Posts Tagged ‘America’

America Losing War on Obesity

Tuesday, July 14th, 2009

A new report — “F” as in Fat:  How Obesity Policies are Failing in America 2009 gives America a failing grade on its efforts to control obesity among children and adults.

The report, released by the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation, found that obeseobesity rates rose in 23 states during 2008, with no states showing decreases.  The number of overweight children is at or above 30 percent in 30 states.

Mississippi came in dead last for the fifth year in a row, with an adult obesity rate of 32.5 percent.  Three states were close runners up:  West Virginia reported a 31.2 percent obesity rate; Alabama had 31.1 percent; and Tennessee had 30.2 percent.  On the opposite side, the states reporting the lowest obesity rates were Colorado with 18.9 percent; Massachusetts with 21.2 percent; Connecticut with 21.3 percent; Rhode Island with 21.7 percent and Hawaii with 21.9 percent.

“Our healthcare costs have grown along with our waistlines,” according to Jeff Levi, PhD, TFAH’s executive director.  “The obesity epidemic is a big contributor to the skyrocketing healthcare costs in the United States.  How are we going to compete with the rest of the world if our economy and workforce are weighed down by bad health?”

Fully two thirds of American adults are now overweight or obese.  Adult obesity rates are higher than 25 percent in 31 states, and above 20 percent in 49 states and Washington, D.C.  Compare this with 1991, when no state reported an obesity rate higher than 20 percent.

Marcus Welby, M.D., May Be Healthcare Reform Solution

Tuesday, July 7th, 2009

Marcus Welby may be making a comeback – not to your television screen – but to your doctor’s office.  Partisans on both sides of the healthcare reform issue in Congress agree that general practitioners should play a starring role in unifying America’s disorganized delivery system.1

“Patient-centered medical home” – meaning a primary-care physician’s office that people visit for most of their medical needs – is the name being give to this vision.  This GP would monitor everything from flu shots to chronic disease management to weight loss and organize care with other practitioners.  According to a 2004 study, if every patient had a healthcare home, the resulting efficiencies could cut costs by 5.6 percent, or $67 billion per year.

This surprisingly simple solution streamlines a wasteful system that consumes 18 percent of the American GDP and a responsibility that falls primarily on private industry, which covers 60 percent of people with healthcare insurance.  IBM, which last year spent $1.3 billion on its employees’ healthcare – the equivalent of one month of the company’s income – has already bought into the concept.

Critics caution that the medical home is overly reminiscent of the “gatekeeper” model of 1990s managed care programs.  Supporters counter that this concept is intended to benefit patients versus insurers.  It’s more akin to practicing medicine 1950s-style, but with digital technology such as electronic medical records to assure a 21st century twist.

“Positive Deviants” Will Revitalize the Healthcare System

Tuesday, June 30th, 2009

The solution to America’s healthcare crisis might just lie in deviant thinking.  This is the message of Dr. Atul Gawande, this year’s commencement speaker at the University of Chicago’s Pritzker School of Medicine.  Gawande is a general and endocrine surgeon at Brigham and Women’s Hospital in Boston, an associate director of their Center for Surgery and Public Health, an associate professor at the Harvard School of Public Health and at Harvard Medical School.

050102_Gawande_Atul_3.jpgHis concept of positive deviants identifies those communities and physicians who discover innovative ways to reduce costs and improve care  to deliver better outcomes.

Gawande cites a nutritionist who spent his career attempting to reduce hunger in Vietnamese villages.  This man asked villagers to identify which families had the best-nourished children to determine a “positive deviance” from the norm.  The answer was that those children’s mothers did not act in accordance with accepted village wisdom had the best outcomes.  Rather, they fed their children even when they had diarrhea; fed them several small meals daily rather than one or two large ones; and fed their children foods that others considered low class but were nutritious such as sweet potato greens.

In the American healthcare system, the positive deviants resist the tendency to view patients primarily as revenue streams – but as human beings.  Rather, these physicians deliver high-value healthcare without focusing too strongly on their practices’ bottom lines; they neither over-treat nor under-treat their patients with extraneous but profitable tests and procedures.

To quote Gawande, “Look for those in your community who are making healthcare better, safer and less costly.  Pay attention to them.  Learn how they do it.  And join with them.”

Healthcare Reform Will Not Mandate Rationing

Friday, May 22nd, 2009

Conservative columnist Charles Krauthammer’s negative assessment of President Barack Obama’s healthcare reform package is based on his belief that the plan is economically feasible only if that care is rationed.

180px-rationingboardnolavachoncTo quote Krauthammer:  “Rationing is not quite as alien to America as we think.  We already ration kidneys and hearts for transplant according to survivability criteria, as well as by queuing.  A nationalized health insurance system would ration everything from MRIs to intensive care by myriad similar criteria.”

Krauthammer’s personal preference is “for a highly competitive, privatized health insurance system with a government-subsidized transition to portability, breaking the absurd and ruinous link between health insurance and employment.  But if you believe healthcare is a public good to be guaranteed by the state, then a single-payer system is the next best alternative.  Unfortunately, it is fiscally unsustainable without rationing.”

Krauthammer is wrong!  In the United States, healthcare is rationed but it is according to your income and insurance status.  And for the 47 million Americans who don’t have insurance, we ARE already rationing everything, “from MRIs to intensive care (to use Krauthammer’s examples)”.  We have to accept that no matter what the system is that we adopt, that rationing will occur.  The issue is rationing that is unethical and doesn’t meet the mission of healthcare.  The way to mitigate rationing in a nationalized system may be to do what the British Medical Association has suggested, which is to define a set of core services – cardiac care, for example – -which may fall under the rubric of life threatening.  These would never be rationed regardless of who you are.  More elective procedures or non life-threatening procedures, on the other hand, would be rationed.  We can’t expect our health system to do it all and this seems a modest proposal.