Here’s My Top 10 Healthcare Issues. What’s Yours?

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I recently contributed to a Linkedin discussion of Telehealth and how it could impact Seniors and Less-mobile Patients. I was asked to join in because my digital home and telecom technology perspective adds to that of medical practitioners, and I took the opportunity to share my top 10 list of healthcare issues from a home healthcare perspective. I crafted the list to stimulate thinking among healthcare professionals and now share it here, inviting you to add your own issues in the Remarks below.

Top 10 Healthcare Issues:

1. INCENTIVES & POLITICS – As a nation with the highest healthcare costs, at over $2.4 trillion per year and rising rapidly, what will the political climate allow? Are we going to focus on reducing costs or maximizing profits? Much of the industry will fight to preserve their pay-per-procedure cash cow, which arguably leads to waste without results. New ACO models aim to reduce unnecessary tests & procedures, prevent returns to hospitals, and coordinate care among specialists, but the industry still has a built-in incentive to treat symptoms rather than provide cures and promote wellness. And lobbyists for powerful special interests want to keep it that way.

2. HOME HEALTHCARE – The nation could save over $1 trillion per year by moving at least half if its healthcare from institutions to homes, but current funding models (Medicare, Medicaid and private insurance plans) don’t support long term care. And since Medicaid only pays when you’re poor, you first have to become poor and be put in a nursing home, which costs four times that of home care. Modern Health Talk ( focuses on technologies for home healthcare.

3. FAMILY CAREGIVERS – Are we going to find a way to compensate unpaid family caregivers who spend an average of 22 hours/week carrying for loved ones and ease their burden, which totals $480B/year total cost in lost worker productivity, reduced earning capacity & retirement income, and increases in their own physical & emotional health? That’s about 3.2% of the U.S. GDP in 2009.

4. DIGITAL DIVIDE – Technology and the Internet are keys to telemedicine, telework, distance learning, e-commerce, and e-government, but the latest FCC report to Congress says a full one-third of U.S. households lack broadband access. That’s either because they have no access to it or because it’s too expensive or they lack the skills or perceived need. So, is telemedicine to focus on the lowest common denominator (voice telephony) or on the latest in high-def telepresence? And are we willing to write-off entire sectors of our population and give them inferior care because they’re poor, black, Hispanic, elderly, live in rural communities, and don’t have broadband Internet access? Or are we going to fund computer literacy and universal access to broadband? Which is cheaper or better?

5. OVERREGULATION – Has HIPAA gone too far? Should it extend to the transmission of medical data or just the storage of it? Do we really need HIPAA-certified home gateways and video conferencing products? Isn’t video conferencing just an extension of a phone call? We don’t have HIPAA phones. Similar issues relate to new FDA proposed rules for mhealth devices, and I can argue that reliability of the telecom network is as important as the reliability of medical sensors if the sensor alert never reaches the remote monitoring service due to QoS issues.

6. RENT VERSUS BUY – Rental models can make more sense for short-term needs while recuperating from an illness or during hospice, and Purchase models can make more sense for fitness, wellness and long-term care, especially when multiple parties are part of the care plan, including doctor, patient, family advocate, and paid caretaker.

7. THE HEALTH GATEWAY – What device will interface between remote monitoring services and in-home (or mobile) medical and environmental sensors? Will it be a specialized box or a TV set-top box, PC, tablet, or smartphone? There’s likely no one answer and the choice may depend on (1) the rent/buy model and (2) the need to interoperate with other subsystems (home security, HVAC, lighting, surveillance, electronic door locks, etc.).

8. BEHAVIOR MODIFICATION – Healthcare debates often involve tough issues of medical ethics, especially when we have personal control over half of the factors determining our health but so  many people still smoke, drink or are obese. Obesity is America’s #1 health and financial risk, bar none. It’s known to cause heart disease, stroke, diabetes and certain cancers, and we’re on track to see half of our population overweight. Should they get the same level of care? As a voting bloc, they’d say yes.

9. YOUNG VERSUS OLD – We as a society feel a responsibility to fund the healthcare needs of young soldiers returning from war without limbs, even if that means spending hundreds of thousands of dollars for bionic arms and legs and rehabilitation. Such expenses seem justified to help them contribute to society and to lessen long-term care costs. But what about the elderly? It somehow seems less justified to spend so much on their end-of-life care needs due to the escalating costs and the fact that they’ve come to the end of contributing to society. So, on one hand it seems prudent to fund the VA and less so to fund Medicare, but seniors also make up a powerful voting bloc.

10. SENIORS – The average lifespan when Medicare & Medicaid were enacted was 67, so Medicare kicked in at age 65 so it would last just two years. But now people don’t want to change that start date, even though the average lifespan is now 78 and could soon exceed 100. But it’s not just about federal funding. Healthcare costs balloon in the last months of life, often with procedures that are either medically unnecessary or unwanted by the patient, but proposals to fund End-of-Live counseling were politicized as “death panels.” Just 9% of adults age 65-69 need daily care, but 50% of those 85+ need care.

MUST SEE info on Healthcare Reform:

The New York Times provides this timeline of nearly 100 years of legislative milestones and defeats.

The above slides are from a great presentation by Dr. James Rohack on Health System Reform. Rohack is a practicing cardiologist and Director of Scott & White Center for Healthcare Policy. He is also a professor at Texas A&M Health Science Center and was the president of the American Medical Association from 2009 to 2010 during debates over Obama’s Healthcare Law. The presentation was held in Sun City, a planned community north of Austin for retirees with active lifestyles. For more information on healthcare reform, visit our links on Understand Obamacare.