Lloyd H. Dean on Health Reform

The San Francisco Chronicle features an in-depth interview with Catholic Healthcare West President/CEO, Lloyd H. Dean. In the interview Dean discusses the potential of healthcare reform in light of the presidential election and current economic crisis, and other issues affecting the health industry and not-for-profit health systems.

According to the feature, Dean, 58, is not the most likely person to run a Catholic health organization. The first African American and non-Catholic chairman of the Catholic Health Association of the United States, Dean was raised as a Baptist, was one of nine children and didn't see a doctor until high school. He was recently included in a list of the nation's top 25 minority health care executives by Modern Healthcare magazine.

A few salient excerpts from the interview:

Q: Given the state of the economy, is health care still at top of the list of domestic concerns, and what are the chances of reform?

A: There's no question that the current economic environment has probably trumped everything. Folks like ourselves, and all across this nation, are really focused on their own financial viability.

But I think a very, very close second is health care and health reform. There was a Gallup poll that came out last week that said, other than getting some stability in the current financial crisis, that health care is still the prevailing issue. It has even trumped some of the issues around Iraq and Afghanistan.

There will be some stabilization - I can't tell you how long it will take - of this fiscal crisis we're in, and health care will jump right back to the top of the agenda. The fact that there are 46 million people who do not have access to care and use the most inefficient way of receiving health care - through our ERs. That's not sustainable.

Q: If you had power to resolve the problem of the uninsured what would you do?

A: I would and will continue to advocate some kind of universal health care in this country. I think that health care is a right. I don't think that it's a privilege. It is a shame that a country of our means has 46 million individuals who do not have access or have no way of paying for their health care.

Many individuals I see and talk to - and even in my own family - have to choose whether they are going to spend money on medicine or spend money on food. Am I going to split my pill in half so that I can buy oil to heat my home through the whole winter?

I have advocated forming coalitions at any level - at the federal level like we do with the Catholic Health Association of the United States, here with the Healthy San Francisco program - I believe it is in the best interest of the country that everyone has access to a minimal level of health services.

I know what it's like to not have health care. I grew up in an environment where the first physician I ever saw was in the high school physical. My father was, we like to say, the surgeon and my mother was the nurse. I come from a family of nine kids. The only time I ever visited the doctor was to join my mother one time when one of my brothers was being born.

As provider of health care, we are compelled to be as efficient as possible and we have to be part of the solution. Health care in this country is way too expensive. If we don't stop this, we won't be able to afford to pay, and that 46 million will be 75 million, and wouldn't that be a shame?

Worst to First? Play Ball!

An op-ed in today's New York Times describes what the healthcare industry can learn from baseball. And it's written by Billy Beane, Newt Gingrich, and John Kerry:

Remarkably, a doctor today can get more data on the starting third baseman on his fantasy baseball team than on the effectiveness of life-and-death medical procedures. Studies have shown that most health care is not based on clinical studies of what works best and what does not — be it a test, treatment, drug or technology. Instead, most care is based on informed opinion, personal observation or tradition.

It is no surprise then that the United States spends more than twice as much per capita on health care compared to almost every other country in the world — and with worse health quality than most industrialized nations. Health premiums for a family of four have nearly doubled since 2001. Starbucks pays more for health care than it does for coffee. Nearly 100,000 Americans are killed every year by preventable medical errors. We can do better if doctors have better access to concise, evidence-based medical information.

Look at what’s happened in baseball. For decades, executives, managers and scouts built their teams and managed games based on their personal experiences and a handful of dubious statistics. This romantic approach has been replaced with a statistics-based creed called sabermetrics.

These are not the stats we studied as children on the backs of baseball cards. Sabermetrics relies on obscure statistics like WHIP (walks and hits per inning pitched), VORP (value over replacement player) or runs created — a number derived from the formula [(hits + walks) x total bases]/(at bats + walks). Franchises have used this data to answer some of the key questions in baseball: When is an attempted steal worth the risk? Whom should we draft, and in what order? Should we re-sign an aging star player and run the risk of paying for past performance rather than future results?

Similarly, a health care system that is driven by robust comparative clinical evidence will save lives and money. One success story is Cochrane Collaboration, a nonprofit group that evaluates medical research. Cochrane performs systematic, evidence-based reviews of medical literature. In 1992, a Cochrane review found that many women at risk of premature delivery were not getting corticosteroids, which improve the lung function of premature babies.

