What Obama forgot to talk about last night

July 23, 2009

Obama presented a false choice last night, either the status quo or Obamacare. But what about empowering consumers and letting markets work? A great post from the Health Care Blog makes some great points on this very issue. It looks at two fictional familes and shows how each deals with three different medical problems —  back pain, chest pain and dementia? The Smiths are passive and rely on the doctor while the Joneses aggessivey reserach their problems and question authority. Here is one example:

When Sam Smith’s back pain flared at age 45, he was quick to accept his doctor’s recommendation for an MRI and a visit to an orthopedic specialist to make sure it wasn’t serious. The MRI showed a possible cause of the pain and (just to be sure) Sam had surgery the following week, marveling at the efficiency of the system. The cost: about $40,000 for surgery, hospital, physician care and rehab.

When Jay Jones, also age 45, had an identical bout of back pain he reviewed a back surgery decision aid on the Web—even before his first visit. He learned that back surgery is not usually needed or always successful. For him the case for surgery was not very strong.

When his doctor recommended an MRI, Jay pointed out that a decision aid helped him learn that 50 percent of back pain cases go away in four weeks, 90 percent in six months, and only 10 percent of back pain cases need surgery. Jay also learned that MRI reports often find things that can lead to surgery even though they were not the cause of the pain. With that information he asked if he might put off the MRI and the surgery while he determined if his back would get better on its own—it did. The cost: $150 for the office call and $12 for the over-the-counter medications. Back surgery is among the most overprescribed treatments.

How to get more Smith families to act like Jones families, as well further empowering the Joneses. Some recommendations:

Supporting the Joneses

Job 1 is to help the Joneses succeed in their efforts by giving them evidence-based, easy –to-use decision aids and self-management guides to implement three basic rules:

  • The Self-Care Rule: Help people do as much for themselves as they possibly can. With the right tools we have become our own travel agents, bankers and investment counselors. We create our own Websites and edit our own movies. Rule #1 would bring that same innovation to health care.
  • The Guidelines Rule: Help people ask for the care they need. Too often in health care there is a gap between what we know works and what we do. On average, people with chronic disease get only about half of the care they should. Conversely, we are often suggested expensive and invasive treatments when simpler treatments do just as well or even better. By giving patients easy-to-read versions of the same medical guidelines their doctors use, they can ask for and get the care they need.
  • The Patient Choice Rule: Help people say “no” to recommended care that is not likely to improve their lives. With the benefit of good information people should be able to decline duplicative or overly expensive testing, unnecessary drugs or surgeries not likely to make a positive difference in their lives—particularly in the last years of life.

All three rules can be implemented quickly and effectively by implementing patient facing “meaningful use” requirements for electronic medical records and by expanding MyMedicare.gov into a virtual health home.

Motivating the Smiths

The second task is to motivate the Smiths to become more engaged in their own healthcare by offering economic and structural incentives to them and to those who serve them.

  • Reduce co-pays for services that prevent complications.
  • Reduce co-pays or premiums for people who use patient decision aids.

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Obama also forgot something else, at least he did when he got 5 minutes into his Today Show interview with Meredith Vieira on Tuesday. At that point he said, “The only tax change I’ve made in the 6 months I’ve been here is to cut people’s taxes.”

He said that – despite the clear and recorded fact that he raised cigarette pack taxes by 150% and raised the tax on one of the poorest well-defined minority groups in the country, smokers so poor they roll their own from shreds of tobacco and scraps of paper, by OVER TWO THOUSAND PERCENT (from $1/lb to $24/lb).

He raised those taxes as one of his very first official acts in office, the SCHIP bill, and he “forgot” during his interview.

Somehow I think he did more than just “forget” while making that statement… and yet virtually no one is calling him on it. Why?

Michael J. McFadden,
Author of “Dissecting Antismokers’ Brains”

Posted by Michael J. McFadden | Report as abusive

If the government did nothing more than implement the HSA (Health Savings Account) model, the national health care problem would be 99% solved. Individuals would have full coverage for catastrophic medical situations and would be in full control of day-to-day medical outlays. Since the individual would be spending THEIR OWN money, the competitive effects would be enormous (in a good way). Congress (ALL of them) and the Obama administration just don’t want individual citizens to have any say in the matter. They want full control. THROW THEM ALL OUT!

Posted by TexGEOas | Report as abusive

The self-care rule: I once had the recurrence of an infection for which the standard of care is immediate treatment with antibiotics. But it was a weekend and I didn’t want to go to the ER for a non-emergency. Since the symptoms are quite uncomfortable, I hit the Web to see what I could do to alleviate them until that Monday. The first website I happened to hit was British. It said the condition should resolve itself in a couple of days. It advised treating the symptoms and if it didn’t resolve in a few days, see the doctor for antibiotics. It also told how to create an “unfriendly” environment for the bacteria. (All the American websites said the same thing: see a doctor immediately for treatment with antibiotics.) I then called my pharmacist who said he’d have the palliatives waiting for me. I followed the Brit’s advice and the infection was gone within 48 hours.

My telling of this little anecdote does not mean I necessarily endorse Mr. Pethokoukis’ proposals, but this is exactly the kind of conversation we should be having right now (and good luck finding any sign of it in the legislation wending its way through Congress). I, too, am a big fan of the HSA model. Most of the time, all the majority of us need are the services of a nurse practitioner or even a physician assistant (I use them whenever possible and I have great insurance). We’ve known for years that we’ve been over-using and abusing antibiotics, as well as any number of other drugs. We need to find ways to stop our abuse of the system that fall well short of having government dictate to us.

Every segment of the health care industry, including we the consumers of health care, is responsible for the mess we find ourselves in, but IMO none more than the government. I find it ludicrous that the same government now considers itself the solution.

Posted by Kyda Sylvester | Report as abusive