Tuesday, January 30, 2007

It's Efficacy( Does it Work?) -Not Quality That Comes First!- Says Dr. Nortin Hadler

Last Monday, Jan 22, Dr. Nortin Hadler author of probably the most important book on U.S. Health Care The Last Well Person: How to Stay Well Despite the Health-care(2005)System since Ivan Illich's Medical Nemesis written over 30 years ago(1976),wrote a groundbreaking piece for ABC News.

Now Dr Hadler is writing for ABC News and I urge you to track his latest thinking periodically on ABC NEWS

He gave me permission to reprint the essay below from last Monday. It is worth your reading.(I have bolded some statements that especially resonate with me)

"Curing Health Care Insurance-Examining the Insurance Mess - and Its Unspeakable Remedy"


Jan. 22, 2007-None of us needs to be told. The health care delivery system in America is indefensible. About $2 trillion fuels the system, some 16 percent of our national productivity. If we were all covered, that's more than $6,500 per person.

Despite such a fortune, about 40 percent of us can't afford the care we are told we need, either because we are inadequately insured or out-of-pocket payments would bankrupt us.

Medical bills broke the back of more than 40 percent of us who have declared bankruptcy. Even those who feel adequately insured are bedeviled by difficulties in getting care; those inadequately insured are tormented by them.

Despite outcries, this sorry state continues to deteriorate. Why?

Clearly, the cause is not a lack of money. Every other resource-advantaged country indemnifies its entire population with less than half of what we spend, with better national health statistics to show for it.

The problem must reside in the way the money is spent.

Is the "Best" Medicine the Most Effective Medicine?

The guiding principle of all health care reform in America is the belief that American medicine is the "best" in the world.

Reform would tackle misdistribution and the inconsistencies in the quality of care. Once these are overcome, all of us will be afforded the "best" to prevent us from getting sick, and the best to heal us when prevention fails.

The savings that would result from a decrease in the national burden of illness would be enough to provide for adequate distribution of care.

It follows that the goal of health care reform is to make certain that American medicine is performed expertly so as to provide optimal quality of care.

Serving this agenda are national committees to establish the criteria for expert care for particular diseases, national committees to collect the data on how particular states, hospitals or practice groups approach these standards, and national committees to see if it matters.

Much of this effort has taken heart disease as the target because of the volume of cases, the costliness of treating these diseases, and the consensus as to the best care. Many a program has been implemented to move practice up to these standards.

The quality movement is enjoying its day in the sun. Legislators and potentates in the hospital and health insurance industries are beating the drum. Few are questioning the basic premise of the quality movement.

Does it matter to the patient if practice meets these consensus standards? There is a crying need for such heresy.

A recent analysis of the Medicare experience (JAMA, Dec. 13, 2006) should muffle the drumbeat. The degree to which practice met the accepted standards for Medicare patients admitted for heart disease did not predict who lived and who died.

Even for the poster child of the quality movement, heart disease, something is amiss.

Focusing on Quality Alone Could Compromise Care

Why wouldn't performing up to these standards of care for heart disease, to "high performance," be advantageous to the patient?

Maybe the Medicare analysis could not detect the shortcomings in the way doctors and hospitals meet standards of care.

More likely, though, is that the standards of care are far less important than the committees that formulated them pronounce.

If what we do to you doesn't work, or doesn't work much, than it doesn't matter how well we do it. It also doesn't matter how cheaply these services are provided; if it doesn't work it's worthless at any price.

The quality movement is putting the cart before the horse. The "horse" is efficacy.

The quality movement overcame great odds to gain its current influence. Physicians and surgeons, like other professionals, are not reflexively disposed to "outsiders" questioning their competence. Even peer review is a prickly process.

I applaud the quality movement and admire many of its leaders. However, quality is not the goal. It is the process. Efficacy first, then quality, promotes effectiveness.

There is an "effectiveness movement," bloodied and bent but unbowed. It can muster far more illustrative science than the quality movement.

But the forces that thwart the demand for effectiveness are powerful, wealthy and predictable.

