June 11th, 2008 by Dr. Val Jones in Health Policy
1 Comment »
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:
- Universal coverage. If we don’t have universal coverage we can’t possibly deal with the universal problems that we have in our country.
- Cost shifting is not cost savings. By excluding people from the system we’re driving costs up for taxpayers – about $1500/person/year.
- 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.
- 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.
- Lack of transparency is a devastating aspect of our healthcare system. We can’t fix a system that we don’t understand.
- Best practices – we need to adopt them.
- 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.
- We have to pool resources to bring down costs.
- We need to enforce the Stark laws and make sure that proprietary medicine is kept in check.
- 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.
- 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?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 11th, 2008 by Dr. Val Jones in Humor, Uncategorized
1 Comment »
Tom Daschle’s opening comment at the Partnership to Fight Chronic Disease conference:
One time I was introduced as a model politician, model South Dakotan, and a model husband. My wife looked up the definition of “model” in the dictionary and it read, “A small replica of the real thing.” I don’t aspire to be a model anymore.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 7th, 2008 by Dr. Val Jones in Health Policy
3 Comments »
I recently attended a half day conference, “Fighting Chronic Disease: The Missing Link In Health Care Reform” sponsored by Emory University and the Partnership to Fight Chronic Disease (PFCD). It was an extremely well run event with an all-star political cast: Tom Daschle, Dick Gephardt, Dr. Mark McClellan, and Nancy Johnson were present. The key medical players included Dr. Nancy Nielson, president-elect of the AMA, and Dr. Otis Brawley, CMO of the American Cancer Society.
The purpose of the conference was to raise awareness about the cost of chronic disease – it accounts for at least 75% of healthcare spending, and 80% of that could be avoided with lifestyle interventions. Shocking, isn’t it? Any discussion of reducing medical costs needs to begin at ground zero – getting Americans to adopt healthy diet and exercise habits.
One of the most entertaining panelists was Chris Viehbacher, the president of North American Pharmaceuticals at GlaxoSmithKline (GSK). Chris is a gifted speaker with a charming Canadian accent – and could probably be the head of a debate team. We had the chance to speak about lobster fishing in Nova Scotia during one of the breaks since we share a common Maritime heritage. He offered some amusing analogies about our healthcare system, and made some points that bear repeating here:
“Half of the people in the US have some sort of chronic illness. Health insurance is like having car insurance when 50% of people are having accidents. Of course nobody can afford it.”
“We need to keep employer-based healthcare because when employers have ‘skin in the game’ they have the incentive to promote healthy behavior at a local level. Monolithic government programs aren’t good at influencing people at the individual level. Employers know each of their employees by name, they are invested in their lives, they provide childcare services and other benefits to them, and each employee’s health affects their bottom line. Employers are a critical force for promoting and facilitating healthy behaviors.”
“Alternative energy sources aren’t that interesting when gas is $1/gallon. But when gas hits $4/gallon suddenly everyone is very interested in alternative energy. The same goes for healthcare. It takes a cost crisis to bring it to everyone’s attention. And now the audience is listening.”
I’ll be cherry picking some other interesting tidbits from the conference in my next few blog posts. I hope they bring you some good food for thought.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 7th, 2008 by Dr. Val Jones in Opinion
3 Comments »
Hot and humid weather has spurred on the growth of many of my outdoor plants, including bamboo, rosemary, and various peonies. However, I was unpleasantly surprised by the arrival of three fungal guests, only one of which I could identify: the dog stinkhorn. As its name suggests, it is one unpleasant-smelling organism. A certain mushroom website described it as looking like “a dog phallus dipped in excrement.” They are not too far off. But sadder still was the assertion that there is no known cure for this fungal invader.
As I considered my new mushroom issue, I suddenly realized that there are interesting parallels with the healthcare system. Let me explain.
First of all, what does the average person do when they experience a new medical symptom/problem? The person goes online to research the symptom for possible diagnoses and treatment options. Is s/he successful? Sometimes yes and sometimes no. In my case, I could only identify one of the three types of fungi in my garden, even after finding this very nice mushroom identifier tool. Why wasn’t I successful? I’m not a fungi expert, and really didn’t know how to navigate my way through the complex descriptors required to correctly identify the little beasts. The questions included the following:
Fungus Website (FW): Is the spore color olivacious?
