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HEALTH REFORM: We Can’t Fix Health Care By (Merely) Fixing Health Care
The health reform bills wending their way through Congress lay the groundwork for a long overdue shift in our system. Right now, as guest blogger Dr. Ira Byock writes, we don't have a "health" care system, we have a "disease care" system. After all, he reminded us, the word "patient" comes from the Latin: one who suffers.
The pending bills would expand prevention and wellness, create medical homes in Medicare (and encourage them in Medicaid), strengthen primary care and care coordination, and start to tackle avoidable hospitalizations and rehospitalizations. The Senate HELP committee even starts to address some of our needs in long-term care. But Dr. Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center and the author of Dying Well argues that if we want to finally address our runaway cost and quality challenges, we must to think outside the conventional health financing box, toward a system that literally cares for and about our health.
I recently cared for an 83-year-old man I'll call Dennis. He was hospitalized after a fall caused by low blood pressure, kidney failure and worsening heart failure due to a calcified heart valve. He described a steady decline in his ability to care for himself over the past eight months, but found that basic help at home was hard to come by.
When Dennis develops an acute medical problem the system kicks into gear. Three times in as many months, he was admitted to the hospital. He had chest pain on one occasion, a sudden fever and confusion on another, and most recently, his fall. Cost is no obstacle. Medicare pays for the ambulance, blood tests, EKGs, MRIs, his cardiac catheterization. It would have paid for his heart valve surgery if he had not refused the procedure.
However, Medicare will not pay for all the help Dennis needs every day at home -- help in getting up and dressed, bathing, preparing meals, handling his medicines. After all, that's not "health care." His three-times-a-week dialysis for his kidney disease is covered, but Medicare requires that a person be strictly homebound to receive visiting nurse services. Since Dennis goes to church most Sundays and to his barber once a month, he isn't homebound under current Medicare rules. That means he doesn't qualify to have a nurse come by to check his blood pressure and help keep his many medications straight. He does not qualify for hospice under Medicare either, unless or until he decides to give up his life-sustaining dialysis and embrace his death.
So once he was stable, I had to discharge Dennis from the hospital. We had to send him home to fend for himself and lurch from one costly emergency to the next.
Politicians tout healthy lifestyles and disease prevention as ways of controlling our nation's health care costs. There is intrinsic value in living long and healthy lives, and I certainly welcome legislation that will finally cover all Americans. But from a coldly economic perspective, merely delaying the onset of the diseases that humans die from is just kicking the can down the road. Even healthy adults remain mortal. Nearly two-thirds of all health care dollars are spent in the last two years of life, whether those last years occur during a person's 60s or 80s.
We must prevent disease when possible, but more important to the twin goals of improving quality while saving costs, we must prevent the complications and crises that plague ill people. In Dennis's case, having a primary care physician -- or medical home -- through which he could get all his medical treatments and planning under one roof would help a lot. So would a weekly visit from a home health nurse. A nurse could have detected his low blood pressure, and prevented the fall that led to his most recent hospitalization. It would have saved lots of money. It would have saved Dennis injury, pain, dislocation and further insults to his already frail health.
I practice and believe in patient-centered medicine. But patient-centered is not enough. It is time for our social policies to become person-centered. Health information technology, administrative efficiencies, and evidence-based medicine are all worth pursuing and may yield savings. But for real savings, and real transformation of our system, we need to connect the dots between social services, community services, health care and even basic civic services.
For Dennis, that might mean having someone from Meals on Wheels check in on him regularly, in addition to delivering dinner. It would include reliable transportation from his apartment to the local Senior Center to share nutritious group lunches and noon-time discussions on advance directives for health care, practical tips for weatherizing his home, and Internet basics to help him keep in touch with his family. Social isolation isn't good for our health either. Perhaps a parish or Stephen's Ministry nurse from his congregation could teach him to check his own blood pressure. A local service club, such as Kiwanis, Lions, Elks or Rotary, might install hand rails in his bathroom tub or shovel his front walk after it snows. Laws and government policies can support such efforts in myriad ways.
Jeffersonian ideals of individualism fail miserably when applied to public health, leaving vulnerable ill and elderly people to feel abandoned. Real reform must dissolve the artificial boundaries between what is medical and what is personal. Health care works best when people live in community with one another, rather than merely in proximity to one another.
