Football and Healthcare

Does football have anything to offer our health care system?  Maybe so.  See my op ed today in the Boston Herald exploring this.

Hospital Mistakes Still Happening

The New York Times today reports on a study, to be released tomorrow in the New England Journal of Medicine, that demonstrates hospitals are not making enough progress on improving patient safety.  The study was conducted over a 5 year period in 10 North Carolina hospitals.  The result is sobering:

"[I]nstead of improvements, the researchers found a high rate of problems. About 18 percent of patients were harmed by medical care, some more than once, and 63.1 percent of the injuries were judged to be preventable. Most of the problems were temporary and treatable, but some were serious, and a few — 2.4 percent — caused or contributed to a patient’s death, the study found."


You can find the story here.  Hospitals are incredibly complex places and there are no simple solutions.  But the fact remains that many of these problems are quite preventable, and far too few hospitals are employing the kind of solutions that we now know prevents these kinds of mistakes.  This study, like many others, should be another wake up call to all of us for greater vigilance in attacking this problem.

Separate Doctors from Industry

UMass Memorial Chief Medical Officer Stephen Tosi and I argue, in this Boston Globe Op Ed, that it is now time for all teaching hospitals and medical schools to place more appropriate restrictions on the relationships between physicians and the pharmaceutical and medical device industries.  We cite UMass Memorial's positive experience as a reason why these organizations have nothing to fear by doing so. 

Perhaps some might take note.  The Atlantic Wire, (which "focuses on the columnists and commentators leading the national dialogue") listed the piece as one of its 5 Best Monday columns.  See the others here. 

More on End of Life

In another great piece of writing that we have come to expect from Atul Gawande, he grapples with end of life decision making, and exposes how ill prepared our medical system is for dealing with this issue. 

"Modern medicine is good at staving off death with aggressive interventions—and bad at knowing when to focus, instead, on improving the days that terminal patients have left."
 
You can find the New Yorker article - entitled Letting Go - here.

It's Brown and Obama!

Usually my predictions are wrong.  So when I occasionally make a correct one, I must take note.  Back in February shortly after Senator Brown was elected, and then again in April (see this post for history), I predicted that Scott Brown may end up finding more common ground with President Obama than the National Republican party.  That may be turning out to be the case.  As noted in this story in today's Boston Globe, he is about to hand the President another major political victory on financial reform. 

Amazing Story

I have written before about end of life issues.  (See here for the Engage with Grace blog rally).  Nowhere have I seen a more profound story to make this all real than this one in yesterday's New York Times Sunday Magazine.  Tragic and well told, this story of a pacemaker that "broke [a] father's heart" is a must read for anyone serious about trying to better understand the incredibly difficult and painful choices that many of us will have the misfortune of having to make at some point in our lives.

Public Support for Reform Rising

"I thought when people began to realize what was in the health care package that they would see it's a good, solid program and that would dispel some of the misinformation."
                                   -Claudia Harris, 72, of Orem, Utah, an English professor at BYU

Turns out Claudia may be right!  See this article on a new poll showing the highest level of public support since the passage of reform.

Hubris in Health Care

Do you think it exists?  Read my piece this week in the Boston Globe Magazine and let me know what you think.

On Law Day - Support Equal Justice

Tomorrow - May 1 - is Law Day.  It is a time to momentarily reflect on the rule of law in our society.  In an "As I See It" column in today's Telegram and Gazette (link here), Joe Fournier and I advocate for support of civil legal aid - a program that provides legal assistance to low income individuals who cannot afford an attorney.  We do so through the eyes of one Worcester man who was helped enormously by the great support of the Legal Assistance Corporation of Central Massachusetts.  Please read his story.   And please do what you can to support legal aid and promote equal justice in our community.

