The weekly summary of the best of the health blogosphere is ready for your reading at MedPageToday. It’s dedicated to healthcare reform.
Grand Rounds 5:18: Ten Suggestions For Healthcare Reform
I’m this edition’s author, just hosting it on MedPageToday’s platform – please excuse the formatting.
Head on over and read it.
Next week’s Grand Rounds will be hosted by Chronic Babe.
I’m writing this post mostly to embarrass my girlfriend Gwen Mayes, but also because I’m mentally exhausted from preparing Grand Rounds for publication tomorrow, and thought I’d engage in some frivolity.
Gwen and her friend Scott are pictured here en route to the Kentucky Inaugural Ball in Washington, DC. Most states are hosting their own celebratory ball tonight – and Kentucky’s Bluegrass Ball won an “Editor’s Pick” from the Washington Post. It’s one of the largest and best balls, and I suppose that makes sense if one assumes that southerners do this kind of thing well (I lived in Texas for four years, so I’m allowed to joke about that).
The Bluegrass Ball has some predictable highlights, including the “Kentucky Bourbon Trail” sponsored by the Kentucky Distillers Association, and a guest list that includes everyone from Governor Steven Beshear and Senate Republican Leader Mitch McConnell to the band “Joey and the Cruisers.” What I did not expect, however, was that the caterer for the event would import “720 heads of Bibb lettuce” as part of a “Kentucky-friendly menu.” I soon learned that Bibb lettuce was first cultivated in Kentucky by Jack Bibb in the late 19th Century. Am I the only person who didn’t know this?
I’ll be attending a few events on Pennsylvania Avenue tomorrow during the inauguration day parade. Gwen and Scott will be spending the night at my place – and I can only hope that they bring me back a goodie bag filled with Kentucky goodness – especially the Bibb lettuce.
Addendum: My friends make a b-line for the Maker’s Mark booth…
And here they are horsing around:
And no, they didn’t bring me any Bibb lettuce back from the ball (dang it)… just a floral arrangement they picked up from some guy in the subway who was returning home from the Indiana Ball. Oh… and some Maker’s Mark.
Dr. Val is hosting the historic inauguration day Grand Rounds at MedPageToday. Please send your submissions to this email address: valjonesmd AT gmail dot com. Put “Grand Rounds Submission” in your email title and please use this format for the body of your email:
Although I have never done a themed Grand Rounds before, it would be terribly remiss of me not to acknowledge healthcare reform on the very inauguration day of our new President, Barack Obama. So please send me your best posts about the change you’d like to see in healthcare. If we do a really great job of this, maybe Tom Daschle will take a looksie? Don’t laugh, but DC is a small world – I share a hair stylist with Tom’s wife, Linda!
Please send me your submissions by midnight, ET, Sunday January 18th. I will include all submissions, but will give more weight to those that are about healthcare reform.
For those of you who are reading this and wondering what on earth I’m talking about – please read about Grand Rounds here. It’s the weekly summary of the best blog posts from the medical blogosphere.
My inaugural Grand Rounds will be published at MedPageToday at 8am, Tuesday, January 20th. (This link will work from that time on). I hope that we’ll reach an unprecedented number of readers on this platform.
I look forward to receiving your submissions!
Warmest Regards,
Val
P.S. Please enjoy Barbara Kivowitz’s Grand Rounds this week – it has a Sci Fi theme! The January 27th edition of Grand Rounds will be hosted by: Chronic Babe.
Dr. Joe Kvedar is the Residency Program Director of the Department of Dermatology at Harvard Medical School. He is also the Founder and Director of the Center for Connected Health, an organization whose provocative goal is to help patients “become their own primary care provider.” I caught up with Dr. Kvedar at a recent health conference, and asked him to explain what his company’s approach contributed to the healthcare landscape.
Dr. Val: What is the Center for Connected Health?
Dr. Kvedar: Connected Health’s mission is to empower patients to be maximally in control of their own health destiny. As much as possible, we’d like to see patients become their own primary care provider.
There are three principles that must work together to accomplish this: first you must have accurate information about the health behavior that you want to change. Measurements must rely on quantifiable data (like the step count of a pedometer) rather than more general self-reports of how physically active you are. Second, the report must be in a format that offers specific feedback to the individual. Trending of information is critical, but the trends must be understood in context. For example a patient with diabetes needs to see how their blood glucose levels are behaving over time, but more than that they need to see how their food intake was influencing these levels. And third, data-driven coaching inspires the application of data to real lifestyle improvements.
