Health Care Reform – Why Are People So Worked Up?

Why are Americans so worked up about health care reform? Statements such as “don’t touch my Medicare” or “everyone should have access to state of the art health care irrespective of cost” are in my opinion uninformed and visceral responses that indicate a poor understanding of our health care system’s history, its current and future resources and the funding challenges that America faces going forward. While we all wonder how the health care system has reached what some refer to as a crisis stage. Let’s try to take some of the emotion out of the debate by briefly examining how health care in this country emerged and how that has formed our thinking and culture about health care. With that as a foundation let’s look at the pros and cons of the Obama administration health care reform proposals and let’s look at the concepts put forth by the Republicans?

Access to state of the art health care services is something we can all agree would be a good thing for this country. Experiencing a serious illness is one of life’s major challenges and to face it without the means to pay for it is positively frightening. But as we shall see, once we know the facts, we will find that achieving this goal will not be easy without our individual contribution.

These are the themes I will touch on to try to make some sense out of what is happening to American health care and the steps we can personally take to make things better.

  • A recent history of American health care – what has driven the costs so high?
  • Key elements of the Obama health care plan
  • The Republican view of health care – free market competition
  • Universal access to state of the art health care – a worthy goal but not easy to achieve
  • what can we do?

First, let’s get a little historical perspective on American health care. This is not intended to be an exhausted look into that history but it will give us an appreciation of how the health care system and our expectations for it developed. What drove costs higher and higher?

To begin, let’s turn to the American civil war. In that war, dated tactics and the carnage inflicted by modern weapons of the era combined to cause ghastly results. Not generally known is that most of the deaths on both sides of that war were not the result of actual combat but to what happened after a battlefield wound was inflicted. To begin with, evacuation of the wounded moved at a snail’s pace and this caused severe delays in treating the wounded. Secondly, many wounds were subjected to wound care, related surgeries and/or amputations of the affected limbs and this often resulted in the onset of massive infection. So you might survive a battle wound only to die at the hands of medical care providers who although well-intentioned, their interventions were often quite lethal. High death tolls can also be ascribed to everyday sicknesses and diseases in a time when no antibiotics existed. In total something like 600,000 deaths occurred from all causes, over 2% of the U.S. population at the time!

Let’s skip to the first half of the 20th century for some additional perspective and to bring us up to more modern times. After the civil war there were steady improvements in American medicine in both the understanding and treatment of certain diseases, new surgical techniques and in physician education and training. But for the most part the best that doctors could offer their patients was a “wait and see” approach. Medicine could handle bone fractures and increasingly attempt risky surgeries (now largely performed in sterile surgical environments) but medicines were not yet available to handle serious illnesses. The majority of deaths remained the result of untreatable conditions such as tuberculosis, pneumonia, scarlet fever and measles and/or related complications. Doctors were increasingly aware of heart and vascular conditions, and cancer but they had almost nothing with which to treat these conditions.

This very basic review of American medical history helps us to understand that until quite recently (around the 1950’s) we had virtually no technologies with which to treat serious or even minor ailments. Here is a critical point we need to understand; “nothing to treat you with means that visits to the doctor if at all were relegated to emergencies so in such a scenario costs are curtailed. The simple fact is that there was little for doctors to offer and therefore virtually nothing to drive health care spending. A second factor holding down costs was that medical treatments that were provided were paid for out-of-pocket, meaning by way of an individuals personal resources. There was no such thing as health insurance and certainly not health insurance paid by an employer. Except for the very destitute who were lucky to find their way into a charity hospital, health care costs were the responsibility of the individual.

What does health care insurance have to do with health care costs? Its impact on health care costs has been, and remains to this day, absolutely enormous. When health insurance for individuals and families emerged as a means for corporations to escape wage freezes and to attract and retain employees after World War II, almost overnight a great pool of money became available to pay for health care. Money, as a result of the availability of billions of dollars from health insurance pools, encouraged an innovative America to increase medical research efforts. More Americans became insured not only through private, employer sponsored health insurance but through increased government funding that created Medicare and Medicaid (1965). In addition funding became available for expanded veterans health care benefits. Finding a cure for almost anything has consequently become very lucrative. This is also the primary reason for the vast array of treatments we have available today.

