O:9:"magpierss":24:{s:6:"parser";i:0;s:12:"current_item";a:0:{}s:5:"items";a:25:{i:0;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-2566190275736499930";s:9:"published";s:29:"2011-04-18T08:27:00.001-07:00";s:7:"updated";s:29:"2011-04-18T08:27:30.254-07:00";s:5:"title";s:30:"Robert Huefner on Single Payer";s:12:"atom_content";s:9770:"Peg McEntee, in her SL Tribune column (find it <a href="http://www.sltrib.com/sltrib/news/51637594-78/care-health-huefner-payer.html.csp?page=1">here</a>), reports on retired UofU Professor Robert Huefner's speech to the League of Women Voters about health system reform.  (Prof. Huefner has <a href="http://utahpatientspac.blogspot.com/2011/04/response-from-robert-p-huefner-health.html">recently</a> been featured on this blog responding to the Utah Healthcare Initiative proposal.)<div><br /></div><div>Excerpts:</div><div><br /></div><div><span class="Apple-style-span"   style="  color: rgb(51, 51, 51); line-height: 17px; font-family:Georgia, 'Times New Roman', Times, serif;font-size:13px;"><p class="TEXT_w_Drop_Cap_C" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Robert Huefner begins with a few startling statistics: In any given year, 1 percent of the U.S. population receives more than a quarter of health care nationally. Two percent get more than a third, and 5 percent more than half.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">The reason boils down to two kinds of medical conditions: acute, meaning someone who has had a heart attack or a bad accident and the like; and people with continuing conditions such as diabetes. Both will require hospitalization or other kinds of institutional care.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Those statistics, Huefner says, are precisely why the United States needs a single-payer system of health care, whether it’s run by the government or through regulations that require insurance companies to join together in universal coverage.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Huefner, a University of Utah professor emeritus, spoke about options for health care reform last week at the League of Women Voters’ annual luncheon.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">In 1950, when Blue Cross and Blue Shield were the only insurers covering hospitalizations and medical services respectively, overall health care costs amounted to about 5 percent of the gross domestic product. But as other insurers got into the game, costs rose, and today amount to 17 percent.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">There are models elsewhere: In Germany, France and other European nations, insurers are what Huefner calls virtual single-payer because they must work as a coalition to keep costs under control.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">That might not be a popular option here, but Huefner believes it’s either that or a government single-payer.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">“It can be said that in the U.S. we are sliding toward a single payer — a government single payer,” Huefner says. “Government now pays more than half of all health care costs, and as much per person as any other country pays for all its health care.”</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Under pressure, President Barack Obama set aside the single-payer option to get the Affordable Care Act passed. But because of the nature of the health care market, Huefner says, “the government is the safety net, and the net keeps catching more.”</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Now how does Huefner, a retired political science professor, know all this? He took his bachelor’s in civil engineering at the U., earned a master’s in city planning from the Massachusetts Institute of Technology and a doctorate in finance from Harvard.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">He joined Utah Gov. Edward Clyde’s office as the state planning coordinator working on public health issues and continued in the Calvin Rampton and Scott Matheson administrations. At the U., he directed the Matheson Center for Health Care Studies, bringing together medical professionals with the social science and engineering departments.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Here in Utah, health care is relatively successful regarding cost and quality. Institutions tend to cooperate, there are plenty of skilled professionals and administrators, technology is growing ever more sophisticated and our lifestyle is good if you don’t count our terrible air quality. We also have few income disparities and a good education system, although it’s certainly not perfect.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">The nation, though, has trouble with the cost of care and quality, not least because of the market-driven system that puts burdens on those enrolled in an insurance plan.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Meanwhile, hospitals cost about twice that of physicians, but it’s the physicians who decide who goes to the hospital. And, Huefner says, there is “a significant amount of care that is either unnecessary or harmful.”</p><div>My comment:</div><div><br /></div><div>Every American family will sooner or later have someone in need of expensive medical care for acute or chronic health care conditions.  Whenever that occurs, even if the family has health insurance, the financial obligations for the care will threaten the family finances.  Health care costs are the most common cause of family bankruptcy and two-thirds of Americans who file bankruptcy because of health care costs had health insurance at the time that the health care problem occurred.  Something that every American family needs yet is apparently too expensive for family financing sounds like it belongs within the purview of community infrastructure, like highways, libraries, fire fighting, and law enforcement.   And, as Prof. Huefner points out, we Americans are already taxing ourselves as if health care is public infrastructure.  About $1.5 trillion of our $4 trillion annual taxes in America will go to health care.  We are the most taxed citizenry for health care in the world.  We just aren't regulating well how those tax revenues are spent.</div><div><br /></div><div>There is a flip side to this coin.  If we don't fund our health care providers consistently and adequately, no matter how much money an individual has, the needed health care won't be available, because the hospital and personnel infrastructure requires continuous sustenance in order to be sustained.  There is a reason that Arabian sheiks seek health care in Europe and the US: health system infrastructure in their homeland has not been consistently built and supported.  They have vast wealth, but do not consistently support care for all citizens and so their money can not buy the care at home when they need it.  The truth is:  when we pay taxes for health care we are not buying someone else's care, we are assuring that the care we need in the future will be there for us and our family members.  So, if we don't regulate well what the health system does with our tax revenues, they will underfund our care providers, like doctors and hospitals, and leave us in want of good facilities and professionals.  When we fund community infrastructure we are not only being charitable, we are making our own lives better.</div><div><br /></div><div>These principles are at the heart of the health system reform proposed by the Utah Healthcare Initiative.  Thanks to Prof. Huefner for highlighting them and to Peg McEntee for publishing his remarks.</div><div><br /></div><div>Yours,</div><div><br /></div><div>Dr. Joe Jarvis</div><div>www.utahhealthcareinitiative.com</div><p></p></span></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-2566190275736499930?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:170:"http://utahpatientspac.blogspot.com/feeds/2566190275736499930/comments/defaulthttp://utahpatientspac.blogspot.com/2011/04/robert-huefner-on-single-payer.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/2566190275736499930";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/2566190275736499930";s:4:"link";s:79:"http://utahpatientspac.blogspot.com/2011/04/robert-huefner-on-single-payer.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"0";}}i:1;a:13:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-1896673669508943862";s:9:"published";s:29:"2011-04-16T07:44:00.000-07:00";s:7:"updated";s:29:"2011-04-16T07:55:50.796-07:00";s:5:"title";s:52:"Response from Drew Quinn JD-Administrative Law Judge";s:12:"atom_content";s:3928:"<span class="Apple-style-span" style="font-family: Tahoma, Verdana, Arial, sans-serif; line-height: 17px; font-size: 13px; color: rgb(42, 42, 42); ">One question I have is whether you will be able to get waivers from CMS to take Medicaid and CHIP away from the health department (as specified in CFR) and put it into the cooperative.  The concept sounds good, and although I understand your point about market forces not being applicable to health care, I still have concerns about one large entity making decisions for all Utahns and kicking the private insurers out.  One size doesn't fit all, as I have found in working with Medicaid rules and policies.  </span><div><span class="Apple-style-span" style="font-family: Tahoma, Verdana, Arial, sans-serif; line-height: 17px; font-size: 13px; color: rgb(42, 42, 42); "><br /></span></div><div><span class="Apple-style-span" style="font-family: Tahoma, Verdana, Arial, sans-serif; line-height: 17px; font-size: 13px; color: rgb(42, 42, 42); ">My comment:</span></div><div><span class="Apple-style-span" style="font-family: Tahoma, Verdana, Arial, sans-serif; line-height: 17px; font-size: 13px; color: rgb(42, 42, 42); "><br /></span></div><div><span class="Apple-style-span" style="font-family: Tahoma, Verdana, Arial, sans-serif; line-height: 17px; font-size: 13px; color: rgb(42, 42, 42); ">Ms. Quinn is an administrative law judge who handles claims filed by Medicaid beneficiaries.  She knows from experience that the unintended consequences of administering government rules and regulations can be harsh.  People who have private health insurance policies also have complaints about the way their benefits are administered.  Denials are a way of doing business in health insurance.  But, when the insured have a complaint against their insurance company, they must file it with the company itself, which then adjudicates that claim.  Not surprisingly, those complaints generally do not change the original company decision.  For Medicaid beneficiaries, however, the complaint is heard by an independent administrative law judge (i.e., no jury) such as Ms. Quinn.  She has the authority to independently order Medicaid to change its behavior concerning a particular case.  To use her analogy, she can alter the size of the benefit, within certain parameters, to make it better fit the situation.  The Utah Healthcare Initiative, inspired by Ms. Quinn herself, proposes that the proposed payer for all Utah health benefits, the Utah Health Cooperative, be subject to a similar administrative law review, organized by the Utah Health System Commission.  By including a fair, equitable, independent administrative law review for all complaints in its proposal, the Utah Healthcare Initiative guarantees that Utah's residents go from the current system of private health insurance, which offers a benefit befitting nobody, to a system where a single set of benefits are financed for all with a size adjustment as necessary through case review.</span></div><div><span class="Apple-style-span" style="font-family: Tahoma, Verdana, Arial, sans-serif; line-height: 17px; font-size: 13px; color: rgb(42, 42, 42); "><br /></span></div><div><span class="Apple-style-span" style="font-family: Tahoma, Verdana, Arial, sans-serif; line-height: 17px; font-size: 13px; color: rgb(42, 42, 42); ">Yours,</span></div><div><span class="Apple-style-span" style="font-family: Tahoma, Verdana, Arial, sans-serif; line-height: 17px; font-size: 13px; color: rgb(42, 42, 42); ">Dr. Joe Jarvis</span></div><div><span class="Apple-style-span" style="font-family: Tahoma, Verdana, Arial, sans-serif; line-height: 17px; font-size: 13px; color: rgb(42, 42, 42); ">www.utahhealthcareinitiative.com</span></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-1896673669508943862?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:167:"http://utahpatientspac.blogspot.com/feeds/1896673669508943862/comments/defaulthttp://utahpatientspac.blogspot.com/2011/04/response-from-drew-quinn-jd.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/1896673669508943862";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/1896673669508943862";s:4:"link";s:76:"http://utahpatientspac.blogspot.com/2011/04/response-from-drew-quinn-jd.html";s:11:"author_name";s:10:"Joe Jarvis";s:10:"author_uri";s:51:"http://www.blogger.com/profile/17261685310251731119";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"1";}}i:2;a:12:{s:2:"id";s:68:"tag:blogger.com,1999:blog-815620327731150455.post-741954828869750404";s:9:"published";s:29:"2011-04-15T08:23:00.000-07:00";s:7:"updated";s:29:"2011-04-15T08:34:49.932-07:00";s:5:"title";s:27:"This Generation's Challenge";s:12:"atom_content";s:8375:"<span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';">That is what former Utah Gov. and HHS Secretary Mike Leavitt called health system reform in a speech he delivered in Colorado (find the Greeley Tribune report about the speech </span></span><a href="http://www.greeleytribune.com/article/20110413/NEWS/704139981/1006/WAP&amp;parentprofile=1001"><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';">here</span></span></a><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';">).  Excerpts: </span></span><div><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';"><br /></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';">LOVELAND — While our nation’s approach to health care is grounded in compassion, today’s economic realities are driving decisions into dollars-and-cents dispassion in which networks, bundled prices and new ways of delivering care will be necessary.<br /></span></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';"><br /></span></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';">He said options to deal with the rising costs include raising taxes and cutting benefits — both of which are unpopular.<br /><br />“Then you only have one choice, and you can begin to drop what you pay health care providers,” Leavitt said. “There will be substantial downward pressure on (how much is paid to) health care providers in the next five to 10 years. Hospitals and clinics will have to learn to do things they haven’t had to do because they’ll be feeling this global economic dispassion. … This is happening in state governments, all around. They have to try to balance their budgets. So this pressure is very much being felt.”<br /></span></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';"><br /></span></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';">“This isn’t a management fad. This is a Darwinian response,” Leavitt said. “No one would join up with their competitors naturally. You do it to survive.”<br /><br />With burgeoning expenses tied up in health care — and networks and tiers of health care coverage developing in response, from Medicaid to self-pay “Cadillac” plans — running the system without government order “would be a problem” and result in inequities, Leavitt said. He said many dilemmas confront health care — end-of-life care, offering affordable access and the ballooning costs of Medicare and Medicaid — and at the root of the debate is whether government should organize or operate the system.<br /><br />Last year’s passage of the Affordable Care Act moved the nation toward an operating system, Leavitt said, but “I think we’ll find something more in the middle, where government is involved with organizing the space” and allowing the market to take it from there.<br /></span></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';"><br /></span></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';">“We’ll all work on this all the time. These forces are going to compel us to change,” he said.<br /><br />Ultimately, there will be winners and losers.<br /><br />“Not every hospital will survive, not every clinic will survive,” Leavitt concluded. “It will be those who position themselves and skillfully navigate the changes of the next decade. Every generation of American has had to deal with something like this to prove we are the number one economy and culture and power in the world. I would suggest this is this generation’s challenge. Because it really does require sacrifice and a willingness to adapt.” </span></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';"><br /></span></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';">My comment:</span></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';"><br /></span></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';">I agree with former HHS Sec. Leavitt that health care costs will force change on the way Americans do health care business.  But I disagree with him that the change will be primarily focused on hospitals and doctors, though I agree that change must occur at the bedside.  The real losers in health system reform must eventually be the insurers whose business model can not survive.  Americans do not need to either raise taxes or cut clinically effective benefits in order to respond to the financial forces impacting health care.  We do need to eliminate wasteful health system spending, including the $400 billion/year wasted on administrative overhead and $700 billion/year in quality waste, both caused by the private health insurance business model.  </span></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';"><br /></span></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';">Let's get on with this challenge.  Join the Utah Healthcare Initiative.</span></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';"><br /></span></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';">Yours,</span></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';">Dr. Joe Jarvis</span></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span"  style="font-family:'times new roman';">www.utahhealthcareinitiative.com</span></span></span></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-741954828869750404?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:165:"http://utahpatientspac.blogspot.com/feeds/741954828869750404/comments/defaulthttp://utahpatientspac.blogspot.com/2011/04/this-generations-challenge.html#comment-form";s:9:"link_edit";s:80:"http://www.blogger.com/feeds/815620327731150455/posts/default/741954828869750404";s:9:"link_self";s:80:"http://www.blogger.com/feeds/815620327731150455/posts/default/741954828869750404";s:4:"link";s:75:"http://utahpatientspac.blogspot.com/2011/04/this-generations-challenge.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"0";}}i:3;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-4938795894629146236";s:9:"published";s:29:"2011-04-14T07:12:00.000-07:00";s:7:"updated";s:29:"2011-04-14T07:36:20.670-07:00";s:5:"title";s:55:"Infections Not An Unavoidable Cost of Hospital Business";s:12:"atom_content";s:6681:"The New York Times, reporting on two studies published this week in the New England Journal of Medicine (find the NY Times article <a href="http://www.nytimes.com/2011/04/14/health/14infections.html?_r=2&amp;partner=rss&amp;emc=rss">here</a>), cited Centers for Disease Control statistics that should alert every American:  "T<span class="Apple-style-span" style="font-family: georgia, 'times new roman', times, serif; font-size: 15px; line-height: 22px; ">he Centers for Disease Control and Prevention in Atlanta still estimates that one in every 20 patients will acquire an infection while hospitalized. Using data from 2002, the agency concluded that hospital infections were associated with 99,000 deaths and costs of $28 billion to $34 billion a year."</span><div><span class="Apple-style-span" style="font-family: georgia, 'times new roman', times, serif; font-size: 15px; line-height: 22px; "><br /></span></div><div><span class="Apple-style-span" style="font-family: georgia, 'times new roman', times, serif; font-size: 15px; line-height: 22px; ">And hospital acquired infection is only one of several categories of patient injury that currently devastates American patients.  </span></div><div><span class="Apple-style-span" style="font-family: georgia, 'times new roman', times, serif; font-size: 15px; line-height: 22px; "><br /></span></div><div><span class="Apple-style-span" style="font-family: georgia, 'times new roman', times, serif; font-size: 15px; line-height: 22px; ">More excerpts from the article:</span></div><div><span class="Apple-style-span" style="font-family: georgia, 'times new roman', times, serif; font-size: 15px; line-height: 22px; "><br /></span></div><div><span class="Apple-style-span" style="font-family: georgia, 'times new roman', times, serif; font-size: 15px; line-height: 22px; "><span class="Apple-style-span" style="line-height: 15px; font-size: 10px; color: rgb(51, 51, 51); "><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; font-size: 1.5em; line-height: 1.467em; color: rgb(0, 0, 0); ">The study of 153 Veterans Affairs hospitals nationwide found a 62 percent drop in the rate of infections caused by methicillin-resistant Staphylococcus aureus, or MRSA, in intensive care units over a 32-month period. There was a 45 percent drop in MRSA prevalence in other hospital wards, like surgical and rehabilitation units.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; font-size: 1.5em; line-height: 1.467em; color: rgb(0, 0, 0); ">The Veterans Affairs strategy employs a “bundle” of measures that include screening all patients with nasal swabs, isolating those who test positive for MRSA, requiring that staff treating those patients wear gloves and gowns and take other contact precautions and encouraging rigorous hand washing. The results may not be easily replicated in the private sector, but they are likely to step up pressure by further undercutting the notion, prevalent at many hospitals not long ago, that infections are an unavoidable cost of doing business.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; font-size: 1.5em; line-height: 1.467em; color: rgb(0, 0, 0); ">“I think our study has shown that it is possible to make this large-scale change, even in a large system,” said Dr. Rajiv Jain, an official with the Veterans Health Administration and the study’s primary author. “If other hospitals were to follow our lead, I think it is possible to decrease these infections.”</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; font-size: 1.5em; line-height: 1.467em; color: rgb(0, 0, 0); ">Infection rates at the veterans’ hospitals had been static in the two years before the new approach was implemented systemwide in 2007. The hospitals then saw significant decreases in every form of MRSA-related infection. Dr. Jain said each hospital spent between $160,000 and $300,000 a year to employ a prevention coordinator and lab technician and to purchase testing supplies, gowns and gloves.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; font-size: 1.5em; line-height: 1.467em; color: rgb(0, 0, 0); ">The overriding message of the V.A. study is that hospitals can make a difference, and that’s important because it shifts the conversation from if it can be done to how it might best be done.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; font-size: 1.5em; line-height: 1.467em; color: rgb(0, 0, 0); ">My Comment:</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; font-size: 1.5em; line-height: 1.467em; color: rgb(0, 0, 0); ">The way we do health care business in America is wastefully expensive, in part because we are injuring our patients in the process.  We can do better.  But we will not improve unless patient care becomes the principle focus of how we do our health care business.  We fell into our present bad habits of poor quality health care because of the perverse incentives that are inherent in pretending that health care is a commodity efficiently distributed by market forces.  These so-called market forces are actually profiteering corporate welfare schemes that induce scrimping on hospital infection control in order to pad quarterly financial gains.  Hospitals which do well with hospital infection control will not only have costs associated with their patient safety efforts, they will also have fewer patients with critical illness caused by hospital acquired infection for whose care they can collect fees.  It is time to come up with health care financing that rewards better patient care.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; font-size: 1.5em; line-height: 1.467em; color: rgb(0, 0, 0); ">Join us at the Utah Healthcare Initiative.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; font-size: 1.5em; line-height: 1.467em; color: rgb(0, 0, 0); ">Yours,</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; font-size: 1.5em; line-height: 1.467em; color: rgb(0, 0, 0); ">Dr. Joe Jarvis</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; font-size: 1.5em; line-height: 1.467em; color: rgb(0, 0, 0); ">www.utahhealthcareinitiative.com</p></span></span></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-4938795894629146236?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:174:"http://utahpatientspac.blogspot.com/feeds/4938795894629146236/comments/defaulthttp://utahpatientspac.blogspot.com/2011/04/infections-not-unavoidable-cost-of.