Most of the high-ticket items (procedures and pharmaceuticals) are minimally effective, or ineffective. Many of these are considered standards of care. Many are cash cows touted by vested interests.

Effectiveness Key to Performance

From my perspective as a clinician who has cared for patients and taught students for more than three decades, if I have to treat more than 20 patients to do something really meaningful for one, the treatment is marginal; I do not prescribe or advocate it and would have no problem if it was not covered by health insurance.

If this seems extreme, consider the fact that many new and expensive treatments available today do not meet the threshold of meaningful results for even one out of 50 patients.

Furthermore, designing trials to test whether new or old treatments meet this one in 20 level of effectiveness is not difficult, expensive or time consuming. We would no longer be marketed to prescribe and consume minimally effective treatments, or treatments that offered no important improvement over the tried and true.

If we have effectiveness at the base of our health care insurance system, adding cost-effectiveness and quality would be rational and straight forward. We could well afford such a rational health care delivery system, with most of the $2 trillion to spare. We would be more "high performance" than any other country.

And our unsung, well trained and caring physicians, nurses and allied health professionals could get back to serving patients instead of the health care delivery system.

Dr. Nortin Hadler is professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and an attending rheumatologist for University of North Carolina Hospitals

Hadler is a brilliant courageous iconoclast who is dedicated to science and is meticulous and thorough with his research homework. He may make you squirm or even possibly your blood boil but I for one take his work to the intellectual "bank"

Thanks Nortin!

Dr. Rick Lippin

Monday, January 29, 2007

The Commonwealth Fund -Rx for Controlling Health Care Costs

The Commonwealth Fund website is one of my favorite sources of sober and intelligent analyses of solutions to our current U.S. health care crisis.

Today I received an e-mail alert from this highly regarded and generous private foundation, founded in 1918 by a woman philanthropist Anna M. Harkness, with then the "broad charge to enhance the common good". The current mission of The Commonwealth Fund is to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.

But my e-mail alert today disappointed me because the #7 point health care expenditure reduction strategy that The Commonwealth Fund published cluster around the following themes and failed to highlight prevention My heart was broken and spirit dashed.

President Karen Davis and her Commonwealth Fund colleagues believe that change can come about by:

-Reshaping market incentives to reward value-driven health care and increase competition

-Generating information on the clinical effectiveness and cost benefit of medical services to support coverage policy and medical decision-making

-Reducing high insurance administrative overhead and promoting competitive pharmaceutical prices

-Reforming provider payment systems to reward efficient and effective care

-Strengthening primary care

-Investing in health information technology

-Investing in insurance reforms to ensure access, affordability, and equity.

Yet this all seems quite admirable!?

If one delves into the report there is reference to prevention as one of "the most desirable strategies" from a public perspective. But prevention seems to get lost in what I can only presume is "Commonwealth" believing that prevention is not yet a politically viable option in the current 2 trillion dollar U.S. "disease care" system-err industry?.

I and others posit that our disease care system is economically unsustainable and that prevention is,in the end,our only real way out of this economic wilderness.

I frankly do not understand why there remains so much resistance to prevention? I personally believe Americans are ready and able to accept it.

But as I have said on this blog a $2 trillion dollar industry doesn't just roll over for those among us who believe so much in prevention and public health. Too many dollars on board for this giant ship to make a sharp turn in choppy waters?

I'd like to hear from you

Be Well,

Dr. Rick Lippin

Thursday, January 25, 2007

Presidential Candidates on Health Care Reform?

I honestly have lost track of how many presidential candidates we have?? And I AM NOT-REPEAT NOT a single issue person- i.e.- Health Care Reform.

But Cervantes and I began this blog in Nov of 2005 because we correctly agreed that U.S."Health" Care was in rapid realtime economic and moral/ethical meltdown.