I do not wish to convey that medical innovations are a bad thing. Think of the tens of millions of lives that have been saved, extended, enhanced and made more productive as a result. But with a funding source grown to its current magnitude (hundreds of billions of dollars annually) upward pressure on health care costs are inevitable. Doctor’s offer and most of us demand and get access to the latest available health care technology in the form of pharmaceuticals, medical devices, diagnostic tools and surgical procedures. So the result is that there is more health care to spend our money on and until very recently most of us were insured and the costs were largely covered by a third-party (government, employers). Add an insatiable and unrealistic public demand for access and treatment and we have the “perfect storm” for higher and higher health care costs. And by and large the storm is only intensifying.

At this point, let’s turn to the key questions that will lead us into a review and hopefully a better understanding of the health care reform proposals in the news today. Is the current trajectory of U.S. health care spending sustainable? Can America maintain its world competitiveness when 16%, heading for 20% of our gross national product is being spent on health care? What are the other industrialized countries spending on health care and is it even close to these numbers? When we add politics and an election year to the debate, information to help us answer these questions become critical. We need to spend some effort in understanding health care and sorting out how we think about it. Properly armed we can more intelligently determine whether certain health care proposals might solve or worsen some of these problems. What can be done about the challenges? How can we as individuals contribute to the solutions?

The Obama health care plan is complex for sure – I have never seen a health care plan that isn’t. But through a variety of programs his plan attempts to deal with a) increasing the number of American that are covered by adequate insurance (almost 50 million are not), and b) managing costs in such a manner that quality and our access to health care is not adversely affected. Republicans seek to achieve these same basic and broad goals, but their approach is proposed as being more market driven than government driven. Let’s look at what the Obama plan does to accomplish the two objectives above. Remember, by the way, that his plan was passed by congress, and begins to seriously kick-in starting in 2014. So this is the direction we are currently taking as we attempt to reform health care.

  1. Through insurance exchanges and an expansion of Medicaid,the Obama plan dramatically expands the number of Americans that will be covered by health insurance.
  2. To cover the cost of this expansion the plan requires everyone to have health insurance with a penalty to be paid if we don’t comply. It will purportedly send money to the states to cover those individuals added to state-based Medicaid programs.
  3. To cover the added costs there were a number of new taxes introduced, one being a 2.5% tax on new medical technologies and another increases taxes on interest and dividend income for wealthier Americans.
  4. The Obama plan also uses concepts such as evidence-based medicine, accountable care organizations, comparative effectiveness research and reduced reimbursement to health care providers (doctors and hospitals) to control costs.

The insurance mandate covered by points 1 and 2 above is a worthy goal and most industrialized countries outside of the U.S. provide “free” (paid for by rather high individual and corporate taxes) health care to most if not all of their citizens. It is important to note, however, that there are a number of restrictions for which many Americans would be culturally unprepared. Here is the primary controversial aspect of the Obama plan, the insurance mandate. The U.S. Supreme Court recently decided to hear arguments as to the constitutionality of the health insurance mandate as a result of a petition by 26 states attorney’s general that congress exceeded its authority under the commerce clause of the U.S. constitution by passing this element of the plan. The problem is that if the Supreme Court should rule against the mandate, it is generally believed that the Obama plan as we know it is doomed. This is because its major goal of providing health insurance to all would be severely limited if not terminated altogether by such a decision.

As you would guess, the taxes covered by point 3 above are rather unpopular with those entities and individuals that have to pay them. Medical device companies, pharmaceutical companies, hospitals, doctors and insurance companies all had to “give up” something that would either create new revenue or would reduce costs within their spheres of control. As an example, Stryker Corporation, a large medical device company, recently announced at least a 1,000 employee reduction in part to cover these new fees. This is being experienced by other medical device companies and pharmaceutical companies as well. The reduction in good paying jobs in these sectors and in the hospital sector may rise as former cost structures will have to be dealt with in order to accommodate the reduced rate of reimbursement to hospitals. Over the next ten years some estimates put the cost reductions to hospitals and physicians at half a trillion dollars and this will flow directly to and affect the companies that supply hospitals and doctors with the latest medical technologies. None of this is to say that efficiencies will not be realized by these changes or that other jobs will in turn be created but this will represent painful change for a while. It helps us to understand that health care reform does have an effect both positive and negative.

