Posts Tagged ‘healthcare system’

David Brooks: “Buckle Up for Round 2”

Monday, January 24th, 2011

“The healthcare reform law was signed 10 months ago, and what’s striking now is how vulnerable it looks,” writes columnist David Brooks in the New York Times. “Several threats have emerged – some of them scarcely discussed before passage – that together or alone could seriously endanger the new system.”  According to Brooks, the threats include:

The courts.  “So far, one judge has struck down the individual mandate, the plan’s centerpiece.  Future decisions are likely to break down on partisan lines.  Given the makeup of the Supreme Court, this should concern the law’s defenders,” according to Brooks.

False projections.  Brooks notes that “The new system is based on a series of expert projections on how people will behave.  In the first test case, these projections were absurdly off base.  According to the Medicare actuary, 375,000 people should have already signed up for the new high-risk pools for the uninsured, but only 8,000 have.”

Employee dumping.  Brooks sees this as the potentially most serious threat.  “Companies and unions across America are running the numbers and discovering they would be better off if, after 2014, they induced poorer and sicker employees to move to public insurance exchanges, where the subsidies are much higher,” Brooks said.

Healthcare oligarchy:  Since the March passage of the healthcare law, “there has been a frenzy of mergers and acquisitions, as hospitals, clinics and doctor groups have joined together into bigger and bigger entities,” according to Brooks.  “The downside to this economic concentration is that there could be less competition and cost control.”

Public hostility.  “Complaints are especially high among doctors.  According to a survey by the Physicians Foundation, 60 percent of private-practice doctors say the law will force them to close their practices or to restrict them to certain categories of patients,” Brooks wrote.

“After the trauma of the last two years, many people wish the issue would go away.  But it’s not going away, especially since costs will continue to rise,” Brooks concludes.  “Some Congresses achieve healthcare; members of this Congress or the next one will have healthcare thrust upon them.”

Recession Hits Healthcare Hiring

Monday, October 18th, 2010

Although healthcare has long been perceived as a recession-proof industry, the pace of employment growth has slowed,  with just 17,000 jobs added monthly during January, February and March for a net gain of 51,000 new positions. That’s less than half the 2008 numbers, although hiring is likely to improve later this year because of pent-up demand.  More than 16 million Americans – one in eight – work in healthcare.  Employment in the industry has grown by 500,000 since December of 2007, a time when 5.1 million jobs vanished from the overall economy.

Even the world-renowned Mayo Clinic, which employs 35,000 people, is feeling the pinch.  The destination hospital has frozen salaries for physicians and senior administrators, reduced travel and overtime expenses and cut 2009 capital spending by $150 million.  Standard & Poor’s downgraded Mayo’s debt in March, citing the institution’s large, unfunded pension liability and break-even operating margins.

In the words of Robert Fogel, a Nobel laureate and professor at the University of Chicago’s Booth School of Business, “It’s a long-term shift reflecting changes in technology and what consumers want.  Healthcare is the growth industry of the 21st century.”

As 78 million baby boomers march towards retirement and old age, the need for healthcare professionals will only grow.  The current slowdown in job growth is a temporary blip on the healthcare radar.

Healthcare: Saving Lives or Prolonging Suffering?

Thursday, August 12th, 2010

There is a cacophony of voices in the media talking about healthcare reform, but it’s more heat than light.  That why Atul Gawande’s most recent article in The New Yorker is so important. Boston-based Brigham and Women’s Hospital general and endocrine surgeon Gawande examines how the trend to prolonging life is one of the reasons behind soaring healthcare costs.Is healthcare saving lives or prolonging suffering?  Everyone needs to read this.

According to Dr. Gawande in Letting Go, “Twenty-five percent of all Medicare spending is for the five percent of patients who are in the final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.  Medical spending for a breast-cancer survivor, for example, averaged an estimated $54,000 in 2003, the vast majority of it for the initial diagnostic testing, surgery, and, where necessary, radiation and chemotherapy.  For a patient with a fatal version of the disease, though, the cost curve is U-shaped, rising again toward the end – to an average of $63,000 during the last six months of life with incurable breast cancer.

