Wednesday, September 30, 2009

Headache from reading insurance bill is preexising condition

Stephen Colbert on health reform (funny stuff)

The Colbert ReportMon - Thurs 11:30pm / 10:30c
The Word - Out of the Closet
Colbert Report Full EpisodesPolitical HumorMichael Moore

Increase in Out of Pocket Care Costs

As policymakers continue to debate comprehensive reform of the nation’s health care system, a new report commissioned by the Robert Wood Johnson Foundation (RWJF) projects that if federal reform efforts are not enacted, the cost of failure would be substantial. In every state, the number of uninsured will increase, employer-sponsored insurance (ESI) coverage will continue to erode, spending on public programs will balloon and out-of-pocket health care costs for individuals and families could increase by more than 35 percent over the next decade. While all income levels would be affected, middle-class working families would be hardest hit.

“We hear a lot about the political toll of health reform, but the cost of failing to reform our health care system will be felt most strongly by our state governments, our communities, and most importantly, our families and neighbors,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation. “Now is the time to act, because delaying reform makes the problem worse. In just 10 years, the cost to American businesses for their workers’ health care could double. The number of uninsured Americans could reach almost 66 million. Individual and family spending on health care would jump 46 to 68 percent, with middle-class families hardest hit. The consequences would be blind to politics and felt by Democrats, Republicans and Independents alike. The only ‘universal’ thing to come from inaction would be the pain.”

Researchers from the Urban Institute used their Health Insurance Policy Simulation Model to estimate how coverage and cost trends would change between now and 2019 if the health system is not reformed. The analysis examines three scenarios:

  • Worst case - assuming slow growth in incomes and high growth rates for health care costs;
  • Intermediate case - assumes faster growth in incomes but a lower growth rate for health care costs;
  • Best case - assumes full employment, faster income growth and even slower growth in health costs

The report shows that under the worst-case scenario, within 10 years:

  • In 29 states, the number of people without insurance would increase by more than 30 percent.
    The number of uninsured could grow by at least 10 percent in every state under the worst-case scenario. All told, the number of uninsured Americans would reach 65.7 million.
  • Businesses would see their premiums continue to increase—more than doubling in 27 states.
    Even in the best case scenario, 46 states would see employer premium costs increase by more than 60 percent.
  • Every state would see a smaller share of its population getting health care through their job.
    Half of the states would see the number of people with employer-sponsored insurance (ESI) fall by more than 10 percent.
  • Every state would see their Medicaid/Children's Health Insurance Program (CHIP) spending rise by more than 75 percent.
    Half the states would see their costs more than double.
  • The amount of uncompensated care in the health system would more than double in 45 states.
    Even in the best case, uncompensated care would increase by more than 50 percent in 48 states.

"While enacting health reform will be difficult and expensive, the cost of failure would be considerable for every state in the union, and affect every community,” said John Holahan, Ph.D., director of the Health Policy Center at the Urban Institute and one of the report’s authors. “Even in the best scenario, the cost of state-funded programs will grow considerably. Without reform, taxes will likely have to increase significantly to pay for higher Medicaid costs and care for the additional uninsured."

Out-of-Pocket Health Care Costs Could Increase More Than 35 Percent in Every State by 2019

Robert Wood Johnson Foundation

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years, the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime.

Urban Institute

The Urban Institute gathers data, conducts research, evaluates programs, offers technical assistance overseas, and educates Americans on social and economic issues—to foster sound public policy and effective government.

Monday, September 28, 2009


I love this map. These folks have done some excellent work. This map and the data behind it were compiled by Dr. Henry Niman, a biomedical researcher in Pittsburgh, Pennsylvania, using technology provided by Rhiza Labs and Google. The map is compiled using data from official sources, news reports and user-contributions and updated multiple times per day. Rhiza's web-based mapping product, Insight, is helping Dr. Niman get official and unofficial data into the tracking system faster while giving researchers and the public many options for viewing the data in a useful and understandable way.

Most Children Not In Favor Of Child Healthcare

A recent survey of children found that they are overwhelmingly opposed to increased doctor visits and vaccinations

Sunday, September 27, 2009

Patient-Centered Care Awareness

October is Patient-Centered Care Awareness Month, but many do not even know what patient-centered care is or how important this philosophy is to health reform. I have written previously on some aspects of patient-centered care (such as letting a patient see and even make their own chart notes). I suggest you see this post first if you have not read it yet, and especially watch the fun video clip so that you are in the right frame of mind for this discussion. Healthcare has been evolving away from a "disease-centered model" and toward a "patient-centered model." I look forward to the focus on patient-centered care this month.