Finally, the Obama plan seeks to change the way medical decisions are made. While clinical and basic research underpins almost everything done in medicine today, doctors are creatures of habit like the rest of us and their training and day-to-day experiences dictate to a great extent how they go about diagnosing and treating our conditions. Enter the concept of evidence-based medicine and comparative effectiveness research. Both of these seek to develop and utilize data bases from electronic health records and other sources to give better and more timely information and feedback to physicians as to the outcomes and costs of the treatments they are providing. There is great waste in health care today, estimated at perhaps a third of an over 2 trillion dollar health care spend annually. Imagine the savings that are possible from a reduction in unnecessary test and procedures that do not compare favorably with health care interventions that are better documented as effective. Now the Republicans and others don’t generally like these ideas as they tend to characterize them as “big government control” of your and my health care. But to be fair, regardless of their political persuasions, most people who understand health care at all, know that better data for the purposes described above will be crucial to getting health care efficiencies, patient safety and costs headed in the right direction.

A brief review of how Republicans and more conservative individuals think about health care reform. I believe they would agree that costs must come under control and that more, not fewer Americans should have access to health care regardless of their ability to pay. But the main difference is that these folks see market forces and competition as the way to creating the cost reductions and efficiencies we need. There are a number of ideas with regard to driving more competition among health insurance companies and health care providers (doctors and hospitals) so that the consumer would begin to drive cost down by the choices we make. This works in many sectors of our economy but this formula has shown that improvements are illusive when applied to health care. Primarily the problem is that health care choices are difficult even for those who understand it and are connected. The general population, however, is not so informed and besides we have all been brought up to “go to the doctor” when we feel it is necessary and we also have a cultural heritage that has engendered within most of us the feeling that health care is something that is just there and there really isn’t any reason not to access it for whatever the reason and worse we all feel that there is nothing we can do to affect its costs to insure its availability to those with serious problems.

OK, this article was not intended to be an exhaustive study as I needed to keep it short in an attempt to hold my audience’s attention and to leave some room for discussing what we can do contribute mightily to solving some of the problems. First we must understand that the dollars available for health care are not limitless. Any changes that are put in place to provide better insurance coverage and access to care will cost more. And somehow we have to find the revenues to pay for these changes. At the same time we have to pay less for medical treatments and procedures and do something to restrict the availability of unproven or poorly documented treatments as we are the highest cost health care system in the world and don’t necessarily have the best results in terms of longevity or avoiding chronic diseases much earlier than necessary.

I believe that we need a revolutionary change in the way we think about health care, its availability, its costs and who pays for it. And if you think I am about to say we should arbitrarily and drastically reduce spending on health care you would be wrong. Here it is fellow citizens – health care spending needs to be preserved and protected for those who need it. And to free up these dollars those of us who don’t need it or can delay it or avoid it need to act. First, we need to convince our politicians that this country needs sustained public education with regard to the value of preventive health strategies. This should be a top priority and it has worked to reduce the number of U.S. smokers for example. If prevention were to take hold, it is reasonable to assume that those needing health care for the myriad of life style engendered chronic diseases would decrease dramatically. Millions of Americans are experiencing these diseases far earlier than in decades past and much of this is due to poor life style choices. This change alone would free up plenty of money to handle the health care costs of those in dire need of treatment, whether due to an acute emergency or chronic condition.

Let’s go deeper on the first issue. Most of us refuse do something about implementing basic wellness strategies into our daily lives. We don’t exercise but we offer a lot of excuses. We don’t eat right but we offer a lot of excuses. We smoke and/or we drink alcohol to excess and we offer a lot of excuses as to why we can’t do anything about managing these known to be destructive personal health habits. We don’t take advantage of preventive health check-ups that look at blood pressure, cholesterol readings and body weight but we offer a lot of excuses. In short we neglect these things and the result is that we succumb much earlier than necessary to chronic diseases like heart problems, diabetes and high blood pressure. We wind up accessing doctors for these and more routine matters because “health care is there” and somehow we think we have no responsibility for reducing our demand on it.

