AHIP Press Release - Health Plans Offer Comprehensive Reform Proposal

Press Release - America's Health Insurance Plans

December 3, 2008

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Health Plans Offer Comprehensive Reform Proposal

Washington, DC – Health plans today offered a comprehensive health care reform proposal to achieve universal coverage, reduce the growth of health care costs, and improve the quality of medical care.

“Today our board is making a strong statement that now is the time for health care reform,” said Karen Ignagni, President and CEO of America’s Health Insurance Plans (AHIP). “Reducing health care costs, improving quality of care, and bringing everyone into the system must be done in tandem to maximize the opportunity for success on all fronts.”

The new proposal is the culmination of three years of policy development by AHIP’s Board of Directors to develop workable solutions to the health care challenges facing the nation. It reflects the concerns and incorporates the ideas that were raised by the American people during a nationwide listening tour as part of AHIP’s Campaign for an American Solution.

“AHIP’s Board and membership are committed to working with policymakers and other stakeholders to ensure that all Americans have affordable, high-quality health care coverage,” said James Roosevelt, Jr., President and CEO of Tufts Health Plan and Co-Chair of AHIP's Policy Committee.

The new proposal outlines strategies to achieve four main objectives: controlling costs; helping consumers and purchasers; achieving universal coverage; and adding value.

Controlling costs: A financially sustainable and affordable health care system can only be achieved by bringing underlying medical costs under control. If health care costs are allowed to continue rising at rates far exceeding economic growth, they will thwart all efforts to improve coverage and care.

Health plans are urging Congress to set a bold target of reducing the future growth in health care costs by 30 percent over the next five years. Based on the current projected growth rate of 6.6 percent, this could produce a cumulative savings of more than $500 billion over five years.

To achieve these goals, health plans are proposing that a public-private advisory group be created to provide specific policy recommendations to Congress on reducing health care costs. This new advisory group would include input from a wide variety of stakeholders to provide objective, independent recommendations.

Helping consumers and purchasers: Insurance market rules need to be reformed to help individuals and small businesses access affordable coverage while avoiding duplication of administrative and regulatory responsibilities. These reforms must be coupled with initiatives to provide one-stop access to coverage options and clear, consistent information on quality and cost of care.

Health plans propose that a new portable health plan be available to individuals and small businesses in all states. This affordable “essential benefits plan” would provide coverage for prevention and wellness as well as acute and chronic care. To maintain affordability, the essential benefits plan would not be subject to varying and conflicting state benefit mandates.

The essential benefit plan would also be made available to workers who are going through a job transition or are eligible for COBRA to ensure they are able to maintain health care coverage.

The proposal also calls for protecting low-income individuals and working families from medical bankruptcy by making available tax credits to those who spend a set percentage of their income on out-of-pocket health care expenses, including premiums and cost-sharing.

Achieving universal coverage: By addressing rising costs, reforming insurance market rules, and enhancing value in care delivery, the nation can provide all Americans – those with and without coverage today – affordable coverage they can keep.

Health plans propose guaranteed coverage for people with pre-existing medical conditions in conjunction with an enforceable individual coverage mandate. To help working families afford coverage, advanceable and refundable tax credits should be available, phasing out as income approaches 400 percent of the federal poverty line.

The plan also calls for shoring up the health care safety net by making eligible for Medicaid every uninsured American living in poverty and strengthening the Children’s Health Insurance Program.

Adding value: The nation must create a 21st century system where quality and effectiveness are rewarded, administrative efficiency is achieved, and primary care and wellness are encouraged.

Health plans commit to streamlining administrative processes and propose making targeted investments in our public health infrastructure. The plan also calls for refocusing our health care system on keeping people healthy, intervening early, and providing coordinated care for chronic conditions; adopting uniform standards for quality, reporting, and information technology; and investing more in research to better understand which treatments and therapies work best – for the nation as a whole and for specific patients.

To learn more about AHIP’s health care reform proposal, visit www.AmericanHealthSolution.org.

Interesting Piece About Changes in the Healthcare System

When I was looking at the Washington Post last weekend, I came across this interesting article about the opinions of healthcare professionals about the changes that will affect the US health care system in the next decade or so. Though the content itself isn't surprising for any of us newly-jaded HPMers, I was surprised by the placement of the article on the front page and the title "U.S. 'Not Getting What We Pay For'". I know we are used to hearing stories about lack of healthcare coverage, but it's interesting to see an article so prominently claiming that the quality of our care isn't commesurate to the amount that we are paying. I'm guardedly hopeful that article like this signify a changing in the public perception of what is to be expected from healthcare.

So what do you guys think? Am I just completely off-base and is the zeitgeist among the average American now that the US healthcare system isn't living up to its potential? Is it even possible to contemplate value when the average insured person isn't paying the true cost of treatment?

America's Health Check-Up

Time Magazine recently did an issue devoted to a review of America's health and put out this article that echos basically everything we have been studying in public health. That we are spending the most for the lowest health outcomes as well as a lack of focus on prevention and even touches on health disparities. I think this is definately something to share with people you might know that don't really understand why you are studying public health.

http://www.time.com/time/specials/packages/article/0,28804,1860289_1860561_1860562,00.html

Deportation While In Coma

Hey Folks ! Happy Thanksgiving!

Yes this is true, I am posting on Turkey Day. You might be asking yourselves, "why is he posting today? What gives?" Well, interesting story.

I just enjoyed a wonderful meal and was hanging out, enjoying the "food coma." Then I started to think, "where did the term 'food coma' come from. I googled the term and came across an interesting story that caught my eye. This article was in the NY Times regarding a patient, Antonio Torres, who was severely injured in a car crash which left him in coma.

A legal immigrant, Antonio was uninsured. So against the pleas of his parents, Antonio was deported to Mexico - WHILE STILL IN COMA. Here's the article link (http://www.nytimes.com/2008/11/09/us/09deport.html?_r=1)

This article floored me. I thought, how is that even possible? Is it legal? That's horrible!

A quote from the article: "There is only limited federal financing for these fragile patients, and no governmental oversight of what happens to them. Instead, it is left to individual hospitals, many of whom see themselves as stranded at the crossroads of a failed immigration policy and a failed health care system, to cut through a thicket of financial, legal and ethical concerns."

I don't usually come across situations where immigration policies are so intertwined with health care policies. I'm definitely not looking hard enough.

This makes me think - this is a huge problem, especially in areas of the United States where there are large populations of legal and illegal immigrants. I wonder, if there was a Universal Health Care system in place in the US, would something like this have still happened?

The Most Expensive Diet You'll Ever Undertake

An interesting paper notes that marriage is associated with a increase in BMI (4.6 pounds for men and 5.8 pounds for women) over two years, and correspondingly, a divorce is correlated with a similar loss in BMI (1.8 for men and 2.7 for women). The authors attribute the weight gain to increased intake of high caloric foods and decreased physical activity. Interestingly enough, spouse BMIs are related in terms of weight gain and not with weight loss. This does provide evidence to the theory about weight control being modified by a shared environment (as we learned for friends and family in 200C). But rest assured with the fact that the authors found that BMI gain or loss does not predict the prospect of divorce.

An interesting aside from one of my favorite health bloggers gives a good economic rationale for why Americans are unhappy with their body image, and that the best thing you can do is align your ideal body image more with your current body state.

Also, for your body image related knowledge, here's an interesting Q and A with the author of The Fattening of America, a book that's atop by Christmas break reading list all about how America incentivises people to be gain weight then lose it. Well worth a read.

