The Future of Healthcare? It’s In The Past

The future of healthcare is impacted by the ripple effects of past developments, trends, market drivers, and market inhibitors

The future of healthcare is largely affected by politics and population health successes of the past, including vaccines, clean water, safe food, sewer systems, public education, and the environment, each causing its own set of ripples in the system. But dampening these positive effects is special interest lobbying aimed at protecting profits. (Wayne Caswell, mHealthTalk editor)

By Tim Perry, MPA, MS, CPHIMS, PCMH CCE, CISSP

Look Back to See Where We Are Going

To celebrate its 200th anniversary, the New England Journal of Medicine published an article in June 2012 titled, “The Burden of Disease and the Changing Task of Medicine“. The authors did a wonderful job of looking not only at clinical data on disease but also shed light on changes in society that affected the prevalence of diseases. A particularly interesting part of the article is a chart depicting the Top 10 Causes of Death in 1900 vs 2010. Notice the changes. Read More …

Health Care Reform – Progress and Next Steps

Obama and White House staff react to passing of the ACA.

President Barack Obama, Joe Biden and the White House staff react to the passing of the Patient Protection and Affordable Care Act (ACA, or Obamacare) on March 21, 2010.

A special issue of JAMA, The Journal of the American Medical Association, on July 11, 2016 published this summary of the Affordable Care Act (ACA), by President Barack Obama, describing successes, challenges, and next steps. JAMA encouraged current and future presidential candidates to submit their own ideas on how best to reform healthcare, so here’s my list of What to Ask Clinton and Trump.

Obama’s article, included below in its entirety, was accompanied by three editorials from Peter Orszag, former director of the Office of Management and Budget under President Obama; Stuart Butler, a senior fellow in economic studies at the Brookings Institution and former director of the Center for Policy Innovation at The Heritage Foundation; and coauthors Jonathan Skinner and Amitabh Chandra, economic and government professors at Dartmouth and Harvard. Read More …

What to ask Clinton and Trump about Healthcare?

I responded to a Huffington Post article about proposed changes to Medicare and questions that should be asked of Hillary Clinton and Donald Trump, but I went deeper into the serious healthcare issues, citing an article I posted yesterday about The Ideal Healthcare System. It referenced differences between public and private sector organizations but primarily spoke of the need to better align incentives to the nation’s health goals. Therefore, my questions to Presidential candidates relate to that larger view of health and healthcare.

What to ask Clinton and Trump about Healthcare?

What would YOU ask Clinton and Trump about Healthcare? (please comment below and share with others)

Read More …

Ideal Healthcare System is Somewhere Between the Extremes

America's Ideal Healthcare System is Somewhere Between the ExtremesKevinMD.com published a good article by internal medicine physician Suneel Dhand. He had worked under UK, Australian and American healthcare systems and brought a broad perspective to suggest that the ideal healthcare system is somewhere between the extremes. He makes good points, and I wanted to respond, but unfortunately comments are closed. That prompted me to post my response here on this blog.  Read More …

Let the Health Care Reform Debates Begin, Again

Let the Health Care Reform Debates Begin, Again

Click the image to see some of our other articles on public policy and health reform.

Editorial by Wayne Caswell, Founder & Senior Editor, Modern Health Talk

According to Forbes, House Republicans released this week a 37-page draft of their plan to “replace Obamacare and reform entitlements.” To that I say, Let the Health Care Reform Debates Begin, Again.

Even though Obamacare has slowed the rising costs of healthcare as our population ages, significantly more work needs to be done to bring our total costs in line with what other advanced nations pay, and with better outcomes. Doing that – continuing to reform health care – has the potential of cutting our $3.4 trillion/year costs in half, thus saving well over $1 trillion/year. Those savings can then be redirected to other purposes, such as lowering taxes, paying down debt, or making strategic investments in education, poverty, research, and infrastructure. The aim of such reforms is to help all Americans regardless of age, income, or socio-economic status.

