People are drawn to the story of the California Octuplets and their mother, Nadya Suleman. The responses range from joy at the miracle of this birth to outrage about the costs and questions about Ms. Suleman’s ability to care for fourteen children.
This story touches us all – whether you have experienced the heartbreak of infertility, the joy of being a parent, or the challenges of trying to live without a paycheck.
So why does this story matter so much? Because it is a symbol of a larger problem in our healthcare system. We have so many incredible tools and tests. The things that doctors can do expand with each new process, each new discovery. Yet, just because we can do something, does not necessarily mean we should do it. This is a societal dilemma.
Ms. Suleman’s fertility doctor had the skill to implant six embryos (which split to 8). Her medical team at Kaiser consisted of 46 physicians and staff. The estimated cost for this process according to “NBC chief medical editor Dr. Nancy Snyderman, …….the estimated cost of delivering the infants and caring for them until they are healthy enough to leave the hospital at $1.5 million to $3 million.” I believe it will cost much more.
The Los Angeles Times is reporting, “Three sources told The Times that Kaiser Permanente has requested Medi-Cal reimbursement for care of the octuplets.”
Now, a private medical issue has become a taxpayer burden. At a time when our country is grappling with an economic crisis and crucial Medicaid programs are slashed, our dilemma becomes what health related activities are Americans willing to, or should, pay. While a proponent for health care access for all Americans, I wonder out loud at what point do we say we have gone too far. As a country, we need to get smarter about the choices we make with our care.
While many question Dr. Kamrava’s motives as this story unwinds. Doctors must make ethical decisions on a daily basis. Doctors need to be less afraid and supported when they say no. Saying no is just as important as saying yes.
As a nation, we owe it to ourselves to figure out the right thing to do, rather than the fastest or the most gratifying. We need to think not just about ourselves, but the ramifications our behaviors and actions have on our fellow Americans.
Get Smart about Health Care, America!
Thursday, February 12, 2009
Entitlement vs. Access to Care - Article 4
Something to Think About
Americans like to be independent. We believe each person should be judged on their merits and rewarded for working hard. Somehow, along the way we have lost this view when it comes to our approach to healthcare.
Today there are three basic classes of healthcare access:
1. Americans working full time for an employer large enough to offer medical coverage;
2. Americans who have qualified for public assistance (Medicaid or Medicare).
3. Everyone else, without coverage, only one illness or injury away from catastrophic medical expenses and bankruptcy.
Many people will say healthcare is a privilege, that it is too expensive to offer coverage to everyone. I say it is too expensive not to. Under our current model, we all pay – we pay through cost shifting. We pay increasingly higher premiums and co-pays if we are working for an employer who offers coverage. We pay in our state taxes, as governments slash spending on roads and education in order to meet the rising demands for Medicaid. Because health care is not available for tens of millions of Americans, we must gamble with our health. When one finally presents for care out to desperation, the diagnosis is generally “train wreck” and the cost of care has increased exponentially with higher morbidity and mortality. Because one cannot afford to see a doctor for preventative and primary care, in the end, we all lose.
As a country, we need to return to our core values. We need to allow all Americans access to care. This means everyone is covered, no one is exempt, or excluded. Everyone is accountable, for eating right and exercising, for controlling his or her weight, for presenting for primary care for preventable diseases, and regular care for chronic disease. Until everyone can see a primary care physician, we will not be able to control the high costs of emergency based care. Until everyone is able to access care, and we no longer have people who must choose between filling a prescription or affording food, we cannot begin to control the extraordinary costs of chronic illness.
I am not proposing new government subsidies. I am proposing we take the dollars we spend today, for insurance premiums, for emergency room care, for prescription drugs, Medicaid, and Medicare. Let us redistribute this money, finding new ways of funding the primary care physician to assure access to all. Allow and support each American to take control of their health and reward those who work hard to manage a healthy lifestyle and proactively manage chronic disease. In these tight economic times, we need each dollar to do more, to go farther. Our healthcare dollars must be used wisely. We all have a stake, and we all need to contribute to paying for care. Life, liberty, and the pursuit of happiness – these are our ideals. When one is ill, it is difficult to pursue these ideals. Hence, shouldn’t access to medical care be part of this picture? The cost is too high to withhold health care in America.
Get Smart about Health Care, America!
Americans like to be independent. We believe each person should be judged on their merits and rewarded for working hard. Somehow, along the way we have lost this view when it comes to our approach to healthcare.
Today there are three basic classes of healthcare access:
1. Americans working full time for an employer large enough to offer medical coverage;
2. Americans who have qualified for public assistance (Medicaid or Medicare).
3. Everyone else, without coverage, only one illness or injury away from catastrophic medical expenses and bankruptcy.
Many people will say healthcare is a privilege, that it is too expensive to offer coverage to everyone. I say it is too expensive not to. Under our current model, we all pay – we pay through cost shifting. We pay increasingly higher premiums and co-pays if we are working for an employer who offers coverage. We pay in our state taxes, as governments slash spending on roads and education in order to meet the rising demands for Medicaid. Because health care is not available for tens of millions of Americans, we must gamble with our health. When one finally presents for care out to desperation, the diagnosis is generally “train wreck” and the cost of care has increased exponentially with higher morbidity and mortality. Because one cannot afford to see a doctor for preventative and primary care, in the end, we all lose.