It is difficult for us to listen to these truths but easy to blame the sick. Maybe they should take better care of themselves! Well, that might be true or maybe they have a genetic condition and they have become among the unfortunate through absolutely no fault of their own. But the point is that you and I can implement personalized preventive disease measures as a way of dramatically improving health care access for others while reducing its costs. It is far better to be productive by doing something we can control then shifting the blame.

There are a huge number of free web sites available that can steer us to a more healthful life style. A soon as you can, “Google” “preventive health care strategies”, look up your local hospital’s web site and you will find more than enough help to get you started. Finally, there is a lot to think about here and I have tried to outline the challenges but also the very powerful effect we could have on preserving the best of America’s health care system now and into the future. I am anxious to hear from you and until then – take charge and increase your chances for good health while making sure that health care is there when we need it.

Health Tips for New College Students

Staying healthy on campus may be one of the more overlooked items of importance when it comes to college living… especially when there are more important things such as deadlines and midterms to be concerned with. But what many college students tend to forget is that on campus, illnesses run rampant especially in the winter. The risks are too great to avoid a daily dose of healthy reminders in order to stay healthy and not have to miss too much class for reasons that could have been avoided. Here are some tips to help college students stay healthy and going strong at the university.

First, before heading off to college, it would be a good thing to get your vaccinations in order. There is a big mix of completely different people from all around the world in close quarters with one another and disease and illness can be easily spread, especially when using shared resources like those of colleges and universities.

Put together a healthy eating plan. With the hectic schedule college demands, it is very easy to simply grab whatever is easy to eat such as a double cheeseburger and onion rings…every day. The dorms make it very easy to not only consume deep fried foods regularly, but in quite an amazing abundance. Try to focus on a healthy diet, sticking with fruits and vegetables and try to make those things, such as french fries, you know shouldn’t be going into your body more like rewards than an everyday necessity in your diet.

Get enough sleep. Sleep is so important in order to keep yourself healthy. Many college students believe sleep is overrated, yes, I confess…but now I correct that mistake. Lack of sleep will only make things worse in the lines of illnesses and even academics. Yes, you may do just fine without sleep, but just think about how much more you will enjoy your college experience while potentially even doing better than you are WITHOUT sleep. No sleep = heightened risk of illness due to lower immune system defense and more.

Try to keep a regular exercise schedule. Sitting around and studying may exercise your brain cells but not necessarily the rest of your body. You can use the college gym or just take a run, but it is a good thing to get the blood circulating through your body and brain. This oxygenation will help improve your studies and will make many things a lot easier for you in the long run, not to mention boost your immune system.

Drink plenty of water. Many students tend to forget this and simply grab a soda. Let’s see…you need a quick drink as you are on the go, ah yes soda machine! You stick your hand in your pocket to find only a little change left. “Oh man I forgot I had those other three sodas earlier. Darn, I am so thirsty and I need something for class!”

Keep a water bottle in your bag and keep it filled. It does wonders and not to mention helps keep your body healthy.

In regards to the “communal living” aspect of college, make sure you are cautious of all the different people who use the restroom at your dorm. This is not home where mom may clean up after you. The college restrooms are, indeed, cleaned once a day or so, but they can get dirty really quick. Wear flip flops in the shower and make sure you try to avoid placing things on the counter tops such as razors that you may be shaving and such with. Be sure to wash your hands regularly in college as well.

Even though it may be rather difficult to remember to do all these things, this is not all. In fact there are many other tips at our website and more. But all I am trying to say in this article is to simply be a little more cautious about staying healthy in college in order to help you stay healthy as well as others. Good luck with all of your future college endeavors and stay well!

Health Architecture Redesign – One End of the Spectrum

Maternal and Child Mortality in Nigeria

For the most part, Nigeria is doing poorly in the health industry. Given its developmental stage however, the country is not expected to perform at the same level of excellence with Industrialized countries. But its poor and jeopardized developmental pathway has retarded its overall socioeconomic progress. The statistics is high for a country that has the amount of human and natural resources Nigeria is blessed with. Loads of institutional patterns of error had plagued the most populous black nation of the world. Malaria, tuberculosis and other third world infectious diseases are still threatening the productivity of the country. With “recovery” system of governance and institutional ignorance, life expectancy in the country is estimated at 47-50 years of age. Nevertheless, life above 50 is characterized by affluence, education, nutritional intelligence or ability to drag on to the end.

