"Nationalized Health Care"

It is a phrase used a lot in reference to the plans proposed by both Sen. Hillary Clinton and Sen. Barrack Obama should they attain the post of President. As Kevin Freking of the Associated Press points out in a recent article, it is an inappropriate usage of the phrase:

Last week, Sen. John McCain, the likely Republican nominee, described his challengers' health care plans as a "move closer to a nationalized health care system." But that's a stretch. To nationalize means to transfer ownership or control to the government. There's still a vast distance between what the Democratic candidates have proposed and nationalized health care.

Clinton and Obama aren't proposing government hospitals or government doctors. They want people to have health insurance, and they want people to be able to choose from a variety of policies. The menu would include private plans as well as an option similar to Medicare. Tax breaks would help lower- and middle-income people pay their monthly premiums.

In addition, proposed employer involvement and the rescinding of Bush administration tax cuts for the wealthy assure that there will be others besides the government paying into the program (whichever it ends up being) once it is enacted.

Such a system would continue the split system that the U.S. has when it comes to health coverage. The elderly, poor, disabled and many veterans would continue to get care paid for primarily by the government. Others would get coverage from private companies, usually through their employer, or through the Medicare-like option.

"Their approach is not taking any other country's system. It's building on what we have in the U.S," said Karen Davis, president of the Commonwealth Fund, which conducts health research.

Freking goes on to provide an illustrative comparison between our system here in the United States and those of Great Britain and Canada. He finds that while many more here in the U.S. chose to skip seeking care out of financial fear, residents of the other two countries tend to have much longer waits when specialist care is needed -- waits that are often a month or longer.

He also touches on economic side effects of the high cost of American health care, such as the fact that stateside manufacturers find it harder to compete in the global marketplace due to the high and rising cost of coverage.

"That's why it costs less to build a car in Canada than in the United States because you've got a bunch of money tied up in health insurance," said Steven Lewis, a Canadian health consultant.

As usual, Freking prescribes a solid dose of information for his readers, including an interesting observation about the one commonality that people in all three countries share. I'll let you read the article to find out what it is....

SOURCE: "Insurance model follows American tradition" 05/10/08
photo courtesy of *clarity*, used under its Creative Commons license

Dr. Rocky White: Evangelical, Conservative, Single Payer Plan Advocate?

Much of the discussion about health care reform in the national arena is centered around the continuing debates between the two Presidential hopefuls of the Democratic Party: Senators Hillary Clinton and Barack Obama. With cost of care an issue of escalating prominence, and groups like the AFL/CIO releasing findings that show their membership believes the American health care system to be broken on a fundamental level, this issue is one whose importance cannot be overestimated.

One option noticeably absent from both candidates' conversations is that of a single-payer solution. A species of solution was endorsed last December by the American College of Physicians, the largest medical specialty organization in the U.S. Amy Goodman of Democracy Now! takes a stab at the subject matter in an interview that appeared in AlterNet. In that interview she speaks with Dr. Rocky White, an evangelical from a rural conservative background who is a proponent of a single-payer system.

And as I began to study and to look at state policy and federal policy and going back -- if you want to understand our health care system, you have to go back fifty or a hundred years to see how we evolved into this. You know, there wasn't some mad scientist in the 1940s who devised this horrible system that we have today. It was just a matter of evolutionary process, so to speak. But as I began to study that and to try and assimilate what it was that was going on, I began to see some very disturbing trends. Part of the reasons that we got to where we're at today are multiple. There's not just one "this is what happened." And as I started to weave that together, I began to say, "Jiminy Christmas! This thing is really screwed up!" And now I'm beginning to understand the health care system very well, not just our group, but as a whole.

And then I began to ask myself, what are we going to have to do to fix it? And so, obviously, single-payer was not even something that I would have even considered ten years ago. In fact, ten years ago I didn't even know the word "single-payer" existed. And so, as I started to look at that and I looked at different ways that we could fix this whole thing -- I mean, you talk about subsidies, expanding Medicaid, all of that -- I began to realize that the only way that we're going to fix this system is we're going to have to put everyone on a Medicare-like system. In order to truly fix the system, we're going to have to put everyone into one single risk pool, we're going to have to share that risk, and the most efficient way to do that is through the tax system.