Dennis died about six weeks after we sent him home. He was surrounded by friends and supported by hospice; he had community. I wait for the day when our health care system can provide care as well as community to patients -- or rather, to people -- all along.
Compulsory Euthanasia?
Obama's gonna kill Grandma?
See:
http://notionscapital.wordpress.com/2009/08/07/obama-wants-to-kill-your-...
Your observations make
Your observations make perfectly good sense. Why have insurance company executives who deny coverage to people in the name of saving money and increasing profits in on the concept of saving money by preventing hospital visits. It seems to me that sending in a nurse practitioner once or twice a week who can identify problems would cost a lot less than a hospitalization.
The Public Plan:
Part 1.
Problems :
1. No systematic, expansive Prevention & Wellness Program.
According to the scoring of CBO on the prevention & wellness program, all fitness centers around the world should close down immediately and all media have to end
reporting health tips about prevention. Rather, all of the excellent health systems seem to have one feature in common, a expansive, systematic preventative program
requiring immense investments.
I think a prevention system works as a 'levee' built against flood by the government, similarly, it also needs non-profit investments from the government 'on a large scale'.
This might offer us one clue of why all of the free states have public insurance policy in place.
Surprisingly enough, the system today is designed around treating patients once they become sick. As far as I'm concerned, the congress affected by the special interests
has turned down the budget request for prevention program in Medicare & Medicaid, which are the most expensive parts of the health program. Let's imagine the astronomical
costs and invaluable lives following the levee breach.
2. A pay for each service / volume compensation, & No E-Medical Record.
As much as 30 percent of all health-care spending in the U.S. -some $700 billion a year- may be wasted on tests and treatments that do not improve the health of the
recipients, and this 700 billion dollars a year can cover a lot of uninsured people, in return, it could lessen the tragic, prohibitive ER cares.
Medical errors ( No e-Medical Record ) & lawsuits, more profits motive, and indirect payments from employers etc would account for it.
Supposedly, 'a pay for each service / volume' compensation seems to leave the medical institutes unequipped with the essential IT system. To understand its importance, If
we imagine the cost difference between the previous and current system in financial institutes, the magnitude of cost-savings and the mess in health care system can
be easily explained.
3. Premium Inflation.
This last spring, due to the demand decrease, the peak fuel price came down below $40 per barrel, though, the
'Similar' insurance premiums keep on rising, accordingly the inaction could bankrupt family, business, and
government 'BEYOND this recession' , as all across the spectrum agree.
Basically, as demand diminish, the price tends to reflect it, nonetheless, the insurers that formed a cartel through
consolidation have replenished the loss by exercising inhumane malpractices involving denying, capping, rapid
premium increase and the like. And this runaway premium ended up in the collapse of middle
class ranging ' from finance to mental health' , alongside the peak fuel price and fast-growing mortgage rate, as all of
us know. Thereby they could be cited as an objective for anti-trust or anti-corruption. If the public plan sets the same rate of the insurers, it will be another headache.
Ironically, the Deficit-sensitive groups have a distinctive common ground, they all have a Deficit-driven background out of
question. Therefore, I'd say they have nothing to say about deficit unless they are free from the sponsors.
And the spoiled menu, 'Takeover and Rationing Cliche' is still marching for bankruptcy, as opposed to its motto.
4. 'Work or Break' health system with no brake or safety system.
Just like marriage, economy also undergoes up and down, however, economic downturn is not reflected in the employment-based system.
The rising mental stress or illness & 'keep eating habit' , which are the epicenter of a number of different diseases,might be traced
to this insecure system and exorbitant premiums.
Part 2.
The Public Plan:
1. Thankfully, the health care reform bill currently before Congress makes several key investments including more primary care doctors in preventive care, and those pieces
of the public plan must be maintained .
2. The pay for 'Outcome' pack is most likely to expedite the introduction of Health Care IT SYSTEM, and it will help doctors focus on their patients.
3. The 'innovative' idea of a 'pay for value / outcome' pack will allow for Quality and affordability
. If you are a physician, and your pay is dependant upon your patient's outcome, you will most likely strive to
prescribe the best medicine earlier in the process, let alone skipping the wasteful, unnecessary risk-carrying
procedures.
