The American Health Care Machine and You: A Call to Conscience–You Can’t Build a Ship Unless You Know Its Supposed to Float

Our nation’s endless decades’ old fight about health care has prevented us from even examining what a health system is supposed to do.  Lacking a clear vision, we have been unable to chart a viable much less sustainable course. From the beginning it has been a medical/surgical system based on fee for service payments.  Doctors and hospitals charge for services and people pay based on those prices, or the discounts some groups are able to negotiate.

We have never agreed as a society  whether health care is the responsibility of individuals and families or whether health care is a social good for the nation, or even a combination.

While I am hard on employers in this blog they are not the villain. The villain is our lack of vision of what a system should do..  Many groups at both the national and local level are fighting for transparency and quality. What is the villain is our lack of vision which has birthed this system with its conflicting and confusing rules. We have some key groups at the local and sometimes state levels that are working to build sustainable quality systems that support individuals, families, employers and the communities and states at large.  The Washington Health Alliance,  The Foundation for Health Care Quality in Washington State,as well as national groups of Employers, such as the Leapfrog Group.  If we are going to make things work we need all parties involved–individuals, families, and employers, which includes unions.  There are others.  We can work together. This is an attempt to show why we need to do so.  


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The American Health Care Machine and You: A Call to Conscience–The Healing Power of Connection(c)

“How many children do you have?” were the first words the doctor said when I arrived at the hospital.  My son was in a devastating car accident.  He had just been taken from the ER to a room where they were cleaning his wounds and running tests.  A social worker ushered me to a private room.  Soon the doctor came and asked about any other children. I had none. He explained my son had only ‘brain stem level’ functioning.  They were testing to see if he had a gag reflex or if his eyes dilated.  And he left.

He didn’t explain brain stem activity or why gag reflex and dilated eyes mattered. I knew the injuries were grave. But I did not know how grave. Was it possible surgery could save him?  Would he recover or be paralyzed? I should have known ‘brain stem’ but was uncertain.

I admit I probably did not hear or absorb everything he said.  Miles was 13.  I was in shock. He had gone out with a group of boys. There was an accident. Yet the doctor’s abrupt manner made him seem my adversary. Only once did he sit or look me in the eye. He came in, checked the monitors, made comments and left.  He gave no clear path or choices.

I don’t blame that doctor for not saving my son.  It was not possible. What remains with me to this day, however, was his behavior—abrupt and apparently indifferent.  I wanted him to level with me, but I also wanted some signal of some personal concern.

I contrast that experience with the care I received after my major stroke. I was barely breathing.  No one expected me to live. I went from ER, to ICU to Neurology.  No one gave up on me. I have fleeting memory flashes before taken to the Rehabilitation Unit a week later.  But, I do distinctly remember people tending to me. Even semi-conscious I heard soft voices echoing ‘sorry’ or felt them fluffing a pillow or straightening a sheet. I felt the kindness. Other voices gave encouragement. Held hope. Whispers of progress. It has been two years since my stroke. That care remains vivid. It has been 25 years since my son died, that doctor’s care remains just as vivid.

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The American Health Care Machine and You: A Call to Conscience–How the New Hospital Community Outreach Requirements Can Be A Win/Win for You and the Hospital

Systemic investment in community health has not always been a high priority for many hospitals. With the Affordable Care Act all non-profit hospitals must now assess community health needs and develop a strategic and periodic plan to meet those needs. Failure to do so can result in a $50,000 fine. This is also a fine per hospital in large hospital systems.

A Cornell University video about  the Truman Medical Center in St. Louis vividly shows a win/win impact for both the community and the hospital. The hospital increased its annual operating revenue by $283 million even while serving an urban inner city, low income communityContinue reading

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The American Health Care Machine and You: A Call to Conscience–Human Consequences of Turning A Blind Eye

“A nation’s greatness is measured by how it treats its weakest members.” ~ Mahatma Gandhi

“Let your conscience be your guide” is a conviction we have not learned as a society when it comes to health care.

As a country we have cast a blind eye on the moral consequences of our health care system.  As I told my son: “Actions have consequences.”  So many people worry that someone will get something for nothing that we have built barricades of rules to control costs by defining who can get care, where they can get it,  what is covered,  and who is going to pay for it. It is the very weight of those rules—private and public—that is collapsing the system with its costs and many all too human consequences.

Over the years a system of separate employer and insurance silos emerged that is based on the odds of someone getting sick.  Until the Affordable Care Act there were virtually no national standards for health care even though there are national standards for transportation and banks. Before the Affordable Care Act, people were denied insurance if they had a pre-existing condition.  Insurance companies could place a lifetime limit on the amount they would pay for someone’s health expenses.  There were no limits on insurance administrative costs and profits. There were no national standards to hold hospitals, doctors and others accountable for quality care. Continue reading

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The American Health Care Machine and You: A Call to Conscience– $40 million executive bonus and what $40 million could cover

 Health care is a top issue in the presidential race, but unmentioned is the $40. 2 million Golden Parachute for Humana’s CEO if the proposed merger with Aetna is approved. 

Humana CEO Bruce Broussard is primed for a huge payday. If the federal government approves Humana’s $37 billion sale to Aetna, Broussard will receive $40.2 million. The “golden parachute” compensation package includes a $6 million severance payout, while most of the remaining money will come from cashing out stock, according to a regulatory disclosure released Wednesday.”   Modern Healthcare March 9, 2016.

