9-11; Eleven Years Later

Let us never forget

And always remember those who have sacrificed and continue to sacrifice to fight for our freedom.

New IOM Report- Will We Listen This Time?

The Institute of Medicine was created in 1970 as a subgroup of the National Academies and Sciences. The Institute is an “advisor to the nation” on the relevant policy and social issues of health and of the challenges facing our health care system and. It includes a lot of smart people from all areas of the health care system.


The Institute has already produced hundreds of studies and papers on a number of health care-related topics. Two of the most notable:

In 1999 the Institute produced “To Err is Human: Building a Safer Health System.” The research highlighted the number of deaths that are the result of medical errors in our health system.

In 2001 it released “Crossing the Quality Chasm; A New Health System for the 21st Century.” This paper emphasized the need for health care to become more “patient centered” and encouraged an entire restructuring of the delivery system. It stated, “What is perhaps most disturbing is the absence of real progress toward restructuring the health care system to address both quality and cost concerns. . .”

It just release another; “Best Care at Lower Cost; The Path to a Continuously Learning Health Care In America.” This study builds on the message it has tried to communicate to the general public for the past 13 years- the health care system is still in need of a fundamental restructuring in how it works and consumers need to be a fundamental part of the new system.

“Best Care at Lower Cost” estimates $750 billion was wasted in our health care system in 2009. Keep in mind Obama and Romney (regardless of what they say) are recommending to reduce Medicare payments (mainly through payment reductions to health plans, hospitals, home health) by $716 billion over ten years.

Eliminating the waste identified in the IOM report could reduce annual health expenditures by $750 billion in a single year or 30% of what we’re spending today. Not bad.

When “To Err is Human” was released in 1999, and “Crossing the Quality Chasm” was released in 2001 the media jumped on the conclusions for a short time, just like it did with the release of this report. Then health care went back to being health care. Our costs continued grow at unsustainable rates, our quality measures haven’t improved much, and somewhere between 75,000 and 100,000 people die unnecessarily each year due to medical errors.

One of these days we’re going to need to start listening to those prophesizing the reality of what we’re facing. The answers are out there and the general public needs to have a better understanding of the alternatives. Health care can be fixed- but is going to require a lot of changes. And we are all going to need to be part of the solution.

Cheesecake Factory Health Care

Atul Gawande is a doctor who likes to write. He has presented some interesting ideas over the years. Health Care may be listening but it certainly hasn’t openly embraced his concepts; at least not yet. His 2009 article in the New Yorker about the high cost of health care in McAllen, Texas is sometimes credited with starting the whole health care reform discussion. His book, The “Checklist Manifesto”, presented the idea of using checklists (similar to the checklists used by pilots) to simplify the decision-making process in making medical decisions. His most recent article in the New Yorker, “Big Med”, discusses the processes used by the Cheesecake Factory and other “volume-based” food preparers and how they might be used to improve both the efficiency and quality in health care.

Health Care takes a long time to accept change. In the New Yorker article, Gawande references a study that examined how long it took several major health care discoveries to reach even half of Americans. On average, it took more than fifteen years.

In 2009, Americans spent over $200 billion in medical tests that were not needed. At the end of life an individual may see anywhere from 15 to 80 different medical specialists. Medical errors and quality challenges add billions more to a system that is already too expansive. While good medicine might not be able to be reduced to a recipe- Health Care could certainly use more effective processes to eliminate the waste and improve the quality of care delivered to the patient.

The Cheesecake Factory model is relatively simple; study what the best people are doing, figure out how to standardize it, and then bring it to everyone to execute.

We may not be able to create a Health Care Cheesecake Factory overnight, however, the system needs to start to be much more open to doing things different than it has in the past. There are some other ideas out there that can work- but it can’t take Health Care another fifteen years to make the changes that are needed. The individual, the patient, doesn’t have that much time.

Minnesota Health Care- A Model For Other States?

I had the opportunity to provide testimony to the Minnesota Health Care Reform Task Force last week. This group was convened to develop new ideas and solutions to improve the health care in the state. Minnesota has always been looked upon as one of the “innovators” in the country when it comes to health care. It is the home of the Mayo Clinic, Medtronic, United Health Group, HealthPartners, Red Brick Health, and many other business model and product innovations that have been used as examples for other states in developing a more effective health care system for themselves.

The Task Force was certainly handed a huge task and must now integrate the federal requirements of the Affordable Care Act into its work. Despite the health care system that has developed in Minnesota over the years, it is still too expensive, too confusing, and many times inefficient.

The Task Force was provided updates from several of the work groups: Access (defining the benefit structures and pricing models to increase the number of individuals “covered” under a private or public health care financing program). Workforce (making certain the health care workforce is prepared to meet the future demand of health care). Health Insurance Exchange (developing the tools to implement a health insurance exchange market in Minnesota).

The four hour meeting was filled with handouts and presentations from the different groups. It was obvious to most that what was being discussed was going to cost a lot of money. It was also fairly obvious of the continuing confusion regarding the “rules” that must be followed to meet the requirements of the Affordable Care Act. Health care is complex- but these discussions made it even more confusing. There was very little (if any) discussion about how the average individual was going to understand any of it.

My testimony tried to at least bring the consumer/individual back into the discussion. I hope they were listening.

As I said, Minnesota is viewed as an innovator when it comes to health care. But Minnesota also struggles with the same challenges as other states to get consumers and individuals engaged and involved. With the complexity we are continuing to create- it’s no wonder.

