Envisioning 2.0

Over the past few months people on both sides of the ideological divide have been debating whether comparative effectiveness – relying on clinical studies to determine whether a medical intervention is more effective than another – is appropriate and can help reduce rising health expenditures.

This week’s edition of the Health Wonk Review features an article by BNet’s Ken Terry in which he says both sides are being disingenuous.  Using the example of virtual colonoscopies he writes:

“[M]edical ‘advances’ of lesser value will continue to be advocated by those who profit from them. When, as a result of comparative effectiveness research, payers have to decide whether to cover a particular type of back operation that has not helped patients any more than conservative therapy, they will undoubtedly find themselves locked in a political fight with surgeons who stand to lose income if nobody can afford the procedure. So we should not expect too much from comparative effectiveness research, as it’s now conceived.”

Terry has a very interesting perspective on the comparative effectiveness question.  When a procedure or medication is less painful or provides a better quality of life should that be considered when deciding which one is worth paying for?  In addition, as I discussed a few weeks ago, will comparative effectiveness research be doomed from the outset if we continue to conduct studies that do not include people from varying racial and ethnic backgrounds?

Clearly, there are no simple answers to this debate.  However, we are clearly benefiting from having a broad conversation about the benefits, drawbacks and scope of comparative effectiveness research.

In 1993, President Bill Clinton began a health reform process that he hoped would expand coverage to many of the nation’s uninsured.  He said that his proposal would reduce health costs, increase our health security and preserve Americans’ choice of medical providers.  Nearly a year later, Clinton’s effort to pass comprehensive health reform had ended.  It had fallen prey to a number of outside factors, including a significant lack of public support for his agenda.

Today, more than 15 years later, another Democratic President is launching an effort to overhaul the US health system.  Today, during a white house conference on health reform attended by politicians, health industry insiders and others, President Obama said:

“In this [health] effort, every voice has to be heard. Every idea must be considered. Every option must be on the table. There should be no sacred cows. Each of us must accept that none of us will get everything that we want, and that no proposal for reform will be perfect. If that’s the measure, we will never get anything done. But when it comes to addressing our health care challenge, we can no longer let the perfect be the enemy of the essential.”

Obama has also taken steps to build momentum for reform by increasing funding for the children’s health insurance program (SHICP) and allocating money in the federal budget for a new health insurance scheme.  By focusing on the costs for a program first, he has removed one major objection to reform.

However, by saying that he wants to get “something” done rather than insisting that a reform bill be perfect he is clearly willing to undergo a process of give and take with others in an effort to solve the problem of the uninsured.  Nearly everyone agrees that we need to do more to increase the ranks of the insured.  What we disagree on is how to do it.

One thing is certain, Obama is a very popular president who has already shown great ability to mobilize a grassroots army in support of his proposals.  I’m looking forward to seeing how he and his advisors use them.

Image Source: HealthReform.gov

With increasing numbers of manufacturers and retailers recalling peanut-containing products such as peanut butter daily, it is very difficult for consumers to figure out what foods to avoid and how the government is responding.  Now, the CDC and its sister agency the FDA, have turned to social media to help quickly disseminate information about the various recalls.

For example, tomorrow, the CDC will be holding a Webinar specifically for bloggers designed to “give blog writers the chance to speak with FDA and CDC subject matter experts about the Salmonella Typhimurium outbreak efforts and future resources for bloggers during food safety incidents.”  This is an important step, as bloggers often spread the word about health news items and have a broader reach (via social network and search engine effects) than traditional media publications.

The blogger Webinar is very interesting and I encourage those interested in learning more about the peanut recall and the government’s evolving crisis communications strategies to attend.  It will take place tomorrow February 3 from 2:30 – 3:30 p.m.

