The New York Times recently reported on Health Reform Private House Parties. At this particular party, the participants easily sided with the angels: health care is a right, insurance should cover everything and coverage should be available from government and businesses. There, that was easy. Bet they had a nice time.

Partygoers were not asked for solutions and the devil is always in the details, so let’s use my favorite – flu shots.

First, the New York Times reported that party participants quickly agreed that “…health care was a right…” It makes me wonder; if health care is a “right,” what of “responsibility”?

- If I have a “right” to flu shots to help prevent flu disease, do I have a “responsibility” to get them to protect myself, reduce my medical care costs, improve economic productivity and protect others around me?
- If I don’t get the shot, infect others and cause them to be ill, am I responsible for the cost of their care?
- If others I infect miss work, am I responsible for the cost of temporary workers or losses incurred by their employer? Am I responsible to the government for the loss in taxable productivity?
- What if they die as a result of the flu I transmit to them? Am I culpable?

Second, participants also agreed “…that insurance should cover ‘everything,’ not just some services….”
- If a flu shot is covered and I choose not to get one, should I be required to pay for any doctor visits and medicines I need?
- Should my employer have the right to charge me for the temporary help that might need to be hired to replace me on the job?
- Should Uncle Sam have the right to tax me for earnings I would have made if I had been on the job?
- Should the cost of something so reasonably priced be covered for everyone? Really, I mean everyone? Even the wealthy who can well afford the cost?

Third, participants agreed that “…coverage should be readily available from the government, as well as from employers….” They agreed that individuals and businesses should have to pay a “small health care tax” to fund care.
- Who are they kidding, “small health care tax?” Have they looked at cost projections lately?
- And what about non-coverage barriers? Coverage is only one barrier to care. Ask those in rural areas, anyone not fluent in English or medically literate.

And yes, I’m still harping on flu shots. The season is not nearly over and there are plenty of doses left to protect the nation from the $87.1 billion – or more – that flu could cost us this winter.¹

1. Molinari NA, Ortega-Sanchez IR, Messonnier ML. The annual impact of seasonal influenza in the US: Measuring disease burden and costs. Vaccine 2007;25:5086-5087.

I hope you a great Thanksgiving holiday weekend!

I recently moved and so cancelled my usual vacation to unpack boxes and get settled. I’ll vacation later. The move delayed more than vacation, however. It also delayed my getting a flu shot, I’m still inside the “window” during which I may not yet be protected by the vaccine and I know that few people I meet are likely to be immunized and therefore any “herd immunity” I might count on to stay healthy is not there either. Sunday afternoon arrived with a feeling I dread….”like maybe I was coming down with something.”

It brought back memories of the first Thanksgiving I learned to cook a turkey. I was ten, my Mom got the flu. Not the just-don’t-feel-good flu we all mistakenly call every winter symptom, but the for-real-very-sick-can’t-lift-her-head-off-the-pillow influenza. Step by step, she talked me through how to make the dressing, stuff the bird and cook it.

That experience showed me what flu can do to a person. Since then my public health experience showed me what it can do to a nation. As a result, I’m an enthusiastic promoter of flu – and other – vaccines. (more…)

As the nation goes to the polls to cast important votes tomorrow, it does so at a time of one of the most challenging global economics period in recent memory. Some policy wonks say that these times will shove health below the radar, as the nation struggles to address more basic productivity concerns. Others disagree, saying rising unemployment will trigger the ‘intolerability quotient’ on the uninsured as we reach the ‘tipping point’ at which a solution, regardless of popularity – or even wisdom – will be legislated.

It will be unfortunate if health care is positioned as merely the ‘problem,’ when health is also the solution. It would be unfortunate if we voted on Tuesday for the candidate we felt might offer the better health care solution, but did not take important health steps ourselves.

Health is an important component of our national and personal economy: half of economic growth in the US in the past 100 years is estimated to be related to improvements in our health.¹ The value of health has also been demonstrated with more recent data, showing that improvements in survival and health between 1970 and 1999 accounted for at least 8% of the increased output of the formal labor force.²

(more…)

Will pharmacist prescribing be good for physicians? Yes.

The practice of medicine has never been more complex or demanding. It’s a perfect storm, especially in primary care. The number of primary care providers is dwindling as older physicians retire, those not at retirement age leave the profession and younger people do not replace them. Even those who do choose primary care are less likely to work long hours. And why should they? They’ll not be paid commensurate with their value and the love of their work is not something they can use to negotiate a mortgage or pay the kids’ tuition. (more…)

A “new” profession of pharmacy is about to be born in the US. There are those who will pace nervously awaiting its arrival. Like expectant fathers they’ll anticipate – but also fear – the consequences of the blessed event. It will change their lives forever. Though at this point there won’t be any turning back, perhaps they’ll wonder if it was such a good idea after all to allow pharmacists to be direct providers of health care, with independent prescribing authorities.

Mr. President, you can help midwife this innovation in health care by keeping those expectant fathers – and especially those in the federal government – out of the way.

What will this baby look like?

The “new” profession of pharmacy in the US will be the younger sibling of the one born at the start of healing traditions created in ancient worlds.

In ancient times the profession was a separate, distinct, third branch of medicine. Patients selected a pharmacist, a physician or a surgeon to treat their condition. I predict that patients in the US will be able to make a similar choice.

It won’t be long now, perhaps even within your term in office. The “new” profession of pharmacy in the US will likewise become independent healers of the sick and enablers of health and wellness, and yes, with totally independent prescribing authorities.

Why do I say that? Everywhere, I see signs of this impending birth.

Pharmacists are trained, skilled and ready:

• All graduates today have Pharm.D. degrees, supplying the country with the best trained pharmacists the world has ever known.
• Their information on medications is superior to all other clinicians.
• They are the best trained clinicians in the interpersonal skills required to manage patients and the problems they encounter with their diseases and lives.

Pharmacists are equipped for the job:

• Their computerized information systems help manage increasing numbers of prescribed medicines and increasingly complex combinations prescribed by separate clinicians.
• Their medication use and disease management infrastructures are among the best in the world.

Pharmacists are needed to assure access and quality care:

• Clinicians have abdicated medication management under reimbursement stress.
• Pharmacy hours and locations make them the most accessible professionally-managed health care settings in the nation.

Pharmacists are preferred professionals:

• Consumers trust pharmacists and want the convenience, quality and care they deliver.
• Payers are looking for effective alternatives to traditional care.

Pharmacists can be held accountable:

• Their information systems are already in place and enable them to be held accountable for pharmaceutical care to a much greater degree than in traditional medical and nursing clinical care.

As you see, Mr. President, when this sibling arrives, it will not be an infant or even a toddler. Nor will it be a weak sister to medicine or surgery.

Perhaps your own clinicians, after they have diagnosed some condition, will refer you to a pharmacist who will take over any pharmaceutical care you need, identify the right doses and combinations of medicines you need, counsel you on how to take them, encourage you to embrace healthy practices (and even give you stress management tips!), monitor your progress and adjust the regimen accordingly.

Will this be good for patients, clinicians, payers and even you, Mr. President?

I have some ideas about how to make it so, and since it’s starting to happen as states expand practice authorities, we need to be sure to “get it right.”

“Getting it right” means that you should not meddle in this. Pharmacy is a profession that is evolving into what patients and health care reform need. Let it happen. Don’t stand in the way and stop this progress.

Pharmacists like my own terrific pharmacist team – Andrew and Greg – are ready. The right question is this: are the rest of us?

That will be the subject of my next blog.