Health Care In 2011: Defining Ourselves as a Country

2010 was another memorable year. We had the Gulf Oil spill, the passage of health care reform, the rise of the Tea Party, and an attempt to rebuild an economy devastated by the Recession of 2008. The November elections pointed out that Americans were tired and wanted change. The election results will change the course of politics in 2011. And, the wars in Iraq and Afghanistan (except for little spurts of topics) remained a side-issue for most Americans (2010 was the deadliest year of the 9-year Afghanistan War and less than 1% of the American population was asked to sacrifice in ways we can’t even begin to comprehend.)

All of these events are related. Slowly but surely they are defining the character of our country. Will we be able to come together as a nation to solve the many challenges we face, or will we remain partisan and divided and only expect others to sacrifice instead of ourselves. All Americans are going to need to sacrifice in some way if we’re going to pull ourselves out. It’s a new mindset for most. Time will tell whether we will.

Kaiser Foundation determined the uninsured in America grew by nearly 4 million people in 2009. Now, over 50 million Americans are without health insurance to finance the health care they may need. The number of Americans without access to some type of health care financing/insurance support now exceeds the population of Spain. This number will likely increase when the study is repeated for 2010.

Uncompensated care for the uninsured reached $57 billion in 2008 with the state and federal governments footing three-fourths of the tab. This number will continue to add to the strains of federal and state budgets as the number without health insurance increases.

The Employee Benefits Research Institute concluded that a couple will require $170,000 in savings for a 50% chance of covering their health care expenses during their retirement- including what would be paid through Medicare. Considering the average savings is only around $50,000 today, it doesn’t take a math wizard to conclude there are challenges ahead. Twenty-seven percent of those uninsured already used all of their savings to pay for the health care they need and many are delaying treatment simply due to cost. Sixty-percent of all bankruptcies are now related to health care expenses.

Only 20% of the Baby Boomers now beginning to flood the Medicare system believe it is financially stable and nearly half believe they will live longer than Medicare itself. The influx of Baby Boomers is going to put a strain on a system that is already strained and adding daily to our national debt.

Something has got to give.

As we enter 2011 and begin to argue again about reforming our health care system let’s not delude ourselves into thinking everything is ok. These numbers are only going to grow if we do nothing or just continue to tinker around the edges. We’ve tinkered around the edges for long enough.

And, yes, it will require sacrifice; sacrifice from everyone this time. Whether you are Republican, Democrat, Tea Party or any of the other variations, and no matter what demographic or economic class you are in, it is how we accept and address these challenges will define us in 2011 and beyond.

“For unto whomsoever much is given, of him shall much be required: and to whom men have committed much, of him they will ask the more.”

A good verse to keep in mind for 2011.

Happy New Year

Just Continuing To Kick the Can Down The Road

It's almost Christmas.

Last year, Congress was frantically putting the pieces together on the health care legislation- which wasn't pretty. This year they are frantically trying to put together the pieces for the omnibus spending and tax bills- even less pretty. At a cost of over $850 billion and loaded with over 6,000 earmarks, this legislation is once again an example of cramming together what is politically viable instead of what is needed for the country. Before signing the omnibus spending bill in 2009, President Obama stated, "This piece of legislation must mark the end of the old way of doing business and the beginning of a new era of responsibility and accountability that the American people have every right to expect and demand." I guess he feels one more time won't matter. We'll really, really make this one the last time. I doubt it.

Last week the House passed the Medicare and Medicaid Extenders Act of 2010 avoiding the 25% cut in Medicare physician payments and freezing provider reimbursement at the current levels until the end of 2011. Physicians breathed a sigh of relief- the Medicare budget was blown to hell. This marks the fifth time we have set aside the sustainable growth rate (SGR) model this year and the fifteenth time it has been set aside since 2001 accruing a liability of another $300 billion. Do you think the SGR model might need to be changed instead of continuing to simply push dealing with Medicare cost increases off in the future?

A few days ago the first judge ruled against the individual mandate included in the health reform legislation signed earlier this year. Republicans celebrated as they felt this supported their calls for repeal. Democrats simply ran (or continued running- they have been running from this for a long time). In the meantime, the $2 trillion spent on health care costs continues to climb and our life expectancy compared to the rest of the world (one measure of how effective our system is) declined.

The Debt Commission report released a few weeks ago stressed we are nearing the edge of the cliff. We heard it, we know it, but we simply continue to put our hands over our ears and yell, "I'm not listening, I'm not listening, I'm not listening," hoping it will all just magically go away and we can return to the way things were. Ain't going to happen.

While stabilizing the economy in the short-term is important, considering the long-term impact of all of this on our debt is more important than ever. We all know we're in a very precarious situation as a nation; we just don't like to sacrifice anything if we don't have to. We're big into "screw-avoidance." Whenever sacrifice is mentioned, we think we're getting screwed. A hint; fixing our financial and health care structure is going to require some shared sacrifice from everyone whether we like it or not.

Or, we can just continue to kick the can down the road as we've always done and enjoy the scenery as we're falling off the cliff. We don't have very far to reach the edge.

Happy Holidays.

Health Care Consumers- An Enigma For Health Care

Last week I sat in on one of the webinars hosted by the Institute for Health Improvement (http://www.ihi.org/). The topic was "bending the Cost Curve" and was intended to continue the never-ending discussion of how to address the health care cost crisis in this country (if you get a chance, sit in one one of these- some of the topics are pretty decent). There were over 600 health care professionals listening in to this one.

We heard all the usual numbers. We heard the usual descriptors; crisis, unsustainable, breaking-point. We listened as one of the speakers discussed the methods used to contain hospital costs in Maryland with propspective payment and bundling approaches. Then, there was one slide that seemed to create a stir with most of the audience (I've posted it here).

When discussing how to get consumers involved- the group was at a loss. When discussing the creation of "discernable health care consumers," changing consumer behaviors, and changing the expectations of individuals, the group honestly did not know what to do. Most in the audience are used to controlling, incentivizing, and directing. When realizing they may need to begin a real dialogue with the general population, this audience simply didn't know how to go about it.

Health care needs to change its image. It needs to realize that consumers are not simply a herd of cattle that needs to be driven in the right direction. With the right relationships and context, consumers (for the most part), know what they need to do. They just need some trust and guidance sometimes. Health care needs to realize that the individual consumer is not simply a component that needs a clinical fix that can be directed by free gifts an money- but an important part of the solution that needs to be part of the dialogue, discussion, and relationship.

If we're ever going to fix the problem we have, health care is going to need to communicate better with the general population. It is going to need to break down the clinical and technical communication approaches it has relied on in the past and begin a dialogue and discussion with the "Joe the Plumbers" of the world. It needs to regain some semblance of trust, relevance, and context for the average individual before they are ever going to get engaged and participate.

Only then will we be able to begin to address the issues with "Bending the Cost Curve." And, hopefully, we won't have 600 health care professionals wondering how to get consumers involved.

We'll have solutions to discuss already making it happen.