Here are some good links to learn more about single-payer issues.
- Mythbusting Canadian Healthcare
- Singlepayer Action -- this is a great page of resources
- Physicians for a National Health Program
- Information about HR 676
Thursday, April 23, 2009
Links to Single-Payer Healthcare Reform
Dr. Hahn to Present Single Payer Healthcare Reform
Come to the Country Inn in Berkeley Springs on April 23rd at 6:30. Details are here!
Wednesday, December 31, 2008
Dear President-elect Obama, we need your help
My wife and I were having lunch with a new family friend today. She hadn't slept well last night as she was so concerned about a loved one.
Her loved one had a brain hemorrhage yesterday. You see, he was laid off from his very interesting job 8 months ago, and had lost his health insurance. Unfortunately, he could not find affordable health insurance, and had stopped seeing his doctor. He'd had a history of high blood pressure and a heart condition, which had previously been well controlled with medication. Without insurance, he could no longer afford the medication, but was at least treating himself with aspirin.
Last night, he was in the bathroom, and suddenly became dizzy. He was taken immediately to the hospital, where he was found to have a bleed in the brain, which required immediate surgery. The aspirin that he was taking led to worsened bleeding than would have normally occurred.
The prognosis is poor. More surgery is necessary to control swelling in the brain. If he survives, he will likely require a prolonged ICU stay, but may be left with brain damage, requiring years of therapy and care.
It is tragic and embarassing that something like this happens in the wealthiest nation in the world.
What's worse is that it was all preventable. Think of the costs of those blood pressure medications versus the costs of these surgeries, hospital care, and follow-up care.
Please, Mr. President-elect, act on this NOW. Thousands die every year due to our broken health care system.
To be successful, health care reform must address:
1. Improving access to care
2. Lowering costs of health care
3. Improving the quality of health care
4. Simplifying the health care system for everyone involved
It won't be easy, and it can't all be done at once. But it must all be done.
We're counting on you. If we have to, we will demand it of you.
Good luck, and Happy 2009!
BE HEALTHY
Her loved one had a brain hemorrhage yesterday. You see, he was laid off from his very interesting job 8 months ago, and had lost his health insurance. Unfortunately, he could not find affordable health insurance, and had stopped seeing his doctor. He'd had a history of high blood pressure and a heart condition, which had previously been well controlled with medication. Without insurance, he could no longer afford the medication, but was at least treating himself with aspirin.
Last night, he was in the bathroom, and suddenly became dizzy. He was taken immediately to the hospital, where he was found to have a bleed in the brain, which required immediate surgery. The aspirin that he was taking led to worsened bleeding than would have normally occurred.
The prognosis is poor. More surgery is necessary to control swelling in the brain. If he survives, he will likely require a prolonged ICU stay, but may be left with brain damage, requiring years of therapy and care.
It is tragic and embarassing that something like this happens in the wealthiest nation in the world.
What's worse is that it was all preventable. Think of the costs of those blood pressure medications versus the costs of these surgeries, hospital care, and follow-up care.
Please, Mr. President-elect, act on this NOW. Thousands die every year due to our broken health care system.
To be successful, health care reform must address:
1. Improving access to care
2. Lowering costs of health care
3. Improving the quality of health care
4. Simplifying the health care system for everyone involved
It won't be easy, and it can't all be done at once. But it must all be done.
We're counting on you. If we have to, we will demand it of you.
Good luck, and Happy 2009!
BE HEALTHY
Wednesday, December 17, 2008
Spend Less, More Care
As always, let's remember that reform of the health care system isn't about abstract ideas, it is about real people in America who are suffering. It's about an insane system, one where I'm now often forced to treat dangerous sexually transmitted diseases with antibiotics without first testing for them, as many patients can no longer afford the testing. It's about a system where I no longer choose medications because they are the best for the patient's problem, but because they are available at Walmart, where they are only $4.
So far, the Obama health care reform plan has few details, except that he would like to find a way to give more Americans access to health insurance, and that somehow, computerization will improve quality and save money (which, by the way, is not a foregone conclusion).
I can't help but feel that the Obama team takes less than a comprehensive view of the American health care system and the problems it faces. This is unfortunate, as failure to address any number of issues will undo his effort to increase the number of insured Americans.
The American health care system faces three main issues:
1. Lack of access to affordable care: 50,000,000 Americans lack health insurance, resulting in 18,000 deaths per year. Many more millions have insurance with a high deductible, effectively limiting their access to care. Compounding the issue are health insurance companies that deny care based on pre-existing conditions, and arbitrary application of incomprehensible rules. Even worse, poor reimbursement rates have systematically created a near crisis shortage of primary care doctors, so that, even if more people become insured, there are no doctors to see them (which currently plagues Massachusetts health care reform efforts).