As globally attractive as Nigeria may seem, especially in oil and gas drilling, the human development report of 2007/2008 did put the black nation in its place. The UNDP report ranked Nigeria close to bottom in the maternal mortality index. The country was only ahead of low income countries under stress (LICUS) like Rwanda, Angola, Chad, Niger, and Sierra Leone. The political argument behind this ranking is rested on the nation’s population and human density; which allows higher contact rates and rapid spread. As much as that part is true; the nation has no clear view on how to keep its citizens healthy.

There is no shared vision amongst the health care stakeholders. This includes care delivery organizations, clinicians, health care consumers and policy makers. Undoubtedly, with higher population comes increase in disease spread. Nevertheless, for Nigeria, there is no in depth profiling of the health of its citizens. The oil rich nation lacks proper information gathering and dissemination systems. These 21st century multi-dimensional development tools inform a country on required patterns of intervention. Every citizen-within accountability age brackets – should understand how much of health care remains a civil right against what is available.

The country needs to get the politics and economics of the situation right. Health promotion and care delivery in the nation needs audacious, practical and quick impact development projects.

Statistics on Maternal and Child mortality:

According to a national estimate, the Nigerian population is at 140 million; 1 in 5 Africans is a Nigerian. By the same report, 23% are women of child bearing age. In 2006, a national report estimated that 65 million Nigerians were females. 30 million of that number is within reproductive age -15-49 years. 6 million Nigerian women are expected to get pregnant every year. In 2007, WHO, UNICEF, UNDP estimated only 5 million of those pregnancies to result into childbirth.

Other statistics emerged in diverse directions. Quickly, these hard numbers may not completely capture the whole picture. And in this writing, they serve as an indicator of what the actual might be. Modern contraceptive prevalence rate is at 8% and unwanted pregnancy among adolescent is put at 60%. The use of antenatal care, by trained provider is calculated at 64%; while proportion of pregnant women delivered by a trained provider is at 37%. Proportion of women delivered at home is 57%; and almost half of teenage mothers do not receive antenatal care.

On nutrition and drugs; 58% receive iron supplements and 30% receive malaria drugs. 50% receive two or more doses of tetanus. In all, urban women are more on the positive side of things than their rural counterparts. For instance, urban women are 3 times likely to receive antenatal than rural women. Though improvements are recorded in a recent national publication, a lot needs to be done.

Enlarged perspective:

This is what the global mortality rate on women looks like. Globally-536,000 women die annually. Though Nigeria contributes 1.7% of the global population; yet on maternal deaths statistics, it represents 10% of the world’s population. Here is the scary part. Since Nigeria represents 10% of maternal deaths, it translates to at least 53,000 women dying annually. That is the equivalent of 10 jumbo jets crashing every month and one 737 jet every day or one woman dying every 10-15 minutes. A Nigerian woman is 500 times more likely to die in childbirth than her European counterpart.

On the part of children, about 5.3 million of them are born yearly in Nigeria, that- at least 11,000 every day. 1 million of these children die before the age of 5 years. A total 0f 2,300 children die daily. This is equal to 23 plane crashes daily. More than a quarter (25%) of the estimated 1 million children who die under the age of 5 years annually in Nigeria, die during the neonatal period. (Source; Academic Report on Improving Maternal, New Born and Child Health)

Granted socio-cultural and economic status of women constitutes major part of this statistics. For instance low status of women, poverty, poor nutrition (in childhood, adolescence and adulthood), ignorance and illiteracy; then again we can also consider religious beliefs-often times this acts as barrier to utilization of available health services-and lastly, harmful traditional practices. Generally there are multi-dimensional causes that contribute to health care difficulties in the country. But if Nigeria can improve on its data generation, collection and distribution, in line with socio-cultural, economic and educational differences; such data management and governance will allow reformers to practically evaluate and monitor intervention programmes. Progress in this format will mean successfully executed intervention procedures against institutional targets and original understanding of crises.