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/4938795894629146236";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/4938795894629146236";s:4:"link";s:83:"http://utahpatientspac.blogspot.com/2011/04/infections-not-unavoidable-cost-of.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"0";}}i:4;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-1324978553156769167";s:9:"published";s:29:"2011-04-13T08:47:00.001-07:00";s:7:"updated";s:29:"2011-04-13T09:04:39.317-07:00";s:5:"title";s:53:"Response from Kent Farnsworth MD-Retired Obstetrician";s:12:"atom_content";s:5159:"Dr. Kent Farnsworth has responded to the Utah Healthcare Initiative proposal for health system reform (find the proposal <a href="http://utahpatientspac.blogspot.com/2011/04/utah-healthcare-initiative-our-proposal.html">here</a>).  Dr. Farnsworth has retired from active OB-Gyn practice, though he continues to volunteer his clinical care skills in Utah and around the world and he serves as adjunct faculty in health policy at both the University of Utah and Utah Valley University.  His comments:<div><br /></div><div><blockquote type="cite" style="font-family: Helvetica; font-size: medium; ">I agree with your concluding observation that because of the lobby influence of special interests groups, the only feasible way to implement the Utah Healthcare Initiative is by a ballot initiative.  I am in support of making this a state endeavor rather than national because of the unique positives already in place in Utah.  I understand the argument of making the proposed sweeping changes but wonder because of the many vested interest groups effected if critical adequate support of many of these same groups can ever be mustered.  It would be very convincing if there was a body of data to show that a "Health Benefit Commission" could really keep up in managing the tasks of establishing and maintaining a <i>Uniform Benefit Package</i> with the inherent load of claims and refereeing of insurance companies.   <br />   On the cost/funding side, how soon would we see a $6 billion savings from waste elimination?  Hopefully soon, to sustain public support since there are a significant number of citizens who are currently paying so little of their health care bill.<br />   The critical strategy it seems will be to gain general public support by presenting these proposals in a way that can be easily understood to be fair and equitable and will result in better care which you and I would define at the best outcome at the lowest cost.  Most understand the first part of this formula and not the second.</blockquote><blockquote type="cite" style="font-family: Helvetica; font-size: medium; "><br /></blockquote><blockquote type="cite" style="font-family: Helvetica; font-size: medium; ">My comment:</blockquote><blockquote type="cite" style="font-family: Helvetica; font-size: medium; ">When people question the feasibility of doing health system reform by ballot initiative, I generally respond by noting that real reform is unlikely by ballot, but impossible by legislation.  And, further, what is unlikely by ballot today can and will become more likely as the financial disaster of American health care financing continues to unfold.  Our national way of life literally can not survive unless we change the way we do health care business.  As Dr. Farnsworth notes, Utah is in a particularly good position to try out comprehensive state based health system reform, with lowest in the nation per capita health care costs driven largely by best in the nation (in many regards) health system performance.  Be we become too self-congratulatory, however, we should remember what Dr. Brent James says about Utah's successes in health care:  "Utah is the cream of the crap" by which he means best in a nation known for its poor and wasteful health system performance.  It is difficult to muster the support of health system players, as Dr. Farnsworth notes, because health system reform requires reducing wasteful spending in health care but one person's waste is another person's profit.  Sweeping change, however, is the best course to attempt because these entrenched health system interests will politically fight incremental, small changes with the same vigor they will battle a comprehensive health policy proposal.  Of course, there is a convincing body of data that a uniform benefit package can be maintained if one looks to the international community.  Other first world nations have been limiting the care people can get while handling the claims (or their equivalent) for many years.  Some of the savings anticipated from the UHI proposed changes in our health system could be realized immediately.  For instance, the wildly expensive overhead of the private health insurance business model, accounting for as much as $1 billion in health system waste in Utah, could be eliminated overnight by replacing many private insurers with the Utah Health Cooperative.</blockquote><blockquote type="cite" style="font-family: Helvetica; font-size: medium; ">Thanks to Dr. Farnsworth for a thoughtful response.  The Utah Healthcare Initiative encourages all Utahns to carefully consider our proposal and post a response.</blockquote><blockquote type="cite" style="font-family: Helvetica; font-size: medium; ">Yours,</blockquote><blockquote type="cite" style="font-family: Helvetica; font-size: medium; ">Dr. Joe Jarvis</blockquote><blockquote type="cite" style="font-family: Helvetica; font-size: medium; ">www.utahhealthcareinitiative.com</blockquote></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-1324978553156769167?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:172:"http://utahpatientspac.blogspot.com/feeds/1324978553156769167/comments/defaulthttp://utahpatientspac.blogspot.com/2011/04/response-from-kent-farnsworth-md.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/1324978553156769167";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/1324978553156769167";s:4:"link";s:81:"http://utahpatientspac.blogspot.com/2011/04/response-from-kent-farnsworth-md.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"0";}}i:5;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-4594282516852434618";s:9:"published";s:29:"2011-04-12T07:41:00.000-07:00";s:7:"updated";s:29:"2011-04-12T07:55:28.080-07:00";s:5:"title";s:49:"Response from Robert P. Huefner, Health Economist";s:12:"atom_content";s:4879:"<span class="Apple-style-span" style="font-family: Tahoma; font-size: x-small; "><div><span style="font-family:tahoma;">Here is another in a series of responses to the Utah Healthcare Initiative proposal for health system reform (find the proposal <a href="http://utahpatientspac.blogspot.com/2011/04/utah-healthcare-initiative-our-proposal.html">here</a>):</span></div><div><span style="font-family:tahoma;"><br /></span></div><div><span style="font-family:tahoma;"> I agree with the seriousness of the problem. I also agree with your statistics re cost, and often defend your accounting of government expenditures when it is challenged.</span></div><div><span style="font-family:tahoma;"></span> </div><div><span style="font-family:tahoma;"><span style="font-family:tahoma;">As we've discussed before, the politics of establishing a Utah single payer, without significant state government expenditures, seem to me to be overwhelming barriers to a reasonable state-level single payer plan. That in turn means that a state-level plan would be a serious (even catastrophic<a></a>) drain on resources for public education and a likely race by states to the bottom for not only public education but also health care benefits.</span></span></div><div><span style="font-family:tahoma;"></span> </div><div><span style="font-family:tahoma;"><span style="font-family:tahoma;">Still, I appreciate your efforts, as they help inform the public of the seriousness and nature of the problems. While you work for a state-level single payer I press for federal responsibility for access and for a combination of federal and state and private initiatives for quality improvement, efficiency, and cost/expenditure controls.</span></span></div><div><span style="font-family:tahoma;"><span style="font-family:tahoma;"><br /></span></span></div><div><span style="font-family:tahoma;"><span style="font-family:tahoma;">My comment:</span></span></div><div><span style="font-family:tahoma;"><span style="font-family:tahoma;"><br /></span></span></div><div><span class="Apple-style-span"  style="font-family:tahoma;">Prof. Huefner is a well-known health economist and therefore his agreement with how the Utah Healthcare Initiative frames the discussion about health care costs is significant.  Take it from him, then, that the US is on the verge (within a few years) of economic collapse due to wasteful health care spending.</span></div><div><span class="Apple-style-span"  style="font-family:tahoma;"><br /></span></div><div><span class="Apple-style-span"  style="font-family:tahoma;">His principle objection to the UHI proposal seems to be political: he finds little evidence that such a dramatic change in how we do health care business can ever pass into statute.  Up to this point in American history he is, of course, correct.  However, as the financial nightmare related to health care costs further develops and becomes increasingly inescapable, who knows what will become politically possible?</span></div><div><span class="Apple-style-span"  style="font-family:tahoma;"><br /></span></div><div><span class="Apple-style-span"  style="font-family:tahoma;">He also believes that state budgets can not handle health care costs inevitably leading to a drain on public education.  In response, let the reader note that Medicaid funding alone is already compromising Utah's public education budget.  We have the system Prof. Huefner argues for, i.e., federal responsibility for access and a combination of federal, state, and private responsibility for quality, efficiency, and cost control, and opportunity costs are already killing our economy through poor funding of education and lackluster investment in new products.  The combination of federal, state, and private supervision of the health care system has meant that no one actually takes responsibility.  The health care system, left to itself, has become a massive public trough for corporate welfare.</span></div><div><span class="Apple-style-span"  style="font-family:tahoma;"><br /></span></div><div><span class="Apple-style-span"  style="font-family:tahoma;">Thanks to Prof. Huefner for his thoughtful comments.  </span></div><div><span class="Apple-style-span"  style="font-family:tahoma;"><br /></span></div><div><span class="Apple-style-span"  style="font-family:tahoma;">Best,</span></div><div><span class="Apple-style-span"  style="font-family:tahoma;"><br /></span></div><div><span class="Apple-style-span"  style="font-family:tahoma;">Dr. Joe Jarvis</span></div><div><span class="Apple-style-span"  style="font-family:tahoma;">www.utahhealthcareinitiative.com</span></div><div><span style="font-family:tahoma;"></span> </div></span><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-4594282516852434618?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:177:"http://utahpatientspac.blogspot.com/feeds/4594282516852434618/comments/defaulthttp://utahpatientspac.blogspot.com/2011/04/response-from-robert-p-huefner-health.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/4594282516852434618";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/4594282516852434618";s:4:"link";s:86:"http://utahpatientspac.blogspot.com/2011/04/response-from-robert-p-huefner-health.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"0";}}i:6;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-2946566731577731428";s:9:"published";s:29:"2011-04-11T12:16:00.000-07:00";s:7:"updated";s:29:"2011-04-11T12:37:39.104-07:00";s:5:"title";s:14:"More On SB 294";s:12:"atom_content";s:8712:"When last we checked in on the SB294 saga, Kirsten Stewart of the SL Tribune had written about how Gov. Herbert's veto of this legislation may be overridden (find our blogpost <a href="http://utahpatientspac.blogspot.com/2011/04/lets-do-what-is-best-policy.html">here</a>).  You heard here first how this legislation is actually a direct attack on the Utah Health Exchange, orchestrated by the insurance industry.  Now comes an op-ed by Shelly Braun, Reform Initiatives Director for the Utah Health Policy Project, Utah's premier Obama-care booster organization, confirming the assault on the Utah Health Exchange (find the op-ed piece <a href="http://www.sltrib.com/sltrib/opinion/51585284-82/health-bill-utah-insurance.html.csp">here</a>).  Excerpts:<div><br /></div><div><div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', Times, serif; font-size: 13px; color: rgb(51, 51, 51); line-height: 17px; "><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">SB294 was a back-room deal that should set off your alarm bells if you care about public accountability and the state’s progress on health insurance reform. It was introduced on the last day of Utah’s legislative session and screamed through the Legislature in less than 24 hours!</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">The bill undermines Utah’s private market health system reform and the Utah Health Exchange, undoes legislation passed just last year, favors young people and single-parent families with only one child while increasing costs for other families and people over 45, and, even worse, it doesn’t come free — the bill was unfunded even though the estimated cost to implement the bill was quoted at $109,000 by the fiscal analyst.</p><div><span class="Apple-style-span"    style="font-family:Georgia, serif;font-size:130%;color:#000000;"><span class="Apple-style-span" style="font-size: 16px; line-height: normal;"><span class="Apple-style-span"    style="font-family:Georgia, 'Times New Roman', Times, serif;font-size:100%;color:#333333;"><span class="Apple-style-span" style="font-size: 13px; line-height: 17px;"><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">SB294 started out as a completely different bill carried by Sen. Stuart Adams, R-Layton.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">It was hijacked on the session’s last day and filled with content that undermines years of progress on Utah’s Health Exchange. It by-passed all rules, had no public debate and passed at literally the last minute of the last day — 11:58 p.m. This end-run push is bad public policy and is not how our legislative process is supposed to work. </p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">nstead of overriding the veto, legislators should have that debate.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">What they will learn is that small-business owners, providers, consumers — Utahns from all walks of life — desperately want affordable and quality health insurance and health care, not closed-door deals between the industry and lawmakers.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">All we ask is that the investment we make in our health insurance plans will be there when we need it. We voted for our representatives and they should work for us.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">The discussion about health insurance should be a public one.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Utah’s Health Insurance Exchange is just starting to build steam, showing steady growth since its 2011 re-launch.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">The same representative who pushed through SB294 at the last minute fought for his key state health reform bill by arguing that the exchange needed to hunker down and really focus on serving the small-business market.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">But SB294 would force the Utah Health Exchange (at its own expense) to back-track and re-tool to accommodate the new pricing tier and the 6:1 rate ratio it creates.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">This sets Utah’s efforts in the small group market back by months, if not longer. State reform has been slow and incremental at best, and SB294 chips away at earlier reforms, undermining the entire process.</p><div>My comment:</div><div><br /></div><div>First, a comment to the Utah Health Policy Project.  You chose to back various health 'reform' proposals which feature the private health insurance business model.  Having done that, your protests against this and other examples of how this business model harms people and makes real reform impossible are useless.  </div><div><br /></div><div>Second, clearly SB294 is a frontal assault on the Utah Health Exchange, which is floundering anyway.  (To say, as Ms. Braun does, that the Utah Health Exchange is 'just starting to build up steam' is ridiculously euphemistic.  There are hundreds of thousands of uninsured Utahns and a few dozen people have purchased a health insurance policy on the Utah Health Exchange.)  The health insurance industry, which is principally responsible for SB294 and the ongoing attempt to override the governor's veto, does not want the Utah Health Exchange interfering with the most profitable business of selling benefits to large employers.  They also don't want the Exchange to somehow force them to sell benefits to the most expensive sector of Utahns (when it comes to health care) in the individual market.  And, when it comes to small businesses, they want the freedom to pick and choose customers by pricing their useless product so that unwanted business will be priced out.  </div><div><br /></div><div>Third, let's be clear about who runs health policy at the legislature.  Big corporate health care interests can always get their business done in the Utah legislature, as this episode clearly points out.  Health care interests are by far the biggest donors to politics in the US, counting both federal and state political donations.  They have the ear of elected officials.  Therefore, they are in the room when the bills are written, the budgets are balanced, and the nose counting is done.  We do have a welfare problem in American health care and it is corporate welfare.  Fiscal conservatives need to have a health care budget epiphany and help get health insurers, Big Pharma, hospital systems, and medical device manufacturers out of the public trough.</div><div><br /></div><div>Yours,</div><div><br /></div><div>Dr. Joe Jarvis</div><div>www.utahhealthcareinitiative.com </div><p></p></span></span></span></span></div></span></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-2946566731577731428?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:154:"http://utahpatientspac.blogspot.com/feeds/2946566731577731428/comments/defaulthttp://utahpatientspac.blogspot.com/2011/04/more-on-sb-294.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/2946566731577731428";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/2946566731577731428";s:4:"link";s:63:"http://utahpatientspac.blogspot.com/2011/04/more-on-sb-294.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"0";}}i:7;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-8010811672159886232";s:9:"published";s:29:"2011-04-11T12:12:00.001-07:00";s:7:"updated";s:29:"2011-04-11T12:12:52.956-07:00";s:5:"title";s:9:"A Warning";s:12:"atom_content";s:3754:"The Deseret News ran the following story (find it <a href="http://www.deseretnews.com/article/705370303/Family-says-daughters-death-should-be-a-warning-to-others.html">here</a>):<div><br /></div><div><span class="Apple-style-span"   style="  line-height: 17px; font-family:arial, sans-serif;font-size:13px;"><p>OGDEN — The family of an Ogden woman who died from meningitis has a warning for the public.</p><p>They're asking people to not ignore or minimize symptoms they're experiencing and to get checked out. By the time their daughter did, it was too late.</p><p>Shaelyn Skeen, 28, came down with a cold a couple weeks ago, which turned into a sinus infection. She didn't have insurance, so she held off going to the doctor until late last week, when the infection moved into her ear.</p><p></p><p>Shaelyn's mother says she appeared to be doing better, and then her boyfriend went to check on her.</p><p>"He found her on the floor, not responsive," DeEtte Skeen said. "(She was) awake, just not really there."</p><p>The hospital diagnosed Shaelyn Skeen with bacterial meningitis — a serious illness categorized by high fever, headache and a stiff neck. Shaelyn Skeen's health went downhill quickly, and doctors pronounced her brain-dead Sunday.</p><p>The family kept her on life support, so her organs could be donated. Her kidneys and pancreas went to patients in Utah, and her heart and at least one lung went to people in Texas.</p><p>"She's my hero," DeEtte Skeen said.</p><p>The outpouring of love and support has been overwhelming, the family said. In exchange, they're asking her friends to take better care of themselves.</p><p>"You know when you have a problem, you know what your body is doing. Take care of it. That's what I told her friends. Please don't ignore the symptoms. Go in, get looked at," DeEtte Skeen said.</p><p>My comment:</p><p>There are several lessons to be learned from this story.  First, the obvious one.  Not having a means to pay for health care will cost some people their lives.  The published data indicates that the total is about 45,000 American lives each year.  Those who argue against finding a way to fund care for all Americans must explain why we should not care about the loss of this young life with so much potential.  Second, generally, patients can not tell which symptoms need medical attention and which are benign.  So-called consumer oriented health insurance forces patients to make decisions about what is necessary care despite the fact that several studies of patient behavior in the face of financial risk demonstrates that lay persons are likely to forgo necessary care, as was the case with Ms. Skeen.  Consumer directed health plans will waste money, because too many people will forgo preventive and early care which is less expensive, and lives, as happened this time.  Finally, the current health care financing scheme in the US is penny wise and pound foolish.  We allow the private health insurance business model to exclude/deny care in the name of small savings (going to their bottom line) which we pay for by losing the productivity of American citizens in many ways, starkly illustrated by the loss of this life in her prime.  </p><p>Let's take this warning seriously.  The opportunity costs of our present health care financing scheme are killing our economy, threatening our government budgets, bankrupting our families, and literally killing our citizens.</p><p><br /></p><p>Yours,</p><p>Dr Joe Jarvis</p><p>www.utahhealthcareinitiative.com</p><p><br /></p><p></p></span></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-8010811672159886232?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:147:"http://utahpatientspac.blogspot.com/feeds/8010811672159886232/comments/defaulthttp://utahpatientspac.blogspot.com/2011/04/warning.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/8010811672159886232";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/8010811672159886232";s:4:"link";s:56:"http://utahpatientspac.blogspot.com/2011/04/warning.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"0";}}i:8;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-1672226088795576783";s:9:"published";s:29:"2011-04-09T10:07:00.000-07:00";s:7:"updated";s:29:"2011-04-09T10:09:51.573-07:00";s:5:"title";s:63:"Response from Kent Michie-former Utah Commissioner of Insurance";s:12:"atom_content";s:1429:"<div style="font-family: Helvetica; font-size: medium; ">I sincerely wish you well on this proposal. The current system (the Health Care Mess) is a Gordian Knot of special interests and your economic figures present a compelling argument as to why we must move forward with comprehensive reform. It is not rocket science as to how to fix it. But it will take the sovereign to do it. The sovereign is, of course, the people. The problem cannot be fixed at the national level but could be greatly aided by the passage of certain encouraging and enabling Federal legislation as you describe. But the basic question must be put directly to the people. I have always trusted a majority of Utahns to be able to see through and do the right thing. When presented with the facts in an unemotional way, they will do the right thing. </div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; ">This is a fabulous idea which if enacted, would show the nation how the problem can be intelligently addressed.</div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; ">Kent Michie</div><div><br /></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-1672226088795576783?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:177:"http://utahpatientspac.blogspot.com/feeds/1672226088795576783/comments/defaulthttp://utahpatientspac.blogspot.com/2011/04/response-from-kent-michie-former-utah.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/1672226088795576783";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/1672226088795576783";s:4:"link";s:86:"http://utahpatientspac.blogspot.com/2011/04/response-from-kent-michie-former-utah.