Serious Reportable Events

The Massachusetts Department of Public Health just released their annual report of serious reportable events in Massachusetts hospitals.  You can see the report here.  There were 383 in total for 2009, up from 338 the year before.  The biggest increase was in pressure ulcers, but the DPH thinks this may be due to better reporting as opposed to an increase in the incident rate.  Falls continue to make up a majority of the events (52%), although they were down from last year (to read why I think falls should not be included on this list, see my October, 2009 Op-Ed here). 

In general, it looks like Massachusetts hospitals are doing better than their peers in other states.  But there were still 24 wrong side surgeries last year.  On this one, the benchmarks shouldn't matter.  There shouldn't be any.  How many commercial airplanes go to the wrong city?

A Blessing In Disguise?

In this post from February 4, I noted that, contrary to the conventional wisdom, we should not be "surprised if the agenda Brown ends up mucking up is not that of the President, but the national Republican Party."  It looks like that may becoming more of a reality, as Brown's snub of the Tea Party this week was just the latest in a string of moves that have frustrated his original supporters.  In this article today in Yahoo News, noting these developments, the writer ponders whether Brown has become a blessing in disguise for the Democrats.  That might be a stretch, but it is further reason not to put too much faith in "conventional wisdom."

Dissecting the Republican Position

Let's consider:

1. The Republicans say there has been totalitarianism. It seems to me the majority ruled, as it has done since the founding of our Republic. Totalitarianism?

2. The Republicans say they have been entirely shut out of the process. But the fact is that more than 200 Republican amendments were accepted in the health reform bill as part of the process. Shut out?

3. A Republican leader predicted that the passage of the bill would be "Armageddon." That could be up there with the "Mission Accomplished" banner as one of the biggest political blunders of all time.

4. Senator Brown says it will not help Massachusetts. But the facts are that thousands of low income individuals will now be eligible for new subsidies, almost 80,000 seniors will benefit from the donut hole fix and Massachusetts will receive an extra hundreds of millions of dollars in Medicaid matching funds. It is hard to understand how one could rationally say this does not benefit Massachusetts.

5. Republicans say mandates are un-American and unconstitutional. But they were for them before they were against them. In an interesting article in today's Globe, the AP documents how the health insurance mandate began as a Republican idea in the 90's as an alternative to the Clinton plan. But when the Dems picked it up, they had to be against it.

6. And how about Romney? You'd think he would learn, as his wishy-washy position on abortion over the years could have cost him the nomination in 2008. Yet here he is, the leader who deserves enormous credit for spearheading the successful reform plan in Massachusetts -- upon which the federal plan was based - and now he opposes the federal plan and wants it repealed. How he thinks he can credibly even think about running for President, given such a disingenuous flip-flop, is beyond me.

7.  The Republicans claim this is a big government take-over and we are leading to socialized medicine.  Again, this ignores reality.  There is no public option.  The states create exchanges, simply to allow individuals who lack private insurance to gain better bargaining power in the purchase of insurance through private plans.  There is no new public plan or government take-over.  There is greater government regulation over insurance companies -- but even Republicans say they want this and the public surely does. 

8. The Republicans repeatedly say that the American people overwhelmingly are against this bill.  Yet, a Gallup poll conducted right after passage showed that 49% of Americans support the legislation and 40% do not. 

9.  Finally, the Republican strategy is now to run in the Fall on repeal of the law. Repeal?! Do they know that repealing the law requires not just taking over the majority in both houses, but actually taking over a veto-proof majority, which all experts from all sides believe is virtually impossible. And that's now their strategy?

They took a big gamble. They all voted against it. They hoped it would take down the Obama Presidency. But they lost. It didn't. And now they are left to explain how their strategy was actually in the interest of the American people, and not just a raw political scheme. They will have a tough time.

It's Done!

219-212.  History is made.

The End In Sight!

It's hard to believe, but by the end of today we may actually have a health reform bill moving to the President's desk for signature (followed by passage in the Senate of a reconciliation bill to fix the worst parts of the Senate bill). If it happens, it will not only be a great victory for our President, who will have achieved more than any other President since 1965, but also (and more importantly) a great victory for our nation.  It's going to be close and no one is claiming victory yet.  But I knew things were looking up when I read that nuns had departed with the Catholic Church to support the legislation. 