This process can be weighed in the WHO’s aims and objectives for primary health care. The forward thinking organization’s recommendation called for practical, scientifically sound, socially acceptable and technologically empowered system of health promotion and care delivery. It also suggests development methods and strategies for spirited self reliance and determination. Now, data collation will largely involve community participation.

There is no better form of promoting self determination; which is the ability of a group to manage their resources as they see fit: Without countervailing harmful effects on its immediate environment or extended neighbours. Based on their core values and norms, the communities can assist in describing and designing an intervention platform, suitable for their developmental status. With such level of inter-participation, reformers can readily identify what part of a community’s capacity tool-set needs assistance and which requires reorientation. Health promotion and care delivery education and its needs can be communicated easily; in a community’s frame of reference.

Nigeria is a signatory to various conventions and declarations on women. For example the UN conventions on the rights of women and children; as well as the Bamako declaration that adopted the women and children health services initiative as a strategy towards attainment of vision 2010.

But these legal rights issue on women and children should be communicated to fundamentalist communities with ease and cohesive diplomacy. Direct use of any kind of force, intellectual or economic, will reduce the chances of success in such locations. Achieving health care best practices in Nigeria requires robust collaboration, shared vision, competitive market development, technological awareness, consumer profiling, responsive policy prescriptions, corporate alignment between capital spending and corporate goals, and finance. These sets of interaction should target core value proposition, interoperability and reduction in silo effects.

Recommendations:

Across health care market are actors in practice that will determine the trajectory of its institutional future. Health care providers’ current concentrations in Africa are basically on episodic and acute medicine. Expansion on these scales of concern is imperative for public health. However, best practices and competitive global health care market will respond more to enhanced management of chronic diseases and life-long prediction and prevention of illness. On predictive and preventive medicine, consumers will need to assume responsibility for their health, as well as establish demands for a transformed health care system. By this attempt, health care blueprints will showcase higher value delivery.

Given this awareness, product suppliers will find it imperative to collaborate with clinicians and care delivery organizations in the development of products that improve outcomes or provide equivalent outcomes at lower cost. These functions are relatively dependent upon norms and values of a given society. Societies on their part ought to engage realistic and rational decisions regarding lifestyle expectations. They will also need to prescribe acceptable behaviour, and lastly understand how much health care should be a societal right versus market service. Health care governance best practices underline disease prevention, early detection and health promotion as a given. As a result, societies will play a bigger role in enhancing and in carrying the professional message of preventive medicine.

Government on the other hand will need to raise various levels and scales of un-sustainability awareness on national health care system. Best practices assigns governments in leadership the role of establishing political will power needed to remove obstacles. They must encourage innovation through development of competitive health care market place, suitable and conducive for direct foreign investments. This can be achieved with well integrated and robust development pathways. Efforts at rebranding or reimagining Africa’s economic performances may not yield appropriate fruit without strong financial systems.

Financial institutions in Africa have the highest lending interest rates. Consequently, there are all sorts of systematic crises in the region’s economies. Optimized financial systems will reduce systematic corporate and household debt crises. This is an algorithmic pathway to regenerate entrepreneurship, public-private partnership, as well as improved economic security on wellbeing and livelihood. Health care governance best practices points towards “commoditization” of health promotion and care delivery. The health care market is evolving rapidly and like technology, countries that refuse to adapt will continue on dependency syndrome. There is high confidence that businesses who understand the development of health care will lead their industries in the future. Dilatory management decisions against this truth may reduce future corporate profitability. This is particularly true for the financial institutions-bank and non-bank. To really address content issues, health care market development requires the same priority IT was obliged during its emergence.

Mostly, development of successful health care market place is beyond infrastructural and IT introductions. It is far above specialist centres introduction. Successful market development requires coordination and integration across sector-stakeholders. Health care governance best practices cannot be achieved without a competitive market place. Purposely, win-win scenarios should be targeted for all stakeholders, businesses and care delivery organizations. But market leadership and institutional largesse will belong to businesses and CDOs that inform their operational, financial, and management visions of this – globally integrated – emerging market.