Wednesday, August 31, 2005

I can't really say

Well, although I trumpeted a celebrated return, I'm sorry to say that it's going to take longer than I thought to regain full speed.

I just want to tell the few of you who read this humble corner of the virtual ether to keep checking back, cuz I'm not giving up. I've just gotten item after item of bad news this summer, and just when I thought that I was ready to get back in the blogging game, disaster struck again.

To be sure, I'm not a resident of Louisiana or Mississippi, and I can't compare my individual struggles with the catastrophic loss of life and property there.

I'm just a girl with a small public space. I want to keep these epiphanies going, but I'm afraid too many of them will depress you.

I'll leave you with this snippet:

I'm so passionate about health care in the US because I've been a patient way too often. And it looks like I'm in for another big round. Stay tuned.

p.s. I lasted 8 days on the the South Beach Diet before decided that I was still way too hungry and I must have carbs. My dinner tonight? Crackers, cheese, fruit and wine. Now that's what I call a diet!

Monday, August 22, 2005

That's your big federal bureaucracy, eh?

Excellent piece on the VA system from Wapo.

I've heard (and read) a fair amount about the great quality of the VA system, but this piece lays out key points quite effectively. What are said key points, you ask? Some pretty amazing statistics about the quality improvement of the VA system in 10 years, including:

• Since 1995 the number of patients has doubled to about 5.2 million. This is while over 12,000 staff were cut and the cost per patient was reduced by half.

• Amazing Health Information Technology (HIT) program with electronic patient records, including lab tests, prescriptions, and nifty scannable bracelets. (For anyone who takes more than two prescriptions, how great would it be to just be scanned rather than spell everything out every time you go! I'm psyched!)

• Performance typically better than the private sector -- check out these results "In 1990, before Baltimore began tracking its performance, rates of screening for breast and cervical cancer were 50 percent and 17 percent, respectively. In 2003, they were 88 percent and 87 percent." Let me tell you, 87% for cervical cancer is amazing by private practice standards.

And of course, the crowning glory on why we need single-payer care:
Medicare officials point out that the VA has the advantage of being an integrated delivery system -- that is, a health plan in which most of the doctors are salaried employees and all care is coordinated and tracked. In Medicare, physicians work for themselves and patients are free to pick and choose their services.

Exactly. Which is why Medicare (and Medicaid, for that matter) are sending the deficit sky-high, not to mention drowning in quality assurance and fee reimbursement quarrels.

So I guess my response to ginormous bureaucracy healthcare would have to be -- thank you government!

Have a nice life

So in my internship this summer, I basically sit around and come up with creative ways to describe low-income people without health insurance. Today's result:

"Socioeconomic and environmental health risks weigh heavier on the poor, often compounding their effects. Health access barriers of low-income, immigrant, homeless and underserved communities are most acutely evident in their poor health outcomes. Those with little education in American society are more likely to be poor, to labor in physically demanding or dangerous jobs and to live in sub-standard housing. These challenges are multiplied by limited resources, language and cultural differences and low literacy levels, particularly related to health care."

That's really just an extremely glossed-over way of saying, "Sorry, but your life sucks, and it's pretty much because you're an immigrant. But good luck to ya!"


Thursday, August 18, 2005

Here We Are

In a nationwide survey of more than 2,000 adults published last fall, 55 percent of those surveyed said they were dissatisfied with the quality of health care, up from 44 percent in 2000; and 40 percent said the quality of care had gotten worse in the last five years.
italics mine

This survey, by researchers at Harvard, the federal Agency for Healthcare Research and Quality and the Kaiser Family Foundation, illuminates the sorry state of the "best healthcare system in the world".

For the first time since the implementation of medicare, over half of Americans are dissatisfied with their health care. It's a seething indictment-- telling us what the average patient already knows -- health care is no good, and it's only getting worse.

The survey is couched in this New York Times piece on the emotional degradation of patients. I won't speak to that, because it's an enormous subject I have strong opinions on, and besides the point of this post. I suggest you read it, but it's not the topic here.

Instead I want to explore some points from Jill Quadagno's recent book, One Nation Uninsured, that give context to the attitudes expressed in this poll. How the hell, with this country's many incarnations of health care delivery, did we get to 55% unfavorable? What's made Americans swallow one substandard form of care after another?

Quadagno's book explores innumerable events that led us down this thorny path. I just want to focus on two decisions from 1942-43. These key shifts in health care law and delivery are inextricable from our current system.

The first major event came in the form of the Revenue Act of 1942, enacted during WWII as a means of keeping corporations from profiteering. Under the law, excess profits (defined as higher than before the war) were taxed at 80- 90% (!). However, health care was counted as a tax-deductible expense, and many employers started hiding profits in generous trust funds for fringe benefits.

