This American Life -- Health Care Edition

Hi all,

I'm sure there are some This American Life fans in our class, so I wanted to point your attention to the last two weeks' episodes of this radio program produced by Chicago Public Radio. Both deal with multiple issues in the health care debate.

For those who don't know, This American Life is a radio show produced by Ira Glass that tells the stories of Americans dealing with ordinary problems to the extraordinary. There are usually anywhere from 2-5 stories per show and they're tied together with some uniting theme.

I know it's a bit more time consuming than reading a NYT article, but if you have 2 hours free, I definitely think these two programs are worth listening to. If not for new information, then for the clever editing and touching and informational anecdotes that experts and lay people tell about their roles in our health care industry. Oh, they're FREE to podcast too!

Links:

Episode 391 - More is Less: http://www.thisamericanlife.org/Radio_Episode.aspx?sched=1320
Episode 392 - Someone Else's Money: http://www.thisamericanlife.org/Radio_Episode.aspx?sched=1321

Also, in case anyone is interested, Ira Glass (the host) will be speaking at Berkeley's Zellerbach Hall on Dec. 5. Not sure if tickets are still available, but this show should definitely be interesting.

When Preventative Care Leads to More Harm Than Good

Preventative medicine is thought to be cost-effective in that diseases can be both prevented or caught in the early stages. However, an interesting article came out in the NY Times yesterday, stating that “some patients are enduring aggressive treatments for cancer that could have gone undetected for a lifetime without [harm].” Furthermore, “some cancers found through screening and treated in its earliest stages still end up being deadly.” This suggests that screening can lead to costly, unnecessary treatments that affect patients’ quality of life without improving survival. Of course, it should be acknowledged that screening leads to good outcomes as well, such as appropriate treatment for aggressive cancers. But where should the line be drawn? When is there too much screening? What should be done to protect patients from being diagnosed with pseudo-diseases and experiencing the psychological and physical consequences of overtreatment?

Link: http://www.nytimes.com/2009/10/22/health/22screen.html?_r=1&ref=health

2 Opinions

Here are 2 different opinions in the health care debate and in support of the public option in particular:

The first is an editorial in the New York Times, "The Public Plan, Continued." The author explains how the Senate Finance and Health, Education, Labor, and Pensions (HELP) Committees must now reconcile their two versions of a bill, the former having struck the public option and the latter still insisting on its inclusion. The opinion of the editorial board lies closer to the HELP Committee's version supporting a strong public option but "with care taken to mitigate adverse effects on rural areas," such as low rates of reimbursement for rural hospitals.

The second is from Robert Reich, former US Secretary of Labor under Clinton and current professor at the Goldman School of Public Policy at UC Berkeley, on his personal blog: "Why Obama Has to do What Letterman Did: Refuse to Pay Hush Money." Reich is critical of both Big Pharma and Doctors, as represented by the AMA, nearly equating their demands on the White House's plan to extortion. He proposes that if the President caves to their demands, it is middle-income taxpayers who will ultimately be forced to provide the hush money in the forms of "still higher premiums, co-payments, and deductibles, higher drug prices, Medicare premiums, and taxes." Reich also warns that if Obama is too soft on the Senate and lets important cost containment efforts fail, we may be dealing with an even scarier prospect than further increasing health care costs: Sarah Palin in 2012.

Policy battle brewing in NYC

This'll be interesting to watch.

NY State Health Commissioner mandates that all health care workers get vaccinated against swine/seasonal flu, but enforcement is temporarily paused under a restraining order while three nurses sue.

http://cityroom.blogs.nytimes.com/2009/10/16/judge-halts-mandatory-flu-vaccines-for-health-care-workers/?hp

Personal liberty is at stake, but so is patient safety. I wasn't aware of this, but apparently vaccination policies for health workers so far have been voluntary; this mandate threatens fines, and even termination. You can see the ferocity of people's opinions in the comments section. What's your take?

Dr. Gupta, Miracle Wrangler

Listening to Sanjay Gupta - CNN star doc and once a buzzworthy possibility for Surgeon General - on the radio the other night, I found myself gritting my teeth. His new book, "Cheating Death," explores medical cases in which the process of death is slowed, then reversed. Excerpt here:

http://www.abcnews.go.com/GMA/Books/read-excerpt-cheating-death-sanjay-gupta/Story?id=8792520&page=4

I'm equally fascinated by the mechanics of death and the tinkering that can take place to subvert it, but something about his framing irked me. The notion of evading the inevtiable being valued above all else - isn't this what's driving our usage and cost and medical-choice-in-the-name-of-freedom?

Won't this eventually swell the cost of emergency care, if more and more Americans demand chilled saline and forced hypothermia to save their loved ones? But putting it in the context of my own parents - would this be something I appreciate about living in America, that I in fact can demand unorthodox treatment?

