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The Relationships Between Poverty and Healthcare

Readers interested in the relationships between poverty and healthcare will want to read several new postings on the Web.

One is an article about my Rhoades Lecture at the Wayne County Medical Society in Detroit, “Poverty and Healthcare in America.” It is posted on the World Socialist Web Site.

Second is by James Marks, MD, MPH, Vice President of the Robert Wood Johnson Foundation, entitled “The Poor Feel Poorly.” It is posted on the Huffington Post site.

Third is “Health and Healthcare in America’s Poorest City,” a tragic and dramatic portrayal of America’s failures to its own in Detroit, also on the World Socialist Web Site.

Finally, here is a link to a collection of papers on social inequalities in health by the McArthur Network on SES and Health, published by the New York Academy of Medicine under the title, “Biology of Disadvantage.”

*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*

America’s Poorest City (Detroit) Leads The US In Healthcare Quality Reform

Photo of Nancy Schlichting

Nancy Schlichting

“Detroit is the poorest city in America. But we’re not going to be victims of circumstance. We’re going to rise up and lead the country in healthcare quality and become part of the economic solution for our community. The Henry Ford hospital name must mean something when people drive up to it.”
- Nancy Schlichting, President and CEO, The Henry Ford Health System, Detroit, Michigan
I sheepishly admit to being surprised that a hospital system in Detroit was singled out for a national award for hospital quality and safety. Who would think that the poorest city in America could be a beacon of light in these dark times in healthcare? The story of Henry Ford Health System, and its female president and CEO, Nancy Schlichting, is both inspirational and motivational. I had the chance to interview Nancy at a recent award ceremony at the National Press Club where she received the 2008 National Health System Patient Safety Leadership Award.


You may enjoy our conversation via podcast, but please forgive the “tinny” sound quality. I recorded our conversation with a little hand-held digital device instead of my usual recorded phone line.

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Dr. Val: Congratulations on winning the National Health System Patient Safety Leadership Award. Has improving patient safety at your hospital been a challenge?

Schlichting: On a given day, a patient may encounter up to 50 different hospital employees. Coordinating our efforts so that the patient’s experience is consistently positive and error-free is certainly challenging.

We have 7 pillars of performance at Henry Ford, and the first is “people.” We like to say that we “have to take care of the people who are taking care of people.” We need to make sure that they have the resources they need, that the processes are in place so they can do their jobs well, and that they get their individual needs met. For example, everyone knows my email address and they can contact me at any time if they’re not getting their problems resolved. I respond to every single email. This creates a culture of openness and responsibility. They know that the person at the top cares about them.

Dr. Val: A prominent community member experienced an unfortunate lapse in communication during his hospital stay, which resulted in compromise of his care, and he eventually died in the hospital. You personally met with his wife and promised her that you’d take the necessary steps to ensure that this never happened again. Tell me more about that.

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The Cost of Universal Coverage: Can We Afford It?

I don’t subscribe to many newsletters, but the Galen Institute’s Health Policy Matters is always a provocative read. Here’s an excerpt from this week’s newsletter:

Incoming White House Chief of Staff Rahm Emanuel said this week that universal coverage will be an early, top priority of the Obama administration.

But where is the money going to come from to pay for these massive reform agendas, which were developed before the meltdown of Wall Street, the $700 billion rescue package, and a projected $1 trillion deficit?

The Obama plan is estimated to cost an additional $100 to $160 billion in the first year alone, yet the president-elect made fiscal responsibility a big part of his campaign platform. If the White House is going to extend the plan to mean universal coverage, the bill will be even more expensive.

Mr. Obama also will be facing the huge flood of red ink in Medicare, with the program starting to run out of money in 2017, about the time a second Obama term would end.

It’s impossible to make predictions in the current topsy-turvy political and economic climate, but these power political power centers, fiscal realities, and the urgency of other issues, including Detroit’s looming bankruptcy and an unstable geo-political climate, make these dreams of sweeping health reform a major challenge.

Mr. Obama will likely use the pending expiration on March 31 of the State Children’s Health Insurance Program (which will be renamed) as a vehicle to expand health coverage to all children and possibly even enact his mandate for children’s coverage. That probably means funneling more money to the states through Medicaid since they must pay part of the costs.

After SCHIP, Congress will take the lead on major health reform legislation from there.

We need to remember that 82% of the American people are happy with their own health care and only a minority is willing to pay higher taxes to get to universal coverage. Also, the employer mandate is a new tax, and it is going to be especially difficult to impose during the economic crisis. And can we really tell people who have lost their jobs that now, in addition to everything else, they are going to be forced to buy health insurance?

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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