Looking At The Numbers

 

If you want to get a good understanding for how well your state is doing in controlling Covid-19, check out the "How We Reopen Safely" website,  a collaboration that provides an easy to understand dashboard of performance criteria and data.  The site updates daily and uses the gating criteria provided by the White House, to track each state's progress towards its reduction in symptoms and cases, health system readiness, and increased testing.

With politicians and protesters screaming about liberty and haircuts, this site offers real time information about evaluating the risk of exposure as we try to figure out what activities we are willing to resume in our new normal.

Since I began following this site about a week ago, Washington State has moved from "trending poorly" to "making progress".  Our biggest deficiency is in the level of testing--we're pretty low at 19 percent.  On the other hand, the spread of the virus measured in the number of days for caseloads to double has increased from 60 to 244 days.  Continued progress is not guaranteed.  Data are updated daily and ratings may change.  When I first encountered the site two states were rated as "trending better" but by the next day had slipped back to "making progress".  I would not recommend making decisions based on a single day's numbers.

Also interesting is a study conducted by the Imperial College in London showing that Americans sharply reduced their movements after stay-at-home orders were broadly imposed in March. With restrictions now easing and mobility increasing with the approach of summer, the researchers developed an estimate of viral spread as of May 17.  The study shows that 26 states have kept the virus spread to a minimum and 24 have not.  The researchers  that "...the U.S. is not under control, as an entire country."  The Washington Post has a good summary article that's easier to follow than the research report, although you will need to dig into the report if you want to find data for a particular state.

Keeping in mind that the report is a one-time snapshot and is not peer-reviewed, I did dig into the report to see how Washington State looks.  I found that information In Figure 4 on page 8.  Washington's R number (the average   number of infections generated by each infected person in a vulnerable population) is below 1 which suggests that the epidemic is waning in the Evergreen State.  That result seems consistent with the "How We Reopen Safely" data.

Finally, I went to the Thurston County Health Department to look at local trend data.  Our caseload peaked in the least week of March/first week of April.  The highest weekly case count--36--occurred then and has declined since.  The lowest number for a complete week is 4 (last week) and the current week has no reported cases yet.  Again, the available data reflects a state that is slowly containing the virus.

Not that I plan to change my virus avoidance behaviors any time soon.  And I expect that some will be part of my new normal but the numbers give me confidence that what we''re doing here in Washington is on the right track

Missing the Bigger Picture

Saw some interesting observations about health insurance reform in the news this past weekend.  First off is James Davis:

James Davis, who runs communications for the Koch network, lamented that the conversation on health-care reform has focused too much on the number of people who have insurance — regardless of premiums or what kind of care those who have it will receive — and not enough on outcomes.

Hard to argue with looking at outcomes.  I spent my entire professional career evaluating the results of public programs and know that, in the end, public programs should produce the desired results.  I also know that identifying and measuring those results can be difficult, but health care has some definite outcomes for for society as a whole.  Mr. Davis is right to ask about results.  It would not take long for him to find that:

 The United States health care system is the most expensive in the world...[and]...underperforms relative to other countries on most dimensions of performance.

Mr. Davis did not say how he would define health outcomes but his statement suggests that he would encourage the Koch brothers to look for ways to promote improved performance at lower costs.  He may not need to do a great deal of research.

Perhaps a magic free market Koch brothers-approved system will change the trajectory of American heath outcomes but I doubt it.  So far, the most successful system the US has come with was the Republican-inspired Affordable Care Act and the Republicans HATED that.  It did reduce the number of uninsured but insurance does not guarantee actual health care.  On the other hand, the ACA did little to reduce costs.  It definitely needs work but I don't have much faith in the Koch's free market libertarian solutions. 

Also in the news is Pennsylvania Senator Patrick Toomey defending a change in the funding formula that will index Medicaid payments to the states to changes in the overall consumer price index rather the typically higher medical price index:

"The idea that there’s a sector of our economy that has to permanently have a higher inflation rate than the rest of our economy is ridiculous,” Toomey said Thursday. “I think that it’s absolutely essential to putting [Medicaid] on a sustainable path so that it will be there for future generations.”