It's a highly unusual perspective compared to others from a similar background -- a fact that Dr. White was painfully aware of as he researched his position.

And I was very sheepish about the whole thing. I mean, here I am, a Republican, thinking about nationalizing health care. It just went against the grain of everything that I stood for. But you have to remember something, Amy: I didn't come to those conclusions with lofty ideals of social justice. It was purely from an economic standpoint. This is the only way that we're going to do -- be able to fix this and do it efficiently.

Go check out the interview. It is three pages of great food for thought. It is also an example of the type of thinking we need now in order to be able to enact positive reform, thinking that sets ideology aside in favor of facts and groundwork.

The health care crisis is one that does not care if its victims are conservative or liberal. It takes no notice of skin color or church affiliation. Ask the 47 million uninsured.

SOURCE: "Evangelical Doctor Touts Better Health Care Plan Than Clinton, Obama" 05/06/08
photo courtesy of Pink Moose, used according to its Creative Commons license

Salazar Speaks Out

On Tuesday, the United States Senate Finance Committee held a hearing entitled "Seizing the New Opportunity for Health Reform." Goals and principles of health care reform were addressed along with a reaffirmation that reform efforts should be comprehensive, not incremental, and that quality health care should be available to all citizens of the United States.

Senator Ken Salzar of Colorado, a member of the Committee, was one of those who addressed the hearing. Here are some excerpts from his address brought to us via the full transcript on Trading Markets.com:

"While many in our nation go without care, it certainly is not due to a lack of health care spending. In 2005, health care expenditures in the U.S. totaled over $2 trillion dollars - nearly 15 percent of our gross domestic product and the highest spending level of any developed nation by far. So I ask myself - with so much of our money being spent on health care services, how can so many of our people lack access to affordable, high quality care" It is a dynamic we all struggle to understand, and I look forward to hearing the panel's thoughts on this during today's discussion.

"When I go back to Colorado and talk to the people in my state, their number one health concern is the cost of care. The price they must pay drives every decision they make when it comes to their personal health - which is certainly not the way we should be making life-altering decisions for our friends and loved ones. For those people without insurance, the problem is obvious - they cannot afford to pay the staggering "sticker price" for health care services out of their pocket - and they rely too heavily on emergency services which are inefficient, expensive and less than ideal. But the growing plight of the uninsured causes difficulty for individuals with insurance as well, as many of the costs of treating the uninsured are passed along to all consumers and result in increased premiums and cost-sharing obligations. This often means that even those with insurance cannot afford to seek treatment because they cannot afford their high deductibles and copayments, creating a vicious cycle of unmet health care needs.

As someone who has had recurring health issues of various sorts, I can attest to this. Many times I have had to forgo seeking professional care because it was a choice of that or rent. (Writers don't make very much unless they happen to be Stephen King or Tom Clancy.) On one or two occasions it ended up with me having to go to the emergency room, vastly increasing the expense both for myself and or others.

Now I have insurance thanks to my wife's job at a local university, although that does not improve matters much from they way they were before. Several hundred dollars a month go towards coverage, but attempts to use it reveal a labyrinth of paperwork and bureaucracy that often seems designed to prevent our use of the policy.

"As I listen to discussions of health care reform, I can come to only one conclusion - our goal must be universal access to affordable, high quality health care for every person in this country. While I am sure that my colleagues on the Committee may have differing perspectives on how we can achieve this goal, I am convinced that there are common principles that can tie us together and hope that former Secretaries Shalala and Thompson can help us identify those areas. Prevention, health technology, primary care, chronic care coordination - these are concepts that we know hold value - and the time has come for us to delve into the details of incorporating them into our health care system and realigning the system's incentives to make sure they are addressed."

