Now those of you familiar with George C. Halvorson's position on chronic conditions are aware that he considers them to be a lion's share of overall health care expenditures. Numerous studies indicate that lung cancer and heart disease -- both of which are inextricably linked to smoking -- are very high on the list of those chronic conditions. With that info in hand, these findings are hardly surprising, but it is the fact that this study presents the first verifiable link between attempts at tobacco control/regulation and health care savings that is a landmark.

Go on over and give the original article a read. There is a lot of documentation and a very nice run down on how they collected and analyzed their data.

SOURCE: "California Tobacco Control Program Saved Billions In Medical Costs" 08/26/08
photo courtesy of Saudi, used under its Creative Commons license

Uninsured Health Care Spending: $30 Billion Out of Pocket

There is a new report from researchers at George Mason University in Fairfax, VA, and the Urban Institute think tank in Washington, D.C. The findings are disturbing. Discussions about health care costs are generally an unsettling course of conversation these days. The dollar signs seem to keep mounting up.

Jane Zhang of The Wall Street Journal reports:

Americans who lack health insurance will spend about $30 billion out of pocket on medical care this year, but others -- mainly the government -- will end up covering another $56 billion in costs, according to a new study.

A grand total of $86 billion? That is quite a pretty penny. The health care equation is most certainly one that tends to produce and incredible amount of dollar signs. Let's take a look at a bit more detail:

The new study estimates the government pays 75%, or $42.9 billion, of the amount uninsured patients can't pay -- through Medicaid, the federal-state health-insurance for the poor and Medicare, the federal program for the elderly and disabled, as well as state and local taxes.

So if the government is paying, that means the money is ultimately coming out of the pockets of the taxpayers. State and local taxes are just the beginning. The other programs listed above all derive their revenue from the tax base as well.

There are a huge variety of factors that play into the final cost of any health care procedure, payment rates tend to fluctuate according to the method by which they are negotiated. The complexity of the issue is succinctly set forth later in Ms. Zhang's article:

Complicating the measure: Some doctors and hospitals donate time and forgo profit to cover poor people, and in some cases private donations cover the costs. Just how much money doctors and hospitals lose in caring for the uninsured is difficult to pin down, partly because group plans often negotiate lower payment rates than other consumers are billed. For this study, Mr. Hadley of George Mason University defined uncompensated care as the difference between how much the uninsured paid and what the providers would have received had those patients been privately insured.

So the net end result, according to the study, is that the majority of the monies used to defray the health care costs of the uninsured end up showing vastly more of an impact on our taxes than on the insurance premiums of those with private policies.

It is predicted that this report in conjunction with the two being released by the Census Bureau today will re-energize the debate about health care reform and health care costs. The Census Bureau reports will focus on income, poverty and the uninsured, and are sure to bring more attention to the issues covered here.

SOURCE: "Uninsured to Spend $30 Billion, Study Says" 08/25/08
photo courtesy of Saad.Akhtar, used under its Creative Commons license

72 Million Find Health Care Bills a Burden

Bloomberg has an interesting article up by Aliza Marcus in which they take a look at the impact that health care costs are having on the average American. By now, everyone is familiar with the fact that 47 million people in the US have no coverage. What you may not be aware of is that for a grand total of 72 million people, the cost of health care is a major issue.

Documentation of the 34% rise in cost over the past two years via Bloomberg:

An estimated 72 million adults under age 65 have difficulty paying their medical bills or are paying off debt from health-care expenses, based on the survey, taken last year and released today by the Commonwealth Fund, a health-policy center in New York. Sixty-one percent of those struggling said they had health insurance.

As someone who has been paying off medical bills from a bout with kidney stones since 2004, I can relate. When viewed from inside the queue, the costs are monolithic, especially on a writer's pay. For the average Joe, it can often become a choice between health care or a roof over your head. Not a pleasant decision to make.

Based on the newer survey, 28 million Americans used all their savings on medical expenses, 21 million built up substantial credit-card debt and 21 million couldn't pay for basics such as food, heat or rent.