Making the tough decisions

As all of you know, the President-elect has proposed a plan to reform this country's health care system. According to PricewaterhouseCoopers' Health Research Institute, Obama's plan could cost up to $1 trillion dollars over the next decade (http://www.bizjournals.com/nashville/stories/2008/11/10/daily34.html). While some might argue that this is a reasonable price to pay for such a plan, what about other priorities that this money could be spent on? Making decisions about the allocation of government resources is incredibly challenging; Sarah and I just got through a three-week long simulation exercise where we were assigned roles of members of the US House of Representatives and had to pass a budget resolution aimed at decreasing the national debt to $42B by the year 2012. Sarah was John Boehner, and I was Nancy Pelosi (yes, our friendship survived). We were given a copy of CBO's 2008/2009 "Budget Options" handbook that outlined the programs and revenue options we had to work with in designing our proposals. This was one of the hardest things I have ever done. The rest of the Democratic leadership and I solicited feedback from our party members (there were 36 Democrats and 24 Republicans), and went about designing our budget. Everyone was assigned a role, and had to make decisions based on how their member of Congress would make his or her decisions. Balancing these was, at times, painful. My friend Evan (James Clyburn in the simulation) and I had at least two twelve-hour days where we had to go through the options and weigh things like whether we wanted to cut Medicare funding for patients with ESRD or cancel the military's F-35 Joint Strike Fighters (these are actual options in CBO's handbook). It sounds absurd, but we had to make cuts and balance the interests of an extremely diverse group of Democrats (and, in the end, moderate Republicans). It was a fun, if somewhat exhausting, exercise, and it taught me a lot about negotiating and compromise, and the importance of understanding why you have made a decision, and being able to defend your stance. If any of you are interested, you should take John Ellwood's PP250 course next fall!

Health Care Reform on the Horizon?

It seems that everyone is beginning to prepare themselves for Obama's proposed health care reforms. The American Health Insurance Plans and the Blue Cross and Blue Shield Association have agreed to support Obama's plan as long as he imposes individual mandates for health insurance. The insurers claim that if mandates are not in place, people will wait until they are ill to purchase insurance, damaging the risk pool and driving up premium prices for everyone.

http://www.nytimes.com/2008/11/20/us/20health.html?ref=health

When we visited the Blue Shield headquarters a few weeks ago, Tom Epstein, their VP of Public Affairs, talked about Blue Shield's lobbying efforts in this arena. They have a PAC that contributes money to candidates and lobbies both on the federal and state level.

Not only are these new developments fascinating, but I think its fun that thing we learn in class actually happen in real life.

Bioentrepeneur/Haas Event and other things;-)

Hello Foundations class this is my inaugural post to "the blog" so please bear with me.

First, I just wanted to remind everyone of the Haas Event "Bioentrepeneurship roundtable" tomorrow evening at 6pm. I registered yesterday and it sounds as if it should be pretty informative. The other bonus is that its in Redwood City, that's right on the peninsula about ten minutes from Palo Alto. I recognize that the Big Game is this weekend, but I promise that it's safe. The attendance fee is $35 which includes dinner, and its advertised as being pretty interactive, so I think it'll be interesting. Looking for company though. Here's the link:

http://www.acteva.com/booking.cfm?bevaid=168599

Second, the NIH Health Disparities Summit is on Dec. 16-18. It will be held in New Harbor, MD which is right outside of Washington DC in a beautiful new complex that overlooks the Potomac River. I'm going to attend and I was blessed to have an abstract accepted for presentation. I've heard that its truly a great meeting and the registration is actually free. So once again it would be nice to have some company. I can even promise a personal tour of DC considering its 15 miles from where I grew up. Here's the link:

http://www.blsmeetings.net/2008healthdisparitiessummit/reg.cfm

Lastly, the data that I will be presenting at the summit was published in the Annals of Surgery this month. It has to do with diversity in the academic surgical workforce. Annals of Surgery is one of our most well respected surgical journals and it truly is an honor to get it published. They even wrote a little editorial about it. I went to Kim and Dr. Bloom with my idea to pursue this last July when Hari, Lyonel, and I started summer school (remediation) ;-). They were very supportive of the idea and then in September Jeff looked at one of the original drafts and was also supportive. So basically what I'm getting at is that if there is a research idea that you want to look into and are passionate about, the support is here at UC Berkely SPH/HPM and this article is proof of that. I would love to get your opinion on it if you find the time to read it. Its been well received by the other surgeons with whom I've spoken, which also serves as proof that many physicians care about health care disparities and public health initiatives more then might be expected/advertised ;-) Here are the links:

Article: http://www.annalsofsurgery.com/pt/re/annos/abstract.00000658-200811000-00003.htm;jsessionid=JjpWX8vQ0SRHkLDd1b2TYPm7pXnQMWCs01hXZrJrzQJtDXFb5rhy!620075815!181195628!8091!-1

Editorial: http://www.annalsofsurgery.com/pt/re/annos/abstract.00000658-200811000-00004.htm;jsessionid=JjpHPZgLyRV31Yp2kHLQkTl5CNQByy846Q57GSpv5k10fnPQ09TG!-409308177!181195629!8091!-1

Let me know if you can't get to it and I can send you the PDF. Well that's it. I hope to see some of you Thursday evening in Redwood City.

Health Econ in the NYT

New York Times has an article all about high-deductible health plans, one of our favorite topics from health economics!

http://www.nytimes.com/2008/11/15/business/15insure.html?pagewanted=1&ref=health

The gist is that in a time of rising health care costs and the general economic downturn, employers are more often offering these consumer directed health plans as the only health benefits choice for their workers.

The article interviews David Lee, and executive from the Pacific Business Group for Health, an employer coalition that provides consultation on health care. They are based in San Francisco and I was able to do an informational interview there.

http://www.pbgh.org/

Googling the flu

Hey all,

This is a super interesting article from today's NY Times about how google is using keyword tracking to anticipate flu outbreaks.

http://www.nytimes.com/2008/11/12/technology/internet/12flu.html?_r=1&em&oref=slogin

Vaccinations: Good or Bad?

The movement of parents avoiding vaccinations for their children has become quite a popular phenomenon. Some studies have linked vaccinations to signs of autism; however, many studies have failed to find conclusive evidence of this. What do you believe?

Additionally, what sort of implications does this have on child attendance in the public school system, where certain vaccinations are generally required?

Read CNNs Vaccines: Separating fact from fiction and decide what you think is the right thing to do.

Personally, I think this is quite intriguing, and especially important for anyone having children to be well informed about. Let me know what you think!!!

UK Royal Commission on Environmental Pollution issues report on health impacts of nanomaterials

The United Kingdom's Royal Commission on Environmental Pollution issued its latest report, entitled "Novel Materials in the Environment: The case of nanotechnology" this morning (it is available here: http://www.rcep.org.uk/novelmaterials.htm). Commission members are concerned that nanotechnology is being used more and more in everyday life, but that regulations lag behind its use. This is partly due to the fact that knowledge about the health and environmental impacts of nanotechnology applications lag behind nanomaterial innovation. The report calls on the British government to recognize the divide between innovation and knowledge in this area, to which the government must (by law) respond. This is extremely interesting for anyone interested in that other link between innovation and health - not the one that makes health care provision all the more expensive, but the one that has the potential to make it all the more necessary in the future.

http://www.nlm.nih.gov/medlineplus/africanamericanhealth.html
http://ndep.nih.gov/campaigns/SmallSteps/SmallSteps_index.htm
http://ndep.nih.gov/campaigns/SmallSteps/50ways/index.htm
http://www.womenshealth.gov/minority/africanamerican/diabetes.cfm
http://www.nhlbi.nih.gov/health/public/heart/other/chdblack/cooking.pdf
http://www.blackhealthcare.com/BHC/Diabetes/Description.asp
http://www.netwellness.org/healthtopics/aahealth/
http://www.diabetes.org/communityprograms-and-localevents/africanamericans.jsp

African American Diabetic Websites

We were asked to post the websites we used in our survey of elderly African American diabetics. We look forward to sharing our findings! 

astounding increases in diabetes incidence in US

From a CDC report released today: "Among 33 participating states with data for both periods, the age-adjusted incidence of diabetes increased 90% from 4.8 per 1,000 in 1995--1997 to 9.1 in 2005--2007."

