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Why Does The US Spend So Much On Healthcare?

Today the Commonwealth Fund came out with a chart that it says is a “grim reminder” of what happens when health care doesn’t get reformed.

If only we had listened to Richard Nixon or Jimmy Carter.  We would have saved tens of trillions of dollars in health care spending.

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

How Will Healthcare Reform Affect Diabetes Care? Kerri Doesn’t Know What To Think

Two weeks ago, I was in Washington, DC with the Better Health team, listening to people talk about voting down government health care.

Last week, I was in Chicago at BlogHer, part of a lunch meeting with Valerie Jarrett, Senior Advisor to the President and Assistant to the President for Intergovernmental Relations and Public Liaison, listening to women at BlogHer talk about passing the government health care bill.

And I have now just entered the land of confusion.

Valerie Jarrett spoke with a room full of bloggers about health care, but she also listened.  She listened while women told their personal stories and she seemed to understand that health care situations aren’t as simple to solve as we’d like them to be. Women candidly told their stories and a few tears even slipped out.  But she listened intently.  And she said she wanted to give a voice to those who might not speak up for themselves.

“Often the people who need it the most don’t speak up because they don’t feel like they have a voice. Give the grass roots a voice, empower them, work together informing people within their communities. You can work to help them get their voice, get info that they don’t have.”

Valerie Jarrett

This lady is important.  Her cell phone rang several times during our lunch (it could have been THE PRESIDENT, for crying out loud) and she had her assistant take the call so she could focus on us.  She handed out her card and scheduled phone calls between some bloggers and her staff to help with the specific health issues that these bloggers were dealing with.  Sure, for them it was a matter of being in the right time at the right place, but she really listened.  I’ve never sat in a room before with a member of high political influence who paid attention to the people more than the information on her cell phone or in her planner.  (Maybe that means I’ve been in the room with the wrong politicians?)

It was a remarkable experience, and the room was electric with hope.

And now I’m even more confused about this health care issue.  I want insurance coverage, I want good coverage, but I don’t want to be excluded due to my pre-existing condition.  I can’t find a happy mental medium with this, but I know there has to be a way for people like me to find health coverage despite diabetes.

With that thought, I’m off to the Joslin Clinic in Boston, with my pregnant best friend in tow, to immerse myself in the best that health care has to offer.  And I hope that whatever decision made by our government leaves me with access to the people I need to help manage my care.

*This blog post was originally published at Six Until Me.*

Interview With Howard Dean At Nurse Ratched’s Place

I love the Internet. It has a way of bringing people closer together. I saw Governor Howard Dean at a town hall meeting in Washington D.C earlier this month. He’s a dynamic speaker. I wanted to ask him some questions, but the place was packed, so I couldn’t get close to him. Not to be deterred, I emailed Governor Dean in hopes of getting a response to a couple of my questions. He not only responded to my email, he agreed to an interview for my blog. See, the Internet really can bring people closer together. I want to thank Governor Dean for stopping by Nurse Ratched’s Place to talk about healthcare reform.

Question: What is your take on the state of our healthcare system? What do you envision for our system, and how do we get there from here? Can America really afford a public option plan?

Answer: Our system is in disarray. We need a system in which the American consumer has real choices, including allowing people under 65 to sign up for Medicare, which is what the public option will look like. That way people can get affordable insurance which can never be taken away, which can’t be denied, and which will follow them through every job, every loss of job, and every move. We can’t afford NOT to have a public option.

Question: How flexible is the public option: will a person be able to move between the public option and private options as their needs and circumstances change?

Answer: People will be able to move back and forth between the public option and private insurance plans as they see fit, up to once a year.

Question: Given your unique perspective as a physician, can you tell us one aspect of the public option that you like and one aspect that you might not be happy with?

Answer: As a physician I would sign up for the public option at once if it is cheaper than what I have now. I would definitely sign my twenty something kids up; it would give them insurance for life at a reasonable cost no matter what they were doing and where they were living.