"Working people are struggling to pay their bills and accruing medical debt,'' said Sara Collins, the fund's assistant vice president, in a statement.

I used to have savings. Really, I did. Thankfully, I have not hit the point where it becomes a choice between the bill and groceries, although there have been months where it went unpaid in order to ensure that I could put food on the table. It gives me an unfortunate inside view of the situation.

Having coverage does little if the bills are unpayable. This is why cost-reducing measures like the enforcement of industry wide standards and practices and implementation of electronic medical records are so important.

SOURCE: "Medical Bills Burden 72 Million Working-Age Adults in U.S. " 08/20/08
photo courtesy of Ashley Pollack, used under its Creative Commons license

What's Wrong With US Health Care: Jane's Story

Karen Hover is a doctor in Maine. As such, she is in a prime position to note the shortfalls, mistakes, and outright failures of the American health care system. On Monday, she wrote a guest OpEd column for The Bangor Daily News in which she puts a face on these wide and dangerous gaps in the way we take care of our sick.

In it, she relays the story of "Jane" (not her real name), an administrative assistant who suffered an accident that broke both her elbows after falling off a roof. As you might imagine, the splints used to immobilize the fractures stretched from fingers to armpits. She rapidly discovered that the splints kept her from being able to do, well, anything.

"I couldn’t scratch my nose, or feed myself, or get a glass of water, or pull my pants down." She needed around the clock care. Jane called her insurance company, which told her that her plan included 100 days of skilled care.

Arrangements were made to go to a rehabilitation facility on Friday, which was good because Jane’s friend had to go back to work. When Jane arrived, around noon, administrators told her that the insurance company had denied her claim and that she could not be admitted because she had no need for skilled medical care. After a couple of hours on the telephone, no one had a better idea, so she was sent back to the emergency room. By this time, she needed to go to the toilet, but staff refused to take her because of fear of liability. Her ex-husband helped her.

Can you imagine? Not the runaround -- that is something we have all come to expect (at least those of us who have had to deal with the health care system directly) -- but the treatment. Imagine yourself with both arms in splints, bladder bursting, lots of people around whose job is to help you, and yet no one does. This points up an aspect of the current system I do not often get to touch upon: the fact that often there seems to be no attempt made to help a patient preserve basic dignity.

The emergency room was packed. She was seen by a doctor who asked her if she had cash to pay for a hospital room. He talked to her about going to a local shelter. Jane was hungry, dirty and in pain. "I just need someone to take care of me," she said. A stranger who had been following the story brought Jane supper at 10 p.m. and fed it to her. She was admitted at midnight.

Jane's adventures are far from over though. It took another eight days of refusing her claim before the insurance agency came around and had her transferred to a rehab facility. Sounds like things should have been fine from there on out, doesn't it? Unfortunately not.

She was sent to the same facility that had treated her so badly before and spent three weeks there, enjoying inappropriate food, an accidental injury, an often unclean toilet, miscommunications between staff and her orthopedist, and a banging door that prevented sleep. The splints were removed. Jane went home with a new case of athlete’s foot. She learned to use her arms again and is now back at work. She feels her family and friends were very supportive.

No, this is not a scene from Stephen King's The Kingdom. It is yet another homegrown horror story cultivated right here in the United States. This is why we need to keep health care at the forefront of the Presidential debate, to stop this from happening.

For Jane's sake.

SOURCE: "Karen Hover: How our health care system failed Jane" 08/11/08
photo courtesy of hypertypos, used under its Creative Commons license

Fed Up Consumers Vote With Their Actions

High costs. Long lines. Horror stories about quality issues and errors in care. These are the things that come most easily to mind for the average American when the topic of health care comes up.

The last time I had to wait in the emergency room, I was there for 9 hours before I even got any pain killers. Since I was there due to an attack of kidney stones you may imagine how displeased I was. For those lucky enough not to have had experience with these vicious little mineral deposits, they are painful enough to leave you doubled over in agony unable to function. One friend of mine who has both given birth to twins and had kidney stones tells me the stones were more painful. Based on my experience, I can believe it.

The bill was extraordinary and even with insurance I am still paying it off four years later.