Indeed, these are all issues that George C. Halvorson brings up in his book Health Care Reform Now! as being critical to effecting substantive, positive change in our current "non system." Let us hope that Sen. Salazar finds many kindred spirits on the Senate Finance Committee.

SOURCE: "Senate Finance Committee Takes First Step to Discuss Broad Health Care Reform Solutions" 05/07/08
photo courtesy of Phil Roman, used under its Creative Commns license

Kaiser Rolls Out HealthConnect

Pacific Business News reports:

Kaiser Permanente said Monday that all of its 8.7 million enrollees in nine states, including Hawaii, and the District of Columbia have access to HealthConnect, an outpatient electronic health record Kaiser says is the world's largest of its kind.

Officials at Oakland, Calif.-based Kaiser said all of Kaiser's 13,000 physicians nationwide now have electronic access to patients' medical records in the system's 421 medical offices and clinics.

But Kaiser still has a ways to go on the inpatient side. Officials said 13 of its 36 hospitals (34 of them in California) have installed the EHR software, giving 3.2 million enrollees the advantages of an inpatient EHR system. Some 14 hospitals are slated to do so this year, including 13 in the Golden State and one in the Portland, Ore., metropolitan area.

The remaining nine hospitals, including the Moanalua clinic on Oahu, will follow in 2009 and early 2010, said Kaiser spokeswoman Ravi Poorsina.

Four billion dollars worth of electronic health records going online. This is a major milestone on the path to reform. It is also the latest evidence of the massive steps taken by Kaiser since 2004.

"Electronic medical records are a cornerstone tool for improving quality and safety in health care. Doctors should have all of the information about all of their patients all of the time. Only a computer and an EMR can do that work," George Halvorson, chairman and CEO of the nonprofit Kaiser Foundation Health Plan and Hospitals, said in Kaiser's May 5 statement.

From eliminating unnecessary duplication of medical tests to coordination of care, this rollout of EHR capabilities is already noted by Kaiser as vastly improving care delivery. 75% of Kaiser clinicians find it a more efficient and effective communication tool, while over 85% find that it makes administering medications safer and more accurate according to statements.

SOURCE: "Kaiser finishes phase of health records project" 05/05/08
photo courtesy of takomabibelot used under its Creative Commons license

Can I Get That Cat Scan as a JPEG?

Thanks to Thomas Hoffman at ComputerWorld, we have this little gem of a story. It is part of a series on the top projects of the year by the Top 100 IT leaders, and with good reason!

FirstHealth of the Carolinas Inc. began replacing its film-based radiological technology with an online digital capture and storage/retrieval system in late 2005 to enable up to 300 of its radiologists and physicians to instantly access clinical images from any location, says Linda Briggs, director of application support.

That 2005 initiative was only the humble beginning. The people behind the program had much bigger plans -- plans that are reaching fruition thanks to their determined efforts. CIO David Dillehunt has had big plans from the beginning and, more importantly, the dedication to see them through. The big success is First Health's Picture Archiving and Communications System (PACS):

PACS, which went live in March 2006, is providing FirstHealth with several clinical and IT-related benefits. For starters, FirstHealth has been wrestling with year-over-year data growth of 100% since 2004. With a mix of more than 650 applications to manage, the organization saw a digital storage architecture as a means to increase its operational efficiencies, reduce costs and improve patient care.

With more people currently on the planet than have existed in the entire history of earth combined, this sort of growth is hardly shocking. Capacity to handle the sort of increases future years will bring is an important concern for any project of this nature and proposed scope.

The digital imaging system has also enabled FirstHealth to slash its annual film budget from around $800,000 to about $50,000 this year, says Mike McCarty, FirstHealth's director of imaging.

$750,000 in savings? This is proof positive that electronic medical records can put a much needed dent in the cost crisis that American health care is experiencing. That is a hefty number no matter who is counting.

The PACS system relies heavily on storage and networking software from NetApp Inc. NetApp NearStore systems enable high-speed, disk-to-disk backup while serving as a permanent archive for the PACS images. NetApp SnapMirror software works with NetApp Snapshot technology to replicate all critical business and patient data among FirstHealth's three hospitals. Meanwhile, NetApp FlexVol storage virtualization software dynamically provisions and reallocates the organization's storage resources as needed.

