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Brown And Healthcare: Massachusetts Isn’t An Emerging Conservative State

I’ve lived in Massachusetts almost my entire life.  So, like everyone else, I was surprised by last night’s stunning election results.  To think, in Massachusetts we elected a Republican to serve out the rest of Ted Kennedy’s term.  It’s one of the few times where I would say it’s possible that a dead man is actually rolling in his grave.

The explanations – coming mostly from out-of-staters – are already coming in.  Coakley was a bad candidate.  Brown worked hard and showed he wanted it more.  It’s the economy.  These are all reasonable, and probably true, but I think they miss what the election was really all about. Read more »

*This blog post was originally published at See First Blog*

Healthcare Reform Q&A With Mother Jones Of Nurse Ratched’s Place

nurse-ratched-smallest-webI hate it when I can’t get into conversations that are happening on my own blog. My job at UGH (undisclosed government hospital) has a way of getting in the way of my real life. Jeanne T. has asked a lot of valid questions about healthcare reform. She also asked me to answer some of her questions. Here we go:

Have you read HR: 3200?

I have not read all of H.R. 3200 – America’s Affordable Health Choices Act of 2009. Reading War and Peace is more entertaining than reading a congressional bill, so I only got through about 150 pages of text before my brain cells started imploding. However, I did learn a few things about the proposed legislation. No one is going to kill your grandma or reduce Medicare benefits. This new legislation will save money by cutting billions of dollars in overpayments to insurance companies and eliminating waste, fraud, and abuse. Maybe that’s why the insurance industry is spending billions of dollars to defeat this bill.

Question: Do you currently have money taken out of your paycheck
for Social Security?
 Do you believe that you will receive Social Security assistance when you pass the age of 65, 70?
 What is the reason that you and I will not receive Social Security checks?

Answer: Do I have money taken out of my check for Social Security? Is the Pope Catholic? The good people at UGH take money out of my check every two weeks for Social Security, and I know that I’ll never see that money again.

I’m a nurse for life, which means I’m not going to retire. In other words, I’m going to die with my Nurse Mates on. Unfortunately, I believe that my peers are going to receive meager monthly social security checks after they retire. I know where you are heading with this question. “If the government can’t run the Social Security Administration, what makes you think that they can run a public health care system?” It’s all President Franklin Roosevelt’s fault. The social security system is the ultimate Ponzi scheme, and Roosevelt set it up as a safety net to help out old folks just before they died. The average life expectancy back when Social Security was set up was around 60 years old. President Roosevelt got messed up because he thought he we would always have more money coming in than going out. He didn’t know that our life expectancy was going to go up, and he had no idea that future administrations were going to tack on more entitlement programs. Now Roosevelt’s Ponzi scheme is out of control, not so much because of government mismanagement, but because we aren’t dying off quick enough to make the system work. Hey, wait a minute. Maybe we need to rethink those death panels. Just sayin’.

Question: Can the US government run a public health insurance agency?

Answer: Yes, I believe our government can do whatever we have the will to do. We put a man on the moon didn’t we? If those blood sucking, profit driven, insurance companies who make their money by keeping us away from healthcare providers can run insurance companies, why can the US government? Uncle Sam wants to keep us around until we’re too old to work so we can keep paying into the social security system. See above.

Question: How do you feel about politicians writing healthcare reform versus healthcare professionals?

Answer: I think that healthcare providers are in a better position to understand the lingo and the fine details that go into healthcare bills, but that doesn’t necessarily make them more trustworthy when they champion causes. The letters “MD” does not mean anything if the person lacks integrity. In my opinion, Dr Howard Dean is a man of great integrity. By the way, there are three nurses in Congress: Eddie Bernice Johnson (D-TX), Carolyn McCarthy (D-NY), and Lois Capps (D- CA). I’ve had the honor of meeting each one of these fine ladies. They rock! Johnson and Capps support public option healthcare reform. McCarthy’s website reports that she supports H.R. 3200 – America’s Affordable Health Choices Act of 2009.

That’s it for part one. I’ll write part two later. Like I said, working at UGH has a way of getting in the way of my personal life. It’s been nice talking to you. Keep the conversation going while I’m working this weekend at UGH.

*This blog post was originally published at Nurse Ratched's Place*

Dr. George Lundberg: A Fine Choice For Surgeon General

Rumor has it that Sanjay Gupta is no longer in the running for the office of Surgeon General. Many people had voiced their concerns about his potential nomination (including Paul Krugman, Maggie Mahar, Gary Schwitzer, Dr. David Gorski, and myself) and it looks as if his lack of experience or training in matters of public health, along with a history of industry ties has put the kabosh on his nomination.

So who will be our next Surgeon General? It’s hard to say, but a petition is circulating on behalf of Dr. George Lundberg – a fine nominee for the position in my opinion. Let me explain why.

A review of Dr. Lundberg’s curriculum vitae easily establishes his professional qualifications for the position. Not only has he been one of the longest standing Editors-In-Chief of all the American Medical Association journals (including JAMA), and the founder of the world’s first open-access, peer reviewed online medical journal (Medscape Journal of Medicine) but has served in an advisory capacity to everyone from the World Health Organization, to AHRQ, the Joint Commission, Harvard’s School of Public Health, the Department of Health and Human Services, Food and Drug Administration and the Surgeon General of the US Navy. He is also a prolific and influential writer, having authored 149 peer-reviewed articles, 204 editorials, and 39 books or book chapters. Dr. Lundberg has a large and devoted national and international audience and is highly esteemed by all who know him.

Dr. Lundberg has provided editorial leadership since the mid 1980s in American healthcare reform, campaign against tobacco, prevention of nuclear war, prevention and treatment of alcoholism and other drug dependencies, prevention of violence, changing physician behavior, patient safety, racial
disparities in medical care, health literacy, and the ethics of medical publishing and continuing medical education.