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"0";}}i:9;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-6960040071532018044";s:9:"published";s:29:"2011-04-08T08:44:00.000-07:00";s:7:"updated";s:29:"2011-04-10T18:26:49.013-07:00";s:5:"title";s:45:"The Utah Healthcare Initiative:  Our Proposal";s:12:"atom_content";s:32591:"<div style="text-align: center;"><span class="Apple-style-span"><u><br /></u></span></div><ol style="list-style-type: decimal"> <li style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px">BRIEF OVERVIEW OF THE ISSUE:  Health System Reform</span></li> </ol> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica; min-height: 14.0px"><span class="Apple-style-span"><span style="letter-spacing: 0.0px"></span><br /></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span class="Apple-style-span"><span style="letter-spacing: 0.0px">Health care costs are busting government budgets in the US at all levels.  Federal deficits on into the future, given current health care spending trends, will be principally due to rapidly rising costs for Medicare, Medicaid, CHIP, and other federal health programs</span>.  All fifty state budgets are threatened by the growth of demand for Medicaid funded health services.  A state senator in Utah stated that ten years ago Medicaid required 9% of the state budget, but doubled to 18% this year and is expected to double again to 36% by the end of this decade.  Total health spending in the US was $2.5 trillion in 2009, accounting for 17.6% of the GDP.  As illustrated in the table below with data from 2007, health spending on a per capita basis in the US is approximately two to three times higher than is the case in other developed nations.  Remarkably, public spending (i.e., derived from taxation) for health care is higher in the US than anywhere else in the world and, in fact, constitutes 60% of American health care spending, or $1.5 trillion (out of a total US tax revenue stream of less than $4 trillion).  Public spending on health care comes at an opportunity cost.  For instance, at the state level, education budgets are threatened by increasing Medicaid costs. In 2010 Utah’s lowest in the nation per pupil spending rate had to be decreased while the Medicaid budget required and received an additional $48 million. </span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span class="Apple-style-span"><br /><a href="http://3.bp.blogspot.com/-Ql6-wRihNjY/TaJWql_QSgI/AAAAAAAAAGM/lA5i_KVJf2s/s1600/Screen%2Bshot%2B2011-04-10%2Bat%2B7.17.08%2BPM.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 239px;" src="http://3.bp.blogspot.com/-Ql6-wRihNjY/TaJWql_QSgI/AAAAAAAAAGM/lA5i_KVJf2s/s320/Screen%2Bshot%2B2011-04-10%2Bat%2B7.17.08%2BPM.png" border="0" alt="" id="BLOGGER_PHOTO_ID_5594128976899492354" /></a><br /></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica; min-height: 14.0px"><span class="Apple-style-span"><span style="letter-spacing: 0.0px"></span><br /></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span class="Apple-style-span"><span style="letter-spacing: 0.0px">Failure to improve American education over the past quarter century has resulted in an estimated $1.3 trillion to $2.3 trillion in lost (or never realized) GDP growth</span>.  Family budgets, too, have been hit hard by health care costs.  The US Census Bureau has found that median income for a family of four is falling and was just over $50,000 in 2009 while the 2010 medical cost for a typical American family of four was just over $18,000.</span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica; min-height: 14.0px"><span class="Apple-style-span"><span style="letter-spacing: 0.0px"></span><br /></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span class="Apple-style-span"><span style="letter-spacing: 0.0px">Health care costs are high in the US because of two principle problems:  poor quality and inefficiency.  Thomson Reuters published a $700 billion per year list of savings possible through improving health care quality </span>by reducing inappropriate care (including defensive medicine), preventing injury of hospitalized patients, and bringing American health care services in line with known clinical science.  Inefficient administration of American health care financing costs up to $400 billion annually<span style="font: 10.0px Verdana; letter-spacing: 0.0px color: #555555">. </span><span> </span><span style="letter-spacing: 0.0px">US health systems are plagued by waste due to poor quality and inefficiency because of the penchant of Americans to expect market forces to introduce accountability into all transactions, including the purchase of health care.  </span></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px"> </span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px">Health care is not a commodity that can be efficiently distributed by a market. A market exists when a completely informed buyer can freely choose to enter into a transaction with a self-interested seller without any positive externality.  Market efficiency is demonstrated when demand rises as price declines.  None of these conditions exist within the health care sector.</span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px"> </span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px">a)  buyers of health care lack clinical knowledge (no caveat emptor) and are not free to decide whether to purchase health services (especially in urgent settings);  </span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px">b)  sellers of health services are not supposed to act in their own self interest which is why society should not tolerate physicians and nurses whose greed pre-empts the best interests of their patients;</span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span class="Apple-style-span"><span style="letter-spacing: 0.0px">c)  positive externality refers to a situation when someone other than the buyer or seller has a legitimate interest in the outcome of a transaction, such as is the case when the general public has an interest in assuring the best care for a patient with a communicable disease.  We have massive infusions of tax dollars into health systems because of positive externalities.  </span>d)  the inverse relationship between price and demand does not hold for health services.  No one ever bought an appendectomy because it was on sale.  Demand for health services is determined by epidemiology (the frequency of disease and injury), not by price.</span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px"> </span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span class="Apple-style-span"><span style="letter-spacing: 0.0px">Lack of accountability in our health system is not a market failure, since health care is not a commodity efficiently distributed by market forces.  Rather, lack of accountability in health systems is a social failure.  For instance, preventable hospital injuries can be discovered and eliminated not by individual buyers (patients) but by public health agencies.  The pretense of markets, so characteristic of American health policy, has created perverse incentives to deliver mediocre care in an inefficient manner</span>.  Reducing poor quality and inefficiency waste will require inventing new social mechanisms to replace the failing business models which characterize the American health care delivery system. </span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica; min-height: 14.0px"><span class="Apple-style-span"><span style="letter-spacing: 0.0px"></span><br /></span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span class="Apple-style-span"><span style="letter-spacing: 0.0px">Recently passed federal and state health ‘reform’ legislation (the Affordable Care Act and its predecessor in Massachusetts) are coverage initiatives and not the needed reform measures (for instance, read the Kaiser Family Foundation summary of the Affordable Care Act online at <a href="http://www.kff.org/healthreform/8061.cfm"><span style="text-decoration: underline ; letter-spacing: 0.0px color: #0c25a6">www.kff.org/healthreform/8061.cfm</span></a>).  Massachusetts officials testified before Congress one year before the passage of the Affordable Care Act that burgeoning costs made the Bay State’s health ‘reforms’ financially unsustainable.  Recent projections by the Congressional Budget Office confirm that the Affordable Care Act will not prevent future “excess cost growth” in health care</span>.  </span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px"><br /></span></p><p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px">In summary, growth in US health care costs far exceeds any international comparison.  Coverage initiatives, the standard American health policy approach over the past 50 years, ultimately fail to contain excessive growth in health care costs.  The business model of private health insurance is administratively wasteful and invokes perverse incentives to deliver mediocre care.  Sustainable health system reform must introduce social accountability into health care delivery while targeting improved quality and efficiency.</span></p><p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px"><br /></span></p><p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span class="Apple-style-span"><span class="Apple-style-span"><span class="Apple-style-span"><span class="Apple-style-span"></span></span></span></span></p><span class="Apple-style-span"><span class="Apple-style-span"><ol style="list-style-type: decimal; "> <li style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px">EXPLANATION OF THE PROPOSED SOLUTION</span></li> </ol> <p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; "><span class="Apple-style-span"><br /><a href="http://2.bp.blogspot.com/-SMuBubFjHG4/TaJWBsAv_xI/AAAAAAAAAGE/xayWOJg_Yp8/s1600/iuytr4ds.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 320px; height: 270px;" src="http://2.bp.blogspot.com/-SMuBubFjHG4/TaJWBsAv_xI/AAAAAAAAAGE/xayWOJg_Yp8/s320/iuytr4ds.png" border="0" alt="" id="BLOGGER_PHOTO_ID_5594128274141740818" /></a><br /></span></p> <p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; "><span style="letter-spacing: 0.0px">The graphic above allows the reader an easy view of the biggest problems in our health system (left side of the chart) and the Utah Healthcare Initiative (UHI) proposed solution (right side of the chart).  This a state-based proposal for comprehensive, sustainable health system reform in Utah.  UHI proposes to create one new government agency (the Utah Health Systems Commission) and re-name an existing publicly owned trust fund (the Public Employee Health Plan will be called the Utah Health Cooperative) while transforming it into the sole payment source for health services need by Utah residents.  UHI also proposes to strengthen the current passive public health surveillance system for patient safety into a mandatory reporting system with trained staff for interventions to improve hospital performance.</span></p> <p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); min-height: 14px; "><span class="Apple-style-span"><span style="letter-spacing: 0.0px"></span><br /></span></p> <ol style="list-style-type: decimal; "> <li style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica; color: #333233"><span style="letter-spacing: 0.0px"> The Utah Health System Commission will have two principle tasks: 1) define the clinically proven set of health benefits for every citizen in Utah; and 2) adjudicate claims against any part of the health system efficiently (i.e., in a fashion similar to workers compensation, with administrative law judges and without punitive damages or juries).  The Commission will be given two years after passage of the enabling statute to determine what diagnostic and therapeutic interventions have been proven effective by clinical science while being the least expensive alternative.  These interventions will constitute the initial Uniform Benefit for all Utah residents.  The Commission will have the task of continuously reviewing clinical science as it evolves to keep the Uniform Benefit updated.  The Commission will also organize an administrative law system, similar to the system which handles claims about workplace injuries and illnesses, for the purpose of adjudicating claims against any part of the health care system, such as malpractice by providers or failure to make payment by the Utah Health Cooperative.  The principle features of this administrative law system will be that no punitive damages will be allowed and no jury trials will be conducted.  </span></li> <li style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica; color: #333233"><span style="letter-spacing: 0.0px">The Utah Health Cooperative (formerly the Public Employees Health Plan) would undergo a two year transformation from its current role of providing efficiently paid health benefits to Utah State government and other public employees.  PEHP is the most efficient payer in Utah, reporting less than 4% overhead while the largest four private health insurers in the state average 15% administrative costs.  Upon passage of the enabling legislation, PEHP would be re-named the Utah Health Cooperative and would immediately begin selling health benefits to all Utahns, whether employed in the public sector or not.  Medicaid, CHIP, and other publicly paid programs would be transferred to the Utah Health Cooperative as soon as practicable.  Private health insurers would have two years to phase out their Utah operations.  The Utah Health Cooperative would negotiate with the US DHHS to become the fiscal agent for Medicare in Utah, anticipating the time when Medicare beneficiaries living in the Beehive State could be phased into full participation in the program.  The most important function of the Utah Health Cooperative, aside from receiving and managing all funds intended to support health services in Utah, would be to use its monopsony clout to improve health system function, including better use of primary care, improved distribution of public health, optimizing behavioral health services, negotiating better prices for pharmaceuticals and medical devices, and supporting continuous quality improvement system wide.  </span></li> <li style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica; color: #333233"><span style="letter-spacing: 0.0px">Patient injury would be reduced through standard public health surveillance and intervention.</span></li></ol><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); min-height: 14px; "></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); min-height: 14px; "><span>START UP COSTS</span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); min-height: 14px; "><span><br /></span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); min-height: 14px; "><span class="Apple-style-span"><span>This proposal is fashioned as a response to federal legislation offered by Rep. John Tierney (D-MA) and Sen. Bernie Sanders (I-VT) known as The States’ Right to Innovate in Health Care Act of 2009 (find a draft of this legislation on the Utah Healthcare Initiative website, URL below).  </span><span style="letter-spacing: 0.0px">This proposed legislation would offer states technical assistance and funding, as well as regulatory flexibility, to assist with the costs of planning and implementing innovative state-based programs through a competitive selection process.  The legislation proposes grants up to $10 million for each state selected, which is an adequate sum for the anticipated planning and implementation of the proposed Commission and Cooperative in Utah.</span></span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); min-height: 14px; "> </p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; min-height: 14px; "><span class="Apple-style-span"><span style="letter-spacing: 0.0px"></span><br /></span></p> <p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; "><span class="Apple-style-span">PROGRAM FUNDING</span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; "><span class="Apple-style-span"><br /></span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; "><span class="Apple-style-span"><span style="letter-spacing: 0.0px">Using a variety of sources </span>a rough estimate of Utah’s total health expenditures for 2009 would be $15 billion.  Approximately 60% of US health expenditures arise from public taxation, or roughly $9 billion of Utah’s total 2009 health spending, leaving $6 billion from private sources (out of pocket from individuals or payments from private employers not offset by tax credits).  Assuming that the relative proportions of waste due to poor quality and inefficiency cited above are applicable in Utah, approximately $6 billion of health spending in Utah during 2009 was lost to the cost of inappropriate care, patient injury, failure to deliver best practice care, and administrative overhead.  Therefore, improved quality and efficiency anticipated through the proposed health system reform would substantially reduce (essentially eliminate?) the need for health care funds from private sources not offset by tax credits or mandated by law.  The proposal accordingly anticipates that program funding will be principally derived through maintaining current public revenue streams paying for health care.  There are currently three major public revenue streams: 1) publicly funded health care programs, including Medicaid, Medicare, CHIP, IHS, and a multitude of smaller health service programs ($4 billion); 2) assorted tax credits for employer/employee purchase of health benefits/care ($4 billion); and 3) funding for federal, state, and local government employee/retiree/dependent healthcare plus government mandated health service payments for workers compensation, vehicle insurance, etc. ($2 billion).  During the initial two years after passage of enabling legislation, while the Utah Health Systems Commission is organizing the Uniform Benefit, the State of Utah will be required to assure the preservation of these public revenue streams for health care by: 1) negotiating with the national government for full carry over of all federal health care funding into a block grant to the state of Utah to be deposited with the Utah Health Cooperative; 2) identifying all state and local tax funding for health care and redirecting those funds in perpetuity to the Utah Health Cooperative; and 3) organizing an equitable levy of private employers and individuals, partially offset by federal and state tax credits, equal to the current level of tax supported health benefits purchased voluntarily in the private sector or mandated by law.</span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; "> </p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); min-height: 14px; "><span class="Apple-style-span"><span style="letter-spacing: 0.0px"></span><br /></span></p> <p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); "><span class="Apple-style-span">PROJECTED OUTCOMES</span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); "><span class="Apple-style-span"><br /></span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); "><span class="Apple-style-span"><span style="letter-spacing: 0.0px">A few years ago a small hospital in rural central Utah undertook a quality improvement effort directed at reducing the morbidity, mortality, and cost related to pneumonia</span>.  The authors of the project successfully reduced the length of time to appropriate antibiotic therapy for patients presenting with pneumonia and therefore dropped the proportion of patients requiring hospitalization, cut average length of stay for hospitalized patients by 1/3, and halved average cost per case.  Unfortunately, because of the perverse incentives currently characteristic of American health care delivery, reimbursement for pneumonia care fell even more than the drop in average cost per case, meaning that the hospital took a financial hit for improving the care of pneumonia patients.  This hospital’s parent organization, Intermountain Health Care (IHC), is a non-profit organization with a community oriented mission, and is responsible for roughly half of all hospital beds in Utah.  IHC has continued to organize quality improvement efforts despite these adverse financial consequences, in part accounting for Utah’s lowest in the nation per capita health care costs.  After the passage and implementation of this proposed legislation, IHC’s mission to improve the quality of care in its hospitals and clinics will be in congruence with the community mission of the proposed statewide payer for health services, the Utah Health Cooperative, with the added advantage of an administratively simple and lean payment mechanism.  Efforts to systematize urgent high level care needs (perinatal, trauma, cardiac, etc.) will be unimpeded by so-called market competition.  The least expensive option for clinically proven care will be sustainably financed for all Utah residents.  Primary care and behavioral health will be financially supported such that chronic care needs can be better managed in the outpatient setting.  Stable funding for clinical health services will allow public health agencies to re-focus on their traditional primary and secondary prevention services.</span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); "> </p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); min-height: 14px; "><span class="Apple-style-span"><span style="letter-spacing: 0.0px"></span><br /></span></p> <p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); "><span class="Apple-style-span">REQUIRED LEGISLATION</span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); "><span class="Apple-style-span"><br /></span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); "><span style="letter-spacing: 0.0px">Federal statutes, rules, regulations, and funding requirements currently effectively prevent any state from taking a comprehensive approach to sustainable health system reform.  Unfortunately, this web of federal complexity in health policy eliminates the ‘laboratories of democracy’ from serious efforts to solve our nation’s most pressing domestic problem: rising health care costs.  The Affordable Care Act is apparently the best that the sole remaining American legislative body (Congress) can do, and, as argued above, is completely inadequate.  Congressional Republicans have been vocally arguing that the states should be granted more authority to pursue health system reform.  President Obama has recently openly agreed with that position as long as any state plan provided for at least the same amount of coverage for no more cost than will be the case when the Affordable Care Act is fully implemented.  </span></p> <p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); min-height: 14px; "><span class="Apple-style-span"><span style="letter-spacing: 0.0px"></span><br /></span></p> <p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; "><span class="Apple-style-span"><span>Given the apparent bi-partisan support for increasing the autonomy of state governments in fashioning health policy, the Utah Healthcare Initiative proposes that members of Congress from both parties consider and pass The States’ Right to Innovate in Health Care Act, offered by Rep. John Tierney D-MA.  The purpose of this act (as stated in Sec. 2 of the draft)</span><span style="letter-spacing: 0.0px">  is to encourage States— (1) to develop plans for universal, comprehensive, cost-effective systems of health care with simplified administration to individuals residing in such States; and (2) to implement such plans by offering transitional grants and by removing Federal statutory and administrative barriers that may inhibit or discourage efforts by States to provide such health care while maintaining Federal payments for health care under Federal health care programs. Within the framework allowed by this act some states (such as Massachusetts) could follow the general outline of the Affordable Care Act and create mandates to buy health insurance, supplemental funding to assist families with the purchase, and health insurance exchanges.  Other states, for instance Vermont, could choose to create a government-based single payer for all health services.  In the event of passage of the States’ Right to Innovate in Health Care Act, the Utah Healthcare Initiative would vigorously encourage the passage of the here-in proposed Commission/Cooperative  reforms.</span></span></p> <p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; min-height: 14px; "><span class="Apple-style-span"><span style="letter-spacing: 0.0px"></span><br /></span></p> <p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); "><span style="letter-spacing: 0.0px">The Utah Healthcare Initiative proposes to put these reforms into effect through a ballot initiative for the simple reason that lobbyists working for the status quo in our health care system are entrenched in Congress and in every state legislature. The business models for health insurers, pharmaceuticals, malpractice lawyers, medical device manufacturers, hospitals, and doctors will be either eliminated or substantially changed by any meaningful, sustainable health system reform. Of course, these various interests will use their vast resources to oppose these needed changes. Only a ballot initiative, which takes the question of health system reform to the patients, has a chance to succeed in making the comprehensive changes in the way we do health care business in this nation. Ballot initiatives can only occur at the state level.</span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); "><span style="letter-spacing: 0.0px"><br /></span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); "></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); "><span style="letter-spacing: 0.0px">FUTURE GOALS</span></p> <p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); min-height: 14px; "><span class="Apple-style-span"><span style="letter-spacing: 0.0px"></span><br /></span></p> <p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; color: rgb(51, 50, 51); "><span style="letter-spacing: 0.0px">The Utah Healthcare Initiative is a political issue committee (PIC) officially registered with the State of Utah Elections Office.  