Now that it is clear to me at least that the US Governors are generally not stepping up to the plate (Cervantes never wavered from endorsing a single payer-universal federal plan) I have personally decided to support those who embrace a single payer-universal health care plan for all US citizens. My only proviso would be there must be an emphasis on prevention

Ida Hellander,MD Executive Director-Physicians for a National Health Program was kind enough-THANKS IDA! to alert me to John Edwards stating in The Washington Post that that he was supporting Universal Health Care

Further more Dr. Hellander directed me to Greg Sargent's blog over at TPM Cafe Blog that Barack(yikes!-he's a smoker!)Obama has made a half hearted attempt to endorse Universal Health Care.

Dr.Hellander of PNHP says Obama's remarks were less than well conceived.There's a lot of talk about "boldness" but Obama's remarks are anything but?

Where is Hillary? The dethroned queen of 92-93 HealthCare reform can rise again! But she must not be shy just because her timing was off by a almost 15 years the first time around and she forgot to invite the providers to the planning table. People can learn a lot in almost 15 years!

Thanks Dennis Kucinich for always being on the progressive forefront on this and other issues

Since Al(he's still my favorite candidate)Gore got an Oscar nomination for his movie on the Environment-An Inconvenient Truth maybe he can do a sequel on health care?

But Michael Moore may beat him to Sundance this time with "Sicko"- a movie in prep about our US "Health" Care System

Stay tuned folks- This is getting real interesting? I'm actually "cautiously optimistic" that Americans might actually see decent health care for all soon?

Dr. Rick Lippin

Wednesday, January 24, 2007

Very Bad News For Preventive Medicine

A group of entrepreneurs has hijacked the concept of prevention as a means toward solving the US Health Care System Crisis.

On Wed January 10 U.S. PREVENTIVE MEDICINE - a for profit company- founded by Christopher T Fey,Founder and Chairman and Brian Baum,President and CEO- was launched. A full page ad in The Washington Post followed.

An e-mail I sent to them today appended below(slightly revised) expresses my opinion on this ill conceived venture

Dear Messrs Christopher Fey and Brian Baum;

I cannot bring myself to wish you and your colleagues well with the launching of US Preventive Medicine -a for profit company.

Until state and federal legislation incentivizes the correct model you espouse, which is prevention, and third party payers cover the services you are offering, in my opinion, you are omitting a huge number of uninsured and underinsured Americans- some say as much as 100 million US citizens.

Furthermore most the most highly regarded Preventive Medicine experts in our nation and the world fully and objectively understand the relationship of poverty and other SES=Socio-Economic-Status factors on health outcomes. I do not see that understanding at all in your for profit expensive high tech diagnostic and therapeutic/interventional approach to prevention. Please correct me if I missed it?

What we need in this nation is a citizen demand for single payer health care with an emphasis on prevention

To build for profit prevention centers even before third party carriers are reimbursing for such services is, in my opinion, nothing less than a very cruel hoax perpetrated on the American health consumer- most especially the disenfranchised. Shame on you.

If you believe my fundamental criticism of US PREVENTIVE MEDICINE is not accurate or fair I would be very pleased to hear from you both.


Richard Lippin,MD

PS- I intend to circulate my letter to you above as widely as I can


Tuesday, January 23, 2007

New NY Gov. Spitzer Wimps Out On Health Care Too

Putting aside the meaningless tripe King George Bush will spew forth tonight on Health Care on National TV,I thought maybe superstar former Attorney General - now Gov. Eliot Spitzer of the great state of New York would see the light and propose a health care plan that would dare to use the phrase "single payer". Instead like Romney of MASS, Schwarzenegger of CAL, Rendell of PA and probably several others.

Mr Spitzer like these other big state Govs have proposed complex plans that 1) are not fully understood because they are overly complex 2)in some cases require federal and state legislation to implement and 3)take too damn long to achieve desperately needed health care for all in their states now. Mostly however they all seem to buy into continuing their relationships with Big Insurance whose overhead costs and greed are bankrupting the health care system- to put aside Big PhRMA/BIO for the moment.

Spitzer had one of the strongest financial incentives to be bold but, alas he wimped out.

Here is what Gov Spitzer said recently at his state of the state address-from ONE NEW YORK- to his New York constituents (excerpt)

Next, we must fundamentally reform our health care system.
No one can afford health care anymore - not New Yorks working families, not our businesses and not our government.

