Democrats: Health Care For All!

This weekend, the Democrats managed to reach consensus on a platform that "commits the party to guaranteed health care for all." Sen. Obama still adheres to his standing position about not mandating coverage, but finding ways to make it more accessible.

While Sen. Obama still declines to adopt a mandate as part of his strategy, the fact that this plank in the platform has been finalized brings the Democratic Party's overall stance closer to the the approach favored by Sen. Clinton.

Now that the Dems have settled on their stance, I'm sure this will be heating up on the campaign trail. Sen. McCain will now have definite targets for debate, and with the recent scandal over John Edwards' affair keeping his wife Elizabeth out of the ring, the Republicans must be heaving a sigh of relief.

Advisers in both the Clinton and Obama camps seem happy, and activists within the party are mollified enough to have dropped their tougher stance demanding a single payer system.

SOURCE: "Democrats adopt goal of health care guarantee" 08/09/08
photo courtesy of Steve Rhodes, used under its Creative Commons license

This Just In: The Percentages! (Again)

Wow! Here we go with another report. Two of them, even! The mountain of evidence that our health care system is fractured, costly, error prone, and generally not functioning just grew a bit higher. More reports have come to light this week. First, the survey entitled "Public Views on U.S. Health Care System Organization: A Call for New Directions," which questioned 1,004 adults about their views of and experience with the American health care system.

Once again, we find that the issues are so obvious you can almost predict what will be said.

• 9 out of 10 want Presidential reforms to improve the quality of health care, ensure that all Americans have affordable care, and reduce the number of uninsured.
• 8 out of 10 support efforts to improve health care performance, access, quality and cost.
• 1 out of 3 said their doctors performed unnecessary procedures or ordered duplicate tests.
• 47 percent said their health care was poorly coordinated.
• 9 out of 10 consider it important that they have one place or one doctor responsible for their primary care and coordination of all their care.
• 9 out of 10 wanted easier access to their medical records.
• Nearly 3 out of 4 (73%) had trouble getting access to health care providers outside the hours of 9am-5pm, M-F without going to an emergency room.
• 26% of adults with health insurance had trouble getting same or next day appointments with providers when ill.
  
• 39% of adults with health insurance had trouble reaching their provider on the phone when needed.

All in all, 82% of Americans believe that the health care system is broken and in need complete restructuring and/or change on a fundamental level. Hopefully this will make an impact during the run for the White House. The vast majority of Americans want Health Care Reform Now!.

Back To The Mall: Urgent Care Clinics

One of the big trends we keep returning to is the retail health clinic. Located in malls or "big box" stores, they combine low cost, excellent access, and short wait times. These clinics are not what I am going to examine today. Instead I'd like to share an article about urgent care clinics.

What's the difference? Laura Landro of The Wall Street Journal defines it:

[...] urgent-care centers aren't to be confused with the new crop of retail health clinics popping up in drugstores, which are run by nurse practitioners who prescribe medicine for minor illnesses and provide vaccinations. Urgent-care-center physicians and other medical staffers can put casts on broken bones, sew up lacerations, provide intravenous fluids for dehydrated patients, and deploy advanced life-support equipment for both adults and children. They often have equipment not available in physicians' offices, such as X-rays.

So basically, this is a concept that could well step in and take a lot of pressure off of emergency rooms if it becomes widespread enough.

These facilities aim to fill the gap between the growing shortage of primary-care doctors and a shrinking number of already-crowded hospital emergency departments, with no appointment necessary and extended evening and weekend hours. Urgent-care clinics are staffed by physicians, offer wait times as little as a few minutes and charge $60 to $200 depending on the procedure -- a fraction of the typical $1,000-plus emergency department visit. Some offer discounts and payment plans for the uninsured; for those with coverage, co-payments vary by insurance plan but may be less than half the amount of an ER visit, which can range from $50 to $200.

The last time I went to the emergency room it cost me five thousand dollars, and all I got was a nine hour wait, some painkillers after hour four, and the useful information that "they're kidney stones and you'll just have to wait it out." This sort of personal experience, one which is incredibly common in modern America, predisposes one to look kindly on this newer breed of medical care.

