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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.

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?

Tom Daschle Will Be Next Secretary of HHS: What Does This Mean For Healthcare?

Tom Daschle - Photo Credit: CBS News

I’ve had my eye on Tom Daschle for many months – and attended a healthcare conference in June ’08 in which he was the keynote. I blogged about his ideas previously, but thought it would be valuable to repost them here (h/t to The Healthcare Blog):

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:

  1. Universal coverage. If we don’t have universal coverage we can’t possibly deal with the universal problems that we have in our country.
  2. Cost shifting is not cost savings. By excluding people from the system we’re driving costs up for taxpayers – about $1500/person/year.
  3. 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.
  4. 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.
  5. Lack of transparency is a devastating aspect of our healthcare system. We can’t fix a system that we don’t understand.
  6. Best practices – we need to adopt them.
  7. 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.
  8. We have to pool resources to bring down costs.
  9. We need to enforce the Stark laws and make sure that proprietary medicine is kept in check.
  10. 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.
  11. 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?


Cartoons & Cocktails 2008 At The National Press Club

I flew back from San Francisco just in time to get to the National Press Club’s annual “Cartoons & Cocktails” event. Two of my cartoons were auctioned off for charity – along with donations from many other artists. Lynn Johnston (the syndicated cartoonist behind “For Better Or Worse”) sent in two original cells, though political cartoons made up the bulk of the offerings (including a signed copy of the scandalous New Yorker cover about Senator Obama). It was truly an honor to have my work featured along with such talented peers.

Of course, I asked my husband to join me at the event to take pictures. I have a new iPhone – and its camera seems to have a bit of a learning curve. I was a little disappointed that my head was cut in half for most of the shots, and that my TV interview with an Indian political team was captured from behind my head. The Washington Examiner had its own photographer – so I might show up in the “social sightings” in one piece.

For your amusement, I offer my husband’s chronicles of the evening:

What Do Doctors Think Of McCain Vs. Obama Health Plans?

Photo of Obama and McCain ABC

A company called Epocrates – which produces drug, disease, and diagnostic guides for physicians – recently surveyed about 1100 physicians about their health policy and political views. These are the 6 questions they asked, with the results listed in descending order of popularity. I think you’ll find it quite interesting:

 

1. Who has a better plan for healthcare reform, Senator McCain or Senator Obama?

Obama: 47%

McCain: 30%

Neither: 23%

2. As a medical professional, are concerns about McCain’s age justified?

Yes: 51%

No: 49%

3. What issue or reform would you most like to see the new president tackle?

Read more »

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