The results of the governor’s and selected legislators’ emphatic effort to “reform” the health care system, ABX11, was defeated in committee, thanks to those with the intelligence and good sense to see the error in this measure. Once again, the insurance industry’s attempts to control the direction of this very important issue have been thwarted.

Arnold obviously has no awareness of the the issue himself, but he should at least seek the wisdom of those who do. Simply review the program and the math: SB840 would provide universal, affordable, choose your own doctor, comprehensive coverage to all Californians and save us $320 billion over ten years in the process.

Seldom, if ever, have we experienced individuals in the upper management levels of the health insurance/managed healthcare industry who speak out with the voice of reason, common sense and intelligence on the subject of “healthcare” vs. health “insurance.” Thus it was with extreme surprise and appreciation that I listened to the comments on this subject recently from Georganne Chapin, JD, MPhil, CEO of Hudson Health Plan in New York. The webcast is available at: http://www.medscape.com/viewarticle/559758?src=mp.

The text of her comments follows:
I am a health insurance and managed care executive so you may find this editorial a bit strange. I believe that the way to fix our healthcare system is to stop relying on insurance and focus instead on healthcare.
So, what’s wrong with health insurance?
Well, first, it’s temporary. This may work for auto policies, but not for human health.
Second, health insurance is mostly contingent on where you live and whom you work for. It’s easy to transfer car insurance, but not health insurance.
Finally, insurance companies make more money by minimizing pay-outs than by keeping people healthy. Human beings — who need preventive care, who have babies, who may lack living wages and job security, and who get older–find the house rules stacked against them.
Plans in Massachusetts,[1] California,[2] and soon New York[3] propose to strew the same old red tape over even more people. Members of the same family could end up with separate policies, with different benefits and different expiration dates. This will make it even harder for doctors and hospitals to figure out whom to bill, which services are covered, and – worst of all – whether coverage will last long enough to complete treatment for a sick patient.
Other developed nations have universal healthcare, not “insurance.” They give healthcare to everybody, they spend less, and they are healthier for it.[4]
But, we have an example of success in this country, too. It’s called Medicare. And while flawed, Medicare meets the most important criteria for a universal healthcare system: it’s permanent, it’s portable, and it’s simple and inexpensive to administer.
The health insurance model is flawed because it depends on people falling between the cracks after they pay their premiums and before they collect their “benefits.” Rather than insurance, providing healthcare to everyone would cost less and deliver more in the long run.
That’s my opinion. I’m Georganne Chapin, President and CEO, Hudson Health Plan.

References
1. Fahrenthold DA. Mass. bill requires health coverage. Washington Post. April 5, 2006;A01
2. Steinhauer J. California plan for health care would cover all. New York Times. January 9, 2007;A1
3. Holahan D, Hubert E, Schoen C. A Blueprint for Universal Health Insurance Coverage in New York. New York: United Hospital Fund and the Commonwealth Fund; December 19, 2006
4. Davis K, Schoen C, Schoenbaum SC, et al. Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care. New York: Commonwealth Fund; May 2007: pub. no. 1027

Michael Moore has taken a lot of heat and praise for his documentary works.  This one will be no different.  But in SICKO, Mr. Moore has taken the message up a notch.  No longer is a political party, specific politician or business leader a major focus.  Now the finger of reproach is pointed at all of us – us Americans, that is.  Because for seemingly practical and innocuous reasons, we have let the delivery of health care in our country become yet another vehicle of greed, inefficiency and basic lack of common sense.

 
I daresay that the average American on the street cannot even begin to fathom the depths to which our “non-system” of health care has reached.  And that same American is brainwashed into believing that any approach as rational, economically sane and compassionate as a single payer, universal health care system is ultimately “bad medicine” if not an outright communist plot.  (Communist plots are rare these days, so I thought I would start the trend again.)

 
To what high level must our national cost of medical care and low level of effectiveness attain before we finally will say, “Stop – there must be a better way!”

 
I don’t know the answer.  I’ve supported positive measures, primarily the legislation developed by Sen. Sheila Kuehl in California, SB 840 (see post below); but our notable governor, for reasons only he can know, vetoed the measure when it passed in the state legislature last year and will, no doubt, do so again this year.  Placing the issue before the California voters would only mean more wasted dollars – in the multi-millions – that would be spent by the “health plan”/insurance industry to preserve their grip on the veritable gold mine they continue to run.

 
One can only hope that enough intelligent people will see SICKO and take the action necessary to educate our leaders and citizenry in general and get us into the modern world of organized health care delivery for all – a right, not a privilege of working status.

Health care will be in the news this year, specifically how to provide health care access to the millions of Americans who currently don’t have insurance or who are underinsured, such as through the “discounted” benefit plans or through Health Service Accounts (HSAs).  The latter have become popular with employer groups who are trying to reduce their health benefit costs by placing the onus of the responsibility on their employees.  This is somewhat the form that existed before there were insurance companies and the associated insurance “premiums.”  People paid for necessary services out-of-pocket and, if necessary, made payment arrangements with the providers for services that were not immediately affordable. 

