A Solution to Ignorance about the Affordable Care Act

One of my earlier posts titled Ignorance & Healthcare presented research from the Kaiser Family Foundation about America's knowledge about the health care reform. A new website was launched this week that intends to better educate Americans on the Affordable Care Act (health care reform). The site is www.healthcareandyou.org and it was developed by a coalition of health care advocacy groups including the American Medical Association and the American Nurses Association.

The great thing about the site is its simplicity. Gone is the political debate that often clouds the facts of the Affordable Care Act. The site delivers the facts about the law tailored to each individual person. Users are greeted by a simple map of the United States and a clean home page. Once a user selects their state, they are directed to a page that contains everything citizens in that state need to know about health care reform. Further, this page gives users the option to classify themselves as "Under 65," "Over 65," or as an "Owner of a Small Business." The site then provides tailored information based on which role you choose. No advertisements, No Political Messages....Just the facts.

A site like this should have been established the moment the Affordable Care Act became relevant; but better late than never. What do you think about the ease of this educational website? Do you think it will be effective in helping American's understand this important legislation? Please feel free to share any comments you have.

Giving in On Health Care Reform?

On Monday President Obama took a significant step back on his health care reform bill. President Obama said that he is willing to amend the law to allow individual states to  opt out of the most critical aspect of the law: the insurance mandate. Under this amendment, states would have the option of not mandating health insurance for all citizens, as long as it could create some other viable option for coverage. In order to be approved for this waiver, the state must meet two requirements:

  1) The state must create another plan that will cover as many citizens as the original health care bill would.
  2) This alternative plan cannot further increase the federal deficit.

If this amendment is passed, states that earn a waiver will still be given the same money by the government to support their new plan.

Although the original law allowed for waivers to be applied for in 2017, Obama's offer to move this date up to 2014 is a significant step back for health care reform. The most important aspect of the bill is being diluted.

Should states be allowed to opt out of this insurance mandate or was the original health care law the best idea? Is this a political move to curb skepticism of the health care reform bill?

The Tradeoff: Medical Technology v. Personalized Care

In my last post I mentioned medical technology as a fiercely growing area that contributes to overall health care spending. In this post I wanted to look at the pros and cons of evolving medical technology (specifically electronic medical records). On one hand, this technology can make doctors extremely efficient, allow them to share patient data and save money by moving away from paper records; On the other hand the technology itself is expensive to implement, difficult to learn and can take away the "personal" feeling most doctors have with patients.

I have two articles that serve as a good contrast and explore this issue thoroughly. The first is an op-ed piece by Doctor Abraham Verghese about his personal experience with advancing medical technology. Doctor Verghese admits that on occasions he gets so caught up in technology, that it seems there is a "digital patient" and a real patient. He explains that advancing technology is starting to take away from the personal aspect of medicine. The second article is a piece by Steve Lohr about the pros and cons of implementing electronic medical records. 

Both articles, although written differently, give a great picture of the trade offs that come with medical technology. As a patient, which kind of medical experience would you prefer? A highly computerized visit that relies on technology for a diagnosis or a more personal visit that relies on doctor-patient interaction and intuition?

Healthcare Spending & End of Life Care

In August, 60 Minutes did a segment on end of life care and how much it costs the U.S. health care system each year. Although the video is from August, the issue it covers is still relevant today. This is a huge issue that comes with a gigantic moral debate attached to it.



The segment presents some staggering stats:

• U.S. spends 55 billion dollars a year  on hospital bills in the last 2 months of patients lives. This 55 billion  trumps both the annual budget for The Department of Homeland Security and The Department of Education. It is estimated that 20-30 percent of these procedures have no meaningful impact on the patient.
• One day in an Intensive Care Unit (ICU) costs over 10,000 dollars. 18-20 percent of Americans spend their last days in an ICU
• While a majority of Americans prefer to die at home, 75 percent die in hospitals & nursing homes.
• The government or private insurance pays for 85 percent of these medical costs

What are the underlying issues?

