Quality health care at lower cost? It could happen

It seems a no-brainer: reward the doctors and hospitals that give the best care, latch on to programs and ideas that offer quality over quantity. But innovation in health care, even when it proves out, has always taken a very long time to work into the system.

In a ‘Talk of the Town’ piece appearing in the latest New Yorker magazine, writer Atul Gawande offers a thoughtful look at some of the hurdles ahead for the newly-passed health bill. They are primarily political: conservatives — even if they’re talking less and less about repeal — will run on pieces they plan to strip out, states will fight the insurance exchanges (such as those that make health coverage near universal in Senator Scott Brown‘s Massachusetts.) And other battle lines will be drawn.

But one primary problem with the dysfunction we are hoping to fix, Gawande points out, is that the current system “pays for quantity of care rather than the value of it.” He illustrates this with a case that makes you cheer, and then feel a little hopeless:

Recently, clinicians at Children’s Hospital Boston adopted a more systematic approach for managing inner-city children who suffer severe asthma attacks, by introducing a bundle of preventive measures. Insurance would cover just one: prescribing an inhaler. The hospital agreed to pay for the rest, which included nurses who would visit parents after discharge and make sure that they had their child’s medicine, knew how to administer it, and had a follow-up appointment with a pediatrician; home inspections for mold and pests; and vacuum cleaners for families without one (which is cheaper than medication). After a year, the hospital readmission rate for these patients dropped by more than eighty per cent, and costs plunged. But an empty hospital bed is a revenue loss, and asthma is Children’s Hospital’s leading source of admissions. Under the current system, this sensible program could threaten to bankrupt it. So far, neither the government nor the insurance companies have figured out a solution.

There is in the new bill, though, a ray of hope:

The most interesting, under-discussed, and potentially revolutionary aspect of the law is that it doesn’t pretend to have the answers. Instead, through a new Center for Medicare and Medicaid Innovation, it offers to free communities and local health systems from existing payment rules, and let them experiment with ways to deliver better care at lower costs. In large part, it entrusts the task of devising cost-saving health-care innovation to communities like Boise and Boston and Buffalo, rather than to the drug and device companies and the public and private insurers that have failed to do so. This is the way costs will come down—or not.

Imagine innovation being rewarded, communities being encouraged to find ways to improve quality of care at lower cost. That’s real reform, and it could just happen.

The next attacks on health-care reform : The New Yorker.

A note to Sarah Palin

The industrious Sarah Palin, having thankfully receded somewhat from front pages everywhere, has been all over cyberspace and the airwaves recently with her Tea Party appearances and her new Fox News job. There is cause for alarm.

Palin is a grand master — or perhaps mistress — of the art of Us v Them politics. Some of us who still hang onto the hope for an Us and Them America were dismayed by her rhetoric. Not that it has changed, just that it was so comfortably forgotten for a while. Palin seems unenthusiastic about letting anyone forget her for a while.

Political commentator Amy Walter suggested, on last night’s PBS NewsHour, that Palin and the Tea Party boosters are simply capitalizing on the general American frustration with the status quo. Politicians like Marco Rubio in Florida and Scott Brown in Massachusetts, she said, are “recognizing the mood” and adjusting their messages to fit.

The mood of the Us-and-Them Together  party is glum. One Tea Party conventioneer explained to NewsHour about Palin that “She speaks like we do, she thinks like we do.” God help us. Maybe someone else will join in the U&T Together Party”s effort to respond to Palin’s latest:

“How’s that hopey changey thing workin’ out for you?” — Well, not exactly as we’d wish, but better, we think, than those hopey changey things you are promoting.

And about that comment you made re running for President of the United States — I’ll just keep on doin’ a darn good job… Could we respectfully request you confine your darn good job to Fox News? The U&T Together Party is not feeling hopey changey about Fox News.

Single-payer healthcare in California: Not Dead Yet

“Is there any hope for health care on the national level,” he was asked? “No.”

But Don Bechler, Chair of the California activist group Single Payer Now, was on northern California’s KZYX yesterday affirming that there is still hope for health care “if we get the insurance companies out.” California voters have twice passed single-payer health plans, both times seeing them vetoed by Governor Scwarzenegger. State Senator Mark Leno has a universal-coverage bill in the current legislature to try once more. It’s a bill anybody would love — unless you’re a body working in the insurance business.

As to the national battle, Bechler says HR 676 (sometimes known as the John Conyers bill) is the best current hope. “We haven’t really given up.” Strategies? “Talk to your congressmen, ask them to co-author HR 676. There are 87 co-sponsors so far. It’s health care for everyone, dental coverage, long-term care.” What’s not to love?

Bechler contends that Massachusetts voters who put Scott Brown did not do so out of anti-health care sentiments as has been speculated in media reports. “That’s the corporate media doing their corporate spin for their corporate buddies in the insurance industry.” Lest there be any doubt, Bechler is not much more enthusiastic about the media than about the insurance business.

As to the threat of filibuster of the current bill, which is at least more likely to pass than HR 676, Bechler suggests the Republican bluff be called. “Put it on the floor. Let the Republicans get up and talk for two months.”

Such a prospect is mind-numbing all by itself. But the national outrage might keep everyone awake.