The Time Has Come For a Societal Shift
 

The Time Has Come For a Societal Shift

For those readers who routinely follow the dialogue of the health care community, it is no surprise that on some issues of implementation of universal health care, my point of view is dramatically different than that of Dr. David Himmelstein, a vocal advocate of the single payer system. However, after reading his CommonHealth blog entry, it is clear that Dr. Himmelstein and I agree on at least two fundamental issues that have the potential to improve the nation’s health status and save significant health care dollars. One, the inappropriate and overuse of technology in health care is not good medical practice and is a major cost driver that affects all of us. And two, wellness and prevention warrant more attention and hold real promise as meaningful ways to manage health care costs and improve health status.

In a study released earlier this week, PriceWaterhouseCoopers predicts that the nation’s medical cost will increase 9.9 percent in 2008 and an additional 9.6 percent in 2009, which is more than double the annual inflation rate. We simply must do something to address the unsustainable increases facing all of us. The timing is right for a societal shift in thinking.

As the CEO of Tufts Health Plan, my goal is for our members to have access to high-quality health care that is affordable. I believe my organization is contributing to that goal by working with physicians to help them deliver the right care at the right time, and in the right setting. This kind of medical management covers a broad spectrum, and yes, it includes prior authorization for some non-emergency, outpatient radiology procedures such as CT scans and MRIs. It is clear that our approach has contributed to improved health care delivery and has saved money for our employers and our members.

But beyond implementing evidence-based guidelines to measure and ascertain what exactly high-quality care is today, the timing is right for medical management to evolve to include what we call “member engagement.”

This initiative represents the next step in the cost and quality continuums by helping members not only effectively navigate the health care system, but also help them better manage their care and treatment, and lead a healthier lifestyle. People must assume more control of their own health.

Why am I so sure that the timing is right for an initiative like this? Because recently, Tufts Health Plan tested the public’s appetite for whether or not they are/or would be willing to make changes in their behavior to achieve lower health care costs. Just as news reports tell us that the sales of SUVs and other large vehicles are declining due to the rising price of gasoline, this blinded, statewide survey told us that nearly 80 percent of the more than 1300 respondents who completed the survey were already taking action to improve their health to avoid paying increased health care costs.

The people who responded to this survey were not necessarily our members, which reinforces for me the ground swell of readiness for change. These actions ranged from participating in stress-relieving activities, improving diet, adding exercise, and/or other weight-reduction activities, to taking prescribed medications as directed, and following doctor recommendations.

The implications of this small, yet statistically significant survey signal that society may be ready to begin to shift its thinking about health. That’s a great thing, not only for helping rein in the unsustainable increases in health care costs, but also for helping all of us attain a better quality of life through managing our health.

James Roosevelt, Jr. is the President and CEO of Tufts Health Plan.

http://www.wbur.org/weblogs/commonhealth/?p=507

This is such horse puckey I could just puke.

GREED is the problem with health care in this country. Both insurance and health care should NEVER have been allowed to be privatized.

for those of you under the age of 50, once upon a time in America hospitals were owned outright by cities and counties, i.e. by the TAXPAYERS and not private (read: corporate) interests.

When CEO's of insurance companies receive BILLION DOLLAR PAYOUTS and the insured get NO relief when they need it, there is something horribly wrong.

When hospitals are more concerned with the "bottom line" than with patient care there is something horribly wrong.

Nearly 40 years ago I paid $5 a month for full coverage insurance. I had to have my appendix out. Paid in full by the insurance. I had to have surgery on my knee. Paid in full by the insurance.

Enter the Reagan administration and controls were removed from insurance companies. Suddenly health care was FOR PROFIT which has resulted in catastrophic rises in health insurance and health care costs.

Until our government STOPS PANDERING to corporate interests nothing is going to change.

Your'e post is such horse puckey I could just puke!

A very abbreviated short history lesson.

Long before the REagan administration U. S. Guvment set wage and price controls on everything. This was World Word II. Before then, most of us paid for health care with cash and some bought health insurance. To attract workers who were in short supply during a time when wages were frozen, companies added health care in addition to wages (and it was tax free) With so many people using insurance to pay for health care today, nobody watches prices the way we watch the price for gasoline, for example. Insurance cost rose.

Please read some Milton Friedman. Please listen to what the Brits on this list say about getting to see special docs. And think about this. Why is it that cosmetic surgery costs don't keep going up 10% per year?

What bugs me about insurance companies, is WHY is it they don't embrace low carb for Type II diabetes? Why to they pay for statins? etc

health costs rose because insurance companies wanted to make more money, and because pharmaceutical companies wanted to make more money. darleen's example isn't that far-fetched... 8 years ago i worked for a company that provided 100% coverage at absolutely no cost to the employee for a single plan... if you chose family coverage, you paid $30 per month. not per paycheck, per MONTH. and still got 100% coverage, regardless of how many family members you covered, be it just a spouse or 12 kids.

3 years ago my husband looked into covering both of us on his work's plan. for him, alone, it was $76 per paycheck (every 2 weeks). to add me to the plan meant he'd pay an ADDITIONAL $174. per paycheck. and even then, the coverage wasn't complete.

cosmetic surgery costs don't go up each year because cosmetic surgery isn't covered by insurance.

