Healthcare Letter

January18th

3 Comments

Over the Christmas holidays, while serving warm Kringle, a local pastry delicacy to a houseguest who was as yet unaware of my commitment to the healthcare debate, I found myself forsaking measured reflection for advocacy. I was almost as heated as the Kringle in responding to my guest’s assertion that with so many Americans unacceptably without healthcare, given the complicities of the issue, aren’t we better off just passing the current legislation, warts, costs and all?

I realize my guest’s core reactions stemmed from feeling overwhelmed by the seemingly inscrutable nature of the problem, while wanting to assure healthcare for his fellow citizens. Americans want to do something when faced with a problem. This is a sentiment that bespeaks the essential decency underlying the debate, a concern for fellow human beings.

As a reasoned response to the “We’ve got to do something” instinct, I’m suggesting an op-ed by David Brooks in the New York Times, appropriately entitled “Hard Call.” In a few minutes of the reader’s time Brooks outlines the pros and cons of voting for Senate package as it was shaping up in mid-December. Today his points and insights are still relevant.

An important passage reads, “If this passes, we will never get back to cost control. The basic political deal was, we get to have dessert (expanding coverage) but we have to eat our spinach (cost control), too. If we eat dessert now, we’ll never come back to the spinach.” As the mother of two young children this analogy struck home.

As we seek and sort out options and solutions, respecting each other’s hopes and fears, I remind myself that the tone and style of the dialogue is as important as the content many times.

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3 Comments

  • Comment by John Scott — January 19, 2010 @ 9:15 am

    I am embarrassed to say I have been carrying around your Healthcare Letter to Americans for months and only now pulled it out of my well worn binder to read. Your insights are both inspirational and real.

    I like many have been on the outside looking
    in at the process of healthcare reform with deep disappointment and
    skepticism. My assumption is that the politicians will pass a healthcare
    bill that they will be both ill understood and ineffective – or worse -
    catastrophic in its unintended consequences! In my very superficial
    discussions with friends on the topic I have focused my arguments on a
    thoughtful interview I heard on NPR that notes that our healthcare reform
    is entirely misplaced. The interview with a well regarded
    expert notes that a bulk of our healthcare costs are arguably directly
    linked to three key areas in the US – obesity, cancer and infant mortality.
    I was shocked and embarrassed to hear we are the worst in each of these
    categories for a multitude of obvious reasons.

    Your letter struck home with its clear message – we have asked the wrong
    questions and without the right questions we can not frame or measure the
    intended results. How will we measure the success of our healthcare reform
    if no one understands the real issues which can only come from thoughtful
    dialogue with the right stake holders (consumers and providers)?

    While I am regrettably not optimistic about what our political process will
    bring, you have inspired me to take a more proactive role. While the list
    of questions and issues you describe is long and often overwhelming, I
    think we can make great progress if individuals choose one or more of
    the issues you note and dedicate their time and resources to improving one
    of the underlying issues that seem to be too difficult for politicians to
    deal with.

    To that end, I have recently been inspired by what my children’s
    school is doing in the field of school children’s wellness and fitness. We
    need a new model for teaching good nutrition and fitness that will
    translate into life habits for our children. If child obesity is the
    leading cause of diabetes, heart disease and even cancer, why would we not
    champion this as a national priority? The metrics are clear and the
    benefits easily measurable on a health, cost and productivity basis. There
    is huge resistance from obvious groups but in the end if we can start with
    changing behavior with our children then I am sure the special interests
    will be forced to follow.

    Your letter has inspired me to take more of a proactive role in this piece
    of the puzzle. I hope others will choose to break what can be an
    overwhelming issue of healthcare into pieces that matter directly to them
    and take direct action versus leaving it to our politicians who are in my
    view in capable of dealing with the complexities of this issue.

    Well done! Thank you…

  • Comment by ginger salazar — January 24, 2010 @ 1:27 pm

    I read your Healthcare Letter to Americans this past summer and have since referenced it in every conversation I have had about healthcare reform with friends and acquaintances. Similar to your friend who sat at your kitchen table eating Kringle, the issues and proposed government solutions can simply overwhelm. I appreciate your unique ability to distill the issues in a common sense way. You are right…coverage, cost and quality of service all need to be addressed for true reform to take place. Simply giving more people access to a broken system, is not the answer. Thank you!

  • Comment by Rob Plamondon — January 25, 2010 @ 9:50 am

    John, you bring up an excellent point on the costs associated with obesity, cancer, and infant mortality. Before I address these, the thing that scares me the most about the legislation passed by the Senate and the House bill is they are focused on how we pay for healthcare, not what contributes to the cost of delivering healthcare (malpractice, defensive medicine, clinical workflow inefficiencies, etc.). At the end of the day, we the consumer, ultimately pay for healthcare regardless of how many insurance companies or government agencies are involved in the payment process.

    Back the point John brought up, I’ll focus on the issue of obesity. I live in the Kansas City area and recently heard a report done by our local Fox affiliate that stated roughly 1/3 of Kindergartners in metro KC schools were overweight or obese. For 5th graders, that number is over 40%. And for adults almost half!!

    I hadn’t really thought about the significance of these figures until I started paying attention to the children at the elementary school two of my boys attend (ironically they are in 5th grade and kindergarten), and noticed how many of the kids were overweight (and asking myself how the parents could allow that to happen). I also notice this with the general population in my day to day activities. As John points out, there are numerous health risk factors associated with obesity, and I am sure many of the individuals I see everyday who are overweight are dealing with these issues and are on medications or other treatment plans to deal with these issues.

    All that being said, I think overall health and wellness is another important issue (along with the other points) that needs to be considered in this debate. To truly bring down the cost of delivering quality healthcare, we have to identify and bring down those things that drive it up in the first regardless of how we pay for it. I am hopeful that the message sent by the good people of the Commonwealth of Massachusetts is a wake up call for our members of Congress and has paved the way for more well thought out approach to these issues and greater transparency on the debates.

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