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.

The holidays are upon us, and we all know what that means for health issues — besides higher sugar and alcohol intake. That’s right, healthcare reform house parties! Check out the message from HHS Secretary nominee Tom Daschle below, and learn more about hosting or attending a healthcare community discussion over the holidays.

Meanwhile, four issues dominating discussions around the web this week are the future of the FDA, the new Nursing Home Compare rating system and web site, physicians and health IT, and of course, healthcare reform issues.

At the Center for Medicine in the Public Interest DrugWonks blog, Peter Pitts shared his recommendations for reforming the Food and Drug Administration:

I was honored when the Obama FDA transition team called and asked for my advice on how the incoming administration could make the agency a more robust and forward-looking regulatory instrument.
…
My suggested areas of focus are

1. A strong, science-based FDA
2. The Reagan/Udall Foundation — a Partnership of Unequals
3. Clarity vs. Ambiguity
4. Information Management
5. Food Safety and Security
6. Risk Communications
7. The Drug Label and the “Safe Use” of Drugs

…
There are, obviously, many, many other important issues … and I look forward to working with the transition team to ensure that the new commissioner can hit the ground running… And kudos to the Obama transition team for reaching out to a wide variety of groups.

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Thursday night on NBC nightly news, Dr. Tim Johnson said “we’re paying for treatments that have never been proven to work” presuming we’re wasting dollars on dubious medical innovations. He described this within the context of the Obama administrations’ announcement of Tom Daschle as the new Health Care Czar who may establish an independent health care board isolated from health care lobbying “interests” and prioritizing US government spending. Within this context, it will likely adopt some process of comparative effectiveness to evaluate health care interventions. Stuart Altman recently said, “we need to move aggressively forward to develop the capacity of this country to do effective comparative research…the nation cannot afford healthcare that is not supported by evidence of sufficient benefit”.

But what really is comparative effectiveness? Comparative effectiveness in the context of health is as old as “medicine itself”, an implicit and explicit comparison of one medical technique to another. If the intervention works (i.e., understanding positive and negative impacts on patient outcomes), than one may translate this into “economic effectiveness”, or “cost-effectiveness” metrics. In our quest to assess value of medical interventions based on meaningful clinical outcomes, decision makers are using a number of well-established academic methodological approaches.

Is this new? No.
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We have all seen the disturbing headlines of economic failures, bailouts, corporate bankruptcies, and massive layoffs. Economies around the world are slowing down. We also see the continued and raging debates over health care costs, delivery and quality as healthcare organizations and providers fight to reduce or control costs while delivering quality health care and attracting a qualified workforce. Whatever the reasons, there is a growing shortage of clinical, health, and allied health workers. Factors cited as contributing to the shortage include an aging workforce; high retirement eligibility; difficulty in recruiting and retaining workers; lack of educational, training, and retraining opportunities; high vacancy rates; high turnover rates; lack of opportunities for career advancement; low pay; and/or increased work load demand.

Recently, increased attention (and resources) has been placed on deploying new clinical technologies, devices, and treatments. Initiatives and advances include automated solutions for electronic health and medical records, bio-surveillance and disease reporting, public health monitoring, electronic prescribing, clinical decision support, personal health records, home health monitoring, and remote consultations. As the demand for and ability of these technologies to improve patient safety and quality grows their adoption will (hopefully) be more widespread. Yet, these technical advances also contribute to the workforce shortage because of the growing need for educated and trained personnel to develop, maintain and use these applications, products, and systems. (more…)

Last week, the Better Health Care Together coalition held a briefing at the National Press Club to unveil a new study written by economist Dr. Robert Litan.

The study, entitled Vital Signs Via Broadband: Remote Health Monitoring Transmits Savings, Enhances Lives, found that the United States could cut $197 billion from its health care bill over the next 25 years by the widespread use of remote monitoring to track the vital signs of patients with chronic diseases such as congestive heart failure and diabetes.

But, and here’s the catch: Dr. Litan warned that adoption of remote monitoring and other telemedicine opportunities will be slowed and benefits reduced unless the United States does a better job of reimbursing health care organizations for remote care and encouraging continued investment in broadband infrastructure that can be tailored to meet the privacy, security, and reliability requirements for telemedicine applications.

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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…)

The current state of health care systems in the United States is not accidental. It has a history and that history counts. Though there are many dimensions to that history, some that fly under the public discourse radar are worth exploring. I want to share my thoughts about a few of these “elephants in the room” that haunt me. This is not an exhaustive report; it simply highlights one of many processes that set the stage for the current conditions in health care today. I will be writing about other ones…

Some social commentators called the 1980s the decade of greed in the United States. I thought it was more accurately a cultural drift where greed was confused with success, embraced as a worthy motive. It was not the Baby Boomers finest hour, or decade for that matter. Just ask their offspring who are inheriting the inevitable results of this greed.

This drift was in part shaped by a conviction held by many that the free market could and would correct itself, even in the context of a complex emerging global economy. (It seems self-evident to note that the last few weeks beg to differ). This worldview created the conditions for the 90s where health care systems, seeing health care reform deep-sixed early in the Clinton administration, drifted toward a cost-containment marketplace mentality. (more…)

We’ve all heard the old adage: “if you don’t have your health, you don’t have anything.” As our nation is mired in the toughest economic times it has faced in decades, that phrase couldn’t be more true. Most Americans have already gotten over their prior urge to splurge on a plasma TV for the next Super Bowl, to take that dream European vacation, or to drive cars whose fuel tanks cost more to fill than their weekly grocery bill. Thousands who found themselves unemployed after the Wall Street crisis came to a head over the last couple of weeks will soon be sharing that sentiment once the shock of it all wears off.

Just pick up any local paper, scan the web, or watch the evening news, and you will be bombarded with detailed accounts of the U.S.’s dismal economic slump, the government bailout of the Wall Street crisis, the record declines in home sales, the increased costs of gasoline and heating oil, particularly when the next hurricane roils away in the Caribbean. But Vanessa Fuhrman’s Sept 22nd article in the Wall Street Journal, “Consumers Cut Health Spending, As Economic Downturn Takes Toll,” highlights possibly the most frightening casualty of the U.S. economic crisis and boils it all down to the most fundamental level, our personal health. People’s inability and/or choice not to fill life saving prescriptions, go to annual checkups, be screened/monitored for existing conditions, will ultimately cost them much more when their conditions worsens than the co-pay or monthly insurance rate they can’t afford to cover. I can only hope that decreased rate of prescriptions being filled is a reflection of them doing more to improve their current health and prevent becoming ill, but I’m not that optimistic.

The health of our nation comes down to the overall health of its citizens, and for any of our policy leaders to insist (in a feeble effort to allay our fears) that our nation’s “foundation is solid” is as nearsighted as it gets. Maybe they’ve been skipping their annual eye exams for lack of ability to pay? I seriously doubt it.