The big question Gawande poses is thus:  What are we getting in return?  “Patients who were put on a mechanical ventilator,” Dr. Gawande continues, “given electrical defibrillation or chest compressions, or admitted, near death, to intensive care, had a substantially worse quality of life in their last week than those who received no such interventions.  And, six months after their death, their caregivers were three times as likely to suffer major depression.”

Dr. Gawande notes that in one study, “Researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure.  Surprisingly, they found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer.  Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months.  The lesson seems almost Zen:  you live longer only when you stop trying to live longer.”

In one case Dr. Gawande describes, “Aetna decided to let a group of policy-holders with a life expectancy of less than one year receive hospice services without forgoing other treatments.  A patient like Sara Monopoli (who was diagnosed with terminal lung cancer at the age of 34) could continue to try chemotherapy and radiation, and go to the hospital when she wished – but also have a hospice team at home focusing on what she needed for the best possible life now and for that morning when she might wake up unable to breathe.  A two-year study of this ‘concurrent care’ program found that enrolled patients were more likely to use hospice:  the figure leaped from 26 percent to 70 percent.  That was no surprise, since they weren’t forced to give up anything.  The surprising result was that they did give up things.  They visited the emergency room almost half as often as the control patients did.  Their use of hospitals and I.C.U.s dropped by more than two-thirds.  Overall costs fell by almost a quarter.”

Healthcare Systems Wastes Up to $800 Billion a Year

Thursday, November 19th, 2009

Healthcare reform could cut up to $800 billion a year in waste.  The American healthcare system does waste money, and healthcare reform legislation could cure some of the inefficiencies.  According to a Thomson Reuters report, the healthcare system wastes between $505 billion and $850 billion annually.  The report notes that, “America’s healthcare system is indeed hemorrhaging billions of dollars, and the opportunities to slow the fiscal bleeding are substantial.  That’s one-third of the nation’s healthcare bill.  The good news is that by attacking waste we can reduce healthcare costs without adversely affecting the quality of care or access to care.”

According to the Thomson Reuters study:

  • The paper-based records keeping system discourages information sharing and totals six percent of annual overspending.
  • The overuse of antibiotics and lab tests to protect physicians against malpractice costs consumers $200 to $300 billion a year.
  • Fraudulent Medicare claims, kickbacks for referrals for unnecessary service and other scams cost consumers up to $200 billion a year.
  • Administrative inefficiency and double paperwork account for 18 percent of healthcare waste.
  • Mistakes total $50 to $100 billion in unnecessary spending, or 11 percent of the total.
  • Preventable conditions such as diabetes cost $30 to $50 million annually.

These findings help explain why American citizens spend more dollars per capita on healthcare and the largest percentage of GDP than any other developed nation.  At the same time, the population is unhealthier, with high incidences of diabetes, obesity, heart disease and neonatal deaths.

Switzerland-Style Healthcare System Could be the Solution

Monday, September 28th, 2009

One instructive lesson in reforming American healthcare may be to adopt the Swiss model, which is regulated by the Federal Health Insurance Act of 1994,  and made health insurance compulsory for all residents.  Previously, Switzerland had an American-style system, which became a national outrage when studies revealed that five percent of the population lacked any coverage.

165298519_12e65e294bToday, 99.5 percent of the Swiss people are insured with coverage funded by the individual who generally pays the full cost of premiums. Government subsidies are provided for the poor, with approximately one-third of all Swiss citizens receiving the subsidy.  “These subsidies are designed to prevent any individual from having to pay more than 10 percent of income on insurance.”  All insurance is private and physician compensation is negotiated between the insurance companies and doctors on a canton-by-canton basis.

The down side is that Swiss healthcare is expensive, with costs rising 10 to 20 percent every year.  Monthly health insurance costs for a family with one child can amount to CHF 1,000 ($944).  Deductibles can be adjusted, though, from CHF 300 ($283) to CHF 2,500 ($2,360).  The state will help with the costs if income (married/without children) is around CHF 30,000 ($28,920) or (married/with children) around CHF 60,000 ($56,581).  In those circumstances, the government pays half the cost of insurance.  Options are available that will lower the monthly costs, similar to the American HMO model.  In these plans, the person must consult with their physician prior to seeing a specialist.

