As reported in the Wall Street Journal Reports Show Strain of Health Costs, two reports just came out showing that out of control health care spending are about the crush the entire system and our country along with it. The first report is from the Medicare Board of Trustees which stated that unless something radically changes, Medicare will go bankrupt in 2024. The second report regards what we pay for health care. Per the WSJ Health Blog:
"The latest Milliman Medical Index, which measures the total cost of health care for a typical family of four covered by a preferred provider plan (PPO), rose 7.3% to $19,393 in 2011. The per-employee cost more than doubled between 2002 and 2011. And the employee’s share of that cost now stands at 39.7%."
In other words, escalating health care costs are destroying business in America making an economic recovery almost impossible and the health safety net for our senior citizens (which working non-seniors currently pay for) will shortly disappear.
We can argue whether or not heath care in America should be entirely government run or completely private. We can argue whether health care is a right for our citizens or an entitlement we can't afford. However, reducing the escalating cost of health care should be something both sides can come together on.
An editorial in today's Washington Post looks to where President Obama and Mr. Ryan could possibly come together:
"The current debate has an ideological incoherence on both sides. Republicans endorse a premium support model for Medicare even as they work to undo the new insurance exchanges in the health-care law. Democrats distrust premium support when it comes to Medicare but support the exchanges, with sliding scale subsidies that amount to premium support, in the health-care plan. The problem of getting health-care costs under control is complicated enough without knee-jerk opposition being the default reaction to any proposal from the other side."
Given that the 2012 elections are not far away, it is unlikely that there will be any common ground seeking in the near future. However, our country can not wait much longer for politicians to put away their partisanship and come together on the one thing that both sides can and should agree on: we are spending too much money on health care and it is bankrupting the country.
Showing posts with label Obama. Show all posts
Showing posts with label Obama. Show all posts
Sunday, May 15, 2011
Tuesday, December 14, 2010
Conservatives Should Read Ezra Klein
I try not to get too polictical on my blog. I consider myself a moderate. I supported passage of the health care reform bill, but mainly because if it had failed, in my opinion, discussions of true health care reform would be stalled for another decade. Though there are some good things about the current legislation (removal of pre-existing conditions for example), there is nothing really that addresses the escalating costs of health care.
Though most political news recently has been about taxes, health care reform is in the news again today, due to a judge's ruling regarding the consitutionality of the individual mandate. You can read the NY Times or Washington Post's coverage. Pundits on the left and right will likely once again discuss their positions on both sides of the health care debate.
However, journalist (and notably liberal talking head) Ezra Klein had some very interesting comments that those on the right would be wise to take note of. In addition to pointing out that the President Obama was the one opposed to the individual mandate during the primaries and criticized Hillary Clinton for supporting this, he states:
The individual mandate began life as a Republican idea. Its earliest appearances in legislation were in the Republican alternatives to the Clinton health-care bill, where it was co-sponsored by such GOP stalwarts as Bob Dole, Orrin G. Hatch and Charles E. Grassley. Later on, it was the centerpiece of then-Gov. Mitt Romney's health-reform plan in Massachusetts.....It was only when the individual mandate appeared in President Obama's legislation that it became so polarizing on the right..... The individual mandate was created by conservatives who realized that it was the only way to get universal coverage into the private market. Otherwise, insurers turn away the sick, public anger rises, and, eventually, you get some kind of government-run, single-payer system, much as they did in Europe, and much as we have with Medicare. If Republicans succeed in taking it off the table, they may sign the death warrant for private insurers in America: Eventually, rising cost pressures will force more aggressive reforms than even Obama has proposed, and if conservative judges have made the private market unfixable by removing the most effective way to deal with adverse selection problems, the only alternative will be the very constitutional, but decidedly non-conservative, single-payer path.
In other words, the only way that we can afford health care coverage for most Americans (whether it be provided by the government or the private sector) is if everyone pays something to have it, and the fiscally conservative Republicans knew this, which is why they suggested this in the first place. Interesting.
Though most political news recently has been about taxes, health care reform is in the news again today, due to a judge's ruling regarding the consitutionality of the individual mandate. You can read the NY Times or Washington Post's coverage. Pundits on the left and right will likely once again discuss their positions on both sides of the health care debate.