In just the last 15 years, state spending on Medicaid as a share of the budget's General Fund has increased from 14 percent to 35 percent.These are dollars we have made an affirmative decision not to spend on education, tax cuts, infrastructure or the kind of health care investments that are so desperately needed, like preventive care,workforce retraining and insuring New York's 500,000 uninsured children. And these are dollars we will need to sustain the local cap on Medicaid expenses-a critical tool to lower property taxes and to relieve pressure on localities.

It will take a fundamental restructuring of our health care system to
make health care affordable again and to free up the resources for
other urgent priorities

This restructuring requires hard choices:

We will be forced to close and consolidate hospitals that have been mainstays of their communities, yet because of excess capacity, have cost taxpayers millions of dollars to support.We must shift spending away from expensive institutional nursing homes toward community and home-based alternatives, so seniors can have the care they want at a price they can afford.

We must use the state's vast bargaining power to reduce the prices we pay to large drug companies and pharmacy chains for expensiveprescription drugs.

And we must aggressively fight Medicaid fraud through a state False Claims Act and a Martin Act for Health Care, which I will propose this year.

The savings from reform will not just be reinvested in other priorities such as education and property tax cuts. Savings will also be spent on the kind of health care investments that make good moral and economic sense.

We will introduce a budget that, in the very first year, guarantees access to health insurance for all of New York's 500,000 uninsured children. And within four years, we will further cut the number ofuninsured. Using a new streamlined enrollment process that guardsagainst fraud, we will enroll the 900,000 uninsured Medicaid-eligible adults.

Expanding access to health care will reduce state spending significantly in the long run, because seeing a primary care doctor costs farless than providing charity care for the same patient in an emergency room and it leads to far better care.

We will also invest in better management of high-cost cases involving patients with multiple chronic illnesses a relatively small number of cases that make up a disproportionately high cost to the system. Better managed care will not just save money for patients and the state,but will lead to better overall care.

In making these hard choices, we will not turn our backs to the millions of New Yorkers who rely on us for their health care. The actions we take will not be arbitrary, but in furtherance of a comprehensive strategy to restructure our health care system".

One of my most intelligent friends calls these approaches "a slice of baloney at a time" and believes in incrementalism in health care reform.

I reject this incrementalism and believe we need a single payer system now

Under Mr. Bush's "reign" health care has dramatically worsened in the US by almost any measure and costs have skyrocketed to unimagined heights. And frankly as a citizen and a doctor in the US I am tired of being ashamed.

As far as I can acertain Dennis Kucinich running for President and Dr.Howard Dean DNC Chair are supporting single payer systems.Who else is? out there?

I am watching Senators Clinton an Obama carefully.

Stay tuned as this unfolds now given that this issue ranks very high among US voters concerns (after the war) say credible polling organizations and "the pols have at last caught on to the polls" and, of course, the stimulus of the Dec.6, 2006 watershed US election is not to be minimized.

The Heathcare Reform Issue is finally with us. I personally hope for moral and ethical reasons as much as financial ones

Dr. Rick Lippin

Saturday, January 20, 2007

Bush's Weak Health Care Card Coming Up

President Bush will be talking about Health Care next Tuesday night during his State of The Union Address(SOTA)

How pathetic.I guess his complete disaster in Iraq leaves him few cards left to play.

Some creative Governors have put forth their own state plans in part because the Feds were doing nothing while the US Health Care System significantly worsened during "W"s six year is office. And now the Dems, finally on the Federal level,- especially none other than Dr.Howard Dean- are planning major Federal overhauls of our broken system in rapid economic meltdown.

Credible polls, by the way, have ranked health care as a major priority for the American public for at least 4 years.

The proposal, according to the Washington Post that Bush will put forth, would give those who buy their own health care coverage the same tax benefits now enjoyed by those with employer-sponsored plans. Bush also will announce steps next week to take some federal money now going to hospitals and institutions and give it to states for programs to get medical coverage for the more than 46 million people without insurance.

Well if there was ever an example of "too little too late" this is it!