Image Source: The New Yorker Magazine

This morning on my train ride into the city, I read an excellent essay by Atul Gawande focusing on health reform that was published in the current edition of The New Yorker.  He rightly suggests that health reform is going to ultimately build on the system we currently have – even though it is far from perfect.  He writes:

“Many would-be reformers hold that “true” reform must simply override those fears. They believe that a new system will be far better for most people, and that those who would hang on to the old do so out of either lack of imagination or narrow self-interest. On the left, then, single-payer enthusiasts argue that the only coherent solution is to end private health insurance and replace it with a national insurance program. And, on the right, the free marketeers argue that the only coherent solution is to end public insurance and employer-controlled health benefits so that we can all buy our own coverage and put market forces to work.

Neither side can stand the other. But both reserve special contempt for the pragmatists, who would build around the mess we have. The country has this one chance, the idealist maintains, to sweep away our inhumane, wasteful patchwork system and replace it with something new and more rational. So we should prepare for a bold overhaul, just as every other Western democracy has. True reform requires transformation at a stroke. But is this really the way it has occurred in other countries? The answer is no. And the reality of how health reform has come about elsewhere is both surprising and instructive.”

This article is wonderful because it is pragmatic and it relies on a nuanced and informed grasp of history to inform predictions about the future.  This is a must-read for anyone interested in pragmatic, doable health reform.

According to the National Alliance for Caregiving and Caring.com, 50 million Americans are providing unpaid health care to family members and other loved ones.  Given this, they have asked President-elect Obama to direct 1 percent of dollars from the economic stimulus package now being debated in Congress to these individuals.  A press release distributed by both organizations notes:

“While the deteriorating economy has hit all Americans hard, it has hit these Americans even harder. Family caregivers are struggling to pay their own bills and, increasingly, those of their loved ones as well; expenses continue to rise and the hours of care they provide each day continue to go uncompensated. The average caregiver spends $5,534 per year out-of-pocket for caregiving expenses.  Like Wall Street, the auto industry, and homeowners, family caregivers need help from Congress to make it through 2009.”

Both organizations have developed five priorities they would like federal elected officials to act on, including increasing funding for the National Family Caregiver Support Program and developing a national paid family medical leave program.

For more information about the campaign and to provide suggestions on how to improve support for caregivers, please click here.

Yesterday the world learned that President-elect Barack Obama is thinking about naming CNN journalist and neurosurgeon Sanjay Gupta to the post of U.S. Surgeon General.   Overall, the reaction to his pick has not been positive.  I’m a regular user of the microblogging platform Twitter and one of my colleagues said (about the post): “Are you ____ kidding me?”

There are many objections to Gupta’s potential appointment, and many of them have to do with his public health qualifications.  In short, he has none.  Gerard M. Farrell, who serves as executive director of the Commissioned Officers Association told the Washington Post “I am unaware of any public health experience or qualifications he has to be the leader of the nation’s public health service . . . This would be akin to appointing the Army chief of staff from the city council of Hoboken.”

Harsh words.  But others believe that the Surgeon General plays a very important role as a communicator.  Many of us remember how former Surgeon General C Everret Koop, the nation’s first “celebrity” Surgeon General transformed how the nation discussed tobacco and viewed HIV/AIDS.  Given Gupta’s high profile,  he could greatly aid public health efforts to reduce obesity and help Americans accept the incoming administration’s health reform proposals.

Although Gupta’s celebrity status could be helpful for health communication and education efforts, there is much to the Surgeon General’s job that takes place behind the scenes.  The Surgeon General plays a key role in setting the nation’s public health agenda and needs the respect and support of the Public Health Service Commissioned Corps and people at the CDC.  Will he be viewed as a lightweight by people within both organizations and spend more time getting up to speed rather than setting the agenda?  Only time will tell.

Regardless of whether Obama ultimately selects Gupta for the post, this it yet another interesting choice in what is shaping up to be a very celebrity heavy administration.

Sen. Tom Daschle has called for Americans to host and participate in health reform “house parties” and health industry insiders have responded to his call. In a clear signal that they want a seat at the health reform table, insurance companies have urged executives and consumers to participate in one of the 4,200+ meetings Americans will be having across the country during the upcoming holiday break. According to the New York Times:

“The meetings, originally envisioned as a way to make good on Mr. Obama’s commitment to “health care reform that comes from the ground up,” could thus turn into living-room lobbying sessions involving some of the biggest stakeholders in the health care industry.”

