HOPE IS NOT A STRATEGY THE DUTY OF THE GENERAL GOVERNMENT OUGHT TO - PDF document

1887 “I DO NOT BELIEVE THAT THE POWER AND HOPE IS NOT A STRATEGY THE DUTY OF THE GENERAL GOVERNMENT OUGHT TO BE EXTENDED TO THE RELIEF OF INDIVIDUAL SUFFERING.” Richard E Ya Deau M.D. FACS, FACHE (HON) “FEDERAL AID IN SUCH CASES ENCOURAGES THE EXPECTATION OF PATERNAL CARE ON THE PART OF THE GOVERNMENT AND WEAKENS THE STURDINESS OF OUR NATIONAL CHARACTER.” Grover Cleveland, Democrat, President of the United States 1937 1894 He dispatched troops to settle a nationwide “THE TEST OF OUR PROGRESS IS NOT railroad strike at the request of J. P. Morgan. WHETHER WE ADD MORE TO THE ABUNDANCE OF THOSE WHO HAVE Many died and some were hung. MUCH; IT IS WHETHER WE PROVIDE ENOUGH FOR THOSE WHO HAVE TOO LITTLE.” Grover Cleveland, Democratic President Franklin D. Roosevelt, Democrat, President of the United States HOPE HOPE VS. ACTIVE ENGAGEMENT  Some hope that healthcare reform will be The alternatives to hope, good expectations, and overthrown by the courts. waiting to see how this all plays out are:  Others hope that healthcare reform will be  Learning from the successes of others who have implemented in toto to acclaimed success. faced these issues of cost, quality and delivery.  Analyzing the failures of expectant care, i.e.  Neither “hope” addresses the issues of healthcare hoping that everything works for the good while delivery within our communities. we do nothing.  Both alternatives insure that there is little change  Replacing “doing what we always have done” in the structure and responsibilities within with a major redesign of all our roles, healthcare, i.e. the “Status Quo” is preserved. relationships, and responsibilities.

THE MONETIZATION OF HEALTH CARE THE MONETIZATION OF HEALTH CARE Whom do we serve? Arizona, 2010 - 2011: With a faltering budget, Arizona took monies Our patients and their needs, from the “transplant fund” while adding or additional funding for border security. This left 97 people who were in the queue for transplants The financial legerdemain that now occupies our without any funding. time and attention. Then one by one they started dying, chronicled on Note: these are “God or Mammon” alternatives. the front pages of the Phoenix paper. THE MONETIZATION OF HEALTH CARE THE MONETIZATION OF HEALTH CARE Pennsylvania 2011: Pennsylvania 2011:  Facing a $4 billion budget shortfall, the state  Blue Cross/Blue Shield plans run substantial summarily disenrolled 41,476 citizens from the surpluses, rising to a cumulative 5.6 billion in its “Adult Basic” insurance program. 2009. The 4 BC/BS plans had agreed to contribute to the “Adult Basic” plan as their tax-  The program was created by Gov. Tom Ridge (R) exempt organization’s “charitable obligation.” to cover those earning too much for Medicaid but too little to afford private insurance.  BC/BS allowed their agreements with the state to expire Dec. 31, 2010.  Another 505,000 working citizens were on the waiting list for enrollment. Pennsylvania Budget and Policy Center THE MONETIZATION OF HEALTH CARE THE MONETIZATION OF HEALTH CARE “Abandoned Babies” Washington State 2010:  Of the 33 “advanced economies,” the United The state-financed plan for the working poor States has the highest infant mortality rate. disenrolled 17,500 members. This is principally related to the incidence of premature babies.  In Feb. 2011 the House of Representatives cut $50 million from the federal budget intended to support state-based prenatal care programs.