This makes it hardly surprising that two topics I have written about here on the Health Care Reform Now! blog are rearing their heads again as many Americans embrace them attempting to avoiding our own system's well documented pitfalls. I speak of medical tourism and the growing number of retail health clinics opening up in big box stores like Walgreens and Wal-Mart across the country.

Via Linda Johnson at SFGate:

The number of people heading abroad for "medical tourism" could jump tenfold in the next decade, to nearly 16 million Americans a year seeking cheaper knee and hip replacements, nose jobs, prostate and shoulder surgery, and even heart bypasses, according to a forecast by health care consultants at the Deloitte Center for Health Solutions.

Meanwhile, the number of retail clinics operating in pharmacies, big-box and discount stores and supermarkets has jumped from about 200 in 2006 to nearly 1,000 last month, according to a second report from the Deloitte center.

[...] The two reports show potential big savings for U.S. consumers - and probably their health insurers - would come at the cost of American hospitals and doctors losing billions of dollars a year in revenue.

"Significant numbers of people are willing to vote with their feet to try something different, whether it's retail clinics or medical tourism," said Paul Keckley, the center's executive director. "U.S. providers are having to pay attention."

Ms. Johnson focused her article more on the medical tourism aspects, examining the benefits, drawbacks, and some very interesting arrangements made with American hospitals for pre- and post-procedure care. Even so, she does cover the rise of medical clinics like the one in my local Walgreeens that are rapidly assuming an important place in the health care landscape.

SOURCE: "Americans look abroad to save on health care - Medical tourism could jump tenfold in next decade" 08/03/08
photo courtesy of eowin, used under its Creative Commons license

The Swiss Approach

One of the things George C. Halvorson stresses in Health Care Reform Now! is that we should look at the systems in place around the world that provide universal care. Not with the idea of adopting a foreign system outright, but rather in order to see what elements we might be able to adopt in order to create a truly American system responsive to our particular needs as a nation. That element of his approach came to mind for me early this morning while listening to NPR with my wife this morning over coffee.

This morning, they aired a program which delved into the way the Swiss system works, and it seems to me that there are a lot of things to consider in their way of administering health care.

Via NPR:

At first glance, Switzerland's health care system looks like it could be the perfect political compromise for the United States.

As Republicans would prefer, individuals — not employers or the government — choose from a broad array of health plans, sold by private insurance companies.

And as Democrats urge, everyone in Switzerland has health coverage (it's required by law), with the government providing generous subsidies for those who couldn't otherwise afford it.

NPR goes beyond that first glance and delves into the system in detail. One of their findings is important but hardly shocking: rising costs are a major issue. While Switzerland's 7.5 million people are very happy with the system as it stands they are not immune to the rising costs that are such an important issue during our own health care debate.

There are many things about their system that are appealing, and the public satisfaction level is unparalleled in the United States. One of the ways in which the Swiss operate (pardon the pun) is that insurers are not permitted to make a profit on basic health plans.

Where Swiss health insurers can and do make profits, however, is on supplemental coverage. This is for things like dentistry, alternative medicine (which is popular in Switzerland), and semiprivate or private hospital rooms. For 30 francs per month, Cecile and her husband have a supplementary policy that covers, "for example, all kinds of prevention, not-on-the-list medication, help at home, glasses, transport, alternative medicine. That's a good one," she says.

Jue Rovner's article for NPR is well worth the read. She speaks with a family that has lived both here in the US and in Switerland and are able to make direct comparisons between the two systems. One thing I found really interesting was the difference in mindset she reveals between the way the Swiss and Americans view the idea of social safety nets such as universal care. Cecile Crettol-Rappaz, one of the women interviewed, states it pretty succinctly:

"You are so used to having this individualistic way of thinking, and that's why you don't have these social [safety] nets. You still have this pioneer mentality where everyone has to take care of themselves."

All in all this is great source material for the debate. I wonder how much attention it will get over the next four months or so.