2. Out of control costs: health care now accounts for 17% of the GDP (it was 8% in the early 1990s when Bill and Hillary took on the system). More than 50% of personal bankruptcies are related to medical expenses. The average cost of a family health insurance policy is $12,000. In addition, the high cost of health care severely affects the bottom line of U.S. businesses.
Why do costs continue to increase far faster than the rate of inflation? Many reasons. Medication costs in America are far higher than in other nations, where the government plays a role in bargaining prices lower. Administrative costs in the American system are outrageously high, accounting for 1/3 of every health care dollar spent in America. Legal threats drive up the costs of care, as doctors order extra tests in an attempt to avoid multi-million dollar law suits, and pay skyrocketing malpractice rates. High-tech, cutting edge care also accounts for part of the problem. And finally, and maybe worst of all, Americans suffer from an epidemic of costly, largely preventable conditions related to lifestyle.
3. Poor quality: despite paying more for care, Americans appear to be getting less. American health care statistics are some of the lowest in the developed world. Again, the causes are complex and many. Efforts to document and study medical errors are stymied by doctors' fears that revelation of any error will result in a lawsuit or other punitive action. American doctors lag in use of electronic medical records because the Bush administration refused to organize and guide the fledgling industry, insisting that it was the job of the markets, which haven't done a good job.
The Obama administration, and most politicians that are vocal about health care reform, focus only on the access to care issue, pushing strategies to increase rates of insurance (and increase costs). Failure to address the costs of care, then, will surely undermine these expensive ventures. Failure to reform medical reimbursement rates to increase the number of primary care clinicians will also undermine the effort. And if we don't address issues of medical quality, which is a complex task that will take a generation to accomplish, than we may be wasting money, and merely giving more people bad care!
Seems daunting, doesn't it? It's not as bad as it seems. The point is that if health care reform is to be successful, it must be comprehensive, and must address how to increase access to care, how to lower the costs of care, and how to improve quality.
BE HEALTHY
So far, the Obama health care reform plan has few details, except that he would like to find a way to give more Americans access to health insurance, and that somehow, computerization will improve quality and save money (which, by the way, is not a foregone conclusion).
I can't help but feel that the Obama team takes less than a comprehensive view of the American health care system and the problems it faces. This is unfortunate, as failure to address any number of issues will undo his effort to increase the number of insured Americans.
The American health care system faces three main issues:
1. Lack of access to affordable care: 50,000,000 Americans lack health insurance, resulting in 18,000 deaths per year. Many more millions have insurance with a high deductible, effectively limiting their access to care. Compounding the issue are health insurance companies that deny care based on pre-existing conditions, and arbitrary application of incomprehensible rules. Even worse, poor reimbursement rates have systematically created a near crisis shortage of primary care doctors, so that, even if more people become insured, there are no doctors to see them (which currently plagues Massachusetts health care reform efforts).
2. Out of control costs: health care now accounts for 17% of the GDP (it was 8% in the early 1990s when Bill and Hillary took on the system). More than 50% of personal bankruptcies are related to medical expenses. The average cost of a family health insurance policy is $12,000. In addition, the high cost of health care severely affects the bottom line of U.S. businesses.
Why do costs continue to increase far faster than the rate of inflation? Many reasons. Medication costs in America are far higher than in other nations, where the government plays a role in bargaining prices lower. Administrative costs in the American system are outrageously high, accounting for 1/3 of every health care dollar spent in America. Legal threats drive up the costs of care, as doctors order extra tests in an attempt to avoid multi-million dollar law suits, and pay skyrocketing malpractice rates. High-tech, cutting edge care also accounts for part of the problem. And finally, and maybe worst of all, Americans suffer from an epidemic of costly, largely preventable conditions related to lifestyle.
3. Poor quality: despite paying more for care, Americans appear to be getting less. American health care statistics are some of the lowest in the developed world. Again, the causes are complex and many. Efforts to document and study medical errors are stymied by doctors' fears that revelation of any error will result in a lawsuit or other punitive action. American doctors lag in use of electronic medical records because the Bush administration refused to organize and guide the fledgling industry, insisting that it was the job of the markets, which haven't done a good job.
