Last night, President Obama spoke to a group assembled at the White House on health reform that aired on ABC TV. At the beginning of the session, the host, Charlie Gibson, asked how many agree that we need to change the health care system in America. Everyone raised their hand indicating unanimous agreement. He didn’t ask the next logical question "How many of you think we will actually pass significant health reform that meets the President’s goals of universal coverage for all Americans, maintaining freedom of choice for people regarding selection of health care providers and treatment options, and reining in costs?"
Based on the backlash from those who are weary of a government run system and of the cost of a universal health plan, and those very powerful players who have a strong (although unstated openly) vested interested in the status quo, I am afraid that the answer would not be unanimous, in fact far from it. While all agree that we need to change, there is such a divergent view of how that change should occur. This is exactly the same place we were 16 years ago when the Clintons tried to change the system, and we see how that turned out.
So what is different now? As the President said, if we don’t change we will bankrupt the American economy. This may be on overstatement, but I think more people will suffer from lack of access to health care and will have to live with painful conditions and probably die sooner. Given that we have accepted a 15% uninsured rate for many years, it appears that we may be able to tolerate that for a longer period of time. What I am saying is that I am skeptical that we will see much change other than some form of insurance reform that opens up a market for individuals to purchase health insurance through a controlled market. This will accelerate the process of disconnecting health insurance from employers, which can be a good thing.
With respect to the cost issue, I still don’t have an answer, and I don’t think the President does either. The only thing I can figure is that new insurance policies will have high deductibles and co-payments that will deter people from accessing care, thus reducing demand. Reduced demand should reduce volume of care which will reduce costs. There are some strong arguments that we as a population are over treated and that less care may be a good thing. What do you think?
Thursday, June 25, 2009
Monday, June 22, 2009
Health Care Reform – YOYO Health Care
Last month I wrote about health care reform and how two of the three parts of President Obama’s goals were easy to accomplish ( choice of health care plans and medical providers and access by all Americans to affordable health insurance coverage) but the third is near impossible under current conditions (rein in costs). In my May 15th blog, I talked about the Yin and Yang of Health Care, whereby the health care system, which is somewhat dysfunctional, is merely a by-product of the health care industry, which is focused on growth and profitability. Those very powerful industry forces along with the fear of a government take over and added federal costs, will, I believe, preclude any major health reform this year. I hope I am wrong, but I am skeptical that we will see much in the way of major reform. That’s not to say that there won’t be some incremental change, such as added regulation of insurance companies that require them to create an affordable individual, as opposed to group, insurance product. I suspect that these plans will resemble a catastrophic insurance model that will come with high deductibles and co-insurance payment. This will further move the U.S. away from an employer based insurance system (currently only 65% of all employers provide health insurance) to an individual market. This may not be all that bad depending on how helpful the health plans are in dealing with individual customers, rather than groups.
All of the possible changes that may occur will move us toward what I call YOYO Health Care: Your-On-Your-Own. We must all get used to making choices on our own regarding health insurance plans, medical providers, and treatment options. Already there is a move by major health systems and insurers to create a "Shared or Informed Decision Making" environment. In Boston, Partners Health Care is promoting the idea of sending patients with certain conditions educational DVDs. Conditions include, Coronary Artery Disease, HIP Osteoarthritis, Spinal Stenosis, Prostate Cancer, Herniated Discs, etc.
YOYO Health Care may work on the cost part of President Obama’s trilogy if there are real incentive built into health reform for self care, prevention, and wellness. In reality, the only thing that is going to slow health care spending is for consumers to avoid acute illness and to better manage chronic illness. Under the current system where the health care industry is rewarded for doing more, more care will be provided. In fact, the health care industry would like nothing more than to "sell" more of its products and services. This helps achieve their revenue growth and profitability goals.
All of the possible changes that may occur will move us toward what I call YOYO Health Care: Your-On-Your-Own. We must all get used to making choices on our own regarding health insurance plans, medical providers, and treatment options. Already there is a move by major health systems and insurers to create a "Shared or Informed Decision Making" environment. In Boston, Partners Health Care is promoting the idea of sending patients with certain conditions educational DVDs. Conditions include, Coronary Artery Disease, HIP Osteoarthritis, Spinal Stenosis, Prostate Cancer, Herniated Discs, etc.
YOYO Health Care may work on the cost part of President Obama’s trilogy if there are real incentive built into health reform for self care, prevention, and wellness. In reality, the only thing that is going to slow health care spending is for consumers to avoid acute illness and to better manage chronic illness. Under the current system where the health care industry is rewarded for doing more, more care will be provided. In fact, the health care industry would like nothing more than to "sell" more of its products and services. This helps achieve their revenue growth and profitability goals.
Monday, June 8, 2009
Why Do Placebos Work?
Several blog posts ago, I addressed the value and impact of the therapeutic relationship (VITR). Since writing that post, I read several supporting pieces on the topic. One is from a fascinating book, Hippocrates’ Shadow - Secrets from the House of Medicine – What Doctors Don’t Know, Don’t Tell You and How Truth Can Repair the Patient Doctor Breach by David H. Newman, M.D. and the other is from Newsweek column by Sharon Begley entitled: "Hooked on a Feeling – This is your brain on a placebo".
Both sources refer to credible research to support the idea that placebos, referred to as sugar pills, a sham treatment, or an inert compound, cure illness and engender health and well-being.
So how can sugar pills, sham treatments, and inert compounds do this? The answer is the there is something to the "tending ritual". The best answer is from Dr. Newman’s book:
"Studies indicate that the significance of the tending ritual of patient – doctor contact is real, and so is the response. The actions and interactions of the patient and doctor when acupuncture is performed, the shared experience of tending and communication, was more powerful than that of almost any pill science has produced. While hard science, the active ingredient, should be respected and given the credit it is due, we must also acknowledge and understand the simplest, and in some cases the most powerful, medicine of all: the contact between doctor and patient."
Sharon Begley’s column states "if neuroscientists have learned anything about placebos, it is that …high-level mental functions control the nitty-gritty of lower-level brain processes. In other words the brain responds to expectations when provided by a trusted care giver.
A basic tenant of integrative medicine, as practiced at the Marino Center, is to foster that trusting relationship and use the art of medicine as Hippocrates envisioned.
Both sources refer to credible research to support the idea that placebos, referred to as sugar pills, a sham treatment, or an inert compound, cure illness and engender health and well-being.
So how can sugar pills, sham treatments, and inert compounds do this? The answer is the there is something to the "tending ritual". The best answer is from Dr. Newman’s book:
"Studies indicate that the significance of the tending ritual of patient – doctor contact is real, and so is the response. The actions and interactions of the patient and doctor when acupuncture is performed, the shared experience of tending and communication, was more powerful than that of almost any pill science has produced. While hard science, the active ingredient, should be respected and given the credit it is due, we must also acknowledge and understand the simplest, and in some cases the most powerful, medicine of all: the contact between doctor and patient."
Sharon Begley’s column states "if neuroscientists have learned anything about placebos, it is that …high-level mental functions control the nitty-gritty of lower-level brain processes. In other words the brain responds to expectations when provided by a trusted care giver.
A basic tenant of integrative medicine, as practiced at the Marino Center, is to foster that trusting relationship and use the art of medicine as Hippocrates envisioned.
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