Recently in Health & Health Care Category

We're #37

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Here's a great video from Paul Hipp that celebrates our #37 ranking in the Health Outcomes by Country survey done by the WHO. Of course, we're #1 in spending on Health Care ... just not so good on the delivery and outcomes side of it.

Via math4barack with more good stuff in his diary "You're trying to make sure everybody has health care and they're putting a Hitler mustache on you."

Senator Lieberman, why aren't you listening?

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The people in this video bring home the need for a genuine public option in health care reform in a very real, down-to-earth way,

Senator Lieberman, they're talking to you. Why aren't you listening?

The Obama Health Care Plan in 4 Minutes

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Learn more at the website.

SciFi medicine happening now

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This is really amazing.

I wonder what the status will be in just 5 years and how long it will take for these medical advances to be available to average health care consumers.

Cartoonists capture the truth

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A Health Care Review

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Dr. Atul Gawande has written an article in The New Yorker which is a must read for any who are interested in the discussion about health care in the US. He delved into the cost of the health care delivery in McAllen, Texas. A location which is "one of the most expensive health-care markets in the country", second only to "Miami--which has much higher labor and living costs. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns. The explosive trend in American medical costs seems to have occurred here in an especially intense form."

Dr. Gawande spent a lot of time digging into what's happening in McAllen, interviewing a lot of people at different levels and locations in the health care industry there. He spends some time comparing it to activity in Grand Junction, Colorado and the Mayo Clinic which now has a satellite clinic in Florida, one of the most expensive health care states, which has become "the most efficient one in the [Mayo] system" with the "same high-quality, low-cost results as Rochester".

The story Dr. Gawande tells of the fragmented, for-profit activity, unregulated activity in McAllen in a frightening one for US health care consumers. It's a very grim picture if it represents the future of our health care system. He concludes with this recommendation.

...McAllen and other cities like it have to be weaned away from their untenably fragmented, quantity-driven systems of health care, step by step. And that will mean rewarding doctors and hospitals if they band together to form Grand Junction-like accountable-care organizations, in which doctors collaborate to increase prevention and the quality of care, while discouraging overtreatment, undertreatment, and sheer profiteering. Under one approach, insurers--whether public or private--would allow clinicians who formed such organizations and met quality goals to keep half the savings they generate. Government could also shift regulatory burdens, and even malpractice liability, from the doctors to the organization. Other, sterner, approaches would penalize those who don't form these organizations.

This will by necessity be an experiment. We will need to do in-depth research on what makes the best systems successful--the peer-review committees? recruiting more primary-care doctors and nurses? putting doctors on salary?--and disseminate what we learn. Congress has provided vital funding for research that compares the effectiveness of different treatments, and this should help reduce uncertainty about which treatments are best. But we also need to fund research that compares the effectiveness of different systems of care--to reduce our uncertainty about which systems work best for communities. These are empirical, not ideological, questions. And we would do well to form a national institute for health-care delivery, bringing together clinicians, hospitals, insurers, employers, and citizens to assess, regularly, the quality and the cost of our care, review the strategies that produce good results, and make clear recommendations for local systems.

Dramatic improvements and savings will take at least a decade. But a choice must be made. Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can't do it. Or we can turn to the local medical communities, which have proved that they can. But we have to choose someone--because, in much of the country, no one is in charge. And the result is the most wasteful and the least sustainable health-care system in the world.

Go read the whole thing. It will be time well spent in gaining a better perspective on what's at stake and what can be done about it.

Tales of a Family Doctor

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A family doctor sat down at his computer and wrote about what he does when he goes to his clinic. The end result is an extraordinary look inside a clinic focused on family practice and the stresses that the current health insurance system places on the people in such an establishment.

I arrived this morning in the office at 8:50 a.m. to find Glenda, my office manager, buried in charts. She had been there since 6:30, simultaneously arranging referrals that had been requested the day before, making sure that we had properly completed the detailed forms required by the Child Health and Disability Prevention Program that helps pay for the preventive care provided to some of our poorer patients, and listening to the voice mail from pharmacies to get the medication refill requests in order for me before the day begins in earnest.

Glenda is a great asset to the practice. An extraordinarily hardworking mother of two, four days a week she commutes with her husband from an outlying suburb to the office, arriving early to avoid the rush hour gridlock and get some of her work done before the phones start ringing. Having been with me for about ten years, she knows the ins and outs of dealing with all the health plans-- which ones require paper referrals, which use the Internet, which force her to hang on the phone waiting for an okay. Only Medicare is easy; all we have to do is provide a patient with the name and phone number of the consultant. MediCal, the California Medicaid program for certain categories of poor people, works the same way in our county but it is a bit more complicated. Not all the consultants we regularly use accept MediCal referrals so the list of available consultants is limited. Glenda is playing what I think of as a game of "keep away" we play in our office. The providers, knowing medicine but not the details of each health plan, send administrative work to the staff; Glenda and the rest put their stamp on the process and return the charts back to the doctors. Eventually the game pauses, but right now Glenda is "losing" with over fifty charts on her desk.