SOURCE: "In Switzerland, A Health Care Model For America?" 07/31/08
photo courtesy of Fr Antunes, used under its Creative Commons license

Clinics Without Doctors

In Washington state, an experiment in accessible health care has been launched. Multicare Express has opened two clinics in the back of local Rite Aid stores, an approach that seems to have legs despite the absence of actual medical doctors in those clinics.

Via Rob Carson of The News-Tribune:

For a flat fee of $59, an advanced registered nurse practitioner will usher you into a 9-by-14-foot exam room (immediately, in most cases) and conduct a routine exam. Lab equipment is limited but adequate for diagnosing common illnesses such as strep throat, earaches, flu and urinary tract infections. The clinics can handle pregnancy tests, adult immunizations and sports physicals.

No appointments. No waiting rooms. No insurance requirements.

No doctors, either, but the ARNPs are fully equipped to diagnose most basic problems and write most prescriptions.

“It’s a new way for patients to enter our system, and it’s a convenience for consumers,” said Kristopher Kitz, a MultiCare business strategist. “Primary care facilities in Pierce County are at capacity, and this is a way to ease that burden.”

Clinics in retail outlets have been opened before -- there are close to a thousand of them across the country -- but despite many advantages, their numbers are actually experiencing a slight drop over this past year. Analysts within the health care industry have stated that the worsening economy combined with the fact that investors did not truly understand the commitment of finances needed to make it work have caused the recent reduction.

Enter MultiCare, an established hospital system that is bringing electronic medical records among other advances to the equation. The fact that they will accept most forms of insurance including Medicare and Medicaid is a major point in their favor especially considering the already reduced pricing.

MultiCare will be holding grand openings at the clinics on August 15 and 16 with free espresso, sodas and an appearance by Tacoma Rainiers’ mascot, Rhubarb.

SOURCE: "CLINICS OPENED AT TWO TACOMA-AREA RITE AIDS- Multicare Express an experiment in health care" 07/30/08
photo courtesy of dpade1337, used under its Creative Commons license

Checkup: Reducing Costs By Paying More

You've all been there. Sitting in a sterile waiting room while you fidget. Finally hearing your name called, allowing you a few precious moments with the man in the white coat. While you are waiting, time seems to drag, but once ushered into the presence of a physician it suddenly seems to kick into overdrive. You can hardly believe that you were in and out so quickly.

It begs the question: can adequate care really be given in the rushed format in which most doctors see their patients?

One answer offered also claims to be a route towards decreasing medical spending. In short, the idea of paying doctors more to take time with their patients (a permutation of the Medical Home concept) to prevent massive costs down the line. It is a grand experiment on the part of a group of state and federal government agencies in conjunction with a number of insurers.

Milt Feudenheim at The New York Times gives us two pages of analysis and commentary on the idea. Here is an illustration of the difference taken from that article:

For want of a careful examination by a primary-care doctor, Mr. Williamson became one of countless Americans each year whose unidentified or under-treated illnesses escalate into medical conditions with catastrophic personal and economic costs. Besides incurring $30,000 in hospital bills paid by his employer’s insurer, Mr. Williamson had to stop working as a customer service representative at Philadelphia Gas Works and go on Social Security disability, at a current cost to taxpayers of $1,900 a month.

With Mr. Williamson’s new doctor, such an outcome would be much less likely.

“I give him my heart and diabetes readings by e-mail and phone, without getting up out of my chair,” Mr. Williamson said. “I can get better directions, at the very moment I need them. It’s life-saving.”

His current internist, Richard Baron, is one of more than 100 physicians in metropolitan Philadelphia taking part in the experiment, which is being conducted jointly by some of the region’s largest insurers. Dr. Baron still gets a fee of only about $64 for each office visit. But his five-doctor group will also receive $200,000 to $300,000 this year beyond their regular fees to keep better track of their 8,400 patients.

“We are trying to do more e-mail care and telephone care, which we haven’t been paid for in the past,” Dr. Baron said.

Insurers are conducting similar pilot projects in at least a half-dozen states, in experiments involving thousands of doctors and nearly 2 million patients. Many more are in the planning stages, at the urging of health policy experts and employers that provide medical benefits.

