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.
Monday, September 29, 2008
Sunday, September 28, 2008
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.
Saturday, September 27, 2008
“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.
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.
Friday, September 26, 2008
Tonight's Debate!
What did you guys think of tonight's debate?
(psssst...does this count as a "post"?)
(psssst...does this count as a "post"?)
Thursday, September 25, 2008
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
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
Wednesday, September 24, 2008
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."
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
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
Monday, September 22, 2008
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.
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
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
Sunday, September 21, 2008
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.
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 :)
Saturday, September 20, 2008
Election fever and a primer in the Canadian health care system
While the
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
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
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
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 15th!
Wednesday, September 17, 2008
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:
You can find a recent powerpoint outlining some of their findings on values online at:
http://www.herndonalliance.org/pdf/celindaLakeNov07.pdf
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
Sunday, September 14, 2008
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.
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.
Thursday, September 11, 2008
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!
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
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
Wednesday, September 10, 2008
Sarah and Emma go to Washington II: Emma's take.
I must echo Sarah's enthusiasm - this was a super event! For me, the excitement was threefold: Firstly, I have always thought that maybe I would enjoy a career as a lobbyist. Mr. Trippler's speech excited me, and got me thinking more about careers in government relations, as well as government relations related to public health issues.
Secondly, occupational health and safety has always been something that is near and dear to my heart: I have a cousin who was permanently disabled in the workplace, as well as two close family members who died in work-related accidents. When I was an undergraduate, I studied workplace safety from a theoretical perspective in my labor economics classes, and if any of you want to see a graphical analysis of risk in the workplace, I am your man! On top of this, in my honors research paper, I looked at the risks shouldered by fashion models when they decide to engage in dangerous eating behaviors to get ahead in the job market. This is definitely not the type of issue that immediately comes to mind when one thinks of workplace safety, I know, but it does fit under the occupational health and safety rubric.
Thirdly, as Sarah said, Mr. Trippler talked about what actions were being taken by individual states, and the fact that the Federal government is lagging behind in some occupational health and safety areas. From a public policy standpoint, this is one of the advantages of living in a country with several separate state-level governments (note for readers: my nerdiness might start to show in the next couple of sentences). During my undergrad, I took a number of public finance courses in which I learned all sorts of fascinating things, including the idea of states (provinces in my case) as essentially policy laboratories. The small size of states (relative to the country as a whole) means that it is relatively less costly to implement programs at the state level. If they work, the federal government can take this into account when looking at the feasibility of implementing similar programs for the country as a whole. Thus, states can be thought of as experimental environments for different policies, which is even cooler if different states implement different sorts of policies to address similar issues. It may be the case that the Federal government has not acted on some occupational health and safety issues for totally unrelated reasons (such as organizational problems in the Occupational Safety and Health Administration offices), but I thought I would take this opportunity to discuss something I believe is cool about public policy in federations.
I think that the main thing I took away from this evening (aside from the excitement of re-living my days as an undergraduate econ nerd) was the breadth of the public health field and the number of opportunities therein. Before a month ago, I had never even heard of the field of industrial hygiene, but the meeting was actually about two things that I identify quite strongly with: safety in the workplace and getting a toe in the policy process to ensure that the concerns of an important group are heard. I definitely encourage all of you to explore relative unknowns lest you let what could be an awesome opportunity slip by!
Secondly, occupational health and safety has always been something that is near and dear to my heart: I have a cousin who was permanently disabled in the workplace, as well as two close family members who died in work-related accidents. When I was an undergraduate, I studied workplace safety from a theoretical perspective in my labor economics classes, and if any of you want to see a graphical analysis of risk in the workplace, I am your man! On top of this, in my honors research paper, I looked at the risks shouldered by fashion models when they decide to engage in dangerous eating behaviors to get ahead in the job market. This is definitely not the type of issue that immediately comes to mind when one thinks of workplace safety, I know, but it does fit under the occupational health and safety rubric.
