One thing Team Obama's gotten right

Ok, so the decision to send more troops to Afghanistan might not seem the most logical, but Obama's decision this past March to expand the number of cell lines approved for stem cell research definitely is. Proof: the NIH announced that they've approved 13 additional lines for researchers receiving federal funding. We all know how important this kind of research is to learning more about a plethora of diseases, and possibly finding cures that can't be developed with adult stem cells. Lucky for us Wolverines, UM researchers received a total of $6.8 million in federal funds through the Reinvestment act for different projects related to stem cell research. Check them out here- even if you don't understand the hard science of it all, realize that the studies here are very promising (and cool!).

Also, for those of you interested in 'food' issues, NY Times also published an interesting article about the comeback of food stamps. Interestingly enough, not much is said about those who abuse the program- something we've discussed at previous meetings.

Who Knows?

Health insurance companies spend enormous amounts on statisticians and experts to help them figure out just how sick you could get. If you're an elderly smoker than you'll probably cost the company a lot more money than a young healthy individual. Which is why smokers pay a lot higher premiums than everyone else. While smoking is an obvious indicator of potential expense, the insurance companies can't always predict how costly an individual will be. As a result, with every new customer comes extra risk.

Economists call this problem an "asymmetry of information," i.e. you know how likely you are to get sick but the insurance company doesn't. Insurance companies can get around this problem by including pricing schemes and co-pays that are designed to get people to reveal information about themselves. Nobel prize winning economist John Stiglitz called this process "screening" and said that it would lead to the inefficiencies in insurance markets if left unchecked.

New research at the National Bureau of Economic Research has shown that the now classic "Stiglitz Model" doesn't always hold for health insurance. Insurance companies can't rely on prices to differentiate types of customers, namely expensive vs. inexpensive. On a macro level this means that the market may not be able to reach what economists call a "competative equilibrium."

The NBER research as well as the "Stiglitz Modle" have a large impact on the health care debate. Both show that the free market which is essential to both the public option favored by Democrats and the counter-plan favored by Republicans can't guarantee an efficient outcome.

Because you have to start somewhere..

Since last year Taylor has been kindly reminding me to blog on the Healthcare site and although I had the best of intentions I was never quite able to turn that intent into action. I'm trying to remedy that this semester, even though I'm getting a bit of a late start. For those of you who don't know who I am (mainly because my meeting attendance has been sporadic at best).. I'm the lone grad student in the Healthcare Center who got involved with Roosevelt last fall due to the fact that Festifall was in between me and my destination of a Noodle and Co. lunch on State St. As I meandered my way through the tables and free candy I picked up a flyers for Roosevelt, and sailing, and ballroom dancing, and backpacking, and ended up sticking with RI... unlike the fates of the rest of that list. I am a 2nd year Masters of Public Health student in Health Behavior and Health Education here at the glorious U of M and I work at the Monto Influenza Laboratory (which conducted the infamous MFlu study here on campus) where we are currently in the recruiting phase of the new HIVE (Household Influenza Vaccine Effectiveness) Study.

While my future posts should (hopefully) provide more intellectually stimulating information I decided to start out with something a little less taxing on your cognitive load. Enjoy!

So goes San Francisco, so goes the Nation?

The healthcare debate of 2009 has become a topic of great importance with 45 million Americans uninsured (Kaiser 2009). The 6 percent annual increase in healthcare costs is unsustainable leading to costs doubling in the next decade (Callahan 2009). From single-payer healthcare to fully privatized insurance, we have heard the gamut of what is best for Americans. The cost of health insurance and service has increased dramatically over the past twenty years (National Governors Association 2008). Federal legislators are debating as we speak as to what is the most effective way to provide healthcare to uninsured citizens. One new policy that has been successful in providing insurance or access to care is the Healthy San Francisco Program (HSF), enacted in 1997 (the coverage then expanded in 2006). HSF was expanded when voters supported the initiative in 2006 (Kaiser 2009). HSF could be a model for the rest of the nation if it is sustainable financially and health outcomes are better with the program than without.

Healthy San Francisco is not considered insurance, but a reorganization of the San Francisco health care safety net, that allows residents to access primary and preventive care through a private and public system partnership (Healthy San Francisco 2009). Participants of HSF choose a medical home where all services are coordinated (including laboratory, hospitalization, and prescriptions). This allows a greater focus on primary care, followed by secondary and tertiary care (Healthy San Francisco 2009).