4. The synergy effect of the combined Health Care IT & a pay for 'outcome' system may allow the clinicians to
'correctly' diagnose and effectively treat a patient earlier in the process so that it can measurably decrease the
crushing lawsuits and deter the excuse for unnecessary cares to make fortunes.
5. The creative idea of 'a pay for outcome' will more likely prompt team approach and decision, as at Myo clinic.
Under the 'pay for outcome' pack, for good reason, best practices as 'recommendations' would simply help them
make a better decision, and the government won't still have to meddle in the final, actual decision-making
process as a non-expert.
6. This New 'Payment Reform' could accelerate the progress in medical science, in return, it will save more cash.
And this idea will be able to bring 'competition' to the private market, as a result, it can contribute to mitigating premium inflation.
7. Supporters of the agreement say it could save the Medicare System more than $100 billion a year and 'improve'
care, that means more than $1trillian over next decade, and virtually needs no other resources including tax on the
wealthiest. Supposedly even the 'conservative' number of such savings might be able to meet the objective of revenue-neutral.
(Please visit http://www.kare11.com/news/news_article.aspx?storyid=820455&catid=391 for detailed infos).
8. Through clinic's network, users of its health-care services can keep up with their health information and information for family members, and receive health guidance and
recommendations from clinic that is optimized for each person.
The system also allows patients to upload information from home-health devices such as blood glucose monitors and digital scales. Patients can authorize whether they
want to share their health information with doctors or other caregivers, and those caregivers can provide health-care and general wellness recommendations based on the
information patients provide.
9. In case the health care reform provides the general public with peace of mind, the rising mental stress, obesity caused by the insecure system and
exorbitant premiums may bend the curve surprisingly.
10. Clearly, the positive impacts involving massive job creation, promising stem cell research, several times more economic effects of 'from bed to work' lie ahead, these will
lead to economic recovery.
Part 3.
Conclusion ;
1. The last thing to expect is rallying for premium inflation
2. Over time, supposedly, the public plan will concentrate more on basic, primary cares, and the private insurers will provide their clients with differentiated services.
3. With the Prevention & Wellness Program as a stable levee in place, the promising pay for value/ outcome reimbursement reform based on IT system could clear the way for revenue-neutral. Some say the installation of IT network will take time, but once this new outcome-based payment system is implemented, the hospitals reluctant to adopt it will most likely rush to introduce it.
4. The final hurdle looks like a scoring issue surrounding the savings on Prevention & Wellness Program, but I'd like to say
health clubs and media reports on prevention tips must be maintained.
Thank You !
Health care
It seems that more and more every day the health care reform is nothing more than Obama's way of taking over the industry. Dennis should have had more care, that is the type of reform we really need. online casino
Debate or Hysteria?
Health Care Concerns or Mass Hysteria?
The Scary New Black Man is Not Going to Kill Our Grandmothers
There has been a wee-bit of "reaction" concerning health care reform and what it means for the average American. According to reports from every major network, some folks at town hall meetings, all over the US are having what appear to be public nervous breakdowns as they confront their local representatives. So, is this "debate" really about health care at all, or are there some other sociological and psychological factors at work?
Perhaps white, middle class, conservative Americans are afraid. Truly afraid, yes, but over health care reform… no. Pssst- we have a black president (the first one ever) and white conservatives are, maybe for the first time, feeling like they are no longer controlling the overall public discourse. Perhaps it’s a normal reaction, when any group feels like it is loosing control, to go a little loopy.
Guns at political meetings, cries about Socialism and government mandated euthanasia—these are just examples of a collective public psychological breakdown of a group who has indeed lost some control over legislation. What those who are screaming the loudest have failed to realize is that it’s not as bad as it seems for them. We, as a nation will—as we always have, find political and cultural homeostasis and grow healthier as a Society.
Health Reform
Where can i get a copy of the Health reform so i can read for myself as to what it says or is the goverment keeping the people from seeing what is realy in it
texts of health bills
there is not yet a single health bill but the committee texts are in the public domain
Senate HELP committee did its version, three House committees did theirs (the House ones started with the same text HR 3200 , but committees amended in different ways). Senate Finance isn't done yet. They are available -- check committee websites for texts and summaries, and the library of congress website (www.loc.gov -- legislation is on a section called THOMAS as in Thomas Jefferson).
