HealthyConcerns.com

Surviving the system, courtesy of the ACS

The American Cancer Society has a lobbying arm called the Cancer Action Network [Read about it here.] The ACS CAN recently launched a big initiative for cancer patients called "Surviving the System". They launched it with a Lobby Day which took place on the 20th.

The idea was to get regular people sharing their stories...and reachng out to their elected officials to ask for health care reform, for cancer patients and in general.

While cancer isn't the number one killer in America, it does claim over half a million lives a year. And getting cancer can be devastating to families for more reasons than just the fear and anxiety over our lvoed ones' health. According to a study released to coincide with ACS CAN's Lobby Day:

•  Nearly one in three people diagnosed with cancer under the age of 65 has been uninsured since their cancer diagnosis.  Scientific research shows that being uninsured can adversely impact your chance of survival.
• One in five families affected by cancer have used up all or most of their savings because of health care costs and more than 40 percent have had difficulty affording their health care costs in the last two years. 
• More than two-thirds of Americans under age 65 who tried to find insurance outside their employer couldn’t afford a plan. 

Our family just went through a cancer scare or two ourselves, but luckily we are all covered, well-covered. Imagining the stress of having no or insufficient coverage, on top of the stress cancer brings on its own...well, I wouldn't want to experience that. 

And once again, it begs a fundamental question: Insufficient or non-existent coverage can impact someone's chance of survival. Is it OK that people live or die in this country based not on whether what they have is treatable or curable or not, but rather on their income level or class or employment status? All of which seems highly volatile in this economy. And what if we're talking about children, who surely aren't responsible for their parent's socio-economic status? 

California is experiencing record unemployment, and I'm guessing a lot of people are losing their coverage. Or being forced to choose between paying exorbitant COBRA payments vs. paying for other necessities, like food, shelter etc.

Those people may be very employable, may have new jobs with coverage waiting around the corner. Is it OK that they have to hope that nothing catastrophic happens to them...whether one-time, like a car accident, or chronic, like a cancer diagnosis...while they're toughing out this economy like we all are?

I continue to think it's not. You can read more about the ACS's perspective and their efforts for health care reform on their site and their blog.

Do patients have a *right* to visitors? Wow.

OK, when I saw the headline of this NY Times blog post, Do patients have a right to visitors?, I really thought it was going to be about something else. I thought perhaps there were cases of family members who were awful to hospital staff and banned, despite a patient wanting to see them. 

I didn't think it was actually about that well-worn cliche: Gay life partners being banned from their partners' bedsides. I mean, admit it, haven't you heard that a million times and wondered if it really still happened?

Call me naive, I thought that argument was more about the possibility, not the reality. I mean, in this day and age? In America? Oh, silly silly blogger!

Well, two such cases are becoming court cases, one in Florida and one in Washington state. The NY Times blog post points to a more detailed column about the cases. If you have a heart, you will feel terribly upset upon reading these accounts.

I don't care about your politics, what kind of people would basically force someone to die alone? Would prevent children from being able to say goodbye to a dying parent?

The phrase is "First, do no harm." There's nothing but harm in these stories. Harm to those poor dying souls. And irreparable harm to their partners and children.

Do you see some rationale I'm missing here?

Is 4% too much to ask? And if it's not why do only patrons pay?

I spent last weekend up in San Francisco, something I do very rarely. It was a gastronomic delight, as we visited four different restaurants and had four different wonderful meals over the course of the weekend.

At one of them, Palomino on the Embarcadero, I noticed this note on the menu:

Now, at first glance, this didn't bother me at all. After all 4% of a $40 lunch bill is $1.60. I would gladly pay $1.60 so that restaurant workers can have health care benefits. If I can afford to eat at this restaurant, I can afford this surcharge.

But as always there is more to the story.

I've always been most aware of health care for restaurant workers as a political issue because of one blogger: Shuna Fish Lydon from Eggbeater.

As early as 2006 she was blogging passionately about this issue, at her own blog and for KQED.

And her perspective on this surcharge is a little more nuanced than mine. She asks why it is the patron alone who bears this cost? Why does this one cost get passed through, and shouldn't it be managed as one more cost of doing business like any other? Why this gets tacked on as a surcharge, when rising rent or food costs are not? 

Of course counter-arguments are that many businesses tacked on surcharges when gas prices were so high, one assumes because they were potentially temporary surcharges. But this one is permanent and legislated.

There are more, obviously peeved, diners sounding off about it at Eater SF.

I'm not sure I see the difference between calling out the surcharge (allowing angry diners to take their business elsewhere) or raising your prices (where again, diners can take their business elsewhere if prices get too high.)

Are we just angry to be reminded about the ridiculous state of our health care system? If so, then I agree with at least one commenter who said the notice about the surcharge is good if it starts conversations about health care.