1. Medical technology has become so good that if patients want to, they can be kept alive much longer with advanced procedures and machines. The problem is, this is very expensive.
2. The U.S. health care system is built so that supply drives demand. This means that doctors are in control of the kind of medical care you demand because they suggest it. If the doctor suggests a certain treatment chances are you will demand that treatment. Doctors get paid by the patients they see and the tests & procedures they do so their incentive is to provide as much care as possible. This is also expensive.
3. Patients often never even see the medical bills they rack up because the government & insurance pays them. If they aren't paying nobody really cares how much these procedures cost.

It was amazing to hear the word "bankruptcy" brought up several times throughout the video. But that's how big of an issue this is; it can eventually bankrupt the United States. The problem is the huge moral debate. We can't just stop caring for people when they begin to die but at the same time a huge amount of money is being spent on this. Is there a moral middle ground or a way around this issue? Should end of life care be rationed or capped at a certain amount? It's a really hard debate to have.

Lower Healthcare Spending with...A Checklist?

Health care spending is out of control for a number of reasons: the health insurance system, U.S. lifestyle, lack of preventive care, prescription drug costs, administrative costs etc. A cure-all solution for health care spending is near impossible. Atul Gawande has a solution that can make a difference and it doesn't involve a controversial bill or fancy new medial technology. It's as common as something you and I use every day: A Checklist.



In the video above, Atul Gawande, a surgeon at Bringham & Women's Hospital, explains his idea for a 19 point hospital checklist. His checklist is something surgeons, doctors and nurses can use to prevent mistakes, infections and deaths during hospital stays. His checklist was initially tested in 8 hospital worldwide. In these 8 hospitals there was a 1/3 reduction in infections and deaths during surgery. A hospital in Michigan implemented the checklist and saw a 2/3 reduction of infections, saved 1,500 lives and over 200 million dollars.

This checklist is being used in less than 1/4 of U.S. hospitals. Imagine if this was required by all hospitals? Hospital infections are negative externalities that cost the health care system a ton of money. A low cost solution like Atul's could save a lot of lives and money.

Are there other simple fixes like Atul Gawande's checklist that can contribute to lower health care spending? Can an idea as simple as a checklist really save lives and money?

Another Point for Healthcare Reform

The New York Times reported on Tuesday that Judge Gladys Kessler of the Federal District Court for the District of Columbia became the 3rd federal judge to  uphold the health care reform bill. As detailed in one of my earlier posts the health care bill is currently working its way through a series of appeals in the U.S. court system.

Judge Kessler's decision on Tuesday makes the "score" of these appeals 3-2 in favor of upholding the health care reform. The most controversial part of the bill is the provision that would require American's to purchase some form of health insurance by 2014. The two judges that have ruled against the bill cited that this provision forces citizens to participate in commerce. In other words, it's causing them to "act" when they don't necessarily want to act. However, Judge Kessler determined that deciding not to purchase something as important as health care is an "act" on it's own.

Is a law too powerful if it is requiring America to purchase health insurance? Do you think this bill will ultimately be ruled unconstitutional if it rises to the Supreme Court?

FDA User Fees For Generic Drugs: Show us the Money

Dr. Margaret Hamburg, commissioner of the F.D.A., asked for new legislation on Friday that would require makers of generic drugs to pay the F.D.A. a "user fee." Each generic drug company would pay the F.D.A. a fee to expedite their approval process.

This is not necessarily a new idea; major pharmaceutical companies pay fees each year to speed up the approval process of their major drugs. Dr. Hamburg justified her call to action by explaining that the F.D.A. has many inspections and approvals to make and that user fees would allow the FDA to better serve the public.

Some criticize this idea because they feel it creates a conflict of interest between generic companies and the government.

Do you think the process of "user fees" is unfair? Does it promote a conflict of interest?