As such, the Utah Healthcare Initiative can receive donations and dispense funds.  UHI is actively seeking donors, participants, and sympathizers through blogs, a website, and an active public speaking schedule.  Currently a member of the Utah State Legislature is working with the legislative counsel bureau to craft the needed legislative language for the ballot initiative.  Essentially this involves writing the proposed changes to Utah’s health system into appropriate statutory format.  Once this ‘bill’ is finished, UHI will begin the ballot initiative process by submitting it to the Lieutenant Governor’s office for review.  UHI anticipates an arduous pathway towards placing the initiative on the ballot and eventually winning the necessary votes from the electorate to secure passage.  Meanwhile, UHI is encouraging the Utah Congressional delegation to join with Rep. Tierney to secure the passage of the States’ Right to Innovate in Health Care Act.</span></p><div><span style="letter-spacing: 0.0px"><br /></span></div><div><span style="letter-spacing: 0.0px">Join the campaign to reform our health system by improving patient safety, reducing wasted overhead, and providing quality service to all patients.  Organize a neighborhood presentation about the Utah Healthcare Initiative.  Invite a speaker from UHI to your community, professional, or service organization.  Donate to the campaign fund using PayPal on this blog or the website.  Become a fan of the Facebook page.  Follow us on Twitter.  Do something or get ready for massive governmental debt and/or much higher taxes.</span></div><div><br /></div><div><span style="letter-spacing: 0.0px">Yours,</span></div><div><span style="letter-spacing: 0.0px"><br /></span></div><div><span style="letter-spacing: 0.0px">Dr. Joe Jarvis</span></div><div><span style="letter-spacing: 0px; ">www.utahhealthcareinitiative.com</span></div><p style="font-family: Helvetica; font-size: 100%; "></p><p style="font-family: Helvetica; font-size: 100%; "></p><p style="font-family: Helvetica; font-size: 100%; "></p><p style="font-family: Helvetica; font-size: 100%; "></p><p style="font-family: Helvetica; font-size: 100%; "></p></span></span><p></p><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-6960040071532018044?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:179:"http://utahpatientspac.blogspot.com/feeds/6960040071532018044/comments/defaulthttp://utahpatientspac.blogspot.com/2011/04/utah-healthcare-initiative-our-proposal.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/6960040071532018044";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/6960040071532018044";s:4:"link";s:88:"http://utahpatientspac.blogspot.com/2011/04/utah-healthcare-initiative-our-proposal.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"2";}}i:10;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-1397099088058906538";s:9:"published";s:29:"2011-04-07T09:22:00.000-07:00";s:7:"updated";s:29:"2011-04-07T10:03:30.651-07:00";s:5:"title";s:28:"Let's Do What Is Best Policy";s:12:"atom_content";s:24999:"The title for this blog entry is a direct quote lifted from a recent article by Kirsten Stewart (find it <a href="http://www.sltrib.com/sltrib/home/51567370-76/health-bill-utah-workers.html.csp#disqus_thread">here</a>) in the Salt Lake Tribune.  The article is about SB294 which was recently vetoed by Gov. Herbert.  Members of the Utah Legislature, led by Rep. Jim Dunnigan (R-Taylorsville), who is an insurance broker, are attempting to override the Governor's veto.  Here are excerpts from the article:<div><br /></div><div><span class="Apple-style-span"   style="  color: rgb(51, 51, 51); line-height: 17px; font-family:Georgia, 'Times New Roman', Times, serif;font-size:13px;"><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">SB294 would have granted health insurance companies greater flexibility in pricing their plans for small employers, allowing them to extend discounts to young workers and parents with one child while hiking premiums for older workers and possibly for larger families.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">The bill never came before a committee but surfaced suddenly in the House and Senate on the final day of the session, where it met with zero debate and was passed nearly unanimously. Twenty days later it was vetoed by the governor.</p><div><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Backers of the measure, including the Utah Association of Health Underwriters and sponsoring Taylorsville Republican Rep. Jim Dunnigan, an insurance broker, pitch it as a return to market-driven rules in force prior to 2010.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Legislation approved last year restricted premium rates for some older workers but had the effect of raising premiums for their twenty-something colleagues. It also stripped single parents – those who work for small businesses – of the option of paying less for coverage than families of three or more.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">That’s unfair, said Dunnigan who believes insurance rates should be based on risk and that older people and larger families should pay more because they use more health care. "That’s what’s driving this, consumers, not insurers. I had a divorced mom call me and say her premium doubled last year."</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">But Herbert vetoed SB294 fearing it will hurt older small business employees.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">If the bill is revived, families too could feel the sting of higher insurance costs, said Lincoln Nehring, senior health policy analyst at Voices for Utah Children. "It’s a big deal for families. But it’s an even bigger deal for seniors who already pay five times as much as younger consumers."</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Under SB294, workers in the 60-plus age range could pay up to six times more.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Brokers downplay the cost to seniors. In a letter to lawmakers urging support for an override, they paint a scenario in which the bill would hike monthly premiums for a 65-year-old worker by $17 and reduce monthly premiums by the same amount for a 19-year-old employee.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Bringing younger, healthier people into the insurance pool will make coverage more affordable for everyone by more broadly spreading the risk, the March 31 letter states.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Effects on the market, though, may be short-lived. Assuming President Obama’s signature health overhaul survives legal challenges and efforts to repeal some of its provisions, it will require nearly all Americans to purchase health coverage by 2014 and insurers will only be able be able to charge seniors three times more than young adults.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Regardless, said Dunnigan, "For the next two or three years, <b>let’s do what is best policy</b>."</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "><span class="Apple-style-span"  style="font-size:medium;">Before offering my own comments, allow me to offer several comments from the Salt Lake Tribune website:</span></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "><span class="Apple-style-span"  style="font-size:medium;">From imjenrus:</span></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "><span class="Apple-style-span"  style="font-size:medium;"><span class="Apple-style-span"  style=" ;font-size:12px;">I'm in my 50's and pay about 20% of my income to health insurance on both myself and wife. This is just another ploy by politicians and insurance companies to raise rates while discounting none. Case in point: Does Utahns honestly believe that insurance companies will drop their rates for the groups of people this Bill says it targets. NO, for if they are already paying what they are in premiums then they'll continue to pay for these premiums, hence, this is an end around to raise my insurance while lowering no-ones insurance rates. There goes my retirement.</span></span></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "><span class="Apple-style-span"  style="font-size:medium;"><span class="Apple-style-span"  style=" ;font-size:12px;">From John Pace:</span></span></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "><span class="Apple-style-span"  style="font-size:100%;"><span class="Apple-style-span"  style="font-size:12px;">As soon as proponents tout the bill as a "market-based approach" to healthcare insurance, they've exposed why they're wrong:<br /><br />The for-profit, market-based healthcare industry is a failed business model.<br /><br />The failed business model has left some 50.7 million working poor and disabled Americans unable to purchase insurance, and therefore unable to access basic preventative and primary medical care.<br /><br />This in turn directly leads to approx 45,000 deaths annually, according to a Harvard study -- and untold suffering among hundreds of thousands that are merely sick or injured but do not die.<br /><br />This is not anyone's fault. It's what any rational for-profit would do. Unfortunately, the rest of us must bear the costs of the system having to make a profit, and its consequent unwillingness to cover those who most need insurance.<br /><br />These very same sorts of externalities, i.e., for-profit companies not serving those who most need service and passing on the consequences to us, are why the government handles most jails and prisons, fixes most roads, runs most K-12 schools, provides most sewer and water, provides for public safety and fire fighting, etc., etc., etc. These are not services where exclusions based upon expanding profit margins can be tolerated.<br /><br />The 2010 ACA fixed a little bit of the problem, but we still have a long long way to go.</span></span></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "><span class="Apple-style-span"  style="font-size:100%;"><span class="Apple-style-span"  style="font-size:12px;">From stobbekranz:</span></span></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "><span class="Apple-style-span"  style="font-size:100%;"><span class="Apple-style-span"  style="font-size:12px;">So funny, they use the self righteous excuse of "providing more insurance for more Utahns" when in REALITY all it is is "providing more money for insurance companies"...which is what this is REALLY all about.</span></span></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "><span class="Apple-style-span"  style="font-size:100%;"><span class="Apple-style-span"  style="font-size:12px;">From healthagent:</span></span></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "><span class="Apple-style-span"  style="font-size:100%;"><span class="Apple-style-span"  style="font-size:12px;"><span class="Apple-style-span" style="line-height: 18px; "></span></span></span></p><span class="Apple-style-span"  style="font-size:100%;"><div id="dsq-comment-body-178684098" class="dsq-comment-body" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; float: none; text-indent: 0px; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-style: normal; text-align: left; display: block; background-position: initial initial; background-repeat: initial initial; "><div class="dsq-comment-message" id="dsq-comment-message-178684098" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 1em; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; float: none; text-indent: 0px; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-style: normal; text-align: left; display: block; line-height: 1.42; background-position: initial initial; background-repeat: initial initial; "><div class="dsq-comment-text" id="dsq-comment-text-178684098" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; float: none; text-indent: 0px; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-style: normal; text-align: left; display: inline; background-position: initial initial; background-repeat: initial initial; ">What is wrong with premiums rising for 'older' consumers??<br /><br />That is how insurance works.<br /><br />How come no one is complaining about the HIGH premiums teenagers must pay for driving a car??<br /><br />How come no one is complaining about the HIGH premiums 'older' consumers must pay for their life insurance??<br /><br />That is how it works.......life is NOT fair...........despite the libs constant desire to make it "always fair....to ALL people"<br /><br />It can not be done.<br /><br /><br /><br />"The worst form of inequality is to try to make unequal things equal."<br />--Aristotle</div></div></div><div class="dsq-comment-footer" id="dsq-comment-footer-178684098"  style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 1em; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; float: none; text-indent: 0px; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background- font-style: normal; text-align: left; display: block; overflow-x: hidden; overflow-y: hidden; background-position: initial initial; background-repeat: initial initial; color:initial;">From quakelive:</div><div class="dsq-comment-footer" id="dsq-comment-footer-178684098"  style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 1em; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; float: none; text-indent: 0px; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background- font-style: normal; text-align: left; display: block; overflow-x: hidden; overflow-y: hidden; background-position: initial initial; background-repeat: initial initial; color:initial;"><span class="Apple-style-span" style="line-height: 17px; ">Insurance is the WRONG vehicle to take care of the health of your body. If you can't/won't understand why, I'm not going to take the time to explain it.<br /><br />Non profit cooperatives and ending taxes on doctors and nurses is the answer. Few people find the answer which is why healthcare is still a mess in this country.</span></div><div class="dsq-comment-footer" id="dsq-comment-footer-178684098"  style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 1em; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; float: none; text-indent: 0px; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background- font-style: normal; text-align: left; display: block; overflow-x: hidden; overflow-y: hidden; background-position: initial initial; background-repeat: initial initial; color:initial;"><span class="Apple-style-span" style="line-height: 17px; "><span class="Apple-style-span"  style="font-size:medium;">My comment:</span></span></div><div class="dsq-comment-footer" id="dsq-comment-footer-178684098"  style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 1em; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; float: none; text-indent: 0px; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background- font-style: normal; text-align: left; display: block; overflow-x: hidden; overflow-y: hidden; background-position: initial initial; background-repeat: initial initial; color:initial;"><span class="Apple-style-span" style="line-height: 17px; "><span class="Apple-style-span"  style="font-size:medium;">If  I'm not mistaken, SB294 is an attempt to reverse last year's legislative attempt to fix the pricing problem on the Utah Health Exchange, the so-called online market for health insurance that is the cornerstone of health reform efforts by Utah's elected leaders.  When the Exchange opened with its first limited trial prices for the health insurance policies were commonly more (often much more) than available traditionally or elsewhere, much to the embarrassment of then Utah House Speaker Dave Clark, who has led the charge for this 'reform'.  He vowed to fix that pricing problem, and did, in legislation passed in 2010.  Now, without hearings, current legislative leadership (which does not include Clark) arrange for passage of SB294, which removes the restrictions on health insurance pricing, or in industry parlance, allows insurers more flexibility.  So, Gov. Herbert's veto can be seen as an attempt to give the Utah Health Exchange a better chance to survive, though, unless the federal Affordable Care Act is altered, the Utah Health Exchange will not comply in its present state with federal rules.  </span></span></div><div class="dsq-comment-footer" id="dsq-comment-footer-178684098"  style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 1em; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; float: none; text-indent: 0px; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background- font-style: normal; text-align: left; display: block; overflow-x: hidden; overflow-y: hidden; background-position: initial initial; background-repeat: initial initial; color:initial;"><span class="Apple-style-span"  style="line-height: 17px; font-size:medium;">But actually, all of this sturm und drang about health insurance, exchanges, and consumer-oriented health plans is beside the point.  I like how John Pace put it: "</span><span class="Apple-style-span" style="line-height: 17px; "><span class="Apple-style-span"  style="font-size:medium;">The for-profit, market-based healthcare industry is a failed business model."  Ultimately, the only way out of our health care mess is to stop depending on a failed business model.  No matter how you fashion the Utah Health Exchange, it is still a place to buy and sell a useless product.  No matter how much federal regulation shapes similar exchanges in all 50 states or supplements the purchase of health plans through these exchanges, health insurance is the world's least efficient method to finance health care and induces poor quality health care delivery to boot.</span></span></div><div class="dsq-comment-footer" id="dsq-comment-footer-178684098"  style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 1em; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; float: none; text-indent: 0px; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background- font-style: normal; text-align: left; display: block; overflow-x: hidden; overflow-y: hidden; background-position: initial initial; background-repeat: initial initial; color:initial;"><span class="Apple-style-span" style="line-height: 17px; "><span class="Apple-style-span"  style="font-size:medium;">healthagent said it all:  What is wrong with rising health insurance premiums?  That is how health insurance works.  Exactly.  Health insurance premiums spiral upward while actual benefits spiral ever downward.  We don't need health insurance.  We need health care.</span></span></div><div class="dsq-comment-footer" id="dsq-comment-footer-178684098"  style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 1em; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; float: none; text-indent: 0px; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background- font-style: normal; text-align: left; display: block; overflow-x: hidden; overflow-y: hidden; background-position: initial initial; background-repeat: initial initial; color:initial;"><span class="Apple-style-span" style="line-height: 17px; "><span class="Apple-style-span"  style="font-size:medium;">Ironically, it was Rep. Jim Dunnigan, a health insurance broker, who said: "Let's Do What Is Best Policy."  I agree, and that would be eliminating health insurance.</span></span></div><div class="dsq-comment-footer" id="dsq-comment-footer-178684098"  style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 1em; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; float: none; text-indent: 0px; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background- font-style: normal; text-align: left; display: block; overflow-x: hidden; overflow-y: hidden; background-position: initial initial; background-repeat: initial initial; color:initial;"><span class="Apple-style-span" style="line-height: 17px; "><span class="Apple-style-span"  style="font-size:medium;">Yours,</span></span></div><div class="dsq-comment-footer" id="dsq-comment-footer-178684098" color="initial" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 1em; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; float: none; text-indent: 0px; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background- font-style: normal; text-align: left; display: block; overflow-x: hidden; overflow-y: hidden; background-position: initial initial; background-repeat: initial initial; "><span class="Apple-style-span" style="line-height: 17px; "><span class="Apple-style-span"  style="font-size:medium;">Dr. Joe Jarvis</span></span></div><div class="dsq-comment-footer" id="dsq-comment-footer-178684098" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 1em; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; float: none; text-indent: 0px; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-style: normal; text-align: left; display: block; overflow-x: hidden; overflow-y: hidden; background-position: initial initial; background-repeat: initial initial; "><span class="Apple-style-span" style="line-height: 17px; "><span class="Apple-style-span"  style="font-size:medium;">www.utahhealthcareinitiative.com</span></span></div></span><span class="Apple-style-span"  style=" ;font-size:12px;"><br /></span><p></p><p></p></div></span></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-1397099088058906538?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:167:"http://utahpatientspac.blogspot.com/feeds/1397099088058906538/comments/defaulthttp://utahpatientspac.blogspot.com/2011/04/lets-do-what-is-best-policy.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/1397099088058906538";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/1397099088058906538";s:4:"link";s:76:"http://utahpatientspac.blogspot.com/2011/04/lets-do-what-is-best-policy.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"1";}}i:11;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-2206944566819317247";s:9:"published";s:29:"2011-04-06T12:16:00.000-07:00";s:7:"updated";s:29:"2011-04-06T12:31:07.626-07:00";s:5:"title";s:40:"House Republicans Propose Budget Changes";s:12:"atom_content";s:2818:"<img src="http://graphics8.nytimes.com//images/2011/04/06/us/politics/aa190.jpg" /><div><br /></div><div>The New York Times (find it <a href="http://www.nytimes.com/2011/04/06/us/politics/06ryan.html?_r=1&amp;partner=rss&amp;emc=rss">here</a>) notes that the proposal for reducing the future federal debt just offered by Rep. Ryan and colleagues in the House Republican Caucus will not become law as long as Pres. Obama can wield a veto pen.  But the proposal, from which the figure above is taken, will shape a great deal of the political debate between now and the next presidential election.  Of course, as noted on this blog many times, the budget problems and future deficits which require action are principally driven by health care costs.  The growing red wedge in the figure is the projected cost of Medicare, which is clearly outsizing any other portion of the federal budget in the coming years.  The Republican proposal for Medicare is simple:  change the program from a defined benefit to a defined contribution and then limit the growth of that contribution.  Of course, that will mean that Medicare beneficiaries will pay an increasing amount for their medical care.  The Congressional Budget Office projects that under this proposal the average 65 year old will pay more than double for their health care in 2030 than is currently the case.  </div><div><br /></div><div>There is no question that health care costs in this nation must be addressed.  The waste that causes enormous and rapidly rising costs for medicine and surgery in this country must be eliminated, or at least substantially downsized.  The question that this Republican proposal poses is this:  Can the average 65 year old take responsibility for eliminating health system waste due to poor quality and inefficiency?  </div><div><br /></div><div>Congress has clearly demonstrated that it can not handle the waste elimination problem.  But, like the dog in the manger, Congress has also made it impossible for states to address this problem on their own.  If Congress must stop allowing health care costs to threaten the federal budget, wouldn't it make more sense to block grant all health care funds to the states with the proviso that the grant amounts will not rise in the future and then turn the states loose to find a way to reduce health system waste?  Wouldn't state governments have a better chance to actually reduce waste than the individual 65 year old patient?</div><div><br /></div><div>Yours,</div><div><br /></div><div>Dr. Joe Jarvis</div><div>www.utahhealthcareinitiative.com<br /><div><br /></div><div><br /></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-2206944566819317247?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:172:"http://utahpatientspac.blogspot.com/feeds/2206944566819317247/comments/defaulthttp://utahpatientspac.blogspot.com/2011/04/house-republicans-propose-budget.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/2206944566819317247";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/2206944566819317247";s:4:"link";s:81:"http://utahpatientspac.blogspot.com/2011/04/house-republicans-propose-budget.