Oil.

So this means, from a health care perspective, we should not support “cap and trade?”  And that we should support ethanol subsidies?  As if health care didn’t have anything else to think about at the moment, Judith D. Schwartz writes that the industry’s dependence on oil should be a top concern:

One might not imagine oil and medicine would mix, but U.S. health care relies on cheap crude in multiple ways: from petroleum-derived pharmaceuticals (including such commonly prescribed drugs as aspirin, vitamin capsules, cortisone and many antibiotics, antihistamines, medicated skin creams and psychiatric medications), catheters and syringes to running and transporting high-tech machines and time-is-of-the-essence ambulance runs. This makes for great aseptic single-use equipment and complex, even heroic, surgeries, but it also leaves our medical system highly vulnerable to any disruptions to the oil supply — which experts say will undoubtedly happen, though no one knows exactly when.

Health care again adds jobs

Health care added jobs in July (as it has continued to do) according to the latest BLS report (pdf).  Two reactions:

  1. Good.  We need employers to add jobs.
  2. It increases health care costs, especially not such a good thing as the economy continues to struggle.

The Health Blog reports that total health care employment has risen from 13.3 million to 13.6 million jobs, with grown seen throughout the industry.

Winning…or losing?

Gosh, there’s a special place in my heart for civil, constructive, advance-the-discussion discourse. David Frum:

What would it mean to “win” the healthcare fight?

For some, the answer is obvious: beat back the president’s proposals, defeat the House bill, stand back and wait for 1994 to repeat itself.

The problem is that if we do that… we’ll still have the present healthcare system. Meaning that we’ll have (1) flat-lining wages, (2) exploding Medicaid and Medicare costs and thus immense pressure for future tax increases, (3) small businesses and self-employed individuals priced out of the insurance market, and (4) a lot of uninsured or underinsured people imposing costs on hospitals and local governments.

We’ll have entrenched and perpetuated some of the most irrational features of a hugely costly and under-performing system, at the expense of entrepreneurs and risk-takers, exactly the people the Republican party exists to champion.

Stop your screaming…

This is embarrassing.  Whatever your allegiances and opinions politically, this is no way to go about a debate.  Screams and chants and physicality in a public forum is irresponsible. This lack of civility is doing nothing for our need to have constructive discussion surrounding the issue.  There’s a real chance that a health care bill will get through Congress no matter how loud some people scream.  And when people start screaming, it’s difficult and uncomfortable for others to listen.  So if there is an actual point to your impassioned tantrum the people who need to hear it (the fence sitters), won’t (aren’t).

If you don’t think that the current reform proposal will solve these problems, then fine.  I’m not convinced myself.  But can we at least go about this in a constructive manner?  Please?

(Maybe I should reassess my naiveté…)

The snail’s route

Well isn’t this just flipped convention, Daniel Gross at Slate writes, “Simply by doing nothing, we’re slowly nationalizing health care.”

The system of employer-provided health care coverage is crumbling before our eyes, and for more Americans—and for more American insurance companies—government-funded health care is all that separates them from financial disaster. A Gallup poll found that the percentage of Americans who say they get their health insurance from an employer has fallen from 58.9 percent in January 2008 to 56.5 percent in May 2009, while the percentage who get it from the government (Medicare, Medicaid, VA benefits) has jumped from 26.5 percent to 29 percent. (The rest purchase it on their own.) But this poll understates the case. About 17 percent of payroll jobs today are government jobs. Crunch the numbers, and it’s more like 39 percent getting insurance from government sources (public programs and public-sector jobs) and about 47 percent from private-sector jobs.

It’s a fable!

I’m left wondering: who would I least like to be, the congressional intern flipping the charts or a fellow Senator in the audience musing about what my House counterparts are doing on their time away from Washington?

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Powered by the Mayo Clinic, an attempt at physical API

So instead of this convoluted, consuming, and confusing reform debate, how about something more fun and innovative?  President Obama (+ others, etc.) has routinely cited the Mayo Clinic and the Cleveland Clinic as models for providing high quality, low cost care.  If they can do it, we ought to be able to learn from them, and roll that model out nationwide, the argument goes.  Well, this is America, and some (including the Mayo Clinic’s Health Policy Center) are (with merit) skeptical, but ignoring that for the moment…

Robin posted an interesting idea (with Noah providing further perspective) inspired by Starbucks most recent attempt to revitalize it’s once proud corporate image where non-branding becomes the branding.