Thirdly, as Sarah said, Mr. Trippler talked about what actions were being taken by individual states, and the fact that the Federal government is lagging behind in some occupational health and safety areas. From a public policy standpoint, this is one of the advantages of living in a country with several separate state-level governments (note for readers: my nerdiness might start to show in the next couple of sentences). During my undergrad, I took a number of public finance courses in which I learned all sorts of fascinating things, including the idea of states (provinces in my case) as essentially policy laboratories. The small size of states (relative to the country as a whole) means that it is relatively less costly to implement programs at the state level. If they work, the federal government can take this into account when looking at the feasibility of implementing similar programs for the country as a whole. Thus, states can be thought of as experimental environments for different policies, which is even cooler if different states implement different sorts of policies to address similar issues. It may be the case that the Federal government has not acted on some occupational health and safety issues for totally unrelated reasons (such as organizational problems in the Occupational Safety and Health Administration offices), but I thought I would take this opportunity to discuss something I believe is cool about public policy in federations.
I think that the main thing I took away from this evening (aside from the excitement of re-living my days as an undergraduate econ nerd) was the breadth of the public health field and the number of opportunities therein. Before a month ago, I had never even heard of the field of industrial hygiene, but the meeting was actually about two things that I identify quite strongly with: safety in the workplace and getting a toe in the policy process to ensure that the concerns of an important group are heard. I definitely encourage all of you to explore relative unknowns lest you let what could be an awesome opportunity slip by!
Fewer US med students choosing primary care - Yahoo! News
Fewer US med students choosing primary care - Yahoo! News
The reality of Workforce Shortage hit home for me by this article whose findings basically highlighted the issue. I was astonished by the fact that only 2% of graduating Medical Students in this study have interests in going into primary care. There are alot of rigours associated with primary care that turns off many physicians (who are they to blame, I mean, the opportunity of more money and less work is attractive even to the most noble of us).
Although the issue is problematic as it is, the continuation of this trend will be catastrophic especially to underserved communites. As we all know, many of these communities provide physicians an even lower incentive to practice due to the low reimbursement and complexities that Medicare and Medicaid (which are most often used) provide.
So my question is, how do we address this problem? I personally like the "Robinson's Theory" ( a number of us shoould already be familiar with this from our Economics class), which basically suggest to create a system in which med school is made to be much more expensive (as if it isn't already expensive enough, right?), but physicians who choose to actually practice medicine/primary care would have their outrageous medical school expenses paid for by the Govt. My memory might be failing me, but I think a similar system is used in Cuba in which med school is free for individuals who commit to working in underserved communities for a number of yrs.
I am sure there a plethora of arguments against this plan (heck, I can think of a few myself), but I'm putting it out there because as future health leaders, it is necessary to start brainstorming on ways to tackle pertinent problems such as this. Anyway feel free to offer your thoughts.
The reality of Workforce Shortage hit home for me by this article whose findings basically highlighted the issue. I was astonished by the fact that only 2% of graduating Medical Students in this study have interests in going into primary care. There are alot of rigours associated with primary care that turns off many physicians (who are they to blame, I mean, the opportunity of more money and less work is attractive even to the most noble of us).
Although the issue is problematic as it is, the continuation of this trend will be catastrophic especially to underserved communites. As we all know, many of these communities provide physicians an even lower incentive to practice due to the low reimbursement and complexities that Medicare and Medicaid (which are most often used) provide.
So my question is, how do we address this problem? I personally like the "Robinson's Theory" ( a number of us shoould already be familiar with this from our Economics class), which basically suggest to create a system in which med school is made to be much more expensive (as if it isn't already expensive enough, right?), but physicians who choose to actually practice medicine/primary care would have their outrageous medical school expenses paid for by the Govt. My memory might be failing me, but I think a similar system is used in Cuba in which med school is free for individuals who commit to working in underserved communities for a number of yrs.
I am sure there a plethora of arguments against this plan (heck, I can think of a few myself), but I'm putting it out there because as future health leaders, it is necessary to start brainstorming on ways to tackle pertinent problems such as this. Anyway feel free to offer your thoughts.
Sarah and Emma go to Washington...well, sort of...
