Blogs and Stories
Can Obama Solve America's Health Care Crisis?
Listening to Drs. Kim, Berwick, and Jarman reflect on what ought to be done gave me hope. They’ve made the right diagnosis—all agreed that it’s the system itself that is broken and tinkering won’t fix it—and had some smart prescriptions. Policies and plans won’t suffice, warned Jim Kim, who’s made a long study of the gap between aspirations and the care that is actually delivered. We need a social strategy, one that will engage Americans eager for a major overhaul of the system. Make hospitals safer, said Don Berwick, who, though an American, was also knighted in Britain for his work averting deaths due to medical error and inefficiencies. We need electronic medical records, said both. (It can’t be that hard: Partners In Health has developed an EMR in Haiti and Rwanda, for heaven’s sake.) Assess each hospital’s performance for age-adjusted death rates, counseled Brian Jarman. And why not extend Medicare, or something like it, to all? (Bush has twice vetoed extending insurance for all children). He also observed that as long as we speak of the “health care industry,” rather than a health service, we should expect to see costs continue to rise. Sober estimates suggest that the magic of the market will have us spending more than 25% of our GDP on health care within a couple of decades. That’s a lot of dosh, as the Brits say. While I have no gripe with spending money on health care rather than pre-emptive military adventures or the bloated Farm Bill, what about education, green energy, fixing dilapidated public infrastructure (from bridges to broadband), and keeping Americans from losing their homes? And as in Haiti and many other poor countries, the drop into destitution—here, that means hunger and death; in the United States, that means foreclosure or choosing between heating your house and filling your prescriptions—is often triggered by illness and catastrophic health expenditures.
You don’t have to be an expert in health policy, I hope, to be part of the much-needed national discussion about how to improve both health and health care. But, happily, we do have experts on the topic, real experts of a different stripe than those so designated over the past decade (years during which banking regulation was in the hands of deregulators, environmental policy was ceded to polluters, and energy policy was dictated by the carbon-fuel cabal, to name just a few recent Orwellian developments). We need a bold new plan, and if we link sound policy to the groundswell of support for safe and equitable health care, this will be the time to extend insurance to all Americans. The impact such developments could have in places like Haiti, and throughout Latin America and Africa, would be enormous, too. Right now, it’s rare that citizens of the global South look north for inspiration, but that can all change.
Lots of health-policy experts are advancing dueling plans, and it takes real expertise, perhaps, to understand the fine print (“Now you miss us policy wonks,” Clinton, husband of an encyclopedically informed health-care policy wonk, said in Florida). Jim Kim, one of the most visionary doctor-wonks I know, has been pushing from Harvard for an Institute for Health Care Delivery to go the final mile and make sure that we can move from policies and plans to real improvements in the prevention and care that Americans, young and old, need.
More disclosure: Jim Kim and I are part of a loose confederation called “Doctors for Obama.” But we’re doctors for Obama in the hope that we can be good doctors to our patients, regardless of social standing or party affiliation. Only a few days after the most remarkable and uplifting election in living memory, it’s not too soon to hope that our new president will call on the best and the brightest to help us make medicine live up to its promise. Are Americans today really opposed to FDR-style social insurance? We can learn something from the British on this score (OK, maybe not as regards dental plans) and from groups like IHI and visionaries like Kim. Patients (and who is not one, as some point?) and doctors alike may need to dig deep to find our inner New Dealers, but it’s high time we built a real social movement for a proper health service worthy of the American people.
John Talks Joe
Lloyd Grove is editor at large for The Daily Beast. He is also a frequent contributor to New York magazine and was a contributing editor for Condé Nast Portfolio. He wrote a gossip column for the New York Daily News from 2003 to 2006. Prior to that, he wrote the Reliable Source column for the Washington Post, where he spent 23 years covering politics, the media, and other subjects.
Why America Must Learn to Bow
Martin Jacques is the cofounder of the UK think tank Demos, writes a regular column for The Guardian, and is a visiting research fellow at the London School of Economics Asia Research Centre. His new book, When China Rules the World, is available now.
Going Rogue: The Index
Christopher Buckley's books include Supreme Courtship, The White House Mess, Thank You for Smoking, Little Green Men, and Florence of Arabia. He was chief speechwriter for Vice President George H.W. Bush, and is editor-at-large of ForbesLife magazine. His new book is Losing Mum and Pup, a memoir. Buckley's Daily Beast column is the winner of an Online Journalism Award in the category of Online Commentary.
