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9 Things in the Health Bill We Should Now Reconsider
Tweet Share on Facebook January 22, 2010 Comment (20)Political pundits are saying that the upset Massachusetts election of Scott Brown to fill Sen. Edward Kennedy's seat is in large part due to anger about the process of health reform: secretive, heavy handed, and peppered with grubby and unfair deals. But I wager that this has obscured the many details of the actual product the public would have to live with. As Congress takes a deep breath and reconsiders the expansive 2,700-page bill passed by the Senate on December 24 and promoted as the one that could be pushed through the House and onto the president's desk unchanged, the rest of us might want to take a closer read, too. Flip through the bill, and get a sense of just what it entails. Here are a few of the many items that pop out and are worthy of some public airing.
1. The Internal Revenue Service would be the health-reform enforcer. Once the government requires everyone to have health insurance, the IRS would move in as the monitor, proactively checking to be sure that the health insurance plans you and 300 million other Americans carry are acceptable to the secretary of health and human services. If you flunked, the IRS would impose a fine for every month you'd been lacking and use its ferocious tax-collecting skills—theoretically including the threat of jail time—to make sure you paid up.
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Health Reform: Let's Lower—Not Raise—Young Adults' Premiums
Tweet Share on Facebook August 26, 2009 Comment (43)People under age 36 form the dominant component of America's 45 million uninsured. Among them, the ages most lacking in health insurance are those in their 20s. You and I know them: They are just out of school, in entry-level or part-time jobs, or between jobs. They are usually blessed with good health, however much they may take it for granted. And they are relatively inexpensive healthwise, compared with those over 60 (by a factor of five or more), because they are spared age-related chronic diseases that consume most of the healthcare dollar, like atherosclerosis clogging arteries of the heart and other organs, degenerating bones and brains, and the vast majority of cancers. Young people have less expensive needs: preventive and primary care and assurance that they will be covered if they do encounter that infrequent, costly, unexpected catastrophic health event.
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Why Rush Health Reform? Let's Fix Insurance First
Tweet Share on Facebook July 21, 2009 Comment (55)By Bernadine Healy, M.D.
President Obama was caught off guard recently when asked how he would react if Malia, Sasha, or Michelle needed medical care not covered by the public health insurance plan he favors. It was a telling and awkward moment; he paused, then indicated he'd seek out whatever care he felt was best for his family. He recalled his grandmother's hip fracture and facing the question of whether surgery would be appropriate for an elderly woman ill with a serious cancer. Pinning or replacing a shattered hip restores mobility and relieves unbearable pain. His response—to get her hip surgery even if it meant paying out of his own pocket—was deeply personal, neither blue nor red.
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Francis Collins: Leader for the 21st Century NIH
Tweet Share on Facebook July 9, 2009 Comment (6)By Bernadine Healy, M.D.
When I was director of the National Institutes of Health in the early 1990s, little did I know the man I was struggling mightily to recruit to NIH would, almost two decades later, become NIH director himself. It's not that Francis Collins wasn't director material even then. It was that I was too focused on bringing him on to be the first permanent head of what was one of NIH's most important scientific efforts of the 20th century: the Human Genome Project.
It was clear through all our negotiations that Francis was an original. Devoutly religious, motorcycle riding, and boyish faced, with a haystack of blondish hair and a devilish sense of humor, he was also one of the most prominent physician-scientists on the planet, having just recently identified the first gene to be linked to cystic fibrosis. Competitive, yes. Driven, of course. And also, just plain nice.
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Why Doctors Take Issue With Obama's Health Reform Plan
Tweet Share on Facebook June 22, 2009 Comment (41)By Bernadine Healy, M.D.
Doctors want to be healers and not bean counters, President Obama observed, warming up a skeptical American Medical Association assembly gathered to hear his plans to reform healthcare last Monday afternoon. The president sought the doctors' support. They proved to be a polite and kindly audience, riveted for almost an hour. I counted close to 50 rounds of applause, much laughter, and only one round of boos.