Senator Toomey said the change was needed to “transition to a normal inflation rate” for a program in which he said costs were spiraling out of control.  Here, too, I can't argue with his underlying premise.  Program costs should not spiral out of control.  But he would simply refuse to address the causes of those spiraling costs.  Instead, he would fund Medicaid only to certain point regardless on the impact it will have on access to medical insurance (which may not guarantee health care but is a sine qua non for any hope of obtaining medical treatment).  When the funding runs out so will insurance coverage for many.

What neither of these men seem to wonder is why American health care costs are spiraling out of control even as the country spends far more per capita than any other nation.  This is a complex question that deserves considerable debate and discussion.  It is not a question that can be crammed into partisan legislation and voted on the quick-time.  Of course, in today's Congress, partisan legislation enacted in haste is exactly what we will get.

WASF.

A Battle Won. More to Come.

Donald Trump claims that the Democrats "own" healthcare now that the Republican has failed.  But like many of Donald's opinions, this is one is also wrong.  True that the Democrats are the architects of the system now in place but much of that system lies within his authority as president.  Obama handed him the keys on January 20.  His failure to craft a replacement means that he's in charge of administering the Affordable Care Act along with his minion, Health & Human Services Secretary Tom Price.

Donald Trump and the Republicans also claim that the Affordable Care Act will collapse of its own weight, that it's going into a death spiral, which like much information from Trump and the Republicans is not true. But Trump and his minions are positioned to monkeywrench the machinery.   We saw this when he canceled outreach efforts during the most recent enrollment period and his directive that IRS no longer enforce the individual mandate.  Plenty of opportunities exist for Trump to push the system into collapse.

If we let him.

The failure of Republican Repeal and Replace is a greater victory than I would have ever expected.  It came about because Paul Ryan offered a completely unacceptable alternative and people mobilized against it.  Now that we know the Affordable Care Act will continue in force for at least the forseeable future, we need to pay close attention to the administrative process to keep Trump's ideological minions from creating the death spiral they fervently wish upon the American people.

That goes for everything else, too.  Trump has seeded the federal government with ideologues who want to lead their agencies into the dustbin of history.  Scott Pruitt at EPA and Betsy DeVos at Education come to mind most readily but they are hardly alone.  They all will have plenty of opportunities for destructive mischief.  Legislative battles are dramatic but the administrative process carries great weight as well and is easily overlooked.  We can't afford not to pay attention.

Caveats aside, the defeat of  Repeal and Replace is worth celebrating.  For the moment, at least, one dreadful change is dead and the ideologues' plans are disrupted.  The trillion-dollar tax cut for the rich at the expense of health insurance for millions won't happen. 

Almost Fall Velo News

The big velo news is that I turned 9000 miles on my bike computer during last week's ride, ending at a nice, symmetrical 9009 before going in for hip replacement surgery two days ago.  Nine thousand was a nice milestone before what I hope won't be much beyond four weeks.  Even with the break, I don't expect to have much difficulty reaching my annual goal of 1040 miles per year.  Since I've not been able to hike due to the painful hip, I managed to get in plenty of mileage before the surgery.  Seems as long as I didn't have to carry my weight, I could ride with with a tolerable level of pain.  That, plus the incredibly dry, sunny weather we've had in Olympia this summer made for plenty of of opportunities to get out.

Summer is the only time of the year I get to ride in the early morning these days.  Early morning rides have always been a favorite.  When I rode in Phoenix they (often before sunup) were almost a requirement during much of the year.  I came to very much like having the streets to myself.  Here in Olympia, early morning rides mean near freezing temperatures and often wet so I don't get the chance very often.  So this summer's been a real treat.  Mornings on even the hottest days (high 80's to mid-90's) here are delightfully cool.  At their coolest, summer morning temps are still warmer than afternoons during other seasons.  Today and tomorrow look like the last of the warm summer days for 2014.  By the time I am riding again we should be heading for the Big Dark and the rain that comes with it.

