Everybody involved in health care knows if you want to start an argument bring up — what else? — health care. Does the U.S. have the best system in the world or just the most expensive? Would creating some form of universal coverage bankrupt the nation or eliminate inefficient, ineffective processes and bend the cost curve? Should all Americans be required to carry some form of insurance no matter their age or current health status? Should Medicare be left as is, should it be modestly rejiggered or should it be replaced altogether with a private plan? Are hospital leaders prepared for the tectonic shifts facing their profession? Do doctors know how to be good team players? Do nurses eat their young?
We've touched on these and many other hot-button issues here in H&HN Daily, and the ensuing conversations among readers have sometimes been, shall we say, enthusiastic. That's a good thing. Vetting all sides of an issue is how we reach consensus in this country — or did before some folks became so hidebound and closed to compromise.
Well, I'm always up for a good debate, so here are a few interesting and provocative things I've stumbled across in various media recently.
• OK, this piece by Bob Rosenblatt in the Los Angeles Times is not really as controversial as just plain informative. He offers a pithy history of health care coverage from the 1940s right up to the present. Henry J. Kaiser's California shipyard needed to attract workers in World War II but was prohibited by a national wage freeze from offering higher pay. Instead, the company provided health care at its clinics and hospitals, with employees paying 50 cents a week. When the war ended, workers quit the shipyards; the hospitals and doctors needed to find new patients, so the company opened the system to the public. "It is just one example of the way America's health insurance system has grown into the strange patchwork program it is today," Rosenblatt writes. He goes on to describe the never-ending tensions between private and public health care proponents, failed efforts to expand coverage by a series of presidents from different political parties, the passage of Medicare and Medicaid, and the reform law that President Obama managed to get through Congress and that now stands before the Supreme Court. The article might not tell you anything you didn't already know, but it's a good refresher on where we are in health care coverage and how we got here.
• More provocative was an op-ed piece in the New York Times titled "Hospitals Aren't Hotels" written by Theresa Brown, an oncology nurse and regular blogger for the paper. Brown contends that tying Medicare payments to patient experience is wrong-headed and could adversely affect care. Though Brown says many of the questions asked under HCAHPS, such as those touching on communication between patients and caregivers, education about medications, and hospital discharge instructions, are important, asking patients how satisfied they are with the hospital experience ignores difficult facts: Patients are there in the first place because they are unwell, some patients will receive jarring prognoses and some will suffer discomfort because of procedures necessary to improve their conditions. She concludes that "a survey focused on 'satisfaction' elides the true nature of the work that hospitals do. In order to heal, we must first hurt."
• We all know by now that the cost of the same medical treatments can vary, sometimes dramatically, from one market to another. In a new PBS documentary, U.S. Health Care: The Good News, T.R. Reid travels across the country to report on "high-value communities," which have found ways to cut costs while still providing excellent care. Much of the film is based on research from The Dartmouth Atlas of Health Care — itself a subject of some controversy in health care circles. Elliott Fisher, M.D., of the Dartmouth Institute for Health Policy, contends that "it is generally agreed that about 30 percent of what we spend on health care is unnecessary. If we eliminate the unneeded care, there are more than enough resources in our system to cover everybody." The documentary cites examples of a wide spectrum of care models that have been successfully undertaken in places ranging from big cities to rural communities. "For all their differences, though," according to the filmmakers, "these communities have several important things in common, including a clear commitment by doctors and hospitals to lower the cost of health care."
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