This “Call to Conscience” is for health insurance companies, their shareholders, as well as for employers, individuals and the health care community. Below are five different comparisons to help understand what $40 million headed for the CEO’s pocket could contribute for some critical health needs.  I added Iowa to show the economic tax burden on some states.

Some things $40 million could cover

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Posted in Affordable Care Act, aging, budget cuts, community action, consumer protection, Economy, Health Care Reform, health care stories, health insurance, hospitals, long-term care, Medicare, patient care, patients' voice, policy and politics, public dialogue, technology and pharmaceutical costs | Tagged , , , , , , , , , , , , , , , , , , | Leave a comment

The American Health Care Machine and You: A Call to Conscience–2—Blockades vs. Building Blocks

Health Care Reform and Its Blockades

We have been fighting over state vs. federal regulation of insurance since 1869 when the Supreme Court ruled that “issuing a policy of insurance is not a transaction of commerce.”

When Teddy Roosevelt introduced comprehensive health reform in 1912, life insurance companies fought it and called it “Socialist” for fear of losing their brokers.  In 1929, the American Medical Association (AMA ) created The Committee on the Costs of Medical Care to address escalating health care costs. When the final report was issued in 1932 the AMA branded the report as “Socialist” even though they had created the Committee.  What killed the recommendations was the call for salaried physicians working in group practices with hospitals and having community health planning to address community needs. Health care became such a lightening rod issue that FDR kept it out of the New Deal for fear it would doom that legislation and Social Security. We’re still fighting the same fight, only now the attack is  on “government run” health care.

The debate of private vs. public responsibility for health care changed with World War II and the wage price freeze. Companies needed workers and needed to reward them for their intense war effort. Employers argued to offer health care benefits instead of wages and they won. Health care became a form of employee compensation for those that worked for large companies. Not everyone worked for large employers. Individuals, seniors, some small businesses and the poor remained without health insurance and too often the means to pay for it.

The private vs. public battle remained well into the 1950’s.  When Truman proposed comprehensive health reform it was killed as “Socialist” with intense attacks from the AMA and the US Chamber of Commerce (employers). Many Chambers still use the promise of more affordable health care benefits to attract Chamber members. When Medicare and Medicaid were passed in the 1960’s to help the elderly and the poor, the law was also strongly opposed by the AMA saying it would doom independent physician practices and intrude government into the practice of medicine.

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The American Health Care Machine and You: A Call To Conscience not Calculators

The American Health Care Machine and You:  A Call to Conscience not Calculators ©.   

Our health care system fails us.  It fails us not only as patients it fails the many health professionals who are also victims of the rules, reimbursements and regulations.  We are buried in bureaucracy after bureaucracy—private as well as public– to make sure no one gets something for nothing. We are plagued by reams of inconsistent and incomprehensible rules, often interpreted by the very people who stand to make money on those rules.  We are failed by partisan politics.  We fail ourselves by remaining voiceless. Our silence harms our elders, our poor and our disabled. That Medicare and Medicaid takes care of them is a myth.

We have been fighting about health care for decades. We have been fighting over state vs. federal government roles since our founding. We have turned the fight into one of personal vs. mutual responsibility as if these two were mutually exclusive. They are actually inseparable. One cannot exist without the other.

There is an old political adage:  “Health care is the third rail of politics. Touch it and die.”  Well, it’s time we Americans not only touch it, we need to seize it to become a voice for change that serves our health and well-being.  Our ability to do so is a reflection of who we are as a society, as a people.  Our health and well-being is a matter of conscience.

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See How America’s Health Care Costs and Outcomes Compare to Others

I have been busy on a project and not blogging as frequently.  Given the discussions about health care in the election, however, I thought people would find this brief graphic video by the Kaiser Family Foundation of interest.  It shows quite clearly our costs and outcomes from drugs to hospitals and doctors and life expectancy.

The Kaiser Family Foundation is a non-partisan, non-profit foundation.   The reporter is Julie Rovner, a seasoned and respected health care journalist.

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Who Have We Become?

Speaker Paul Ryan’s new call to repeal the Affordable Care Act is either a bluff or completely blind and heartless. Imperfect as it is—and the legislation certainly has flaws—the Act assures people have access to health insurance even with a pre-existing health condition and fewer families face bankruptcy, crushing debt or lose their homes because of medical costs.  Hospitals and doctors are now held accountable for patient safety and outcomes. They face public reports and fines if they fail to do so.  They beginning to focus on value and send one bill for a procedure, such as hip or knee replacements, rather than two separate confusing bills.

Insurance companies now must limit their profits and administrative costs to 20 to 25% of member premiums. If they fail to do so, they must return some of the premium dollars members paid. Insurers can no longer set a lifetime maximum financial limit on what they will pay for a person’s medical costs.  People can get coverage immediately when they buy insurance not wait for their coverage to begin. Medicaid now covers more people, including single males for the first time. Individual have subsidies to buy insurance. Nursing homes must report their ownership, a first step to hold them accountable.  Doctors must now report their financial ties with pharmaceutical companies. Hospitals can  now  be fined $50,000 for failing to survey community health needs and developing a plan to meet those needs.

With exceptions for some employers, all insurance policies must offer the same Essential Benefit packages.  This guarantees some promise of administrative simplicity and guaranteed benefits people can count on, thereby reducing wasteful administrative costs. People can choose the basic set or they can buy additional benefits. Mental health services must be covered like all medical and surgical procedures. There are many more provisions.

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