Giving accurate information about yourself (in a format that is contextually trended over time) to a person that you trust can inspire behavior change. People are more likely to change their unhealthy choices when they know they’re accountable to someone for them. An appropriate coach can be anyone from a friend in a social network to a digital avatar, to a doctor or nurse.
Dr. Val: So what’s the rate limiting step in getting this behavior change model adopted? Is it lack of financial incentives?
Dr. Kvedar: That’s certainly part of it, but it’s even more than that. Healthcare providers gravitate towards human resource-intensive solutions. Providers are simply not used to thinking of technology as a tool. Instead, they often perceive the solution to better patient compliance as an increase in staff to serve them. But this is not feasible given our provider shortage and increasing healthcare burden. It’s just really hard for doctors to imagine that patients could be coached effectively by an avatar, yet there are many examples of it working. Read more »
The Kaiser Family Foundation and Harvard School of Public Health teamed up to survey Americans about their healthcare reform priorities (Kaiser has been doing this every year since 1992). A random sample of 1,628 adults participated in the telephone survey between December 4-14th, 2008. The results were presented at a press conference that I attended on January 15th.
Although you might want to view a presentation of the entire webcast here, I’ll summarize the points that I found the most interesting:
Dr. Robert Blendon (Professor of Health Policy at the Harvard School of Public Health) offered some fascinating commentary on the survey results:
1. Americans Are Fickle About Healthcare Reform Issues. Most public opinion polls do not take into account the degree of conviction with which people describe their health reform priorities. In reality, the public is generally quite ambivalent regarding the specifics of how to achieve reforms like improved access to care, and decreased healthcare costs. The Kaiser survey clearly demonstrated the public’s tendency to agree with specific reform ideas, but then change their minds when the potential downsides of such initiatives were described. So for example, most survey respondents liked the idea of an employer insurance mandate (requiring employers to subsidize employee health insurance costs), but when asked if they would favor it if it might cause some employers to lay off workers, then they no longer supported the mandate.
2. Public And Government Priorities Differ. While the public is primarily focused on relief from skyrocketing healthcare costs, the government is focused on healthcare delivery reform.
3. Americans Don’t Want Change To Affect Them. An underlying theme in the survey was that the average respondent didn’t want to pay more for healthcare, and they also did not want to be forced to change their current care and coverage arrangements.
4. It’s All About Money. America is in a near economic depression, and therefore the healthcare reform climate is very different from that of 1992 (when the Clinton reform plan stalled). Middle income Americans in an economic downturn are not willing to pay more taxes. The only way forward in our current economy is to find a revenue stream for reform that does not increase taxes on the average American. Blendon summarizes:
“It isn’t enough that all the groups agree on how to spend money on healthcare. ‘Who is going to pay?’ is the critical issue.”
At this point in time, it looks as if the American public is most supportive of the healthcare reforms listed below (but their opinion is certainly subject to change, depending on how the political discussions unfold, and how the media influences the debate). Blendon also cautions: “This doesn’t mean that this is a sensible health reform plan, it’s just what has public support at the moment.”
Healthcare Reform Initiatives Currently Favored By Americans
Expanding Coverage
1. Health insurance mandate for children
2. Fill the Medicare doughnut hole
3. Tax credits to employers to help them offer coverage to more employees
4. Health insurance for the unemployed
5. Eliminate medical underwriting (“pre-existing condition” carve outs and such)
6. Expand Medicare to cover people ages 55-64 who are without health insurance
7. Require employers to offer health insurance to their workers or pay money into a government fund that will pay to cover those without insurance
8. Increased spending on medical care for veterans
9. Increased spending on SCHIP
Controlling Costs
1. Negotiate for lower drug costs under Medicare
2. Allow Americans to buy prescription drugs imported from Canada
3. More government regulation of healthcare costs
4. More government regulation of prescription drug costs
5. Regulate insurance companies’ administrative spending and profits
Raising Revenue
1. Increase the cigarette tax
2. Increase income taxes for people from families making more than $250,000 a year
***
As you can see, the public supports reform that would result in substantial increases in healthcare spending without a clear idea of how to pay for those initiatives. Our government, in partnership with healthcare’s key stakeholders, is going to need to come up with a reform plan that identifies new revenue streams to cover the costs associated with expanding coverage. I find it hard to believe that increasing taxes on cigarettes (and a few very wealthy Americans) is going to be sufficient. If ever there were a time to nurture our American entrepreneurial spirit, it’s now.
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