Last night Emma D. and I attended the Northern California Chapter of AIHA (American Industrial Hygiene Association) to meet our professional development requirement for class. You might be thinking that this sounds like an *unusual* meeting for HPM students to attend, but we were drawn by the speaker: Aaron Trippler, AIHA Director of Government Affairs. And to be fair, although we do not use it in OUR everyday academic lives, Industrial Hygiene (IH) plays an important role in workplace health and safety and covers workers' rights and other policy-related issues of interest to us wonkly-types. (And as it turns out, there are a lot of jobs available in this industry; to find out more, visit: http://www.aiha-ncs.org/.)
Trippler, who was extremely animated and an excellent speaker (which DOES make a big difference at long meetings!) addressed a crowd of IHers and described the current political climate in DC, especially as it related to important issues in IH, such as baryllium, asbestos, combustable dust, and other ergonomics and workplace safety issues. Perhaps the most important information gleaned from this talk was that, due to the nature of Washington around election season (i.e., kind of a slow mess regarding passing new legislation, especially when it deals with environmental health and safety regulation, which tends not to be high-visibility), the states are taking up a lot of environmental health and safety issues and running with them.
What kind of issues? (See, I knew you were going to ask that question...) Right now ergonomics is entering the scene and making it onto the agenda of more and more state legislatures. Also, regulations for things like combustible dust (Google: Georgia sugar factory explosion) are becoming important since states can often quickly enact safety legislation to protect citizens.
But this meeting (to us!) was so much more than an update about the status of IH in DC; Emma and I also gained more insight into the world of health policy and management. We were able to see how a professional association and interest group (a very well organized one at that!) interacts with legislators and states but also with its own members in different chapters around the nation. And, for an evening, we were able to step off the HPM "beaten path" and meet some interesting and influential public servants and other IH professionals, whom we often overlook because they are behind-the-scenes, but they are the ones keeping us safe at work and in public places :).
Addendum: Perhaps the most amusing part of the evening was when a hotel worker came into the meeting to close the window and in doing so, had to use a ladder. Immediately, members of AIHA began shouting out ladder safety information and two members jumped up to hold the ladder for the worker. While definitely funny, it was also great to see people so passionate about their work!
Trippler, who was extremely animated and an excellent speaker (which DOES make a big difference at long meetings!) addressed a crowd of IHers and described the current political climate in DC, especially as it related to important issues in IH, such as baryllium, asbestos, combustable dust, and other ergonomics and workplace safety issues. Perhaps the most important information gleaned from this talk was that, due to the nature of Washington around election season (i.e., kind of a slow mess regarding passing new legislation, especially when it deals with environmental health and safety regulation, which tends not to be high-visibility), the states are taking up a lot of environmental health and safety issues and running with them.
What kind of issues? (See, I knew you were going to ask that question...) Right now ergonomics is entering the scene and making it onto the agenda of more and more state legislatures. Also, regulations for things like combustible dust (Google: Georgia sugar factory explosion) are becoming important since states can often quickly enact safety legislation to protect citizens.
But this meeting (to us!) was so much more than an update about the status of IH in DC; Emma and I also gained more insight into the world of health policy and management. We were able to see how a professional association and interest group (a very well organized one at that!) interacts with legislators and states but also with its own members in different chapters around the nation. And, for an evening, we were able to step off the HPM "beaten path" and meet some interesting and influential public servants and other IH professionals, whom we often overlook because they are behind-the-scenes, but they are the ones keeping us safe at work and in public places :).
Addendum: Perhaps the most amusing part of the evening was when a hotel worker came into the meeting to close the window and in doing so, had to use a ladder. Immediately, members of AIHA began shouting out ladder safety information and two members jumped up to hold the ladder for the worker. While definitely funny, it was also great to see people so passionate about their work!
