But I did want to share a few links to some of the more thoughtful (or provocative) articles and reviews, representing critics on both the left and right. I also wanted to draw your attention to another recent book providing a conservative perspective on health reform.
- Here’s a Sunday New York Times book review by Zephyr Teachout.
- Here’s Malcolm Gladwell in the New Yorker.
- And Peter Orszag (who was in the Obama administration when the bill was being written and appears in the book) at Bloomberg View writes about what he thinks Brill got wrong.
- Avik Roy at Forbes has a conservative perspective.
The second book (and I should say that while I have a copy, I loaned it to a colleague before I read it myself…) is by the Washington Examiner‘s commentary editor, Philip Klein, who looks at the options and thoughts on the right in “Overcoming Obamacare: Three Approaches to Reversing The Government Takeover of Health Care.” It hasn’t been as widely reviewed as Brill’s book but Aaron Carroll gives it an interesting write-up in the Incidental Economist blog.
Think Cultural Health is “dedicated to advancing health equity at every point of contact. With growing concerns about health inequities and the need for health care systems to reach increasingly diverse patient populations, cultural competence has become more and more a matter of national concern.”
Highlights from the site
- Free continuing education programs designed to help individuals at all levels and in all disciplines promote health and health equity, including
- Communication tools and resources that will help you and your organization communicate effectively with your patients and clients, including A Patient-Centered Guide To Implementing Language Access Services In Healthcare Organizations.
- CLAS Clearinghouse, a compilation of resources and publications on the Web related to the provision of culturally and linguistically appropriate services.
One may search by types of resources (as education and training), audience (as patients and consumers), and topics (as disparities)
- Centers for Disease Control and Prevention, Office of Minority Health & Health Disparities (OMHD)(Centers for Disease Control and Prevention)
- National Center on Minority Health and Health Disparities
- Office of Minority Health(Dept. of Health and Human Services, Office of Minority Health)
- Care for Cultural Competency? Check Out the Office of Minority Health’s New Web Site (aa47.wordpress.com)
- Cultural Competency in Care (journeytosatori.wordpress.com)
- Cultural Competence in Health Communications (pdresources.wordpress.com)
by MAGGIE KOZEL, MD at KevinMD.com (November 27, 2011)
Imagine what health care in the United States could look like if we devised a system that was based on sound medical practice and proven cost effectiveness. What if we put our brains, energies and passion behind designing the smartest health care system possible?
That was the question that kept poking through my train of thought as I read a study that appeared in the most recent issue of Pediatrics, the official journal of the American Academy of Pediatrics. Thestudy, out of UCLA, examined the association between length of well-child visits and quality of the visits, including things like developmental screening and anticipatory guidance. No big surprise that the longer the duration of the well child visit, the greater the likelihood that the content of the visit was aligned with recommended practice guidelines from the AAP. The discouraging news however is that one third of visits were reported as being less than 10 minutes in duration; these occurred to a greater degree in private practice. Longer visits of 20 minutes or more made up 20% of the encounters, and were more likely to occur in community health centers.
The big winners in the pinch for time? Guidance on immunizations and breastfeeding were offered in 80% of even the shortest visits. The biggest loser: developmental assessments, which don’t even achieve a mediocre occurrence of 70% until we pass the 20-minute mark for visit duration….
Our fee for service approach to health care dictates that procedures and tests pay well while addressing a child’s emotional problem gets a doctor little more than a backed up waiting room. From the patient’s view, underinsured children have to rely too much on emergency rooms, while insured parents can only get basic child rearing advice from someone with a medical degree. Health insurance companies and the pharmaceutical industry shape medical practice – and our collective health – through their reimbursement policies, marketing and aggressive lobbying. So 25% of US children are on chronic medications, while half the children in pediatric practice are not receiving basic screening and advice. The obsolete business models that the health care industries rely on are like the tyrannosaurus-rex in the room, emphasizing expensive, short term quantity rather than cost-effective long term quality, while cognitive care – a high level of skill and expertise delivered face to face in a personal manner – is what is becoming extinct.
- Maggie Kozel, M.D.: Modern Pediatrics Needs Health Care to Evolve (huffingtonpost.com)
- Why can’t the United States have a smarter health care system? (kevinmd.com)
- The culture of medicine needs to change (jflahiff.wordpress.com)
- Four Major Flaws in Our Healthcare System (triplepundit.com)
- CareSource Teams Up with the Ohio Chapter, American Academy of Pediatrics to Support Asthma Pilot Project (prweb.com)
by MARK RYAN, MD at KevinMD.com
Why do we need to occupy healthcare? Why are we here, on this website, calling for change? We are so often told that America has the best healthcare system in the world. If that were so, then there would be no need to change anything. We could continue running things as we currently are, and all would be well …
Except that we do not have the best healthcare system in the world. And we do need to change our current dysfunctional system.
When I make this statement, naysayers usually point out that America is the destination of choice for people all over the world who come here for care of their complicated medical problems. Advanced cancer, for example — the US is apparently the place to be if you need high tech, high-intensity care. Another argument is that patients come here to jump the line to get hip surgery or heart surgery that would require a much longer wait in their original country… although it is not often that this claim is supported with evidence that the procedure in question could not have waited.
So: I have staked a position, one that is contrary to the common wisdom. I have made the claim that American healthcare is not the best in the world. It is now necessary to defend this position:
- American healthcare is not #1 in the world. In this World Health Organization (WHO) analysis, the US ranks 37th. We place just behind Costa Rica. Other nations that outrank us: Dominica, Chile, Saudi Arabia, Cyprus, Greece, Colombia, and Morocco. Just below us: Slovenia, Cuba, Brunei, New Zealand. Essentially every developed nation in the Western Hemisphere performs better than we do.
- It’s worse than it looks. As this analysis shows, we are 39th in infant mortality, 43rd for adult female mortality, and 42nd for adult male mortality and some of the US’s quality measures have not increased as much as other nations’.
- We rank last among seven developed Western-style democracies in US healthcare performance (graphic here). We ranked 7th out of seven in efficiency, equity and “long, healthy, productive lives” 6th in quality care, and tied for 6th in access. This last category (access) is ironic, given that many of the arguments against reforming the US healthcare system focus on the potential loss of patients’ access to their physician; it appears this access is not as robust as we might believe.
- Our healthcare spending per capita is 50% greater than the next highest nation’s, and our healthcare spending in the US is increasing faster than most other nations’, and the % of national GDP spent on healthcare in the US is the highest in the world (reference here).
- According to this just-released report from the Commonwealth Fund, the US scored 64 out of 100 points and lagged behind other developed nations. You can see the short version of the report here.
- Americans pay top dollar for healthcare (elkrapidslive.com)
- Investing more in healthcare (medicine.com.my)
- Americans line up for free healthcare (rt.com)