Obama's Choice: Appease an Ally or Do the Right Thing
Paul Farmer, MD, PhD, is Presley Professor of Social Medicine at Harvard Medical School, associate chief of the division of global health equity at Brigham and Women’s Hospital, and a co-founder of Partners In Health, a nonprofit organization that provides free health care and undertakes research and advocacy on behalf of the destitute sick. He is known for helping create innovative community-based approaches to treat HIV/AIDS and TB in resource-poor settings, particularly in Haiti and Rwanda.
A Disaster Worse Than Katrina
Paul Farmer, MD, PhD, is Presley Professor of Social Medicine at Harvard Medical School, associate chief of the division of global health equity at Brigham and Women’s Hospital, and a co-founder of Partners In Health, a nonprofit organization that provides free health care and undertakes research and advocacy on behalf of the destitute sick. He is known for helping create innovative community-based approaches to treat HIV/AIDS and TB in resource-poor settings, particularly in Haiti and Rwanda.
I appreciate this, but I'm alarmed that professional nursing is not mentioned. (I'm the nurse who asked you the question about a nursing presence on your open access journal's advisory board and in the journal's research content.)
I am increasingly alarmed and disheartened to learn that nursing doesn't have a voice or a vote on the Obama transition team, nor in Obama's health platform. Yet, a bottom up essential healthcare services model has at its center, professional nursing.
Although the media narrative almost always is limited to physicians, hospitals and patients, I defy anyone to explain how healthcare happens in the absence of professional nurses.
I blog about this ad nauseum, and I hope that the public will be interested enough to read so that they (all of us) can make more fully informed choices about the redesign of a US health care system and the allocation of scarce resources.
We need to extend healthcare- NOT health insurance- to
every American. Healthcare should not be a for-profit enterprise. Simply put, there can be no real reform without dispensing with insurance companies. We should have a government-sponsored single-payer system. "Tweaking" the current system won't work. Just like cancer, the insurance malignancy must be excised in its entirety.
If the question posed is "can Obama fix health care" why isn't it answered or at the very least the questions outlined and how to date policy and inertia have failed the system.
All very good to read the information provided but what is your thesis? Really don't care if you respond from Haiti, Africa, Boston or Delta Airlines. Please answer the question you posed.
I'm glad Dr. Farmer mentioned medical harm as a leading cause of death. It's not a mainstream concept but a classmate and I tried to make it easier for people to understand as part of our MPH program. I urge you to check out our video:
http://www.youtube.com/watch?v=SP9Ly7xOMn8
The American system of economics and of medicine are both in great periods of constraint. Regulation has hampered access to medical care and to financial options, such as short term installment loans. For emergencies, there should still be options open for both medicine and for finances. The Physician's Foundation recently released survey information where 78% of those surveyed responded that there are already too few family practitioners, and half of those surveyed are frustrated and angry with both government and HMO regulation and are looking to close their practices. As the population grows, the doctor to patient ratio is diminishing, and it will reach a breaking point. In a similar manner, if bank and government regulation find a way to eliminate the only other legal alternative option to short term emergency financing - short term installment loans - then the consumers will be stretched to the breaking point. Already many are too far in debt with credit cards, and no one wants to seek out a loan shark. Studies have been showing conclusively that the absence of payday installment loan lenders has only produced negative impact, such as the one by Jonathan Zinman, Assistant Professor of Economics at Dartmouth College. Doctors and consumers should be contacting their representatives and establishing their right to put their decisions over their finances and their health in their own hands, where it belongs. Click to read more on Short Term Installment Loans
As an Intensive care nurse I see many seniors.....75-90yr. receive aggressive life saving treatments that often times prolongs life for less than a year resulting in poor quality of life. There seems to be less dignity for them. Quite often the Dr, no longer calls the shots but is at the whim of a more educated family and public who wants everything to be done . The family has a hard time letting go or the miracles of modern medicine that are hoped for, are used to prolong a persons life. More money is spent in the last decade of life than all the years previous. These bedside issues need to be looked at in revamping the healthcare system.
Quoting Bill Clinton? Is this the same Bill Clinton who stood by and watched the Rwandan genocide, doing nothing?
For me it is simple, I long for the day when even just the spoken terms, humanism/socialism are considered -or better yet, embraced - and capitalism is feared. When will we finally put human rights before corporate rights? What happened to the simple, honest and humane "golden rule?" If I had a nickle for every time that I have heard someone say that they are "afraid we are headed for socialism" I could pay for a new healthcare system myself! Educate thy selves! Socialized healthcare may very well help us all someday!
Thank you.
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