However, journalist (and notably liberal talking head) Ezra Klein had some very interesting comments that those on the right would be wise to take note of. In addition to pointing out that the President Obama was the one opposed to the individual mandate during the primaries and criticized Hillary Clinton for supporting this, he states:
The individual mandate began life as a Republican idea. Its earliest appearances in legislation were in the Republican alternatives to the Clinton health-care bill, where it was co-sponsored by such GOP stalwarts as Bob Dole, Orrin G. Hatch and Charles E. Grassley. Later on, it was the centerpiece of then-Gov. Mitt Romney's health-reform plan in Massachusetts.....It was only when the individual mandate appeared in President Obama's legislation that it became so polarizing on the right..... The individual mandate was created by conservatives who realized that it was the only way to get universal coverage into the private market. Otherwise, insurers turn away the sick, public anger rises, and, eventually, you get some kind of government-run, single-payer system, much as they did in Europe, and much as we have with Medicare. If Republicans succeed in taking it off the table, they may sign the death warrant for private insurers in America: Eventually, rising cost pressures will force more aggressive reforms than even Obama has proposed, and if conservative judges have made the private market unfixable by removing the most effective way to deal with adverse selection problems, the only alternative will be the very constitutional, but decidedly non-conservative, single-payer path.
In other words, the only way that we can afford health care coverage for most Americans (whether it be provided by the government or the private sector) is if everyone pays something to have it, and the fiscally conservative Republicans knew this, which is why they suggested this in the first place. Interesting.
Tuesday, March 2, 2010
Why Barack Obama should come clean about his smoking and what he can do to quit
As a physician I believe that your personal health should be private. I can certainly understand why the American people would want the right to know about a potential presidential candidate's health prior to an election. However, afterwards, the health of a President, unless life threatening should probably remain private. That said, the President recently had a complete physical and the results of that physical are now public. In addition to knowing the President's blood pressure and cholesterol numbers, we now also know according to a New York Time's report (President in ‘Excellent Health,’ Routine Checkup Finds) that President Barack Obama continues to smoke. Though I still believe that health should be a private matter for patients, even if that patient happens to be the President, since our President has chosen to reveal his health information, I think that he should officially come clean about how much he smokes. According to the New York Times report, all we know is that he doesn't smoke on a daily basis, but rather smokes infrequently. In June, the President was quoted as saying, “Have I fallen off the wagon sometimes? Yes. Am I a daily smoker, a constant smoker? No.”
Tobacco smoke in the US is an important matter. It is currently the single leading cause of preventable death and accounts for billions of dollars in health care costs. Given our current health care crisis, including the escalating costs of health care, I think it would be important for the President to discuss the burden of tobacco in this country as well as his own struggle in quitting cigarette smoking.
Now as far as what the President can do, a lot depends on how much he smokes. My guess is that he probably smokes a few cigarettes a few days a week during stressful times. If this is the case, then withdrawal is likely a minimal concern, and his nicotine consumption is probably just reinforcing this very bad habit. If that is the case, stress management techniques are probably the best way to quit. I advise patients who smoke only a few cigarettes a day to think about what else they can do to manage their stress besides smoking. For example, taking a walk, reading a book, meditation, prayer, etc. Something that is relaxing and reduces stress. Certainly our President is under a lot of stress and one can understand why he would need some sort of stress relieving activity. Smoking cigarettes is obviously not the best way to reduce stress.
If the President does smoke more than just a few cigarettes a day, the current guidelines recommend that most patients benefit from pharmacotherapy (medication). Nicotine replacement in the form of lozenges, gum or the patch have been effective in doubling quit rates. Even more effective than nicotine replacement are pills, specifically buproprion or Chantix (Varenicline). Recently there's been some concern about safety issues regarding Chantix, ( see More FDA warnings should not be cause for worry. and Where's the Good News about Chantix? ) initially brought up by the FDA. However, these safety concerns have not seemed to have panned out, and more recent studies seem to indicate that Chantix is very safe given certain precautions, specifically worsening of mental conditions. Patients using any form of a medication should be aware that quitting cigarettes (with or without medication) can worsen underlying mental health conditions, such as depression or anxiety.