The big government health care programs, Medicaid and Medicare, are also studying the concept. A Medicaid experiment already under way in North Carolina saved the government program in that state about $162 million in 2006. That was 11 percent less than the state would have spent under the old system of reimbursement, according to an audit by Mercer, a consulting firm.

This looks like an idea that might have legs. It is axiomatic that more careful and comprehensive care should drastically reduce the longterm costs of health care. Whether this approach will yield a solution or not is something only time will tell, but the logic is sound.

Certainly a set of initiatives to watch!

SOURCE: "Trying to Save by Increasing Doctors' Fees" 07/21/08
photo courtesy of Papalar, used under its Creative Commons license

Community Prevention For $10 a Year

For $10 annually per person we, as a country, could invest in community-based disease prevention programs could save the U.S. $2.8 billion each year in health care costs. The savings could take effect in as little as a year or two according to a study released Thursday by the Trust for America's Health.

I first discovered this in the Baltimore Business Journal, where they point out:

The U.S. could save more than $16 billion annually within five years, or a return of $5.60 for every $1 invested. In that five-year time frame, D.C. could save $57.2 million, Virginia could save $385.1 million and Maryland could save $332.2 million.

The report focuses on disease prevention initiatives that do not require medical care, such as increased access to affordable, nutritious foods, increasing sidewalks and parks in communities, and raising tobacco tax rates.

The study found that reducing Type 2 diabetes and high blood pressure rates by 5 percent through such programs could result in $5 billion saved in heath care costs in five years.

Prevention is a loud chorus in the song of health care. While some things may not at first seem to be health care issues, I think we can all follow the logic of needing access to healthy food in order to properly nourish our children. Personally, as a smoker, I'm in favor of the higher tobacco tax. It might help me finally quit.

The study itself is well worth a look, and includes a breakdown of projected returns on a program of this nature broken down on a state by state basis. This excerpt from the report itself helps illustrate why this sort of strategy is important and can produce results that can alleviate the financial stresses that are crippling our system and bankrupting our citizenry:

"Health care costs are crippling the U.S. economy. Keeping Americans healthier is one of the most important, but overlooked ways we could reduce these costs," said Jeff Levi, PhD, Executive Director of TFAH. "This study shows that with a strategic investment in effective, evidence-based disease prevention programs, we could see tremendous returns in less than five years -- sparing millions of people from serious diseases and saving billions of dollars."

In Health Care Reform Now!, George C. Halvorson lays out the numbers on just how much chronic conditions and preventable health issues comprise of our overall health picture. I'll give you a hint. The number is well over half.

SOURCE: "Prevention for a Healthier America
Investments in Disease Prevention Yield Significant Savings, Stronger Communities" 00/00/00
photo courtesy of PublicResource.org, used under its Creative Commons license

Gasoline: The New Health Care Cost

There are many factors that add to the cost of health care for the modern American. Now, as we ramp up for the Presidential race, another line item has been added to the bill: gasoline. With the shortage of qualified nurses and the current freeze on Medicare cost increases, this is an issue of increasing import.

Via Gary Gosselin's article in The Oakland Business Review as syndicated through MLive.com:

Home health care workers and businesses are adjusting services and spending as they adapt to high fuel prices.

Michigan home care workers make 11.5 million visits a year, driving an estimated 161.3 million miles, according to the National Association for Homecare & Hospice.

With many of the home care workers performing nonmedical functions, the pay is relatively low, in the $8- to $10-an-hour range.

The article includes interviews with numerous providers of home health care that detail many of the cutbacks being enacted in order to combat the high price of gas. From employees who can no longer afford to make it to work to additional surcharges on health care to cover fuel, it paints an uneasy picture of reduced services for the increasingly large ranks of elderly who require home-based care. As more and more Baby Boomers reach advanced age and gas prices continue to skyrocket, the impact of fuel prices will extend its reach farther and farther.

Home health care is predicted to increase thirty percent between now and 2012. This is on top of the increase from only 633,000 workers in the industry during 2000 to a whopping 913,300 in 2007. The spike in numbers here reminds me of the prices I see at the pump daily, steadily rising. With an overall 50% increase in gas prices since this time last year the trends do not seem heartening.