Question: One of my nursing coworkers wanted me to ask you this question. How will healthcare reform impact nursing workforce issues? Will we see mandated caps on salaries, and how will healthcare reform impact nurse to patient ratios?

Answer: Workforce issues are not addressed in any of the health care options being discussed in Congress. Most Democrats I know favor nurse/patient staff ratios to protect quality of care.

Question: Preventative healthcare is a key component in the healthcare reform debate. What are your thoughts on a proposal that would make the Chief Nurse Officer of the United States Public Health Service the National Nurse? In your opinion, would establishing the Office of the National Nurse have any impact on health promotion or on healthcare reform?

Answer: As a lot of people know, I am a huge supporter of the Office of National Nurse, and since Congress has been slow to act, I am hoping some changes can be made directly by HHS while we await more complete action by Congress.

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

Valerie Jarrett, White House Senior Advisor At BlogHer09

Valerie_Jarrett_official_portrait_smallI was honored to receive an unprecedented opportunity to hear a Senior Advisor to President Obama speak about his health care reform efforts at BlogHer 09.

Valerie Jarrett, Senior Advisor and Assistant to the President for Public Engagement and Intergovernmental Affairs, spoke to an intimate group of bloggers at a luncheon today.

And I was 15 minutes late.

How humiliating! This was definitely not the event where one should be “fashionably late”.

Ms. Jarrett was totally cool though, and said “Come on in and tell us who you are!” Apparently I had just missed intros; the discussion was just starting.

(Photo credit: Wikipedia)

********************

Now I’ve been pretty clear about not wanting a government run health care system, and I attended the luncheon knowing I did not have a clear grasp on the President’s proposal. (I have downloaded the Bill, have not had a chance to finish it.) I wanted to keep an open mind; I wanted to learn as opposed to opine.

The best way to learn is to keep your mouth shut and listen. That is exactly what I did.

It was not easy.

*****

Ms. Jarrett is warm, sincere and truly passionate about the President’s efforts at health care reform;  Ms. Jarrett has full faith in the ability of the President to positively reform our health care system.

Now, if I heard and understood correctly, what the President wants is a public plan as an option; a choice to obtain health care coverage through the government should you find yourself unemployed/without any health care coverage.  Ms. Jarrett was adamant that the goal is not a single-payer government run plan, but there was some group questioning of (1) why the idea of a government plan is perceived as scary and (2) whether or not it would be tantamount to socialism and indeed, what would be wrong with that anyway. One blogger noted that she knew many Canadians who were happy with their health care.

These questions were more rhetorical in nature. Honestly, I don’t think time would have permitted in-depth discussion.

*****

There was discussion on how bloggers can get out the message of health care reform and ideas on how the President can best communicate his ideas to the public.  It was noted that the President is holding press conferences for which he is asking full coverage because he wants the entire story told, not just sound bytes.  (Side note: I found this interesting because just recently ABC News encamped in the White House for an entire day – and the topic was health care reform.)

I actually did have a question enter my mind, as I was intrigued by the idea that the public plan was an option: I wanted to know if one could move in and out of the public plan as desired, or were you stuck in the public plan once it was chosen.

I didn’t get a chance to ask, as the discussion moved forward with two bloggers sharing stories of their personal experiences with the health care system.  Very personal, heart wrenching stories. Their frustration and anguish was palpable. Ms. Jarrett listened with empathy; she truly cared about what my fellow bloggers had/were enduring.

I found out later that both bloggers left with her personal business card with her office number for them to call her directly after the conference.  That was impressive.

*****

So, some final thoughts.

I like Valerie Jarrett.  It was amazing that she took time to come and speak to us, and it was informative. She speaks straight, she is sincere and she seems very passionate and compassionate regarding health care reform.  I’m a bit more informed about what the President is looking for.  This was the advantage shutting up and listening. I don’t necessarily agree but I’m starting to at least get a hold of the concept.

Gratuitous political commentary: I think a little too much time was spent decrying the last administration. It’s over; time to move on.