Although the phrase "patient-centered care" is defined and used in a variety of ways, the essential theme is the importance of delivering healthcare in a manner that works best for patients. In a patient-centered approach to healthcare, providers partner with patients and their family members to identify and satisfy the full range of patient needs and preferences. Organizing the delivery of healthcare around the needs of the patient seems like an obvious approach, but healthcare is a complex system and very little about it is simple. Over 30 years ago when the idea of patient-centered care was born it was swiftly dismissed by all but the most philosophically progressive providers as unrealistic, too expensive and unattainable. To learn more about our own efforts in this area see Courage to be First. Times have certainly changed...

With the introduction of the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) patient experience of care survey, there now exists a standardized tool to evaluate the way care is provided from the patient perspective. HCAHPS examines those aspects of the health care experience that mean the most to patients, including communication with nurses and physicians, cleanliness and noise levels, pain control, and quality of discharge instructions and medication information. Of course, reimbursement methods can drive organizational changes in philosophy and we are now seeing many healthcare systems embrace a patient-centered focus.

The development of a patient-centered medical home provides an enhanced model of primary care in which care teams attend to the multi-faceted needs of patients and provide whole-person comprehensive and coordinated patient-centered care. Since 2006 more than 30 states have initiated projects to advance medical homes in Medicaid and Children's Health Insurance Programs (CHIP), and several states also are driving state-wide transformation. This National Academy of State Health Policy/Commonwealth Fund report provides state policymakers with examples of promising practices and lessons learned.

There is evidence that patient-centered care improves outcomes. The study in the Journal of Family Practice The Impact of Patient-Centered Care on Outcomes found that patient-centered practice improved health status and increased the efficiency of care by reducing diagnostic tests and referrals. There is little doubt that putting the patient at the center of their care makes

If you want to know more about patient-centered care then first go to the Planetree website at These websites also provide valuable information on patient-centered practices:


Google Turns 11

Google has turned 11 years old today (hence the special logo on the Google home page)


Google Data Center in my hometown of The Dalles, Oregon

Saturday, September 26, 2009

Race and Healthcare

President Obama resumed his push to overhaul the healthcare system, speaking at the Congressional Black Caucus Foundation’s Annual Phoenix Awards Dinner. He spoke at last year's event as a member and was hailed by caucus chair Rep. Barbara Lee as "our great President" in her introduction to an enthusiastic crowd.

He told the members of the Congressional Black Caucus (CBC) that there comes a time when "the cup of endurance runs over." Obama said the country has been waiting for health reform since the days of President Theodore Roosevelt and Harry Truman. "We must bring about a better healthcare system in this country," he told the audience. "Not in 10 years. Not in five years. Not in one year. This year!"

The President spoke of "affordable choices" to the uninsured but did not mention any plan for a government-run public option. Members of the CBC have said that they will not support a plan that does not include a public option. But the President made a strong case for his plans, borrowing a line from Martin Luther King Jr., saying that health reform called for "the fierce urgency of now."

With 42 members, the CBC counts as its members some of the most powerful leaders on the Hill. Rep. James Clyburn (D-SC) is majority whip, Rep. John Conyers (D-Mich) heads the judiciary panel, and Rep. Charles B. Rangel (D-NY) chairs the House Ways and Means Committee. The President believes that support of the CBC will be crucial to efforts at health reform. And one of the driving factors is the apparent racial inequality of healthcare resources and access.

In a recent Urban Institute study Estimating the Cost of Racial and Ethnic Health Disparities researchers analyze the cost burden associated with excess rates of diseases such as diabetes, hypertension, stroke and renal disease among Hispanics and African Americans relative to non-Hispanic whites. The study predicts that in 2009, "Medicare alone will spend an extra $15.6 billion while private insurers will incur $5.1 billion in additional costs due to elevated rates of chronic illness among African Americans and Hispanics." The researchers also estimate that "over the 10-year period from 2009 through 2018 the total cost of these disparities [will be] approximately $337 billion, including $220 billion for Medicare."

The link between civil rights and health reform is a natural line for many, and the President is showing his usual political acumen in joining the two. However, he is also steering clear of making it a purely racial issue. As a society, many believe that we should be color blind (and judge people based on the content of their character not the color of their skin) so there will be tricky waters to navigate ahead.

The new book Race, Ethnicity, and Language Data: Standardization for Healthcare Quality Improvement (you can read prepublication online here)identifies current models for collecting and coding race, ethnicity, and language data; reviews challenges involved in obtaining these data, and makes recommendations for a nationally standardized approach for use in health care quality improvement.