I am almost too embarrassed for the President and the Nation to watch

But being a good and forever hopefull US citizen I will tune in and urge you to do so also

Next Tues January 23rd-9 PM EST

Dr.Rick Lippin

Friday, January 19, 2007

Single Payer is Necessary Now

While I was busy blogging about California's and Pennsylvania's Health Care Proposals just put forth last and this week respectively Guy Saperstein, one of the "100 Most Influential Lawyers in America" (according to the National Law Journal) posted a compelling case for a single payer health care system on AlterNet on Tuesday.

Saperstein correctly points out that by every objective documented measure the US has a second rate health care system which, too boot, is economically unsustainable. Also he states we are paying for a massive,inefficient bureaucracy - namely the private insurance based health care system destined collapse our system.

The reason,he says, however that the Dems are not generally endorsing a single payer system,like Medicare,which already exists for 40 years and does generally work, is that a single payer system will be viewed as "socialized medicine" and therefore is not politically viable. Fear among politicians of the Insurance industry and Big PhRMA/BIO lobbies are very real.

I began asking the question on this blog beginning in a Feb 06, as the Nov 06 elections loomed in Nov "where are the Dems on Health Care?- Where was Democratic leader Dr. Howard Dean?" Hearing silence I turned to writing about creative solutions from Governors and a few ex-governors.(Richard Lamm and John Kitzhaber)

Well apparently Dr. Dean has recently appeared (re-appeared?) on this issue endorsing single-payer at a Democratic Alliance conference in Miami correctly saying that "healthcare is emerging as a top-tier political issue?" Really? I thought every credible poll has been telling us that for at least two years?

Well it's still not to late and I say we rally around Dr.Dean and The Democratic Alliance- A group of Progressive Philanthropists and the American public who is fed up to get this job done now.

My one regret about the Saperstein piece on AlterNet on Tuesday is that it failed to reference even one word about prevention and health promotion- clearly our only way out of the economic meltdown of our high-tech, high cost "disease" care system.

So I again include my own 8 point health care plan from 1995 called "Grow Up America" below which undoubtedly is even less politically viable than a single payer system


- Stop prolonging death. It's both expensive and dehumanizing at best, greedy and cruel at worst.

- Empower US citizens to assume increased individual responsibility for health and convince medical consumers that it is in their best interests not to assume the role of helpless, dependent victims/patients.

- Yet also recognize that we have medicalized America’s social problems. So we must provide healthy and safe jobs for all able citizens thereby reducing poverty and all its subsequent health impacts (possibly 1/3rd of Health Care Costs)

- Provide healthy environments including healthy air, water, soil and food.

- Rebuild America's public health infrastructure to ensure we provide appropriate macro and individual interventions to especially low income citizens such as childhood and adult immunizations and response to man-made and natural catastrophes.(added 2006)

- Face the reality that a very large percentage of illnesses, injuries and hospitalizations are entirely preventable. Subsequently, the elimination of tobacco, alcohol, drug and medication abuse alone could immediately reduce medical costs by a factor of at least fifty percent.

- Incent and train physicians to maintain the health of patients and populations. Radical changes in provider re-imbursement and medical education strategies are necessary

- Recognize that early childhood preventive medical education can profoundly affect lifelong health behaviors.

I would posit that my plan would cut health care costs anywhere from 1/3rd to 1/2 of our current 2 Billion dollars =16% of our GNP national health expenditures

But, alas, I am a realist? Who wants to grow up? Some patients that I see do but probably not enough to vote for a preventive based health care system?

Anyway Saperstein characterizes the current US health care system as "fast approaching a perfect storm". He is correct and we need to read his article and turn it into federal legislation quickly.

I'll wait for another decade for Prevention! I am a patient but persistant man.

Be Well all,

Dr. Rick Lippin

PS- Hey Michael Moore - Where is your movie on the US Health Care crisis allegedly entitled SICKO?

Wednesday, January 17, 2007

"Prescription for Pennsylvania"

The title of this blog is Governor Ed Rendell's long awaited Health Care Reform Plan for Pennsylvania (this bloggers home state) that he unveiled today in a noontime speech.