Well, some people think that’s creepy.  Here’s Robin’s insightful take on what Starbucks should be doing instead:

What if Starbucks was offering up a Starbucks API—a set of hooks into a vast, efficient coffee shop support system with incredible economies of scale? You, the local coffee shop owner, simply plug in, and wham, your costs drop by thirty percent because you’re leveraging Starbucks’ insanely optimized supply chain. You can use as much or as little as you want.

The idea: create a “physical API (as Noah termed it, here’s a read-up on API if you’re unfamiliar)” of the Mayo Clinic or Cleveland Clinic. Copy their entire way of doing business and paste it into hospitals around the country.  In a nicely wrapped package deliver their systems for decision-making, integration, coordination, and expertise.  Include their human resources practices, innovation efforts, and technology.  Import their employment model, their bargaining power, and of course brand recognition.  This is a beta release so if anything is left out, it can be included in a later version.

Mix with water.  Implement.  Poof!  Great health care!

Just think about it, Local County Hospital, powered by the Mayo Clinic or Our Lady Health Care System, supported by the Cleveland Clinic; it’s a definite brand extender.

Joking aside, the idea in a (somewhat) more realistic form has some potential.  The two Clinics are very good at what they do (so are other health care systems around the country, for that matter) and widespread importation of  their business and medical practices which allow them to provide quality care at low costs to other delivery systems is an admirable goal.

WORDS: “Galapagos Effect”

Robert Fabricant, for your consideration:

The health-care industry in this country has suffered hugely from the Galapagos Effect. It has evolved its own ecosystem and business practices that reflect this isolation. This can be seen in every link in the value chain, as consumption and payment are completely disassociated in this country. Health care has evolved in isolation from many of the forces that have re-shaped other industries in recent years. This isolation is readily apparent to each of us whenever we step into a doctor’s office or hospital waiting room.

Despite their best efforts, industry leaders continue to betray an outdated, manufacturing mindset, referring to everything that has impact in the field–that touches communities and provides real human value–as “delivery.” This one-way model of engagement is truly shocking in an age dominated by communications technologies and connectivity. Health is not ‘delivered’ to people. It relies on active engagement and participation. It is a dialogue.

Obesity is a problem and we don’t know what to do about it

What makes the obesity problem so difficult is that it pretty much came out of nowhere and we, in essence, have no reliable solutions to pursue.

The Wall Street Journal wrote last week:

The singular feature of American obesity is its steep, out-of-nowhere rise. For most of the 20th century, U.S. obesity rates were stable, with a slight upward trend through the late 1970s. Suddenly, they spiked across all demographic groups and have continued to rise unabated. In sheer body mass, the entire population is heavier than it used to be, and the heaviest are much heavier. Just between 1998 and 2006, obesity rates increased by 37%, according to the CDC.

The costs are nearly as startling. In a study published this week in the journal Health Affairs, CDC researchers estimate that obesity now accounts for 9.1% of all medical spending—$147 billion in 2008. The Milken Institute estimates that chronic disease costs more than $1.2 trillion every year. On top of the medical resources devoted to preventable illness, a fatter and sicker work force is a drag on economic growth. In effect, we’re eating money. (link to Health Affairs study)

Last week the CDC held its wittily named “Weight of the Nation” conference to discuss obesity in order to game plan its approach to fighting the problem.  What’s been tried/suggested (a few): discourage auto transit, eliminate agriculture subsidies, ban food advertising, interventions in the school, family, and community.  Read about them here in a piece by Megan McCardle; her summary of obesity-fighting efforts indicates most interventions up to (right) now have been rather unsuccessful:

But the political opposition these actions would face is absolute(ly) enormous. Americans were not blindly seduced into an auto-based lifestyle by the paver’s union; they voted for lots of roads because they like their cars. Every president since Reagan has wanted to eliminate farm subsidies, and every president since Reagan has thoroughly, utterly, entirely failed. Similarly, the food and entertainment industries are not going to stand idly by while you do away with 10% of advertising revenue. “Fix the schools” and “fix crime” are two agendas that society is currently aggressively pursuing, with limited success. And I’m skeptical that you’re going to find something north of $30 billion a year for the kind of early-child interventions that really seem to make a difference.

Addressing the obesity problem at the point of (health) care is too late.  It’s (mostly) a problem of individual choice and it seems the solution likely falls in the same hemisphere.  But that’s rhetoric, now onto the implementation…

Any ideas?

RELATED UPDATE: Guess we’ve been “shaving the bear…”