The Obama administration, and most politicians that are vocal about health care reform, focus only on the access to care issue, pushing strategies to increase rates of insurance (and increase costs). Failure to address the costs of care, then, will surely undermine these expensive ventures. Failure to reform medical reimbursement rates to increase the number of primary care clinicians will also undermine the effort. And if we don't address issues of medical quality, which is a complex task that will take a generation to accomplish, than we may be wasting money, and merely giving more people bad care!
Seems daunting, doesn't it? It's not as bad as it seems. The point is that if health care reform is to be successful, it must be comprehensive, and must address how to increase access to care, how to lower the costs of care, and how to improve quality.
BE HEALTHY
Monday, December 8, 2008
Real People! Real Suffering! We Need Help Now!
As the political powers begin to bang the drums of health care reform, I once again want to make the point that real people all over America are suffering at the hands of the current system, and that radical reform is needed now. As always, information is omitted to protect confidentiality.
One patient detailed to me an incredible tale about their new health insurer. The new policy covers three visits to the doctor per year. The patient saw a specialist twice, for a problem that began a few months earlier. The insurer denied the claims for the two visits because the problem had began prior to the policy's start date, and therefore was a pre-existing condition. However, the two visits were counted toward the three visit maximum anyway! Subsequently, the patient saw a physician for a physical, and some testing was done. The testing required a follow-up test. The insurer got the dates of the work mixed up, and counted the final test as the third doctor visit, and denied the claim for the physical, which had occurred earlier, and of course, was much more expensive. Of course, the insurer has had no problems collecting its premiums!
It feels as if health insurers, besides collecting their ever-increasing premiums, are willing to do little else without a fight.
We saw yet another patient with dental pain who could not afford an appointment with a dentist. All we can do is prescribe antibiotics and medication for the pain, and hope for the best. As we learn more about the effects of inflammation on the body, and how dental problems are a serious source of inflammation, we realize that, in addition to being painful, this untreated dental condition may lead to many other serious, and costly, problems in the future.
And today a colleague told me about an uninsured patient who has been diagnosed with cancer. We will begin the often confusing and demoralizing process of trying to get low cost treatment for the cancer at a university hospital. Just what a person needs when they are diagnosed with a life-threatening illness.
What do we need? Universal, high quality health care, with no exclusions, at an affordable price.
When do we need it? NOW!
BE HEALTHY
One patient detailed to me an incredible tale about their new health insurer. The new policy covers three visits to the doctor per year. The patient saw a specialist twice, for a problem that began a few months earlier. The insurer denied the claims for the two visits because the problem had began prior to the policy's start date, and therefore was a pre-existing condition. However, the two visits were counted toward the three visit maximum anyway! Subsequently, the patient saw a physician for a physical, and some testing was done. The testing required a follow-up test. The insurer got the dates of the work mixed up, and counted the final test as the third doctor visit, and denied the claim for the physical, which had occurred earlier, and of course, was much more expensive. Of course, the insurer has had no problems collecting its premiums!
It feels as if health insurers, besides collecting their ever-increasing premiums, are willing to do little else without a fight.
We saw yet another patient with dental pain who could not afford an appointment with a dentist. All we can do is prescribe antibiotics and medication for the pain, and hope for the best. As we learn more about the effects of inflammation on the body, and how dental problems are a serious source of inflammation, we realize that, in addition to being painful, this untreated dental condition may lead to many other serious, and costly, problems in the future.
And today a colleague told me about an uninsured patient who has been diagnosed with cancer. We will begin the often confusing and demoralizing process of trying to get low cost treatment for the cancer at a university hospital. Just what a person needs when they are diagnosed with a life-threatening illness.
What do we need? Universal, high quality health care, with no exclusions, at an affordable price.
When do we need it? NOW!
BE HEALTHY
Wednesday, December 3, 2008
Oh Canada
Let me tell you about a couple of patients this week in my 21st century American medical office...as always, information is omitted to protect confidentiality, unless otherwise noted.
I was seeing a patient for an acute problem. They related that they also suffered pain from tooth decay, and had chronic dental abscesses. They went to a dentist, who required a down payment for the necessary dental work. They'll have to wait until they can save up the money.
Another recent patient came in with a serious skin infection. I had prescribed an antibiotic, and asked the patient to return for close monitoring. Unfortunately, they were unable to come for the followup due to lack of funds. I also found out later that they had been unable to afford the antibiotic I had prescribed, as well. I changed the antibiotic prescription to another pharmacy, which we thought might be less expensive.
American health care, where we add insult to the injury, literally. Heartbreaking, isn't it?
And now, I'd like to share an email that I received recently from friends who live in Canada, describing their experience with the Canadian system...
