Category Archives: Reform

Preventing Hospital Errors Part II by Howard C. Berkowitz

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Given the medical community’s reluctance to step up and admit to mistakes, Medicare has decided to get tough, saying that it will stop reimbursing  hospitals for the thirteen adverse advents listed below. Before discussing the list, let me suggest that not all of these events are within a hospital’s control. I’ve rated the mishaps on the list from 1 to 4, with “1” indicating something that, I agree, should never happen, and “4” referring to something that, in my experience, a hospital may not be able to prevent.

    The 13 Things That Should Never Happen in a Hospital
   1. Catheter-associated urinary tract infection [2]
   2. Bed sores [1]
   3. Objects left in [THE PATIENT”S BODY] after surgery [1]
   4. Air embolism, or bubbles, in bloodstream from injection [1]
   5. Patients given incompatible blood type [1]
   6. Bloodstream Staphylococcus (staph) infection [2]
   7. Ventilator-associated pneumonia [2]
   8. Vascular-catheter-associated infection [2]
   9. Clostridium difficile-associated disease (gastrointestinal infections) [3]
  10. Drug-resistant staph infection [3]
  11. Surgical site infections [3]
  12. Wrong surgery [1]
  13. Falls [4]

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Comment on Class and Health

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(To see the original post on Class and health, click here.  To add your comment, scroll down and click on “Contact” on the left-hand side of the page.)

From Alan Abrams (a.k.a. Alan_A
at the hpscleansing.com/group
community forums)

I just read Maggie
Mahar’s health blog after linking to it from an agonist.org blog on universal health care.
I then read Maggie Mahar’s blog [post] on
"Class and Health."  thus this quote:

"And yet, and yet . . . Schroeder sees reason for "cautious
optimism." Although we trail behind other countries, we are healthier than
we once were. We have reduced smoking ratse, homicide rates and motor-vehicle
accidents. Vaccines and cardiovascular drugs have improved medical care. But
progress in other areas will require "political action,"
Schroeder declares, "starting with relentless measurement of and focus on actual
health status and the actions that could improve it. Inaction
means acceptance of America’s poor
health status."

Healthier than we once were? Really?  Are…smoking, homicide rates, and
motor-vehicle accidents adequate measures of the overall improving general
health of Americans?

What about these:

  • 58 Million Overweight; 40 Million Obese; 3 Million morbidly Obese
  • Eight out of 10 over 25’s Overweight
  • 78% of American’s not meeting basic activity level recommendations
  • 25% completely Sedentary
  • 76% increase in Type II diabetes in adults 30-40 yrs old since 1990

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Comment on Class and Health

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(To see the original post on Class and health, click here.  To add your comment, scroll down and click on “Contact” on the left-hand side of the page.)

Maggie,

A couple of thoughts on this.

First, Americans who work in physically demanding and/or dangerous jobs such as coal mining, steel manufacturing, auto manufacturing, etc. do not live as long, on average, as the population overall despite comparatively good wages and benefits.  I don’t think countries like Iceland and Switzerland have nearly as many people relative to their populations working in these jobs as the U.S. does.  Japanese people in the U.S. also live longer than most people.  I suspect that it’s due to a combination of diet and genetics. However, as they are here longer and adopt a more westernized lifestyle and diet, they probably don’t live as long as Japanese people in Japan with comparable socioeconomic status do.

Second, regarding social inequality, I think our system, does, to a large extent, reflect our more entrepreneurial culture.  While reasonable people can differ about how much taxes should be raised on higher income people to both reduce inequality and raise money for worthwhile public priorities, I think it is important to remember that there could also be economic costs. In Western Europe and Canada, the total tax burden on middle and upper income people generally exceeds 50% of gross income.  It’s expensive to sustain a welfare state with a generous social safety net.  I think, at the end of the day, those countries, which embraced socialism decades ago, are trading less inequality and more economic security for less economic growth and less opportunity, especially for its younger people. 

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Class and Health

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When compared to other developed countries, the U.S. ranks near the bottom on most standard measures of health. Many people assume that this is because the U.S. is more ethnically heterogeneous than the nations at the top of the rankings, such as Japan, Switzerland, and Iceland. But while it is true that within the U.S. there are enormous disparities by race and ethnic group, even when comparisons are limited to white Americans our performance is “dismal” observes Dr. Steven Schroeder in a lecture  published in the New England Journal of Medicine yesterday.

