False competition: an obstacle for prospective healthcare

By Sanjay Kishore

This past week I traveled to DC with 10 other undergrads passionate about health policy. During my visit I had the intriguing experience of visiting Housing Works, a prominent homelessness and HIV/AIDS advocacy organization famous for its history of activism, social justice, and civil disobedience. While we thought we were going on a simple tour, I soon realized that I would walk away with much more perspective on the state of health policy than when I entered.

As it turns out, the Washington Post had published an article the previous night quoting a local councilwoman who said she was considering reallocating HIV/AIDS funding to other obesity-related medical conditions affecting her district – none other than primarily diabetes, heart disease, and hypertension. Since she was the swing vote for passage of the budget, it was likely her demands would be included in the final bill. As I stood in the office of Housing Works, I saw the HIV/AIDS lobby begin to mobilize. Conference calls were made, frustrations exchanged, talking points drafted, and responses strategized. As student aides for the day, we too played a part. Our role? Drafting a letter to the councilwoman forcefully explaining that HIV/AIDS funding could not be cut by a single penny. And write we did, composing a message to be used as a call to action that would surely fill the legislator’s inbox.

To Housing Work’s credit, their rationale was this: instead of distributing money to different diseases (take from HIV, give to diabetes, etc.), why not create a better health system that addresses all of these health problems holistically? This seems completely rational - yet, there was a caveat. To accomplish health system strengthening, they wanted more overall funds devoted to health without reallocating money away from HIV/AIDS.

This example speaks to the challenges prospective health care faces as it encourages policymakers to combat chronic disease. Perhaps these funds would have helped eliminate “food deserts,” improve access to community exercise facilities, and allow free physicals in disadvantaged neighborhoods. But it would have been at the expense of helping individuals with other health needs. The reality is clear: in the midst of a $3 trillion deficit, governmental resources for health are limited. And paying more for one disease (in this case obesity) means paying less attention to another (HIV/AIDS)

Is this a false competition? Perhaps. Though we all stand for health as a human right, over-specialization may be hindering our collective progress. Can students play a role in facilitating collaboration and uniting narrow interest groups? You bet. Creating a stronger health system is not just a talking point – it’s a solution that will require compromise and force us to seek common ground. One thing is clear: it’s going to be a lot harder to de-politicize a movement to alleviate chronic disease than perhaps anyone of us youth ever thought.

Controversy over reform – what’s the deal?

By Sanjay Kishore:

While healthcare has already become a firestorm of controversy for the Obama Administration, the President’s recent reform bill received another blow this past week – once again, from the courts. As reported by the New York Times on January 31st, a federal judge in Florida followed the precedent set by a Virginia court and struck down the constitutionality of the March 2010 Patient Protection and Affordable Care Act (PPACA).

In both court decisions, the issue in contention was the law’s inclusion of an “individual mandate” – a provision that requires all Americans to obtain health insurance or otherwise face a monetary penalty. Essentially, these two justices believe the federal government has overstepped its bounds by pressuring people into purchasing insurance – a sentiment recently echoed by Republican legislators as they passed a symbolic vote to repeal PPACA in the House of Representatives earlier this month.

Obviously, momentum for healthcare reform has shifted in the past year. But, what does all this controversy actually mean – especially in the context of prospective health?

Many advocates of PHC – including students like myself – realize the first step to increasing prediction and prevention in our healthcare system isn’t developing new technologies or utilizing fancy screenings: it’s extending access to what we already have. Before 2010, uninsured Americans had no financial incentive to seek preventive medical treatment – after all, if you’re an individual living on a tight-income, why visit a doctor when you’re healthy? As a result, almost 45 million Americans faced an economic pressure to delay seeking medical assistance until a traumatic incident – say, a heart attack – became too severe to bear.

Though PPACA’s expansion of insurance to 32 million Americans didn’t solve the problem, it was a solid start. If we are serious about halting the spread of chronic disease and promoting wellness in the US, we must extend access to health insurance.

As students interested in preventive healthcare, it’s in our best interests to keep our ears tuned – and our voices loud – for the next few years could be telling for the future of American healthcare!

Debating Health Care Reform: more talk, little action

Recently, the Duke University chapter of the Benjamin Rush society held a debate on health care reform.

Moderated by Dr. Christopher J. Conover, the topic was, “How does America achieve affordable, accessible, quality healthcare?” Debate participants included Sally Pipes, Dr. Hal Scherz, Dr. Peter Kussin, and Dr. Gustavo Montana.

The audience was polled just prior to the debate as to whether health care reform would be best addressed by (1) government regulation (2) self-regulation by the private sector or (3) unsure. The same question was asked at the conclusion of the debate. Although no formal statistical analysis was performed, the numbers remained essentially unchanged before and after the debate. One hour of intense discussion among three physicians and a national health care reform expert in the presence of medical students, health care professionals, and members of the public resulted in more of the same – not unlike what we’ve seen in the last two years across both the political and private sectors. . It’s clear people’s opinions on health care reform reflect core moral, political, economic, and philosophical beliefs, and those don’t often shift over the course of an hour-long discussion or a three-minute news splash.

Despite the heated discussion, there were several points that both the “conservative” and “liberal” panelists agreed upon. They agreed that the current system is broken and that PPACA is unlikely to fix it. They agreed that physicians need to be more involved in discussions of health care reform. They agreed that cost-effective care, guided by cost-effectiveness research, is important to improving health care efficiency. They agreed that patient care needs to be coordinated among providers and systems.

Prospective health care provides a solution that cuts across political and personal mores. This approach provides regulation not by government or private companies, but by physicians in partnership with their patients. It provides cost-effective care, not by mandate, but by physician and patient cooperation. It supports rational reimbursement based on documented outcomes. It is a non-partisan, non-government, non-private, but physician and patient based approach that avoids the devastating road-blocks that plague current “debates” on health care reform. Dr. Kussin advocated for an American Solution several times during the debate. If the United States is to find a uniquely American solution to the question of health care reform, it will take all of America, not just one-half. Focusing on the development and implementation of models of reform such as prospective health care provides a real solution for how to provide rationale care, reduce costs, improve outcomes, and increase patient satisfaction. And who can’t agree on that?