The surgery went well and I have been feeling pretty good, all things considered.  I was in the hospital one nigh after the surgery and came home yesterday.  The three day pain block the surgeon used on the incision has worked well so far but I am definitely sore and moving slowly.  The pain block wears off tomorrow so the next few days may be a challenge but my surgeon prescribed both strong and less strong painkillers and I also learned some pain reduction and relaxation techniques from a hypnotherapist.  I think I'm good to go.

My 2 Cents on the VA

In the late 70's the Richmond Mercury ran a story about dire conditions at the local VA hospital.  The story described neglect and poor care.  I recall something about having to bribe orderlies to change bedpans.  Safe in my employer-based health plan then, I hoped I would never be so destitute that I would have to rely on VA for health care.

 
Twenty years later the VA  was running a much-improved health system that served me well beginning in 2003.  Imagine that.  Scheduling appointments can be challenging at times but for the most part, I'm satisfied with the care I receive from VA.  But then, I'm reasonably healthy and my health care needs have been minimal.   I have employer-based health coverage these days and see a private doctor for my routine health care but I also see a VA primary care physician once a year to keep current.  A friend who is a member of my VA doc's Quaker community tells me that my doc says his supervisor complains about him taking too much time with patients.  VA care can be a backstop but I hope never to need it again.

Working with veterans at Coffee Strong tells me that the VA experience is different if you need intense or extended service, especially for mental health problems.  I hear stories from stressed-out vets of long waits for and between appointments.  When they finally get an appointment the result is often drugs (usually added to what they are taking already).

I bring all this up as some context to the current VA scandal.  The VA has been a troubled organization in past decades as well as the most recent.  The current scandal is not exactly brand new; previous investigations raised red flags.  If Shinseki never saw them, he is clearly out of the loop, relying on senior administrators unwilling or afraid to speak truth.  If he did see the reports, he didn't take effective action or relied too heavily on subordinates whose concerns were more about themselves than the veterans they supposedly served.

The system is broken--at least for those who need it most--and it's nothing new.  Any student of organizational behavior and VA history can easily learn about the department's dysfunctional culture.  Apparently General Shinsheki missed that lesson along with the various warnings about problems.  As much as I admire him for his willingness to speak truth to CheneyBush about the number of troops needed to stabilize Iraq and his genuine compassion, I think he's unlikely to ever again have much credibility as VA secretary.
 

Will Capitalism Pervert Everything?

The Washington Post has a good article on profit-making in the hospice industry.  Apparently profits are good, largely at the expense of the public. 

My only experience with hospice was during my friend Mel's last days last June.  I was most impressed with the care provided for Mel and assistance to his family.  All in all, very good.  The hospice worker(s?) was a volunteer but was part of an organization (a friend also volunteered there) that scheduled visits, provided medical equipment and probably other services.   If I thought about the larger organization, I assumed it was non-profit.  This morning, following the link from the provider located at the address where I returned a stray part from the oxygen system, I found the home page of the LHC Group.  It does not look particularly non-profit. 

Profit status notwithstanding, the hospice care I witnessed during Mel's passing was everything I could wish for myself or anyone.  I wasn't in on all the details of the family's experience with the hospice but I have no complaint about anything I saw.  I also recognize that those services come at a cost.  Money will be involved. 

So it should not come as a surprise to learn that hospice care is big business.  More surprising, though,  to find that Mel is among the least welcome patients.  He died within a week; short durations are not at all profitable.  Reading the Post article, I find that idea of hospice care has  been turned on its head to create profits for investors at public expense.  The "recruiting" practices of the various companies bothered me.  I would think that the need for hospice care would be initiated by the individual or family, not in response to a sales pitch.  But that's all part of the for-profit business plan:  expand, grow and produce profits.