Somewhere in the process there were times when grateful patients paid for services in goods they themselves had grown or produced.  These times will never return, of course.  We truly need to develop a rational approach that will provide universal access to services with a means of payment within reach of all people and reimbursement acceptable to all types of health care providers.

In California, this year will see at least four ideas proposed in the legislature, including one from Governor Schwarzenegger; but the only truly feasible one is still SB 840 offered by Sen. Sheila Kuehl (see item below).  The other proposals are piecemeal, more costly and less efficient than necessary and simply “band-aids.”

But I want to propose another form of responsibility for health care that is seldom discussed.  It is obviously not a popular idea or it would be accepted widely, which it isn’t, for reasons that social scientists perhaps would have some explanation – we simply do not want to take responsibility for our own health, by which I mean taking those steps that would obviate the need for extensive insurance coverage at all.

We have become too reliant on the medical-pharmaceutical complex to take care of our medical needs.  When asking a group of people whether they have a “health plan,” many will readily state that they do and will specify that they have Blue Cross, Aetna, Health Net, etc. or a third party administrative arrangement through an employer or union.

What I mean by a “health plan” is simply a personal plan for getting and staying healthy.  There are hundreds of books published on the subject as well as a myriad of infomercials touting products to prevent disease and health food stores with aisles of products and information.   The only difficult part is to simplify it all so that it doesn’t seem like such a monumental task to maintain health and so that we don’t spend excessive amounts on things that simply aren’t what they claim to be.

After nearly 40 years of study and investigation into the subject of health and wellness, I’ve narrowed the process down into some simple steps, most of which require no additional spending.  The following mnemonic will help remember the elements of the plan:

W – Water, an essential element.  Our body’s cells are mostly water and remaining properly hydrated is key to health.  Most water in the US is acceptable, some is better than others as measured by impurities and Ph level (optimal is 7.0-7.2 range).  Much of the bottled water is no better than what comes from the tap.  Water is a basic part of nutrition in general, which is probably the toughest element to address.  We like to eat and we like “tasty” foods, which generally means fatty foods.  I have investigated and tried a variety of approaches to a health diet and have ended up taking the best information and applying it the best I can to daily practices.  For a period of about 5 years I was religiously vegan and other than an initial drastic weight loss, I didn’t realize much difference in overall health.  In fact, my cholesterol level, which was one of my primary reasons for doing this, didn’t drop at all.

E – Exercise. Another tough one.  It is scientifically proven that with proper nutrition and exercise, we will maintain appropriate weight and overall health.  Again, I’ve tried numerous programs and equipment, which usually ends up in one of our garage sales.  It’s obvious just by looking at the general population that regular exercise is not a priority for most people. Proper exercise will help with rest or relaxation.  Our world is moving very fast and we are expected to keep up with it.  Well, what would happen if we didn’t.  Sleeping is the only time that our bodies can regenerate and you can’t “catch up on it.”  Lost sleep is lost. 

L – Laughter.  We take life much too seriously.  “Laughter is the best medicine” has been addressed in many ways and I personally find it so.  If necessary, I’ll pull out a funny video to watch and just laugh out loud.  It puts everything into perspective.

L – Love.  This is very simple.  Unfortunately, love is misunderstood and, in fact, can be taken to mean something that is detrimental.  The closest true meaning of “love” is forgiveness. 

It’s everyone’s responsibility to learn the path and the answers for themselves. Finding the personal motivation is key. I have no fear of death; but I don’t want to be in pain, in a nursing home or be taken care of by a family member or friend. That’s what keeps me “on the plan.”

Again, it is just information and each person is responsible for exploring for themselves and implementing what works for them. Our health is our responsibility. Just remember the fourth of the Four Agreements, always do your best.

This is an extremely brief summary.  Each element can be expanded upon and discussed, which my wife and I do occasionally in individual or group sessions. Anyone interested in this can do so in a response to this web log item.

Thank you.

For the sake of simplicity, I’m going to submit two email excerpts relating to the subject of SB 840, the California Health Insurance Reliability Act (CHIRA).  The first one (CHIRA – Part I) is below. The second one (CHIRA – Part II) references my response to a letter from State Senator Jeff Denham, which indicates that State legislative leaders (or their staff) are not necessarily aware of pertinent information, and certainly the general population could be even less well informed if they do not take the effort to investigate the issue fully.
 
My original letter to the editor was at the request and approval of George Lundberg, M.D., Editor-in-Chief of MedGenMed (Medscape LLC) and Adjunct Professor of Health Policy, Harvard School of Public Health, Boston, MA.
 
*******
 
Dr. Lundberg:
Regarding the judging of proposals for true health system reform based on your 11 evaluation characteristics, (“American Health “System” Reform – Part 6” )^[1] , a model proposed for California should be put to the test of those elements. 
 
Senator Sheila Kuehl, Dem-Santa Monica, has authored SB 840, the California Health Insurance Reliability Act (CHIRA)^[2].  This measure deserves to be reviewed and discussed beyond the State’s borders as its success in the world’s sixth largest economy would signal a shift in healthcare delivery systems toward fiscally sound, comprehensive, affordable and consistent health insurance coverage. 
 