Not unlike his counterpart Governor on the other coast, Gov. Arnold Schwarzenegger from California, Gov Rendell offers up an Rx that is a potpourri of initiatives,incentives and assessments(taxes?) to try to address what Rendell correctly states is a situation where "no longer is it a question of whether we can afford to act. The cost of inaction is far greater in terms of individual health consequences and from the increasing burden on taxpayers"

Like Mr. Schwarzenegger's Golden State plan this Keystone state plan will include sacrifices for all- and hopefully benefits for all underinsured and uninsured Pennsylvanians.

Among the positive aspects of the Rendell plan are:

- CAP=Cover all Pennsylvanians- a complicated set of initiatives through the private insurance system to ensure that all Pennsylvanians ultimately have health insurance- But when this blogger asks is ultimately? And thumbs down from me on working the benefits through mostly employers and the private insurance industry.

- Increasing access by enabling nurses, nurse practitioners,midwives,physician assistants and other non-physician health practitioners to practice to to the fullest extent of their training and skills. Even working weekends and nights is incentivized- Good for you Mr. Governor- That took courage! (hopefully you won't need to see a Doctor soon?)

- Improving quality of care with emphasis on patient safety initiatives and chronic disease management programs- GREAT! and long overdue!

- Rewarding wellness programs to reduce paying for avoidable medical services. "The health care costs related to tobacco and adult obesity in Pennsylvania totaled more than $9 Billion says Rendell an enormous economic burden" You got my vote their Mr. Governor- Out go the cheesesteaks

- Keeping Pennsylvanias, especially the poor and uninsured, out of the emergency room- a very expensive way to deliver health care. "Pennsylvanians statistically are more likely than the average American to go to the emergency room" for care. I'm for that one too Mr Governor.

My consternation with the plan is that it is too complex and will take too much time to implement. Several components of the plan will require legislative and federal approval.

Also, in the end. I believe Mr. Rendell "wimped" out on us (and missed his own opportunity) as a leading, hopefully progressive Democrat, by not endorsing Universal Single Payer Health Care for all Pennsylvanians and by example the rest of the nation.

You are definitely correct Mr. Governor- Government cannot and should not solve all the state's problems. But Government, at all levels, needs to engage health care. The business model(US penchant for "the free market solves all problems") applied to health care has been an abysmal failure rendering the US Health Care system an embarrassment in the international community.

Human beings and human flesh are not commodities. It's time we recognize that.

For more on the Rendell Rx visit Governor's Office of HealthCare Reform

Dr. Rick Lippin

Tuesday, January 16, 2007

Pennsylvania's Fundamental HealthCare Reform Problem

Almost lame duck Pennsylvania Governor Ed Rendell will be announcing his Health Care Reform plan for the Keystone State's approximately 12 million residents this week. I'll be watching carefully as a Pennsylvanian and a HealthCare Crisis blogger

Unlike other Governor's Mr.Rendell has a special problem. It turns out that Pennsylvania has probably the largest concentration of Health Care and related Industries in the US maybe second only to the New England region?

So once Mr.Rendell announces his plan(s) I'll be providing my comments on it.

But the cheesesteak eating-sports loving- affable Governor- former effective Mayor of Philadelphia (1991-1999) and Chair of the Democratic National Committee=DNC (1999-"Go Al Gore") see Wikipedia has the classical problem of one industry's profits (health care) are another industry's costs.

For more details on exactly how concentrated the Health Care Sector is in and around Philadelphia for example The New England HealthCare Institute, in partnership with the prestigious Milken Institute, published a January 04 report entitled On the Critical List: Health Care Job Vitality in New England-Addendum to The Economic Contributions of the Health Care Industry to the New England Region.An entire section 11 was devoted to A Case Study: The Pennsylvania and Philadelphia Story.

