CHW Urges Lawmakers to Enact Reform

Our new ad campaign launched yesterday, which coincides with the launch of our new health care reform website: www.chwHEALTH.org/reform. The site, and our ads, highlight our commitment to improving health care through innovation and focuses on how those innovations can help lower costs. The campaign includes a series of video messages from CHW President/CEO Lloyd Dean that urges America’s leaders to pass health care reform legislation this year.

The series of issues ads, created by the San Francisco advertising firm EC1, will appear in the print and online versions of the Washington Post, the Washington Times, The Hill, Roll Call, and the Wall Street Journal, as well as on key websites including CNN, the New York Times, Roll Call, the Drudge Report, and Politico. 

We've been longtime supporters of health care reform. We took our first official positio in support of universal access in 1992, and in 2003, we established four principles for reform – universal access, stable financing, and improved quality and accountability.

In 2007 and 2008, we launched our first series of advertisements advocating for health care reform in California. We also convened leaders in business, academia, health care, labor, religion, and research for a think-tank style, invitation-only discussion designed to generate new ideas for reforming the U.S. health care system. The Healthcare Leadership Summit was moderated by Leon Panetta, who was then the director of the Leon & Sylvia Panetta Institute for Public Policy.

And in March 2009, we released the findings from our annual Health Security Index™, based on a nationwide survey of more than 1,150 adults. The survey found that despite the ailing economy, more people in the U.S. are worried about rising health care costs (67%) than are worried about losing their jobs (37%). The survey also found that for the first time, a majority of U.S. adults (51%) believe the nation’s health care system is getting worse.

The Cost Conundrum

The New Yorker prints and excellent article by Atul Gawande on health care costs. He focuses on McAllen, Texas, in Hidalgo County, which happens to be one of the most expensive health care markets in the U.S. The problem?

Local executives for hospitals and clinics and home-health agencies understand their growth rate and their market share; they know whether they are losing money or making money. They know that if their doctors bring in enough business—surgery, imaging, home-nursing referrals—they make money; and if they get the doctors to bring in more, they make more. But they have only the vaguest notion of whether the doctors are making their communities as healthy as they can, or whether they are more or less efficient than their counterparts elsewhere. A doctor sees a patient in clinic, and has her check into a McAllen hospital for a CT scan, an ultrasound, three rounds of blood tests, another ultrasound, and then surgery to have her gallbladder removed. How is Lawrence Gelman or Gilda Romero [both hospital administrators] to know whether all that is essential, let alone the best possible treatment for the patient? It isn’t what they are responsible or accountable for.

After reading the article it may not surprise you that Hidalgo County also ranks third on our Community Need Index's highest need counties in the U.S. (right after Kings and Bronx counties in New York).

Are Urgent Care Centers the Future of Primary Care?

This week the Chicago Tribune examined the growing trend of urgent care centers and concluded that, for many, they are preferred over primary care physicians. According to the Tribune:

Urgent care centers have been gaining ground in Illinois and across the country recently as an attractive medical option for time-pressed families trying to avoid spending hours in a hospital ER or days waiting for a doctor's appointment.

Sometimes known as “docs in a box,” the centers offer walk-in medical services and extended hours to customers with sore throats, ear infections, sprained or fractured limbs, simple wounds and other non-life-threatening medical problems. Doctors provide the care, assisted by nurses, and generally X-ray and laboratory services are available. Most centers are open 365 days a year, and insurance policies cover most services.

This convenience-oriented format, started more than 20 years ago, is getting a boost as hospitals and private firms build new centers, responding in part to new competition from retail clinics in Walgreens, CVS and Wal-Mart stores.

For patients, the centers offer easy access and affordable care, charging a fraction of what services would cost in an emergency room. Many insurers, keen to keep costs down, have begun encouraging people to use urgent care as an alternative to ERs in the evenings or weekends when their doctors' offices are closed.

That puts the onus on patients to evaluate their symptoms and recognize what level of care they need, said Dr. Sandra Schneider, an emergency-department physician at the University of Rochester Medical Center in New York and a vice president of the American College of Emergency Physicians.
…

For some consumers, urgent-care centers are usurping primary care physicians -- a trend some medical experts view with alarm. Pina Lobraco, a mother of two young girls who lives in Addison, said she finds it easier to pop into a nearby Alexian Brothers Hospital Network immediate-care center than to call her doctor and wait to get an appointment.