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5743a2.htm

What Baseball Can and Can't Teach Us About Healthcare Delivery

Greetings all,
I thought that I'd like to direct everyone's attention to an interesting opinion piece about what how healthcare systems can alter their best-practices through statistics-rich evidence-based medicine. The article notes how baseball management has changed its methods through sabermetrics (valuable baseball-y statistics), and how similar successful efforts have been attempted in the health field. If you're a tad skeptical, a nice rebuttal is provided here from one of my favorite health care blogs. At the least it is something for us HPMers to think about before we nod off at the 8 AM biostatistics class.

Enjoy!

Also, a little self-promotion for the site that I'm contributing to about public-private interventions in the developing world. For anyone who is at all interested in learning about new methods of health delivery in the developing world give it a read over. The chief dude behind the site, Dominic Montagu at UCSF, is co-teaching a class next semester on the topic. Check it out at www.ps4h.org.

UPDATE: Apropos of the article above, I forgot to mention that the lead writer is the one and only Billy Beane the A's awesome GM, and the co-writers are John Kerry and Newt Gingrich, so read it.

The FDA and Bisphenol A

Earlier this year, the Canadian government put Bisphenol A on its list of toxic substances and started drafting regulations to ban the sale of baby bottles containing the substance. BPA is a chemical that can mimic the hormone estrogen. Its harmful effects are more acute for infants, whose bodies cannot expel the chemical as fast as older children and adults. When the story first broke, the reaction was swift: I remember seeing several news stories about it, and it was next to impossible to find either plastic baby bottles or glass baby bottles in stores - the former because they had been pulled by manufacturers, and the latter because concerned parents had bought them all up because they were "safe."
In the United States, the FDA recently released a report stating that the low doses of BPA that humans get from eating out of plastic containers that contain the chemical are not harmful. This finding has seemingly been controversial, however, with many scientists questioning the initial report. In response, the FDA asked an independent panel to review the findings, and it has found that the margins of safety used by the FDA for BPA are inadequate. Further, the panel said that the FDA failed to consider all of the relevant scientific literature about BPA when it made its initial conclusion. It is not known yet whether or not (or when) the FDA will review its decision on BPA, but the findings of the panel will likely put pressure on the agency to do so. For more information, there is an article on the CBC's website: http://www.cbc.ca/health/story/2008/10/29/bpa-fda.html.

Lloyd Dean - Sunday Chron

I am still thinking about the amazing session with Lloyd Dean from last week....quite a visionary leader and someone we will have to watch to see what he does if the election tracks to the current polls and Obama is elected.

Coincidentally, this Sunday the Business section of the SF Chronicle had an interview with Mr Dean:

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/10/26/BUL613LU85.DTL&hw=lloyd+dean&sn=001&sc=1000

Kim

Canadian Election Results

The results of the Canadian election are in: the Conservatives are back in power with a strengthened minority of 143, while the Liberals took 76, the NDP 37, and the Bloq 50. Although the Conservatives strengthened their minority, they still do not have a majority, which means that they will need the cooperation of at least one of the other parties to pass legislation. When I last posted about the election, I mentioned that the Conservatives had no health care policies to speak of (and, in fact, no platform at the time). However, on October 9, Stephen Harper (the Canadian Prime Minister) announced plans to invest $10 million dollars between now and 2010 to support the development of a National Lung Health Framework, which is a strategic action plan to promote lung health, and to provide $15 million for a study of how Alzheimer's and Parkinson's disease affect Canadians. Over the past two years, the Conservatives have invested in important health care initiatives, such as the establishment of the Canadian Mental Health Commission and provincial wait times guarantees, so there is no reason to believe that they will not make good on these promises. At the same time, the more far-reaching health care platforms of the other parties will likely not be realized over the next four years unless the parties can work together to force the passage of new health care legislation.

Women's interest in health vs. pop culture

http://news.bbc.co.uk/2/hi/health/7662942.stm

I read this article from BBC News that tries to compare women's interest in popular culture vs. their interest in breast cancer. The statistics from the 1000 women surveyed show that 4 out of 5 women can name celebrities but only half check themselves for breast lumps once a month. It is true that over 40, 000 women in the UK are diagnosed with breast cancer each year, however I do not believe it is true that women are more interested in the gossip page than their risks at contracting this disease.

Pretty much everyone in this class has our 200C Core class, and we all listened to Lori Dorfman speak about media advocacy. I believe that this article is a perfect example of framing. This article does mention the seriousness of breast cancer and the concern women should have about their own health. It also illustrates the lack of care some women take in their own regular examination. Yet, the article frames the issue in such a way that it blames the victim. Women are the victims of breast cancer, and often are uninformed about their risks unless they have someone in their life who has been a victim of the disease. It may be true that more women read tabloid magazines and know who is dating whom, than their risks of developing cancer. However, this does not indicate to me the apathy surrounding breast cancer health the article suggests.

A more productive framework for this article would be to inform about the problem and then give suggestions on what women can do to get more information. The article mentions the Breast Cancer Campaign, (whatever that is) but there is no suggestion on where the public can even get a breast exam. There is no mention of how to be proactive about one's breast health and no guidance on what women should do should they find a breast lump at all.

I believe that part of the problem of lack of information is articles like this one. By blaming women for being more interested in celebrity drama than their health, we ignore the fundamental problem with the system. Information about popular culture is just easier to acquire. People absorb what is put in front of them and with articles like this, we miss the point: breast exams should be done regularly by all women and a conversation about breast cancer should be had with one's doctor. When reading this the majority of people would ignore the institutional shortcomings of lack of information about this topic, and blame the personal choices of women to not give themselves monthly exams.

Emma's Field Trip to the Alameda County Public Health Department

This afternoon, I was invited by Pam Willow, a legislative analyst at the Alameda County Public Health Department, to sit in on one of the Department's Legislative Council meetings. For all of you public health policy wonks, this was heavenly. The goal of this Council is to raise awareness of public health issues throughout the County, and to ensure that public health policies and programs are appropriately targeted to community needs. The Council is an engine within the department for legislative advocacy and the development of effective health policy. It is the only council of its kind within any of Alameda County's departments, and Ms. Willow was not sure if a similar council exists anywhere else in the country. On the agenda today was the Council's 2009 legislative platform, which is to include issues such as fighting health inequities and chronic disease, reducing inequities in HIV/AIDS, and promoting a healthier built environment. If you want more information about the Legislative Council, you can access their website here: http://www.acphd.org/user/services/AtoZ_PrgDtls.asp?PrgId=55.

WHO Membership Questions from Last Week

So, apparently, the only countries that aren’t members of the WHO are: Kosovo and Taiwan, and, weirdly enough, Lichtenstein. With regard to Kosovo, it hasn’t stopped the WHO from doing interventions there, but on the other hand, China has strong-armed the WHO into denying Taiwan’s doctors and hospitals access to information. Non-UN members (Niue and the Cook Islands) have been admitted, and non-governing areas like Puerto Rico and Tokelau have been allowed membership under an associate status. Furthermore, other members can be admitted as observers, like the Palestinian Liberation Organization and Vatican City.

Apparently though, the WHO does have problems when involved with countries that are disputed, such as Western Sahara. No clue on how they’d respond to health threats on the Principality of Sealand, the Gay and Lesbian Kingdom of the Coral Sea Islands, or other micronations.

This has IMPLICATIONS for health care...

Yesterday, I attended a part-talk and part-press conference given by CA Senator Barbara Boxer. Boxer toured the UC Berkeley Institute for Quantitative Biosciences to “learn more about green technology programs being researched by the interdisciplinary department,” according to the Daily Californian.

Boxer, who has not made visits to UCB a priority during her 16 years of service, was a welcome presence and an insight into national politics for those who are unabashed policy wonks (like me). However, I think her visit signified something greater.

Politicians (especially those of the Democratic variety) are often between a rock and a hard place when it comes to university constituencies. There is no guarantee that students will be registered to vote (or registered to vote in a specific district) and too many visits to a campus can often be seen as pandering to the “liberal elite.” Boxer’s record of visits to UCB shows this and for what it’s worth, I can offer some compelling anecdotal evidence to support this as well :).