On this, the frist full day of Spring, hope springs eternal!

A Good Clean Joke

With all the seriousness of health reform, I thought it might be time for a good joke (courtesy of my friend Gary Lapidas). So here it is:

Two middle aged men, Art and Phil, were best friends.  And more than anything, they loved baseball.  They would often watch games together and root for their favorite team, the Boston Red Sox.  They could not imagine life without baseball.  That got them to wondering -- do they play baseball in heaven?   They would often discuss this, debating back and forth.  Finally, they decided to enter into a pact.  Whoever arrived in heaven first would promise to somehow come back and let the other know whether they play baseball in heaven. 

Years went by and they became old, but continued to enjoy baseball together.  Sadly, Art suffered a stroke and died.  Phil was forlorn but he often wondered whether his friend Art was playing baseball in heaven.  One day as Phil was having a quiet breakfast alone, Art suddenly appeared in front of him. 

"Oh my gosh, Art, is that really you?!"

"Yes it is, Phil." said Art. 

"Well, tell me, do they play baseball in heaven?" said Phil. 

"Well Phil. I have good news and bad news.  The good news is that they do play baseball in heaven."

"Oh that is wonderful Art.  And what is the bad news?"

"The bad news is that you're pitching tomorrow." 

Obama Should Go Further

President Obama will speak today about four proposals of Republicans that he will accept in the health reform legislation, apparently setting the groundwork for a reconciliation vote.  Unfortunately, he does not go far enough on malpractice reform.  Here is what he said, from the NYT:

"The president said he also supported providing $50 million in grants to states to help them test alternatives to the current system of resolving medical malpractice claims. But Mr. Obama stopped far short of endorsing Republican proposals to impose hard limits on damage awards in medical malpractice lawsuits."

He should go further. 

The Cost of Doing Nothing - Version II

Avid readers of this blog (all three of you!) may recall this old post of mine from November discussing the significant cost of doing nothing on health reform.  See this interesting story in the New York Times over the weekend, by the same title, and essentially making the same points. 

The Health Care Summit: Analysis and A Way Forward

A very interesting day indeed. On the substance, both sides scored points and put forth thoughtful and credible arguments about how to move forward on health reform. Before going any further, let's stop and celebrate that point alone. How refreshing! Real dialogue and debate on meaningful issues. Sure, there was some posturing and demagoguery, but no talk of death panels (at least not that I heard) or other misinformation and distortion that has been spewed about over the past year. That alone is a big win for our country.

In the end, score it a tie on the substance. Few will be moved from their positions by the substantive arguments. But here's the interesting thing. This public debate has not been about the substance. The irony is that the public hates the bill, but likes everything in it. The debate, sadly, has been more about process and size and scope. The public is incredibly confused and, given the economic climate, quite scared about what they perceive (correctly) to be a massive change that may cost a lot of money. And that has been fully and effectively manipulated by Republicans in saying it is too big and we should start over. (It is also quite cynical because you have to be from Mars to not know that their true goal is to cause a massive failure by the President, then criticize him for wasting everyone's time and not getting anything done while he had a majority, all in the hopes of gaining seats in November).

And this leads to my reason for believing that politically, today will prove to be a huge win for the President. First, he demonstrated to the country he is serious about these issues, wants to engage in real dialogue to try to forge a compromise, and showed courage to put himself out there to the World to debate the substance of such important topics (could you imagine George W. Bush doing this?). And as usual, he was quite articulate and came across as very sincere. The public likes him and this will add greatly to his credibility on this issue. Whether or not they agree with everything that is in the bill, they will believe that he really does want to do the right thing for the country and for them (and they will likely respect and reward that, notwithstanding their concerns with the bill, in the same way the country did not like many of Bush's policies after 9-11, but nevertheless respected and rewarded him for wanting to do everything he could to protect them. I believe this is the main reason Bush won the election in 2004).