Of course there are also issues and drawbacks, as there are with everything. The lack of standards or a system of accreditation are cause for concern amongst many. In an effort to address this and preclude formal regulation, the Urgent Care Association of America has struck an agreement with the Joint Commission (the non-profit responsible for accrediting hospitals and health-care organizations) to take over accreditation and publish national quality standards by 2010.

Lee Resnick, President of the Urgent Care Association and Director of University Hospitals Urgent Care, says urgent care clinics diagnose serious health issues like cancer for patients who come in for something that seems more trivial. Simple symptoms may bring in patients who the doctors recognize as having heart attacks or strokes. The short wait time allows these illnesses to be revealed in time to get patients into an ambulance and on their way to an ER, where admissions can be fast-tracked due to the initial diagnosis.

Go check out Ms. Landro's article. It has a whole lot more analysis.

SOURCE: "Options Expand For Avoiding Crowded ERs" 08/06/08
photo courtesy of Charlie Bosmore, used under its Creative Commons license

Dateline Illinois: New Bipartisan Legislation

Senator Dick Durbin has allied himself with a variety of business and labor groups to co-author legislation to provide more affordable health care options for small businesses.

Via All American Patriots:

The bi-partisan legislation was introduced in partnership with Senators Olympia Snowe (R-Maine), Blanche Lincoln (D-Ark.) and Norm Coleman (R-Minn.). Nationwide, there are 47.1 million employees in 5.8 million small businesses and 14.1 million self-employed individuals.

The Small Business Health Options Program (SHOP) addresses the number one problem for many small businesses and the self-employed -- the high cost of providing health care for their employees -- by:

* Allowing small businesses to band together and spread the risk over a large number of participants in order to obtain lower premiums.
* Providing tax credits for small business owners to offset contributions to employee premiums.
* Banning health status rating in order to protect businesses from large rate increases simply because one employee gets sick.

Developed to help combat annual premium jumps that usually rank in the double digits, this bill is receiving praise from a number of concerned parties. From Charles McMillan, the President-Elect of the National Association of Realtors to Todd Stottlemyer, President and CEO of the NFIB, supporters are sanguine about the effects this will have for both independent contractors and employees of small businesses. The extreme nature of this burden is illustrated by McMillan's comment that for the average realtor, "the total cost of health insurance can rival or even exceed their monthly mortgage."

As an independent contractor myself, I understand the fears and the costs involved. I am consistently grateful for the fact that I have health insurance, which I only have because of my lovely wife's health care plan from her job. Even insured I often become the statistic as I put off health care that is not urgent due to the rising costs.

I can assure you that this is one piece of legislation I will be keeping a careful eye on.

SOURCE: "Senator Durbin Introduces Bipartisan Legislation to Provide Affordable Health Insurance Plan for Small Businesses" 08/05/08
photo courtesy of Larsz, 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

Write a Prescription For A Platform

Once again we return to the political side of health care, a side that will be instrumental in shaping its future one way or the other. Right now there is news of interest from the Democratic Party. They have come together to hammer out the details of the official party platform on health care.

Mark Silva at The Chicago Tribune's political blog, The Swamp, brings us the current incarnation of the wording:

The committee charged with crafting a platform for the Democrats agreed today in Cleveland to call health care "a shared responsibility between employers, workers, insurers, providers and government. All Americans should have coverage they can afford."

He also details a low-key tug of war between Obama's people and the Clinton camp concerning the proposed wording, with the Clinton side pulling for stronger language supporting shared responsibility among other things.

The wording agreed upon today is merely a draft, pending approval Saturday when it is presented to the full platform committee in Pittsburgh, PA. The final proposal will be presented to the Democratic convention on August 25 in Denver, CO. I wonder how many permutations it will go through?

SOURCE: "Health care: Democrats start writing Rx: Fulfilling the promise of 'universal health care,' that's the question." 08/03/08
photo courtesy of macwagen, 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