Monday, September 14, 2009

A Startling Reason Why We Need Health Care Reform

Startling Reason Why We Need Health Care Reform

(It was a heroic story, but to me, it was also deeply unsettling. How was it possible that Pronovost needed to beg hospitals to adopt an essentially cost-free idea that saved so many lives? Here’s an industry that loudly protests the high cost of liability insurance and the injustice of our tort system and yet needs extensive lobbying to embrace a simple technique to save up to 100,000 people.) Excerpt from this link

An alarming article; in my own experience I can count family and friends who have died or almost died due to hospital irresponsibility and negligence. My father developed the clot that killed him while in a hospital. My mother died of the mastectomy before she could die of the cancer. My father-in-law died after hospital staff yanked out his lung and put him in regular care instead of an ICU.. A friend died in child birth because the hospital anaesthesiologist did not realize she was regurgitating and put her under while she was drowning in her own vomit. I wonder, is this sad/bad enough to make the townhallers come to their senses? I THINK NOT!
AND THAT'S SADDEST OF ALL! Please read the beginning of this enlightening article below.

How American Health Care Killed My Father

Almost two years ago, my father was killed by a hospital-borne
infection in the intensive-care unit of a well-regarded nonprofit
hospital in New York City. Dad had just turned 83, and he had a
variety of the ailments common to men of his age. But he was
still working on the day he walked into the hospital with
pneumonia. Within 36 hours, he had developed sepsis. Over the
next five weeks in the ICU, a wave of secondary infections, also
acquired in the hospital, overwhelmed his defenses. My dad became
a statistic—merely one of the roughly 100,000 Americans
whose deaths are caused or influenced by infections picked up in
hospitals. One hundred thousand deaths: more than double the
number of people killed in car crashes, five times the number
killed in homicides, 20 times the total number of our armed
forces killed in Iraq and Afghanistan. Another victim in a
building American tragedy.

About a week after my father’s death, The New Yorker ran an
article by Atul Gawande profiling the efforts of Dr. Peter
Pronovost to reduce the incidence of fatal hospital-borne
infections. Pronovost’s solution? A simple checklist of ICU
protocols governing physician hand-washing and other basic
sterilization procedures. Hospitals implementing Pronovost’s
checklist had enjoyed almost instantaneous success, reducing
hospital-infection rates by two-thirds within the first three
months of its adoption.But many physicians rejected the checklist
as an unnecessary and belittling bureaucratic intrusion, and many
hospital executives were reluctant to push it on them. The story
chronicled Pronovost’s travels around the country as he
struggled to persuade hospitals to embrace his reform.

It was a heroic story, but to me, it was also deeply unsettling.
How was it possible that Pronovost needed to beg hospitals to
adopt an essentially cost-free idea that saved so many lives?
Here’s an industry that loudly protests the high cost of
liability insurance and the injustice of our tort system and yet
needs extensive lobbying to embrace a simple technique to save up
to 100,000 people.

And what about us—the patients? How does a nation that might
close down a business for a single illness from a suspicious
hamburger tolerate the carnage inflicted by our hospitals? And
not just those 100,000 deaths. In April, a Wall Street Journal
story suggested that blood clots following surgery or illness,
the leading cause of preventable hospital deaths in the U.S., may
kill nearly 200,000 patients per year. How did Americans learn to
accept hundreds of thousands of deaths from minor medical
mistakes as an inevitability?

My survivor’s grief has taken the form of an obsession with
our health-care system. For more than a year, I’ve been
reading as much as I can get my hands on, talking to doctors and
patients, and asking a lot of questions.

Keeping Dad company in the hospital for five weeks had left me
befuddled. How can a facility featuring state-of-the-art
diagnostic equipment use less-sophisticated information
technology than my local sushi bar? How can the ICU stress the
importance of sterility when its trash is picked up once daily,
and only after flowing onto the floor of a patient’s room?
Considering the importance of a patient’s frame of mind to
recovery, why are the rooms so cheerless and uncomfortable? In
whose interest is the bizarre scheduling of hospital shifts, so
that a five-week stay brings an endless string of new personnel
assigned to a patient’s care? Why, in other words, has this
technologically advanced hospital missed out on the revolution in
quality control and customer service that has swept all other
consumer-facing industries in the past two generations?