So, based on my attempt at applying your evaluation elements, let’s see how this program might measure up compared to your grade of the 2005 American system of 52 and my grade of the current American system.
 
1. Access for all to basic care:  CHIRA eligibility is based on residency, not on employment, income or insurability.  All residents will have coverage of all care prescribed by a patient’s health care provider that meets accepted standards of care and practice.           
CHIRA Score:            9                      Current system score:            5
 
2. Produce real cost control: The plan not only involves no new spending on health care, this measure will make the health care system more reliable and secure by stabilizing the growth in health spending; linking spending increases to the state GDP, population growth, employment rates and other relevant demographic indicators.           Administrative costs will be capped by statute.
CHIRA Score:            9                      Current system score:            5
 
3. Promote continuing quality: “Quality” is an elusive characteristic.  Current systems attempt to fill the quality measure gap, but I believe that the best measure of quality is when consumers vote with their feet, given the opportunity to do so.  In CHIRA, providers will be free to apply their medical training and skills and patients can choose their providers based on their perception of those providers’ quality of care.  Also, the plan will invest in statewide medical databases to assist in improving health care quality and in creating programs to encourage personal responsibility for good health.  However, even a program like CHIRA can’t effect this change completely on its own. Consumers still must choose healthy lifestyles, including educating themselves and adopting appropriate nutrition and exercise programs.
CHIRA Score:            6                      Current system score:            4
 
4. Reduce administrative hassle and cost: Providers and consumers will not have to deal with the maze of confusing health care delivery system bureaucracies. The estimate of the current system is that half of every dollar spent on health care is squandered on clinical and administrative waste, insurance company profits and overpriced pharmaceuticals. The CHIRA model is based on independent studies showing estimated savings of about $20 billion through reduced administrative costs in the first year alone.  Analyses also show estimates through system wide bulk purchasing of $5.2 billion in the first year.    

CHIRA Score:            9                      Current system score:            4
 
5. Enhance disease prevention: The plan will combine needed cost controls with medical standards that use the best available medical science and place an emphasis on preventative and primary care to improve California’s overall health in a way that also saves billions of dollars. CHIRA gets an A for Effort, but; again, an educated, motivated and involved consumer is essential to disease prevention.
CHIRA Score:            7                      Current system score:            4
 
 
6. Encourage primary care: With some limited exceptions, consumers will be required to select a personal primary care physician.    Access to primary care providers could save $3.5 – $6 billion in unnecessary emergency room visits and preventable hospitalizations.
CHIRA Score:            9                      Current system score:            4
 
7. Consider long term care: Considerable expert analysis on Long Term Care is included in the development of the plan.  Beyond the 100 days of skilled nursing facility care post hospitalization, it is not a part in the initial benefits; but it is planned for subsequent inclusion with further review and incorporation of appropriate guidelines.        
CHIRA Score:            2                      Current system score:            1
 
8. Retain patient autonomy: All licensed providers and accredited facilities may participate.  Every Californian will have the right to choose his or her own personal primary care physician.  Some limited continuing service arrangements will be allowed for patients under specialist care initially, but generally a referral for specialist visits will be required from a consumer’s primary care physician or emergency physician.
CHIRA Score:            7                      Current system score:            5
 
9. Retain physician autonomy: Physician freedom from the profit-driven motives of most managed care plans is a major feature of the plan.  It will put medical decision-making back in the hands of medical professionals and their patients. Overall governance will be from an elected Commissioner and the State Health Agency which, while having physician and other health care provider representation, will have boards that include others, such as members of the public, consumer advocates, policy experts, and labor leadership.
CHIRA Score:            8                      Current system score:            6
 
10. Limit professional liability: The information system enhancements, inherent controls and quality improvement measures of the plan will present a foundation for malpractice premium stabilization and reduction.  Any specific malpractice reform would be a separate issue.
CHIRA Score:            6                      Current system score:            4
 
11. Possess staying power: A plan such as CHIRA has the balance of incentives and controls necessary to maintain the stability and assurance of consistent health insurance delivery over long periods of time with fluctuating personal, societal and economic conditions.  It has the mechanisms to account for the inevitable changes that will arise in health care delivery operations and technology.
CHIRA Score:            9                      Current system score:            6
 
Totals:
CHIRA Points:             81                     Current system points:            48
 
Well, as you say, no reformed health care system can be perfect nor satisfy all the constituencies.  But CHIRA could be on the right track as a model plan for assuring and stabilizing health insurance coverage for a large and diverse population base.
 
Thank you,

Joe Polaschek

References

1.   Lundberg GD. The American Healthcare “System” in 2005 – Part 6; How to Grade the Current System and Proposed Reforms. Medscape General Medicine. Posted 3/11/2005.  Available at:
http://www.medscape.com/viewarticle/500423?src=search
 
 
2.   http://info.sen.ca.gov/pub/bill/sen/sb_0801-0850/sb_840_bill_20050222_introduced.pdf  (Link to the full text of SB 840, the California Health Insurance Reliability Act)