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"1";}}i:12;a:12:{s:2:"id";s:68:"tag:blogger.com,1999:blog-815620327731150455.post-282476591510810644";s:9:"published";s:29:"2011-04-05T09:16:00.000-07:00";s:7:"updated";s:29:"2011-04-05T09:52:40.739-07:00";s:5:"title";s:31:"More On Health Care Information";s:12:"atom_content";s:16325:"<span class="Apple-style-span" style="font-family: 'times new roman', 'new york', times, serif; font-size: 19px; "><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span style="font-size:100%;">The following was written by Dr. Lauren Florence, chair of the Health Information Initiative of Utah: </span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span style="font-size:100%;"><br /></span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span style="font-size:100%;"> Approximately 30% of the cost of ever-increasing health insurance premiums is spent on the transfer of information such as in billing and insurance related administrative overhead.<sup>1 </sup><span> </span>Assuming the same in Utah, where the Dept. of Health estimates that Utah healthcare expenses in 2010 were $16 billion, $4.8 billion (30%) was spent statewide on personnel, services, and systems that generate, move and store financial, administrative and clinical health information. Since the population of <st1:state st="on"><st1:place st="on">Utah</st1:place></st1:state> is about 2.8 million people, the cost of healthcare information flow was about $1,700 per person in 2010.</span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span style="font-size:100%;">Much of that seemingly exorbitant cost is due to every healthcare provider, facility and insurance carrier having a unique information system. None of those systems communicate well with each other. This results in an inability to access health records in a timely and reasonable fashion when a patient presents for care.</span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span style="font-size:100%;">Usually a patient can remember enough when they arrive at a new doctor’s office or facility to start filling in the paper forms. But to have available only what patients can remember, is at the very least annoying for them and can be life threatening when treatment is time critical or for the demented, comatose or witholding patient. Relevant procedures, or laboratory and radiologic tests may have been completed but the results may not be in the patient’s possession or memory. Finding the results of the tests may be so time consuming as to warrant repeating them with the attendant costs.</span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span style="font-size:100%;"><span> </span>If the widely dispersed health information available in the electronic data systems of the 21<sup>st</sup> century were readily accessible at the point of care, healthcare could be less expensive, higher in quality, and more timely. Yet, it isn’t. The data systems for healthcare records<span style="color: black; "> were mostly created by billing companies and then expanded to include patient health data and so </span>aren’t clinically useful for the doctors. Even though the Affordable Care Act offers both carrots and sticks to encourage doctors and other healthcare providers to adopt electronic health records systems, the current choice is so poor that the doctors’ clinical care of patients is not improved with their use. <span style="color: black; ">No subsidy or fine will greatly increase the use of the current systems. Without doctor buy-in, current health record systems will languish in their expensive boxes.<o:p></o:p></span></span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span style="font-size:100%;"><span style="color: black; "><br /></span></span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span class="Apple-style-span" style="font-size: 12px; "><span class="Apple-style-span" style="font-size: 19px; "></span></span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0.25in; "><span style="font-size:100%;">An ideal healthcare information system would be able to deliver the patient’s entire health record at the time of service to any doctor’s office or facility as directed by the patient. Doctors could make healthcare decisions based on all relevant information when face to face with the patient. Modeled after the credit card system, the ideal health record system automatically coordinates and transfers uniform data by rules set up in the program. Unique identifiers are used for each patient, doctor, and point of care.</span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0.25in; "><span style="font-size:100%;"><span>      </span>The data is entered in object oriented programming form at each point of care. Object oriented data entry allows smaller or more restricted portions of a patient’s record to be delivered to other chosen points of care i.e. pharmacies, physical therapists, ambulance services, etc.</span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0.25in; "><span style="font-size:100%;"><span>      </span>With an ideal healthcare information system, patients could see their personal medical information at any time. Their records would be in their own control and shared only with those of their choosing. Corrections by the doctors who entered the data could be made at any time the patient desires.</span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0.25in; "><span style="font-size:100%;"><span>      </span>The patient’s uniform health record would be kept in the office of every doctor the patient chooses to see. This record would be backed up offsite, according to HIPPA rules, at a national data center whose only job is to protect data, such as IBM or EDS. The national company would be contracted to establish the system’s secure communication network, store the records in the company’s data processing center, <span> </span>maintain the network’s computers and servers, and staff the system’s Service Centers.</span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0.25in; "><span style="font-size:100%;"><span>      </span>The <st1:place st="on"><st1:placename st="on">Service</st1:placename> <st1:placetype st="on">Center</st1:placetype></st1:place> is an area of cost containment due to economy of scale. Health data management including merging data to create a uniform record, coordinating the automatic transfer of information, correcting any discrepancies, and updating changes that each and every office and facility must currently do individually can be done once for all in the<st1:place st="on"><st1:placename st="on">Service</st1:placename> <st1:placetype st="on">Center</st1:placetype></st1:place>. Employees of the Service Centers would also customize the system software for each point of care. Since each of the office and facility computers in the system would contain all of the ICD, CPT, as well as hospital and pharmacy codes, the customized screens would show only the codes needed for that particular office or facility to be used in a point and click format. <span> </span>Customization could be modified at any time and is part of maintenance.</span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0.25in; text-indent: 0.25in; "><span style="font-size:100%;">The system should run as a not-for-profit dedicated to decreasing the cost of healthcare for the patients while improving quality of care. The dealings of any entity, involved with the described health information system, will be made transparent by the system. Where the waste is will be obvious and would be another area of savings.</span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0.25in; text-indent: 0.25in; "><span style="font-size:100%;">When the people who actually buy health care, (i.e. patients, employers, and taxpayers) in the form of the governing board of the information system, identify savings and demand that these savings be returned to them, (with the threat of not doing business with any entity that is keeping the realized savings) the savings will return to the people who pay for healthcare.</span></p></span><span class="Apple-style-span" style="font-size: medium; ">Skilled expertise to run the system, such as computer scientists and efficient managers would be hired. Doctors are crucial to organization of the system since they have dedicated their lives to the care of patients and understand health delivery. But the control must rest with the patients whose records are within the system.</span><p></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span class="Apple-style-span" style="font-size: 12px; "><br /></span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span class="Apple-style-span" style="font-size: 12px; "><span class="Apple-style-span" style="font-size: 19px; "></span></span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0.25in; "><span style="font-size:100%;"><span> </span>Software which would create an ideal system such as has been described was written 15 years ago and is available for all to use. The feasibility of this system has been shown by use in two different demonstration projects in <st1:state st="on"><st1:place st="on">Michigan</st1:place></st1:state>. Approximately 250,000 patient records from the offices of about 250 doctors were included in the demonstration projects. <span> </span>EDS was contracted in the demonstration projects for about $20 per patient per year to establish the system’s secure communication network, store the records in the company’s data processing center, maintain the network’s computers and servers, and staff the system’s Service Centers.</span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0.25in; text-indent: 0.25in; "><span style="font-size:100%;"><span> </span>To set up another demonstration project using this tested system in <st1:state st="on">Utah</st1:state> that would cover a large enough population of patients to make the system begin to show cost savings (about 250,000 patients) is expected to require about the same amount of money as the <st1:state st="on"><st1:place st="on">Michigan</st1:place></st1:state> studies. Compare this $20 per patient per year to the $1,700 per patient per year that we are now spending to manage health information.</span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0.25in; "><span style="font-size:100%;"><span>      </span>The data from this first <st1:state st="on"><st1:place st="on">Utah</st1:place></st1:state> project would give more credibility to the concept of a uniform, coordinated medical record system. This data could then be used to raise funds to set up about a dozen coordinated regional Service Centers in communities of approximately 250,000 patients all over the state.</span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0.25in; "><span style="font-size:100%;"><span> </span><span>     </span><st1:state st="on"><st1:place st="on">Utah</st1:place></st1:state> has a population of about 2.8 million. At $20 per patient, it would cost about $56 million to manage all the health information in the state of <st1:state st="on"><st1:place st="on">Utah</st1:place></st1:state> annually. Compare this to the $4.8 billion (about $1700 per patient per year) that we now spend. Compare this also to the $100 million estimated to update just the 28 year old state Medicaid software. We were told this number when we met with the <st1:state st="on"><st1:place st="on">Utah</st1:place></st1:state> state Medicaid directors in 2010. <span> </span></span></p><span class="Apple-style-span" style="font-size: medium; "> </span> <p></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span style="font-size: 9pt; ">1. <st2:sn st="on">Kahn</st2:sn>, James et al., “The Cost of Health Insurance Administration In <st1:place st="on"><st1:state st="on">California</st1:state></st1:place>: Estimates For Insurers, Physicians, And Hospitals” Health Affairs, November, 2005</span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span style="font-size: 9pt; "><br /></span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span class="Apple-style-span" style="font-size: medium;">My comment:</span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span class="Apple-style-span" style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span class="Apple-style-span" style="font-size: medium;">If you were to go on vacation to Las Vegas and be foolish enough to want to bet all your assets in the casinos, they could access all of your financial information quickly. But if you were to have a heart attack in Las Vegas after losing all of your assets in the casino, the physicians in the emergency room would not have any access to the relevant health information in your medical records.  </span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span class="Apple-style-span" style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span class="Apple-style-span" style="font-size: medium;">Our health system is not designed to provide the best possible care to patients.  It is designed to make the most money possible from patient care.  We have electronic records in our health system which are designed to bill/pay for health care, but not care for patients.  Dr. Florence is proposing that Utahns spend less on electronic information systems but get better performance in support of patient care.  Who, other than profit-taking organizations, would be opposed?</span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span class="Apple-style-span" style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span class="Apple-style-span" style="font-size: medium;">Yours,</span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span class="Apple-style-span" style="font-size: medium;"><br /></span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span class="Apple-style-span" style="font-size: medium;">Dr. Joe Jarvis</span></p><p class="MsoNormal" style="margin-top: 0in; margin-right: 0in; margin-bottom: 0pt; margin-left: 0in; text-indent: 0.25in; "><span class="Apple-style-span" style="font-size: medium;">www.utahhealthcareinitiative.com</span></p><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-282476591510810644?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:170:"http://utahpatientspac.blogspot.com/feeds/282476591510810644/comments/defaulthttp://utahpatientspac.blogspot.com/2011/04/more-on-health-care-information.html#comment-form";s:9:"link_edit";s:80:"http://www.blogger.com/feeds/815620327731150455/posts/default/282476591510810644";s:9:"link_self";s:80:"http://www.blogger.com/feeds/815620327731150455/posts/default/282476591510810644";s:4:"link";s:80:"http://utahpatientspac.blogspot.com/2011/04/more-on-health-care-information.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"0";}}i:13;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-7957358968283737869";s:9:"published";s:29:"2011-04-04T07:58:00.000-07:00";s:7:"updated";s:29:"2011-04-04T08:17:54.041-07:00";s:5:"title";s:37:"A Rapidly Developing Financial Crisis";s:12:"atom_content";s:2783:"I recently heard a nationally known leader in health system improvement speak about the current problems of the US.  His principle thesis was that the American health are system will draw our country into another financial crisis within just a few years.  Here are some of the facts he alluded to:<div><br /></div><div>1)  In 2009 the US had $14.1 trillion in debt, up 42% over the previous four years. </div><div><br /></div><div>2) But the present value of unfunded future obligations is actually $60 trillion, including $43 trillion for Medicare, federal employee, and veteran health benefits.  </div><div><br /></div><div>3) Our nation's total economic value for all of our assets combined is $45 trillion.  </div><div><br /></div><div>4) Health economist Alain Enthoven of Stanford University:  "The United States does not have decades to wait for health system reform; in 2009 about $1.15 trillion of the federal budget was spent on health care.  And health care expenditures are growing 2.7% per year faster than non-health care gross domestic product.  [The current] reform bill does practically nothing to slow health expenditures."</div><div><br /></div><div>5)  The Medicare Board of Trustees, in their 2009 Annual Report:  "The long-range financial imbalance could be addressed in several different ways. . .these changes would require an immediate 134% increase in the tax rate or an immediate 53% reduction in expenditures."</div><div><br /></div><div>6)   50% of all resource expenditures in hospitals is wasted on:  1) recovering from preventable foul-ups; 2) building unusable products; 3) providing unnecessary treatments; and 4) simple inefficiency.</div><div><br /></div><div>We either reform our health system to eliminate the massive amount of waste or we watch our economy slide into second class status.</div><div><br /></div><div>This speaker also called the shifting of public resources away from education and into health care a 'hanging offense'.  He's talking about the opportunity cost of paying more and more for health care and getting less and less.  </div><div><br /></div><div>Finally, it should be noted that most agree with Prof. Enthoven, quoted above, that we do not have very much time to deal with this oncoming fiscal crisis.  There seems to be agreement that it could hit us within the next presidential term of office.</div><div><br /></div><div>Who will help organize a campaign for sustainable health system reform?</div><div><br /></div><div>Yours,</div><div><br /></div><div>Dr. Joe Jarvis</div><div>www.utahhealthcareinitiative.com </div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-7957358968283737869?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:175:"http://utahpatientspac.blogspot.com/feeds/7957358968283737869/comments/defaulthttp://utahpatientspac.blogspot.com/2011/04/rapidly-developing-financial-crisis.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/7957358968283737869";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/7957358968283737869";s:4:"link";s:84:"http://utahpatientspac.blogspot.com/2011/04/rapidly-developing-financial-crisis.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"0";}}i:14;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-3230275803368016401";s:9:"published";s:29:"2011-04-01T00:22:00.000-07:00";s:7:"updated";s:29:"2011-04-01T00:34:19.789-07:00";s:5:"title";s:57:"96% of Americans Favor Mandatory Report of Hospital Error";s:12:"atom_content";s:5883:"Lois Collins of the Deseret News published a report about a recent poll by Consumer Reports concerning patient safety in American hospitals (find the story <a href="http://www.deseretnews.com/article/700123138/Consumer-Reports-poll-Most-of-us-want-hospitals-to-tell-public-about-errors-infections.html">here</a>).  Here's a sampling of what she reports:<div><br /></div><div><span class="Apple-style-span" style="font-family: arial, sans-serif; font-size: 13px; line-height: 17px; ">More than three-fourths of those polled "expressed high or moderate concern" that they or a family member could be hurt by a hospital infection while being treated at a hospital. And 71 percent were equally concerned about harm from a medication error, while two-thirds were worried about surgical errors.</span></div><div><span class="Apple-style-span" style="font-family: arial, sans-serif; font-size: 13px; line-height: 17px; "><br /></span></div><div><span class="Apple-style-span" style="font-family: arial, sans-serif; font-size: 13px; line-height: 17px; "><p>But the big number — 96 percent — came when asked if hospitals should be required to tell the health departments in their states when they make a medical error. And 82 percent believe the public should be able to find that out, as well.</p><div>Some states have passed laws that require hospitals to report certain types of medical harm to their health departments. Only 10, though, require that those reports be made public. In Utah, specific types of medical errors or patient harms must be reported to the Utah Department of Health, says department spokeswoman Charla Haley. But those reports are not made public.</div><div><br /></div><div><p>The Consumer Reports survey follows on the heels of a November 2010 <a href="http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf" style="text-decoration: underline; color: rgb(28, 88, 140); ">report</a> by the Office of the Inspector General in the Department of Health and Human Services that found one in seven Medicare patients experienced serious or long-term medical harm or even death as they were being treated in a hospital. And a similar number experienced temporary harm. Researchers said that, just among those covered by Medicare, hospital infections and medical errors added an additional $4.4 billion to the bill for hospital care and it "contributed to" 180,000 deaths each year.</p><div class="pageNumbers" style="margin-top: 0px; margin-right: 0px; margin-bottom: 8px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: solid; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-top-color: rgb(177, 195, 212); border-right-color: rgb(177, 195, 212); border-bottom-color: rgb(177, 195, 212); border-left-color: rgb(177, 195, 212); overflow-x: hidden; overflow-y: hidden; "><ul style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; height: 16px; ">The problem has been getting attention for years, since a landmark study on medical errors and patient harm by the</ul>Institutes of Medicine was released in the 1990s.</div></div><div class="pageNumbers" style="margin-top: 0px; margin-right: 0px; margin-bottom: 8px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: solid; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-top-color: rgb(177, 195, 212); border-right-color: rgb(177, 195, 212); border-bottom-color: rgb(177, 195, 212); border-left-color: rgb(177, 195, 212); overflow-x: hidden; overflow-y: hidden; "><p>The Consumer Reports survey, conducted in late January, included interviews with 1,026 people nationwide and has an error margin of plus or minus 3.1 percent.</p><p>The survey found that 57 percent believe it is "common" for patients to be harmed by a medical error in the hospital and almost half said it is "very or somewhat common for patients to be seriously harmed by their care."</p><div><span class="Apple-style-span" style="font-size: medium;">My comment:</span></div><div><br /></div><div><span class="Apple-style-span" style="font-size: medium;">It is all too common for patients to be harmed by errors and omissions happening during the process of receiving care.  The best way to handle this problem is to treat it as the public health disaster that it is and institute mandatory reporting.  Public health surveillance programs are effective responses to any number of epidemic problems, from flu to TB to cancer to trauma.  Patient safety will improve when care systems know that errors and omissions will be reviewed and receive an appropriate response.  </span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">Are we serious about health system reform or not?</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">Yours,</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">Dr. Joe Jarvis</span></div><div><span class="Apple-style-span" style="font-size: medium;">www.utahhealthcareinitiative.com</span></div></div></span></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-3230275803368016401?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:178:"http://utahpatientspac.blogspot.com/feeds/3230275803368016401/comments/defaulthttp://utahpatientspac.blogspot.com/2011/04/96-of-americans-favor-mandatory-report.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/3230275803368016401";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/3230275803368016401";s:4:"link";s:87:"http://utahpatientspac.blogspot.com/2011/04/96-of-americans-favor-mandatory-report.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"1";}}i:15;a:12:{s:2:"id";s:68:"tag:blogger.com,1999:blog-815620327731150455.post-585358814610556901";s:9:"published";s:29:"2011-03-31T09:37:00.000-07:00";s:7:"updated";s:29:"2011-03-31T09:58:50.276-07:00";s:5:"title";s:52:"Can We Price Health Care High Enough to Reduce Cost?";s:12:"atom_content";s:5846:"It is the general attitude of elected politicians from both parties that Americans pay high health care costs because the price of health care is made artificially too low through health insurance.  People need to have 'skin in the game' (very ironic term) in order for them to make more cost-effective decisions in purchasing health care.  Thus, we have seen a proliferation of 'cost-sharing' arrangements in health care financing, like co-payment, deductibles, co-insurance, consumer directed care, health savings accounts, high deductible health plans, and now even Medicaid cost sharing arrangements.  But do these cost sharing arrangements actually reduce health care costs?<div><br /></div><div>A recent report from the Robert Wood Johnson Foundation (find it <a href="http://www.rwjf.org/files/research/121710.policysynthesis.costsharing.brief.pdf">here</a> or the longer version <a href="http://www.rwjf.org/files/research/121710.policysynthesis.costsharing.rpt.pdf">here</a>) actually takes a look at data to answer that question.  Findings in brief:</div><div><br /></div><div><div style="font-family: Helvetica; font-size: medium; ">*  Patient cost-sharing is not necessarily an effective mechanism for significantly slowing health care spending. Most people are healthy and cost-sharing would only modestly affect their health care spending. People who are very sick or who have serious chronic health conditions are typically deferring to their physicians rather than making choices about medical care based on cost-sharing. Moreover, by itself, cost-sharing is highly unlikely to slow the growth in spending unless the expected increases in the costs of appropriate care for the very sick also slow.