Now, perhaps Boxer came to UCB because she is not running for election this year and has a safe seat if she does choose to run again in 2010. And, of course, it is also likely that she values UCB’s research achievements and contributions. But UCB has been making research breakthroughs at least since 1992 (when Boxer was elected), so why was this seen as an opportune time to come for a visit? (And no, she did not really try to soothe any fears about the impending end of the world from the Wall Street melt down.)

This optimist thinks that her visit was symbolic of the greater access being afforded to youth through the Obama campaign. I know that politicians visited universities and engaged youth before Obama (and some might call this an optimistic view of the world), but never before have young people made up such a potentially large portion of the electorate. Obama is changing the framework through which we participate in and learn about the political process, and if in doing so his actions encourage others to do so as well, then all the better!

Raw Food & Natural Healing - Buy it or not?

After looking around on CNN.com at some of the recent health news, I stumbled across an article: Woman goes raw, loses more than half herself.  I was reminded of the Hippocrates Health Institute, where my sister was employed for a while after graduating college.  I went to visit her in the earlier part of the decade, and was witness to alternative healing methods (including the promotion of the raw diet -- when you checked into the resort, you only received one cooked meal a week).  The combination of organic, enzyme-enriched foods as well as magnetic therapy, exercise, juice-fasting & cleansing, detox (...and the list goes on), has saved the lives of those who have been told by medical professionals, that there is nothing left that medicine can do for their health.  While these methods may currently be more expensive than the everyday individual can afford, this type of sustainable lifestyle appear to prove to be more beneficial than some expensive medical processes that you can get under insurance coverage.

I'm wondering if health insurance will every broaden its horizons into this type of healing that promotes health through alternative formats  (which in turn could prevent a lot of common health issues that we see related to poor nutrition).  I would hope that the observations of these alternative forms of healing, would be proof that they are effective; and in return, give consumers the option of being able to undertake these forms with some type of insurance that makes them affordable.  Programs, like the one at the Hippocrates Health Institute, educate individuals about how to make this lifestyle sustainable.  This sustainability seems like it would be less costly in the long-run, in preventing many health issues that cause frequent visits to the hospitals (that we recently discussed have been cutting down their max capacities) and hike up insurance costs.  Thoughts anyone???

My Shameless Plug: For those of you who are interested in the raw and vegan lifestyle, my sister co-authored a book that is both educational in this type of living as well as provides some tasty recipes. You can buy it on Amazon at the following URL: 

Newest Edition -- Healthful Cuisine: Accessing the Lifeforce Within You Through Raw and Living Foods

It comes HIGHLY RECOMMENDED!!! 

Public Health Law and Childhood Obesity

On Friday afternoon, I had an interview with Manel Kappagoda of Public Health Law and Policy, which is part of the Public Health Institute in Oakland. She is currently the Deputy Director of the National Policy and Legal Analysis Network to Prevent Childhood Obesity (NPLAN). The Network is working on developing model ordinances to tackle the specter of childhood obesity in America with funding from the Robert Wood Johnson Foundation. Childhood obesity is one of RWJF’s program areas, and the Foundation is committed to reversing the epidemic by the year 2015.

The ordinances that NPLAN is developing are essentially legal tools designed to create social norm changes that will lead to a healthier population. One of these was recently released for communities interested in requiring restaurants to include nutrition information on their menus. It is based on a law that was passed by the Californian Senate but later vetoed by Governor Schwarzenegger. NPLAN will continue working to develop similar regulations that will help communities keep their children healthy at least through 2010, when their current funding will end. Ms. Kappagoda was incredibly enthusiastic about the work she is doing, but spoke of some of the challenges in preventing childhood obesity; she talked about laws that exist in Quebec that prevent the advertising of children’s products directly to children and the fact that the 1st Amendment would prevent similar laws from being adopted in the US, even though these have had a strong positive effect on the health of children in Quebec.
Ms. Kappagoda stressed that she and her colleagues are not advocates, but that they are just developing products based on the best research available and distributing these to advocate groups and interested governments across the country. If you want more information on this program, or anything else that PHLP is doing, their website is here: http://www.phlaw.org/. They also have a very interesting program on public health and urban planning called "Planning for Healthy Places." This is definitely an organization to keep in mind if you are interested in public health policy and public health law!

VP debate

What did everyone think of the VP debate? There were a few healthcare remarks... I was very excited, lol

AP: Obama attacks McCain on health care

Apparently the Obama campaign is going to talk a lot about health care in the next few days. It will be interesting to see how this all plays with voters...

Obama attacks McCain on health care

By NEDRA PICKLER

CHICAGO (AP) — Barack Obama launched a multifaceted attack on presidential rival John McCain's health care proposal Saturday, elevating an issue that has been on the back burner in the White House race but remains a top concern for voters.

Obama planned to criticize McCain's plan to tax health care benefits as "radical" during an event in Newport News, Va., while his campaign echoed the message in four new television ads, four separate mailers targeted to swing state voters, radio commercials and events in every battleground state.

The McCain plan would be a dramatic change to the way Americans get health insurance. The Republican presidential nominee, who makes opposition to tax hikes a centerpiece of his campaign, has proposed to tax the health benefits that 156 million people get through the workplace as income. In exchange, McCain would give tax credits to help pay for insurance — $2,500 for individuals and $5,000 for families, paid directly to the insurer they choose.

"On health care, John McCain promises a tax credit," an announcer says in one of Obama's new ads, over images of families examining their bills. "But here's what he won't tell you: McCain would make you pay taxes on your health benefits, taxing your health care for the first time ever, raising costs for employers who offer health care so your coverage could be reduced or dropped completely. You won't find one word about it on his Web site, but the McCain tax could cost you thousands or even your health care. Can you afford it?"

It's true that McCain doesn't mention that he would tax health benefits on the section of his Web site where he describes his plan. But the Obama ad also leaves out some important context — the tax credit McCain plans to offer would be more generous than the current tax break, at least for most families for the first several years, according to an analysis by the Tax Policy Center.

The Obama campaign's mailings repeat the same message, with pictures of families receiving medical treatment and Obama consulting with doctors, and one piece centered around a doctor saying they fear patients will lose the coverage they have through their employers under McCain's plan. The campaign found a local doctor in each swing state to be featured in the mailing delivered to voters in that state.

In remarks prepared for his Saturday rally, Obama tells voters that under his opponent's plan, younger, healthier workers would purchase cheaper insurance outside the workplace, leaving an older, sicker pool to drive up the cost of the employer-based system.

"As a result, many employers will drop their health care plans altogether," Obama said. "And study after study has shown, that under the McCain plan, at least 20 million Americans will lose the insurance they rely on from their workplace."

An assessment by health care economists published last month in the journal Health Affairs projected McCain's plan would lead 20 million people to lose their employer-sponsored insurance. But it also found that 21 million people would gain coverage through the individual market.

Republican National Committee spokesman Alex Conant responded, "Barack Obama is lying about John McCain's plan to provide more Americans with more health care choices. Obama's plan only offers more government, while McCain's plan offers more choices."

Polls show Obama has taken a lead in the race recently, fueled by voters' increasing confidence that he would be better equipped to handle the struggling economy. The campaign said they long planned to focus on economic issues in these final weeks of the campaign, but the debate over the government's $700 billion Wall Street bailout focused voters on financial concerns more than they could have imagined.

The push on health care is an opportunity to raise the debate on a pocketbook issue that voters rank near the top of their concerns as the campaign enters its final month. According to an AP-Yahoo News poll taken last month, 78 percent of voters rate health care as at least a very important issue, which puts it behind the economy in a group of second-tier issues along with Iraq and terrorism.

The candidates have sharp differences on how to address increasing health care costs and help cover more than 47 uninsured Americans.

Obama wants the government to subsidize the cost of health coverage for millions who otherwise would have trouble affording it on their own. He also would also require all but small businesses to make a "meaningful" payment for health coverage of their workers or contribute a percentage of payroll toward the cost.