However, what may not be obvious from Dr. Lundberg’s list of extraordinary accomplishments, is his extraordinary character and wisdom. I had the privilege of working with George at the Medscape Journal of Medicine and reported directly to him. From this vantage point I was able to to observe his impartiality, his commitment to honesty and integrity, and his ability to walk the line between inclusivity of opinion and exclusivity of falsehoods. George is a defender of science, a welcomer of ideas, and an impartial judge of content. He can capture an audience, nurture imagination, and see through deception. George is exactly the kind of person we need as Surgeon General – he can be relied upon to discern truth, and maintain his faithfulness to it under political or industry pressure.

But best of all, George understands the central role of trust in healthcare. In his recent book, Severed Trust, George analyzes the policy decisions that have shaped our current healthcare system, and laments their inadvertent collateral damage: the injury to the sacred trust between physicians and patients.

If we want to come together as a nation to restore hope and trust in America – and we want to create an equitable healthcare system that leaves none behind, restores science to its rightful place, and heals the wounds endured by both providers and patients, then we need a Surgeon General like George Lundberg to help us.

I can only hope that his candidacy will be given the full consideration it deserves.

Tom Daschle Will Be Next Secretary of HHS: What Does This Mean For Healthcare?

Tom Daschle - Photo Credit: CBS News

I’ve had my eye on Tom Daschle for many months – and attended a healthcare conference in June ’08 in which he was the keynote. I blogged about his ideas previously, but thought it would be valuable to repost them here (h/t to The Healthcare Blog):

Tom Daschle, former Senate Majority Leader from South Dakota, was the keynote speaker at the Fighting Chronic Disease: The Missing Link in Health Reform conference here in Washington, DC. His analysis of the healthcare crisis is this:

US Healthcare has three major problems: 1) Cost containment. We spend $8000/capita – 40% more than the next most expensive country in the world (Switzerland). Last year businesses spent more on healthcare than they made in profits. General motors spends more on healthcare than they do on steel.

2) Quality control. The US system cannot  integrate and create the kind of efficiencies necessary. The WHO has listed us as 35 in overall health outcomes. Some people ask, “If we have a quality problem, why do kings and queens come to the US for their healthcare?” They come to the best places like the Mayo Clinic, the Cleveland Clinic, or Johns Hopkins. They don’t go to rural South Dakota. We have islands of excellence in a sea of mediocrity.

3) Access. People are unable to get insurance if they have a pre-existing condition. 47 million people don’t have health insurance. We have a primary care shortage, and hospitals turning away patients because they’re full.

His solutions are these:

  1. Universal coverage. If we don’t have universal coverage we can’t possibly deal with the universal problems that we have in our country.
  2. Cost shifting is not cost savings. By excluding people from the system we’re driving costs up for taxpayers – about $1500/person/year.
  3. We must recognize the importance of continuity of care and the need for a medical home. Chronic care management can only occur if we coordinate the care from the beginning, and not delegating the responsibility of care to the Medicare system when the patient reaches the age of 65.
  4. We must focus on wellness and prevention. Every dollar spent on water fluoridation saves 38 dollars in dental costs. Providing mammograms every two years to all women ages 50-69 costs only $9000 for every life year saved.
  5. Lack of transparency is a devastating aspect of our healthcare system. We can’t fix a system that we don’t understand.
  6. Best practices – we need to adopt them.
  7. We need electronic medical records. We’re in 21st century operating rooms with 19th century administrative rooms. We use too much paper – we should be digital.
  8. We have to pool resources to bring down costs.
  9. We need to enforce the Stark laws and make sure that proprietary medicine is kept in check.
  10. We rely too much on doctors and not enough on nurse practitioners, pharmacists, and physician assistants. They could be used to address the primary care shortage that we have today.
  11. We have to change our infrastructure. Congress isn’t capable of dealing with the complexity of the decision-making in healthcare. We need a decision-making authority, a federal health board, that has the political autonomy and expertise and statutory ability to make the tough decisions on healthcare on a regular basis. Having this infrastructure in place would allow us the opportunity to integrate public and private mechanisms within our healthcare system in a far more efficient way.

What do I think of this? First of all, I agree with much of what Tom said (especially points 2-7) and I respect his opinions. However, I was also very interested in Nancy Johnson’s retort (she is a recently retired republican congresswoman from Connecticut).

Nancy essentially said that any attempt at universal coverage will fail if we don’t address the infrastructure problem first. So while she agrees in principle with Tom Daschle’s aspirations and ideals, she believes that if we don’t have a streamlined IT infrastructure for our healthcare system in place FIRST, there’s not much benefit in having universal coverage.

As I’ve always said, “equal access to nothing is nothing.”

I also think of it this way: imagine you own a theme park like Disney World and you have thousands of people clamoring at the gates to enter the park. One option is to remove the gates (e.g. universal coverage) to solve consumer demand. Another option is to design the park for maximal crowd flow, to figure out how to stagger entry to various rides, and to provide multiple options for people while they’re waiting – and then invite people to enter in an orderly fashion.

Obviously, this is not a perfect analogy – but my opinion is that until we streamline healthcare (primarily through IT solutions), we’ll continue to be victims of painful inefficiencies that waste everyone’s time.  It’s as if our theme park has no gates, no maps, no redirection of crowd flow, no velvet-roped queues, and the people who get on the rides first are not the ones who’ve been waiting the longest, but the “VIPs” with good insurance or cash in the bank. It’s chaotic and unfair.

Quite frankly, I think we could learn a lot from Disney World – and I hope and pray that next year’s healthcare solution is not simply ”remove the gates.”

What do you think?

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