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Last night I had the utter joy of mixing together some of my most very beloved things: one of my favourite people and I went to the Constitution Center and listened to Tommy Thompson and Tom Daschle discuss the political ramifications of health care. Because of the size of lectures at the Constitution Center, we were also able to speak with the Senator and the Secretary afterwards. Absolute heaven! (And believe me when I say, great for us, great for Tom, not so great for Tommy.)

When we talk "Health Care" people want to talk about the cost of their prescriptions, or the waits in the ER, or whether the "right" answer is free market or "single payer". And that wasn’t what they were discussing. Nope -- better.

Secretary Thompson and Senator Daschle talked about the POLITICAL ramifications of health care to us as a society. What it means for us as a country to have a health care system as broken as ours, and what choices we must consider as a country.

They were both in singular agreement when they spoke of the problems which currently exist, pointing out that when the US is measured against everyone else, by almost every objective measure, we lose. Big time. And because these guys are both consummate politicians who have worked on health care policy for years, they didn’t even hand out all the bad news. For those of us who have ever worked in health care, we know it is even worse than they pointed out.

They cited statistics which pointed out that we rank 15th out of 19th of industrialized countries in our ability to prevent deaths in people under 75 years of age, dead last in our infant mortality rate. They both spoke on the issue of chronic diseases, and our unwillingness as a country to do anything about prevention.

They both made the automatic error of saying that 75% of our "health care dollar" goes to the treatment of chronic care. What they actually meant to say was that "75% of the part of the health care dollar spent DIRECTLY on health CARE is spent on chronic diseases and its secondary manifestations, exclusive of the part of the health care dollar spent on administration, advertising, profit, fraud and waste."

Although their statistics diverged somewhat, they both pegged the cost per capita for health care at between $8,200 and $11,500 per annum. That is, the total spent last year, on average, for each American on health insurance premiums, health care costs, the amount we each pay in to cover health care for people with no insurance, plus what we pay in to Medicare and Medicaid even if we’re not using it yet. They are both in lockstep about how this number will double (to 21% of GNP) over the next several years.

They diverged in their individual assessments of overall health care in America -- Thompson contended that no matter what, the US has the best health care SYSTEM in the world because "If you need to be treated for cancer or some other disease, where would you go: England? Canada? No, you’d come here." (Mr. Secretary was not correct in his assessment). Daschle explained it far better: he explained that the health care system in America is "Islands of excellence in a sea of mediocrity." (All quotes and paraphrases are from the notes I scribbled.)

Daschle framed the problem by saying that everywhere else in the world, health care is like a triangle, where the bottom: the most money, the most care; is spent on preventive care, and you spend up the triangle to the most specialized care until you run out of money. Here in the US, he said, the reverse is true, we spend first on high tech. I could go on for 3,000 words on how right he is, and why that leads to fully 50% of all American adults dying of some form of cardiovascular disease, but I digress.

In terms of talking solutions, Doug Kmiec, the moderator, asked them to frame things against the health care proposals of McCain and Obama.

Thompson’s solution has to do with buying pools on the state level. (And if you want to see his earlier proposals, Google "Badger Care" and look what he did while Governor of Wisconsin, and then check out what he tried to do as Secretary of HHS). He is also a big fan of electronic medical records, paid for by the money collected by the government for fraud and abuse ($2.5 billion last year).

Before the lecture, moderator Doug Kmiec had come out to see if anyone in the audience had any questions they wanted him to ask the panelists. He asked Thompson my question: how does McCain’s denial of insurance to those with pre-existing conditions fit in with this program? Thompson said that his plan was different from McCain’s -- it only works if everyone is in the pool, albeit it sans legal mandate.

Daschle looked at some solutions in a similar light to Thompson. They both agreed on the need for preventive care, as do all of us in the field.