SF Chronicle: State budget impasse threatens health services
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/09/06/MN6V12OVN5.DTL
State budget impasse threatens health services
San Francisco Chronicle, Sept 6
"...Many service providers, who gathered Friday outside the Capitol, said they've already received loans, maxed out their credit cards and even poured in personal funds to keep their centers open - and they are running out of time, money and options. Among them was Sarane Collins, 44, who in her own words is a 'chief financial officer of a sinking ship' that cares for 18 adults with disabilities in three homes in Santa Rosa. After cutting paychecks Friday to about 40 employees, her nonprofit will be broke, she said. Collins is hoping she can get a loan from the North Bay Regional Center, one of 21 nonprofit centers in California that administer funds to centers serving people with disabilities... Collins last received payment from the state on July 10. Since then, her nonprofit, called Slow Sculpture, has taken out a $60,000 line of credit and maxed out its credit cards at $50,000. The pharmacist who works with her clients has loaned $30,000 of his personal funds, and Collins has also poured in $15,000 of her own money... She is considering telling her board of directors to shut down the nonprofit. Two or three of her 18 clients have family members who can take them in, while the rest would have to find skilled nursing care elsewhere, she said. 'Some of our guys need constant oxygen,' she said. 'Five people are tube-fed. We have people with seizure disorders. Some have as many as 20 medications each day. We have people who have stage-4 sarcoma cancer, and 90 percent of our clients are in wheelchairs.'..."
On the subject of P4P...
After reading the NYT article that Kim posted on the pitfalls of P4P, I started wondering how Great Britian's P4P system is structured. For anyone who watched the Frontline video of the primary physician that was interviewed, he seemed pleased with the bonuses he received from producing better health outcomes for his patients. The video presented what seemed like a flawless view of the P4P system in Great Britain. From what I gathered, the way P4P works in countries like Great Britain and New Zealand is that the P4P goals are adjusted by economic status of the surrounding community in which the clinic is located. This is predicated on the knowledge that lower socioeconomic patients have poorer health than patients with higher socioeconomic status. In this way the P4P system does not create disincentives for physicians to work in underserved communities if they're not meeting their P4P goals. Any thoughts of whether this aspect of P4P could work in the U.S.?
Here is the article that talks about this:
http://www.minnesotamedicine.com/PastIssues/April2006/CommentaryApril2006/tabid/2386/Default.aspx
Tuesday, September 9, 2008
TIME article: "Thinking Long Term"
I noticed this article in TIME that talks about a method to reduce the burden of the upcoming baby boomer’s reaching retirement age. One way insurers are trying to address to the high cost of anticipated assisted living and other elder care is with “life style” planning similar to mutual funds. The plans allow you start with small investments and then start adding more coverage as get closer to actually needing the elder care.
I wonder if enough people would buy these plans to make a significant difference in the expected influx of elder when the baby boomers retire? I would lean towards people being scared about Medicare not being able to cover this influx with all the attention the issue has been getting, but there are also statistics out there how people grossly underestimate their actual end of care needs and the idea that baby boomers are in denial of their own aging and economic burden. Although the plans have an inherent social economic exclusivity that doesn’t really present them as a solution to the problem, maybe it could help.
http://www.time.com/time/magazine/article/0,9171,1838769,00.html
Monday, September 8, 2008
Recommended Reading
Quint Studer starts his book Hardwiring Excellence with a discussion of what he calls “Fire Starters.” These are people who have had a great effect on the lives of others, or, in the health care field, those “who are committed to transforming health care through compassion, imagination, and often, sheer determination.”* The author’s description of “Fire Starters” immediately made me think of a book that I read over the summer entitled Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World, by Tracy Kidder. I know that each of you is very, very busy with course readings and assignments, but I would recommend that during your time at the
Dr. Paul Farmer is a physician, a professor at
Mountains Beyond Mountains is an amazing book about a truly inspirational individual; Dr. Farmer’s determination to ameliorate the health conditions of those in
**PIH has projects in
Welcome to Fall 2008 HPM Class
Hi everyone - here is the class blog.....I hope you all will find it a useful forum to share ideas, react to articles, postings etc. Please review the blog posting guidelines handed out in class (and in Resources area on bspace).
To kick things on a content front, I attach a link to a recent article in the NYT http://www.nytimes.com/2008/09/09/health/09essa.html?ref=health
that touches on P4P - something we surfaced in class last week. As you can see it can look very different depending where you come at this from. This essay from a cardiologist points out some very real pitfalls.
Kim
To kick things on a content front, I attach a link to a recent article in the NYT http://www.nytimes.com/2008/09/09/health/09essa.html?ref=health
that touches on P4P - something we surfaced in class last week. As you can see it can look very different depending where you come at this from. This essay from a cardiologist points out some very real pitfalls.
Kim
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