I saw the notice. I didn't mind it. I thought it was kind of cool that San Francisco was trying to do something instead of just talk about it.

That was my gut reaction, as an occasional diner in SF.

What's yours?

Universal Health Care, examined

Joe Paduda from Managed Care Matters caught my eye with his Top 10 Reasons Universal Health Care is Bad. The thing is that he listed the ten reasons without commentary, although some were willing to go at it over whether these were valid or invalid reasons in his comments.

Friday he followed up with a post examinig Item #1 on his list: "Universal Healthcare Will Lead to Rationing".

I hope he follows up every single item from the Top 10 list in this fashion!

Here's some interesting data to get you hot and bothered to read the whole post:

Here's what a bit of specific data show (excerpted from the Commonwealth Fund report).

• The percentage of U.S. patients who waited six days or more for a doctor appointment when sick was not significantly different from the rate in Canada (23% v. 36%), the worst-performing country
• Only 47 percent of U.S. patients were able to see a doctor on the same or next day when sick, versus 61 percent to 81 percent of patients in the four better-performing nations
• U.S. patients were less likely than patients in Canada (12% v. 24%) but more likely than patients in Germany (4%) to wait four hours or more to be seen in the emergency department
• U.S. patients were less likely than patients in four countries (except Germany) to wait four weeks or longer to see a specialist (23% v. 40%–60%) or to wait four months or longer for elective surgery (8% v. 19%–41%) (Schoen et al. 2005)

Robbing Peter's Energy Tax to Pay Paul's Health Care Costs

On the one hand: Bob Laszewski makes a compelling case that we shouldn't use money raised via an energy tax to pay for health care reform. He's completely right that doing so may not motivate folks to fix the real problem that health care costs are out of control and the health care system is totally inefficient.

On the other hand: Everyone likes to talk a lot about how we should run the government like we have to run our own budgets. But that argument holds absolutely no water, because in real life, some things bring in money, and some things are cost centers, and you don't really care much if you're paying for your health care bill with money you earned on something that has nothing to do with health.

Now, in a business, if you have multiple lines of business, you do want to have individual product lines or services be profitable. Even so, there are always departments that are cost centers, and they have to be paid for from somewhere. There are even products that are loss leaders...because theoretically their market position it easier for other products to be more profitable.

Point being it is hardly unique to the government to have revenues come in and subsidize some part of your expenses that has nothing to do with the revenues in question. What's the biggie?

In other words: It ain't so simple.

And before you jump all over me I refer you to paragraph one: "He's completely right that doing so may not motivate folks to fix the real problem that health care costs are out of control and the health care system is totally inefficient."

The second-guessing continues on Richardson case

Terrible news this past week when actress Natasha Richardson died, subsequent to what seemed to be a minor fall while learning to ski.

Such cases always spur second-guessing, and as this post at Kevin MD illustrates, this case is no different. Some people are turning this into a political football, wondering if somehow the Canadian style of national health care system is what did Ms. Richardson in. When I read the actual timeline, it seems clear that this was a case of the accumulation of a bunch of questionable human decisions every step of the way. Throw in the lack of helicopter availability in the area where they were vacationing, and in a case where time is of the essence, they lost it over and over.

The single most questioned decision has got to be: Who turned away the ambulance that arrived 17 minutes after her fall, and why did those EMTs agree to leave without even seeing the patient? The two hours lost right from the beginning is likely be all the delay required to make her situation unsalvageable.

And yet, how many of us would do the same if we felt fine, could walk, talk, etc? Well, maybe not anymore. But just in the comments and links in this BlogHer post, plenty of women share their stories of being bonked on the head and not immediately jumping to get checked out. 

We can only hope that this tragic death convinces people that a head injury is nothing to ignore or "wait and see" about...hit on head? Get thee to an emergency room...stat!

What do you think of Sanjay Gupta as Surgeon General?

Well, to answer that question, perhaps first you need to know what the Surgeon General actually does. So, for that, you might want to go read the interview Dr. Val does with the 17th Surgeon General of the US, Richard Carmona. 

Now, Dr. Val is clearly not too hep to the idea of Gupta as SG.

But not everyone is so automatically opposed. You can find people on both sides of the argument in the comment thread on this Kevin MD post.

And Robert Laszewski over at Health Care Policy and Marketplace Review actually claims Sanjay Gupta could be a great pick for Surgeon General.

But then there's recent Nobelist and current NY Times columnist Paul Krugman telling us the trouble with Sanjay Gupta.

Not to mention the Daily Green seeming to have strong feelings about it, as evidenced by the post The 6 Most Idiotic Positions of Dr. Sanjay Gupta. Gee, tell us how you really feel.