On Mother's Day, Lobraco was at the center with Daniella, 4, who had started crying and holding her ear earlier in the day. “I don't know why it is, but a lot of times it seems [the girls] get sick in the evening or early in the morning or on the weekends,” she said.

“My regular doctor doesn't know who I am,” Lobraco said later in an interview. “But these people [at the center] know me -- they see me all the time.”

Granted, this anecdote from Ms. Lobraco and others in the Tribune article don’t constitute quantitative evidence, but they do represent the preferences of busy people who aren’t being adequately served by traditional care delivery models. Especially alarming is that Ms. Lobraco has a better relationship with the staff at the urgent care center than with her regular doctor.

With shortages of primary care physicians throughout the country and appointment wait times increasing, will urgent care centers and other walk-in clinics replace primary care physicians as consumers’ first choice for care? And how will this impact the continuum of care? Can primary care doctors tailor their services and hours to offer comparable convenience? In fact, several newspapers, including Minneapolis Star-Tribune and the Washington Post, have been reporting recently that there is a growing number of doctors performing house calls in cities across the nation.

Your Voice Matters in the Health Reform Debate

At Catholic Healthcare West, we believe that a health care system that guarantees access to medical care will make our country stronger. And a system founded on compassion will make our country better.

For those of you who are new here, this blog is intended to capture multiple viewpoints and insights. We believe that no one organization or individual alone has the answer to the current health care crisis, but together we can find the right solution. So we're asking for your opinions. How can America put the "care" back in health care?

What has your experience been moving through the health care system? What has worked well? What hasn't?

Take a look at some of the things we've heard, then share your story by adding a comment to our blog. Let us kow your ideas for improving health care in the U.S.

You Know It's Real When...

...protestors show up to disrupt your hearings. 

May 5th's Senate Finance Committee Roundtable Discussion on Expanding Health Care Coverage may have been more exciting than most, but we're no closer to consensus on how to pay for the reforms.

We are, however, coming closer to consensus on several key issues. Most of the representatives at the Roundtable were in favor of mandating that everyone have health insurance (so long as subsidies are in place for low-income families). There's also general agreement on health insurance portability, strengthening Medicare, and using health care IT to help drive efficiency and lower costs.

The elephant is still in the room, though: how are we going to pay for it?

Are We Ready for Health 3.0?

The realization of change in the U.S. health care system has, in many ways, been centralized in the Health 2.0 movement (see the always excellent The Health Care Blog for the full scoop on all Health 2.0 happenings).

Health 1.0 was characterized by disenfranchised patients and a "Dr. Knows Best" approach. This model has effectively given way to the Health 2.0 model, which is more interested in giving consumers the information they need to make more informed choices about their health care. The empowered consumer, the argument goes, will make the system more efficient and individuals healthier.

The individual responsibility prized in the Health 2.0 model may soon give way to Health 3.0. In this model, personal responsibility becomes part of the social contract we all have with one another. Not only will consumers be given the tools and information they need to make better choices -- they'll be expected to do so. And there will be consequences for not doing so.

Just as the government and some private insurers are moving to a "pay for performance" model with physicians and hospitals, so too are employers now beginning to require their employees maintain a certain level of physical health in order to receive the benefits of the company's health plan. This is Health 3.0. It is the completion of the movement from disempowerment to empowerment to expectation, and we anticipate that it will be an important part of the health care reform solution.  

Is The Reform Debate Too Narrowly Focused?

Over the past sixty years, many solutions have been offered to reform our nation's broken health care system - a system characterized today by relentlessly rising costs, and a growing inability of people to pay for it.

Time and again, national reform proposals have been introduced and scrutinized primarily for their fiscal impact. Each time, these proposals have failed to achieve the support necessary to be implemented.

We have long felt that fiscal analysis alone is insufficient to the task of reform. Why? Because whether you are a political leader, a corporate CEO, an economist, a school teacher, a parent -- when you or someone very important to you becomes ill you want attentive, quality care immediately.