I guess a house call is out of the question?

SOURCE: "Some predict shakeout in Michigan as fuel prices hit home health care" 07/17/08
photo courtesy of Svadilfari, used under its Creative Commons license

Remote Moitoring Device Gets FDA Approval.

Technology is often a topic here on the Health Care Reform Now! blog. Electronic medical records and the coupled aspects of savings and efficiency that they bring to the table are a central part of George C. Halvorson's approach to reform. Today, I would like to talk about a new innovation, one which will help fill in the blanks on medical records, electronic or otherwise.

I am speaking of the Intel Health Guide PHS6000, a nifty little gadget that takes over a lot of the monitoring and communications needs of chronic care. Catherine Paddock over at Medical News Today has a nice little review of the device:

Intel's Health Guide has an online interface that allows clinicians to monitor and manage patients remotely. The interactive device which can be attached to blood pressure monitors and other home based equipment, sends vital sign data to the clinician, shows patient reminders, presents multimedia educational content, and allows patients and clinicians to communicate by video conference and email. It looks like a medium sized chunky laptop with a touch screen.

I think we could be seeing something big kicking off here. Ease of use studies have been underway for sometime now and projections show the gadget hitting the market around the end of this year. Once this and devices like it become commonplace, it should help put a hefty dent in cost of care by eliminating unneeded office visits as well as by providing up to the minute data for treatment.

SOURCE: "Intel's Home Care Remote Monitoring And Communication Device Gets FDA Approval" 07/14/08
Press release photo courtesy of Intel

From Jersey To Arizona: Reform Legislation

From the Upper East Coast to the dry expanses out West, health care reform is making waves. As the ad campaign of Health Care For America Now! begins to roll out (see my earlier posting), the state governments of both New Jersey and Arizona are in the news because of their actions on this topic.

In the Northeast, we have New Jersey Gov. Jon S. Corzine who just signed a health insurance reform bill into law that includes an expansion of NJ Family Care, a source of low cost insurance options for those who are in need.

Via the Philadelphia Business Journal:

The legislation increases the number of low-income families who qualify for the program and phases-in mandatory coverage for all children in the Garden State. [...]

Corzine wants to see all New Jersey residents have health insurance by 2011.

"While there has been much national dialogue about universal health care, here in New Jersey, we're actually doing something about it," he said.

That quote should be making its rounds of the Internet soon. As always, only time will reveal whether the legislation will prove effective or if it's all just more sturm und drang. The concept is sound, but implementation seems to frequently fall victim to funding problems. Let us wish them well in their efforts. Any steps towards universal health care on the state level have the virtue of testing the viability of the approaches espoused allowing us to form a better picture of what a uniquely American system of universal care will end up looking like.

Now let us shift our view to Sen. John McCain's home state of Arizona. Howard Fischer of Phoenix's East Valley Tribune brings us an interesting story about a battle on the floor of the State House of Representatives.

House Minority Leader Phil Lopes, D-Tucson, said voters should reject an initiative being pushed by some doctors and others to constitutionally prohibit forced enrollment in either private or government-run health insurance programs. The measure also would bar any law which limits an individual's choice of doctors.

"They are trying to protect the system that I think everybody, most people, think is broken," Lopes said.

While Lopes has an interest in stopping this controversial legislation because it would disallow his own universal health care plan for the state, he still has some valid points. If Sen. Obama wins the race for the Oval Office, his proposed mandates, while only involving children, would be directly at odds with this proposed law.

Lopes supports a single payer approach centralizing the payment for health care services through the government. His opponents present an argument that resonates with many Americans, one of independent choice.

But Jeff Singer, a Phoenix surgeon and one of the architects of the initiative, said the measure is not aimed at any specific plan or concept. Nor is it aimed at halting what he said is necessary reform of health care.

"We just want to make sure that whatever kind of health care reform is ultimately instituted, that it doesn't infringe upon the rights of people to make their own decisions regarding what kind of plan they want to be in, or if they want to be in a plan, what kind of health care they want, what kind of doctor they want, whether they want alternative care, whatever," he said.