But Daschle took it one level further, speaking to the idea that we must reintegrate "health" into our schools, and our society. He said that while the government says "If you want a car, you must have auto insurance, if you want to own a home, you must carry homeowners’ insurance, why not health insurance?" He said "while health care is not a legal right, it is a moral right." He pointed out that the government is not in the banking business, we ceded that to the Federal Reserve. We need something akin to the Fed for health care. When asked about a single payer system, he seemed to be in favour, but pointed out that there is not the political will to enact it.

Thompson pointed out that every GM car has $1,725 built into the price to cover health care, while Toyota only spends $225 per car. And while that statistic is correct, he neglected to mention that the reason WHY is that health care costs are underwritten by the Japanese government.

So what ARE the political ramifications of the crisis of health care provision in the United States?

Start with a simple numerical fact: In Iraq, we have lost an average of 2 Americans a day since the invasion, or about 700 people a year. Here at home, we lose 100,000 Americans a year due to drug errors. As Thompson said, this is the equivalent of a 747 crashing every day and a half.

While we can talk about the financial ramifications of uninsured Emergency Room patrons, and monies available for drug research, and a zillion other things, the simple political ramification to ALL of us is that our current health care system is just what Tom Daschle implied - great for those of us who can afford great care, and a death sentence for those who cannot.

Originally posted to docjess on Wed Jun 18, 2008 at 02:43 AM PDT.

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Comment Preferences

  •  I think Daschle is right on the money (4+ / 0-)

    when he says we need to move more toward a system that highlights preventive medicine not specialized care. Our medical system should have as its' focus healthcare not making money. He hit it out of the park with this statement:

    "Islands of excellence in a sea of mediocrity."

    Ultimately I believe it will take a single payer system to achieve this goal.Physicians for single payer

    "Those that know, don't say, those that say, don't know"... Tao te ching... Then why am I posting a comment?

    by zenmasterjack on Wed Jun 18, 2008 at 03:02:10 AM PDT

  •  Electronic Medical Records (3+ / 0-)

    are not the panacea that the politicians seem to feel they are.  It's a generic term, and the specifics turn out to be pretty messy.  Systems that don't talk to each other, various messaging systems, user interfaces, and so on are all issues that have made many EMR implementations a nightmare.  That's just on the technology side. The legal/regulatory side is just as bad.  Who "owns" the record, who is going to have access to it, security and so on.  The existing rules and regulations aren't adequate in the least.

    I've worked in that field, and it's annoying (to say the least) to have some politician give out a pronouncement that EMR's will solve some problem within healthcare - principally save money.  

    •  not a panacea (1+ / 0-)
      Recommended by:
      vgranucci

      But EHRs do help improve care, limit mistakes and lower costs.  You're right that more uniform standards are needed.  This is happening with some Medicare initiatives where reporting is (or will be) required to assess quality of care.  Follow the standard if you want those Medicare bucks.
      As far as ownership, privacy, security, etc.  HIPAA isn't perfect but covers much of this.  
      I'm tangentially involved in this area and find that the main point of resistance is start up cost.  

      •  Myth (3+ / 0-)

        Actually, there are studies that show they don't improve care or limit mistakes.  Neither do they necessarily lower costs - in some instances, they vastly increase it.

        I was directly involved in several EHR projects.  It's not "start up costs" - those are easily accounted.  It's the operational costs that spiral out of control.  EHR system 1 in one organization won't talk to EHR system 2 in another.  Lab systems, scheduling systems, pharmacy systems, radiology systems, finance & billing systems don't interface easily with each other or the EHR.  Ironing out those details involve massive effort and cost.  If you want an example, just look at Britain's recent fiasco.  

        Then you have the user interface issues. You end up with physicians looking at a computer screen, entering data instead of looking at the patient.  You don't always get the right information at the right place - defining user roles and rights turns out the be a lot harder than most people realize.  One of the other big problems can be summed up by the old acronym:  GIGO.  

        HIPAA does not cover ownership.  Ownership of the record is not the patient's - it's the physician or healthcare practice/hospital. privacy and security protections it does offer only apply to health care providers and payers.  That's why in there's a lot of concern about Microsoft's and Google's move into health information storage.  They aren't covered by HIPAA.  