It's not just that the increasing cost of health care is reducing opportunities to invest in other areas of our society, or that it is reducing our competitiveness in the global economy, or that it is rife with inefficiencies. It is all that. But from the perspective of a society that values attention to the suffering of its members, it is also something more.

There are a lot more folks out there talking about broadening the perspective on the health care reform debate beyond finances, including Susan Blumenthal and Denis Cortese, who espouse seven strategies to address the nation's health care crisis. Lincoln Weed and Lawrence Weed argue for addressing medicine's missing foundation. And Anne Tumlinson reminds us not to overlook our long-term care facilities when embarking upon reform.

Why Healthcare Costs So Much

Ezra Klein takes on the onerous task of detailing why U.S. healthcare costs so much. He opines:

The hypothesis I'm going to offer is not definitive, and is not meant to be. But my read of the evidence is that at the root of our health care problem is an almost pathological aversion to making hard choices -- an aversion that has, in its steadiness and implications, become the most consequential choice of all.

At the risk of cannibalizing an upcoming print feature, health care costs are on autopilot. In other areas of life, decisions are made based on whether a particular use of money is a good value as opposed to other uses of that money. Given a budget of $10, a hungry journalist who wants to expense his lunch must choose between the sandwich and the soup. He cannot choose both.

The American health care system doesn’t work like that. There is no budget. We don't want one. We’re profoundly uncomfortable saying that a person’s life, or health, is not worth the price of a particular procedure. And so we don't. We are too terrified of waiting for a procedure to even think of not providing it. We ask only that the procedure be proven effective against a placebo. Beyond that, we make no decisions, and we prefer it that way. Better to let five people die passively than kill one consciously.

Andrew Sullivan is also exploring this issue on his blog. As always, the posts are telling.

The Greater Worry - Health Costs or Job Loss?

President Obama's health care reform road show comes to California today. Catholic Healthcare West's president/chief executive officer Lloyd H. Dean will be speaking at the town hall about health care costs and what we can do to bring them under control. You can watch the live feed at 10:30 am (PST) this morning.

Meanwhile, we've released the findings from our national Health Security Index survey. Most surprising is that in the current environment of corporate layoffs and downsizing, more people in the U.S. are worried about health care costs than are worried about losing their jobs. And fully 83% want Congress to act this year to bring meaningful reform to our health care system. It's clear the country is ready for change - the question now is whether all the conflicting interests can come together and agree on a plan that will work.

Speak Out As If Our Lives Depended On It

Micah Weinberg at the New America Foundation offers an alternative to the "public vs. private" insurance programs being offered by health care reform advocates. The crux of the debate is whether opening up Medicare to the uninsured represents a real solution or a kind of socialized medicine.

But Weinberg calls it a "false choice:"

Health care reform could offer Americans a choice of a public insurance plan that competes fairly with private plans. In basic terms, this fair competition would have three critical ground rules: equality under the law, self-sufficiency and free choice. Equality under the law means that all regulations apply equally to all plans, public and private. Self-sufficiency means that all plans cover their own costs. Free choice means that those who cannot afford insurance will be given government subsidies to choose either a public or private insurance plan.

He also proposes looking to several states, which have successfully created public-private partnerships to offer plans insured by the state. We have had a lot of success with public-private partnerships, including our work with Healthy San Francisco and a collaboration in Los Angeles to open a trauma center at California Hospital Medical Center after the closure of Martin Luther King/Drew Medical Center.

In the end, we have to agree with his final assessment:

Falling back on easy answers in this debate is a hard temptation to resist. From one side we hear, "We should just let the free market work," from the other, "We should have a single-payer system … like Canada."

The problem with these simple slogans is that neither reflects the reality of the challenges that we must face if we are to end the health care crisis and restore the strength of our economy. We must call upon each side of this debate to work together toward a practical solution. Though it is difficult to make the voice of moderation heard, we must speak out as if our lives depended on it.

Because in the case of health care policy, they actually do.

This has been our mantra for some time now. It will take the best minds from many fields to make health care reform a reality, but it's imperative that we do so. Our president/chief executive officer, Lloyd Dean, will be in attendance at the White House Health Care Summit in Los Angeles on April 6th and we'll continue to advocate for a health care system that provides affordable health insurance to all.