To encourage the country's physicians to join his journey, Obama in his gracious way delivered some strong and scary talk. If comprehensive health reform is not passed, he warned, the financial health of the nation—not just our medical system—will require life support: "If we do not fix our healthcare system, America may go the way of GM: paying more, getting less, and going broke."
Doctors' overtreatment of patients was one of his big themes. All doctors have seen it, he said. And he's right. It can occasionally be a nasty way to juice up income, which is categorically unethical. But this is by no means the predominant explanation for overtreatment, which some have calculated as accounting for 20 to 30 cents of every health dollar.
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7 Ways Health Reform Is Going to Affect You
Tweet Share on Facebook June 10, 2009 Comment (157)By Bernadine Healy, M.D.
Change is coming to medical care in America, and it may be a done deal by summer's end. From Capitol Hill to the White House, enthusiasm is running high for President Obama's plan to morph with lightning speed the current patchwork, private-public blend of healthcare into something closer to a single-payer, government-run system. Steadfastly promising to bring high-quality, affordable care to everyone, the president assures people that they will keep their own doctor and insurance if they want, see a return of some $2,500 to their pocketbook, and become decidedly healthier. But restructuring will inevitably call for sacrifice on the part of most individuals. Today, Sen. Ted Kennedy introduced a 600-plus-page bill, the first of several bills that will be issued in a flourish in the next few weeks. Since full details of what might make it into the final legislation won't be known until later this month at the earliest, barely a month is left for any kind of public discussion before a July vote. Enough common threads have emerged, however, to indicate that people should start looking beyond the headlines now for an idea of how the new system will affect them personally. For starters, here are seven ways that your healthcare experience is apt to change:
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Health Reform: We Need Details, President Obama
Tweet Share on Facebook May 26, 2009 Comment (55)By Bernadine Healy, M.D.
One thing that's clear from the political winds blowing at both ends of Pennsylvania Avenue is that the perceived secret to getting health reform done is to keep the details away from pesky critics until it's almost too late to say no. On this, President Obama and a select group in Congress have emerged as a phenomenal tag team. Obama is the frontman, speaking in great generalities and making pledges that are almost too good to be true, while those in Congress, emboldened by a nearly filibuster-proof Democratic majority, are at work behind closed doors on the nuts and bolts. The promise is that all Americans will soon be guaranteed affordable, high-quality healthcare and the freedom to choose whatever doctor or health plan they want, all at a savings of some $2,500 per family. This comes with an even broader assurance: the very salvation of our economy, which Obama preaches is doomed without the cost-tightening of health reform. But slow down here. We need to look critically at this sales pitch, because reform comes with a price that is only gradually being revealed.
At the moment, committees in the House and Senate are penning their sweeping legislation on a timetable that will not allow for a public viewing before mid-June. Passage is expected in July, in time for a presidential-congressional victory lap by summer's end. The reason for this breathtaking pace? A big one is the fear that if it doesn't happen fast, it won't happen—and that many of those who lived through the Clinton health plan debacle in 1994 believe that the devil in the revealed details of that plan sank it.
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Swine Flu's Fall Return: 3 Steps We Must Take Now
Tweet Share on Facebook May 12, 2009 Comment (48)By Bernadine Healy, M.D.
The H1N1 virus, or swine flu, first brought to public attention a mere couple of weeks ago, quickly spread from its epicenter in Mexico to at least four other continents, 30 countries, and more than 5,000 people, reaching near-pandemic levels before subsiding. So far, the global outbreak of this novel strain, decoded by researchers as a mongrel mix of mostly swine, a touch of bird, and enough of human to make it jump from animal into people, has caused milder and less transmissible disease and far fewer deaths than originally feared. But it would be dangerous to assume that we are out of the woods.
