Archive for the ‘health systems’ Tag

Make like Apple: Think Different

About half way through my term of service with AmeriCorps, I have written lesson plans for our new college counseling curriculum and I am building our volunteer managment program from the ground up. I can imagine these activities are similar  to the process needed to write a communication plan for a health behavior intervention and then work to train the community health workers that would education the community about that health intervention, but I can not be sure. I have amazed myself with how much my thought process has changed in such a short period of time. My first concern has become what is probable rather than what is possible for organizational sustainability. Where I used to focus on only the program I worked on, I now have to make tough decisions about our limitations.

I know that professional and personal development has improved as a result of my daring to think differently about my potential and my role in a nonprofit.

GlaxoSmithKline is daring to think different(ly)  as well by expanding access to medicines for neglected diseases in some of the least developed countries. The corporation also plans to open access to their medical technologies in development to other sciences to expand research on treatments for neglected diseases. Whether out of a moral obligation or the pursuit of a financial opportunity, this unprecedented level of access has the potential to help countless numbers of patients. Furthermore, this is the first time that I have heard of a private sector company acting on the reality that universal access to treatment while necessary is not sufficient for eradication of certain diseases.

There needs to be a simultaneous focus on expanding access and improving health systems to build capacity for increased usage. Even then, it is unlikely actions GSK takes now will become the only road for eradication of diseases. As a corporate social responsibility venture, GSK may reap the benefit of positive public relations and somewhat increased profits from the now possible sales. However, it is difficult to tell how many countries will be able to afford medicines even at these discounted profits. The real benefit for developing countries lies in the potential for increased research for neglected diseases that affect developing countries most. OneWorld Health is the only major nonprofit pharmaceutical company that focuses on research and development of treatments for neglected diseases; having a major Big Pharma company devote more time and resources might be enough to tip the balance for some substantive development.


Universal Health Care Series: The Inevitability Argument

This post is Part V in a series exploring reasons to support universal health care.

It would be nice if we could wave a bureaucratic magic wand to make problems go away. It would be even nicer if the antidote to the health care crisis was strengthening the freedom of choice that the market affords and if this actually led to greater equality. Unfortunately, freedom and equality are a bit like oil and vinegar; they don’t mix especially well.

I know that I am not old enough to remember Hillary Clinton’s campaign to reform the health care system. But the video below brings back some characters familiar to many of you.

Harry and Louise fought to hold on to the health care system in 1993. Fifteen years later, those same characters lament their short-sightedness. Do we want to be in Harry and Louise’s shoes 15 years from now? The current system is on a collision course for failure; it is just a matter of when.

Growth in health care costs consistently outpace the rate of inflation, yet consumers have little to show for the money spent. Health insurance companies continue to find technicalities and other superficial reasons to deny care to consumers who pay the high premiums. People are being left behind with little or no coverage. God forbid you have a preexisting condition, especially a chronic one. The safety net for children’s health and safety has almost disappeared. With the current administration’s implicit blessing for increased privatization, doctors are dropping off the Medicare rolls. Even supposedly non-for-profit health systems are wolves in sheep’s clothing, often driving up the costs of care.

While individuals fare progressive worse under the private health care system, pharmaceutical companies have never been better. For all the supposed motivation the free market give them to engage in research and development, it appears that plastering their logos from here to Timbuktu is more of a financial priority. When you consider the human cost of these lopsided priorities (high drug costs, overprescription, and decreased medical research in the private sector), you have to wonder why people are fighting so hard to keep privatized health care. Who do you think the consumer will want to clean up the mess?

Universal Health Care Series: The Consumerist Argument

photo courtesy of snappybex

photo courtesy of snappybex

This post is Part IV in a series exploring reasons to support universal health care. You can find the other parts of the series here.

If you have ever tried to closely read your health insurance policy, it is fairly complex and confusing even for the well-educated. The fine print is disadvantageous to consumer knowledge and influence. After all entities such as Consumer Reports, The Consumerist and Ralph Nader exist for a reason; safeguards and information sharing are necessary to protect the consumer from industry sometimes.

That fine print in your policy may bear part of the blame for the estimated 25 million people are underinsured, individuals who have private insurance coverage but still have problems with access to care. Universal health care empowers the consumers not only in increasing access, but also in other ways that allow information decisions about one’s health.

Greater transparency and clarity in policy

Universal coverage favors patients’ rights; a single policy will clearly explain procedures and services. A single policy also mean less general administration and bureaucracy which promotes clearer lines of accountability.

Greater continuity in quality of care

Universal coverage gives consumers more freedom because they do not have to worry about gaps in coverage due to life changes: changing jobs, moving, etc. It also gives consumers who have preexisting conditions the freedom to leave their jobs without fear of not getting coverage with a new insurance company. Universal coverage ends the paradoxical phenomenon of the underinsured. Right now, millions are paying insurance premiums to receive nothing in return in benefits despite on paper having benefits.

