Making History with Health Care Reform

Take a few minutes and watch this powerful feel-good video about finally passing health care reform.

The history of health care reform is long and rather arduous. Its amazing to think we’ve finally passed it.

Health Care Reform and Seniors

Yesterday’s LA Times featured an interesting piece by Bruce Chernof (Dr. Bruce Chernof is president and chief executive of the SCAN Foundation and former director of the Los Angeles County Department of Health Services.)  The op-ed discusses the impact of HCR on our nation’s seniors.

You can view the original article here.

Bruce discusses how HCR helps seniors: it creates long term care insurance, it expands home and community services to avoid nursing home placement, it reduces fraud and invests in new technologies, etc.

I think this sort of coverage is important for HCR.  The reform legislation has a long road of implementation it must weather. Seniors and other Americans should be aware of the benefits of the bill, and the direct impact it will have on their lives.

Bruce closes his piece eloquently:

“Neither the product nor the process has been perfect. But most good efforts in life are about progress and not perfection. If you’re a senior, or caring for a senior, or if you plan to live beyond the age of, say, 65, this bill is a good beginning on transforming our health and long-term care system into one that works for everyone.”

((Please note that Bruce is a mentor of mine and I may be slightly biased))

Food Subsidies and Health

The United States is experiencing an obesity epidemic.  Too many people are fat.  Fat people experience increased rates of diseases, from diabetes, to cancer.   How do federally funded subsidies contribute to this?  The above food pyramids speak for themselves.  The US govt largely subsidizes meat and dairy while the nutrition recommendations suggest only a small consumption of meat and dairy. More importantly, eyeball the green portion of the pyramid–fruits and veggies. You’ll see that a medium-sized portion of the pyramid on the right is green.  The pyramid on the left has no green area.  If the US govt subsidize fruits and veggies, would a salad cost less? Would it be easier for school children to access healthy foods in their cafeterias? Would there be a growing Fruit and Veggie lobby in Washington?

Climate Change and Human Health

Climate scientists say they are 90% certain that the globe’s climate is changing due to human activities.  We’ve all read the newspaper articles about increasing temperatures, higher seas, glaciers melting and the like.  Maybe some of us have even invested in fluorescent light bulbs or an energy efficient car.  But what effects does this have on our own health?

It turns out climate change has a huge impact.  There are both direct and indirect effects of climate change on human health.  The direct effects are somewhat obvious:  infectious diseases, air quality and natural disasters.  As the climate warms, the geographic footprint of infectious diseases, such as malaria, will certainly change, exposing new and unprepared populations.  This is already happening in Africa.  Air quality is so poor that cities worldwide have had to issue warnings that certain demographics stay indoors all day.  Climate scientists do not know exactly what will happen with natural disasters, but many predict increasing flooding in some areas, droughts in some areas, and increased frequency and severity of tropical storms.

More concerning, and less talked about, are the indirect impacts of climate change on human health: food scarcity, safe and clean water sources and population displacement.  Malnutrition is already the single biggest public health problem worldwide, not to mention the impact of micronutrient deficiencies.  Studies show that agriculture yields decrease as the ppm of CO2 increases.  New studies demonstrate that crops grown at increases C02 levels also have lower protein content and have much less Fe an Zn.  Water scarcity is already an issue in some areas and this will only be exacerbated as the planet’s climate changes.  While some places will experience droughts, some other regions will experience flooding. Increased flooding leads to a host of other health problems, ranging from cholera to malaria and beyond.    The food and water effects of climate change are staggering.

Scientists and researchers are adding to the alarming evidence that climate change will have a drastic impact on human health.  This provides us with yet another reason to invest in research and technologies that provide us with alternative energy sources to carbon.  Our lives are at stake.

A toilet in a bag.

courtesy of peepoople.com

Anyone who has spent time in a big city in the developing world (or developed world for that matter) knows that part of the stench of any major city is that of human waste and excrement.  High population growth rates combined with migration into the city has caused large populations in cities that are not built to sustain all the new citizens.  More importantly, many citizens can’t afford access to sanitation facilities.  In slum areas in Mumbai, for example, the government has built toilet and sanitation facilities in some of the slums.  However, these facilities are only built in registered slums, and they tend to be overused in general.

The PeePoo solves this problem with a simple small plastic bag:

“The Peepoo (pat.pend) is a personal single use toilet, that sanitise the human excreta shortly after the defecation, preventing the faeces from contaminating the immediate as well as the larger environment.

The toilet is a high technology product for a low economy. As with the original Tetra-Pak it uses a minimum of material whilst providing maximum hygiene.”

Check it out here or see the new NYT article about the PeePoo here.

The article suggests that the product of the bag can be used for crop fertilizer, though I am unaware of any large tracts of land that exist in the urban slums where these bags would be most useful.  I am also a bit concerned about what happens to the bag after use.  Urban slums tend to be lacking in sanitary disposal of waste in general.  Often the street side or alleyways serve as garbage dumps.  We will see what comes of this innovation in the future!