Based on this evidence, the use of corticosteroids tripled. The result? A nearly 10 percentage point drop in the deaths of low-birth-weight babies and millions of dollars in savings by avoiding the costs of treating complications.

CHW is an advocate of evidence-based medicine. We've been working for the last several years on reducing variance in treatment so that the treatments we know to be the most effective are the ones that are used the most often. We encourage others to join us in this effort and make care safe and cost effective.

The Financial Crisis and Healthcare

Health care is as essential to social well-being as the availability of food and shelter. When health care is unavailable or inadequate, individual suffering permeates the wider community. Over the past sixty years, many solutions have been offered to reform the nation’s health care system – a system characterized today by rapidly 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.

At CHW, we believe fiscal analysis alone is insufficient to the task of reform. The values and aspirations associated with the reform measure must also be taken into account. We believe the debate should be re-framed and the question should be: When considering how to provide for the health care needs of its members, what should be expected of a compassionate society?

In a time of severe financial crisis we believe reform is even more urgently needed. Consider this excerpt from a Chicago Tribune op-ed:

The financial markets are gyrating. The world economy is teetering. The U.S. government is making a $700 billion or more bailout to avert a worldwide disaster. No surprise, health care has become a side show. Or has it? Not only does this upheaval actually make health-care reform more pressing, it makes comprehensive reform—change in the way health care is paid for and how care is organized and delivered— more realistic and feasible.

"Socialism" has come to Wall Street. For more than 60 years, Republicans have criticized as "socialized medicine" any reform proposal that gave government a central role in funding health services or in regulating providers.

The charge has always been false. True socialism requires governmental ownership of the means of production. No health-care reform proposal, even the most ardent single-payer plans, ever suggested the government should employ doctors, or own hospitals, pharmacies, home health-care agencies or drug companies.

The phenomenal failure of Wall Street dramatically changes the appetite of the country for regulation and for shoring up the safety net. With trillions of dollars evaporating in this crisis, millions of middle-class Americans face the prospect of losing their homes and jobs, and witnessing a dramatic contraction of their retirement savings. In response, the public will desperately want financial security, and health care is a critical element of that.
This financial crisis also means Americans may be more willing to forgo gold-plated comprehensive insurance that covers everything with few restrictions. Under the threat of losing everything, Americans may feel content with the guarantee of a decent plan that covers cost-effective treatments with some restrictions on choice and services to save money. This should enhance the chances for a bipartisan deal on health care.

It will take the best minds in America to make a compassionate system a reality, but it’s imperative that we do so. A system that guarantees access to medical care is a system that makes our country stronger. And a system founded on compassion is one that makes our country better.

Quote for the Day

"What we need is what the ancient Israelites called hochma - the science of the heart - the capacity to see, to feel, and then to act as if the future depended on you. Believe me, it does." — Bill Moyers

The Bailout and Mental Health

While the $700 billion bailout may be getting some economists down, it's also providing parity in health care for mental health. The New York Times gives greater detail, but in essence insurers have for decades set higher co-payments and deductibles and stricter limits on treatment for addiction and mental illnesses.

By wiping away such restrictions, the new law will make it easier for people to obtain treatment for a wide range of conditions, including depression, autism, schizophrenia, eating disorders and alcohol and drug abuse.

The goal of mental health parity once seemed politically unrealistic but gained widespread support for several reasons:

• Researchers have found biological causes and effective treatments for numerous mental illnesses.
• A number of companies now specialize in managing mental health benefits, making the costs to insurers and employers more affordable. The law allows these companies to continue managing benefits.
• Employers have found that productivity tends to increase after workers are treated for mental illnesses and drug or alcohol dependence. Such treatments can reduce the number of lost work days.
• The stigma of mental illness may have faded as people see members of the armed forces returning from Iraq and Afghanistan with serious mental problems.
• Parity has proved workable when tried at the state level and in the health insurance program for federal employees, including members of Congress.

Dr. Steven E. Hyman, a former director of the National Institute of Mental Health, said it was impossible to justify insurance discrimination when an overwhelming body of scientific evidence showed that “mental illnesses represent real diseases of the brain.”

This is good news for advocates for those in need of mental health services and we're very much in support of any measures that allow for better management of health conditions.