</div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; ">*  Cost-sharing is not well-targeted on low-value services. Patient cost-sharing generally has been organized in broad categories (e.g., outpatient care, inpatient care, emergency department care). These broad categorizations do not help people distinguish between essential and nonessential services. Comparative effectiveness research could help insurers and government programs better target cost-sharing to improve value.</div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; ">*  Caution should be used when increasing cost-sharing for low-income populations or the chronically ill. Not only are low-income populations disproportionately affected by increased cost-sharing, but they also are more price sensitive than other income groups. Unless the cost-sharing increases are concentrated on services that are ineffective or unnecessary, low-income groups may avoid necessary medical care as a result. Increased cost-sharing for people with chronic conditions may result in higher expenditures for hospitalizations and other adverse outcomes if necessary care is reduced.</div></div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; ">My comment:</div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; ">These findings confirm what a reasonable, thoughtful person could surmise from actually thinking about health care services.  When people are sick they are not shopping, they are patients.  They are not looking for a good price for health care, they are asking their doctor to help them and then following his/her advice.  The fact that they are sick determines that they will seek health care, not the price of the health care.  People don't want health care (like chemotherapy or surgery) but will undergo it if necessary.  And the price is not relevant to the decision.  Cost sharing arrangements, therefore, do not reduce health care costs in the acute care setting.</div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; ">But cost sharing arrangements can increase health care costs in the chronic disease setting.  That is because patients don't know what care is low-value and what care is high-value.  When they are individually fiscally constrained by cost sharing arrangements, patients will as likely not purchase high value health care services and will then go on to become more sick, require more care, and therefore cost more to care for.  I don't mean to imply that patients are stupid, they are simply untrained.  Clinical training is an expensive and difficult endeavor, which requires many years of experience.  Doctors have that training, the lay person who is ill with a chronic disease does not and therefore seeks professional advice.  </div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; ">In summary, we do not have high health care costs in the US because we have been too generous with our health care financing.  We have high health care costs because we are too generous with the corporate welfare that we give away to insurers, pharmaceutical companies, and other for-profit interests.  We allow them to waste our health care resources on high overhead and poor quality care.</div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; ">Yours,</div><div style="font-family: Helvetica; font-size: medium; ">Dr. Joe Jarvis</div><div style="font-family: Helvetica; font-size: medium; ">www.utahhealthcareinitiative.com</div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-585358814610556901?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:178:"http://utahpatientspac.blogspot.com/feeds/585358814610556901/comments/defaulthttp://utahpatientspac.blogspot.com/2011/03/can-we-price-health-care-high-enough-to.html#comment-form";s:9:"link_edit";s:80:"http://www.blogger.com/feeds/815620327731150455/posts/default/585358814610556901";s:9:"link_self";s:80:"http://www.blogger.com/feeds/815620327731150455/posts/default/585358814610556901";s:4:"link";s:88:"http://utahpatientspac.blogspot.com/2011/03/can-we-price-health-care-high-enough-to.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"1";}}i:16;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-2767535563069602359";s:9:"published";s:29:"2011-03-30T13:30:00.000-07:00";s:7:"updated";s:29:"2011-03-30T13:40:24.035-07:00";s:5:"title";s:60:"Tapping the Unmet Potential of Health Information Technology";s:12:"atom_content";s:2856:"This was the title of a recently published article in the New England Journal of Medicine (find it <a href="http://healthpolicyandreform.nejm.org/?p=14007&amp;query=TOC">here</a>).  Excerpt:<div><br /></div><div><div style="font-family: Helvetica; font-size: medium; ">Although EHRs laudably provide immediate access to patient data and electronic messaging functions, clinicians have been frustrated by the difficulty of using them to support care delivery and coordination. Transforming EHRs into effective clinical tools rather than a means of capturing information primarily for documentation and billing purposes will require progress on multiple fronts.</div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; ">Continued research on clinical care processes, the design and use of HIT, and payment reform, as well as ongoing support for clinicians, will be key to the effective and meaningful use of HIT. Today’s EHRs do not sufficiently support aspects of care delivery that are vital to improving care and controlling costs.</div></div><div><br /></div><div>Comment:</div><div><br /></div><div>It seems that the current state of development of electronic health records is incomplete.  Quote from the article:<span class="Apple-style-span" style="font-family: Helvetica; font-size: medium; ">"Today’s EHRs do not sufficiently support aspects of care delivery that are vital to improving care and controlling costs."</span></div><div><span class="Apple-style-span" style="font-family: Helvetica; font-size: medium; "><br /></span></div><div><span class="Apple-style-span" style="font-family: Helvetica; font-size: medium; ">We have a way to go before the electronic medical records live up to their hype.</span></div><div><span class="Apple-style-span" style="font-family: Helvetica; font-size: medium; "><br /></span></div><div><span class="Apple-style-span"  style="font-family:Helvetica;"><span class="Apple-style-span" style="font-size: medium;">Comments?</span></span></div><div><span class="Apple-style-span"  style="font-family:Helvetica;"><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></div><div><span class="Apple-style-span"  style="font-family:Helvetica;"><span class="Apple-style-span" style="font-size: medium;">Dr. Joe Jarvis</span></span></div><div><span class="Apple-style-span"  style="font-family:Helvetica;"><span class="Apple-style-span" style="font-size: medium;">www.utahhealthcareinitiative.com</span></span></div><div><span class="Apple-style-span" style="font-family: Helvetica; font-size: medium; "><br /></span></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-2767535563069602359?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:173:"http://utahpatientspac.blogspot.com/feeds/2767535563069602359/comments/defaulthttp://utahpatientspac.blogspot.com/2011/03/tapping-unmet-potential-of-health.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/2767535563069602359";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/2767535563069602359";s:4:"link";s:82:"http://utahpatientspac.blogspot.com/2011/03/tapping-unmet-potential-of-health.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"1";}}i:17;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-4876943444768480561";s:9:"published";s:29:"2011-03-29T09:42:00.000-07:00";s:7:"updated";s:29:"2011-03-29T09:56:01.673-07:00";s:5:"title";s:39:"ACOs: Accountable to whom and for what?";s:12:"atom_content";s:13616:"Years ago I heard the CEO of a for-profit managed care organization in Nevada argue that for-profit health care corporations were better for society than non-profit health care organizations because of accountability.  He found that non-profits were accountable to no one while he, as CEO, was accountable to a board of directors.  Of course, his accountability was principally to assure that the investors in his corporation, who elected the board of directors, made as much money as possible through the corporation.  Profits are in direct competition with quality patient care within the for-profit health care corporation.  <div><br /></div><div>So now, the Affordable Care Act requires accountability from the health system through a brand new kind of organization, redundantly named "Accountable Care Organization" or ACO.  Apparently the problem of accountability has not been solved yet.  This is directly the result of our national penchant for market-oriented health system policies.  We keep expecting the invisible hand of Adam Smith to hold health care organizations accountable.  So will the new kind of organization be different than the traditional market orientation?  This from the Wall Street Journal  (find it <a href="http://online.wsj.com/article/SB10001424052748703300904576178213570447994.html?KEYWORDS=medicare">here</a>):</div><div><br /></div><div><div style="font-family: Helvetica; font-size: medium; ">The Wall Street Journal</div><div style="font-family: Helvetica; font-size: medium; ">March 28, 2011</div><div style="font-family: Helvetica; font-size: medium; ">The Model of the Future?</div><div style="font-family: Helvetica; font-size: medium; ">By Avery Johnson</div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; ">The 2010 health-care law encourages the development of accountable-care organizations as a way to improve care and reduce costs.</div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; ">So what exactly are accountable-care organizations, anyway?</div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; ">In broad outline, these entities propose to unite doctors and clinics or hospitals in groups that pool their resources with the goal of trimming spending while boosting the quality of care. When the group can show that it is improving care and delivers it for less than the cost projected—arrived at by crunching historical patient data for that market—a share of the savings goes to the ACO's bottom line.</div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; ">ACOs exist more on paper than in reality, for now.</div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; ">"An ACO is like a unicorn; everyone thinks they know what one is, but no one has ever seen one," says Gene Lindsey, president and chief executive of Atrius Health.</div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; ">Elliott Fisher, the Dartmouth Medical School professor who helped coin the term ACO, and who worked with members of Congress to draft the ACO concept into the health-care law, concedes that "there are some really important questions about whether this will work."</div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; ">But, Dr. Fisher adds: "I think it's the best hope we have."</div></div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; ">And this, from the American Medical Association (find it <a href="http://www.ama-assn.org/amednews/2011/03/28/gvsb0328.htm">here</a>):</div><div style="font-family: Helvetica; font-size: medium; "><br /></div><div style="font-family: Helvetica; font-size: medium; "><div>American Medical News</div><div>March 28, 2011</div><div>Cost control the next step for Massachusetts health reform</div><div>By Tanya Albert Henry</div><div><br /></div><div>In February, Massachusetts Gov. Deval Patrick unveiled his cost-containment plan to follow up on the landmark 2006 coverage expansions. If approved by legislators, it would define and encourage accountable care organizations within the state; give the state insurance commissioner the ability to scrutinize insurers' rates, including underlying physician pay, and disapprove rates that are excessive; and revamp the medical liability system to try to resolve disputes more quickly and curb defensive medicine.</div><div><br /></div><div>Accountable care organizations</div><div><br /></div><div>* Mandates that ACOs provide patient-centered primary care coordination and referral services.</div><div><br /></div><div>* Requires ACOs to share financial risk, distribute savings and meet quality measures.</div><div><br /></div><div>* Expects ACOs to be competent in population health management, financial and contract management, quality measurements, and communication.</div><div><br /></div><div>* Charges ACOs with providing behavioral health services, either internally or by contract.</div><div><br /></div><div>* Makes physician participation voluntary.</div><div><br /></div><div>* Allows primary care physicians to belong to only one ACO but places no limits on specialists.</div><div><br /></div><div>* Requires MassHealth, the Group Insurance Commission, the Commonwealth Connector and all other state-funded insurance programs to implement ACOs and alternative payments by January 2014.</div><div><br /></div><div>Comment from Dr. Don McCanne:</div><div><br /></div><div><div>Accountable care organizations (ACOs) began as an abstract concept of integrating health care providers into a not-yet-defined entity that would be rewarded for improving quality and reducing costs. Without knowing what they were, Congress included them in the Affordable Care Act (ACA). Dartmouth's Elliott Fisher, who was one of the first to promote the concept, now says that "there are some really important questions about whether this will work."</div><div><br /></div><div>Nevertheless, Massachusetts, which is serving as a prototype for the now-enacted ACA, is intending to move forward with its version of ACOs. Their model not only measures quality and distributes savings, but it also shares financial risk. Also it includes exclusive primary care networks, limiting patient choices. The intent of Dr. Fisher and his colleagues is very noble, but it appears that we may be opening up the process to enable a return to the worst of the managed care era.</div><div><br /></div><div>Quoting from a personal communication from Steffie Woolhandler and David Himmelstein, "Universal, geographically-based, non-profit ACOs are called a national health service, a reform we would heartily endorse. Unfortunately, the ACOs actually being pursued are profit-driven recreations of full-risk capitated HMOs."</div><div><br /></div><div>Very soon HHS will be releasing their guidelines for ACOs. The question we need to ask then is will these organizations be designed specifically to provide patients higher quality care at more reasonable costs, as Dr. Fisher envisions, or will they be designed by businessmen to... well, you know.</div></div><div><br /></div><div>My comment:</div><div><br /></div><div><p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px">US health systems are plagued by waste due to poor quality and inefficiency because of the penchant of Americans to expect market forces to introduce accountability into all transactions, including the purchase of health care.  </span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px"> </span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px">Health care is not a commodity that can be efficiently distributed by a market. A market exists when a completely informed buyer can freely choose to enter into a transaction with a self-interested seller without any positive externality.  Market efficiency is demonstrated when demand rises as price declines.  None of these conditions exist within the health care sector.</span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px"> </span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px">a)  buyers of health care lack clinical knowledge (no caveat emptor) and are not free to decide whether to purchase health services (especially in urgent settings);  </span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px">b)  sellers of health services are not supposed to act in their own self interest which is why society does not tolerate physicians and nurses whose greed pre-empts the best interests of their patients;</span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px">c)  positive externality refers to a situation when someone other than the buyer or seller has a legitimate interest in the outcome of a transaction, such as is the case when the general public has an interest in assuring the best care for a patient with a communicable disease.  We have massive infusions of tax dollars into health systems because of positive externalities.   </span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px">d)  the inverse relationship between price and demand does not hold for health services.  No one ever bought an appendectomy because it was on sale.  Demand for health services is determined by epidemiology (the frequency of disease and injury), not by price.</span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px"> </span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px">Lack of accountability in our health system is not a market failure, since health care is not a commodity efficiently distributed by market forces.  Rather, lack of accountability in health systems is a social failure.  For instance, preventable hospital injuries can be discovered and eliminated not by individual buyers (patients) but by public health agencies.  The pretense of markets, so characteristic of American health policy, has created perverse incentives to deliver mediocre care in an inefficient manner</span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px">.  Reducing poor quality and inefficiency waste will require inventing new social mechanisms to replace the failing business models which characterize the American health care delivery system. </span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica; min-height: 14.0px"><span style="letter-spacing: 0.0px"></span><br /></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px">Recently passed federal and state health ‘reform’ legislation (the Affordable Care Act and its predecessor in Massachusetts) are coverage initiatives and not the needed reform measures (for instance, read the Kaiser Family Foundation summary of the Affordable Care Act online at <a href="http://www.kff.org/healthreform/8061.cfm"><span style="text-decoration: underline ; letter-spacing: 0.0px color: #0c25a6">www.kff.org/healthreform/8061.cfm</span></a>).  Massachusetts officials testified before Congress one year before the passage of the Affordable Care Act that burgeoning costs made the Bay State’s health ‘reforms’ financially unsustainable.  Recent projections by the Congressional Budget Office confirm that the Affordable Care Act will not prevent future “excess cost growth” in health care</span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px">.  </span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica"><span style="letter-spacing: 0.0px">In summary, growth in US health care costs far exceeds any international comparison.  Coverage initiatives, the standard American health policy approach over the past 50 years, ultimately fail to contain excessive growth in health care costs.  The business model of private health insurance is administratively wasteful and invokes perverse incentives to deliver mediocre care.  Sustainable health system reform must introduce social accountability into health care delivery while targeting improved quality and efficiency.</span></p> <p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica; min-height: 14.0px"><span style="letter-spacing: 0.0px"></span><br /></p><p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica; min-height: 14.0px">Dr. Joe Jarvis</p><p style="margin: 0.0px 0.0px 0.0px 0.0px; font: 12.0px Helvetica; min-height: 14.0px">www.utahhealthcareinitiative.com</p></div></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-4876943444768480561?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:177:"http://utahpatientspac.blogspot.com/feeds/4876943444768480561/comments/defaulthttp://utahpatientspac.blogspot.com/2011/03/acos-accountable-to-whom-and-for-what.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/4876943444768480561";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/4876943444768480561";s:4:"link";s:86:"http://utahpatientspac.blogspot.com/2011/03/acos-accountable-to-whom-and-for-what.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"1";}}i:18;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-1309403906352504045";s:9:"published";s:29:"2011-03-28T09:04:00.000-07:00";s:7:"updated";s:29:"2011-03-28T09:22:20.813-07:00";s:5:"title";s:35:"A Man and his Peripheral Neuropathy";s:12:"atom_content";s:5893:"I received the following comments from a friend who lives in Utah and is uninsured:<div><br /></div><div><span class="Apple-style-span" style="font-family: Tahoma; font-size: 13px; ">"I am a 54-year-old male, both my wife and I are self-employed and cannot afford medical insurance.  I am not overweight, have a business that requires constant movement, and I don't eat too poorly.  The medical coverage plans we've looked into require high monthly premiums and an equally high deductible.  By the time we paid the monthly premium and met the deductible we would be out-of-pocket nearly $6000.  So really what would we get for our money?  Peace of mind?  Not at all since we don't have the finances available to even meet the deductible let alone the monthly premium requirements for which we would actually get very little help. <br />I have known conditions, each of which could ultimately be life threatening but there is very little I can do about them because the procedures are too expensive that could "solve or cure" these situations.  We do have credit cards, we do not have a credit line available; so simply put, if we don't have the cash then we are stuck.  For example, back in a day when we did have insurance I was diagnosed with Barrett's esophagus, a pre-cancerous condition caused by gastroesophageal reflux disease (GERD).  It is recommended I have a minimum of one an annual "scope" to verify those abnormal cells have not changed further to esophageal cancer.  However it has been over four years since my last scope due to the expense and lack of insurance to cover at least some of the cost.<br />Additionally I have high blood pressure, high cholesterol, high triglycerides, and an annoying disease known as idiopathic neuropathy.<br />All of these conditions with the exception of one, could truly cause my untimely death.  But the current expenses associated with medical treatment and drugs are out of reach for me.  A single doctor visit including office fee, blood work, medications, and follow-up could easily run what it takes me two weeks of work (50 hours per week) to earn.  How do I meet other expenses when this is so high?  I don't begrudge anyone, medical personnel, the right to earn a living; but it is so difficult when it appears to me medical insurers have helped create this situation.<br />State run health insurance would be an incredible blessing to me and my family.  Indeed, even a life-saving blessing.  I hope I'm still around to see it come to fruition."--Name Withheld By Request</span></div><div><span class="Apple-style-span" style="font-family: Tahoma; font-size: 13px; "><br /></span></div><div><span class="Apple-style-span" style="font-family: Tahoma; "><span class="Apple-style-span" style="font-size: medium;">My comment:</span></span></div><div><span class="Apple-style-span" style="font-family: Tahoma; "><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family: Tahoma; "><span class="Apple-style-span" style="font-size: medium;">My friend is a fit, hardworking grandfather.  Like many others, he just can not afford health insurance.  He pays his taxes and therefore pays a substantial amount for health care that others receive.  The business model of for-profit health insurance excludes him, either overtly or by price, from American health care financing despite his heavy tax investment in our health care system.  If we collectively were to eliminate the wasteful business practices and poor quality now prevalent in America's health care systems, the taxes that we all pay (including those of my friend) would cover all clinically effective care needed by all legal American residents without anyone needing to pay premiums, co-pays, deductibles, or co-insurance.  To put it differently, my friend is actually paying his share for health care, but is being denied the life-saving, clinically proven health services he needs.  The health insurance he will be offered if Obama-Care is ever fully implemented will not provide him with either financial security or high quality care.  The health insurance plans anticipated in the new federal law will be very expensive and yet will have a poor actuarial value (will not cover very much).  </span></span></div><div><span class="Apple-style-span" style="font-family: Tahoma; "><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family: Tahoma; "><span class="Apple-style-span" style="font-size: medium;">The Utah Healthcare Initiative health system reform proposal offers my friend a chance to realize the health benefits that he already pays for through his taxes.  I, too, hope he is around to see it come to fruition.