"We are using the Canadian Health care system exclusively. Our family doctor, which we choose ourselves, has to refer us to a specialist (e.g. neurologist) if we need one, and both the family doctor and the neurologist visits are paid for. We pay nothing. Some things, such as unnecessary plastic surgery, are not covered by the system.
Carol, our daughter, had to have emergency surgery a couple of years ago for a bladder tumour, and everything, including specialists, tests, surgery, etc. was covered. People do have Blue Cross for things such as private rooms and special treatment. We have no personal health insurance. I prefer to pay slightly higher taxes when I am healthy, than to worry about paying for treatment when I am sick, or to worry about getting sick.
Cynthia and John were both premature babies and had to stay in hospital and incubators for several weeks until they were big enough and healthy enough to come home. We paid nothing.
We are entitled to a yearly physical exam and an eye examination every year. Extra visits for problems between these times are paid for if they are necessary. Dental is not covered.
I definitely would not trade our system for yours.
Our system is not perfect. Many people fall between the cracks, but the government does try to rectify the problem cases. At the present time we have a shortage of nurses and doctors, partly because they graduate (the doctors especially) with huge student debts, and, after graduating, are offered a lot of benefits and high wages to move to the States, so we lose a lot of Canadian trained people to the States.
Hope this clarifies things for you. Everybody has a different story. There are long waiting times for hip and knee surgery but life threatening situations are dealt with immediately."
Compare and contrast...if you had a choice, which would you choose?
YOU DO HAVE A CHOICE! SINGLE PAYER NOW! Real people suffer and die every day at the expense of the broken American medical finance system.
BE HEALTHY
I was seeing a patient for an acute problem. They related that they also suffered pain from tooth decay, and had chronic dental abscesses. They went to a dentist, who required a down payment for the necessary dental work. They'll have to wait until they can save up the money.
Another recent patient came in with a serious skin infection. I had prescribed an antibiotic, and asked the patient to return for close monitoring. Unfortunately, they were unable to come for the followup due to lack of funds. I also found out later that they had been unable to afford the antibiotic I had prescribed, as well. I changed the antibiotic prescription to another pharmacy, which we thought might be less expensive.
American health care, where we add insult to the injury, literally. Heartbreaking, isn't it?
And now, I'd like to share an email that I received recently from friends who live in Canada, describing their experience with the Canadian system...
"We are using the Canadian Health care system exclusively. Our family doctor, which we choose ourselves, has to refer us to a specialist (e.g. neurologist) if we need one, and both the family doctor and the neurologist visits are paid for. We pay nothing. Some things, such as unnecessary plastic surgery, are not covered by the system.
Carol, our daughter, had to have emergency surgery a couple of years ago for a bladder tumour, and everything, including specialists, tests, surgery, etc. was covered. People do have Blue Cross for things such as private rooms and special treatment. We have no personal health insurance. I prefer to pay slightly higher taxes when I am healthy, than to worry about paying for treatment when I am sick, or to worry about getting sick.
Cynthia and John were both premature babies and had to stay in hospital and incubators for several weeks until they were big enough and healthy enough to come home. We paid nothing.
We are entitled to a yearly physical exam and an eye examination every year. Extra visits for problems between these times are paid for if they are necessary. Dental is not covered.
I definitely would not trade our system for yours.
Our system is not perfect. Many people fall between the cracks, but the government does try to rectify the problem cases. At the present time we have a shortage of nurses and doctors, partly because they graduate (the doctors especially) with huge student debts, and, after graduating, are offered a lot of benefits and high wages to move to the States, so we lose a lot of Canadian trained people to the States.
Hope this clarifies things for you. Everybody has a different story. There are long waiting times for hip and knee surgery but life threatening situations are dealt with immediately."
Compare and contrast...if you had a choice, which would you choose?
YOU DO HAVE A CHOICE! SINGLE PAYER NOW! Real people suffer and die every day at the expense of the broken American medical finance system.
BE HEALTHY
Monday, December 1, 2008
Give U.S. Patients a Slice of the Pie Rather than Pie in the Sky
It's important to remember when discussing health care reform and health care policy that what we're dealing with is REAL PEOPLE'S LIVES (AND POSSIBLE DEATHS)...so I include, as often as possible, vignettes from my office practice (as always, details are omitted to protect confidentiality)...