My office, a small practice which I own and staff, has grown over the nearly 20 years I've been practicing family medicine in the San Francisco suburb of Burlingame. At first I worked alone, delivering babies, assisting at surgery, rounding on my hospitalized patients, but always spending most of my time seeing patients in my office across the street from the hospitalOver time, in order to make sure that I could take vacation and to spread the overhead, the practice has grown and now we are a group of five part time physicians and two nurse practitioners supported by seven full and part time staff. [...]

Shortly after I arrive and begin to call back patients who've left messages overnight Glenda comes by with a small stack of charts that have been giving her trouble. A couple require a short letter from me changing the "diagnosis code" I used when completing a lab order form. Some insurance companies, it turns out, do not pay for preventive screening tests, so when I ordered a cholesterol or a prostate cancer screening test at the time of a physical, the test would not be covered under a patient's insurance policy. Fortunately, the lab often catches these slips and notifies us so I can correct the "error". For better or worse, the two patients' whose charts she brings today have elevated cholesterol levels, so I feel honest indicating that fact in the letter, knowing that the insurance company will not balk at payment. [...]

The private health care insurance system which we deal with every day is an insidious bureaucratic monster. The morass of more than 1300 insurance carriers in this country introduces an administrative mess beyond belief. In our small office of essentially two full time equivalent providers, seven full time support staff are needed to cope with the complexities introduced by this system. I am quite certain that the wasted effort this system creates is so great that if we had a unified system of health care I could see 10-20% more patients - with two fewer staff. Looked at from another direction, at least 10-20% of my current income is wasted on insurance bureaucracy which benefits no one. [...]

Three medical assistants spend hours daily communicating with patients about medication refills and calling or faxing pharmacies. Most insurance companies allow patients to collect only a one month supply of medication at their local pharmacies (three months if patients can figure out how to manage a mail order program). The rule makes financial sense for insurance companies. Why should one company pay for a year's supply of medication if a patient may well switch insurance companies or lose their coverage after one month? Unfortunately, the rule doesn't make sense for patients. Studies show that compliance with chronic medications is abysmally low, in part because of rules like this.

The churn in insurance coverage as people move, change jobs, or suffer economic hardships which lead them to cut back on expenses introduces a huge set of problems for our little office, and wasteful costs for the medical system. Easily half of the new patients we see explain their search for a new doctor (no small task in a community where primary care providers are retiring in far greater numbers than they are starting out) as the result of an insurance change. So we often "reinvent the wheel", setting up a new chart, getting to know a patient, revising medications, reviewing old medical records, helping those with complex medical issues reestablish with new consultants. The economic implications for the system are obvious.

There's so much more in his post that I encourage you to go read the original. He concludes with some thoughts about the future of health care in America and he makes a lot of sense. Let's hope people who need to hear his input are listening.

The doctor's name is Aaron Roland and his bio notes that he "is a family physician who years ago left Yale Law School and a career in politics for the front lines of primary care. He now returns to fight for national health insurance for all." His opening comment mentions the organization, "Physicians for a National Health Plan" or PNHP, specifically pointing out a blog at the PNHP website which may be of interest.

Why are we failing these veterans?

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The NY Times editorial on "The Plight of American Veterans" is worth some of your time.

Recent surveys have painted an appalling picture. Almost half a million of the nation's 24 million veterans were homeless at some point during 2006, and while only a few hundred from Iraq or Afghanistan have turned up homeless so far, aid groups are bracing themselves for a tsunami-like upsurge in coming years.

Tens of thousands of reservists and National Guard troops, whose jobs were supposedly protected while they were at war, were denied prompt re-employment upon their return or else lost seniority, pay and other benefits. Some 1.8 million veterans were unable to get care in veterans' facilities in 2004 and lacked health insurance to pay for care elsewhere. Meanwhile, veterans seeking disability payments faced huge backlogs and inordinate delays in getting claims and appeals processed.

The biggest stain this year was the scandalous neglect of outpatients at the Walter Reed Army Medical Center and a sluggish response to the needs of wounded soldiers at veterans clinics and hospitals. Much of this neglect stemmed from the Bush administration's failure to plan for a long war with mounting casualties and over-long tours of duty to compensate for a shortage of troops.

So how much have you thought about what sacrifice you could make that would honor and support these veterans and their families who have given so much more? Or do you not "bother your beautiful mind" about such things?

Well, here's a place to start. Sen. Webb is proposing an updated GI Bill. Go learn more about it and call your congressional reps and senators and express your support for it.

Cross-posted from Dwahzon's Village