In addition, I have blogged previously about Electronic Cigarettes , which I have received a number of comments (also see More on Electronic Cigarettes or E-cigs ). I think those who responded are mostly e-cigarette users that have misunderstood my objections to e-cigarettes. My objection is not that I am opposed to the existence of electronic cigarette. It's more that e-cigarettes are not regulated, so 1) their safety cannot be completely ascertained and 2) they are being promoted as a smoking cessation treatment, which they have not proven to do. E-cigarettes are likely a healthier alternative to tobacco smoke, but should be regulated by the FDA since they do contain nicotine. I'm also bothered that electronic cigarettes are sold in our shopping malls, and can potentially be purchased by children. Electronic cigarettes are probably less carcinogenic, than tobacco cigarettes. However, nicotine itself has unhealthy effects, and the goal of smoking cessation should be getting off nicotine completely. All of the treatments for smoking cessation such as the patch and the gum and even the pills are only supposed to be used for short periods of time, usually three months to no more than 6 months. Electronic cigarettes might be safer replacement for tobacco cigarettes, but are not designed to get patients off of nicotine. Generally, most of the nicotine replacement products work by giving patients a continuous supply of nicotine, and eventually weaning that level down once the patient has been off tobacco cigarettes for a few weeks. For example, with the nicotine gum or lozenge, you don't take a piece of gum every time you crave a cigarette. Rather, you use the gum continuously throughout the day, starting with about 15 pieces per day eventually decreasing the number. Theoretically, the electronic cigarette could be used in that manner, but by just replacing a tobacco cigarette, you are not addressing the behavioral issues related to smoking cessation. So, while I believe that electronic cigarettes may be safe, I also believe they should be regulated by the FDA and should not (until proven) be used or promoted as smoking cessation agents.
The President could also call 1-800 QUIT NOW. This is a 24/7 support line designed to help patients quit tobacco products. It is free and fully funded by money from this tobacco settlements. This program can be used use in conjunction with treatment from your health care provider as well as with medication, nicotine replacement and other smoking cessation techniques.
Bottom Line: While I do believe the President's health is a personal matter, since he has come out admitting that he is still smoking cigarettes despite his promises to our First Lady, I believe that he should admit to exactly how much he still smokes as well as further discuss his own personal struggles with his addiction. This will hopeful bring additional attention to the problem of cigarette smoking, which remains the single leading cause of preventable death in our country.
Tobacco smoke in the US is an important matter. It is currently the single leading cause of preventable death and accounts for billions of dollars in health care costs. Given our current health care crisis, including the escalating costs of health care, I think it would be important for the President to discuss the burden of tobacco in this country as well as his own struggle in quitting cigarette smoking.
Now as far as what the President can do, a lot depends on how much he smokes. My guess is that he probably smokes a few cigarettes a few days a week during stressful times. If this is the case, then withdrawal is likely a minimal concern, and his nicotine consumption is probably just reinforcing this very bad habit. If that is the case, stress management techniques are probably the best way to quit. I advise patients who smoke only a few cigarettes a day to think about what else they can do to manage their stress besides smoking. For example, taking a walk, reading a book, meditation, prayer, etc. Something that is relaxing and reduces stress. Certainly our President is under a lot of stress and one can understand why he would need some sort of stress relieving activity. Smoking cigarettes is obviously not the best way to reduce stress.
If the President does smoke more than just a few cigarettes a day, the current guidelines recommend that most patients benefit from pharmacotherapy (medication). Nicotine replacement in the form of lozenges, gum or the patch have been effective in doubling quit rates. Even more effective than nicotine replacement are pills, specifically buproprion or Chantix (Varenicline). Recently there's been some concern about safety issues regarding Chantix, ( see More FDA warnings should not be cause for worry. and Where's the Good News about Chantix? ) initially brought up by the FDA. However, these safety concerns have not seemed to have panned out, and more recent studies seem to indicate that Chantix is very safe given certain precautions, specifically worsening of mental conditions. Patients using any form of a medication should be aware that quitting cigarettes (with or without medication) can worsen underlying mental health conditions, such as depression or anxiety.
In addition, I have blogged previously about Electronic Cigarettes , which I have received a number of comments (also see More on Electronic Cigarettes or E-cigs ). I think those who responded are mostly e-cigarette users that have misunderstood my objections to e-cigarettes. My objection is not that I am opposed to the existence of electronic cigarette. It's more that e-cigarettes are not regulated, so 1) their safety cannot be completely ascertained and 2) they are being promoted as a smoking cessation treatment, which they have not proven to do. E-cigarettes are likely a healthier alternative to tobacco smoke, but should be regulated by the FDA since they do contain nicotine. I'm also bothered that electronic cigarettes are sold in our shopping malls, and can potentially be purchased by children. Electronic cigarettes are probably less carcinogenic, than tobacco cigarettes. However, nicotine itself has unhealthy effects, and the goal of smoking cessation should be getting off nicotine completely. All of the treatments for smoking cessation such as the patch and the gum and even the pills are only supposed to be used for short periods of time, usually three months to no more than 6 months. Electronic cigarettes might be safer replacement for tobacco cigarettes, but are not designed to get patients off of nicotine. Generally, most of the nicotine replacement products work by giving patients a continuous supply of nicotine, and eventually weaning that level down once the patient has been off tobacco cigarettes for a few weeks. For example, with the nicotine gum or lozenge, you don't take a piece of gum every time you crave a cigarette. Rather, you use the gum continuously throughout the day, starting with about 15 pieces per day eventually decreasing the number. Theoretically, the electronic cigarette could be used in that manner, but by just replacing a tobacco cigarette, you are not addressing the behavioral issues related to smoking cessation. So, while I believe that electronic cigarettes may be safe, I also believe they should be regulated by the FDA and should not (until proven) be used or promoted as smoking cessation agents.
