Wednesday, February 25, 2009

The President's Address, 2/24/09...

I was particularly interested in listening for Mr. Obama's address to congress. The transcript and video of his address are available on the White House blog, at So, what did he really have to say about healthcare reform?

"I suffer no illusions that this will be an easy process. It will be hard. But I also know that nearly a century after Teddy Roosevelt first called for reform, the cost of our health care has weighed down our economy and the conscience of our nation long enough. So let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year."

I'm particularly interested in the approach... he mentions the healthcare meltdown as weighing down "the conscience of our nation" - that's a hint that he and I would agree that we have a moral failing in the system of healthcare rationing we have in America. (Oh, you don't think we have rationing? Just ask our uninsured if they have access to the most basic of preventive services - they don't do pap smears in the Emergency Department, Mr. Bush. Or, ask our nation's retired military if they can find a local specialist, or even primary care doctor, to take care of them. I've talked about this 'economic rationing' before...)

But, the language that is stressed most is that America demands healthcare reform as an economic issue. Finally! Someone is saying it out loud! If you can't agree on the morality issue, then I think we can all find that we should work to reduce the high cost of healthcare, as it is a significant contributor to our economic burden.

I've often told of the per capita cost of health care as it relates to my own age... In the year I was born, 1962, the per capita cost for the US in the provision of health care was ~$200. And, the money we spent on health care was something like 5% of our GDP. The latest numbers show that per capita healthcare costs are now ~$8000+, and has risen to represent 16.3% of GDP in 2007. And, the trend of an aging population and costs rising faster than inflation would anticipate that healthcare costs will rise to 20% of GDP in 2017.

How does that compare with other countries? The data reported in this article is now several years old, and lists US per capita costs as $4000 in 2001. But, the article does have a nice comparison of costs across countries.

And, the journal Health Affairs has a nice editorial piece which calls for reform now. My favorite comment in the article is the revelation of the two major barriers to reform: "Democrats and Republicans".

So, the president is positioning healthcare reform as an economic issue, and now our task is to be diligent to watch that the reform process still includes the moral issue in the proposals.

"Yes, we can."

Wednesday, February 11, 2009

Healthcare as a right...

I've talked about this issue before - access to adequate health care as a basic human right. As my son scanned the news last night, for his journalism class, he paused on a story about this very issue. The commentator opened by making the statement that prisoners are the only Americans who have a right to health care granted by the Constitution. "Really?", he said. Yeah, really...

The eighth amendment guarantees the right of prisoners to be free from cruel and unusual punishment. And, the Supreme Court has affirmed that lack of timely access to medical care would be cruel and unusual punishment.
This comes to light as we are all reeling from the Great Recession. And, because the State of California has so many more prisoners than space to keep them, we are reminded of this right to health care. You see, a recent decision by a panel of federal judges tells California that they will need to release 55,000 prisoners, since the overcrowding conditions impedes this access to health care.
So, to extend this analogy, if the US Supreme Court were to affirm that access to health care is a fundamental human right, as does the World Health Organization and the United Nations, would that mean we would then have a responsibility to send 46 million of our citizens to another country, one with universal healthcare access? (46 million is the often-quoted number for the number of uninsured Americans; with the Great Recession, we have certainly seen the number of newly-uninsured patients in our Centers increasing.)

Saturday, February 7, 2009

It's about time...

It's been way too long since I have commented here; ...

We find ourselves in some new days.  All of us.  And, I guess, "It's about time."

At our Community Health Center, we've been feeling the changes.  In the late fall, one of our Behavioral Health Professionals sent out an email asking for help.  You see, she had been finding more and more patients who were seeking help because they were losing their homes.  Her plea:  does anyone know of any resources to help these people?  The answer:  No, other than to refer them to the limited shelter beds available in our communities.  The Great Recession is real, and it's touching us now.

I had a wonderful chance to hear a leader in the National Association of Community Health Centers ( speak at a regional conference in October.  Dan Hawkins is Senior Vice President at NACHC, and in those days leading up to the election, spoke of the differences in the candidates plans for healthcare reform.  (Run this google search for "Dan Hawkins" and "NACHC" and you can see some of the work Dan has done for Community Health Centers.)  The analysis of Mr. Obama's plan offered some promise.  Maybe now we could do something together to get this fixed... As I did a photowalk around Denver, I was struck by the message of hope echoed in the sign, "All Together Now".  

But, where are we now?  The country, and the world, has turned nearly all attention to the economy, blaming greed and housing and bad business practices for the onset of the Great Recession.  And, the nation and it's leaders seem to have mostly forgotten about healthcare.  

And, I think back to many discussions I've had over the past few years.  Discussions about how inhumane our current healthcare "system" is toward our less-fortunate neighbors.  Even our previous President thought that the Emergency Department was the answer to the millions of children he had denied access to healthcare by refusing to sign the State Childrens Health Insurance Plan into law.  "After all, you just go to the Emergency Room."  [Our current president sees this issue a little differently.]

And, during these discussions, I'd often hear the sentiment that, if the poor people need something else from our healthcare "system", the should just use their political power to influence our elected leaders to make it happen.  The poor, I'm afraid, don't have that power.  If they did, perhaps they wouldn't be poor!  

But, now, all of us are poor!  The list of names of those losing billions to Mr. Madoff includes many people who are smarter than the rest of us.  And, have you taken a look at your 401K lately?  So, now, maybe the "nouveau poor" will be able to speak for the "old poor".  Maybe now, we can really turn our attention to the work of creating a healthcare system for all of us.  Even the prestigious New England Journal of Medicine sees that there may be a silver lining to the recession which is causing so much suffering now - finally, healthcare reform.  

It's about time...All Together Now...