When the System Works

I have long been a critic of our health care system. I remain a critic of the system itself, as I believe it serves neither patient nor provider well with all its rules, rates, eligibility, networks, access, coverage and too often poor quality and inadequate safety.  In this morass, however, are gems that shine when the system works.  The system worked for me when I had my stroke two years ago. It worked again when I had a recent health crisis.  Neither time could I speak for myself.  The first I had an ardent advocate. The second time it was doctors I did not know in a local hospital that happened to be under contract with my insurer. I was just an unknown patient who came through the Emergency Room.   And the system worked.

Because the hospital was under contract with my insurer, the doctors had access to my medical records indicating a series of urgent visits. When I met with them in the morning, they had a summary for me about what had happened, why I was having some of the symptoms and started a round of antibiotics to deal with an advanced infection.   I was dehydrated and confused.  They were compassionate, straight forward and thorough. They explained the tests and why. They explained why it was important that I stay.

That was the surprise.  I hear stories of people being discharged a day or two after heart surgery.  Short lengths of stay—and pushed out.  One friend in her mid-80s was discharged two days after a hip replacement until she quite insistently protested. This is what I was expecting—a quick in and out and you’re on your own.

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Pharmaceutical costs–what’s behind them

I have been recovering from my hip replacement surgery with a few post surgical complications from another ailment.  That said, I could not resist sharing this link from the Kaiser Family Foundation news service. They are a 501© 3 non-profit organization and are not politically active.  This article is by a veteran journalist whom I respect.  I hope you find the article of interest.  The recent ‘epipen’ price is a case in point with its 400% increase. I was talking with a teacher friend over the weekend and their school system cannot afford to buy one.  You may wish to share this article with your elected representatives.


Coming next some tribute for the doctors and nurses who provide seamless and compassionate care.

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Intensity of the Response

During the Progressive movement in the early 1900′s Teddy Roosevelt ran for president with  the Bull Moose Party after his failed second bid for the presidency.  After the Civil War the  economy boomed, but by 1890 the census showed that 9% of the population controlled 71% of the wealth.   Swept up in the Progressive movement of the times, Roosevelt included health care as a key part of the party’s platform.  His plan met with immediate opposition from life insurance companies that labeled it socialist for fear that universal health coverage would eliminate the need for their brokers who sold insurance.  The ‘socialist’ label stuck and has stuck in one form or another ever since.

Given the fear of universal health care, the 1932  Committee’s recommendations for salaried physicians and community health planning faced intense opposition from the AMA.  The Committee’s report also faced the same label of ‘socialist’  which was broadly spread over the New York Times.  The Committee’s report was dead and buried.

The opposition to the report had been so intense that by the time Franklin D. Roosevelt became president during the Depression health care was pulled from the New Deal for fear it would sink the other key parts of the program, such as Social Security.

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Going Under the Knife and A 1932 Health Care Report

I go into surgery for a new hip on the 29th.  With so much talk on health care reform  in the election, I want to give a few links to a series of articles I wrote in 2010 about The Committee on the Costs of Medical Care which was  published in 1932.  I provide these links  because the issues are nearly the same—cost, quality and the need for patient centered care!

This was not government funded report. It was funded by private foundations such as Rockefeller Fund and Milbank Memorial Fund, among many others. The members were health professionals, business leaders and consumers.  This issues?  Costs were bankrupting American families; quality was uneven; fee for service billing raised costs; insurance model raised costs; lack of preventive care increased costs and failed to meet community health needs. The Committee believed the best care was when it was a collaboration between doctor and patient.

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The Inability to Compromise: A Brief Health Reform Outline-1752–2015 (c)

In the 1990’s I asked a respected, seasoned health policy professional 10 years my senior what he saw as the major obstacles to health care reform.  Without skipping a heartbeat he said:  “The inability to compromise.”

We Americans actually have more in common than we think when it comes to health care: safe, quality, effective and affordable–and caring. We just don’t hear that from the political parties, especially in election season. What we hear instead are rote political answers.  I thought for years that if we could just listen to each other without the rhetoric that we might actually be able to learn from each other, find what we have in  common and move forward.  What was I thinking?

Our failure to listen to each other is our fatal flaw. Our politics is still stuck in state vs. federal rights and stuck in our failure to agree on how to balance personal responsibility with social good. Our failure to listen is reflected in the long piecemeal, contradictory, costly and bitter fights over health care policy since the 1800′s.

With that in mind and in lieu of editorial comment, I offer parts of my outline of the long and often ugly history of health care reform in our country: Continue reading

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The Healing Power of Listening

The Power of Communication:  Kathleen O’Connor Public Member, Medical Quality Assurance Commission, Washington State

“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. 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……..

I contrast this with the care I received after my major stroke. I was barely breathing. No one expected me to live….

For the full article read Medical Quality Commission Update!, Summer, 2016 page 6. :http://www.doh.wa.gov/Portals/1/Documents/3000/MedicalCommissionUpdate!Summer2016.pdf

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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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