American Health Care and You: A Call to Conscience–Our Veterans and the ACA

Today, November 11 is Veterans’ Day a day to remember and honor those who served our country.

Yet now nearly 25% of our veterans are homeless.  Over 20 commit suicide every day. They fought grizzly wars for us in Korea and Vietnam and now in Afghanistan, Iraq, the Middle East, Africa and elsewhere.  We no longer have the draft. These brave men and women volunteered to serve our country, many with multiple deployments.

My father was a career Naval Officer who served as a fighter pilot in the Pacific during World War II and in Korea.  We had health care benefits for life as a career officer. This included me until I turned 21 as it should. I was not on active duty.

Our Veterans Administration began in the 1930’s to care for wounded soldiers from World War I.  Our World War II soldiers and sailors returned to ticker tape parades and the GI Bill.  There has been no such recognition or reward since.

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Drug Money: Companies Flipping Drugs for Profit and Costs of Cancer Care and Drug Company Political Contributions, Drug Coupons and Costly Diabetes Drugs

I don’t usually do this, but these four articles speak for themselves on drug costs and I am on my way to a conference.

1) Drug companies are selling their drugs to others after a patent expires and those companies can/do jack up the price.  This is from Bloomberg News, a reputable business publication:

http://www.bloomberg.com/news/articles/2016-11-02/buy-and-flip-booms-in-drugs-market-as-private-equity-moves-in?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=36890353&_hsenc=p2ANqtz-8ApeujdzXuBIbsRKwqN4-EykDsc-YnQl6YLc5GamDQhbzH5Oi5kboDkf22XJCYIBn3_VWA1rk1mbI-ZbKVR7UhsZzAig&_hsmi=36890353

2) The cost of cancer care:  One of the reason some people file for bankruptcy or go into deep debt and often re-finance their homes. This from the National Center for Biotechnology Education:

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Under the Radar: Foreign Investments in Our Health Care

The debate over universal coverage vs. the marketplace rages on, but little attention has been paid to  foreign investment in our health care system. Investments and ownership range from physician practices, to hospital systems and now home health and hospice care through mergers and acquitions.

The O’Connorreport first reported on these foreign investments in 2014 with a little known fight that started at a hospital in Eugene, Oregon between the hospital, its hospitalists and Peace Health over Peace Health’s decision to contract with a private for profit company, Sound Health, for hospitalist services.  http://oconnorreport.com/2015/03/european-companies-financing-american-health-mergers-under-the-radar/

Sound Health is a private for-profit physician services organization of hospitalists and post-acute services based in Tacoma, Washington.

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An Economist’s Insights on Cost and Access; World Stroke Day Oct.29. (new web coming soon)

Those wondering about our costs and access might find this article on some research findings of interest. http://theincidentaleconomist.com/wordpress/why-the-u-s-still-trails-many-wealthy-nations-in-access-to-care/

The findings may surprise you!

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National Contest for Patient Stories: $1,000 first place (new website under construction)

The national Patient View Institute in conjunction with the Leapfrog Group is sponsoring its 2nd Annual Patient’s View Impact Award. www.GoPVI.org , www.leapfroggroup.org

The award is for patient stories that can change health care for the better.  All stories must be told by patients or their loved ones. Submissions with multimedia elements are strongly encouraged. The award winner will receive $1,000 and a trip to Washington DC for the award ceremony on December 6th.  

DEADLINE: NOVEMBER  11  6PM

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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.

http://khn.org/news/government-protected-monopolies-drive-drug-prices-higher-study-says/

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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