November 10th, 2010 by Richard Cooper, M.D. in Better Health Network, Health Policy, News, Opinion
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In a high-profile paper in the September issue of Health Affairs, Thorson and coworkers showed that the care at St. Mary’s Hospital in Grand Junction, CO was superior to that of 20 other unnamed hospitals. Grand Junction is, of course the smal town in SW Colorado that became famous when President Obama visited there during the health care reform debates during the summer of 2009, and here’s what he said:
“Hello, Grand Junction! It’s great to be back in Southwest Colorado. Here in Grand Junction, you know that lowering costs is possible if you put in place smarter incentives; if you think about how to treat people, not just illnesses. That’s what the medical community in this city did; now you are getting better results while wasting less money.”
So, Grand Junction, a town of 58,000 people located in SE Colorado, where there are virtually no blacks and fewer Native Americans but where family practice rules, is supposed to be the model for the nation. Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
June 23rd, 2010 by Richard Cooper, M.D. in Better Health Network, Health Policy, Opinion
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Solutions to problems are generally sought from within the problems themselves. Two recent examples are healthcare and finance. In both cases, the solutions are believed to be better-structured and regulated systems. In blogs, articles and speeches, I have stressed that — while there are myriad ways that healthcare can be improved — the real solutions to high healthcare spending lie outside of healthcare.
Poverty and its associated manifestations are at the core of the healthcare spending crisis. The high costs of caring for the poor will continue to overwhelm the system, no matter how it’s structured and improved. Rather than looking for solutions through changes in process and regulation, the major solutions to healthcare’s excessive spending reside in areas such as K-12 education, neighborhood safety, and the creation of jobs that can lift low-income families from the cycle of poverty.
Simply stated, the U.S. does not and will not have the resources to provide equitable care for those among us who confront inequitable circumstances in every other aspect of their lives. Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
April 5th, 2010 by Happy Hospitalist in Better Health Network, Health Policy, Opinion, True Stories
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We learn from the healthcare reform bill that the federal government will help subsidize Medicaid funding for all the new patients who qualify, but they will only do it for two years. After that, the states are on their own. Medicaid unfunded liabilities will crush state governments everywhere.
Why is Medicaid so expensive and going bankrupt? I’ll give you one example why. This is played out day after day, night after night in communities all across our country. And the only ones paying for it are you and me. The ones spending all the money have no incentive to stop.
I’m in the ER the other day when I see a chief complaint fly by on the radar. What is that chief complaint, you ask? Let me tell you a story.
Refused By Detox
The patient was so drunk even the community detox center refused him. So how did this play out? The patient was taken by ambulance from his home to a small-town community ER for altered mental status. There he was checked into the ER and seen by a small-town community ER physician, family practice resident, or PA or NP.
Diagnosis: Acute alcohol intoxication. Plan: Discharge to community detox center. Read more »
*This blog post was originally published at The Happy Hospitalist*
April 1st, 2010 by Richard Cooper, M.D. in Better Health Network, Health Policy, News, Opinion, Research
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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*
March 23rd, 2010 by Richard Cooper, M.D. in Better Health Network, Health Policy, News, Opinion
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The final House “Manager’s Amendment to Reconcilliation“ provides $400M for hospitals located in counties in the lowest quartile of Medicare spending, adjusted for age, sex and race — but not income. Coupled with annual cuts of $10B in DSH and $1.5B for re-admissions, this is bad news for the poor and the hospitals that care for them. Mayo Clinic wins!
Note that adjustments cannot be based on counties. Urban counties are too big and economically varied. When the extremes of wealth and poverty are averaged, mean household income is 128% of average in Washington DC, 113% in LA, and 108% in Chicago (Cook County), all with dense and costly poverty ghettos. Without any poverty, mean household income in Olmsted County (home to Mayo Clinic) is the same as in LA. Very few truly poor counties will qualify for such payments. This is another example of the truism that “Poverty is the Problem; Wealth is the Solution.”
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
