Health Reform in a Changed Political and Policy Environment

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Several pieces of information and events have recently made me appreciate how the policy and political environment for health reform will be very different in 2009 from what we’ve seen before.

First was an article in the November 22nd issue of National Journal, (“The New Power Landscape”), which describes how the process for influencing legislation (a.k.a. lobbying) will be different in the coming years: “On the way in is a more collaborative approach that relies on identifying allies and building coalitions with other interest groups, as well as grassroots organizing.”  The article specifically posits that the importance of access to influential people, (i.e.…

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Health Reform – How Much Expansion?

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Morton Kondracke, a columnist for Roll Call newspaper, (sorry on-line subscription required to read the full article), had a very interesting and insightful piece yesterday where he outlines some of the reasons that health reform in 2009 will be more expansive than in might have been a few years ago.

He makes two very concrete and connected observations.  First, that the economic downturn will increase the number of people without health insurance by 5-6 million, and probably add a similar number to the rolls for Medicaid and SCHIP – which will add to States’ budgetary problems.  And second, that the costs of health reform are likely to be much greater than expected – assuming of course that there isn’t a dramatic economic rebound. …

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Making Physicians Better, and Making Better Physicians

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A few recent reports point to ways for improving the quality of physician delivered care that has little to do with technology or complex interventions.  The first involves how physicians interact with patients, and the second examines the work hours for physicians in training.

Etiquette in Medicine
The first article, by Dr. Michael Kahn in the New York Times, describes six recommended actions for physician to create a good rapport with hospitalized patients. Dr. Kahn collectively calls these actions “etiquette-based medicine”:

  1. Ask permission to enter the room; wait for an answer
  2. Introduce yourself; show your ID badge
  3. Shake hands
  4. Sit down.
…

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Napping to Increase Productivity

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The New York Times had a great short report about a scientific study comparing a short nap to caffeine for improving a person’s memory.  The study found what many people have suspected for years – a nap is better than caffeine.

The benefits of napping are something that proponents of “power napping” have known for years. (Disclaimer: I’ve used the 20 minute power nap for years to re-energize and turn an afternoon impaired by a severe case of “the weakies” into several very productive hours.)

The study specifically found that naps were better for improving recall of a word list after both 20 minutes and 7 hours. …

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Healthcare Consumerism, Deductibles and Copayments, and HSAs — More from HUMANA

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Humana’s “educational” YouTube video series expanded this week with three new videos that range from benign, to strangely confusing, to something else.

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The first video, “Deductibles and Coinsurances,” does a reasonable job of explaining the different ways people can pay their share of healthcare costs after the monthly premium, i.e. what is a copay, and how a deductible is applied.  The one area where they could have been clearer is explaining that a co-pays and coinsurance both are the portion that a patient pays for healthcare services, but that a co-pay is a fixed dollar amount, while coinsurance is a percentage of the costs of the service, i.e.…

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Baby Biotechs Treading Water

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Monday’s Boston Globe had an article about how smaller biotech firms are having to cut spending to stay afloat since the current economic environment has made it almost impossible to raise more cash.  This shouldn’t be surprising given that these companies spend years (and years) developing new treatments and technologies before they are ever able to sell anything – assuming that their R&D does produce something that can be sold.  And the investing/lending world is currently not very interested in such long-term and speculative prospects. The immediate result is that these companies are laying people off, reducing their office space and actually mothballing research projects.…

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Avoiding Drug Interactions – Advice from the FDA

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As new and better medicines are developed, people are taking more medicines on a regular basis.  (It is estimated that about 20% of people take 3 or more medicines for chronic conditions.) This is a good thing for improving health, but it also presents potential problems when medicines interact with each other, or they interact with foods, over-the-counter medicines, or dietary/nutritional supplements that people are also taking.  That is why it is always important to talk with your doctor and pharmacist about your medicines and any other things you are taking.

To provide people with updated information on this issue, the FDA recently released a new Consumer Information document titled, “Avoiding Drug Interactions.…

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Serotonin: Brains, Bowels, Bones and Beyond

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One of the fascinating aspects of medicine and biology is how one substance can have so many functions.  A recent article about the effects of serotonin on bone cells and bone formation in the New York Times illustrates this point. While this finding about serotonin and bone formation may be important for developing new ways to treat osteoporosis, it is especially fascinating because serotonin does so many other things in the body.

Serotonin is probably best known for how its levels affect mood – which is the basis for the medicines to treat depression in the class known as “Selective Serotonin Reuptake Inhibitors,” or SSRIs.…

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Engage With Grace

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Many bloggers are posting information today about a initiative to encourage conversation about a very difficult topic: How we want to die. This collective effort to prompt discussions about this topic at the beginning of the holiday season is very timely, and it is a good complement to my post last week about empathy and compassion in healthcare.

What follows is essentially the same text that appears on many other blogs along with a picture of the “One Slide” listing the 5 conversation promoting questions that are at the core of the Project:

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Engage with Grace: The One Slide Project is an astonishingly simple idea that literally touches everyone.…

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Humana Does Drugs

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Humana has put another couple of videos on YouTube in their ongoing series to explain – from their perspective – how the healthcare system works.

The first new video is “Insurance Companies and Prescription Drugs.” Like their other videos, this one paints the insurance industry’s as rosy and altruistic, while stating that “Prescription drug manufacturers are allowed to set their own prices, and they often build large profit margins into name brand drugs to recoup the costs of researching, marketing and advertising.”

This statement strikes me as very curious.  First, how do companies “build large profit margins into name brand drugs?”…

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Proposals for Expanding the Full Range of Compassionate Care

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Two recent events made me think about how traditional medical care and medical education address the issue of compassion.

The first was at the annual dinner for the Kenneth B. Schwartz Center when they gave out their annual Compassionate Caregiver Award, and reviewed the accomplishments of  previous awardees.  These individuals have all made remarkable differences in the lives of patients and families through their empathy and personal connections.

The second event was reading about the passing of Florence Wald, the former Dean of Nursing at Yale who organized the first hospice in the United States in 1974 because of her interest in compassionate care at the end of life.…

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Another Humorous? Humana Video

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Last week I wrote about Humana’s YouTube videos designed to “explain” parts of the healthcare system.  Well they just put another one titled, “Some Doctors Cost More. Why?”

Two interesting points about this video: First, at the beginning they describe  insurance companies (like Humana) as “Providers.” (The narration uses the term “health coverage providers,” but the graphic shows “PROVIDER.”)

While physicians and other clinicians really dislike being called providers, I think they wouldn’t want to see that term used for insurance companies either, since it implies that the insurance company is actually providing healthcare.  (I usually reserve the term provider to describe broad groupings of clinical entities, such as, “providers of oncology care in the Chicago area,” – which would include physicians, nurses, hospitals, etc…)

And second, the title and content of the video doesn’t focus on the total costs of care or services provided by individual physicians, but mostly only patients’ co-pays – which are lower when they use the physicians that are in-network for their insurance plan.…

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