THE MONETIZATION OF HEALTH CARE ARE THERE ANY ANSWERS? “Abandoned Babies” “Massachusetts”  This budget also cut Centers for Disease Control Gov. Deval Patrick of Massachusetts told the and Prevention nearly $1 billion, which was, in House Energy and Commerce Committee he some part, for preventive health programs was “indifferent” to the federal proposals to including preterm birth studies. address Medicaid, as his state had already {Note: Premature births cost the country at least overhauled its health care system so that 98% $26 billion a year. Every 10% reduction in the of its residents now have health insurance. number of premature births, in addition to saving thousands of babies, would save $2.6 billion.} ARE THERE ANY ANSWERS? ARE THERE ANY ANSWERS?  Reduce the 23.5% of people readmitted from The Oregon Medicaid study looked at 30,000 post-acute-care skilled-nursing facilities. covered enrollees against the experience of 45,000 not covered.  Reduce unnecessary hospitalizations of nursing home residents. When evaluated against the control group these {Nursing homes have a financial incentive to enrollees were provided significantly more care - hospitalize residents on Medicaid: a three day including preventive medicine, had lower hospital hospitalization may qualify them for Medicare admissions, and their financial situation improved. part A payments at 3-4 times the Medicaid rate.} Joseph G. Ouslander, M.D. Amy Finkelstein, MIT economics professor NEJM 365;13 1165-66, September 29, 2011 National Bureau of Economic Research ARE THERE ANY ANSWERS? ARE THERE ANY ANSWERS? Diagnose Alzheimer’s disease early Diffuse best practices more effectively. Earlier cognitive function testing enables:  There are a selection of individual physicians and  Preparing families to cope with AD. health care organizations that deliver care at a  Insuring that the patient, while still competent, has a cost 20% lower than average. voice in future medical decisions.  If the rest of the industry followed their example,  Learning to manage memory loss & behavioral change, thereby decreasing or delaying hospitalization. health care spending would drop from 17% GDP  Avoiding acute care strategies for a chronic disease. to 13% GDP, leaving $640 billion available to You can minimize the chaotic and tragic things that address other public and private sector needs! can happen if everybody involved understands Alzheimer’s disease and knows what to do. The $640 Billion Question-Why Does Cost-effective Care Diffuse So Slowly? Victor Fuchs, PhD, Stanford University Susan Okie, M.D. Georgetown University School of Medicine NEJM 364;21 1985-96, May 26, 2011 NEJM 365;12 1169-70, September 22, 2011

YOU DON’T HAVE TO HAVE ALL THE ANSWERS YOU DON’T HAVE TO HAVE ALL THE ANSWERS Hospice has long used self-help groups to assist Patients are turning to the internet site families with their mutual needs as well as to www.PatientsLikeMe.com. provide emotional support, relieve isolation, and  110,000 patients communicate with each other daily. build a “community” of like people.  They represent over 1,000 serious diseases. These support systems are not widely integrated  Well resourced families, with access to world class into the health-care community. personal physicians and scientists, are passionately Many support groups arise, driven by patient engaged with each other. advocacy, from sources other than the local  This site is managed for content integrity and a healthcare delivery systems. balance between patient, clinical and research perspectives by Paul Wicks* PhD. *MIT’s “Humanitarian of the Year award” for 2011 GOOD AND EVIL GOOD AND EVIL To deal with evil, real or perceived, you must Each of you, in fact virtually every member of replace it with good society, has a story of the disappointments,  institutions, failures and perceived evils within the healthcare system.  programs, All too often these stories obscure your great  personnel, and works, successes and advancements in  support systems therapeutic practice. Providing exceptional care, all of the time, for all of the people in an affordable environment. END NOTE “Physicians are the most influential element in We will not be punished for our health care. The public’s trust in them makes profligate behavior. physicians the only plausible catalyst of policies to accelerate the diffusion of cost-effective care. Are U.S. physicians sufficiently visionary, public- We will be punished by our minded, and well led to respond to this national profligate behavior. fiscal and ethical imperative?” The $640 Billion Question-Why Does Cost-effective Care Diffuse So Slowly? Victor Fuchs, PhD, Stanford University NEJM 364;21 1985-96, May 26, 2011

Move from HOPE to Owning the Problem  Decrease Costs  Increase Quality  Provide Better Outcomes.