As a country, we need to return to our core values. We need to allow all Americans access to care. This means everyone is covered, no one is exempt, or excluded. Everyone is accountable, for eating right and exercising, for controlling his or her weight, for presenting for primary care for preventable diseases, and regular care for chronic disease. Until everyone can see a primary care physician, we will not be able to control the high costs of emergency based care. Until everyone is able to access care, and we no longer have people who must choose between filling a prescription or affording food, we cannot begin to control the extraordinary costs of chronic illness.
I am not proposing new government subsidies. I am proposing we take the dollars we spend today, for insurance premiums, for emergency room care, for prescription drugs, Medicaid, and Medicare. Let us redistribute this money, finding new ways of funding the primary care physician to assure access to all. Allow and support each American to take control of their health and reward those who work hard to manage a healthy lifestyle and proactively manage chronic disease. In these tight economic times, we need each dollar to do more, to go farther. Our healthcare dollars must be used wisely. We all have a stake, and we all need to contribute to paying for care. Life, liberty, and the pursuit of happiness – these are our ideals. When one is ill, it is difficult to pursue these ideals. Hence, shouldn’t access to medical care be part of this picture? The cost is too high to withhold health care in America.
Get Smart about Health Care, America!
Monday, February 9, 2009
Personal Electronic Health Records - Article 3
We had a great response to our last posting, a summary of President Obama’s Healthcare plan. This week we want to dive into the detail on the proposed $50 billion ($10B a year for five years) investment to move from paper to electronic health records.
Electronic records allow medical teams to work together and share information. This reduces errors, improves quality, and reduces cost. President Obama’s plan calls for uniform standards for sharing information between systems. The money will create the tools to allow all health workers to access information electronically.
I have supported electronic health records for over a decade. I know firsthand how it improves office visits. Electronic records help make sure clients receive the right tests, the right medications, and the right referrals for specialty care. In the emergency room, I have seen how the lack of a complete patient record causes mistakes. These mistakes, such as giving a medication the patient is allergic to happens every day. A national electronic record would immediately help prevent these issues.
The benefit of moving to electronic records is great. So is the danger. These records contain private, personal information. Today a small number of people have access to our paper documents. Once the information becomes electronic, the numbers of people with access increase. The most important issue is control of this information. We should be able to access our own information. We should be able to see our conditions, our medications, and our test results. We should be able to define who we want to have access to this information. We want our doctors to have access. We want our nurses and our medical caregivers to have access.
However, there are other risks. For example, drug companies might use this information to identify people with a certain issue (like high blood pressure). Using this data, the drug company could try to sell their drugs to targeted patients. The electronic health record must be protected against any attempts to market, or profit, or use our personal information in any way not directly tied to delivering healthcare.
We must demand control of our information. We must own the information and the ability to give others access to it. There are many great companies working on the electronic medical record. We need a seat at the table, to make sure our voice is heard and that we own our own data.
Your comments are important to us! Please post your comments.
Get Smart about Health Care, America!
Electronic records allow medical teams to work together and share information. This reduces errors, improves quality, and reduces cost. President Obama’s plan calls for uniform standards for sharing information between systems. The money will create the tools to allow all health workers to access information electronically.
I have supported electronic health records for over a decade. I know firsthand how it improves office visits. Electronic records help make sure clients receive the right tests, the right medications, and the right referrals for specialty care. In the emergency room, I have seen how the lack of a complete patient record causes mistakes. These mistakes, such as giving a medication the patient is allergic to happens every day. A national electronic record would immediately help prevent these issues.
The benefit of moving to electronic records is great. So is the danger. These records contain private, personal information. Today a small number of people have access to our paper documents. Once the information becomes electronic, the numbers of people with access increase. The most important issue is control of this information. We should be able to access our own information. We should be able to see our conditions, our medications, and our test results. We should be able to define who we want to have access to this information. We want our doctors to have access. We want our nurses and our medical caregivers to have access.
However, there are other risks. For example, drug companies might use this information to identify people with a certain issue (like high blood pressure). Using this data, the drug company could try to sell their drugs to targeted patients. The electronic health record must be protected against any attempts to market, or profit, or use our personal information in any way not directly tied to delivering healthcare.
We must demand control of our information. We must own the information and the ability to give others access to it. There are many great companies working on the electronic medical record. We need a seat at the table, to make sure our voice is heard and that we own our own data.
Your comments are important to us! Please post your comments.
Get Smart about Health Care, America!
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