Real-time access to patient information has helped improve the quality of patient care by enabling FirstHealth physicians to make faster decisions about treatment, says Drusi Smith, a senior clinical analyst at the organization. That in turn is helping FirstHealth reduce the length of patient stays in its hospitals, Smith says.

Once again, we see the multiple advantages that electronic medical records bring to the table. Regional efforts such as the PACS covered here are an important step forward, hopefully into a future where we achieve true health care reform!

SOURCE: "Health care goes digital with instant image access" 05/05/08
photo courtesy of brainsik, used according to its Creative Commons license

Cost Factor. Again.

I know it keeps coming up. I really wish it did not.

The cost of health care keeps floating to the surface of the ongoing national debate. While the subject of universal coverage is frequently on people's lips, it is often the cost issues that place people among the 47 million uninsured. As we proceed to wade through the point and counterpoint of the ongoing race for the Oval Office this subject gets touched upon with increasing frequency.

In a Letter to the Editor published in The New York Times, Jennifer Baron writes:

Ultimately though, universal coverage, regardless of when a mandate is introduced, cannot succeed until health care becomes affordable. To achieve this we must recognize that costs are only a symptom, albeit an intractable one, of a far deeper problem overshadowed by the wrangling over universal coverage: the dysfunctional structure of our health care system.

Only after reshaping the way health care is paid for and delivered will costs sustain and decrease. And only then can universal coverage become a reality.

In the Kansas City Star's MidWest Voices Steve Winn writes:

New reports this week underscore the critical need to rein in health care costs. They are damaging the economy, squeezing American families and worsening the federal government’s fiscal problems.

And as many health care experts have observed, Americans aren’t even getting their money’s worth. The country ranks well behind many other countries on health measures.

As someone who has felt this crunch personally in the past, I can understand easily how this issue is beginning a slow boil. With millions being wasted on antiquated paper based systems and other outmoded approaches there is plenty of room for improvement and reform.

SOURCE: "Reshaping Health Care" 05/01/08
SOURCE: "Thrsday Editorial: Fixing the Health Care Squeeze" 05/01/08
photo courtesy of stopnlook, used under its Creative Commons license

With This Ring I Do Thee Insure

As a relatively recently married man, I remember well the vast array of concerns and issues that revolved around both the decision to get hitched and the process itself. One factor that did contribute somewhat to our decision was the fact that my wife had health insurance through her work at a major university. As a freelance writer and blogger, I did not.

While for us it was a tertiary concern, a recent study shows that a small but significant percentage of the population base their decision to marry on the issue of health insurance. Ricardo Alonso-Zaldivar of The Houston Chronicle shares the results of this intriguing survey:

In a poll released Tuesday, 7 percent of Americans said they or someone in their household decided to marry in the past year so they could obtain health care benefits via their spouse.

"It's a small number, but a powerful result, because it shows how paying for health care is reflected not only in family budgets, but in life decisions," said Drew Altman, president of the Kaiser Family Foundation, which commissioned the survey as part of its regular polling on health care.

Now as I said, it was one factor among many for my wife and I. Not a deal breaker or deal maker, but worthy of consideration. That said, I know two couples that did finally decide to tie the knot because of health care and insurance issues. A situation that is vexing to say the least. Maybe I am just a romantic at heart, but I do not think that health care should have to be a factor when deciding whether or not to purchase a wedding ring.

It's not just marriage that is being impacted either:

The survey found that the costs of health care outranked housing expenses, rising food prices and credit card bills as a source of concern.

Of those surveyed, 28 percent said they had experienced serious problems because of the cost of health care, nearly tied with 29 percent who had problems getting a job or a raise.

The state of health care in the United States is truly at a crisis point. What this nation needs is health care reform, and we need it now.

SOURCE: "Poll: 7% of Americans marry for health insurance" 04/29/08
photo courtesy of babasteve, used under this Creative Commons license