“The mix that Switzerland represents between private enterprise and general state regulations that make healthcare accessible to everyone is really an interesting example for the United States,” said Felix Gutzwiller, a Radical Party senator and head of Zurich University’s department of public health.  In Switzerland, administrative costs consume on average five percent of health insurance revenue.  In the United States, it’s closer to 20 percent.

In terms of satisfaction, the World Health Organization puts Switzerland in 20th place in its rankings of healthcare systems around the world.  The United States ranks 37th, sandwiched between Costa Rica and Slovenia.

Wanda Jones: Time to Reinvent Hospitals and Medical Office Buildings

Wednesday, September 9th, 2009

great_ormond_st_readyHospitals and medical office buildings must undergo a complete rethinking to move them functionally and architecturally from the 1970s to models that make sense for the 21st-century.  Wanda Jones, healthcare futurist and president of the New Century Healthcare Institute, believes that we need to reinvent hospital design and construct linear-spine facilities that provide patients with more personalized medicine.  This anticipates expansions, contractions, removal and replacement of patient towers by dividing the number of patient beds into two, three or four towers.  This way, they can be incrementally changed without interrupting the others and are readily adaptable to specific programs.

In a recent interview for the Alter+Care Podcasts on Healthcare, Wanda Jones discusses the paradigm shift in terms of new technologies that will make obsolete the knowledge base on which healthcare systems, hospitals and physicians have made money up until now.  Every surgical specialty will use robotics, and cures for cancer will be based on technology that has arisen out of the human genome project.  The New Century Healthcare Institute is a research-and-development and educational foundation devoted to population-based planning and adaptation of the healthcare system to future conditions.

RIP: The Senate’s Liberal Lion and Healthcare Reform Champion

Tuesday, September 1st, 2009

ted-kennedy-dies-001Ted Kennedy’s passing deprives President Obama of a critical political ally in his efforts to reform healthcare.  In his role as chairman of the Senate Health, Education, Labor & Pensions committee, Kennedy fought tirelessly for decades to reform a system that today deprives 47 million Americans of affordable, accessible healthcare coverage.

In The Guardian, Michael Tomasky notes that, “The heavens somehow conspired to make this Kennedy death, however expected it might have been, nearly as heartbreaking as those of his vigorous younger brothers.  It’s not just that the great cause of the last 40 years of his life, reforming America’s healthcare system, sits at a perilous juncture, although it certainly is that, in part.  But the tragic irony of the timing is even greater, because we see in the very healthcare debate that so needed his input the precarious state of the institution to which he devoted his life, and which he shaped and influenced more than probably any other senator in history.”

Kennedy, writing in the July 27, 2009, Newsweek, declared that healthcare reform is “the cause of my life”. “In 1973, when I was first fighting in the Senate for universal coverage, we learned that my 12-year-old son Teddy had bone cancer.  He had to have his right leg amputated above the knee.  The pathology report showed that some of the cancer cells were very aggressive.  I decided his best chance for survival was a clinical trial involving massive doses of chemotherapy,” according to Kennedy.

“During those many hours at the hospital, I came to know other parents whose children had been stricken with the same deadly disease.  We all hoped that our child’s life would be saved by this experimental treatment.  Because this was part of a clinical trial, none of us paid for it.  Then the trial was declared a success and terminated before some patients had completed their treatments.  That meant families had to have insurance to cover the rest or pay for them out of pocket.  Our family had the necessary resources as well as excellent insurance coverage.”

Other heartbroken parents were not able to pay for the continued treatment and that made Kennedy realize that “No parent should suffer that torment.  Not in this country.  Not in the richest country in the world.”  So passionate was Kennedy that Americans have access to healthcare that he often paid for others’ treatment out of his own pocket when they could not afford it.

Kennedy made healthcare reform his lifelong passion, vowing “We will end the disgrace of America as the only major industrialized nation in the world that doesn’t guarantee healthcare for all of its people.”

Wherever you stand on the issue, there is no doubt that Kennedy was a great senator, a statesman that Republicans and Democrats respected and emulated.  He did not live to see the healthcare bill passed, but perhaps his death will quell partisan dissension and bring us closer to a solution.