Emphasis in the above quote is my own.

While I am a fiercely independent individual myself, I have a feeling that enacting universal health care, or at least universal coverage, may well end up requiring mandates in order to ensure that everyone participates. The story above is one that should make everyone consider their exact feelings on the subjects of autonomy, choice, and universal care.

SOURCE: "N.J. 'doing something about' universal health care with law, Corzine says" 07/09/08
SOURCE: "Controversial measure aims to prevent universal health care" 07/08/08
photo courtesy of Alejandro the Great, used under its Creative Commons license

Examining McCain's Proposed Health Care Tax Credits

Jonathan Cohn has a very interesting article up on CBS News. In it, he examines a recently released paper from the Center for American Progress which dissects Sen. McCain's proposed tax credits -- tax credits that are supposed to fix our broken health care system.

Under our current system, group health premiums (e.g., insurance you get through your job) are exempt from both income tax and payroll tax. Sen. McCain has suggested doing away with that exemption and replacing it with a tax credit ($2,500 for individuals, $5,000 for families) tied to the purchase of individual insurance.

Via Mr. Cohn's article:

McCain's advisers say that the credit would grow at the rate of inflation -- that is, it'd get more expensive at approximately the rate of other goods (or, at least, how the government measures the price increases of other goods). Health care expenses, of course, keep going up faster than other expenses, mostly because of medical technology and the (largely unrestrained) demand for it. So if people kept paying for the same level of insurance, the tax credit would quickly fall behind: They'd end up paying more in taxes. According to the report, "In 2009, the credit will cover 36 percent of an average employer-provided family policy (based upon CBO projections). By 2018, however, the credit will cover only 24 percent of the cost of the same policy."

(This is all in addition to the fact that, for many families, the credit will not be enough to buy a policy — even now — because health care for families costs a lot more than $5,000 a year.)

Now, to its proponents, this feature of the tax credit — the fact that it increases so slowly — is a feature, not a bug. It's designed to encourage people to be more thrifty in their purchase of insurance. Ideally, they'll go for less generous policies — ones that don't subsidize so much wasteful care.

Mr. Cohn points out the crude nature of this approach to cost control, noting that it puts the entire weight of the problem on the backs of consumers while providing no guarantee that adequate health care will be forthcoming. No guarantee of available coverage, much less for pre-existing conditions. No limits on the amount of cost out-of-pocket for consumers.

One reason I enjoy Mr. Cohn's work is that he does embrace transparency in his writing. In the beginning of the article he notes that he has not yet had the opportunity to vet the report in full and that these are initial conclusions only. He closes with a reminder:

OK, and now to that caveat I promised at the beginning. Unlike Barack Obama, McCain hasn't been clear about exactly how he proposes to change the tax treatment of health insurance. And there are rumors around that they might not get rid of the existing deduction entirely, preserving it at least for payroll taxes. It's not clear how that'd affect the paper's conclusions, since the paper assumes the entire deduction goes away. But, of course, if McCain keeps some of the existing tax break, then either his plan won't have as dramatic effect period — or it will run up a higher deficit.

All in all, well worth reading, if for no other reason than to remind yourself that in the convoluted discourse on American health care it pays to dig below the surface on all claims and proposals.

SOURCE: "McCain’s Fuzzy-Math Health Care Plan" 07/05/08
photo courtesy of SoggyDan, used under its Creative Commons license

The AMA on EMRs

Technology is a repeated refrain in the ongoing national health care dialog. The virtues are well known, especially to readers of this blog. Studies have been enacted by numerous foundations and organizations that show the massive savings of both money and time that electronic medical records (EMRs), properly implemented, can provide. By the same token, the discussion of EMRs also brings up a consistent set of issues that are of concern to medical providers: cost of implementation, privacy issues, and technical standards.

Thanks to the online edition of AMedNews, we can take a look at the American Medical Association's views prior to the hard copy's release date of July 7, 2008, addressing this triple header of concerns.