Maybe this system works--Mel was well-cared for--but I'm skeptical.  Our profit-driven health care system produces poor results at high cost so extending that model further is not wise.  In the short term, think of the additional care that could be purchased with what Medicare now pays for corporate profit.



    

For the Commonweal

Looking at this chart of "winners and losers" from the Affordable Care Act, I see that a few "lose" while many gain.  As a society, we are healthier.  Even the whiners end up with markedly improved coverage.  Yes, it may be a hassle but in the end more Americans will have health insurance.  We're better off for it.

And by the way, all you anti-Obamacare kamikazes out there, remember that this whole jury rigged scheme was a Republican idea to begin with.  Medicare For All would have been much, much simpler.

Health Care Clusterfuck

Even American doctors think the system is dysfunctional.

Rejectionists

My first reaction to news that some Republican governors would decline to participate in the Medicaid expansion provisions of the Affordable Care Act was that that the motherfuckers were just trying sabotage what they couldn't kill in Congress or the courts.  Jeezuz guys, this is a national program and you are (supposedly) a responsible public official, so do your fucking job and make it work!  Without state participation in Medicaid expansion, many of the 30 million Americans newly insured by the ACA actually will not be insured.  Last week's Supreme Court decision gave states the right to refuse the deal and it looks like Republicans will use that option.

On second, somewhat more sober thought, maybe the Republican governors are just continuing the debate about health care and how to finance it.  If the Republican governors succeed in denying health care to enough people, the ACA will have failed and we will just have to come up with something that does work.

I doubt if those rejectionist Republican governors wanted to restart the health care debate.  I think they are trying to kill what, for all of its flaws, is a public response to a critical public problem.  But all they can kill or sabotage is this particular scheme.  The need will still be there.

So will the Public Option.

And They Call it Job-Killing

Health-care law could give rise to entrepreneurs.

The Supposedly Democratic Process

Reading about the legislative machinations necessary to move the health care finance bill through congress on a simple majority vote, I'm disappointed to think that a Democratic congress and president cannot get even a simple majority for any sort of public option.

Most Americans support a public option.

The public option has worked remarkably well for seniors covered by Medicare.

A public option is one of a number of effective policies for achieving universal health coverage at reasonable cost in other industrialized nations.

And an overwhelmingly Democratic congress cannot muster a majority for a stripped-down version of one of its most longstanding goals?

Pretty. Damn. Poor.

Velo Drumming Health Care Solstice News

The previous rant began on a Saturday morning. By the time it posted on Sunday evening, much of the ennui that comes from paying too much attention to public affairs had been dissolved by some pleasant personal moments. Saturday afternoon I submitted a three minute video to complete a digital field and editing course at Thurston County TV. Even better, the sun came out for a few hours around mid-day on Sunday--enough to ride 14 miles--before the steady rain returned later in the afternoon. By that time, Maggie and I had joined drummers making a powerful noise in the capitol rotunda. All that took some of the edge off any residual bile I felt about the health care finance bill.

Make no mistake, the senate bill is not an effective reform by any means. I guess I'm happy that it might do something but skeptical its prospects. I'm definitely not happy that the changes are so weak, meager and ineffective, nor am I happy about the fact that this legislation is about the best that can be expected from the American political system. I little noted the goings-on this week but will, no doubt, long remember them.

More fun was watching Andre Nkouaga, a musician from the Ivory Coast, shoot a video at the Washington Center for the Performing Arts. Maggie had been helping out so we ended up backstage and in the audience during the last hours of two days rehearsing and filming. Lots of activity and lots of technology was on hand, everywhere--all the bits and pieces that will edit seamlessly into a performance video. I know this because I am a newly certified field and digital editor.

Next day is Christmas Eve and the town is winding down for Christmas. The office closes at noon on what turns out to be a beautiful sunny day. After sunset Maggie and I walk through the neighborhood to check out the neighbor's decorations and lights. The first quarter moon is high in the southern sky. Jupiter is in western sky. The evening is cold. It's good to return to the warmth of home and hot chocolate.