So what, exactly, does that mean? Basically the government indirectly encouraged employers to offer health insurance and fringe benefits as a way of avoiding penalization for excess profit. After the war, many corporations had this infrastructure in place, and continued to offer healthcare, enjoying the tax-deductible benefits.

Quadagno’s next revelation jumps on the back of the 1942 decision. It’s the story of how the labor movement kept the U.S. from a national health insurance program by demanding employers provide health insurance. And its effects reach much further, directly creating the situation today, where 45 million people are uninsured. It’s also led to the unrest cited in the poll above, as employers shift insurmountable insurance risk and cost to their employees.
Quadagno on page 50:
The second important ruling was a 1943 decision by the National War Labor Board that employer contributions to employee benefit plans would not be counted as wages. The trade unions had been unable to demand higher wages because they were bound by their no-strike pledge. The board’s decision gave them the opportunity to negotiate health and pension benefits in their collective bargaining agreements as a substitute for wage increases.

This ruling granted unions a new and influential bargaining tool, one that was immediately utilized for their betterment. Over 50% of strikes in 1949 and 70% of strikes in 1950 were over benefits. The ruling also served as a powerful incentive for new members. Employees were much more likely to join unions if they could receive health insurance.

Employers, in turn, were willing to provide benefit packages instead of higher wages because they were tax exempt. And with these (and other) changes, the number of people with health insurance increased from 6 million to 75 million between 1940 and 1966.

So there you are, the two main reasons we have employer based health insurance. Any plan that calls for change must consider these incentives. If rearrangements occur, like removing the tax deductible status of health care (which would certainly fix that budget deficit), expect employer-linked health insurance to dissolve. On the other hand, don’t expect big business to jump on the national health insurance wagon. Any changes that lessen the employer’s burden in the meantime will destroy chances for a nationalized plan. We desperately need the aid of employers in the face of such bitter enemies as the AHA, AMA, and Pharma.

I'm back!

Please read that title with the appropriate James Brown impression in mind.

Well, after an over-extended absence (I haven't been so great about those vacations, huh?), I've returned to my humble iamstellaness abode. I feel amply prepared. And I know you all have been waiting at the edge of your keyboards for my return. If you're nice enough, I just might stay this time.

So a few things.

First, a wave of "must find new songs-- now!" has pulled me under, and I've gone i-tunes crazy tonight. I can't begin to express my contented joy sitting on my comfy bed, with my beautiful i-book, my super librarian glasses, and a great collection of stupendous emotion-provoking music pouring into my ears. Do you ever get those moments? Where you've found a beautiful new song, and you feel drunk? (Really? Or are you looking at me right now with that I-have-no-clue-what-you're-talking-about-it's-just-music face?)

So, said songs?

1. Glass, Concrete and Stone by David Byrne
(I had to include a lyric snippet)
"Everything's possible
when you're an animal
not inconceivable
How things can change, I know

So I'm puttin' on aftershave
nothin' is out of place
gonna be on my way
Try to pretend, it's not only

Glass and concrete and stone
That it's just a house, not a home.
And its glass and concrete and stone"

2. En Tus Pupilas -- Shakira (did any of you catch that girl crush article from the NYT last week? I have a serious case of that con Sra. Shakira)

3. Photobooth -- Death Cab for Cutie

4. One -- Cowboy Junkies (I'm also perpetually in love with Sweet Jane)

5. We both go down together -- The Decembrists

6. Zebra- John Butler Trio

In light of the list, it's important you don't get a false impression. I am not an audiophile. By any means. My favorites bands have pretty much been the same for 8 years (which I imagine reflects badly on me). Audiophiles irritate me. Your music is not better than my music! I love my music just fine thankyouverymuch. I just want to share some flashes of inspiration in case anyone was interested. That's all.

Second, and now I know you are getting the wrong impression of me -- I'm starting the South Beach Diet tomorrow.

Okay, before you go all postal, I have real bonafide reasons for doing this besides any coincidental cosmetic benefits.

Oh man, I almost convinced myself there!

Actually I'm not lying. In the past year I've been unbelievably hungry. I eat a completely normal amount of food for someone my size and I'm always starving within 45 minutes. It's honestly like I didn't even eat. This is also an incredibly annoying problem because my appetite is pretty much insatiable. I don't eat ginormous meals every 45 minutes (although I would like to!) so I just end up spending a majority of the day starving.

So, Kate, exactly what does this have to do with the South Beach Diet?

Well, dear reader, I'm so glad you asked! Apparently what happens to me is a consequence of eating too many foods with high glycemic indexes (I love me my carbs)! These pesky high glycemic index foods are creating all these drops in my insulin levels! If I stop eating ALL carbs for 2 weeks -- yes 14 days-- then eat a lot more whole wheat products, I won't be so hungry!

Hey, it's worth a try. And I'll keep you all posted throughout my torture experiment. I hope it works, otherwise I'm off to the endocrinologist. I'd prefer to try changing my eating before I going on any meds.

So, enough about me, how are you?