Now for my totally off-the-cuff observation. I could not help but notice this was the exact opposite of my experience in DC last week. This was a full-on Obamafest, last week seemed like an “anything BUT Obamafest”. This week the “opposition” was putting out misinformation, last week the “opposition” was trying to cram a bill through before Congress could read it.

Is there no middle ground? Does it have to be this contentious? Maybe it’s the way of politics and I’m just now realizing it.

Between the two events, I guess I have now been exposed to a “fair and balanced” view of health care reform by Washington insiders.

So….why does it still feel like I have vertigo?

*****

This post was written from my own notes and memory. It was actually live-blogged in real time and if you would like to read the entire transcript, it is written here: Valerie Jarrett/Health Care Reform Live Blog BlogHer 09.

Valerie Jarrett, White House Senior Advisor Talks to Bloggers at BlogHer09

*This blog post was originally published at Emergiblog*

Canadians Are Turning To Market-Based Healthcare Solutions

Many Americans look to Canada, as an example of a government-run health care system that works.

But is that really what it is?

Health care in Canada is funded mostly publicly, but is provided mostly privately.  That is, most care is delivered by privately run hospitals and medical clinics, with fees paid for by the various provincial governments.

Americans often call this system “single payer,” but it’s really not true.  There are many other payers.

For example, if you’re injured on the job, your care is paid by a workers compensation insurance plan funded by employer premiums.  Millions of  Canadians also have supplementary health insurance policies, typically called “extended health care” coverage, which cover things not paid for by the government, like prescription drugs and other medical services.  There is also a growing market for full medical insurance plans, and critical illness plans to provide cash to offset the out of pocket burdens of medical cost.  As much as 30% of Canadian health care expenses are funded through these non-government payers.

However paid for, supply (and funding) for health care has not been able to keep up with increasing demand.  The result has been well-documented: long waits for health care services.  Waiting is a normal part of the Canadian health care experience, with provincial governments publishing  information on wait times and working to fix them.  The Canadian Supreme Court admonished the provincial governments in 2005, saying “access to a wait list is not access to health care.”

And so an interesting dynamic has emerged.

Canadians are justifiably proud of their extraordinary health care system, and care deeply about preserving its core principles.  But they also care deeply about looking after each other, and are as creative and innovative as any people on the planet.  As wait times have grown, so has a burgeoning private market.

Hospitals running diagnostic imaging equipment like MRIs are only paid by the government to run during certain hours of the day.  So creative hospitals decided to run the same machines during the overnight hours, charging patients (rather than the government) a fee for the service, which could be provided on an expedited basis.  While politically controversial, it made it possible to serve more patients without the need for additional government funding.

These types of ideas have grown, extending now to stand-alone diagnostic centers.  A couple of days ago, I visited one, Mayfair Diagnostics, in Calgary.  This center was created by a group of physicians, who, like others I have met, knew they couldn’t change the system, but could improve the part in which they work.  So they bought leading imaging equipment and opened up centers that cater to self-pay patients, as well as those funded through other sources.  They actively promote themselves as a way to get needed medical insight only a couple of days – as opposed to the 6-8 week average wait patients would otherwise face.  Doctors working in this center also work in hospitals serving government-sponsored patients, making the Mayfair center and others like it a supplement to the government system.  And at a price of $650 for an MRI, it’s inexpensive by U.S. standards.

Other kinds of private centers have opened up as well.  Some operate almost as membership-only medical practices, offering much of what might be considered primary care.  Others provide even more comprehensive services, making most aspects of ambulatory care available on a privately-paid basis.  For certain specialties like orthopedics, some even offer complete hospital surgical services.

The Canadian system remains very different from the American one.  Canadians do not want their system transformed into anything that reflects American “rugged individualism.”  And yet the natural human desire to look after oneself and ones family poses dilemmas.  When a loved one is sick, all the abstract ideas melt away, and you think – how can I do everything I can to get help, now.

We’re all entitled to that kind of help — Americans, Canadians, whatever.

The ways Canadians are trying to make sure everyone gets that help are slowly changing the face of Canadian health care.

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

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