We were seeing a patient for a serious injury today, and they also happened to mention that they were no longer taking their antidepressant. The patient had a terribly heartbreaking family loss earlier this year, and had become seriously depressed, suffering horribly as a result. I felt the severity of the depression warranted psychiatric care, but as they had no insurance, involving a mental health professional was not an option. With the aid of an antidepressant (which we initially were able to supply through free samples), the patient had begun to improve, thankfully. However, when the samples ran out, I wrote a prescription for the medication, but it turned out that the medication was too expensive. So the medication was stopped. Back to square one.
And that get's us to an article that ran in the Washington Post yesterday, "U.S. 'Not Getting What We Pay For': Many Experts Say Health-Care System Inefficient, Wasteful."
The idea is that all we have to do to reform health care is provide better quality care, using evidence-based medicine and computerized records, and the enormous savings generated will be enough to finance care for ALL. It's a popular view, especially now that Tom Daschle, one of its main proponents, has been chosen as the new H.H.S. secretary.
It's not that the idea doesn't have merit. It's that our ability to deliver, in a meaningful way, the types of changes being discussed, and the resultant savings, is a long way off.
The first step in achieving quality medical care is the ability to measure the quality of care (which is in it's infancy). To change the quality of medical care, we would need to be able to measure, in real time, the quality of most, if not all, medical care. That would take computerized records that, first of all, were capable of such measurements (most are not); and two, could pool and analyze the data (today we have hundreds, if not thousands, of types of computerized records, most of which do not communicate with one another).
It's not that this can't be done. I work with a group that has developed an impressive computerized medical record software, which is easily capable of the above.
It's that achieving this in the near future is very unlikely, and shouldn't delay other aspects of health care reform, that could help people now.
Don't get me wrong. I think that, as part of comprehensive health care reform, in addition to completely re-working our health care finance model, we should improve the quality of the care delivered, using the best evidence and technology we have at our disposal, and encourage (strongly) Americans to take better care themselves, so that we have less preventable chronic health conditions. In fact, to be really successful, I think all these things are necessary.
It's just that we can't wait for all these things, which may take a generation or more to complete, to delay immediate help for the millions who are suffering at the hands of our system currently.
The best, and most meaningful, and immediate change that we can make today, that will help millions today, is to enact single payer health care finance reform.
Real people can't wait any longer.
BE HEALTHY
We were seeing a patient for a serious injury today, and they also happened to mention that they were no longer taking their antidepressant. The patient had a terribly heartbreaking family loss earlier this year, and had become seriously depressed, suffering horribly as a result. I felt the severity of the depression warranted psychiatric care, but as they had no insurance, involving a mental health professional was not an option. With the aid of an antidepressant (which we initially were able to supply through free samples), the patient had begun to improve, thankfully. However, when the samples ran out, I wrote a prescription for the medication, but it turned out that the medication was too expensive. So the medication was stopped. Back to square one.
And that get's us to an article that ran in the Washington Post yesterday, "U.S. 'Not Getting What We Pay For': Many Experts Say Health-Care System Inefficient, Wasteful."
The idea is that all we have to do to reform health care is provide better quality care, using evidence-based medicine and computerized records, and the enormous savings generated will be enough to finance care for ALL. It's a popular view, especially now that Tom Daschle, one of its main proponents, has been chosen as the new H.H.S. secretary.
It's not that the idea doesn't have merit. It's that our ability to deliver, in a meaningful way, the types of changes being discussed, and the resultant savings, is a long way off.
The first step in achieving quality medical care is the ability to measure the quality of care (which is in it's infancy). To change the quality of medical care, we would need to be able to measure, in real time, the quality of most, if not all, medical care. That would take computerized records that, first of all, were capable of such measurements (most are not); and two, could pool and analyze the data (today we have hundreds, if not thousands, of types of computerized records, most of which do not communicate with one another).
It's not that this can't be done. I work with a group that has developed an impressive computerized medical record software, which is easily capable of the above.
It's that achieving this in the near future is very unlikely, and shouldn't delay other aspects of health care reform, that could help people now.
Don't get me wrong. I think that, as part of comprehensive health care reform, in addition to completely re-working our health care finance model, we should improve the quality of the care delivered, using the best evidence and technology we have at our disposal, and encourage (strongly) Americans to take better care themselves, so that we have less preventable chronic health conditions. In fact, to be really successful, I think all these things are necessary.
It's just that we can't wait for all these things, which may take a generation or more to complete, to delay immediate help for the millions who are suffering at the hands of our system currently.
The best, and most meaningful, and immediate change that we can make today, that will help millions today, is to enact single payer health care finance reform.
Real people can't wait any longer.
BE HEALTHY
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