Dr. Val: What part of the mushroom is the spore, and what kind of olive are you referring to? I don’t know how to answer that.
FW: Describe the stem type. Is it lateral, rudimentary, or absent? Does it have a volva?
Dr. Val: Um… If the stem is lateral, does that mean it’s sticking out of the side of the mushroom? What makes a stem rudimentary? Does that just mean it’s not fancy? And as for the last question… that sounds kind of pornographic and I don’t think I’d know a fungus volva if I saw one.
FW: Can the pore material be separated from the flesh of the cap?
Dr. Val: What’s pore material?
FW: Is the mushroom edible, hallucinogenic, or poisonous/suspect?
Dr. Val: Well, it definitely looks “suspect” but there’s no way I’m going to test it out for poisonous or hallucinogenic effects.
And so it went. I tried to answer some of the identifier questions to get me to the correct fungal I.D. and in the end I received this message, “we were unable to find a match for your search.”
When patients try to find a diagnosis for their symptoms online, they will inevitably have a similar experience. Medical speak is like a foreign language, subtle differences between signs and symptoms seem obvious to experts, but can be opaque to patients. And even a very bright and educated consumer is bound to get lost in figuring out appropriate next steps. I’m a savvy woman, but when it comes to mycology (the study of fungus), I’m completely lost. How much more complicated is it to navigate the subject of human disease for those who don’t have formal training in medicine?
My point is this – medicine is incredibly complex, and a knowlegeable heatlhcare provider is critical in helping patients successfully navigate the maze. With all the health information on the Internet, it’s tempting to self-diagnose. But that’s a dangerous proposition – one that might lead you to presume that (to use my analogy) a poisonous mushroom is edible, or that a life threatening symptom is innocuous.
The Internet can be a great educational tool, but use it in conjunction with a close relationship to a trusted expert. If you don’t have a primary care physician, you can find one here. If you’d like to have your question answered by a physician online, try the Revolution Health forums. Not every question is selected for a professional reply, but many are. For a guaranteed response, eDocAmerica is a great resource.
Good luck, and I hope that your garden remains fungus-free. I’m now going to try to find a mycologist to tell me if it’s really true that there’s “no cure” for the dog stinkhorn. Unless any of you know the answer?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 3rd, 2008 by Dr. Val Jones in Expert Interviews
No Comments »
The following interview with Alzheimer’s researcher, Dr. Jeffrey Cummings, is a continuation of part 1…
Dr. Val: Tell me about the comorbidities associated with Alzheimer’s and how caregivers can prepare for them.
Dr. Cummings: Being a caregiver is a real challenge. It’s so difficult to take care of someone who may be incontinent, agitated, psychotic or depressed. All of these symptoms occur with increasing frequency as the disease progresses, and can challenge even the most devoted caregiver.
There are educational programs that can help to explain to caregivers where these behaviors are coming from, and can teach them how not to exacerbate the symptoms. For example, it’s important to avoid confrontation with the patient. If he or she doesn’t want to take a shower in the morning, then it’s better just to let it go.
Reducing friction between the caregiver and the patient has been shown to delay the time to nursing home placement, so there are behavioral interventions on the part of the caregiver that can be very beneficial.
Dr. Val: What can online companies like Revolution Health do to support patients with Alzheimer’s disease and their caregivers?
Dr. Cummings: We’ve learned that there are things that people can do to protect themselves against getting Alzheimer’s disease. This includes physical exercise (at least 30 minutes per day 3 times per week), active engagement in leisure time activities, eating a diet high in anti-oxidants (such as salmon, green leafy vegetables, and blueberries), avoiding head trauma (e.g. wear helmets while cycling), controlling high blood pressure, and controlling cholesterol.
It would be great if Revolution Health included all of these healthy lifestyle strategies in a comprehensive Alzheimer’s prevention agenda.
Dr. Val: Is there a role for the “brain games” movement in Alzheimer’s disease?
Dr. Cummings: That’s an interesting question – though I’ve seen very little data supporting brain games in particular. We do know that active intellectual engagement reduces the risk of Alzheimer’s disease, but once one has the disease, it’s less clear whether these kinds of programs can actually reduce progression. At the very least they may reduce agitation by active engagement of the patient, leaving less time for them to be unoccupied. I’d really encourage the people who are developing brain games to test them in well controlled trials. The games could be tested in the same way that drugs are tested.
*Listen to the full interview here*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