McCain wants patients to have more control over their care and how their health care dollars are spent. His tax credit could help people buy insurance through their employer or directly from insurers in the individual market, licensed in any state.

The assessment published in Health Affairs found McCain's plan could lead to employers declining to offer coverage if they know workers can get it elsewhere. The authors also said Obama's requirement for employers to contribute would lead to job losses or pay cuts.

A Good Pharmaceutical Industry Book

Apropos of the power player presentation last week of the pharmaceutical industry -- I would strongly recommend that if you want to get additional insight into how Big Pharma works take a look at Marcia Angell’s “The Truth About the Drug Companies: How They Deceive Us and What to Do About It.” Though the title makes it seem like a bit of a polemic, it offers a fairly objective assessment of Big Pharma’s business model, as well as a great legislative and organizational history that has led up to it’s current state. Dr. Angell is a former editor of the New England Journal of Medicine, and writes in a clear, objective, and engaging style. It gives a great rundown of marketing tactics, lobbying weights, and development processes in the pharmaceutical companies. Moreover, she offers some very excellent suggestions about how to reform the industry (removing DTC advertising, limiting patent extensions, and others).

If you're too taxed to, you know, read - check out her interview talking about the book on NPR here, and a nice rebuttal by the drug industry here.

Sunday's Times: The Bailout

I just read an article in the NYT about the bailout and I was left feeling a little bit uneasy about it. Apparently, Congress is supposed to draft a bill in regards to the bailout by tomorrow and put it on the House floor. At this point, I'm not sure how possible it is for a bill of this sort to pass considering all of the conflicting viewpoints within the "elite"(government officials). Recalling an article from health policy class (for anyone in it), it is extremely complex to get through this so called "legislative maze" in order to get a bill passed. I'm also skeptical about the bailout being the absolute last resort to save our economy. It could be possible that the media is framing the issue of the bailout as the last resort just to increases the chances of passing the bill. The public will probably be targeted by the media seeing that Congress aknowledges public opinion when making decisions.

“Ground gain minimal. Casualties huge. Conclusion — press on.”

http://www.nytimes.com/2008/07/06/health/06avastin.html?pagewanted=1

This morning I stumbled on an article that is a few months old but really lays out the enormous complexity of new drug development and its effects on patients. In this case, the article focuses on a relatively new cancer drug that has been shown to prolong patient life for several months. Although the clinical results have not been conclusive on this drug's benefit and the price tag is huge, most oncologists and patients, faced with desperate situations, rely on biologics like this one in the terribly difficult struggle against advanced cancer diseases.

This article really illuminates the complex interactions between drug company development and research, insurance prices, medical management, and patient hopes and needs.

Tonight's Debate!

What did you guys think of tonight's debate?




(psssst...does this count as a "post"?)

Sometimes You Need to Laugh So You Don't Cry

Hi all - hope you found the CPHP event worthwhile. When I got home, I was reading the SF Chron and came acrossan article outlining a recent report from the Kaiser Family Foundation with HRET that says Americans are paying more for their employer sponsored health insurance and getting leaner benefits. The average commercial premium for a family is now $12,680/year with the familiy contributing almost 25% of the cost - double what they were expected to contribute in 1999. The full survey can be found on their website www.kff.org. This came out on the heels of a study by the Center for Studying Health System Change (quite a name) saying more and more people in the US (est. 57M) are facing challenges paying their medical bills.

In light of all that, it seemed a little humor was in order and leave it to the Onion to supply it in a timely fashion:

http://www.theonion.com/content/news/man_succumbs_to_7_year_battle_with

Kim

CBO Report on Pharmaceutical Industry

The link to the 2006 CBO Report on Pharmaceutical R&D is http://www.cbo.gov/ftpdocs/76xx/doc7615/10-02-DrugR-D.pdf 

This includes much of the data in our talk with more detail and great graphics. 

One correction:  2005 Pharma R&D spending was $40 billion compared to $25 billion by the NIH.  If you look at figure 4.1 on page 28 you'll see how NIH R&D spending hovered around $10 billion per year from 1976 to 1996 before rising 2.5 fold in the last twelve years (adjusted dollars).  Where are the life-saving advances, the blockbuster drugs and procedures that should be the dividends of this research? What accounts for the increase in spending?

If so much research is funded by the NIH why isn't the NIH funded by its own royalty stream? Surely with that level of investment, patentable discoveries are being made!

The answer may lie in the Bayh-Dole Act of 1980, which assigned the rights to discoveries made by NIH funded studies to Universities, non-profits and small businesses, i.e., everyone except big Pharma. As a result, start-ups get funded by pharmaceutical companies and VC's (who get a lot of their funding from big Pharma), develop the new drug with all kinds of favorable treatment and then get acquired when the product is near market. The Pharma company gets paid profit on their investment, keeps risk and costs off of their books and gets full access to the patents without having to pay a dime to the NIH. Sweet deal for Pharma! 

PhRMA is one of the largest lobbying organizations in America, with more than 1000 lobbyists (2+ per congressman) and more than $100 million spent each year to influence legislation. If you haven't seen 60 Minutes Report "Under the Influence" I highly recommend it.  http://www.cbsnews.com/stories/2007/03/29/60minutes/main2625305.shtml

The Coming Economic Crisis

I have attached the lastest update from CNN regarding the President's address as well as Sen. McCain/ Sen Obama's decision for participating in Friday's debate.

I am interested in hearing your thoughts about how this event will affect the future of our nation?

Which canadiate do you think will have the advantage in addressing this crisis?

Do you think people would want Universal Health Care if things tend to worsen economically?

I look forward to your responses!


(CNN) -- Presidential candidates Sen. John McCain -- who said Wednesday that he was suspending his campaign because of the nation's economic crisis -- and Sen. Barack Obama will meet Thursday with President Bush to discuss a proposed Wall Street bailout.

McCain suspended his campaign, saying it was time for both parties to come together to solve economic crisis.

McCain and Obama accepted Bush's invitation to discuss the proposed $700 billion bailout with him and congressional leaders at the White House, the candidates' aides said Wednesday night.
Also Wednesday night, McCain and Obama said in a joint statement that the bailout plan was "flawed" but that "the effort to protect the American economy must not fail."
"Now is a time to come together -- Democrats and Republicans -- in a spirit of cooperation for the sake of the American people," read the statement, which was released about 15 minutes before Bush made a televised address on the economy.
Earlier Wednesday, McCain announced that he would suspend his campaign to go to Washington and participate in negotiations on the bailout plan, and he called for a postponement of Friday's presidential debate. Watch McCain's announcement »

His campaign suggested that he would skip the debate if Congress hadn't passed legislation addressing the crisis by then. Obama, however, said the debate in Oxford, Mississippi, should go forward.

"It's my belief that this is exactly the time when the American people need to hear from the person will be the next president," the Democrat said in Clearwater, Florida. "It is going to be part of the president's job to deal with more than one thing at once. It's more important than ever to present ourselves to the American people."

The University of Mississippi, the host of Friday's presidential debate, said it is going ahead with preparations for the event. Watch Obama say debate shouldn't be postponed »
McCain's suspension of his campaign hours before Bush's address to the nation on the troubled state of the U.S. financial system, a problem for which Bush's administration has proposed having the Treasury Department buy up to $700 billion in firms' troubled assets -- mainly mortgage-backed securities -- whose values declined as the housing market imploded.
The plan's goal is to stabilize the companies and prompt them to lend again. Watch Bush's address »

While McCain and Obama jointly called for bipartisan cooperation on the economic crisis, in a separate statement Obama outlined some principles he said should guide the legislation and called on McCain to support them.

Obama said the plan should help the "millions of families facing foreclosure" and not just Wall Street; create "an independent, bipartisan board to ensure accountability and complete transparency"; have Wall Street repay taxpayers for the bailout; and have an independent, bipartisan board to oversee the bailout.

"This plan cannot be a welfare program for CEOs whose greed and irresponsibility has contributed to this crisis," Obama's statement said.
Before Bush invited McCain and Obama to the White House, Senate Majority Leader Harry Reid issued a statement saying that the presidential debate should go on.