Indeed, as the risk seems to abate, the public health focus must now shift promptly to the hard-to-gauge threat that this H1N1 influenza poses when flu season begins in the fall. And here our predictive abilities are no better than a coin flip. We have faced just three flu pandemics in the past century, two of which turned out not to be serious. But the pandemic of 1918 took half a million lives in the United States and, conservatively, 50 million worldwide. That virus, also an H1N1 strain, though of avian origin, first emerged in the spring like a lamb, only to return in the fall like a lion, having mutated into a fierce and deadly form. Granted, science and medicine were rather primitive at the time. But the experience is not something that public health officials can ignore. Margaret Chan, the director-general of the World Health Organization, said last week that she would rather be overprepared than have to answer questions after a deadly outbreak about why WHO did not take sufficient action.
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Health Reform, Too Tough on Hospital Readmission
Tweet Share on Facebook May 1, 2009 Comment (22)By Bernadine Healy, M.D.
As President Obama has it, the nation's sick house is putting us into the poorhouse, and medicine seems not too far behind Wall Street in bringing on our economic woes. Thus, with a few swoops of the presidential pen, Obama has already laid the groundwork for a massive overhaul of America's healthcare system into a more publicly managed, cost-conscious enterprise that focuses more on wellness than sickness. And wellness does come cheap. Driving most government outlays, however, are the many millions of Americans—particularly the elderly—with extremely resource-intensive chronic diseases.
So far, no pain: The reform process meant to reduce the nation's $2.2 trillion annual healthcare spending currently has many belts expanding, not tightening. Billions are being poured into the proposed pillars of health reform—a national electronic medical record for all and comparative-effectiveness research programs that will guide more standardized and coordinated care. Some are skeptical that these will cut costs, but the jury's still out. What's tried and true, however, is the government's power to restrict reimbursement as a means of changing medical behavior. Medicare, which covers virtually all of the elderly by fiat (if elders don't buy into it, they lose their Social Security) has the power to say "No" to expensive treatments. That's great if the care is unnecessary. But the rub is that you can't always tell when you're not at the bedside or if you don't know the medical facts about a given patient.
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Swine Flu: At Level 5—and in Need of More Rapid Diagnosis
Tweet Share on Facebook April 29, 2009 Comment (38)By Bernadine Healy, M.D.
At least eight countries around the globe now have confirmed cases (91 in the United States) of the never-before-seen strain of influenza virus that appears to have only recently jumped from swine to human in a small rural village in Mexico bordering a pig farm. It is so far suspected to have claimed some 160 lives and infected approximately 2,500 people, though only a small number have been confirmed by viral typing. Thanks to rapid genetic analysis, scientists from Mexico and Canada not only identified the microbe as a new strain of the H1N1 type of influenza in a matter of weeks but have shown that this is no ordinary form of influenza, which is typically a mild virus when it has circulated in people for a long time. That this novel strain of swine flu has been carried to so many countries by travelers and has shown signs of human-to-human transmission in Mexico and the United States has prompted the World Health Organization to elevate the risk for a global pandemic from where it had been, a stable 3, to a 4 earlier this week and, today, a 5. This denotes a "a strong signal that pandemic is imminent" if not inevitable, as one WHO official said. All countries should now activate their pandemic preparedness plans, the WHO cautions, emphasizing increased surveillance and early detection.
It is still way too early to tell how the swine flu pandemic threat will play out, since most of the cases have a Mexican connection, and most infections outside Mexico have been mild. And there's not a lot of evidence yet of rapid and sustained human-to-human transmission. So it's good to stay informed and heed public-health advice about sensible hygiene, but don't panic. Still, the wily ways of the new swine flu virus, which so quickly tripped off emergency public-health alerts, identify a big hole in our medical preparedness for fast-moving outbreaks: the ability to rapidly diagnosis the specifics of a pathogen-induced illness when a patient first seeks care. Despite many successes in developing gene-based technology that can quickly and precisely identify microbes in the air and in people since the anthrax hit after 9/11, we have not deployed microbe detection technology in doctors' offices and clinics, where such outbreaks—natural or nefarious—first show up.
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