Greater incentive for changes in system infrastructure

Implementing universal health coverage has some indirect effects on the infrastructure of the health system over time. The most important potential change is making health care more convenient for the consumer. Generally, area public hospitals that act as the sole safety net are few and far between for the consumers that need access to them. The geographic obstacle is one of many that prevents consumers from taking advantage of care that is free currently. Increasing equality of the distribution of points of access to care helps to improve the health of the consumer. Ensuring access also gives an incentive for a growth in the number of primary care specialists in comparison to the number of specialists due to the increase in demand.

Universal Health Care Series: The Economic Argument

This post is Part II in a series exploring reasons to support universal health care. You can find the other parts of the series here.

Number crunchers consider this:

  • The United States spends more than any other country in the world on health care (16 percent of the national GDP).
  • For doctors that would like to volunteer, bureaucratic obstacles such as burdensome paperwork and high license fees up to $1000 from state medical boards prevent many doctors from alleviating the overcrowding in free clinics and government community health centers.
  • Each dollar spent on ensuring people are healthier and more productive would generate $20 in benefits.
  • In 2006, U.S. health care spending was about $7,026 per resident and accounted for 16% of the nation’s Gross Domestic Product (GDP). Total health care expenditures grew at an annual rate of 6.7 percent in 2006, a slower rate than recent years, yet still outpacing inflation and the growth in national income.
  • Analyses of data from the 2005 Medical Expenditure Panel Survey indicate that total medical spending is much lower when coverage is provided by public health coverage such as Medicaid when compared to private health insurance coverage.
  • Over the last 25 years, health systems’ average total profit margins have remained reasonably stable at around 5 percent. About one-quarter of all US hospitals, many of them safety nets, have reported negative margins, and continually teeter toward failure.
  • Health care costs are expected to rise by 10 percent in 2009.
  • California HMOs earned over $4 billion in profits in 2007 and spent $6 billion in administrative costs such as CEO salaries rather than using the revenue to reduce insurance premiums for the consumer.

Few individuals and organizations benefit under the current health care system except certain CEOs. I am not going to touch the issue of executive compensation; however, per capita costs have risen faster than the rate of inflation, leaving more families behind. While there is a moral imperative to care for the wellbeing of others, increasing access to health care can not be considered without a consideration for the economic impact of a change.

The major objection is that universal health care will simultaneously decrease efficiency and choice while increasing costs. Universal coverage does not mean writing a blank check to every American. Rather, creating an umbrella of health coverage rather than a patchwork quilt takes advantage of economies of scale for purchasing and well as facilitating the development and implementation of best practices from a central authority.

The economic savings emerge in other areas of society as well. A healthier population is economically more productive because they are fewer days missed due to illness. Small business is likely to flourish because business owners do not have to fear covering employee health care costs. Increasing efficiency through technology, making prevention and health promotion a central focus of health care, and encouraging behavior change will also help to cut costs.

As private industry has had a horrible track record of policing itself, universal health care is the most viable alternative for addressing the dual problems of gaps in coverage and escalating costs.

Universal Health Care Series: The Moral Argument

This post is Part I in a series exploring reasons to support universal health care.

The moral argument in favor of universal health care dictates that ensuring equality of access to health care is a moral imperative. This moral imperative can stem from religious beliefs or through secular channels such as natural rights and human rights.

photo courtesy of kaibara

photo courtesy of kaibara

Religion and spirituality play a strong role in social activism, stressing personal development in faith as well with a call to improve the state of the world. James 2:26 says that, “As the body without the spirit is dead, so faith without deeds is dead.” It is not merely enough for believers to profess their faith. Those beliefs are supported, sustained, and demonstrated through the social conscious actions of believers.

Activism and social justice are not restricted to Christianity. The religious call to social justice says that people should treat people the way they would like to be treated, also known as the Golden Rule. You can find a version of the Golden Rule in 21 world religions, encouraging respect and urging individuals to take personal responsibility for addressing injustices in basic human needs.

Given the prevalence of religious duty to upholding justice and equality, it is hard to justify the strength of one’s faith while supporting a system that has 45.8 million people without health insurance and many others underinsured. To do so institutionalizes practices, policies and systems that favor people who have the resources to meet their needs. Universal health care ensures that health, a fundamental need, is accessible to everyone regardless of how much money they make or where they live.

Moral obligations can come outside of religion through the concept of human rights. This year marks the 60th anniversary of the publication of the Universal Declaration of Human Rights, a comprehensive document that enumerates the rights of every person regardless of race, gender, creed, sexual orientation, income, and national laws. Given the recent anniversary and the push to meet the Millennium Development Goals, there is a renewed focus on increasing knowledge and awareness of human rights.

Article 25 specifically addresses the right to health care stating,

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

The article really does not leave wiggle room for a health care system that ensure the right to medical care to the majority of the population. Ensuring that every person has access to health care truly protects the  right to “life, liberty and the pursuit of happiness” boldly stated in the Declaration of Independence. Lack of insurance complicates health outcomes; people who are uninsured get sick more often, earn less money, and die sooner as a result of the disadvantage of not having sufficient access to health care.

The real question is what are you willing to do to fulfill your moral duty?