"If there were ever a time for both candidates to hold a debate before the American people about this serious challenge, it is now," he added.

McCain senior adviser Mark Salter said that the campaign will suspend airing all ads and all campaign events pending Obama's agreement.Salter also said McCain called Bush and talked to colleagues in Washington and learned that passage of the bailout plan as it then stood was next to impossible. Between McCain's announcement and Bush's speech, congressional leaders said progress has been made in negotiations.

"We agree that key changes should be made to the administration's initial proposal," House Speaker Nancy Pelosi and House Republican Leader John Boehner said in a joint statement. "It must include basic good-government principles, including rigorous and independent oversight, strong executive compensation standards, and protection for taxpayers."

Obama told reporters that before McCain suspended his campaign, he had called McCain on Wednesday to propose a joint statement of principles to govern the bailout.
McCain announced the campaign suspension shortly after their conversation, Obama said. The joint statement came out hours later.
Sen. Chuck Schumer, D-New York, said McCain's move was "just weird."
"We haven't heard hide nor hair of Sen. McCain in these negotiations," said Schumer, chairman of the Senate Banking Committee. "He has not been involved except for an occasional, unhelpful statement, sort of thrown from far away, and the last thing we need in these delicate negotiations is an injection of presidential politics." Watch Schumer call McCain's move "weird" »
But Sen. Lindsey Graham, a McCain ally, said that having the candidates join in negotiations over the bailout would be "enormously helpful."
"We need a solution on this financial crisis more than we need a foreign policy debate," said Graham, R-South Carolina. "The next seven days could determine the financial well-being of this country. We can postpone the debate for a week."
And Rep. Roy Blunt, the Republicans' House whip, said McCain's decision "is a testament to the fact that [he] is a guy who would rather be part of the solution than run away from the fight."
The bailout plan has met with a cool reception in two days of hearings on Capitol Hill, where both Democrats and Republicans have expressed skepticism about the proposal drafted by Federal Reserve Chairman Ben Bernanke and Treasury Secretary Henry Paulson.
McCain said he believes that Congress could forge a consensus on legislation "before the markets open on Monday."

Congress and the White House are trying to negotiate the details of what would be the most sweeping economic intervention by the government since the Great Depression. Bush has asked Congress to act quickly on the bailout proposal after news of failing financial institutions and frozen credit markets.

"The clock is ticking on this crisis. We have to act swiftly, but we also have to get it right," Obama said Wednesday in Dunedin, Florida. "And that means everyone -- Republicans and Democrats, and the White House and Congress -- must work together to come up with a solution that protects American taxpayers and our economy without rewarding those whose greed helped get us into this problem in the first place." iReport.com: Which candidate took the right approach?

Obama said it's unacceptable to expect the American people to "hand this administration or any administration a $700 billion check with no conditions and no oversight when a lack of oversight in Washington and on Wall Street is exactly what got us into this mess."He said that struggling homeowners must be taken care of in any economic recovery plan -- and that taxpayers should "not be spending one dime to reward the same Wall Street CEOs whose greed and irresponsibility got us into this mess."

Sunshine Act

Hi - after class I saw this article on an online database a pharma (Lilly) plans to set up to share names of all outside physicians it makes payments to for consulting, etc

http://www.nytimes.com/2008/09/25/health/policy/25drug.html?_r=1&hp&oref=slogin

This is in advance of a bipartisan bill called the Sunshine Act that would create a national registry of such payments. Part of the transparency trend,

Kim

The “Medical Home” – It’s So Hot Right Now.

Ever have one of those weeks where you hear a band for the first time on Monday, and by Friday you just can’t walk five steps without being aurally accosted by them? Then you wonder whether you’ve actually been either: a) completely oblivious to a major change in the cultural zeitgeist (say, you missed the Beatles on Sullivan) or b) you wisely ignored a vapid fad that the trend-sters jumped on (say, the Macarena). Welcome to my last week and the term “patient-centered medical home.”

So, a primary-care medical home is a new primary-care framework wherein a physician-directed practice provides “accessible, continuous, comprehensive, and coordinated [care] ... delivered in the context of family and community.” Moreover, medical homes would provide patients, for an additional fee, coordinated and continuous management of a chronic medical illnesses. They serve to form a “primary source of access to basic primary care services, allowing PCPs to provide a source of confidence, advocacy and coordination for patients among the fragmented and disjointed health care system.”

If this is confusing, don’t worry. To be fair, most people don’t really know what a medical home means. A recent Health Affairs article notes that there needs to be a “broader consensus on what medical homes reasonable can be expected to accomplish, and how they can be best developed.”

Overall, the movement behind medical homes seems good to us public health people because of the intent to promote increased medical efficacy and primary care / preventive interventions. Furthermore, coordination of services for patients would reduce costs and errors from redundancy.

Challenges of the patient-centered medical home include the normal stumbling blocks of doctors trying to lobby for preventive services against acute clients. Moreover, it would require a larger primary care center and advanced IT to do this increased coordination, which would be tough for small group PCP practices. Also concerns exist whether PCMHs should target sub-populations and thus risk overspecialization. Furthermore, doctors worry that PCMHs, by expanding primary care beyond the individual to population needs and preventive interventions, run the risk of overstretching the bounds of primary care, thus reducing the effectiveness of primary care in traditional interventions.

All in all, I can see both sides of the issue. The question remains whether this will really decrease costs, and increase quality and effectiveness. On the latter two points, I can say that with my previous work with high-risk homeless substance abuse clients, the intensive case management, similar to the PCMH model, showed surprisingly good outcomes. However, I don’t know if what works for the … interesting clients I used to work with will Grandma Bessie with diabetes in Tuscon.

Issues, concerns, comments?

For further reading, c.f. the following articles and blog which I based most of this post around (and quoted from, natch). The blog I've found is a good update on the health policy world.

Follow Up to Values Session Last Week

Hi there -am loving all the energy on the blog - keep it up. I wanted to share a link to a recent NYT article that is related to one of the values mini-cases we did last week on the MD charged with over-prescribing http://www.nytimes.com/2008/09/20/us/20pain.html?ref=health

A recent study claims these types of criminal prosecutions of is rare. The piece also has a link to the 6/17/07 NYT Sunday Magazine story that inspired this situation in case anyone wanted to go back and read about one physician and how he got caught up in the system.

Kim

America's Fascination with "Anorexic Politics*"

*= I don't know if that term's ever been used - but I like it. So in case this is the first time it's ever been used, I TOTALLY want to copyright it and coin it, so I can feel cool.

Anyhoo...

So in line with our impending election season, I had a few thoughts on how initiatives and measures are approached...

Thomas Jefferson's quote, "Great innovations should not be forced on slender majorities," seems to be the quote of the century for our lovable U-S-of-A, and why not? Why try to attempt legislation or acts or propositions or measures, etc when you only have a few more supporters than the other guy? Does one really want to push forth their agenda when one lacks a popular/majority support?

It's really a tough call, but I think it's sort of indicative of how our current legislation process is structured. When one attempts to bring up new policy issue, they have the tough task of proving the policy is worth debating, but after this initial barrier, there is a lot of freedom in designing the "meat" of the policy. However, when one brings up policies that have been debated and debated and debated - positions have already been taken, interests have already been set, and the "ding ding 'Lets get ready to rumblllllllllllllllllllle' " sides have been taken.

So is that why we, as a society and government, never try to "go for broke" with huge sweeping changes and reforms? I think so. It's apparent that in order to make change, we have to aim for incremental changes, b/c big successful reform attempts that can unify many interests are rare.

Barring any sort of huge national event ( 9/11, Kennedy Assassination, etc) that can unify the country, interests are just too frayed and numerous. Some of the most historical events in our country occurred during a "perfect storm" of events - After Kennedy's assassination, a new democratic majority, and LBJ's push for Great Society - when interests were somewhat similar. That's when we had a breakthrough in civil rights acts, healthcare reform, education, anti poverty, etc.