I’m a businessman, and in no sense a health-care expert. But
the persistence of bad industry practices—from long lines at
the doctor’s office to ever-rising prices to astonishing
numbers of preventable deaths—seems beyond all normal logic,
and must have an underlying cause. There needs to be a business
reason why an industry, year in and year out, would be able to
get away with poor customer service, unaffordable prices, and
uneven results—a reason my father and so many others are
unnecessarily killed.

Like every grieving family member, I looked for someone to blame
for my father’s death. But my dad’s doctors
weren’t incompetent—on the contrary, his hospital
physicians were smart, thoughtful, and hard-working. Nor is he
dead because of indifferent nursing—without exception, his
nurses were dedicated and compassionate. Nor from financial
limitations—he was a Medicare patient, and the issue of
expense was never once raised. There were no greedy
pharmaceutical companies, evil health insurers, or other popular
villains in his particular tragedy.

Indeed, I suspect that our collective search for
villains—for someone to blame—has distracted us and our
political leaders from addressing the fundamental causes of our
nation’s health-care crisis. All of the actors in health
care—from doctors to insurers to pharmaceutical
companies—work in a heavily regulated, massively subsidized
industry full of structural distortions. They all want to serve
patients well. But they also all behave rationally in response to
the economic incentives those distortions create. Accidentally,
but relentlessly, America has built a health-care system with
incentives that inexorably generate terrible and perverse
results. Incentives that emphasize health care over any other
aspect of health and well-being. That emphasize treatment over
prevention. That disguise true costs. That favor complexity, and
discourage transparent competition based on price or quality.
That result in a generational pyramid scheme rather than
sustainable financing. And that—most important—remove
consumers from our irreplaceable role as the ultimate ensurer of value.

These are the impersonal forces, I’ve come to believe, that
explain why things have gone so badly wrong in health care,
producing the national dilemma of runaway costs and poorly
covered millions. The problems I’ve explored in the past
year hardly count as breakthrough discoveries—health-care
experts undoubtedly view all of them as old news. But some
experts, it seems, have come to see many of these problems as
inevitable in any health-care system—as conditions to be
patched up, papered over, or worked around, but not problems to be solved.

That’s the premise behind today’s incremental approach
to health-care reform. Though details of the legislation are
still being negotiated, its principles are a reprise of previous
reforms—addressing access to health care by expanding
government aid to those without adequate insurance, while
attempting to control rising costs through centrally administered
initiatives. Some of the ideas now on the table may well be
sensible in the context of our current system. But fundamentally,
the “comprehensive” reform being contemplated merely
cements in place the current system—insurance-based,
employment-centered, administratively complex. It addresses the
underlying causes of our health-care crisis only obliquely, if at
all; indeed, by extending the current system to more people, it
will likely increase the ultimate cost of true reform.

I’m a Democrat, and have long been concerned about
America’s lack of a health safety net. But based on my own
work experience, I also believe that unless we fix the problems
at the foundation of our health system—largely problems of
incentives—our reforms won’t do much good, and may do
harm. To achieve maximum coverage at acceptable cost with
acceptable quality, health care will need to become subject to
the same forces that have boosted efficiency and value throughout
the economy. We will need to reduce, rather than expand, the role
of insurance; focus the government’s role exclusively on
things that only government can do (protect the poor, cover us
against true catastrophe, enforce safety standards, and ensure
provider competition); overcome our addiction to Ponzi-scheme
financing, hidden subsidies, manipulated prices, and undisclosed
results; and rely more on ourselves, the consumers, as the
ultimate guarantors of good service, reasonable prices, and
sensible trade-offs between health-care spending and spending on
all the other good things money can buy.

These ideas stand well outside the emerging political consensus
about reform. So before exploring alternative policies,
let’s reexamine our basic assumptions about health
care—what it actually is, how it’s financed, its
accountability to patients, and finally its relationship to the
eternal laws of supply and demand. Everyone I know has at least
one personal story about how screwed up our health-care system
is; before spending (another) $1trillion or so on reform, we need
a much clearer understanding of the causes of the problems we all
experience. MORE HERE

Let's keep our heads, while we continue to watch THE



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