Health Care

Here's a bit of what we learned at an informative Health Affairs briefing tied to its September/October issue on "Bending the Curve."

1. There may be no such thing as a free lunch but if we do some simple (relatively speaking) health system changes, we may get a free snack
2. Moving from Medicare "demonstration projects" to Medicare "pilot projects" is a big deal. (If they work, we can go ahead with implementation much more quickly)
3. Harvard economists can do great slides (maybe not quite as good as our Gumby, but we still like the whole tricycle vs red sports car thing).

After attending a Sunday evening wedding in New York earlier this month, I woke up at some uncivilized pre-dawn hour to return to DC for work and to attend an interdisciplinary (and ideologically eclectic) lunch here at New America. We had some foreign policy types, and some domestic policy types, and even one Hollywood type, and the conversation floated from one theme to another (universal pre-K? the war in Afghanistan?) in a rather interesting way until a conservative participant posed the question that dominated much of the rest of our luncheon.  Doesn't Zeke Emanuel, he asked, want to ration care to save money and stop access to expensive cancer drugs? Doesn't he want to remake the Unites States health system over to look like Britain's? (I'm paraphrasing, but only slightly).

For quality-oriented health care communities across America, "yes we can" has nothing to do with politics.  It's about what they do every day. In red states and blue.

Four of the top health policy experts in the nation -- a bipartisan crowd, by the way, and they are all physicians -- convened representatives of 10 of high-quality, low-cost communities in Washington recently (we wrote about it). In a New York Times op-ed today, they explain why the rest of the country should take note: this can be our future.

Instead of screaming at each other about fictional plots to have the government start euthanizing people,  we should pay attention. They write (emphasis ours):

We have reached a sobering point in our national health-reform debate. Americans have recognized that our health system is bankrupting us and that we have dealt with this by letting the system price more and more people out of health care. So we are trying to decide if we are willing to change -- willing to ensure that everyone can have coverage. That means banishing the phrase "pre-existing condition." It also means finding ways to pay for coverage for those who can't afford it without help.

For all the news of delay in the House and Senate -- it's disappointing but not surprising. And it's not fatal: For those of you who don't (literally) have surgical scars on your feet from spending years of your life standing on marble floors in hallways outside closed doors in Congress -- here's how it works. There's no deal. There's no deal. There's no deal. There's no deal. Then there's a deal.  When it happens, it can happen fast. And then the sun comes out and everything looks different. 

Here are a few glimmers of light via this morning's Washington Post's update on the Senate Finance Committee:

Although (chairman Max) Baucus continued to insist in public that negotiators will be "ready when we're ready," he gave (Senate Majority Leader Harry) Reid and other Democrats private assurances Thursday that his panel will complete work on its bill by Aug. 7, the start of the Senate's month-long recess, and in keeping with Obama's new deadline. After asking all staff members to leave a meeting, Baucus said Thursday night, a bipartisan group of senators on the committee heard an optimistic report from Congressional Budget Office Director Douglas W. Elmendorf that their emerging plan would begin to reduce health-care costs. A formal report on the estimate is expected to be completed in several days.

Today we'll share more of the innovative work being done by the Health CEOs for Health Reform by taking a look at Ascension Health’s Clinical Excellence initiative.

In 2003, Ascension Health, the nation’s largest nonprofit health care system, introduced a system-wide “Call To Action” to provide excellent clinical care. Committing to a transformational goal to provide “Healthcare that works, healthcare that is safe, and healthcare that leaves no one behind,” Ascension set out to eliminate all preventable injuries or deaths within five years -- by July 2008.

As Ascension Health President and CEO Anthony Tersigni describes in the video below, the results were nothing short of remarkable, far surpassing initial expectations.

The health sector will create millions of new jobs in the coming years, according to a new White House employment forecast. In a report released this week, President Obama’s Council of Economic Advisers predicts major growth in health care jobs over the next several years. The CEA writes:

Health care is forecasted to remain a large source of job growth in the labor market.  The long-term trend toward more employment in health care is expected to continue, with many health care occupations, including medical records and health information technicians, registered nurses, clinical laboratory technicians, and physical therapists, expected to grow.

Overall, the report estimates a 48 percent increase in health-care jobs from 2000-2016. Driven by an aging U.S. population that will require more care, jobs in “health care support occupations” are expected to grow at an even faster clip.

Our favorite line in Len Burman's Washington Post op-ed on why unions should embrace a cap on the amount of health insurance that could be tax free:

If employers replace Cadillac health plans with Chevy plans, their employees might be able to afford other useful stuff, like Chevy automobiles.

It's an elegant piece so go read it, but the gist of his argument is that unions have sacrified wages for really big tax-protected health benefits, when they'd really be better off with more cash in their pocket. And probably more job security -- to say nothing of what it could mean for General Motors... 

We often hear about the developed world assisting developing nations so it was refreshing to read the recent Wall Street Journal article that tells us it can also be the other way around. U.S. health programs are drawing lessons from medical practices in developing countries. When the AIDS clinic at the University of Alabama at Birmingham recognized that their patient no-show rates were growing, they looked far and wide for solutions. They found one in southern Africa.

Alabama's "Project Connect" has adapted a model developed in AIDS clinics in Zambia. Doctors see patients within five days of an initial call to clinic to gather psychosocial and medical history along with blood tests. A social worker also interviews new patients to try to identify and address issues (which often turn out to be complex and mutli-layered) that might prevent patients from coming back for ongoing care. The strategy is getting the job done. The Journal reports that "the no-show rate dropped from 31 percent in 2007 to 18 percent through June 2009."

I remember visiting an AIDS clinic in South Africa in 2004 and was shocked to see how empty it was. I asked a doctor why, and he said that they get patients in and out quickly by collecting all needed information before the patient actually saw a doctor. This was a stark difference from the AIDS clinic in San Francisco where my aunt worked, and where lengthy waits were the norm. I asked the same question many are asking today: "If they can do it, why can't we?"

At a meeting we attended about health reform the other day, one side of the room was saying of course prevention saves money and the other side was saying with equal certitude that of course prevention doesn't save money. (Forget the irony that we were having this discussion over a pizza lunch. With no salad.) A lot of other people are having this debate, and we attended a helpful panel discussion recently sponsored the Alliance for Health Reform.

We'll grant that if you look, you can find good solid economic arguments that prevention (depending on how it's defined, but more on that in a minute) doesn't save money. At least it doesn't save money in the five- or 10-year budget windows that Washington is used to talking about (and which legislation must be measured against). Economist Louise Russell has been writing about this for years, and her widely cited article earlier this year in Health Affairs (and a shorter version on the Hastings Center blog) makes that argument. Note she is not saying prevention isn't a good thing; she's saying it isn't a "money-saver," strictly defined.

But you can find good solid arguments, too, that prevention and wellness does save money, and can save it quickly. A number of major corporations—Intel, Pitney Bowes, IBM, to name a few—report a high return on investment within a few years (sometimes sooner). They have taken a variety of steps—incentives for diet and exercise, tobacco-counseling, health screenings, no-copay screenings—that are producing a healthier workforce at lower cost.

 As they say on Facebook... It's complicated. Let's break it down.

The New York Times Economix blog, following up on last fall's "Ideal Stimulus Package" grab bag of ideas, invited a whole bunch of consumers, patients, workers, doctors, businesses, insurance companies, tax and public finance experts to opine about what health care reform should look like (not sure if they asked the trickier question of how to pay for it). First batch of responses is up now. Check back later for more.