But powerful opposition to true reforms comes from within the medical industrial complex that stands to lose over $1 trillion/year in revenue and so spends twice as much on political lobbying as the military industrial complex. It’s important that the public keep House Republicans from being tempted to cave into the lobbying pressure. So what should our goals be? Read More …

The Disruptive Force of Technology in Healthcare

A LinkedIn discussion of mHealth argued that, “Technology is Just a Tool. It’s Not The Solution to Healthcare’s Problems” — I couldn’t disagree more and posted this response…

Those in the Ivory Tower should worry about the disruptive force of technology in healthcareMy Editorial Opinion

Okay, Technology is not the end-all, but it’s MUCH MORE than just a tool for solving healthcare’s problems. The accelerating pace of tech innovation is a disruptive force that’s breaking business models and helping to move us away from the fee-for-service model that’s primarily responsible for Americans spending twice as much as those in other advanced nations for healthcare. (See Moore’s Law and the FUTURE of Healthcare.)

Those at the top of the healthcare mountain, especially those resisting more rapid adoption of disruptive technology, are most at risk of obsolescence. As noted in 101 Minitrends in Health Care, 429 of the original [1955] Fortune 500 companies are no longer in business today.

As medical devices keep getting cheaper, smaller, more accurate, and easier to use; more & more functions once associated with doctors in hospitals will move down-market toward consumers at home, office or wherever they are. Telehealth video calls and telemedicine sensor monitoring will extend across town, across state lines, and across international borders as payers (including Medicare) realize that medical tourism often offers better outcomes at less cost.

All of these trends will democratize healthcare, increase competition, and help move the emphasis away from sick care and toward health & wellness. As Benjamin Franklin said, “an ounce of prevention is worth a pound of cure.”

4 Paths to End of Life – one costs less than we thought

ANN ARBOR, Mich. — There are 4 paths to end of life, but last-ditch, high-tech heroic treatments and days in the hospital intensive care unit is NOT what makes dying in America so expensive. The common belief is that this is where we should focus efforts to spend the nation’s healthcare dollars more wisely, but think again.

4 paths to end of life - This chart shows that having multiple chronic illnesses is far more expensive.

A new study finds that for nearly half of older Americans, the pattern of high spending on healthcare was already in motion a full year before they died. That’s thanks to the care they received for their multiple chronic health conditions — including many doctor visits and regular hospital stays over the year, not just in their final days. Read More …

Why Medicare-for-All is Not Enough

Doctors Prescribe Single-Payer Health Care Reform

Doctors Prescribe Single-Payer Health Care Reform

Dr. David Himmelstein speaks at a news conference about the new Physicians’ Proposal for Single-Payer Health Care on the steps of City Hall in New York, May 6. Photo: Annette Gaudino

Well before Bernie Sanders entered the presidential race, a nonpartisan group of 39 leading doctors set out to fix the glaring problems in the Affordable Care Act (ACA, or Obamacare). The single-payer plan they proposed, essentially Medicare-for-All, has since been endorsed by over 2,000 physician colleagues and published in the American Journal of Public Health, according to this article in Huffington Post.

The HuffPost article generated lots of reader comments, and I just had to respond because this is the sort of debate I love to jump into. It brings together many different perspectives, especially those of consumers who too often aren’t heard from by politicians. Here’s a summary of my responses and answer to the question, “Is Medicare-for-All enough?” Read More …

Subject: Jail versus Nursing Home

Jail versus Nursing Home

By Patrick Joseph Roden, PhD at aginginplace.com LLC (original at AginginPlace.com)

One of the many lessons that one learns in prison is, that things are what they are and will be what they will be. (Oscar Wilde)

My colleague, Emory Baldwin AIA, sent this thought-provoking piece his father shared with him; after contemplating the merits of institutional living. This will get you thinking about how society treats its “interned.”

Subject: Jail vs. Nursing Home

FOOD FOR THOUGHT: Let’s put the seniors in jail, and the criminals in a nursing home. Read More …

Presidential Report on Independence Technology

Independence TechnologyIn an 80-page report issued this week, the President’s Council of Advisors on Science and Technology (PCAST), made several recommendations to address America’s aging population with independence technology. They include:

  • mHealth innovation,
  • remote patient monitoring,
  • telehealth expansion and reimbursement,
  • broadband access for seniors,
  • more sophisticated wheelchairs, and even
  • home designs for sustained independence.