On standards:

As work continues to develop a national strategic plan for health IT, including any coordination of the multiple government initiatives already under way, it is essential that doctors have a strong voice. It is physicians, after all, who will be expected to invest heavily in making the system work.

The AMA also stresses that physicians with small practices should be given a voice in this discussion since they comprise the majority of medical practices in the United States. This push for standards, compatibility and systems thinking is one that is at the core of George C. Halvorson's approach. Involving the actual physicians in the crafting of these standards is extremely important. After all, they will, as pointed out above, be footing the bill.

On privacy:

To boost confidence in an integrated network, the Health Insurance Portability and Accountability Act's privacy and security rules that apply to physicians, as well as other health care professionals and health plans, should be extended to any party that works with confidential health care records. This would include workers' compensation carriers, researchers, life insurance issuers, employers, marketing firms, health IT and personal health record vendors, and health information exchanges.

Doctors, says the AMA, do not need to see an expansion of their HIPAA obligations. The organization states that this would slow down transmission of patient data as new restrictions are implemented. Instead, their proposal hinges upon expanding the privacy strictures of HIPAA to apply to anyone handling this confidential data.

On implementation:

Physician reimbursements already are under intense pressure, and the Congressional Budget Office itself has released a report doubting estimates of extraordinary, health IT-related savings. It's no surprise that many practices, especially small ones, find it justifiable to avoid health IT investment. Meaningful grants, loans and other financial incentives are essential for giving physicians the financial security they need to accept and accrue the benefits of health IT.

With the cost of implementing EMRs quoted at $37, 000 per practicing physician (and that is a starting number that does nothing but increase), these sort of incentives seems to be in order. It would be a nice change from the perverse incentive standards of the modern day medical profession.

The article goes on to relate the AMA's position as it attempts to influence the U.S. Congress, which even now is deliberating the proper ways to push expansion and implementation of health information technology. Go take a look and see for yourself what your opinion is of their stance.

SOURCE: "Removing health IT barriers: The AMA advocates that federal legislation to encourage technology use should incorporate physicians' ideas, particularly in regard to technical standards, privacy and financing." 07/07/08
photo courtesy of Daquella manera, used under its Creative Commons License

21st Century Dynamic Duo: Bankruptcy and Health Care

Since my wife's family is mostly in the Indiana area, I tend to check out the news up there fairly frequently, especially with the recent levee failures and flooding. That is how I stumbled upon this letter to the editor by Fran Quigly, Director of Operations for the Indiana-Kenya Partnership, on IndyStar.com. The introductory paragraphs should be enough to get you started:

It is Friday morning at the federal courthouse in Downtown Indianapolis, and U.S. Bankruptcy Court Trustee Gregory Silver sits behind a low table in a room on the fourth floor calling out names of Hoosiers who have filed for discharge of their debts. In a somber scene with the air of a fiscal confessional booth, many petitioners come forward with slumped shoulders and slightly bowed heads, and then softly answer Silver's questions about the financial collapses that led them to this room.

A young woman from Southside Indianapolis has racked up enormous debt due to the costs of childbirth. A middle-aged couple from the Northwestside was sued for payment of their medical bills. Another woman had the misfortune of being attacked by a dog before health insurance from her new job kicked in. Even after turning a lawsuit settlement over to bill collectors for hospitals and doctors, she still owes them $35,000.

The rest of the letter is well worth reading, and if you have strong stomach the comments are interesting as well. I think the comment streams one finds on articles like this make for an interesting study, most particularly the anonymous comments. People tend to speak their minds pretty staunchly when they do have to worry about being connected to their opinions publicly.The results can often be both vile and illuminating.

On a subject that combines high profile and controversy in the fashion that health care currently does the comments come thick and fast, a maelstrom of invective and opinion that demonstrate just how impassioned our populace is becoming on the subject.

The letter goes on to suggest potential paths for improvement, and quotes a 2005 Harvard study that found fifty percent of bankruptcies in the U.S. stem from medical bills.

Fifty percent. Think about it.

SOURCE: "A day in bankruptcy court would make you sick" 06/30/08
photo courtesy of danesparza used under its Creative Commons license