Christmas morning, Maggie and I hike the loop trail in nearby Watershed Park for the first time. The low winter sun pours abundant light into this wooded area. Along the way we hear all sorts of calls and chirps. We see hear and then see a pileated woodpecker working its way up a dead tree, making distinct thumps with each peck. Farther up the trunk, it plunges its entire head into larger openings.

The park is a gem, a gift of nature on this Winter Solstice.

The sun is well over the horizon now (9:00 am) on this day after Christmas. I was up for the last few hours of the long darkness, early enough to see Mars and Saturn in the clear winter sky. The bright, sunny day looks perfect for a bike ride.

Health care finance can wait.

Sausage & Policy

As part of a busy week, I spent time last week pissed off with the perverted health care finance bill as it has come to be during Senate deliberations. The bill is egregiously bad—it provides a guaranteed income base for an already rich industry with few guarantees that the for-profit insurers will actually fulfill the promises of the bill. It may expand insurance to 30 million uninsured. It may end discrimination via pre-existing condition rest. Much of it will not come into effect until 2014. For THIS I compromised? What a fucking fool I am.

Yep, I didn’t insist on a single payer, unified system that would eliminate all this bullshit. I was responsible, not an ideologue. And look what I got—another jury-rigged system that does nothing to simplify health care and will in many respects entrench the flaws of the current system.

THEY, on the other hand, didn’t compromise. They being all he self-interested parties who did a masterful job of confusing, bamboozling and frightening most Americans. Opportunists plateau-bargained, upping their demands and conditions with each concession made in their direction. They just drew their lines, shouted long and loud, flooded congress with lobbyists, spouted misinformation and delayed, delayed, delayed. In the end, they forced congress and the president to accept more of the same with some regulation (which can be further thwarted in design and implementation) and government subsidies that will further enrich the insurance industry at the public’s expense.

During all this, I called my senators and congressman asking for more unified and rational health care finance. I signed petitions. I did all that shit. And supposedly millions of others did the same. But it makes no difference. We still end up paying for profit. Our nation, our economy and individuals also pay in the form of lost opportunity due to ill health. None of that will change under this bill. It’s still the same fucking story.

Paul Krugman says we should support passage to get what accomplishment we can out of all this effort. So does Ted Kennedy’s widow. Something’s better than nothing, right? After being ass-fucked by Republicans and their health and insurance industry allies, I could find some satisfaction in shoving this goddamned bill down their throat. Even better, doing it on Christmas Eve.

But that still leaves this nation with another lost opportunity in designing a health care system that is rational, fair, effective and affordable. Krugman and Kennedy argue that this year’s legislation is one step. That’s true, as far as it goes. But the last step was taken in 1965 when Medicare was created and that was really the first step in a journey that began in the late 1940’s. In the meantime, every other major industrialized nation in the world has made that journey ahead of America.

Of course, what I think and want is of no consequence to anyone other than me. It sure hasn’t affected the direction of health care financing in this nation.

Health Finance Ho-Hum

Today's Senate vote on the health finance bill leaves me completely ambivalent about the outcome. The massive lobbying, wholesale misinformation and political expediency have combined to produce legislation that that falls far short of universal access and meaningful cost control. The rough beast now slouching toward passage does nothing to reduce the overhead costs—profit and administration—of health care in the US. It adds complexity and perverse incentives to a system that already has plenty of both. The likely results offer little reason for enthusiasm.

What hope I do retain is that maybe this year’s legislation will be a step toward a better system. TR Reid, in Healing America, builds his model of the “best health care system in the world” on a unified system that leverages collective purchasing power bargaining. Something along those lines would be a considerable improvement over what is likely to emerge from Congress this year.