What follows is a highlighted extract from the report’s Executive Summary. Read More …

HEALTH or SICK Care?

 

Health or Sick Care

Dr. Sachin H. Jain wrote a good article in Forbes calling for Redesigning Health Care to Meet the Needs of Our Sickest Patients, and I’m publishing my response here.

“While I understand the need to improve care of our sickest and most frail elderly patients, my view conflicts with that of the medical industry, which we mistakenly call the “healthcare” industry.  Read More …

Will 2016 see connected health transformation?

Will 2016 be the year of connected health transformation? That was the topic of a LinkedIn discussion that I weighed in on with the following comment.Digital Mind

Domain experts often make bad predictions (see http://mhealthtalk.com/cazitech/home/favorite-quotes/). Better is to hire futurists who look at many scenarios, extrapolated trends, R&D status, patent portfolios, hiring patterns, and market accelerators & inhibitors to understand what levers can help clients encourage a “preferred” version of the future. A better question is, “WHAT health transformation do you WANT to occur in 2016, and how do you get that?”

DRIVERS include public policy and consumer awareness that our profit-driven, fee-for-service model is broken. Add the “potential” of cutting spending in half (We spend twice that of other advanced nations) while also improving outcomes (We live sicker & die younger). That $1.5 trillion per year savings could help reduce the debt, lower taxes, fix infrastructure, or fund education and other public investments. While other policy decisions may save billions over 10 years (results not realized while politicians are in office to take credit), true health reform can save trillions EVERY year a politician is in office, a huge incentive. BUT, there’s a catch.

INHIBITORS include the corrupting influence of big money in politics and the fact that the medical industrial complex (hospitals, insurers, drug companies, testing companies & equipment providers) spend twice as much the military industrial complex on lobbying to protect their $3 trillion annual revenue, which is 18% of GDP. Overcoming that resistance requires a strong public outcry. Will that happen in 2016?

I have dozens of articles on this topic at Modern Health Talk, but the most relevant to this discussion include:

Transforming Our Flawed Healthcare System

Data shows how most of healthcare’s inflation has resulted from increased administrative spendingData shows how most of healthcare’s inflation has resulted from increased administrative spending.

According to a Forbes article by Dave Chase, “The current U.S. healthcare system is a deeply flawed and wasteful system that has caused enormous damage to our economy and society. It has decimated household incomes, retirement accounts, education budgets, government services budgets, and more. It’s estimated that nearly half of all spending in the current healthcare system is waste. However, a generational transformation is happening right now to change this system.” Read More …

Chipping Away at Healthcare Special Interests Yet?

Is it just “One Step Forward and Two Steps Back?” or is something bigger happening?

Last week I read an excellent article in Huffington Post by Charles Francis, and it inspired today’s post about public interests versus special interests. In this article I’ll reflect on the healthcare progress consumers are making despite politicians working against them. But first, more on the obstacles we face.

Special Interests Pull Puppet Strings

In How Mindfulness Meditation Can Transform Health Care, Charles examines the need to change consumer behavior toward healthier lifestyles, so I thought about the role of incentives and awareness education. I’ve written about that before, but today I’ll take a broader look at the many factors influencing the health and productivity of our nation’s workforce and why I remain guardedly optimistic that we’ll overcome political corruption. Included are links to many related articles and this list of over 130 past articles on healthcare policy. Read More …

Texas has the Highest Uninsured Rate

Uninsured Residents - Red States versus Blue StatesThe data is in from a WalletHub analysis of 2015’s States with the highest & lowest uninsured rates, and as an Austin resident, I’m again embarrassed to say that Texas has the highest uninsured rate.

Having insurance is vital to the health of your family and your wallet. It can significantly reduce your out-of-pocket medical expenses, the leading cause of personal bankruptcy in the U.S. Today, however, 11.7 percent of all Americans — many of whom earn a low income — remain without coverage.