I don't like the action-hero title, your overly enthusiastic delivery, or your grasping for Jules Verne; but, Dr. Gupta, I kinda see your point.

Reestablishment of the White House Initiative on Asian Americans and Pacific Islanders

Today, President Obama followed Clinton's lead from a decade ago to recognize the needs of the Asian American and Pacific Islander (AAPI) Communities by signing the executive order for the reestablishment of the White House Initiative on Asian Americans and Pacific Islanders, which would improve the quality of life in underserved AAPI communities by increasing access and participation in federal programs. Because AAPI's are continually aggregated together in data and research despite the many diverse groups and needs, they are vulnerable to less federal funding and access to programs that could significantly make an impact. I'm really excited that President Obama acknowledges the challenges AAPI communities face, especially in health and educational disparities due to the "model minority myth" and lack of adequate research. This was the reason why I went into public health in the first place! :)

Some excerpts from his speech:

"It's tempting, given the strengths of the Asian American and Pacific Islander communities, for us to buy into the myth of the "model minority," and to overlook the very real challenges that certain Asian American and Pacific Islander communities are facing: from health disparities like higher rates of diabetes and Hepatitis B; to educational disparities that still exist in some communities -- high dropout rates, low college enrollment rates; to economic disparities -- higher rates of poverty in some communities, and barriers to employment and workplace advancement in others."

"It's the impact of a Department of Health and Human Services that funds research on the diseases that disproportionately affect Asian American and Pacific Islander families. It's the impact of a Justice Department that upholds the Voting Rights Act and its promise of language assistance and equal access to the polls. And it's the impact of evidence-based research and data collection and analysis on AAPI communities -- so that no one is invisible to their government."

To watch the video, go here and skip to the speech: http://www.whitehouse.gov/video/The-President-Observes-Diwali/

Tax Capping - What Do You Think?

I'm far from being an economist, but reading and hearing about tax capping today in 200c was by far the most promising financing mechanism I've come across thus far. I know Professor Dow commented on this at the Healthcare Reform Workshop this past month, but a lot of that frankly flew over my head...but today, it made sense! Wow...I finally saw the light.

I understand that eliminating tax breaks is probably sensitive, but the "Win-Win" article written by Jonathan Gruber was actually fairly enlightening. It was realistic, in that he recognized that eliminating it would be a no-no, and so reducing it would be a good bet. I don't find that so bad now do you? Given that it'll generate a good amount of revenue to fund many of these proposed reforms at the same rate at which costs rise makes total sense to me. Call me naive, but when I was employed, it didn't even occur that my premiums were tax-free, I simply chose the cheapest premium and didn't even make the calculation if I was going to save more in taxes had I chosen a more expensive one! I totally agree with Professor Robinson's arguments for tax capping. I think it's realistic and fairly on the moderate side of things.

Frankly, I am a bit disheartened because the bill seems to be losing the whole point of meaningful reform, at least in my definition of "meaningful" - which in my ideal world - means cost-control and realistically financed universal access if not coverage. After reading about the Healthy SF fact sheet today, the plan seemed promising. A group of friends were at Cha Cha Cha (tapas bar with awesome sangria and mojito by the way) in SF last Friday, and one of us pointed out that there was actually a line item for Healthy SF on our $100 bill (fyi, there was about 6 of us and we were hungry and had alcohol) for a mere $2.50. Seriously, that's like 1/50th of the total cost which is pretty much nothing! I'd be curious about whether or not SF does report healthier outcomes and I'd be curious as to how they'd measure that and determine that but it seems to be working well.

I am completely perplexed frankly by all this. We expect so much but we are unwilling to pay for anything or assume any responsibility; but when we don't get it and all hell breaks loose, we look to other people (i.e. gov't) and say "Well, why aren't you doing anything???" I guess this goes back to the fundamental values of our society in general I guess. Are we seriously that fickle??? I think I may have just posed a rhetorical question.

All disclaimer out there, I'm a self-professed Obama fan, and completely admire the guy for taking on this job amidst all the madness right now. It doesn't mean I agree with everything he's doing but in my opinion, he deserves the Nobel Peace Prize for just maintaining some sort of peace and order in trying to pass health care reform. On the global level, I'm not so sure and even if you disagree- just be happy for the guy for the sake of being happy for someone who got an award. Ok I know it's trivial and a bit like comparing apples to oranges, but we were generally happy for Taylor Swift when she won the VMA even though many people didn't think she deserved it and that Beyonce has done so much more, why can't we be happy for the President we voted into office for winning the Peace prize? Yes, I digree I know...but disagree with me by all means!