Healthy San Francisco is only one option by which a covered employer can satisfy its obligation to make the required health care expenditure (HCE). In complying with the San Francisco Health Care Security Ordinance, employers have a variety of options to choose from, such as private health insurance, direct reimbursement to employees, health-spending accounts, the HSF City Option or a Medical Reimbursement Account (San Francisco Health Care Security Ordinance 2006). The Medical Reimbursement Account (MRA) account does not have to be used in the community to which they reside.

In order to see if this program can be implemented statewide in California, the political climate and leanings of the legislature needs to be evaluated. This is important because the passage of HSF statewide will depend or legislators preferences as well as the voter’s if this becomes a ballot initiative. An individual district analysis of the state house and senate would help to either support the passage of statewide legislation or reveal that HSF does not have the legislative support it needs. A survey of voter’s preferences and political leanings will also help to support or show a lack of support for the initiative.

Healthy San Francisco is a major progressive move toward universal access to health care. To research whether this is a sustainable policy it is necessary to evaluate the funding methods of HSF and whether or not this places an undue burden on County businesses. To understand if HSF is placing an undue burden on employers a review of the lawsuit and challenges to the legality of HSF is necessary. It is also imperative that HSF does not stagnate businesses because of the employer mandate.

Malcolm's Blog

Policy proposed to community organizers, advocacy groups and nonprofit organizations:

- National campaign between reform groups to restructure campaign system; candidates with adequate number of popular supports are given time to prepare stances on a series of issues deemed to relevant voters by electoral commissions, which are listed in print online and in newspapers prior to candidate elections so that appearance has little influence on voter selection; campaigning limited to periodic broadcasts of the candidates or publication of candidate stances together; public financing; ban on all private financing of candidates

- Publicly registered associations for the recognition of different interest groups before the Congress and the presentation of their viewpoints

- Reestablishment of mandatory public news regulations for broadcasting networks and the enhancement of public news outlets

- Recommendation for nationally coordinated effort to push

Policy proposed to legislators:

- Medical board for research and review of all known medical treatments and assessment of evidence; this function could be integrated into an effort to review the efficacy of treatments over a long-term, continuous basis; meant to evaluate efficacy in comparison to cost effectiveness in context of severity of diseases and disorders

- Establishment of a board under the jurisdiction of the Department of Health to send out representatives for newly tested therapies and treatments to doctors’ offices; bans on private parties sending out representatives to doctors’ offices; establishment of public records for tested treatments for different conditions, diseases ad disorders

- Establishment of enhancement of public libraries; creation of a Wikipedia-like database of information actively researched and revised by librarian and research staff; can be accessible online and via telephone and mail, especially for the elderly; publicly funded and free to the public as with the standard public libraries; public campaign to enhance awareness of new information source that is consolidation of many sources as well as reliable, accurate and concise; emphasize measures such as trust fund and reliance on philanthropy to stress autonomy from federal government

- Institution to assist legislators with insight into voter preferences; delegated the task of frequent administration of polls, creation of focus groups, facilitation of surveys, etc, to aid politicians in the most reasonably accurate assessments of voter preferences

Emily and Kathleen's Blog: Long-Term Care Coverage

As our country continues to discuss health care reform and how to best provide quality care to all Americans, we must remember to address our nation’s most vulnerable citizens. Unfortunately, however, health care for the elderly is often left out of health care debates, despite the fact that the elderly often have long-term needs and there are millions of seniors and persons with disabilities who cannot afford health care. Providing health care for the elderly is only going to become an increasingly growing problem as baby boomers age and are faced with expensive and persistent health crises. Today, there are nearly 10 million Americans who need long term care services, and this number will increase to 15 million by 2020 – evidence that our nation must address long-term care issues and its exorbitant costs.

Of people turning 65 years old today, 69 percent will need some type of long-term care – a statistic that is daunting when considering the extreme costs of care, combined with the reality that many elderly are retired and are therefore on a fixed income. Currently, there is no single, coherent system to help the elderly pay for long-term care. Instead, various sources (such as family budgets, Medicaid, a small portion of Medicare, and private insurance) are relied upon to help fund long-term care. With the reality of a growing baby boom population, and thus a growing demand for long-term care, this fragmented system is not sustainable. Currently, only one in five people can afford to pay for long-term care, and to further compound issues of coverage, many health insurance companies refuse to serve people with pre-existing conditions. The majority of people who are in need of long-term care, therefore, have no means to pay for such services, and current policies require Medicaid recipients to be impoverished before they can receive assistance.