For the second year in a row, WalletHub’s analysts drew upon the most reliable data to estimate the rates of uninsured pre- and post-Obamacare for the 50 states and the District of Columbia. For a broad perspective of those rates, they broke the national figures down to the state level and other categories, including age, race and income level. A summary of their findings are included below. Read More …

Proposed Legislation to Make Homes Accessible

The City of Austin last year passed a law requiring all new homes be more visitable and accessible to people with mobility disabilities. Now U.S. Representative Jan Schakowsky has introduced a bill that would do the same nationally, at least for homes built with federal dollars. Maybe someone will amend it to catch up with where Austin has been for nearly two years now. Let’s hope so.

Eleanor Smith Inclusive Home Design Act Will Make Homes Accessible

Wheelchair Lady doing LaundryBy Jan Schakowsky, U.S. Representative for Illinois’s 9th congressional district (original on Huffington Post)

9/28/2015 — Today, I introduced the Eleanor Smith Inclusive Home Design Act, which would require new homes built with federal dollars to meet accessibility standards — including a zero-step entrance, wheelchair accessible doorways and bathrooms, and climate controls that are at a height reachable from a wheelchair. Above, I announced the introduction of this legislation to advocates at a Rally with the National Council on Independent Living. They support the legislation. Read More …

Consumers Screwed with Insurance Loopholes

Insurance Loopholes & Master Pricing:
How Surprise Medical Bills Knock Consumers Down

Medical Records (photo courtesy of CX2)

Most of us know which local hospitals and doctors are covered by our insurance providers, but even when we make sure that we only see an in-network physician or surgeon, nearly one-third of privately insured Americans are still hit with higher-than-expected medical bills, often because their in-network hospital brought in or contracted out to an out-of-network service provider. How did we get to the point where so many consumers have so little information about what to expect when their hospital bill arrives? (read full article)

Consumers Screwed with Insurance Loopholes

As explained in this excellent article, even though Obamacare intended to address rising prices by promoting prevention, price transparency, and competition among payers & providers – and there has been progress – the system remains hopelessly complex and in need of serious and more aggressive reform.

I’m more convinced than ever that we need to move toward a single-payer system like Medicare-for-All, modeled after other nations that pay half as much and have better outcomes. Meanwhile there may be a role for the new Consumer Protection Agency, because complexity always allows the greedy to find loopholes and screw consumers, while it makes it more difficult for consumers to protect themselves. But if we rely too much on that, the agency could grow immense.

Most consumers, I think, are willing to assume more personal responsibility and Want to seek the best value in care, but that’s difficult to impossible under America’s current and convoluted Sick Care system, which has perverse incentives to view patients as paying customers and treat their symptoms, thus keeping them coming back, paying.

Healthcare Costs are Rising Fast. Need Reforms

NEWS: 24/9/2015 – Healthcare costs are rising so fast in advanced economies that they will become unaffordable by mid-century without reforms, according to a new OECD report.

Fiscal Sustainability of Health Systems: Bridging Health and Finance Perspectives finds that going over budget on health spending remains endemic in most OECD countries. Maintaining today’s healthcare, and funding future medical advances, will be difficult without major reforms that will require health and finance ministries to work together, it says.

Read More …

Population Health and Patient Engagement

Could a Population Health System Improve Patient Engagement?

That was the question asked in an article by mHealthIntelligence.com, but after asking the question they gave no place to reply, so today’s post is my response, which is also posted on LinkedIn.

Money Stacked

America arguably has the best Medical care in the world, but we really don’t have a HEALTH care system.

According to the WHO, Americans live sicker and die younger while spending twice as much as other nations on medical care. So imagine the benefits of prioritizing Population Health, along with the public policies that could/should result.

Besides just understanding what contributes to poor health (poverty, obesity, stress, sedentary lifestyles, our food supply, a toxic environment, etc.), and crafting policies to address those contributors, we would also seek to understand what contributes to good health (nutrition, exercise, sleep) and find ways to improve those, including putting in place incentives that cause behavioral change. It makes sense, because as Benjamin Franklin said, “An ounce of prevention is worth a pound of cure.” Read More …