Health Care and 2009

Americans like to celebrate the New Year. Nothing says starting fresh more than fireworks, Auld Lang Syne, and staying up to see Dick Clark's New Year's Rocking Eve in Times Square to watch the ball drop. What about the Tournament of Roses Parade in Pasadena, California, or all the resolutions that everyone make to start the year all over again. Some of those will involve the traditional "feel good" personal health initiatives such as working out at the gym, losing weight, exercising, and a host of other ways to get in better shape. However, the majority of people drop those attitudes fade within a few weeks like new winter snow on a warm day. Additionally, there will be challenges with finances, the housing market, the stock market, banking, jobs and many other issues in the general economy. Americans should be prepared to tighten their belts in 2009.

According to Highbeam Research, the coming of a new year gives us cause to reflect on the events of the year past and to plan for a new and exciting year ahead. Personal and professional activities generally begin with vigor at the start of a new year, as we try to compensate for what was not accomplished in the old year. It is a time for renewing our values and planning for a better day.

Welcome to a brave new year. ‘Brave’ might be the appropriate word, considering the recent events in the world’s financial markets, according to Executive Healthcare Management. We don’t know yet how much this will affect the healthcare sector, but there are bound to be repercussions. Job losses, for example, could lead to more people joining the 15 percent of American who currently have no health insurance. Research funding could be harder to come by. Some healthcare companies may be forced to downsize, or even close their doors altogether. There is no need to despair, however. The healthcare sector is relatively recession proof – people will, unfortunately, always get sick – so provided we don’t panic, most of us should emerge unscathed. We could even see the situation as an opportunity to finally grasp the nettle, and transform our health system into one that provides good care to every citizen, not just to those who can afford it.

Our nation's health care system will be dissected this year according to the News-Leader of Springfield, Missouri. Problems associated with health care cost in the nation are multi-faceted with no easy solutions. A sluggish economy is hindering efforts to resolve this issue and more of our citizens are falling into the ranks of the uninsured. High health insurance costs have made insurance unaffordable and led employers and employees to drop health insurance. The only way we will ever get a handle on health care is to understand the cost drivers that are pushing health care cost up and hurting the uninsured and the insured. Insurance reforms to reduce premiums need to be addressed. Perhaps more competition could lead to better value in the system. Another step in the right direction would be more transparency from providers and insurance companies. The insured also need to be more proactive. The more the insurance company and/or state program pays, the higher premiums go up. We need to find ways to create a medical home (doctor's office, clinic) for patients to use instead of flooding our emergency rooms. Curbing use of the ERs would lead to cheaper cost and a better outcome.
A large segment of the uninsured falls between the ages of 21 and 35. Some feel they do not need insurance because they are young and healthy. Educating young citizens about the importance of health insurance would benefit everyone. A simple catastrophic policy with high deductible is not all that expensive and could be very beneficial when health care is necessary. Most Americans are employed and are creative, innovative, and hardworking people. They want solutions to improve our health care system. Waiting on government programs to pull us out of the quicksand is not the answer.

When it comes to health care, we can all agree that change is desperately needed according to the CEO of the Robert Wood Johnson Foundation (RWJF). The major health problems of our time will not be solved within the clinical care system as it is currently built, nor simply by addressing health care costs or expanding coverage. We can’t afford to just throw more technology or more intensive treatment at people, nor should we have to. More treatment isn’t the right prescription. We need better treatment and we need less disease if we want good health for all. Americans have worse health outcomes than patients in other industrialized nations, even though we spend nearly three times more on health care per person. We rank 46th globally in average life expectancy and 42nd in infant mortality. Race, ethnicity and income inequality affect the health of millions and the care they receive . America is founded in the pursuit of a vision, the realization of an ideal. In words that are built into our national DNA, all of us are created equal, endowed with the inherent and inalienable right to life, liberty and the pursuit of happiness. None of that is possible without good health. Making sure that every person in America has a fair chance for a healthy life and an equal opportunity for adequate health care is not about ideology, it’s about the future of our nation. Unfortunately, in today’s America, when it comes to health and health care, we are not all equal. In the U.S., health disparities are enormous. Decades of expert research tells us that education, economic development, housing, job security, geography, and income all affect health just as strongly as personal behavior. We even know now that poverty contributes to mortality of American adults at about the same rate as cigarette smoking. Right now, there are more than 47 million people in the United States without health insurance. The uninsured not only get sicker, but their outcomes are worse. In addition to those without coverage, there are many people who only have access to poor care, but don’t even know it.

The time has come to bridge the gap between “what we know” and “what we do,” according to the RWJF. Collaboration is key. Without it, the financial, clinical, professional and personal forces that frame our health and health care universe will continue to struggle with many of the same old pieces of the puzzle. People tell us they want to be more engaged in making their own health care decisions in partnership with doctors they choose, know and trust. They want doctors, nurses and hospitals to publicly report how they perform and they want to see solid evidence of what works best for them as patients. They want environments that make healthy choices the easy choices. Improvement is key too. People want their doctors, nurses and other health care professionals to hold “do it better” along side “do no harm” as the highest of their professional standards. They want everyone to receive exactly the same high quality of care. And people want their own voices heard as the community figures out how it is going to retool health care.

We must broaden our focus of what constitutes a “health issue” according to the CEO of the RWJF. Good health comes from healthy lifestyles, good choices, and a supporting environment in which to make those good decisions. While quality has long been at the top of the agenda when it comes to health care, it has only recently received attention in public health circles. As a society, we have not developed good ways to measure quality in public health practice, and we have not communicated the outcomes the public should expect from their local and state health authorities – such as immunizing all children, eliminating tobacco use and promoting regular physical activity – to people’s daily lives. Communicating the results that public health can deliver is critical to achieving such broad societal goals. Take childhood obesity. We’re at risk of raising the first generation of Americans to face substantially more disability and disease than their parents. A recent New England Journal of Medicine study shows that up to 37% of male and 44% of female teenagers in the U.S. will be obese by the time they turn 35 in 2020. Federal officials already put the cost of related medical expenses and lost productivity at $117 billion per year, and researchers predict one of every five dollars spent in the future on elder care will be related to obesity. These trends must be reversed, and we need to establish performance baselines and benchmarks that will help improve public health agencies’ performance and make them accountable to the people they serve. The path toward improving the quality of care in the U.S. is clear, straight, and passable. We expect success because the only ideology that counts here is the healthiest possible state of the union for all Americans.

Health care in 2009 will be a major concern not only for all Americans, but also for the new administration and legislators both at the state and federal levels. Government run health care is not the answer. The private sector must do a better job of making health care affordable and accessible to all Americans without heavy handed mandates or interference from legislation. We deserve the privilege of personal choice, and we must work together with insurance companies and the medical community to make it happen.

Until next time. Let me know what you think.