I really can't say I know what to think. I can't say I think much about the Surgeon General. The only two I can name are C. Everett Koop and Jocelyn Elders. And I can't understand exactly why Obama would expend a controversial selection on such a low-profile role?

All very odd. Your thoughts?

Bucking the trend and praising the U.S. health care system?

Recently the Obama transition team asked Americans to get together, talk about health care in America and report back the thoughts, ideas and suggestions from such meetings. You can read more about the questions the Obama campaign suggested as discussion points here, but they range from defining the biggest current problem in our system to questions about how each group thinks public policy can actually help to questions delving into what kind of care people had gotten, and how they had health insurance to begin with.

Dr. Val Jones from Better Health held one such group, and her report on it is interesting, mostly because she seems to feel that most of us take a glass half empty approach to looking at our health care system, while she definitely sees the glass half full

She says: "Although we had been instructed to compile a list of compelling stories about system failures – instead we decided to be rebellious and discuss “what’s right with the healthcare system” and compile a list of best practices" 

But reading the suggestion question list (again, excerpted here) sounds like they weren't exactly the crazy rebels they wanted to paint themselves as. Yes, there were questions asking to illustrate a system gone wrong, but mostly the question guide seems to want to delve into finding out what people want and what they would consider best practices to be. As an employer I found it particularly interesting that the Obama team wanted to know if people in the room knew how much their employers paid for the health care benefits they, as employees, received. I'm betting most have no idea whatsoever. 

Anyway, Val goes on to list 10 good things. She mentions Kaiser Permanente a few times, which interested me, since they're my provider. I'm actually quite satisfied with the care and coverage I've received as a long-time Kaiser customer, but let's be clear that I (knock on wood) haven't taxed them too hard.

A couple of the items on the list have nothing to do with the American health care system per se. I wouldn't consider #4-Social Media, for example, an American health care system feature or innovation, those same apps (and people participating on them) are available worldwide. 

And one other big blind spot about the list is that some of the positives listed are only available if you already have insurance. Which is awesome, but I think it's a given that most of us consider the number of Americans who do not have insurance to be one of the biggest problems and burdens on the system. I find it unintentionally ironic (or maybe I mean oxymoronic) to refer to "democratic" accessibility, which just happens to be limited to those already with coverage.

I think most of us who are looking at our system as glass half empty are doing so because it seems un-American to be satisfied with being able to make a list such as Val's, knowing it doesn't even apply to so many people. 

Here's my analogy: Would you go to a Club Med resort in the middle of an impoverished region (as many of them are) and tout the availability of fresh, potable water within the resort's confines as one of the things that country's government was doing really well...while people died every day outside its walls from the lack of clean drinking water? I don't think so...the pride about providing for resort-goers might be mitigated just a bit by shame over being unable to take care of the rest of your countrymen and women.

So, what I would have liked to see close out Val's list was at least one idea, from what sounds like an esteemed group gathered at her house, about how to truly democratize those great things happening in our health care system. And how to improve accessibility for those uncovered and level of coverage to those under-covered.

Isn't THAT the biggest challenge the Obama administration faces?

Val: How about a sequel? :)

Now I've heard everything...twice!

Two stories this week made my jaw drop:

1. The UK televised an assisted suicide

Hey, I'm actually for assisted suicide, but I think it's incredibly morbid and exploitive to televise it, sorry. 

2. Dead people are getting a little nip and tuck, post-mortem, to look better for their funerals

For. God's. Sake.

Donate that damn money, you vain, creepy people who would do this. How about donate it to organizations that fix cleft palates for children in developing nations, like Operation Smile.

My only question: Did the person televising his suicide get a little work done pre-appearance?

Bah!

Health Care vs. Health Insurance...words matter

InsureBlog has a short but to-the-point post on why "health care" is not synonymous with "health insurance" and why it matters.

Their basic point is that trying to fix the rising cost of health insurance without dealing with the underlying problem of the rising cost of health care will lead to moving the problem around, but not solving it. I'm sure they're right.

But I more often hear people actually confuse "health coverage" with "health insurance". And I'd love to see a post addressing how those two terms differ and why it's important.

I recently watched Michael Moore's documentary Sicko, and he focused primarily on people who did indeed have health insurance...but discovered that they weren't really covered for very much or very well.

I think a big takeaway from that movie is that yes, it's terrible that 1 in 6 Americans doesn't have health insurance at all, but our health care system is a real clusterf$%^ because the 5 in 6 who do have health insurance often don't have sufficient coverage. At least that was my takeaway.

And for all those naysayers who say the problem with that lies with irresponsible people and foolish government mandates I would simply ask why health insurers are ever more profitable? not ever more revenue-generating...ever more profitable.

They certainly seem to be doing OK in this era of rising health care costs.