Patient-Centered Awareness Month

Patient-Centered Care Awareness Month is an international awareness-building campaign that occurs every October to commemorate the progress that has been made toward making patient-centered care a reality and to build momentum for further progress through education and collaboration. Hospitals and health care organizations around the world are encouraged to celebrate by empowering patients, strengthening their patient-centered practices, and publicly proclaiming to their patients and communities their commitment to patient-centered care.

For the past two years, health care organizations around the United States, Canada and the Netherlands have celebrated Patient-Centered Care Awareness Month. In addition, fourteen state governors commemorated the month signing proclamations officially recognizing the importance of patient-centered care to their states’ citizens.

What is “Patient-Centered Care”?

Although the phrase “patient-centered care” is defined and used in a variety of ways, the essential theme is the importance of delivering healthcare in a manner that works best for patients. In a patient-centered approach to health care, providers partner with patients and their family members to identify and satisfy the full range of patient needs and preferences.

Organizations practicing patient-centered care recognize that:

A patient is an individual to be cared for, not a medical condition to be treated.

■Each patient is a unique person, with diverse needs.

■Patients are partners and have knowledge and expertise that is essential to their care.

■Patients’ family and friends are also partners.

■Access to understandable health information is essential to empower patients to participate in their care and patient-centered organizations take responsibility for providing access to that information.

■The opportunity to make decisions is essential to the well-being of patients and patient-centered organizations take responsibility for maximizing patients’ opportunities for choices and for respecting those choices.

■Each staff member is a caregiver, whose role is to meet the needs of each patient, and staff members can meet those needs more effectively if the organization supports staff members in achieving their highest professional aspirations, as well as their personal goals.

■Patient-centered care is the core of a high quality health care system and a necessary foundation for safe, effective, efficient, timely, and equitable care.

in reference to: Register for the 2009 Planetree Annual Conference! (view on Google Sidewiki)

Friday, September 25, 2009

Healthcare Polls

Latest healthcare polling data shows that most Americans are still confused about the health reform proposals. The president's approval rating for handling health care is up seven points from one month ago, and more Americans overall support his plans than oppose them - but four in 10 say they still don't know enough about the proposals.

As many as 59 percent of Americans say they are confused by the current health care reform proposals, while just 37 percent say they understand them. Correspondingly, only 32 percent of Americans say Mr. Obama has clearly explained his plans for health care reform, and 62 percent say he has not.

CBS News/New York Times Poll. Sept. 19-23, 2009. N=1,042 adults nationwide

Do you approve or disapprove of the way Barack Obama is handling health care?

Approve Disapprove Unsure
% % %


47 45 8


40 47 13


46 38 16


49 37 14


44 34 22

"Which of the following three statements comes closest to expressing your overall view of the health care system in the United States? (1) On the whole, the health care system works pretty well and only minor changes are necessary to make it work better. OR, (2) There are some good things in our health care system, but fundamental changes are needed. OR, (3) Our health care system has so much wrong with it that we need to completely rebuild it."




% % % %


19 51 27 3


17 55 27 1


16 49 33 2


13 51 34 2


12 49 38 1


14 50 35 1


8 56 34 2

"Are you generally satisfied or dissatisfied with the quality of the health care you receive? Would you say you are very satisfied/dissatisfied or somewhat satisfied/dissatisfied?"





% % % % %


41 37 10 8 4

"Regardless of how you usually vote, who do you think has better ideas about reforming the health care system: Barack Obama, or the Republicans in Congress?"



in Congress
Both (vol.) Neither

% % % % %


52 27 2 11 8


50 23 1 13 13


55 26 1 7 11

"Do you think you understand the health care reforms under consideration in Congress, or are they confusing to you?"

Understand Confusing Unsure
% % %


37 59 4


31 67 2

"Do you mostly support or mostly oppose the changes to the health care system proposed by Barack Obama, or don't you know enough about them yet to say?"



Don't Know

% % % %


30 23 46 1

"Would you favor or oppose the government offering everyone a government-administered health insurance plan -- something like the Medicare coverage that people 65 and older get -- that would compete with private health insurance plans?"

Favor Oppose Unsure
% % %


65 26 9


60 34 6


66 27 7


64 29 7


72 20 8

"What if changes to the health care system do not include the option of a government-administered health insurance plan? In that case, would you favor or oppose the changes under consideration?"

Favor Oppose Unsure
% % %


38 40 22