Financing long-term care will not only be beneficial for the growing population who cannot afford it, but also for sustaining current, pivotal programs – such as Medicaid – which are becoming burdened by this growing demand for long-term care. The extent to which the entire health care system is currently being crippled by the unbearable costs of long-term care is evidenced by the fact that one third of Medicaid’s budget is directed towards providing long-term coverage, even though only ten percent of its beneficiaries use these services. The need to create a program that provides long-term care coverage, therefore, is necessary to aid the elderly, as well as to relieve state budgets and to ensure that programs such as Medicaid do not collapse.

In acknowledging the dire need to address issues of long-term care coverage, we suggest implementing a program that will subsidize costs for patients through an additional program to Medicare and Medicaid. This plan would call for the creation of an employer-based, national long-term care insurance program that will be funded through an additional tax taken out of workers’ paychecks similar to Social Security. This tax would be deducted on an “opt-out” system, allowing for individuals to opt out if he or she does not wish to participate in funding this program. All people eighteen and older in the work force would be eligible to participate, and would need to contribute for at least twenty years before they could benefit from the program—with a grandfather clause that would not require those in the workforce now to contribute for this long. Additionally, the institutional bias that is in place now in the Medicaid system needs to be removed so that individuals in need of long-term assistance have the choice of receiving their care and services in their own communities. This system would allow not only for more funding for long-term care patients, but also a variety in the kind of care that would be available to them to ensure better and more effective care for more people.

Additionally, another aspect of our plan would include providing a tax credit for families who choose to take care of their loved ones in their own home. Currently, family spending is in the billions per year and it has created a strain on many family incomes as a result. This tax credit would provide incentive for more families to provide long-term care for their family members in their own homes, which could additionally help with the burden felt by insurance companies and private sector health care providers. We believe that this tax credit would greatly assist many families who are currently spending significant funds on their loved ones as well as help decrease the inevitable stress the baby boom generation will be placing on health institutions over the next few decades.

While our nation is currently focusing much attention to health care reform, little of this debate has been directed toward the issue of long-term care and the rising number of baby boomers that will be needing it in the very near future. It is our belief that this kind of policy is necessary to ensure there is sustainable coverage for those in need of long-term care. This plan not only provides funding for these kinds of services, but it also creates the possibility for various types of care for long-term care patients, which could open up a new market for private sector care providers in this area. A long-term health care coverage plan, therefore, can be regarded as a positive reform measure not only for those in need of services, but for the entire nation.

Phil's Blog: Addressing Prescription Drug Abuse

The idea of prescription drug abuse is prevalent in American popular society. From the health care debate to the vices of Dr. House, a strong pessimism exists about our culture’s addiction to medication.

Particularly, narcotic analgesics have drawn increasing criticism for being overprescribed. These drugs, more commonly known as “pain-killers”, include names such as Vicodin and Morphine. While these drugs certainly help and should be used to help with short-term pain, analgesics are commonly prescribed to treat chronic long-term pain.

Two issues exist with this treatment, discounting side-effects. One, narcotic analgesics put the patient at risk of addiction, which causes them to seek out further medication beyond their immediate health needs. Two, this type of drug causes habituation: The medication becomes less effective as the patient continues the regimen, requiring higher doses to achieve the same end. The combination of these issues can lead to an increasing addiction that is expensive and hazardous to the health of the individual.

Due to these consequences, narcotic analgesics should not be used for long-term treatment. Health care providers need to develop an alternative approach to medication for helping patients cope: One possible solution is comprehensive pain clinics. Pain clinics use several different sciences and arts to help individuals negotiate pain, including physical therapy, chiropractic, massage therapy, psychiatry, psychology, and alcohol and drug counseling. While these programs do not exclude prescription drugs from their regimens, they try to decrease the dependence of the individual on medication. The encouragement of pain clinic programs can help avoid the vices of narcotic analgesics while allowing for their use in the short-term. The goal of every physician should be to help patients deal with their pain inside their health interests, and not to try to prescribe it out of existence.