Some Obama advisers are afraid that health industry advocates will attempt to “pack” the meetings with supporters. However, others, including a prominent member of the Obama transition team, are less concerned.

It is clear that insurance companies are very worried about Obama’s pledge to create a parallel public insurance framework that will take all comers, regardless of age or disease status. However, managed care companies are not sure why Obama needs to set up another system. In a major concession, America’s Health Insurance Plans, an industry trade group, has signaled that managed care companies are willing to cover all who ask for insurance – if the incoming President pledges to institute an individual mandate for all Americans. In this case, all adults would be required to enroll in an insurance plan.

However, with health costs steadily increasing and the national debt approaching $1 trillion, it is unlikely that Obama and Daschle will accede to this request without taking steps to curb medical inflation.

It will be interesting to see whether the house parties bear fruit and how the health insurance industry will adapt to Obama’s reform efforts. However, it’s very likely that everyone won’t get what they want.

Please note: This will be my last post for the year, as the holidays are approaching.  I’d like to thank everyone for taking the time to read this blog and I wish all of you a merry and bright holiday season and New Year! I’ll see you all in January 2009.

Today, I went to Joe Paduda’s Managed Care Matter’s looking for the latest edition of the Health Wonk Review (here). However, I was greeted by an excellent and highly relevant analysis of “Joe the Plumber’s” tax and health costs under Senators John McCain and Barack Obama’s respective plans. I won’t comment on his analysis, but leave it up to you to decide whether it is accurate. And, if you find a competing analysis (one that shows how McCain’s health plan will benefit Joe the Plumber) please let me know.

For the past seven days, much of the world has been riveted by the unfolding economic crisis and the efforts of government institutions to staunch the bleeding.  The New York Times reported yesterday that the United States and Britain are currently working on a joint response to the crisis.  The upshot: the countries are considering partly nationalizing banks in order to (hopefully) stabilize them.

Ever since the great debate over the $700 billion rescue plan passed by Congress recently, we have witnessed the socialization of free market economies across the world.  Citizens are watching in fear and apprehension as their governments attempt to save their bank deposits and retirement accounts.  Although many are conflicted by these activities, most agree that something must be done.  Interestingly, for conservatives in the US, government has suddenly become a force for good rather than a source of evil.

Given this, I thought that an e-mail I recently received from the Cato Institute about Barack Obama’s health plan seemed especially jarring.  The think tank will soon publish a new Briefing Paper, “Does Barack Obama Support Socialized Medicine?” Cato’s Michael Cannon answers that question with a resounding “yes.”

For many years, opponents of massive government intervention in the US health system have used the term “socialized medicine” to convince people that this strategy is a bad idea.  However, many people also believed that our financial institutions needed fewer regulations rather than more.  Now, it is abundantly clear that this philosophy has led to many unintended consequences.  Now people are calling for increased government intervention and more stringent regulation.

Now, what does this mean for healthcare?  Currently, the economic crisis is causing increasing numbers of Americans to forgo much-needed medical care.  In addition, with unemployment steadily increasing, many more people are going to be without health insurance. Given these trends, the term “socialized medicine” becomes a lot less scary. People – especially those with young children – will want access to health care, even if it is subsidized and more heavily regulated by the government.

As a communicator, I make it my business to understand when a message is either ineffective or beginning to ring false.  Arguing against single-payer health care because it will be akin to socialized medicine no longer works in the current environment.  Free marketers need to come up with some new rhetoric.

Over recent months, the Massachusetts universal health insurance plan has received some knocks because people were hesitant to enroll in the program and its ever-increasing costs.  Now, a new government analysis provides us with a better sense of how the plan is doing.  Massachusetts reports that “since the implementation of health care reform, enrollment in private insurance has grown by more than 191,000.”  In  addition:

o    Massachusetts employers have not dropped health insurance

o    Outlays for emergency room visits decreased by 37%, saving the state $68 million

o    The percentage of patients seeking certain types of preventive care has increased

You can view the government report by clicking here.