Just one example-Perhaps the most important structural factor in Pennsylvania's "advantage" is its remarkably strong pharmaceutical cluster says the above report. As private funding plays an increasingly important role in the health care industry, Philadelphia's proximity to pharmaceutical company headquarters and research laboratories is a significant advantage in the search for new sources of job growth.Primary U.S. operations and/or major research and manufacturing facilities for most of the world's top 10 pharmaceutical companies ranked according to sales are located in the greater Philadelphia area. Companies with a major presence near Philadelphia include Merck, GlaxoSmithKline, Novartis, Bristol-Myers Squibb, AstraZeneca, Roche, and Wyeth. While many of these companies have operations in New England, particularly specialized research laboratories, the vast majority of their expenditures remain in the greater Philadelphia area.

However other industries in Pennsylvania are "crying uncle" as health care costs -especially drugs- have dramatically soared over the past decade in particular!

What is Governor Rendell to do? Can he pull the rabbit out of the hat? I regret to say I doubt it. Out of sheer destiny of geography Ed Rendell and the citizens of Pennsylvania are right smack in the middle of an economic meltdown of a treatment based "disease" care system which is economically unsustainable.

To Rendell's credit he trying other sectors like renewable energy and of course tourism, but it may be too little too late for the citizens of Pennsylvania. Installing or tilting at windmills is not going to solve Pennsylvania's Health Care dilemma.

More to come on the Rendell plan this week

Dr. Rick Lippin

Monday, January 15, 2007

Arnold "The Governator" Schwarzenegger Kickstarts HealthCare Debate

The more I thought about the drama that unfolded last Tuesday night when California Governor Arnold Schwarzenegger announced his health care reform plan the more I felt compelled to write again.

Firstly there he was "The Terminator"- Austrian born Republican Governor of the nation's largest state -former 7 time winner of the Mr. Olympia title (in part thanks to anabolic steroids) -standing before a crowd on crutches just recovering from a severe right broken leg- calling for Universal Health Care coverage for his fellow citizens. 6.5 million Californians are uninsured -more than any state in the union.

Billy Shakespeare would have loved it.

The plan, which is another complex "Rube Goldberg" legislative initiative, is designed to please or piss off every special interest group or medical system stakeholder in the Golden State.

While I can't seem to download the multipage legislation per se-the devil being in the details- I found one statement the Governor's office that interested me most. In a press release of January 8th Schwarzenegger shared responsibilities and shared sacrifices

Of course I was particularly interested in the paragraph of the release that dealt with "Encouraging personal responsibility for Health and Wellness by implementing the Governor's Healthy Incentives/Rewards Programs in both the public and private sectors" Here is the language from the press release and I assume the speech.

"Encouraging personal responsibility for health and wellness: Implement "Healthy Action Incentives/Rewards" programs in both the public and private sectors to encourage the adoption of healthy behaviors. Californians, who take personal responsibility to increase healthy practices and behaviors, thereby reducing their risk of chronic medical conditions and the incidence of infectious diseases, will benefit from participation in this groundbreaking program."

I wrote to the Governor's office to provide details since this interested me a great deal. I honestly never thought I would live to see a US Governor use the term "wellness" in my lifetime since the word grew out of the health lexicon of the 1960's counter culture.

Anway I give the hybrid "Republicrat Governator" credit for standing up on crutches just a few days after a serious skiing injury requiring surgery and kickstarting (The Gov. is a motorcycle enthusiast as well) a national dialogue on healthcare.

I fully understand that the Feds have more important issues to cope with right now but US Health Care is too far broken and much too expensive to ignore much longer.

Thanks Arnold!

Dr. Rick Lippin

Friday, January 12, 2007

Two Heavyweight Thinkers on Health Care Weigh In

I told you I would be keeping an eye on California knowing that the "new" Governor Arnold Schwarzenegger would be announcing his health care plan for The Golden State last Tuesday.

Well, rather than doing my own analysis with the exception of one of my persistent drumbeats, below I refer you to two serious intelligent essays on the California plan

Interestingly both writers come to fairly similar conclusions about lukewarm (it's a start) support of the plan

The first is an excellent blog by Kevin Drum writer of Washington Monthly's-"Political Animal"- http://www.washingtonmonthly.com/ posted on Wednesday January 10 under the title Community Rating.