Modern Healthcare Names President Obama 2009’s Most Powerful Leader

Monday, August 31st, 2009

obama-health-care-logoPresident Barack Obama’s historic effort to reform the nation’s broken healthcare system has placed him at the top of Modern Healthcare magazine’s “100 Most Powerful” leaders for 2009.

Despite the fact that the Democrats are losing some steam on healthcare reform and the Republicans are looking stronger for the 2010 midterm elections, Modern Healthcare magazine has saluted the importance of President Obama’s initiative and his willingness to risk his significant political capital on the most difficult issue in America.

According to Modern Healthcare, “As the debate rages on over reform, it’s clear that the top man In this year’s list, President Barack Obama, will face many more hurdles as he works to broker deals with sectors of the healthcare industry to achieve cost savings in his No. 1 domestic priority, while herding a still-divided Congress into approving a bill that he can sign his name to and claim as a victory for his administration.”

Modern Healthcare’s top five healthcare leaders for 2009 include:

1. Barack Obama, President of the United States, Washington, D.C.

2. Kathleen Sebelius, Secretary, Department of Health and Human Services, Washington, D.C.

3. Nancy-Ann DeParle, Director, White House Office of Health Reform, Washington, D.C.

4. Max Baucus, U.S. senator (D-MT) chairman, Senate Finance Committee, Washington, D.C.

5. Chuck Grassley, U.S. senator (R-IA), ranking member, Senate Finance Committee, Washington, D.C.

Healthcare’s Best-Kept Secret: Nurse Practitioners

Thursday, August 13th, 2009

If healthcare reform is to successfully overcome the realities of Washington politics, there is one problem in covering the millions of Americans who lack insurance coverage – the physician shortage.  Currently, there is a 30 percent shortage of primary-care physicians, and with less than 10 percent of 2008 medical school graduates choosing that career track.  When Massachusetts enacted mandates for universal health insurance in 2006, the state’s primary-care physicians48019286 were overwhelmed.  A similar scenario could occur on a national scale.

Nurse practitioners — who have advanced nursing degrees, are licensed by the state and often are allowed to prescribe medications — may fill that void because they can treat and diagnose patients at less cost than physicians.  Medicare reimburses nurse practitioners at 80 percent of what they pay doctors for similar services.

Nurse practitioners are vital to healthcare reform because they focus on patient-centered care and preventive medicine.  The House of Representatives has listed nurse practitioners as primary-care providers on their healthcare reform legislation bill.  The profession lobbied intensely to include this legislative language so they can play an important role in a revamped health system.

“We seem to be healthcare’s best-kept secret,” said Jan Powers, health policy director for the Academy of Nurse Practitioners.  Although nurse practitioners typically have less medical education than physicians, they are well trained in skills such as bedside manner and counseling.  “In the United States, we are so physician-centric in our health system.  But it should be about wellness and prevention, not about procedures and disease management,” said Rebecca Patton, president of the American Nursing Association.

House Proposes $1.5 Trillion Healthcare Reform Package

Wednesday, July 22nd, 2009

The House of Representatives has proposed a $1.5 trillion package that would make healthcare coverage a right and a responsibility for all citizens.  If passed, medical providers, employers and the wealthy would pick up the tab.  The United States is the only developed nation that lacks healthcare coverage for all citizens, and approximately 50 Health Care Reformmillion people do not have access to insurance.

“We cannot allow this issue to be delayed.  We cannot put it off again,” says Representative Henry Waxman, a California Democrat and chairman of the House Energy and Commerce committee.  “We quite frankly cannot go home for a recess unless the House and the Senate both pass bills to reform and restructure our healthcare system.”

President Obama is promoting healthcare reform every chance he gets.  In a Michigan speech about spending for community colleges, he said, “There’s going to be a major debate over the next three weeks.  And don’t be fooled by folks trying to scare you saying we can’t change the healthcare system.  We have no choice but to change the healthcare system because right now it’s broken for many Americans.”

Organizing for America – Obama’s campaign organization – is launching a series of 30-second television ads on healthcare reform that will air in Washington D.C., on cable networks nationally and on local stations in eight states.  The ads depict ordinary citizens telling their stories about problems with the current healthcare system.