This is such horse puckey I could just puke.

GREED is the problem with health care in this country. Both insurance and health care should NEVER have been allowed to be controlled by the government.


Government is the problem not private business. Everything the government touches turns to crap. What makes you think they can do any better with health care?

They can't.

Government and privatization both have problems...

What we need is a better, more efficient hybridization, taking the good, ditching the bad of each... providing a safety net so people don't go bankrupt with a broken back, and still foster innovation and specialization to provide the best care possible

And I agree, there should be much more focus on wellness and natural healing, and allowing people more choice and say in their health.

Nutritional therapy, lifestyle adjustment, stress management,exercise... these should be the focus of healthcare, not drugs and surgery which should only be used in acute emergencies, if then.

You mean insurance-run HMOs? Most doctors won't embrace it because they think their patients won't comply. And they're probably right. This WOE is widely known and widely ridiculed on a lot of diabetes forums. Sad, but true.

I'm sure you see the vicious circle effect there. Doctors don't embrace it so diabetics ridicule it. Diabetics ridicule it so doctors don't recommend it.

Problem is, doctors are supposed to be advising patients of what works best. Only *after* proven noncompliance should the alternatives be suggested. My own doctor does that very thing. I didn't do low carb when he first raised it, but I did when it became apparent it was the only thing that had a prayer of working for me.

I have friends for telling me what I want to hear. I pay doctors to tell me what I need to hear. Any patient not getting that is getting ripped off.

Because most other countries with government-controlled health care have healthier citizens and lower health care costs?

Bernstein is the diet that makes diabetics uncomfortable because it is so very strict. I think a lot of diabetics would do well on South Beach and I think doctors would be more comfortable recommending it. To me, it is a very sensible way of eating. No one wants to be told they can never eat another piece of fruit as long as they live, particularly type 1s who can eat just about anything with insulin. And that's basically how it is with Bernstein.

They can't even run their own Senate cafeteria. What do you think they would do to your HEALTH CARE SYSTEM??

"Since 1993 the U.S. Senate's network of restaurants has lost more than $18 million, and an estimated $2 million this year alone. We're only six months into the year. They've lost $2 million, in their chain of restaurants. I didn't even know they had one. Why do they have a chain of restaurants? That's the dumbest thing I've ever heard."
http://www.firesociety.com/forum/th...nment-Waste---/

As for Government run hospitals. We have one in Colorado Springs. At a time when costs were escalating, they decided to take city money and spend it on employee bonuses....not reducing rates to the citizens who SUPPORT THE DAMN THING with their tax dollars!

But what constitutes "healthier citizens"? Maybe we it's not that we go to the dr. so much because we're sicker--maybe we're sicker because we go to the dr. too much.

I think a big part of the problem in the US is that popular culture and the alarmist nature of our 24-hour news cycle has medicalized every twinge and twitch and persuaded too many of us that anything short of perfect health (read: perpetual youth) is the same thing as illnes and someone should have a pill for it. How many ads have you seen urging you "talk to your dr." about some pill without even hinting at what the pill is for! Big Pharma is AT LEAST as much to blame as government neglect or Big Medicine. If it was up to them, every one of us would be taking half a dozen prescription meds every day.

Personally, I'd like to see a federal insurance program specifically for catastrophic illness, sort of like unemployment insurance, but all other medical insurance companies disbanded. They just suck money out of the economy and give nothing back. Drs. could go back to practicing medicine instead of cost control, and regular medical care could go back to being just another, reasonably affordable necessity like food and housing.

They have lower healthcare costs because they seem to have better health. They seem to have better health because they don't go to the doctor so much. They don't go to the doctor so much because they don't want to wait in line for little or no service. They have to wait in line because the doctor gets paid the same amount whether they see a patient or not. When they get really sick they come here to get good healthcare, lowering our "healthy" population numbers while raising their home country's.

Then there is the fact that no one in the old USSR had a drinking problem. Because the State said so. They also had fewer health problems. Because the State said so. We should emulate them. We could ration healthcare until our numbers were as good or better than those other countries.

Many of the Socialist countries are begining to privatize their State run health care, so of course it is time for us to jump on that dying horse.

Whatever health care solution is going to bankrupt our economy if we don't get people to eating healthier diets. Unfortunately the notion of what is healthy is so twisted and wrong that any public policy is going to backfire.

Japan's Health care system:


Taiwan:


I forget which country it was but they basically walked in without an appt and had a short wait. And they go to the doctor a lot more than we do.

By contrast, the US spends more than 15% of our GDP on health care and we don't even insure everyone.

http://www.pbs.org/wgbh/pages/front...etc/graphs.html

The show is very interesting. All of the countries had issues with their system, whatever it was. Most of the countries do have some form of private health care so if you do want to go outside the system you can.

I can see that politically it could be tough. You would have huge pressures to provide more services (like we do with everything government does) and huge pressures not to raise taxes. That only works for so long... eventually something has to break that stalemate. Maybe while the system is being built it has to have built into it the means to cover it's costs so that is removed from the political process entirely.