Second, the Republicans were in a bit of a bind. They have been saying all along the entire legislation is crap. Yet today they engaged in a serious debate about issues in these bills and actually reached agreement in several areas, thereby giving validity to at least certain portions of the bills. The fact is that many provisions of the bills were put in at the request of Republicans. So they have now conceded (implicitly or otherwise) that there are some substantive and serious provisions in the legislation. And given the fact that the President took the initiative to proactively reach out to them to forge a compromise, they will be under intense pressure now to actually make some compromises of their own or they will truly look like the "Party of No." Thus, no longer will they be able to effectively pursue their slash and burn agenda of dismissing and trashing the whole bill.

Now for the way forward. As I have said all along, the House should pass the Senate bill.  But here are three specific ways they should improve it. First, they should remove all of the most egregious "special deals." Even though these deals exist in all legislation, this issue has done more than anything else to infect the process and distract and outrage the public. And there is no substantive defense to most of it. It undermines the Dems efforts to try to act with integrity in the best interest of the country at large. And of course stripping the bill of these deals removes the best talking point of the Republicans. Second, the Senate should agree to other modest changes by the House to give them a "win" and allow them to claim victory in making improvements to the bill. It won't change much about the substance, but it will go a long way to making house members feel better and give them something to run on in November (i.e., "thanks to my insistence, we actually improved the bill."). 3. Finally, and this will be most controversial, the Democrats should add a serious and meaningful provision on malpractice reform. It is simply indefensible, in this age of out-of-control healthcare costs, to not take on this issue. It is true that actual malpractice costs add relatively little to the cost of health care. But defensive medicine (the practice of ordering tests and procedures for fear of being sued if you don't) adds quite a bit. And by not taking it on, you appear as if you are trying to curry favor with trial lawyers. The fact is that everyone must give their pound of flesh if we are to succeed in this effort and the failure to address this issue in such a comprehensive bill is a huge and unacceptable void.

If the Dems do these three things, they have preserved the "heart" of their comprehensive reform, which is good for the country. But they have also improved the bill, stripped it of its most insidious components, and added an issue that should have been in from the beginning. They will also being showing real compromise, which will improve public support, and they will put the Republicans in a real box. How could the Republicans ever say the Dems did not compromise in good faith when they added perhaps their number one priority (malpractice reform). This will probably result in a few Republican votes. But even if it doesn't, the Dems will gain the upper hand politically and can move to reconciliation in a far better posture to defend their actions come November. One can hope. What say you?

National Health Reform Will Benefit Massachusetts

See this excellent Op Ed (although I am admitedly biased) in today's Globe co-authored by UMass Memorial CEO (and my boss) John O'Brien dispelling the myth that national health reform will do nothing to benefit Massachusetts.  As he and his co-author Phil Edmundson note, it will actually do quite a bit. 

From Ronald Reagan to Goat

Last evening, Senator Scott Brown announced that he would join 4 other Republicans to vote with Democrats against a Republican filibuster designed to stop a vote on President Obama's jobs bill.  As I predicted in my February 4 post, Brown may end up frustrating Republicans more than the President.  I just didn't think it would happen this soon.  In this story from the LA Times, James Oliphant notes that on account of this vote, almost overnight Scott Brown "has gone from being the darling of America's conservative activists to being their goat."  Oliphant notes that many of these activists were hailing Brown to be the next Ronald Reagan who could usher in a new era of conservatism, but now only days later they have exploded into the blogosphere with this:

"Cries of "letdown," "betrayal," "sellout," and "RINO" -- "Republican in name only" -- flew around Twitter. By late Tuesday afternoon, more than 4,200 people had left comments on Brown's Facebook page, most harshly negative."

Perhaps this says something about those activists who supported Scott Brown.  But it clearly says something about Scott Brown.  It says that in this early test, he is putting his money where his mouth is and trying to be the independent voice he claimed he would be.  Let's hope it continues.