Revival

After having taken a rather lengthy hiatus from blog posts, I hope to start regular posts. Given my class schedule and work schedule, I’ll do my best to post a couple of times per week. There is a lot going on in health care right now–the Obama administration will be discussing health care reform on Feb 25 (mixed opinions about whether HCR will pass this year, mixed emotions about whether HCR should pass this year), the H1N1 scare has almost totally died away, and Health Affairs just published an issue dedicated to technology and health in developing countries. I can’t wait to get back to writing about all these issues! Look for more posts soon.

Health Care Reform in Perspective: A Symposium

On Friday September 25th HSPH held a symposium on health care reform, sponsored by the New England Journal of Medicine.

The following individuals sat on the panel to discuss the current health care reform debate.

Henry J. Aaron, Ph.D.
Senior Fellow in Economic Studies, Brookings Institution, Washington, D.C.
Aaron’s research addresses a number of health care challenges, including Medicare reform, health care rationing and health care finance.

Katherine Baicker, Ph.D.
Professor of Health Economics, Department of Health Policy and Management, HSPH
Baicker’s research focuses primarily on the factors that drive the distribution, generosity and effectiveness of public and private health insurance, with a particular focus on health insurance finance and the effect of reforms on the distribution and quality of care.

Jacob S. Hacker, Ph.D.
Professor of Political Science, Yale University, New Haven, and Resident Fellow, Institution for Social and Policy Studies
Hacker is an expert on the politics of U.S. health and social policy and is the author of a 2007 proposal for universal health care, “Health Care for America,” that became a template for several presidential aspirants’ plans.

Mark V. Pauly, Ph.D.
Professor of Health Care Management, Professor of Business and Public Policy, and Professor of Insurance and Risk Management, Wharton School, and Professor of Economics, University of Pennsylvania, Philadelphia
Pauly’s research areas include medical economics, health policy, health insurance and other insurance, public finance/public choice and regulation.

Arnold Epstein, M.D., moderated the discussion:
Professor of Health Policy and Management, Harvard School of Public Health
Dr. Epstein’s research interests focus on access and quality of care especially for disadvantaged populations.

Dr. Epstein began the discussion by speaking about the past, present and future of health care delivery in the US. Clearly, Pres. Obama has taken a different route than Pres. Clinton did in the early 1990′s. While Clinton essentially drafted the health care reform plan in the executive branch, Obama has left the legislation up to Congress. A total of 5 committees in the House and Senate have legislation over health care reform. The bills have many similarities, including the necessity to change insurance markets, regulate the insurance industry, expand Medicaid, mandate (employer or individual) and subsidies to help purchase care. The bills also have various (and important) differences including how to create better competition (a public option?), how big the subsidies will be (and how to fund the subsidies), how to reign in Medicare spending (cuts?), and finally, the political actions that will be necessary to pass a bill (cloture vs. reconciliation).

Hank Aaron was the first to speak. Aaron argued that the public option has been overhyped. He said that it would not fulfill the hopes of the advocates, and the fears of the critics are greatly overblown. Because of the lobby of private insurance in Congress, a public plan would never win out over private plans. The public plan would never become the most-chosen option, because essentially Congress would not let this happen. This point struck me as both truthful and sad.

Hacker, on the other hand, was a huge proponent for the public plan. He said it is vital to the goals of reform: it provides a choice for citizens, and it provides savings through competition. In his view, the health care reform proponents need to fight the fear. There is a fear about losing coverage, a fear of government and increased taxes. Invoking Pres. Obama’s campaign slogan, Hacker said to fight fear with hope- and a vision for reform. (He also spoke rather humorously about the strange and unrequited love story of Baucus and Grassley.)

Dr. Baicker, one of HSPH’s own health economists, broke down reform into simple terms. She said its about giving people the resources to buy health care and health insurance. Specifically, this targets low income individuals who don’t have resources or individuals with high health expenditures who cannot afford to pay for health care. The question becomes: how much health care. (Trigger-rationing!) We know some health care is of high value but for other types of health care the value is difficult to ascertain. We spend lots of money on health care that has limited value. (Yes, we spend money on health care that has limited–or unknown–value. But if someone in your family was suffering from cancer, you would probably want to try even the treatments that had “limited” value. Bringing the issue to the personal level changes this thought process) Basically, people purchase insurance for health care because health is both expensive and variable. For Baicker, the issue of a mandate for insurance is more of a philosophical question.

Special thanks to NEJM for sponsoring this symposium. NEJM’s chief editor briefly spoke about the Journals (somewhat new) focus on health policy and health care reform. Each issue now has 1-3 health policy related pieces. You can find all of the NEJM articles related to health care reform free of charge: http://healthcarereform.nejm.org/

Former Minister of Health of Mexico Speaks on H1N1

Last week, Dr. Julio Frenk, the former Minister of Health of Mexico and current Dean of the Harvard School of Public Health, spoke about H1N1 and Global Security. Dean Frenk spoke with his usual entertaining style and wit. The room was filled with students, professors, researchers and media.