The President could also call 1-800 QUIT NOW. This is a 24/7 support line designed to help patients quit tobacco products. It is free and fully funded by money from this tobacco settlements. This program can be used use in conjunction with treatment from your health care provider as well as with medication, nicotine replacement and other smoking cessation techniques.
Bottom Line: While I do believe the President's health is a personal matter, since he has come out admitting that he is still smoking cigarettes despite his promises to our First Lady, I believe that he should admit to exactly how much he still smokes as well as further discuss his own personal struggles with his addiction. This will hopeful bring additional attention to the problem of cigarette smoking, which remains the single leading cause of preventable death in our country.
Wednesday, July 8, 2009
Let Google Solve Our EMR problems
The Wall Street Journal reported today that Google was going to launch their own operating systems for PC's competing with Microsoft's dominant Windows platform. Google seems to continuously creating new, innovative and useful products. This very blog is hosted on blogger, which is now a Google product. Since they seem to be doing such a good job, why not let them solve the electronic medical records problem?
EMR's are a big part of President Obama's health care plan. I certainly value the use of EMR's. They provide me the data I need when I need it. They allow me to communicate more effectively with my staff. Using e-Prescribing in our EMR I am able to fill prescriptions faster and more accurately for my patients. Finally, through our EMR, patients can communicate directly with their physicians. (We use Touchworks by Allscripts. I have no vested interest in the product or company)
However, I do not believe that EMR will really save a lot of money. Time is money, and EMR's do not save time. EMR's do improve quality of care. They allow you to do more in a given amount of time, but do not save time., and in fact may add time because you can do more. The best example I can give for non-EMR users is that just in the way that your email and Blackberry have not saved you any time from the days when you relied on phone calls and the US postal service (have they not instead created more work?), EMR's do not save time. Politicians point to cost savings in preventing duplicate work. There might be a few duplicate tests or procedures prevented, but likely not that many and not nearly enough to call investment in EMR's a cost-reducer.
In my post $19 Billion For Health IT-Money Well Spent? I also call into questoin how the stimulus package is funding health IT. Looks like that money went to hospitals to improve exsiting systems, and not to help the primary care physician offset the HUGE cost of implementing an EMR in his or her practice. The software, hardware and support needed for most EMR's cost far more than the average physician practice can afford.
The real issue with EMR's is interoperability. The are many companies that make many products and not too many systems talk to each other. In our hospital alone, we now use up to eight different computer systems to store and retrieve patient information. Your primary care doctors EMR should be able to talk to the Pharmacy's computers, the lab's computers, the hospital's computers, the radiologist's computers, the specialists consulant's computers, etc.
Regardless of whether you support a single payer system or a tax rebate for patients to purchse their own health care; wouldn't it make sense to have one really good EMR that every doctor could use? Wouldn't it be great if this was on a web based platform, meaning that all you would need is a computer (or netbook, or web based mobile phone) and a high speed internet connection and you could have access? Most docs already have that. Wouldn't it be great if interfaces could be created so that all parties "spoke" to each other? Wouldn't it be great if this system could include functionality so that patients could communicate with their physicians, request appointments, and see their lab results?
Who better to create this EMR than Google? The interoperability/interface issue stems from the fact that there are so many proprietary systems. Each company that makes an EMR wants its EMR to be used by everyone. Just throwing money at all of these companies is not going to solve the problem or make EMR's more affordable or usable. The goverment already has a pretty good EMR used in the VA. It works well inside the VA, but doesn't talk to others. Even in a single payer, government run health care system, would you have the goverment re-vamp the VA EMR? Why not go to the pros at Google? They have already started the process with Google Health, though this is a personal health record and not an EMR. They good create a Google Medical record (GMR) that interfaces with their existing Google Health platform. Sure, they would have a monopoly, but in this case the benefits to the public, patients and doctors far outweight the risks. If the Google EMR was supported by the goverment, then you could create restrictions to limit any of their profit.
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