But that’s in the future. Maybe. For now all we have are HR 3962 and the blended Senate bill. Weak as these may be, they still face further compromise so that that final result may not differ greatly from the system that it will supposedly improve. It will certainly be no simpler, nor is it likely to relieve most Americans of the prospect of choosing between medical care and bankruptcy. Its lack of universal coverage leaves the costs of uncompensated care unresolved. This year’s effort leaves much to be desired.

Forty-plus years ago, Medicare was hailed as a first step toward universal care. Few would have predicted then that, well into the next century, America would have the most expensive and least effective health care model among developed nations. Yet, here we are, still waiting to take that next step, even with four decades’ experience with a single payer system that works. The performance of my congress and president do not give me much confidence that our political system can enact any truly effective reform that the moneyed classes do not like.

This is hardly a surprising conclusion. It’s not like this hasn’t happened before (health care ’93) or in other issues (perpetual war). Lack of surprise notwithstanding, I’m still disappointed. Maybe it’s because this kind of systemic failure shows how far America has moved from the idea of “the general Welfare” so prominently written into the US Constitution.

Reason enough to be disappointed.

Two Writers

Throughout the health care finance debate, I've been impressed with Timothy Noah's articles. He covers both the economics of the issue and the political processes that decide policy. Today's column on the Congressional Budget Office evaluation of the House Democrats' health finance bill is about the best discussion yet. Noah clearly describes what "bending the cost curve"--that Holy Grail of this year's debate--means and what the CBO's numbers mean in that context.

Noah makes, as did the Association of Health Insurance Plans, an implicit case for a single, universal system, divorced from profit-seeking. That case is the profit-seekers' incentive to maximize profit and shed liabilities that reduce that profit. A public option that becomes the last resort for unprofitable, costly individuals may well cost a lot more than projected. Short of strictly limiting premiums and medical fees, for which the votes don't exist as Noah points out, the public option may be doomed even if it actually becomes law.

In contrast to Noah's commentary, which is the here and now of the current debate, , I am also reading T.R. Reid's The Healing of America. Reid is another writer who explains policy well. In this book Reid uses his injured shoulder as a template for exploring health care in other countries. I am only through France, Germany and Japan so far. One common thread is that these nations have essentially a single system for establishing medical fees and payments, a system that limits the income of health providers in those countries.

Reid's prologue tips his hand: he believes America can learn from the experiences of other nations. One of the ideas Reid describes is France's Le Carte Vitale. A plastic card with an embedded microchip, Le Carte Vitale, carries a person's complete medical history and serves as the basis for French medical billing and payment. Reid finds no record rooms and back office staff in the French medical clinics he visits. They are unnecessary. He notes that the French take a certain amount of pride in coming up with the Vital Card before America did.

Between Reid and Noah, I can safely predict that the health care finance bill that passes this year will not be the last. I can also hope that whatever jury-rigged, compromised and bartered system emerges from this year's debate will further demonstrate the inherent contradictions of a profit-driven health care finance. Maybe then we will seriously address the issue. The rest of the developed world has done so.

Why Not Simple?

From a discussion of "Cadillac health plans" likely to be taxed under one health financing bill:

But many not-so-fancy plans also qualify as "Cadillacs" under the finance committee's definition. That's because the term refers to total cost—not a particular set of benefits—and many factors—like the state you live in, the size of your company, and the makeup of that company's work force—can affect costs. Premiums tend to be significantly higher in Massachusetts than in Idaho, for example. (The employer/employee contribution also varies by state.) The smaller the business, the fewer employees who go into the pool, the less leverage the organization has to negotiate lower premiums. And if the workers have an average age of, say, 54, their premiums are going to be a lot higher than if the average is 25.

This is only one example of the mind-numbing complexity of the private insurance model for health care finance. Remember, the time and energy that goes into tracking and understanding the details is effort to not spent on health care.

A single payer system would not need to do this.

Think Occam's Razor.

Real Facts

Today's Washington Post has a good analysis by Ezra Klein of the full cost of health care for individuals and families. Not many journalists have explored the personal costs of health care in America in such detail. Most discussion of cost is that it is huge and bad. Lots of atmospherics and lofty phrases but light on the real information. Timothy Noah also writes informatively about heath care finance.