Why? It’s not the lack of universal access to healthcare" says Schroeder, though that’s important. And it’s not just that we don’t exercise enough and eat too much—though that is a major cause. But there is one factor undermining the nation’s health that we just don’t like to talk about in polite society: Class. When it comes to health, class matters.

Schroeder, who is the Distinguished Professor of Health and Health Care at the University of California San Francisco (UCSF) underlines how poorly even white Americans stack up when compared to the citizens of other countries by pointing to maternal mortality as one measure of health. When you look at “all races” you find that in the U.S. 9.9 out of 100,000 women die during childbirth.  Focus solely on white women, and the number is still high—7.2 deaths out of 100,000 –especially when compared to Switzerland where only 1.4 women out of 100,000 die while giving birth.

Statistics on infant mortality reveal the same pattern: among “all races” 6.8 American children who were born alive die during infancy; limit the analysis to “whites only” and 5.7 infants die—compared to just 2.7 out of 1,000 in Iceland. .) When researchers compare maternal mortality and infant mortality in white America to rates of death in the 29 other OECD countries, white America ranks close to the bottom third in both categories.

Turn to life expectancy, and you find that white women in the U.S. can expect to live 80.5 years, only slightly longer than American women of all races (who average 80.1 years). Both groups lag far behind Japanese women (who, on average, clock 85.3 years). The gap between “all American men” (who live an average of 74.8  years) and white men in the U.S. (75.3 years) is wider—but not as wide as the gap between white men in the U.S. and men in Iceland (who live an average of 79.7 years).

“How can this be?” asks Schroeder. After all, as everyone knows, the U.S. spends far more on health care than any other nation in the world.

The answer is a stunner: the path “to better health does not generally depend on better health care,” says Schroeder. “Health is influenced by factors in five domains — genetics, social circumstances, environmental exposures, behavioral patterns, and health care. When it comes to reducing early deaths, medical care has a relatively minor role. Even if the entire U.S. population had access to excellent medical care — which it does not — only a small fraction of premature  deaths could be prevented.” [my emphasis]

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HILLARY CLINTON’S NEW PLAN

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   I have written two posts analyzing Hillary Clinton’s healthcare plan. You will find them on www.tpmcafe.com (where I am a contributor). You can comment there.

   

    

Do We Really Have to Cut Back On How Much We Spend on Health Care?

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After all, we’re the wealthiest nation in the world. And what is more important than the health of our citizens?

Nevertheless, even in the U.S. resources are finite. And in 2007, Congressional Budget Office director Petter Orzag warns, “The central fiscal challenge facing the nation involves rising health care costs.” In a recent letter to the House Subcommittee on Health chairman Pete Stark, Orzag frames the problem in a way that no one can ignore by comparing how much faster healthcare spending is growing than income per capita. “The rate at which health care costs grow relative to income is the most important determinant of the nation’s long-term fiscal balance,” he explains. “It exerts a significantly larger influence on the budget over the long term than other commonly cited factors such as the aging of the population.”

Let’s cut to the bottom line: If health care inflation continues to outstrip income growth over the next forty years at the same rate that it has over the past 40 years, spending on Medicare and Medicaid alone will rise to 20 percent of GDP in 2050. (To give you a sense of how big a slice of the pie that is: today, the entire federal budget equals roughly 20 percent of GDP).

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If We Mandate Insurance, Should 20-Somethings Pay Less?

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Should insurers be able to offer less expensive policies to the young and healthy? Or should they be required to offer the same benefits to everyone at the same price?

In states where insurance is mandated, should twenty-somethings get a break? In a post on Health Care Policy and Marketplace Blog Robert Laszewski addresses these questions. He begins by focusing on a report  just released by the health insurance trade association (AHIP). The study looks at state health insurance reforms of the 1990s that tried to eliminate discrimination by insisting that insurers must sell “individual” policies to people who are not covered by an employer or another group without discriminating on the basis of health, age or gender. According to the AHIP, these reforms have had some “unintended consequences.”

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