</span></span></div><div><span class="Apple-style-span" style="font-family: Tahoma; "><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family: Tahoma; "><span class="Apple-style-span" style="font-size: medium;">Yours,</span></span></div><div><span class="Apple-style-span" style="font-family: Tahoma; "><span class="Apple-style-span" style="font-size: medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family: Tahoma; "><span class="Apple-style-span" style="font-size: medium;">Dr. Joe Jarvis</span></span></div><div><span class="Apple-style-span" style="font-family: Tahoma; "><span class="Apple-style-span" style="font-size: medium;">www.utahpatientspac.com</span></span></div><div><span class="Apple-style-span" style="font-family: Tahoma; font-size: 13px; "><br /></span></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-1309403906352504045?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:173:"http://utahpatientspac.blogspot.com/feeds/1309403906352504045/comments/defaulthttp://utahpatientspac.blogspot.com/2011/03/man-and-his-peripheral-neuropathy.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/1309403906352504045";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/1309403906352504045";s:4:"link";s:82:"http://utahpatientspac.blogspot.com/2011/03/man-and-his-peripheral-neuropathy.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"2";}}i:19;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-5118578396567417796";s:9:"published";s:29:"2011-03-25T07:53:00.000-07:00";s:7:"updated";s:29:"2011-03-25T08:09:28.051-07:00";s:5:"title";s:40:"Health Care in Japan: Better and Cheaper";s:12:"atom_content";s:5755:"Utahns have a chance to learn about the Japanese health system by attending a workshop to be held March 28-29 in Salt Lake City at the Heritage Center in Fort Douglas.  The workshop is free, open to the public, and begins at 1:00 PM both days.  Here is part of Kirsten Stewart's report about the workshop from the Salt Lake Tribune (find it <a href="http://www.sltrib.com/sltrib/home/51497365-76/health-care-japan-center.html.csp">here</a>):<div><br /></div><div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', Times, serif; font-size: 13px; color: rgb(51, 51, 51); line-height: 17px; "><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Earthquake-stricken Japan has been capturing attention.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">But the industrialized nation faces another challenge, one revealing for America — guaranteeing an aging citizenry access to quality health care at a time of economic instability.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Health care in Japan is universal and mandatory and delivered at half the cost of U.S. health care, said Janet Theiss, director of the University of Utah’s Asia Center, which is sponsoring a workshop Monday and Tuesday on Japanese health policy.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">To developed countries like the U.S., now in the throes of reforming its health care system, Japan serves as a model, said Theiss. “They spend a lot less money and they cover everybody and quality of care over there is very high. We will talk about what that means, how those savings are achieved and how our two systems compare.”</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">There is a lot of talk these days about how Americans will shoulder the medical costs of aging baby boomers and Japan has the world’s oldest population, said Theiss. “We’ll explore the consequences of that for long-term care, end of life care and the stresses on the social system and medical resources.”</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "><span class="Apple-style-span" style="font-size: medium;">My comment:</span></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "><span class="Apple-style-span" style="font-size: medium;">Americans don't have high health care costs because our population is aging.  Japan's population is older and they spend half what we do on health care.  And they have excellent care.  In fact, they spend less because they more consistently have excellent care than we do.  Higher quality health care costs less.  It's way past time for Americans to give up the notion that we have the best health care in the world.  We have the most expensive health care in the world.  We have the most profitable health care system in the world.  We have the least efficient health care financing in the world.  And we have the health care system least likely to prevent death amenable to health care in the first world.</span></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "><span class="Apple-style-span" style="font-size: medium;">We spend more than any other country and have little to show for it.</span></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "><span class="Apple-style-span" style="font-size: medium;">Time to retrench.</span></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "><span class="Apple-style-span" style="font-size: medium;">Yours,</span></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "><span class="Apple-style-span" style="font-size: medium;">Dr. Joe Jarvis</span></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "><span class="Apple-style-span" style="font-size: medium;">www.utahhealthcareinitiative.com</span></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; "><br /></p></span></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-5118578396567417796?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:179:"http://utahpatientspac.blogspot.com/feeds/5118578396567417796/comments/defaulthttp://utahpatientspac.blogspot.com/2011/03/health-care-in-japan-better-and-cheaper.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/5118578396567417796";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/5118578396567417796";s:4:"link";s:88:"http://utahpatientspac.blogspot.com/2011/03/health-care-in-japan-better-and-cheaper.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"0";}}i:20;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-6107784951291439250";s:9:"published";s:29:"2011-03-24T10:43:00.000-07:00";s:7:"updated";s:29:"2011-03-24T10:44:33.890-07:00";s:5:"title";s:52:"How the Health Insurance Business Model Doesn't Work";s:12:"atom_content";s:5637:"This week we are featuring comments about the first anniversary of the passage of Obama-care. Germane to this topic is an op-ed piece published in the Ogden Standard Examiner entitled, sarcastically, "The Best Health Care in the World" (find it http://www.standard.net/topics/opinion/2011/03/23/best-health-care-world). Here is the entire piece:<br /><br />In 1974, I left my teaching assignment in California to return to Utah where I would enter the ranks of small business. We left an excellent health care provider called Kaiser Permanente.<br /><br />My wife was having a problem conceiving a child and was told by the Kaiser doctor after several tests that included an X-ray of her brain that he could not find the reason for her problem. He recommended that she have another X-ray every three or four years to rule out a tumor in her brain.<br />We moved to Ogden, and I began managing an equipment rental company here and another rental store in Orem. We located an insurance company to cover our family of four and our eight employees. We paid premiums for three years without a claim when my wife decided to have another X-ray on her brain as recommended by the Kaiser doctor.<br /><br />Again, there was no evidence of a tumor, yet our insurance company cancelled our policy and claimed we had failed to list a pre-existing condition on our application. Our attorney said we had a good case against the insurance company, but suggested that the insurance company had attorneys on staff and could delay the results for a long time.<br /><br />Our attorney recommended that we select a health care company that would not do that to a customer.<br /><br />We applied to several insurance companies, each having a question on their application; "have you ever been turned down or had a policy cancelled." We marked yes, but without cause. We located one that would accept us and our employees and we signed up.<br /><br />After about four years of paying premiums without a claim, my wife went in for a CAT-SCAN of her brain. This time they found a small benign tumor and she had surgery on the following week.<br /><br />The surgery went well, but the insurance company took out chapter 7 bankruptcy.<br /><br />This left us with the doctor and hospital bills. It was a major setback for a small business like ours. We received a letter from her doctor stating that she was in excellent health and had recovered fully from the surgery.<br /><br />Our doctor could not find a reason she should not be covered with health insurance. We applied to 37 different health insurance providers; each turned us down.<br /><br />I did not understand, so I asked her doctor to send me everything that he had sent to anyone about my wife's case. He sent me a packet about a half-inch thick, with the minute-to-minute coverage of the operation. I learned much later, there are only two sources that all insurance companies use to determine if they will cover people with insurance. When these companies receive a negative report -- even unsupported by a doctors position, we can apply to 100 or more different insurance companies and get the same results<br /><br />Without the ability to obtain insurance, we decided to set up a medical savings account with a stock broker and make payments each month as though we had coverage with an insurance company. Five years after my wife's operation, I found a company that would insure us again.<br /><br />I went to the insurance commissioner's office in Salt Lake City, and asked them if they had any reason why I should not apply with this company. They said they had no such information to give us.<br /><br />We signed up with them and paid monthly for 14 months before they took out bankruptcy.<br /><br />When I returned to the commissioner's office and asked them when they were first aware of the company's problems; they said they had been on their watch list for the last three years.<br /><br />I asked them why they failed to give me that information when I came to them before. They said they could only give out information that had gone through a legal process; otherwise what they might say could help cause them to fail.<br /><br />Thankfully my wife and I have reached the age of the socialist program of Medicare.<br /><br />My wife has had no serious medical problems since the brain surgery and her great desire is to outlive anyone who turned us down for medical insurance. Now, if you think this is an isolated case, I have heard many stories that are similar to our experience in the small business community.<br /><br />Doug Olson lives in Eden.<br /><br />My comment:<br /><br />Mr. Olson could not have articulated the problems with the health insurance business model better. Because Obama-care relies on this faulty business model, we have health 'reform' which props up this level of dysfunction and foists it off indefinitely on the nation. When we buy insurance, we expect to be buying some level of financial security. Health care costs are the leading cause of personal and family bankruptcy and the vast majority of people declaring bankruptcy because of illness or injury have health insurance at the time the health problem occurs. Therefore, it's time we admit that the private, for-profit health insurance business model belongs on the scrap heap of history. Let's collectively haul it out to the city dump and burn it.<br /><br />Yours,<br /><br />Dr. Joe Jarvis<div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-6107784951291439250?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:175:"http://utahpatientspac.blogspot.com/feeds/6107784951291439250/comments/defaulthttp://utahpatientspac.blogspot.com/2011/03/how-health-insurance-business-model.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/6107784951291439250";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/6107784951291439250";s:4:"link";s:84:"http://utahpatientspac.blogspot.com/2011/03/how-health-insurance-business-model.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"0";}}i:21;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-8001003854007537734";s:9:"published";s:29:"2011-03-23T10:13:00.000-07:00";s:7:"updated";s:29:"2011-03-23T10:32:35.357-07:00";s:5:"title";s:50:"Adding to an unsupportably expensive health system";s:12:"atom_content";s:13180:"<img src="http://media.economist.com/images/images-magazine/2011/03/19/us/20110319_usp001.jpg" /><div><br /></div><div>The Economist noted the birthday of the Affordable Care Act (PPACA or Obama-care) with an editorial statement (find it <a href="http://www.economist.com/node/18389179?story_id=18389179">here</a>).  Excerpts:</div><div><br /></div><div><span class="Apple-style-span" style="font-family: Verdana, Arial, sans-serif; color: rgb(51, 51, 51); font-size: 10px; "><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 13px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 1.3em; vertical-align: baseline; background-image: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: transparent; line-height: 20px; background-position: initial initial; background-repeat: initial initial; ">The reality of politics has obstructed (the) grand dream (of the Affordable Care Act). Republican leaders in Congress are trying to repeal the law outright. Several federal judges have ruled that one of the central provisions of the new reforms, an “individual mandate” requiring everyone to purchase coverage, is unconstitutional. And a recent poll by the Kaiser Family Foundation (KFF), a non-partisan outfit, revealed that hostility to the laws among politically vital independents has shot up sharply. One year on, how fares Mr Obama’s proudest achievement?</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 13px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 1.3em; vertical-align: baseline; background-image: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: transparent; line-height: 20px; background-position: initial initial; background-repeat: initial initial; "><span class="Apple-style-span"  style="font-size:85%;"><span class="Apple-style-span" style="font-size: 10px; line-height: normal;"><span class="Apple-style-span"  style="font-size:100%;"><span class="Apple-style-span" style="font-size: 13px; line-height: 20px;">The chief strategy used by the administration to win over sceptics and to undermine legal challenges is to present the new laws as an unstoppable juggernaut. For example, when Kathleen Sebelius, the secretary of health and human services, spoke about the reform to the Senate Finance Committee on March 16th, she pointed to evidence of an “enormous difference it has made in the lives of Americans”.</span></span></span></span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 13px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 1.3em; vertical-align: baseline; background-image: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: transparent; line-height: 20px; background-position: initial initial; background-repeat: initial initial; "><span class="Apple-style-span"  style="font-size:85%;"><span class="Apple-style-span" style="font-size: 10px; line-height: normal;"><span class="Apple-style-span"  style="font-size:100%;"><span class="Apple-style-span" style="font-size: 13px; line-height: 20px;">. . .</span></span></span></span>but here’s the rub: many Americans do not believe Mrs Sebelius. Roughly half of those polled by KFF thought Obamacare had already been repealed or were unsure of its legal footing.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 13px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 1.3em; vertical-align: baseline; background-image: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: transparent; line-height: 20px; background-position: initial initial; background-repeat: initial initial; "><span class="Apple-style-span" style="font-size: 10px; line-height: normal; "></span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 13px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 1.3em; vertical-align: baseline; background-image: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: transparent; line-height: 20px; background-position: initial initial; background-repeat: initial initial; ">As for costs, Mr Obama’s reforms deserve praise for expanding coverage, but they do this by adding millions of people to an unsupportably expensive system. Analysts estimate that America’s health spending will continue to soar under the reforms (see chart). That is a point hotly contested by Mr Obama’s team, who usually point to theoretical future efficiency gains and innovations that will save pots of money.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 13px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 1.3em; vertical-align: baseline; background-image: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: transparent; line-height: 20px; background-position: initial initial; background-repeat: initial initial; ">So it came as a shock when Deval Patrick, the governor of Massachusetts and one of Mr Obama’s closest friends, took a different tack. Asked recently about the pioneering health reforms in his state, which served as a model for the national reforms, he first gave a backhanded compliment to Mitt Romney (the state’s former Republican governor, now distancing himself from those reforms as he repackages himself to run for president in 2012). Mr Patrick then revealed the dirty little secret of Obamacare: “What these folks did in Massachusetts is frankly the same thing that the Congress did, which is to take on access first, and come to cost-control next.” In other words, America will soon have no choice but to come to grips with costs. Whatever one thinks of Mr Obama’s reforms, there is no denying that they have brought that day of reckoning closer.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 13px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; vertical-align: baseline; background-image: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: transparent; line-height: 20px; "><span class="Apple-style-span" style="font-size: medium;">My comment:</span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 13px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; vertical-align: baseline; background-image: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: transparent; line-height: 20px; "><span class="Apple-style-span" style="font-size: medium;">Americans have known or suspected the dirty little secret of Obama-care ever since it passed:  we can not afford the Affordable Care Act.  Why?  Because we can not afford to continue to shovel money at the private health insurance business model, which would long ago have been thrown on the scrap heap of history if government at all levels would only stop propping it up.  We also can't afford to pay 60% more for pharmaceuticals than is the case for any other first world country.  And we can't continue supporting hospitals that injure American patients so often that death due to preventable injury while hospitalized is the 5th leading cause of death in the United States.  And we can not continue paying for inappropriate care--care which has no chance of improving the patient's health status.  And we can't afford a health care system that does the right thing for patients in a timely fashion only about half the time.  </span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 13px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; vertical-align: baseline; background-image: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: transparent; line-height: 20px; "><span class="Apple-style-span" style="font-size: medium;">Obama-care is not health system reform.  But it has, as the Economist points out, brought us much nearer the day of reckoning on health care costs.  We either get busy and do real health system reform, or watch our economy and our health system slide into second class status.</span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 13px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; vertical-align: baseline; background-image: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: transparent; line-height: 20px; "><span class="Apple-style-span" style="font-size: medium;"><br /></span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 13px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; vertical-align: baseline; background-image: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: transparent; line-height: 20px; "><span class="Apple-style-span" style="font-size: medium;">Yours,</span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 13px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; vertical-align: baseline; background-image: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: transparent; line-height: 20px; "><span class="Apple-style-span" style="font-size: medium;"><br /></span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 13px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; vertical-align: baseline; background-image: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: transparent; line-height: 20px; "><span class="Apple-style-span" style="font-size: medium;">Dr. Joe Jarvis</span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 13px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; vertical-align: baseline; background-image: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: transparent; line-height: 20px; "><span class="Apple-style-span" style="font-size: medium;">www.utahhealthcareinitiative.com</span></p></span><p></p></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-8001003854007537734?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:173:"http://utahpatientspac.blogspot.com/feeds/8001003854007537734/comments/defaulthttp://utahpatientspac.blogspot.com/2011/03/adding-to-unsupportably-expensive.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/8001003854007537734";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/8001003854007537734";s:4:"link";s:82:"http://utahpatientspac.blogspot.com/2011/03/adding-to-unsupportably-expensive.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"0";}}i:22;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-7348332863123595574";s:9:"published";s:29:"2011-03-22T09:14:00.000-07:00";s:7:"updated";s:29:"2011-03-22T09:54:35.863-07:00";s:5:"title";s:37:"PPACA One Year Later:  Lasting Fruit?";s:12:"atom_content";s:10159:"The Washington Post ran an article (find it <a href="http://www.washingtonpost.com/obamas-health-care-overhaul-hits-1-year-mark-some-welcome-benefits-while-others-fear-costs/2011/03/21/ABRdCx4_story.html">here</a>) on the anniversary of the Patient Protection and Affordable Care Act (PPACA or Obama-care) which questions whether the legislation will have any lasting value.  Excerpts:<div><br /></div><div><span class="Apple-style-span" style="font-family: arial; font-size: 12px; line-height: 21px; ">One year after President Barack Obama signed his historic health care overhaul, the law is taking root in the land. Whether it bears lasting fruit is still in question.</span></div><div><span class="Apple-style-span" style="font-family: arial; font-size: 12px; line-height: 21px; "><br /></span></div><div><span class="Apple-style-span" style="font-family: arial; font-size: 12px; line-height: 21px; "><span class="Apple-style-span" style="line-height: 10px; font-size: 10px; "><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 17px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-size: 1.2em; line-height: 1.8em; ">The legislation established health insurance as a right and a responsibility. Thousands of families, businesses and seniors have benefited from its early provisions.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 17px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-size: 1.2em; line-height: 1.8em; ">But worries about affordability and complexity point to problems ahead. And that’s assuming it withstands a make-or-break challenge to its constitutionality that the Supreme Court is expected to decide.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 17px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-size: 1.2em; line-height: 1.8em; ">Public divisions over the law are still so sharp that Americans can’t even agree what to call it. Supporters call it the Affordable Care Act, a shorter form of its unwieldy official title. It’s also known as “Obamacare,” the epithet used by Republicans seeking its demise.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 17px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-size: 1.2em; line-height: 1.8em; ">While Obama returns from Latin America on the signing anniversary Wednesday, administration officials will fan out across the country. Community commemorations started Monday, underscoring that the health care battle has moved to the states. Even states suing to nullify the law’s requirement that most Americans carry health insurance are proceeding with at least some of the building blocks.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 17px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-size: 1.2em; line-height: 1.8em; "><span class="Apple-style-span" style="line-height: 10px; font-size: 10px; "></span></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 17px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-size: 1.2em; line-height: 1.8em; ">Affordability is the main worry for critics. A recent poll by the nonpartisan Kaiser Family Foundation found that one in five Americans said they had been negatively affected by the law, and about half of those cited costs. Some blamed the law for this year’s premium hikes, although many experts say the impact was marginal.