Dr. Frenk began his speach by again emphasizing that the world is now “a single neighborhood.” Globalization and ease of travel, among other things, have shrunk the globe’s epidemiological space. Global health is not the opposite of domestic health. Instead, health is unified as a single area of interest. Frenk dispelled the vision that risks flow from South to North and solutions flow from North to South.

The first and most uncertain wave of H1N1 (swine flu) has passed. What was once unexpected and unknown has transformed into the known and expected. (Public health experts knew pandemic influenza was coming….the question was where and when) We know that the virus shows no signs of mutation. Most who contract the virus suffer moderate illness which is generally susceptible to medications. Clinical trials are underway for a vaccine, and it appears that it will be fully protective to individuals that receive it. Currently, there is some concern that the vaccine may be available to Americans “too late.” Unlike the seasonal flu, which peaks in January or February, H1N1 is expected to peak by mid October, around the time the vaccine should be available. First priority vaccines will be available to: health care and emergency workers, pregnant women, everyone aged 6 months to 24 years, adults up to age 64 with medical problems, and people caring for infants under 6 months old. (Notably missing from this list are the elderly, often considered at risk because they are often frail and have comorbidities.) In general, Dean Frenk seemed confident with the response to swine flu.

How does health relate to global security? Dr. Frenk views health security as a 3 dimensional issue: 1) epidemiological security in the form of prevention against disease and injury. 2) health care security constituted by access to quality care 3) economic security defined by ability the purchase and have access to food, shelter, and care.

In the past 12 months Americans have experienced the financial meltdown, the beginning of pandemic influenza, and increased and serious efforts towards health care reform. The coming months will show how the nation reactes to this diverse and interrelated challenges.

Regina Benjamin, Surgeon General?

This week President Obama nominated Regina Benjamin as Surgeon General. I knew very little about Dr. Benjamin, and also about the role of Surgeon General.  It was fairly easy to do some research on both Dr. Benjamin and the role of the S.G.

Regina Benjamin already has a host of accomplishments:

In 1998 she was awarded the Nelson Mandela Award for Health and Human Rights. She was the first black woman and the first doctor under age 40 elected to the American Medical Association’s board of trustees (though I lost  respect for the AMA after their reaction to health care reform, among other things) In 2002  she became the first black woman to head a state medical society.  She also won a MacArthur Foundation genius grant. (The list goes on)  She is clearly a leader and a do-er. (See Huff Po’s article)  I’m impressed by her resume and her commitment to help the under-served.

I also came across an Op-Ed that Dr. Benjamin wrote for the NYT in 2006 as she helped the Bayou region recover from Hurricane Katrina.  Dr. Benjamin writes about helping victims of the hurricane: constructing a makeshift clinic in the shelter, working out of a cramped trailer, and finally re-building her clinic, only to see it burn down  in a fire. (To see her clinic’s website go to here)

According to the Dept of Health and Human Services (DHHS), “The Surgeon General serves as America’s chief health educator by providing Americans the best scientific information available on how to improve their health and reduce the risk of illness and injury.”  The Surgeon General also “serves as the operational Commander of the Commissioned Corps of the United States Public Health Service (PHS), a uniformed force of 6,000 health professional officers dedicated to promoting, protecting, and advancing the health and safety of the people of the United States.” (More on Duties here)

Perhaps the most widely known action of the Surgeon General is the warning labels on cigarettes and alcohol. Surgeon Generals, though not policy-makers themselves, often advocate for sometimes unpopular health policies.  Surgeon Generals can also play crucial roles in epidemics, such as during the outbreak of  HIV/AIDS in the 1980′s.  Given her history, I hope that Dr. Benjamin will work to close the coverage gap, increase access to care for all Americans, and promote preventive and primary care.

*With Dr. Benjamin’s appointment we see more proof that President Obama is appointing knowledgeable and educated individuals.  Thank you Obama for bringing brains back to the government!

Letter to the Editor

I sent the following letter to my home state local newspaper.  Write a letter to your local newspaper editor, encouraging support for health care reform with a public option!

Dear Editor,

Our health care system is badly broken. American families and businesses urgently need a solution. Our patchwork system fails to keep costs down and prevents millions of Americans from seeking the preventive care that they need.

Forty-six million Americans are uninsured, and millions more remain under-insured. Premiums are growing four times faster than wages and half of all personal bankruptcies stem from medical expenses.  The United States has the most expensive medical care in the world, but ranks below most developing countries in infant mortality and other important public health indicators.

President Obama has challenged Congress to pass real health care reform in 2009 that upholds the basic principles of:

* Reducing costs by improving efficiency and investing in preventative care and health information technology.
* Guaranteeing every American the right to choose their plan and doctor, including a public insurance option.
* Ensuring quality, affordable care for every American.

Congress must past real health care reform in 2009. This must be a bi-partisan effort to fix our deeply broken system. I encourage Senators Wyden and Merkley to work for and pass health care reform with a public option. I encourage all Oregonians to get behind our Senators and Representatives and support health care reform.

The only thing more expensive than fixing health care is not fixing health care. I am hopeful that 2009 will be a good year for health care reform, but we cannot pass legislation without the support of our Congressmen/women.