So since we're sort of in a "nationally unified" rut, what do we do? We aim for legislation and acts that aren't detailed enough that we're painted into a corner with a bullseye on our chests, but we also aim for something that's not vague enough that we get nailed to the wall for having some half-ass idea that more rhetoric than substance. But here's the other problem - it seems like the best offense is a good defense - and everyone just relies on their defense. That may be why it seems like we're still in a score less game.

Anytime any measure comes up for review - critics can just shoot it down by attacking the details or faulting its vagueness, most recently evidenced by the flop of Clinton's Healthcare plan. And to add insult to injury, when plans are lacking details - critics fill the gaps with misleading information and go on a media blitzkrieg with false representations. Sure this is wrong, and they'll issue a small back page apology for not "fact checking," but the calculated damage is usually already done. The majority of the public may not be swayed (they may not have even heard the adverts), but then again, the public doesnt matter. They just vote on the people who will make the decisions. As long as they media campaigns can sway the big whigs, then the goal has been accomplished, or better yet, as long as the media can influence some of the constituents (who later flood their local congressman's office with phone calls, giving the polictician the illusion of popular discontent), then the goal to influence the big whigs is uber-accomplished.

So this idea of "Anorexic Politics" in terms of legislation - the assumption that we have to be thin enough to be accepted by society, and not too fat to open up oneself for criticism - could be why we're hurting ourselves and sitting in a scoreless game (I know - I'm using tons of metaphors).

So I dont blame anyone for following Mr. $20 himself - Thomas Jefferson. Sure, "great innovations should not be forced on slender majaorities" but then again, that's probably why our society hasnt seen any great innovations in a while. We can't seem to find a way unify everyone. So until we can get that unity, incremental change seems to be the order of the day.

And until then, we'll just be sitting, watching a scoreless game and starving ourselves.

US healthcare system a great role model?

Emma this is really interesting... I'm embarrassed to say this (more like type this), but being an ignorant American I have absolutely no clue how the Canadian health care system, let alone general government works. I'm particularly interested in the New Democratic Party, it sounds as if their ideas about how to improve Canada's healthcare system take on a very public health 'preventative' method; I especially like the plan's idea to "build provincial capacity to train doctors and nurses." 

I took a look at the New Democratic Party's website and their specific ideas on how to reform Canada's healthcare system (http://www.ndp.ca/page/6736); they have some interesting ideas. They emphasis preventative methods, suggesting child health and nutrition education, funding for cleaning up unsafe water systems, law changes for toxic phthalates, and many other great ideas.

The website is anything but shy when addressing the US's healthcare system, quick to find flaws, stating "Public health care is fairer than the US for-profit system- where a fatter wallet means better care and 45-million Americans have no health coverage at all. It's also more efficient, costing $2,000 less per person every year" The website also goes on to say, "Stop US-style privatization- calling for reliable federal funding linked to provincial commitments not to subsidize the expansion of for-profit care" (they bold and enlarge "stop US-style privatization" on the website, it was a key point)

Apparently our country is a great role model... a great role model for what NOT to do!

Very interesting... I'd love to know the results of the election, you'll be hearing from me on October 15th Emma :)

Election fever and a primer in the Canadian health care system

While the US is in the middle of a pretty intense election, Canadians are also getting ready to cast ballots on October 14, 2008. This election was only called recently, and while I am sure that a number of you are not schooled in Canadian political science and are wondering what that means, here is not really the place to explain election cycles (although I can, and I will, if you want – all you have to do is ask!). Just know we Canucks operate in a different system called the “Westminster” model based on the British system of government. But, I digress; I thought, in light of our different health care systems, it would be interesting to contrast the health care plans being put forth by Obama and McCain with the health care proposals being put forth by the three main Canadian parties: the Liberals, the Conservatives, and the New Democratic Party (NDP).

Canada’s health care system is very different from its US counterpart, so while the two Presidential candidates here bicker over how to change the current system of health insurance, leaders of Canadian political parties don’t have to worry about what structure this system will take – everyone already has health insurance that is provided by provincial governments. The fundamentals of the Canadian universal health care system that we have today were hashed out in the middle of the 20^th century by Tommy Douglas, a provincial leader in Saskatchewan, so the governments (Provincial and Federal) have had about a half a century to refine program parameters. These parameters are called the Five Principles, and are set out in the Canada Health Act, which stipulates that each province must have a health care program that is universal (covers all citizens), portable (so when a person leaves his or her home province, he or she is covered in other provinces, as well), and publicly administered (although delivery of certain services can be private). Each program must also be comprehensive, which means that each province must cover, at minimum, all insured services offered by doctors, hospitals, and dentists. The comprehensiveness requirement does not mean that all medical services are covered, but only that a list of services (the “core”) must be covered by a province – many Canadians have additional health care coverage in order to pay for things like eye glasses or certain dental procedures. The last of these principles is accessibility, which guarantees reasonable access to insured services by Canadians. Every province must have these principles in place to receive health care funding from the Federal government. In sum, the situation confronting Canadian politicians is drastically different than that facing McCain and Obama. Given this, what are Canadian leaders focusing on in their health platforms?

The Liberal party leader recently announced that, if elected Prime Minister, his government would implement a $900 million catastrophic drug plan to ensure that Canadians facing “catastrophic” drug charges due to serious illness are not crushed by the financial burden of expensive pharmaceutical treatments. Pharmaceuticals are not in the “core,” so they are not currently paid for by the government. The leader of the Liberal party did not lay out the exact parameters of his plan, but said they would be negotiated with the provincial premiers in the event that his party wrests power from the ruling Conservatives. Other measures that the party would take in the health care realm are not outlined on their website. For more on the Liberal plan, go here: http://www.liberal.ca/ story_14602_e.aspx.

The Conservative Party, which has been in power for the past two years, has no health policy plan on their official website (http://www.conservative.ca/?section_id=2444 &language_id=0). Instead of steps that they will take if they are re-elected, the “health care” section of their website focuses on what they have accomplished since coming to power, and attacks the poor records of the other major parties. This attack includes a list of what the Liberal Party (the Conservative Party’s main opponent, and right now Canada’s second most popular party) failed to accomplish in the health care realm when it was in power from the early 1990’s until 2006.

The NDP (http://www.ndp.ca/home) want to improve the Canadian health care system by implementing universal prescription drug coverage, building provincial capacity to train doctors and nurses, creating more long-term care spaces and expanding home care coverage for seniors, and stepping up disease prevention efforts. Based on their websites, the NDP has the most comprehensive platform of the three parties. However, the NDP is the only three of these parties that has never formed a government at the Federal level in Canada, and this is unlikely to change come October.

It is important to note that these are not the only three Canadian political parties – there are others, including the Green Party and the Bloq Quebecois. However, the Conservatives, the Liberals and the NDP are the only three national parties that have a presence in the national legislature. The Green Party has never had a member of its party elected to the House of Commons, and the Bloq is a separatist party from Quebec that maintains a substantial presence in the House of Commons, but will never be a majority because it does not run candidates outside of Quebec (and will, therefore, never form a government).

The three parties each talk about health care, but their plans (if they even offer one) are not central to their platforms, because health care is not as acute an issue in Canada as it is here. The reforms outlined above all tinker with what already exists – they are not as bold as the plans of the Presidential candidates here, but they don’t really need to be, as the issues that Canadians face are not as acute as those that Americans must grapple with. It will be quite interesting watching both elections unfold, and if you want to know the Canadian results, come and see me on October 15^th!

Healthcare Values: Polling and Research

In light of today's discussion on US Values, I wanted to make sure everyone was aware of the work being done by the Herndon Alliance and Lake Research Partners.

The Herndon Alliance is a "nationwide non-partisan coalition of more than 100 minority, faith, labor, advocacy, business, and healthcare provider organizations... expanding the base of people supporting affordable healthcare for all, and increasing the breadth and depth of voices working and speaking out for healthcare reform".