Several reliable nonpartisan groups such as the Kaiser Family Foundation (www.kff.org) have summaries and analysis of the bills.
Joanne Kenen
Americare
POLICY AND POLITICS:
To get a change in the American society takes good policy, tested at the state and local level, and good politics. What is the “hook” or appeal in selling health care reform? The system is out of control and requires fixing (as has been true over the last 50 years) but effectiveness and efficiency are hot political buttons. What does it take to crystallize public opinion? Amazon's Edward L. Bernays Page
The progressive’s reforms at the turn of the century were based on SHAME and GUILT. The shame of the cities and meat packing was direct threats to citizen’s welfare and safety. The PR message now should be “are we the only modern society without universal health care?” Canadians are taken care of, French are taken care of, and people are better treated in dozens of countries at less cost! Stop being so afraid of the truth and the lie that we have the best in the world – we are in grave danger, there is a crisis, panic .. Health Insurance Costs: http://www.hlc.org/HRD_Common_Ground_--_FINAL.pdf
WRONG: NOT TRUE - FACT CHECK…AND IMPORTANT
The face of clear and present danger should be personal stories of middle class families destroyed by getting sick. The cornier the better, more soap opera the better, the more painful the better. We are talking about deep sub conscience motivation below the rational mind; as is most effective advertising. Bernays was an outspoken proponent of propaganda as a tool for democratic and corporate manipulation of the population. His 1928 bombshell Propaganda lays out his eerily prescient vision for using propaganda to regiment the collective mind in a variety of areas, including government, politics, art, science and education. To read this book today is to frightfully comprehend what our contemporary institutions of government and business have become in regards to organized manipulation of the masses.
The American public is not conservative about money. They are not financially conservative, but motivated by immediate satisfaction. The traditional middle class put off purchases until there was money in the bank, (puritan ethic) while lower class people demanded immediate gratification. If they want something they pay for it on the “old never never” credit cards and then put it on their equity loans using their homestead as an ATM machine. Thus was the cause of the economic crisis.
They vote for politicians who promise benefits without pain or taxes, the “check is in the mail campaign”. The “conservative movement” is more social than economic and based on prejudices between regional, racial, tribal, moral family values, religious, WASP vs. foreigners not self interest since people are voting against their own economic self-interests. Republican get tax cuts for the rich 1% by their “values” agenda based on prejudice and fundamentalism. The rich fear a liberal popularism of buying vote with an endless stream of entitlements the rich end up paying for.
In Health Insurance Market the fault does not primarily lie with the insurance industry but a twist in employer based policies. Two thirds of the premium cost paid by the employer is invisible to the employee. If the employee pays $300 a month the company pays $600 for a total of $900 or $10,800 a year. If there is a prepaid plan that is more effective and efficient and cost less but is not as convenient the small reduction in employee cost is not motivation. The employer needs to reward the employee with a share of the employer’s savings. The employee pays $200 a month and saves $100 but the employer saves $200 that needs to be paid in wages so the full $300 or $3600 saving is manifest. The saving should not be taxed but be pretax as are health benefits.
BREAVEHEART:
A new AMERICARE in the Centers for Medicare and Medicaid Services (CMS), determines to be federally qualified or that are an approved Competitive Medical Plan (CMP) http://www.opm.gov/insure/health/planinfo/types.asp
What is needed are new comprehensive, Medicare medical plans on a regional and state wide basis. In short it opens the Medicare system to everyone in the exchange. At the same time it moves Medicare and Medicaid to Medicare or service alliances based on per capital costs or bundled, global payments that could decrease “fee for service” and cut costs by another 20%. This is a form of single buyer that has proved itself the best may to reduce costs and improve quality. The Clinton plan was universal as in all other industrial countries. BUT….
One person’s waste, abuse or fraud is another person’s income, their private plane, and Palm Beach mansion. The policy that could solve the problem is not political possible, what is politically possible does not solve the problem.
The reason “the public option” is critical is that employers can migrate from over priced private plans to a form of Medicare for all. When almost everyone is included there is less cost shifting (where uncollected bill of uninsured are paid by the insured) and premium could decline. The insurance companies don’t want public competition; and the medical community is not excited by the change that reduces their incomes. NOW THE PLOT THICKENS:
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