        The EHR has the potential to offer all those selling points.  The problem is that it's being sold as if they currently exist, and the reality is that it's still in alpha or early beta for most of it.  

        •  not a myth (1+ / 0-)
          Recommended by:
          vgranucci

          Just because you can point to problems.  Of course there is much work to be done, ehr's aren't quite plug and play, but what is the alternative?  
          I don't see any problem with promoting the adoption of this technology.  
          How many providers who have adopted ehr's would return to the old way of doing things?  
          I'm not sure what Britain fiasco refers to (a security issue?) but there is a lot of really good data from great britain about ehrs and the improvement in quality of care.
          Somewhere I have a lit review from about a year ago.

          •  You have a remarkable definition fo success (1+ / 0-)
            Recommended by:
            vgranucci
            •  what is the anti-ehr agenda? (1+ / 0-)
              Recommended by:
              vgranucci

              So, do you believe paper records are superior?  Or just that ehrs provide no benefit?  

              Much of the criticism is coming from physicians who resent being forced to spend money that they feel could be better used on a new lexus.

              Only one of your links above have anything to do with anything I talked about.  I assure you that there are many other studys that it condradicts

              I guess I'm going to have to find that freakin lit review.  One of these days I'll dig it up.  Maybe I can make it part of diary here.

              •  No, but I get fed up (3+ / 0-)
                Recommended by:
                samddobermann, vgranucci, Hens Teeth

                with people making it seem like a panacea.  You are representing the promise as the reality.  You asked about what was the fiasco in Britain - I promptly showed you what it was.  Billions over budget, poor implementation, and massive parts of it are still almost 10 years away from being in place - when they were supposed to be finished three years ago.  Kaiser Permanente is another case study - they spent a fortune developing one system, scrapped that and went with another - which was also over budget and behind schedule.  

                Unlike you, I've been directly involved in EHR projects, for 15 years, either in implementing them or as a consultant.  I've sat through more sales pitches, more post-mortems, and more "in the next 5 years" professional meeting presentations than I ever wanted to.  Your assertion was that the whole problem was in the initial costs.  I hate to break it to you, but that's a minor part of the TCO.  You can actually get an EHR package "for free."  Supporting it, and making it work is going to cost you, though.  

                The idea that implementing one will automatically make all those good things happen is predicated on the technology being mature.  It isn't.  

                •  the first thing I said... (1+ / 0-)
                  Recommended by:
                  vgranucci

                  on this topic was that it's not a panacea.
                  Many of the problems are being tackled right now.
                  HIT is more mature in Great Britain and I was referring to studies showing how it could improve quality of care.  Not the logistical problems of implementing an integrated nationwide system.  Same thing with Kaiser.
                  What do you suggest? status quo?

  •  Tommy is way off (7+ / 0-)

    I've written this before...but we NEED health care for our paraplegic son, and we must go to Europe for it. That's because the total philosophy of our health care system is different than theirs, and superficial comparisons don't show that.

    In a commercially-driven system, the decisions are always actuarial. The conventional wisdom is that paraplegia is forever, so all that the company will pay for is maintenance. (We joke that the only medication they approve is WD40)

    In Europe, they look for potential. So there are many clinics including ours that simply ask: "What can you do today that you couldn't do yesterday?" After 5 years, our T5 complete son is now fully functional through T12 and partially functional in the lumbar region. The "research" that shows that paraplegics don't recover is just flat out wrong, and used to justify neglect.

    This is just one case. I could write about ten other conditions this morning, off the top of my head, where our commercially-driven health care system reduces the potential and productivity of our citizens.

    And Tommy is totally wrong. Yes, we have more MRI machines here (with competition for them.) But the consumer must decide which doctor and move from specialist to specialist. In other countries you may wait longer for an elective knee replacement, but get cancer and you have a team ready for you right away.