And, their strategies are:

1. Identifying the beliefs and values of Americans.

2. Exploring the opportunities and barriers for reform.

3. Developing initiatives and strategies that are consistent with the research findings and help us move reform forward.

4. Identifying the areas of commonality between different affinity groups and engage them with the research findings.

5. Developing strategies and communications mechanisms that allow our partners to successfully build public support for our ultimate goal of guaranteed affordable health care for all.

You can find a recent powerpoint outlining some of their findings on values online at:
http://www.herndonalliance.org/pdf/celindaLakeNov07.pdf

Can't We All Just Get Along?

I wish I had some sort of illuminating and intelligent response ready to go after reading Matt's post on re-re-re-re-filtered water but I can only sit here thinking - "wow - talk about a paradigm sh*t."

In any case, my thoughts this week revolve around the idea of consensus building and the need to get along with different types of individuals/groups/interests. In many ways, the key to getting policies, plans, and strategies to move forward is deceptively simple: lets just find the idea we can all agree on.

All throughout what we've been learning, whether via school and/or personal experiences, it's stated (implicitly or explicitly) that working in the real world and getting things done takes effort, patience, communication, compromise, and resolve. I'm sure we can count tons of times where we wanted to do something one way, and it seemed obvious to us that it was the easiest, efficient, and correct way to do it. But then some John "Trying to steal my Thunder" Doe would come in and throw a wrench into the thing for no apparent reason asking his dumb, rhetorical, kindergarten questions. Sure we wanted to tell this guy "you're delaying the inevitable" or "we've already decided and its better so just get with the program" or "you're a couple donuts short of a dozen." Sure we wanted to go to the HR rep who hired the guy and say "thanks for turning work into a daycare center." (Note: if this happens to you - perhaps a hug or vacation might be in order). BUT - we don't. Why is that?

1. We don't want to get fired, 2. What if tomorrow you're the guy who isn't quite sure what's going on. What if you need a just a tad bit of guidance before throwing your weight behind the proposal/idea/plan/etc. and 3. We need to have a collective support. We understand that in order to have progress and move forward - it's going to take some "stewardship" and effort to make sure everyone understands what's going on. It's going to take some compromise and follow through by all parties involved. You don't want to face roadblocks and opposition just b/c you didnt take the time to explain yourself fully and you clash with your colleagues. People are afraid of what they don't know - so it's up to us future leaders to shed light on the dark, take steps towards the unknown, and explain the unexplainable - in ways that educate but don't alienate.

Combine this with the fact that legislatures never really create comprehensive social welfare programs or regulations - administrative agencies use their discretionary authority to develop detailed rules and appropriate measures. Even if policies/measures are enacted at higher levels, it falls to administrators to flesh out the follow through, and make sure the policy stays true to its intent.

And for many of us, our careers will lead us to those policy and managment levels, where we will be responsible for fleshing out the rules and measures. We are going to have to be able to get along with our colleagues, with our critics. We are going to need each other's support to push ideas through, and in other cases, to call ideas into question. We can't lose our patience or get annoyed b/c someone took our parking spot, or someone doesn't see our point.

I hate to state the obvious, but turns out sometimes individuals will let their personal biases cloud their judgment. Shocking - I know. It would suck royally if the person holding the deciding vote on a measure to provide free immunizations to children votes negatively b/c - officially - it wouldnt reach the children who need it most, but - unofficially - it's because one were condescending in a meeting the week before.

I want to believe people wouldnt let personal feelings/phobias get in the way of the greater good, but it does happen and whenever there are many differing ideas and little agreement, people often say "there are too many chiefs, not enough indians."

That's why it's imperative we all get along and develop those consensus building skills. We will be responsible for finding a common ground and consensus among a sea of differing view points. We will be responsible for balancing different types of personalities. We will have to shelve personal feelings for something bigger than just you or I. Sometimes we will lead, and sometimes we will follow - but as long as we are moving forward - I think it's a journey that'll be worthwhile.

Shi*ting Paradigms: Why we should be drinking our sewage

Hi HPM class! Glad to be e-here.

Following is one of my postings from the PolicyMatters website which is the Goldman School's journal. I have more posts here:http://www.policymatters.net/ingram.html

Thanks for reading!

I always wondered how recognizable a much lauded "paradigm shift" would be while it was actually underway. Would one be able to sense the tides of public opinion reverse? Would some kind of collective mass exhalation be audible one the shift was complete? "Oh, we've evolved again. Sigh."

I need wonder no more. Reading the New York Times magazine this week, I personally met a paradigm shift today over lunch, and, as you'll see, it's testament to my own shifting paradigms that I didn't lose my lunch upon reading the article.

The article deployed a cute little euphemism -- "indirect potable reuse" -- in its summary of a rather gruesome proposition. Apparently, Orange County's golf links and McMansions have been hogging lots of water, and the region is developing a little problem with access to this precious resource. An interesting solution has arisen and it involves a beautifully simple cyclical process of harnessing one's own waste.

I'm talking about poop and pee. And I guess a little dirty shower water too. Raw sewage as grist for the drinking water mill. In Orange County, a new, ultra high-tech system is utilizing physical and chemical processes to clean, and clean, and clean again, municipal sewage. After all that scrubbing, the end product is drinking water.

It turns out that it is entirely tenable to transform the most repugnant of human byproducts into safe, potable, and relatively cheap water.

Of course, many of us loath the idea of a cycle that involves our rear ends. This collective fecophobia is so irrationally pervasive that the poor scientists who devised this gorgeous system have to eventually dump the filtered water back into the more "natural" environment of some lake, where it sits around for a while looking pretty before we can suck it back up and pipe it to our homes. Meanwhile, the filtered water gets dirty again while sitting in the lake. All this so we can think to ourselves that the water in your glass came from a high alpine pond, rather than your drain.

While there is a fair amount of sensationalism and emotion wrapped up in this particular psychological leap -- golden shower to goblet -- the real point here is much larger and more important. We cannot continue to think about a unidirectional movement of resources. Extraction, use, and refuse has been a cycle that has driven human development since earliest human civilization, but it is one that we are nearing the end of. The idea of material goods moving from "cradle to cradle" has been discussed in an excellent book by the same name. The authors argue that recycling, reclaiming, and reusing materials is now key to mitigating climate change and achieving economic stability in the long term. We cannot continue to think in narrow terms of valuable raw materials vs. burdensome waste materials. Instead, all "waste", including human waste, should be harvested for its persistent value.

Perhaps the defining feature of a paradigm shift is the moment where everyone looks at one another and says "Huh. That seems to work pretty well. Shoulda done that sooner." Whether or not we are there yet with the "toilet to tap" policy idea is debatable. What is not debatable is that we need this paradigm shift, and soon.

Global Poverty and Health Crisis

I first wanted to start off by thanking Emma and Sarah for describing such an incredible experience at the conference they attended!

Speaking of conferences, I received an invitation in the mail for two different conferences regarding Global Poverty and Health Crisis lead by renowned faculty at UC Berkeley. I extend the invitation to anyone who is interested.

Here is the information:

Global Poverty: Challenges and Innovations in the New Millennium
Wednesday October 29th in San Francisco City Club
Faculty speakers: Ananya Roy and Tom Kalil

Learn how the world at large-- and Cal students in particular-- are responding to the increasingly global nature of our society. See how Berkeley students use science and technology to enhance public health particularly among the world's poor.

Health Crisis in America:
Thursday, October 30 Montgomery Theater, San Jose
Faculty speakers: Pat Crawford, Stephen Shortell, Robert Tijan

Hear about the incredible promise that stem-cell research holds. Learn about emerging approaches for fighting obesity. Discuss the potential for improvement in America's health system.

6-7pm: Networking reception with no host bar

7-8:30pm: Lecture and Q&A session

$20 per person
$25 at the door (seating limited)

Visit discovercal.berkeley.edu to register

Questions: Call 888.UNIV.CAL

This is a great opportunity to listen and engage with renown faculty/ alumni who attend as well as network for future job/ internship opportunities.

I hope some of you will mark your calenders for these events!

Sheila Baxter