I'm with George

Like many Americans, I watched President Obama's speech Wednesday night. As always, I was impressed with his calm rationalism mixed with a stirring call to shape the future. Obama did an excellent job of selling a plan that is clearly within the realm of the Conventional Wisdom. What I would have preferred was leadership for real change.

That's why I am pleased to see George McGovern speaking out for Medicare for All in today's Washington Post. I'm pleased not because I want to see a government takeover of health care but because a single payer system is simple and it works. Look at the convoluted flow charts of the various plans now in play before Congress. They are complex, Rube Goldberg contrivances that leave me and most Americans bewildered. I did not like Bill and Hillary Clinton's proposal 16 years ago for the same reason. Obama's version is sounds little better. Simple works best but no one in Washington seems willing to understand this most basic principle.

From a practical point of view, I waffle back and forth between insisting on single payer and some compromise, which is what Obama's plan is. I don't know if it is better to move something this year or hold out for real change. I'm pretty sure the system will do the former but I am equally sure that the underlying problems will not go away and that the Obama will not be, despite his fervent wish, the last president to call for health care reform.

I hope I am wrong but I don't think another tinkering quick fix is the final answer. If we're lucky, the bill that passes Congress this year will offer a bridge to a better, more practical system. But as we've seen so far, significant change that would be to re-think the whole system from the ground up will require courage and leadership. That's hihgly unlikely in America these days, especially when government regulation or enterprise is a possible solution. The idea of effective government action in the interests of the broad community has been so demonized and dismissed in the past 30 yesrs that to even mention the idea is to be considered a "tax, spend and waste Liberal."

And that's why I am not disappointed in Obama; I didn't really expect him to bring that kind of change. I hoped he might. Certainly he is the first politician since Bill Clinton to offer me that hope. But like Clinton, Obama in office is part of the Prevailing Consensus. So far he has changed little and his health care plan looks very conventional. But maybe?

In the meantime, I'll stick with George. He was right in 1972. He is right again in 2009. I'm proud to say that I cast my fist ever presidential ballot for him.

postscript

Badtux the Snarky Penguin actually beat George into print (can I say that about a blog?)with this post about Medicare for All.

Holy Contradiction!

Roman Catholic bishops are weighing in on the health care finance debate. Not surprisingly they want proscriptions on abortion funding and protection for conscientious objection to abortion among medical proviers. Some are also warning against "socialization" and "monopolizing" and big government. They assert the Catholic social teaching of "subsidiarity" - essentially, that decisions are best made at the lowest level possible.

It's a most attractive idea--very American--but certainly ironic in a religion that boasts an authoritarian heirarchy and rule by decree of a supposedly infallible bishop selected from a small coterie.

Just sayin'

A Very Model Practice

Washington Post today has a story about Group Health Cooperative, the Washington State health care system that has served this area for the past 60 years. The cooperative, which is both insurer and provider, is often mentioned as an alternative to the public option in reforming health care finance. Group Health has a good reputation and the number of complaints is minuscule compared to other insurers. The description of care at Group Health reads much like the VA practice model:

Everything at Group Health's 26 clinics are integrated. So when a patient meets with their doctor, all their records with any other Group Health specialist is immediately available. Patients are encouraged to make appointments online, and e-mail or call their physicians with questions, keeping them from having to make frequent office visits for easily answered concerns. Group Health says that it saves more than $12 million a year by resolving routine patient questions through a 24-hour phone line that is staffed by nurses and doctors.

I don't know if the VA saves $12 million a year with its 24/7 phone line. I do know that I can speak with a nurse at any time if I have a concern.

What the Group Health and VA practice models tell me is that cost-effective health care is possible. What's best is that these models emphasize primary care, a service that is increasingly scarce in the contemporary fee-for-service model.

Neither may be a panacea but both are models should be strongly encouraged in the way we pay for health care.