The second piece is New York Times Senior Columnist Paul Krugman's piece in the New York Time today entitled Golden State Gamble. http://www.nytimes.com/
If you go to the Times today you will be able to read the Editorial without forking over any of your hard earned dollars. But after today you'll need to pay an annual fee for the NY Times Editorials (in my opinion it's worth it!-especially Dowd!)

Anyway my drumbeat referenced above is about the importance of prevention and health promotion which the California plan did not adequately address-Too politically dangerous but ultimately an economic imperative.

So once again I refere you to http://www.wecandobetter.org/and www.healthpromotionadvocates.org

A treatment based "disease care" system (vs. "health care") is simply not economically sustainable.

Dr. Rick Lippin

Monday, January 08, 2007

More Emphasis on States Leading in Health Care Reform

Today USA Today published a front page story on the evolving role of the states in Health Care Reform stating that 43 out of 50 states have made expanded medical coverage a priority for their state legislatures in 2007. For full article go to http://www.usatoday.com/news/nation/2007-01-07-states-health-coverage_x.htm

Our own blog here has been writing since February of 06 that, for good or for bad, the states would take the lead in Health Care Reform since in this writers opinion the Feds-

- Have other very real and very important pressing priorities even under Pelosi/Reid for 2007

- Still view health care as a potential third rail of politics since witnessing the debacle of the dethroned queen of major US Health Care reform (then First Lady -now Presidential Candidate) Sen. Hillary Clinton mismanage this issue beginning in 1993

- Are busy either announcing or posturing on both sides of the aisle for Presidential runs coming sooner than usual (like warm weather in January)

Below are a few URLS that will help you determine why our Nations' Governors, both Pubs and Dems, are marching down this path now and how they are doing it. One is a brief blurb is from The Kaiser Family Foundation http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=41987

As usual The Commonweath Fund has good research and sound advice for the states in this recent piece http://www.cmwf.org/publications/publications_show.htm?doc_id=437168

Never shy, former Speaker of the House Newt ("Contract with America") Gingrich had launched The Center for Health Transformation in 2003 as a project of the Gingrich Group, a consulting firm founded in 1999 by Gingrich and specializing in "transformational change". The Center is "a collaboration of transformational leaders dedicated to the creation of a 21st century intelligent health system in which knowledge saves lives and saves money for all Americans". The Art of Transformation a book by Newt Gingrich and Nancy Desmond promotes their agenda as does their website http://www.healthtransformation.net/

Many of the states seem to focusing first on covering all children/citizens- hard to argue with that! Except OUCH!- where is the money for 85 year old grandpa's quadruple coronary bypass surgery? Or even worse where is the money for the immoral prolongation of death and dying in many of our nations' hospitals and nursing homes?

But the fundamental dilemma with most of these state plans is that they still are mostly focusing on health care financing and are not getting at what former two term Oregon Governor Dr. John Kitzhaber calls transforming US Medicine from "disease care" to true "health care" See http://wecandobetter.org/

As part of their week-long series on health care, "Prescription for Change," in October of last year ABC News came to Portland to speak with John Kitzhaber. You can read the story
http://abcnews.go.com/Health/PrescriptionForChange/story?id=2580596&page=1. In my opinion he's got it right!

Kizthaber correctly says we have to have the courage to change our entire construct of thinking about medicine and emphasize prevention -working medicine from the front (much less expensive) end. He says almost in disbelief "It's really mind-boggling to think that we continue to cling to this thing, in spite of the fact that it's not working for any of us."

As I have done before I encourage you to visit the website of my friend Dr. Michael P. O'Donnell www.healthpromotionadvocates.org who has advocated for Health Promotion programs and Health Promotion research for over 30 years! Talk about persistence paying off! O'Donnell now has very well crafted legislation at the federal level which the states would do well to explore for incorporation into their ambitious plans for 2007

(As the DGA =Democratic Governors Association said last year-"WE CAN'T WAIT FOR 2008"

Dr. Rick Lippin