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Democrats and Republicans Agree On At Least One Healthcare Issue

I posted this at Medpolitics.com today… but it is displaying some weird code, so I decided to repost it here.

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For the first time in recent memory the Republicans and the Democrats are on the same page on a healthcare issue: the problem of chronic disease. Former Surgeon General Dr. Richard Carmona told me that chronic disease contributes more to healthcare costs than any other single issue, and that many chronic diseases are preventable through diet and lifestyle measures. Both political parties seem to agree that America must become a “wellness” culture. However, they don’t exactly agree on how that may be achieved. The Democrats would expand the government’s role in stimulating healthy behaviors while the Republicans would use market forces and grass roots efforts to encourage personal accountability.

WHAT THE DEMOCRATS SAY ABOUT CHRONIC DISEASE:

An Emphasis on Prevention and Wellness.

Chronic diseases account for 70 percent of the nation’s overall health care spending. We need to promote healthy lifestyles and disease prevention and management especially with health promotion programs at work and physical education in schools. All Americans should be empowered to promote wellness and have access to preventive services to impede the development of costly chronic conditions, such as obesity, diabetes, heart disease, and hypertension. Chronic-care and behavioral health management should be assured for all Americans who require care coordination. This includes assistance for those recovering from traumatic, life-altering injuries and illnesses as well as those with mental health and substance use disorders. We should promote additional tobacco and substance abuse prevention. (“Renewing America’s Promise,” pg. 10).

WHAT THE REPUBLICANS SAY ABOUT CHRONIC DISEASE:

Prevent Disease and End the “Sick Care” SystemChronic diseases — in many cases, preventable conditions — are driving health care costs, consuming three of every four health care dollars. We can reduce demand for medical care by fostering personal responsibility within a culture of wellness, while increasing access to preventive services, including improved nutrition and breakthrough medications that keep people healthy and out of the hospital. To reduce the incidence of diabetes, cancer, heart disease, and stroke, we call for a national grassroots campaign against obesity, especially among children. We call for continuation of efforts to decrease use of tobacco, especially among the young. (“2008 Republican Platform,” pg. 38).

Whichever party is elected this November, one thing is certain – more emphasis will be placed on encouraging Americans to adopt healthier lifestyles. The Partnership to Fight Chronic Disease is doing its part to coordinate these efforts and raise awareness of lifestyle modification programs that work. As for me, I’ve traded my car for a pedometer.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Political Quote of the Day

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.

Dr. Val Goes To BlogHer Conference

From July 26-29 I’ll be in Chicago at the annual BlogHer conference.  BlogHer is a community of women bloggers determined to make the world a better place.  Revolution Health is proud to be a sponsor of BlogHer this year, and I’ve been asked to moderate a break out session contained within the “Earn Our Votes: What Questions Do Women Bloggers Want Candidates to Answer in Election 2008?” session. Revolution Health is non-partisan, and my role as moderator is to facilitate sincere discussion.

The break out session is 25 minutes long, and the goal is to distill all the important healthcare questions into only 3 key questions that women would like to ask presidential hopefuls about healthcare.  In order to get the discussion going, I’ll present a list of questions featured recently on YouTube and in the BlogHer blogs.  Please feel free to add questions in the comments section of this blog, and we’ll discuss them in Chicago on Saturday.  Hope to see you there!

References

The recent CNN/YouTube Democratic Debate featured the following healthcare questions:

  • How will your healthcare plan address the needs of the aging population, specifically those with Alzheimer’s, heart disease and diabetes?
  • What will your healthcare plan do to address the need for affordable preventive medicine services?
  • Does your healthcare plan cover undocumented workers?
  • How do you intend to make sure that all Americans have some form of health insurance?

Various posts from the BlogHer conference blog:

Affordability / Universality

  • How can we pay for healthcare in US sustainably?
  • How can we make sure that anyone in the US not only has access to healthcare, but can afford it?
  • How do we weed out those who choose not to have healthcare from those who desperately need it?
  • How can we make healthcare a right, not a privilege, for every citizen?
  • How can we mandate that all children in the US are insured?
  • How do we protect families from insurance companies who deny claims in the face of a health crisis?

Women’s Issues

  • How can we ensure increased access to family planning?
  • How do we get birth control to be covered universally under health insurance policies?
  • How do we achieve “scientific fairness” to women?
  • How can we make women’s and children’s health issues a priority?
  • How do we improve health education for women and children?
  • How can we make childbirth and maternity leave less of a burden for working mothers? Especially as disability insurance is not offered to all nor is it usually enough. Women can afford to take time off after having a child.
  • Can a woman’s reproductive rights be protected in US healthcare?

Ethics / Technology

  • How can we ensure everyone has the same access to the same tests and treatments?
  • How can we protect research, such as stem cell research, that has the possiblity to wipe out diseases?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Why I worry about a government-sponsored universal coverage system

Within the past few years the Centers for Medicare and Medicaid Services (CMS) chose to enforce a rule (casually known as the “75% rule”) that resulted in denial of services to many heart, lung, and cancer patients requiring rehabilitation therapies.

CMS was looking for a way to cut costs in rehabilitation facilities, and decided to create a rule whereby these facilities would lose their approval status if they admitted too many patients with certain conditions. The CMS arbitrarily decided that 75% of all patients admitted to inpatient rehabilitation facilities had to have one of 13 diagnoses, or else the rehab facility would not qualify for Medicare reimbursement. Many important diagnoses were not included in those 13, including cancer, heart and lung disease, and many types of orthopedic injuries.

What does this mean? It means that getting admitted to a rehabilitation facility is no longer based on need, but on diagnosis code. Because of the financial pressure exerted by CMS (Medicare is the primary payer for most facilities) these rehab centers cannot afford to be delisted. So they turn away patients in need, for patients who have the “right” diagnosis.

What has this rule done?

  1. Limited clinical decision making by doctors – a physician is no longer able to recommend patients for acute inpatient rehabilitation purely based on their need for it.
  2. Decreased choice for consumers – people recovering from heart attacks, cancer or COPD (to name a few) will generally not be offered the opportunity to be rehabilitated in an acute, inpatient setting.
  3. Reduced quality of care – rehabilitation facilities specializing in oncology or cardiopulmonary rehab will need to divest themselves of aggregated expertise. Since these centers would no longer qualify for Medicare funding, they can’t afford to remain centers of excellence in these fields of medicine. Instead, they will need to turn their attention to the 13 diagnoses that qualify for inpatient rehabilitation.
  4. Puts lives in danger – patients who are not admitted to acute rehab will be forced to recover in nursing homes (also known as “sub acute facilities”) that do not have the level of expertise to take care of them safely.

The 75% rule is one example of the kinds of decisions that a government sponsored universal healthcare system will make. When one payer (government or non-government) develops a monopoly, their decisions can single-handedly limit consumer choice, prevent physicians from exercising clinical judgment, and decrease quality and safety of care. What will Americans say when the decision to fund organ transplants for people over 65, for example, is denied across the board?

When medicine is no longer applied in a personalized (case by case) manner, and population-wide rules are in effect, we will face ethical dilemmas far surpassing those we already have. A system that serves the needs of many still fails the needs of some – and when we lose the flexibility to “bend the rules” for the exceptions we will lose the best of what American medicine has to offer.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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