  •  I mentioned to some folks at my church (5+ / 0-)

    (who each have very nice employer-provided insurance plans) that I was thinking of dropping my health insurance with its high deductible "since, if I am sick enough to need it, I would be too sick to work."  Both men shook their heads, and said, "There are huge financial risks to that."  To which I replied, "There are huge financial risks either way I choose."  I didn't have time to elaborate, because I needed to tend to something that was my volunteer job that morning.

    Where are the folks in the Republican party who were so interested in stopping bankruptcies a few years back?  Why are Americans virtually the only people in the world who go bankrupt because of medical costs?

    To say my fate is not tied to your fate is like saying, "Your end of the boat is sinking."--Hugh Downs

    by Dar Nirron on Wed Jun 18, 2008 at 05:23:55 AM PDT

  •  I am SO jealous! (2+ / 0-)
    Recommended by:
    vgranucci, yoduuuh do or do not

    Thanks for the report - I would love to have been there.

    I have the distinction of being called a media whore by Courtney Love. -Maynard J. Keenan

    by arielle on Wed Jun 18, 2008 at 05:35:01 AM PDT

  •  well (2+ / 0-)
    Recommended by:
    Cathy Willey, vgranucci

    cynical citizen's view of America: we pay the highest retail prices in the world for most things and we don't have health care -

    thanks for the diary excellent

    Even our dogs and cats know it is time for a change. Al Gore 6/16/2008

    by pollwatch on Wed Jun 18, 2008 at 06:09:40 AM PDT

  •  each year (3+ / 0-)

    http://www.americanhealthcarereform.org/

    EXCERPT

    18,000 people per year die because they don't have health insurance and the health industry enjoys being able to charge whatever they please and decide which services they will provide us, if, indeed, they will provide services at all.  

    The health care system in America is "Islands of excellence in a sea of mediocrity." - Sen. Tom Daschle

    by pollwatch on Wed Jun 18, 2008 at 06:16:31 AM PDT

  •  read (5+ / 0-)

    somewhere recently that Canada pays it primary care physicians more than their cardiac surgeons; it lowers national health care costs helpful for their 'federal' budget bottom line;

    another way to put it: In Canada a carton of cigarettes cost $10 and a heart transplant is free

    The health care system in America is "Islands of excellence in a sea of mediocrity." - Sen. Tom Daschle

    by pollwatch on Wed Jun 18, 2008 at 06:24:04 AM PDT

  •  Government-paid health care saved my life. (3+ / 0-)

    Last fall having Medicare suplemented by Medicaid saved my life.  I had been very tired for a few months when I got lumps on my leg.  If I hadn't had insurance that really paid for care, I would have lived with it.  But I went to my doctor instead, who thought I had valley fever, a spore that gets into the lungs and causes a variety of symptoms, different in each case.  Part of diagnosing me was a CT scan, which also found a tumor in my kidney.  I had surgery a few weeks later.  The cancer was found before I had any symptoms, and it was all removed.  The tumor had been there for a couple of years and was almost the size of the kidney.

    My point is that single payer care works.  I have lived without insurance, but my care has been wonderful since the government has been paying for it.  I have also had insurance that never paid for anything, and excellent private insurance.  I am convinced that enough stories like mine, publicly aired, could begin to change minds.  And having paid into social secrity for years, I know that I was not taking anything away from anyone.

  •  When Obama starts having the hearings on health (1+ / 0-)
    Recommended by:
    Cathy Willey

    care, the needs and our disaster of a "system" as well as the experiences of nurses, doctors and other providers I think it will be so riviting that networks may pick it up from c-Span.

    Then the questioning of all the big execs justifying all their expenditures like for marketing and PR and fat salaries.Then thay can explain denials and waits and  – – – well everything.

    Then the answer will rise from the problem.

    Bush and McCain and their Social Security Privatization Plan.

    by samddobermann on Wed Jun 18, 2008 at 11:53:15 PM PDT

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