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Rushing Healthcare Legislation Through Without Consensus

I belong to a terrific organization that brings together C-level executives, once a month, to discuss issues each of us face.  It’s called Vistage.  One of the subjects we talked about yesterday was health care.  It was like a focus group made up of seasoned, senior executives from many different industries.

The discussion revealed the tremendous divide between what ordinary Americans think about health care and what policy makers in Washington are doing.  It’s a combination that is almost certain to ensure that whatever reform passes may make our problems worse, rather than better.

At the meeting were about 30 executives, representing everything from financial services, commercial real estate, manufacturing, high technology, pharmaceuticals, insurance, retail, non-profits, travel and others.  Although all thought health care costs were in a state of crisis in America, I did not hear anyone say this was the case in their business.  To be sure, some complained that health costs were high, and that there were few alternatives available.  But others described changes they had made to their plan designs that had actually reduced their corporate health expenses.

We talked about the proper role of government, the comparative worth of systems in other countries, the responsibility of people to take care of their own health, end-of-life care, over-treatment, the uninsured, access to care, comparative effectiveness, and our own expectations of what the system should do for all of us.  There was no consensus among this group of 30 business leaders as to these subjects and what we should do about them, other than that they are important topics that we need to address.  I suspect this is true outside of this group, too.  Indeed, the huge collection of issues that fall under the category of health care reform is something I’ve pointed out before.

But the President and leaders in Congress want debate on health care to end.  They want a a bill to pass in the next couple of weeks.

Most of the group members were surprised to hear that Congress had already drafted legislation and was getting ready to vote on it.

It’s a remarkable thing.  We are in the midst of trying to redesign the largest health care system in the world, and we’re barely debating the merits of it.  How many members of Congress will have read the 1,1018-page bill once they vote on it?  How many Americans will understand what implications it has for their health care if it — or something like it — becomes law?

The President often says that the status quo in health care is “not an option.”  The trouble is, the status quo in health care is a rapidly changing thing.  Today, every day, employers and doctors and so many others are busy making real, meaningful changes to our health care system.  Not by waiting for committees of Congress to pass legislation, but by getting together and doing things that improve the quality and cost of care and the lives of patients.  We need to be listening to their stories, and learning from them.  Congress hasn’t done this, and can’t now.

There is an opportunity to build a real consensus around the important issues we talked about yesterday.  We can transform our health care system in ways that make all of us proud.  But it can only happen by working through these hard questions, not by hurrying to pass a bill before the August recess.  Those who say we have a once in a generation chance to reform health care today may be right, but not for the reasons they think.  By passing bills without consensus on this deeply important and emotional issue, they are ensuring that no one will really want to try to reform health care again for a very long time.

Which leaves us very much where we started.  I will continue to do my part to share the important stories of how real people are making real reform.  The political attention to reform may end sometime this year, but the reality of people trying to figure out what to do when sick will continue.

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

Health Care Policy Summit Brings Together Unlikely Allies

Better Health’s policy writer, Gwen Mayes, caught wind of an interesting new conference being held tomorrow in Miami. She interviewed Ken Thorpe, Ph.D., one of the conference organizers, to get the scoop. You may listen to a podcast of their discussion or read the highlights below. I may get the chance to interview Billy Tauzin and Donna Shalala later on this week to get their take on healthcare reform initiatives likely to advance in 2009. Stay tuned…

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Mayes:  Tell us about the upcoming conference in Miami on January 28th called “America’s Agenda: Health Care Policy Summit Conversation.”

Thorpe:  The conference will start a conversation on the different elements of health care reform such as making health care more affordable and less expensive, finding ways to improve the quality of care and ways to expand coverage to the uninsured.  The conference is unique in that we’ve brought together a wide range of participants including government, labor, and industry for the discussion, many of whom have been combatants over this issue in the past.

Mayes:  Will there be other meetings?

Thorpe:  This is the first of several.  There will others in other parts of country over next several months.  President Obama and HHS Secretary Designee Tom Daschle have talked about engaging the public in the discussion this time around.  So part of this is an educational mission and part of it is to reach consensus among different groups that have not always agreed in the past.

Mayes:  What encourages you that these groups will be more likely to reach consensus now when they haven’t in the past?

Thorpe:  The main difference is that the cost of health care has gotten to the point that many businesses and most workers are finding it unaffordable.  In the past, most businesses felt that, left to their own devices, they could do a better job of controlling health costs by focusing on innovated approaches internally.  What we’ve found, despite our best efforts, working individually we haven’t done anything to control the growth of health care spending.    The problems go beyond the reach of any individual business or payer and we need to work collectively.

Mayes: How will health care reform remain a priority in this economy?