Until groups like these begin to accept the economic realities we are facing, develop approaches based on a set of quantifiable objectives not utopian dreams, simplify the entire process, and include the perspectives of the “average citizen” in all of their discussions and decisions, we will probably just end up with a nice set of recommendations we can’t afford, that cost a lot of time and money to put together, and that we’ll just put on the shelf. We may move forward a little- but not nearly as far as we need to. But at least we're doing something.

The Supreme Court Decision and GSK; Which Way Will We Go?

It was fun to watch the cable news channels trip over themselves as they initially incorrectly reported the outcome of the Supreme Court decision last week. In their quest to report first- they reported wrong. Such is the price we have to pay when we want the news instantaneously. We’re going to need to be even more cautious when we’re determining what to believe; especially when it comes to deciding what to believe about health care.


Since the decision was made- the pundits have been trying to figure out what it really means. For all practical purposes, the guts of the law were upheld. It’s just that what things are called, and how things will work are going to change pretty substantially.

Even with the decision finally made, the health care debate is going to continue. The country is still divided on it view of the law. But the intensity of the division has intensified. The rhetoric behind the discussion will get even uglier than before. Just like we should have learned as the cable channels first reported the decision, what is reported will not necessarily be the truth.

The fundamental question we will continue to grapple with is this: how much should the government organize the health care mess we have created this country versus how much can we really rely on the “free market” in its ability to fix it.

Today, pharmaceutical company GlaxoSmithKline (GSK) agreed to a $3 billion settlement essentially resulting from health care fraud. The company was selling pharmaceuticals to markets where the drugs were not intended, and for conditions that had not been tested. The general public was exposed to some very substantial risks. But the GSK sales folks, some physicians, and others made a lot of money in the process; just following the American Dream. The GSK annual report states the ultimate aim of GSK’s business strategy is “to deliver sustainable improved long-term value and returns to shareholders.” There is no mention of delivering quality products at an affordable price to their customers. These companies are big, and the focus is financial. In an article about the fraud for Forbes Mathew Harper writes, “Criminal fines for giant drug companies, no matter how big, are less a deterrent than a cost of doing business.”

The free market left on its own can be dangerous.

So, we are still left to decide between a bloated and expensive health care law generally administered by the federal government that few understand and many people still don’t like, and uncertainty as to whether it will work, and a free market approach that continuously struggles to put the patient, the individual, ahead of profits.

I’ve said all along the answer is somewhere in-between. We just don’t have the right leaders in place to put a middle-ground approach together. The debate will continue.

Do Health Plans Have A Heart After All?

United Healthcare, Aetna, and Humana all stated they would continue with some of the provisions required in the Affordable Care Act regardless of what the Supreme Court decides about the constitutionality of the law itself. United Healthcare specifically said they would continue to allow children to stay on their parent’s plans until the age of 26, eliminate all lifetime limits for health care expenses, streamline appeals and complaints, and not allow the cancellation of health insurance after-the-fact (rescissions).

United Healthcare CEO Stephen Hemsley said in a statement, “The protections we are voluntarily extending are good for people’s health, promote broader access to quality care, and contribute to helping control rising health care costs.”

Do health insurance companies have a heart after all?

Make no mistake, they are making these decisions for business reasons not for the general welfare of the population. If the Supreme Court strikes down the law (or portions of it) taking these provisions away would be a public relations nightmare. Health plans don’t need any more negative p.r. And don’t think paying for them will be free- we will all be paying the cost.

While this is a smart business strategy I am left to wonder. If these protections are good for people’s health, promotes broader access to quality care, and contributes to helping control rising health care costs, why weren’t they providing them before?

Maybe the “free market” needs some help and guidance after all.

Creating More Informed Health Care Citizens

                                                         We’re waiting to hear the outcome of the Supreme Court's decision about the Affordable Care Act. We should get the word before June 28. The odds are (from what I’ve heard and read) the most contentious part of the legislation (the requirement for everyone to have health insurance) will be declared unconstitutional by a 5-4 vote. Nobody really knows, but that seems to be the scuttlebutt. The question we are then going to face is if that part of the law goes away, how will the rest of the law work? Or will it at all? And if Romney wins in November and succeeds in repealing the entire law (a campaign promise), will all of this be for naught? Nobody said changing the way health care works was going to be easy. But it has to be done.

Americans are going to need to understand that the status quo is not an option. The way our health care system works needs to change. It’s simply too expensive. It is going to need to be different than it has been in the past no matter what approach is used to try to fix it. Individuals are going to need to step up to the plate more than they ever have before and be informed, take responsibility, and participate. They are going to need a basic understanding of reality instead of relying on their emotions to form opinions and make decisions.

Many states (Minnesota included) are already trying new approaches without federal involvement. While some states may be taking some action, others don’t have the funds, the will, or the expertise to take on the challenge. This is a national issue that needs everyone involved. The key to success in any effort is to get individuals engaged to become part of the solution- not be part of the problem.

The Citizens League and Bush Foundation are holding a series of “conversations about health care” across Minnesota to receive citizen input about their perspectives of what needs to be done to address the health care challenges we face. The information they gather will be used to help state policy-makers make decisions about health care in the state. I took my US Health Systems class to one of the events. I was once again amazed with the lack of understanding of the general public as to what is really going on. (You can link to the Bush Foundation blog post I was asked to write by clicking here).

We need to teach and train the general public better about health care better than we have. The logic and details of the Affordable Care Act were communicated poorly and have since been buried in politics. The system we have created is complex and confusing- but can be explained. The health care system itself has tried some education efforts but has a trust issue with the general population. So the problem of a relatively uninformed general public remains.

If we can create a better informed public by teaching the facts, the options, and the roles they will need to play discussion just might be more productive. Until then, we’re simply going to continue to tread water. You can only tread water for so long before you sink. I hope we don’t get to that point, but you never know.