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 17px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-size: 1.2em; line-height: 1.8em; ">“If they have a bad experience in the marketplace, it’s very possible they’re going to attribute that to the law,” said Mollyann Brodie, Kaiser polling director. “It certainly presents a challenge for the proponents.”</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 17px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-size: 1.2em; line-height: 1.8em; ">A lead author of the bill, Democratic Sen. Max Baucus of Montana, remains a strong supporter but laments not devoting more attention up front to cost control. “It gave detractors an opening,” he said.</p><div><span class="Apple-style-span" style="font-size: medium;">My comment:</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">Read the article to find examples of individual Americans who claim to have been either helped </span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">or hurt by the effects of this legislation.  But Sen. Baucus hits the nail on the head.  PPACA</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">will fail because it does not deal up front with cost control.  While he now laments that fact, he</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">is personally responsible for having brought the corporate health care interests into the drafting</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">of the bill.  Those interests wrote their own corporate welfare into the bill, which is why there is</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">no cost control measures 'up front'.  Sen. Baucus is the man who held a $10,000 a plate fund</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">raiser for his re-election to which he invited health care executives (find the press notice as we</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">blogged about it <a href="http://utahpatientspac.blogspot.com/2009/07/huge-down-payment.html">here</a>).  The Democrats in Congress and the White House tried to lace this loser </span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">legislation with a sugar coating.  There have been people who have received benefits from the </span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">early provisions of the bill.  But there is no doubt that this bill is a budget buster, as has been </span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">documented on this blog many times (for example <a href="http://utahpatientspac.blogspot.com/2010/10/price-problem-another-obama-care.html">here</a>, <a href="http://utahpatientspac.blogspot.com/2010/10/taxpayers-cant-afford-affordable-care.html">here</a>, <a href="http://utahpatientspac.blogspot.com/2010/10/ppaca-is-not-health-reform.html">here</a>, and <a href="http://utahpatientspac.blogspot.com/2010/09/ppaca-does-not-bend-cost-curve.html">here</a>).  </span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">The observance of the first anniversary of the passage of PPACA is a sad day.  We are no closer</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">to health system reform, but the day our health care costs will doom our economy is much</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">closer.  </span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">To each reader I issue a challenge:  Do something or give up your right to complain when you </span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">are victimized by our profit-oriented health system, or when our economy fails under the weight</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">of our wasteful health care business practices.</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">Yours,</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">Dr. Joe Jarvis</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">www.utahhealthcareinitiative.com</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><br /></div></span><p></p></span></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-7348332863123595574?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:174:"http://utahpatientspac.blogspot.com/feeds/7348332863123595574/comments/defaulthttp://utahpatientspac.blogspot.com/2011/03/ppaca-one-year-later-lasting-fruit.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/7348332863123595574";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/7348332863123595574";s:4:"link";s:83:"http://utahpatientspac.blogspot.com/2011/03/ppaca-one-year-later-lasting-fruit.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"0";}}i:23;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-4279950641005532229";s:9:"published";s:29:"2011-03-21T08:41:00.000-07:00";s:7:"updated";s:29:"2011-03-21T08:53:13.002-07:00";s:5:"title";s:41:"Start From Scratch On Health Care-BU Prof";s:12:"atom_content";s:11652:"A link to this article an Yahoo (find it <a href="http://finance.yahoo.com/tech-ticker/%22we-are-bankrupt%22-u.s.-needs-to-%22start-from-scratch%22-on-healthcare-says-kotlikoff-536047.html?tickers=hum,aet,wlp,tlt,tbt,XLV,UNH&amp;sec=topStories&amp;pos=9&amp;asset=&amp;ccode">here</a>) was sent to me by my son, who is a financial analyst in California:<div><br /></div><div><span class="Apple-style-span" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 15px; "><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; "></p><blockquote><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; ">Congress passed another stopgap budget measure Thursday that will keep the government up and running through April 8th, but both sides of the aisle remain far from a long-term solution.</p><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; ">The problem, says Laurence Kotlikoff professor at Boston University, is both parties in Washington lack the political will to deal with the the crux of the issue: entitlement reform. </p><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; ">"We are bankrupt today," he tells Aaron in this accompanying clip. The cure for the country's ills starts with meaningful and cost effective health-care reform.  Obamacare is not that solution, Kotlikoff argues. "He set that up in a way that can be tremendously expensive," he says referring to the President's plan, "and he also did nothing to stop the explosion of costs in Medicare and Medicaid."</p><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; ">Kotlikoff suggests we "start from scratch" a solution very similar to what Rep. Paul Ryan (R-WI) and Alice Rivlin have suggested for Medicare -- except he would extend it to all Americans, not just seniors.</p><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; "><i style="text-overflow: ellipsis; line-height: 1.22em; ">Editor's note: What follows is drawn from Jimmy Stewart is Dead  (John Wiley &amp; Sons, 2010); published here with the author's permission.</i></p><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; "><i style="text-overflow: ellipsis; line-height: 1.22em; ">The Medical Security System (MSS), which I proposed in The Healthcare Fix  (MIT Press, 2007), to fix our healthcare mess is very simple.  Each American would receive a voucher each year. The amount of the voucher will equal the person’s expected annual healthcare costs that are covered under the MSS Basic Plan.  Each person’s voucher amount will be determined based on objective health indicators (e.g., blood tests, X-rays, MRI scans) reported via electronic medical records, using individual risk-adjustment software. Thus an 80-year-old, advanced diabetic male living in Miami might get a $70,000 voucher, whereas a perfectly healthy 14-year-old girl living in Kansas City might get a $3,500 voucher.</i></p><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; "><i style="text-overflow: ellipsis; line-height: 1.22em; ">Each American would use his/her voucher to buy the Basic Plan from a health insurance company.  Since health insurers would be compensated via the size of the voucher for taking on customers with pre-existing conditions, they would have no incentive to cherry pick.  Nor would they be allowed to do so; no insurance company would be permitted to refuse coverage of anyone.</i></p><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; "><i style="text-overflow: ellipsis; line-height: 1.22em; ">Those who can afford it would be free to buy supplemental insurance from the same insurance company from whom they purchase their basic plan.  This eliminates cherry picking (adverse selection) in the supplemental insurance market. Insurance companies would, however, be free to offer their clients financial and other incentives to improve their health. Insurers would also be able to establish co-pays and deductibles. These incentives to properly use, but not overuse the health-care system would be subject to review by the independent panel of medical practitioners set up to oversee MSS.</i></p><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; "><i style="text-overflow: ellipsis; line-height: 1.22em; ">This panel would also determine what the Basic Plan covers. It would do so subject to a strict budgetary ceiling, namely, total MSS voucher payments would not be permitted to exceed 10 per cent of GDP. Ten per cent of US GDP appears to suffice to finance basic healthcare, including nursing home care and prescription drug coverage, for the population. It is certainly a larger share of GDP than is being spent in every other developed country on basic healthcare.</i></p><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; "><i style="text-overflow: ellipsis; line-height: 1.22em; ">Once the vouchers are handed out, Uncle Sam is off the hook.  The insurance industry and doctors, hospitals, and other private providers will be responsible for providing the Basic Plan based on the vouchers provided. Since US GDP will grow, total MSS expenditures will grow as well. Hence, the MSS panel will be able to add new medications, surgical procedures, new diagnostic technologies, etc. to the Basic Plan’s coverage.  But the panel will add these new coverages to the Basic Plan at a much slower pace than would occur under the current system.  This will dramatically reduce the growth rate of federal health-care spending, ensuring that the 10 percent ceiling on federal MSS expenditures relative to GDP is never violated.</i></p><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; "><i style="text-overflow: ellipsis; line-height: 1.22em; ">This plan, to fix our entire health-care system, is not just pie-in-the-sky.  It's essentially identical to the Rivlin-Ryan plan proposed this Fall by former CBO Director and former OMB Director, Alice Rivlin, and House Budget Committee Chair, Paul Ryan, to fix Medicare.  But Medicare is not the only federal health-care system whose spending is out of control or will be shortly.  The others are Medicaid, the new health exchange (whose costs will likely explode due to its induced unraveling of employer-based healthcare), and the implicit tax expenditures (revenue losses) associated with the exclusion from taxation of employer-paid health insurance premiums.  Hence, we need to fix the entire system and to do so from scratch.</i></p></blockquote><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; "><i style="text-overflow: ellipsis; line-height: 1.22em; "></i></p><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; "><span class="Apple-style-span" style="line-height: 15px;"><i><span class="Apple-style-span" style="font-size: medium;">My comment:</span></i></span></p><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; "><span class="Apple-style-span" style="line-height: 15px;"><i><span class="Apple-style-span" style="font-size: medium;">Prof. Kotlikoff is correct that we can not mess around with health care anymore.  We need to reduce the amount we spend on health care substantially.  The Affordable Care Act is baloney (as the professor says) when it comes to health system reform.  I disagree with the voucher program, because it still depends on the wasteful business model of the health insurance industry.  But he's right that the debate about 'socialism' in medicine is ridiculous, we already tax ourselves far more than any other country and most funds for health care come from government spending.  He's also right that we need an overt mechanism in the public sector to define what we spend this massive health care budget on.  Listen to the brief audiovideo tape of the professor discussing his proposal.</span></i></span></p><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; "><span class="Apple-style-span" style="line-height: 15px;"><i><span class="Apple-style-span" style="font-size: medium;"><br /></span></i></span></p><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; "><span class="Apple-style-span" style="line-height: 15px;"><i><span class="Apple-style-span" style="font-size: medium;">Yours,</span></i></span></p><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; "><span class="Apple-style-span" style="line-height: 15px; font-size: medium;"><i>Dr. Joe Jarvis</i></span></p><p style="text-overflow: ellipsis; margin-top: 0px; margin-right: 0px; margin-bottom: 0.77em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.45em; "><span class="Apple-style-span" style="line-height: 15px; font-size: medium;"><i>www.utahhealthcareinitiative.com</i></span></p></span></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-4279950641005532229?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:176:"http://utahpatientspac.blogspot.com/feeds/4279950641005532229/comments/defaulthttp://utahpatientspac.blogspot.com/2011/03/start-from-scratch-on-health-care-bu.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/4279950641005532229";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/4279950641005532229";s:4:"link";s:85:"http://utahpatientspac.blogspot.com/2011/03/start-from-scratch-on-health-care-bu.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"0";}}i:24;a:12:{s:2:"id";s:69:"tag:blogger.com,1999:blog-815620327731150455.post-6313726967906215785";s:9:"published";s:29:"2011-03-19T08:55:00.000-07:00";s:7:"updated";s:29:"2011-03-19T09:24:48.804-07:00";s:5:"title";s:42:"Makena: Why Market Forces Fail In Medicine";s:12:"atom_content";s:12260:"The Salt Lake Tribune ran an important story about the rapid rise in cost for a drug known as Makena (find the story <a href="http://www.sltrib.com/sltrib/home/51459407-76/drug-cost-makena-births.html.csp">here</a>).  First, here is the sidebar explanation about what Makena is:<div><br /></div><div><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: 11px; color: rgb(51, 51, 51); "><p class="BOX_Head" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 5px; margin-left: 0px; font-size: 14px; font-weight: bold; color: rgb(0, 0, 0); font-family: Helvetica, Arial, sans-serif; ">What is Makena, and who uses it?</p><p class="BOX_Text_w_Bullet" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 5px; margin-left: 0px; display: list-item; list-style-position: inside; list-style-type: square; ">Makena is a synthetic form of the hormone progesterone that first came on the market more than 50 years ago to treat other problems.</p><p class="BOX_Text_w_Bullet" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 5px; margin-left: 0px; display: list-item; list-style-position: inside; list-style-type: square; ">It’s believed the treatment calms the muscles of the uterus, experts said. A 2003 study of women at risk for preterm birth found that only about 36 percent of those given the progesterone drug had preterm births, compared with 55 percent among those not on the drug.</p><p class="BOX_Text_w_Bullet" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 5px; margin-left: 0px; display: list-item; list-style-position: inside; list-style-type: square; ">By some estimates, about 130,000 women a year might benefit from the drug. Only a fraction of them get it, but the number has been growing steadily.</p><p class="BOX_Text_w_Bullet" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 5px; margin-left: 0px; display: list-item; list-style-position: inside; list-style-type: square; ">These very early births produce children who — if they survive — need months of intensive care and often suffer disabilities. The cause of sudden preterm delivery is not understood, but it occurs in black mothers at much higher rates than whites or Latinos.</p><p class="BYLINE_End" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 5px; margin-left: 0px; ">Mike Stobbe, AP medical writer</p><p class="BYLINE_End" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 5px; margin-left: 0px; "><br /></p><p class="BYLINE_End" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 5px; margin-left: 0px; "><span class="Apple-style-span" style="font-size: medium;">To summarize, Makena is a man-made form of a female hormone which moderately decreases the number of pre-term births among women whose pregnancy is at risk (for various reasons) for having labor start too early.  Makena has been around for a half century, long past the time when research and development costs could be driving the price of the drug.  Mostly, the drug has been made available through local pharmacies which mix the drug on their own.  The FDA has discovered that there is too much variability in the quality of the locally mixed Makena products and has decided to certify a mass production process.  Here is the rest of the story in excerpts from the Tribune:</span></p><p class="BYLINE_End" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 5px; margin-left: 0px; "><span class="Apple-style-span" style="font-size: medium;"><br /></span></p><p class="BYLINE_End" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 5px; margin-left: 0px; "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', Times, serif; font-size: 13px; line-height: 17px; ">Until now, a form of progesterone given as a weekly shot has cost as little as $10 per injection. But starting this week the price shot up to $1,500 a dose, meaning the total cost during a pregnancy could be as much as $30,000.</span></span></p><p class="BYLINE_End" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 5px; margin-left: 0px; "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', Times, serif; font-size: 13px; line-height: 17px; "><br /></span></span></p><p class="BYLINE_End" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 5px; margin-left: 0px; "><span class="Apple-style-span" style="font-size: medium;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', Times, serif; font-size: 13px; line-height: 17px; "></span></span></p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">The drug has been made cheaply for years, mixed in pharmacies that make custom-compound treatments that are not federally approved.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">But recently, KV Pharmaceutical of St. Louis won exclusive government approval to sell the drug, known as Makena. The March of Dimes and many obstetricians supported that because it means quality will be more consistent and it will be easier to get.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">None of them anticipated the dramatic price hike, though — especially since most of the cost for development and research was shouldered by others in the past.</p><div><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Morley said Medicaid must cover Makena but will also continue to cover the less-expensive compounded version until further notice from the U.S. Food and Drug Administration, which approved Makena but was not involved in setting the price.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Last month, KV sent cease-and-desist letters to compounding pharmacies, telling them they could face FDA enforcement actions if they kept making the drug.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">The FDA doesn’t recommend the use of compounded versions of drugs when an FDA-approved version is available.</p></div><div><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">Makena’s cost is justified to avoid the mental and physical disabilities that can come with very premature births, said KV Pharmaceutical chief executive Gregory J. Divis Jr. The cost of care for a preemie is estimated at $51,000 in the first year alone.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">To get FDA approval, the company is spending hundreds of millions of dollars in additional research, including an international study involving 1,700 women, Divis said.</p><p class="TEXT_w_Indent" style="padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 12px; margin-left: 0px; ">“Makena can help offset some of those costs,” Divis told The Associated Press. “These moms deserve the opportunity to have the benefits of an FDA-approved Makena.”</p></div><div><span class="Apple-style-span" style="font-size: medium;">My comment:</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">This is another illustration about why market forces don't work in health care.  The FDA had to step in to regulate the production of Makena because absent a public agency the public could be unknowingly buying an inferior product.  Patients just do not know how to judge the efficacy of pharmaceutical products.  But once the FDA approved a particular product, in this case the product made by KV Pharmaceutical, a monopoly was artificially created and the seller did what sellers in a "market" do:  it acted in complete self-interest.  All the justifications offered by KV Pharmaceutical are irrelevant to their real motivation which is to make as much profit as possible without regard to the health and welfare of human beings.  Unlike buyers in a real market, the users of Makena are coerced by the circumstances of a pregnancy, which are completely out of their control, to buy this drug.  Price does not determine the demand for a product in health care.  The occurrence of disease and injury determines the demand for health care products.  People don't seek an appendectomy because it is on sale this week.  And they don't choose to buy Makena because it happens to be cheap.  Nor do they choose to not purchase Makena because its price has just been jacked up from $10 to $1500 a dose.  </span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">Market forces function when buyers have complete knowledge about the various market offerings (caveat emptor) and are free to choose to buy or not.  In health care delivery, market forces can not hold sellers accountable because patients are not shoppers (or buyers): they are coerced by illness and injury to seek care and can not possible know what care they need nor whether the care that is offered is best quality.  </span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">It matters to all of society if as many babies as possible are delivered at term.  We need the next generation to be as healthy as possible.  Let's not be so stupid as to look the other way and pretend that the so-called health care 'market' will achieve optimal health for our newborns.</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">Yours,</span></div><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">Dr. Joe Jarvis</span></div><div><span class="Apple-style-span" style="font-size: medium;">www.utahhealthcareinitiative.com</span></div><div><br /></div><div><br /></div></span><p></p></div><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/815620327731150455-6313726967906215785?l=utahpatientspac.blogspot.com' alt='' /></div>";s:12:"link_replies";s:172:"http://utahpatientspac.blogspot.com/feeds/6313726967906215785/comments/defaulthttp://utahpatientspac.blogspot.com/2011/03/makena-why-market-forces-fail-in.html#comment-form";s:9:"link_edit";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/6313726967906215785";s:9:"link_self";s:81:"http://www.blogger.com/feeds/815620327731150455/posts/default/6313726967906215785";s:4:"link";s:81:"http://utahpatientspac.blogspot.com/2011/03/makena-why-market-forces-fail-in.html";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:3:"thr";a:1:{s:5:"total";s:1:"1";}}}s:7:"channel";a:13:{s:2:"id";s:44:"tag:blogger.com,1999:blog-815620327731150455";s:7:"updated";s:29:"2011-10-11T13:38:04.679-07:00";s:5:"title";s:30:"The Utah Healthcare Initiative";s:8:"subtitle";s:50:"Bringing health care reform to the voters of Utah.";s:42:"link_http://schemas.google.com/g/2005#feed";s:55:"http://utahpatientspac.blogspot.com/feeds/posts/default";s:9:"link_self";s:61:"http://www.blogger.com/feeds/815620327731150455/posts/default";s:4:"link";s:36:"http://utahpatientspac.blogspot.com/";s:8:"link_hub";s:32:"http://pubsubhubbub.appspot.com/";s:9:"link_next";s:91:"http://www.blogger.com/feeds/815620327731150455/posts/default?start-index=26&max-results=25";s:11:"author_name";s:14:"Dr. Joe Jarvis";s:12:"author_email";s:19:"noreply@blogger.com";s:9:"generator";s:7:"Blogger";s:10:"opensearch";a:3:{s:12:"totalresults";s:3:"925";s:10:"startindex";s:1:"1";s:12:"itemsperpage";s:2:"25";}}s:9:"textinput";a:0:{}s:5:"image";a:0:{}s:9:"feed_type";s:4:"Atom";s:12:"feed_version";N;s:8:"encoding";s:5:"UTF-8";s:16:"_source_encoding";s:0:"";s:5:"ERROR";s:0:"";s:7:"WARNING";s:0:"";s:19:"_CONTENT_CONSTRUCTS";a:6:{i:0;s:7:"content";i:1;s:7:"summary";i:2;s:4:"info";i:3;s:5:"title";i:4;s:7:"tagline";i:5;s:9:"copyright";}s:16:"_KNOWN_ENCODINGS";a:3:{i:0;s:5:"UTF-8";i:1;s:8:"US-ASCII";i:2;s:10:"ISO-8859-1";}s:5:"stack";a:0:{}s:9:"inchannel";b:0;s:6:"initem";b:0;s:9:"incontent";b:0;s:11:"intextinput";b:0;s:7:"inimage";b:0;s:17:"current_namespace";b:0;s:15:"source_encoding";s:5:"UTF-8";s:13:"last_modified";s:31:"Tue, 11 Oct 2011 20:38:04 GMT
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