Thorpe:  The two go hand in hand.  As part of our ability to improve the economy we’re going we have to find a way to get health care costs down.  Spiraling costs are a major impediment to doing business and hiring workers.  To the extent we can find new ways to afford health care it will be good for business and workers.

Mayes:  Health information technology is also an important aspect.  What are the common stumbling blocks to moving forward?

Thorpe:  There are three issues we have to deal with.  First, we have to have a common set of standards for how the information flows between physicians and physicians, and with payers and hospitals.  What we call interoperability standards.   Second, we have to safeguard the information.  Finally, cost is the biggest challenge because most small physician practices of 3 or 4 physicians don’t have electronic record systems in place.  To put in a state-of-the-art system can cost $40,000 per physician and most cannot afford this expense.  I think the stimulus bill will provide funds to help with these costs.

Mayes:  There’s always growing interest in the patient’s role.  How will this be addressed?

Thorpe:  We have to find a better way to engage patients in doing better job of reducing weight, improving diet and those with chronic disease to follow their care plan they worked out with their physician.  We also want to make it more cost effective for patients to comply with the plan.  Patients who comply with health plans will have better outcomes at lower costs. 

Mayes:  Who’s on the agenda in Miami?

Thorpe:  It’s at the University of Miami so it will be hosted by President Donna Shalala who was Secretary of HHS under the Clinton administration so she is well versed on health policy.  Also attending is the head of PhRMA, Billy Tauzin, a former Congressman and former majority leader of the House, Dick Gephart.  There will be some lay people as well for a nice cross section of consumers, labor, providers, business and others.

Mayes:  How can people learn more about American’s Agenda and the conference?

Thorpe:  The executive director of American’s Agenda is Mark Blum.  He can be reached at 202-262-0700 or at America’s Agenda.org.

Top Five Pediatric Stories of 2008

By Dr. Stacy Beller Stryer, M.D.

Reflecting on the past year’s successes and failures as a parent is an important and worthwhile exercise to do each January. In previous January blogs, I have published my own list of resolutions for the New Year to help you get your own creative juices flowing. This year, however, I have decided to talk about the top five news stories related to pediatrics in 2008.

The top news story in 2008 is the election of Barack Obama as our next President. President-elect Obama wants affordable, comprehensive and portable health care for everybody . His goal is for all uninsured children to be able to sign up for healthcare plans. He wants to expand Medicaid and state health insurance programs, and to develop a government-funded health insurance plan that will compete with other companies. President-elect Obama also wants comprehensive health education taught in schools.

A second important pediatric-related news story is the recall of cough and cold medicines, including decongestants, expectorants and antitussives, for children, particularly those ages 2 years and less. The reason for the recall is because studies have found that the risks of dangerous side-effects far outweigh the benefits. A study which came out last year from the Centers from Disease Control found that over 1500 children under age 2 visited the emergency room for serious side effects due to taking cold medicines in 2004 and 2005, and that 3 children died. In addition, insufficient studies have evaluated the efficacy and side effects in children. Actually, these medicines were previously developed based on studies done with adults.

Another important finding concerns the use of cigarettes. If you smoke and light up that cigarette only when you are outside your house or when your children aren’t home, you may still be harming them (OK – this was reported in the January issue of Pediatrics but I heard about it December 31st!). According to a recent study published in Pediatrics , this “third-hand smoke” causes toxins to remain everywhere, such as on clothes, hair, couch cushions, and carpets, for extended periods of time. The toxins include heavy metals, carcinogens, and radioactive materials that children may ingest, especially if they are crawling on the carpets. If this isn’t enough of a reason to quit smoking, I don’t know what is!

Unlike some other fatal illnesses, researchers have been able to decrease the risk of sudden infant death syndrome (SIDS) significantly over the years when they discovered that placing an infant to sleep on his back significantly reduced the risk. Another study published last October in the Archives of Pediatrics and Adolescent Medicine that placing a fan in an infant’s room during sleep decreased the risk of SIDS by 72%.

The last news story which made significant changes in pediatric practice this past year concerns the identification and treatment of elevated cholesterol levels in toddlers and children. In July, the journal Pediatrics published revised guidelines for pediatricians, including initiation of lipid screening in children, beginning at age 2 years, in those who have a family history of high cholesterol or early heart disease, or in those who are overweight, have diabetes, or smoke. The American Academy of Pediatrics has also begun to recommend a decrease in the fat content of milk in overweight children beginning at age 1 year. Finally, they now recommend medication as early as age 10 years in certain children with elevated lipid levels despite exercise and diet change.

There are many other important findings from 2008, but I thought that these were among the most important. Now stop reading and get back to your New Year’s Resolutions for 2009!

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