|
|
What's making news in health care? Here's John G. Taylor's take. With 30 years experience as a journalist at newspapers around the country, John G. Taylor is Community's director of public affairs, responsible for government and community relations.
-
Came across my notes from a December 2001 conference I attended where various national health policy leaders spoke to members of the California Association of Public Hospitals.
It was the darkly nervous days after 9/11. The conference's most pointed presenter was Dr. David Himmelstein, who is still professor of medicine at Harvard Medical School and backer of a single-payer universal coverage health system.
I wondered, were his insights accurate as I jotted them back then, and what about seven years later?
- Financial suffering is part of the dying process.
- We have de-facto health rationing. One-third of Americans are inadequately insured and die prematurely.
- The uninsured don't use more care than anyone else, they just use it in the ER because they can't access it elsewhere.
- The death risk for the poor is higher under managed care than under fee-for-service medicine.
- Managed care sends stroke patients to nursing homes for warehousing rather than more expensive rehab facilities.
- Large numbers of uninsured work for health providers.
- 80% of time spent at a doctor's office focuses on dismissing a medical problem while 20% is to ascertain the psychosocial problems a patient really has -- that last component is why you really need the physician.
- Unnecessary surgery is assault and battery -- going after someone with a knife for financial gain.
One other note caught my eye, coming from Dr. David Lawrence, now retired chair and CEO of Kaiser Foundation Health.
There's still a deep-seated belief, he said, that when you're sick, it's your own damned fault. In reality, he said, it's an accident, genetics or where you walked. And this needs to hit home to the middle class.
Maybe I heard them wrong. Maybe they were accurate then or wrong then. What about now? What do you think?
|
-
Respect and ridicule are never dispensed equally. Just ask "The Big Five" who are trying to hash out an already-overdue California budget that has a $15.2 billion hole, and growing.
The Sacramento Bee threw some pretty sharp elbows in its July 1 coverage of the budget huddlers and the potentially disastrous impact they might wreak on state health care.
Reporter Kevin Yamamura called The Big Five "one of the least experienced teams ever." Here a few culls from his assessments:
- Gov. Schwarzenegger: This is his 5th budget. He knows that legislators will move at their own pace irrespective of how he tries to muscle them.
- Senate Minority Leader Dave Cogdill (Modesto): His first budget. "Some Democrats believe his budget demands have been difficult to pin down, and they may not trust his intentions."
- Assembly Minority Leader Mike Villines (Clovis): Second budget. He "is considered politically astute and has coordinated well with Cogdill."
- Assembly Speaker Karen Bass (Los Angeles): First budget. She's big into consensus building, but because she's so new she may get less wiggle room with fellow Dems.
- Senate President Pro Tem Don Perata (Oakland): Fourth budget. Lots of experience but is termed out in November so he's got no political fallout to fear.
The Sac Bee's editorial pages took direct aim at Schwarzenegger's 10% cuts in Medi-Cal, under the heading: "The choice is clear: Increase taxes or let the impact fall on children and the elderly."
You can find the entire editorial at http://www.sacbee.com/110/story/1051327.html but here is one very telling segment:
"As senators and Schwarzenegger are well aware, kicking poor people out of the Medi-Cal program will only force them to go to the emergency room, or avoid treatment for diabetes, high blood pressure and other chronic diseases.
"While campaigning for health care reform last year, Schwarzenegger often talked about the "hidden tax" that uninsured people impose on hospitals, businesses and local governments. It would be revealing for the governor to calculate the hidden tax he will impose on this state if these Medi-Cal cuts are fully enacted.
"A better option would be a modest, broadly distributed levy – yes, a tax – to prop up this state's health care program for the poor. Consider it a down payment on a once-and-future goal: a more universal system of health coverage."
(For more information about how cutbacks might hit hospital services, the California Hospital Association offers info at http://www.savemyemergencyroom.com/ )
|
-
Pity -- or praise -- the residents of New York City, my old hometown. As Californians are legally mandated to learn the wonders of "hands free" phone use while driving, the Big Apple is nuking trans fat in nearly all prepared food.
The full T-F ban takes effect July 1, with a 3-month grace period before chefs will be flogged with hefty ($2,000) fines for concocting anything with the tasty, artery-clogging substance.
Consider what's against the law in Nu Yawk City and/or Nu Yawk State -- the city in 1978 imposed a fine on dog owners who don't clean up after the pets' "public posturing"; in 2001, the state became the first in the nation to impose a "hands free" phone law; and in 2003 banned smoking in nearly all businesses. Now Nu Yawk City is the nation's first big city to take a crack at making heart-disease, obesity and, some might say, gourmet cooking and freedom of expression -- illegal.
If that totally fries your cannoli, be of good cheer. The New York College of Technology, one of the region's top culinary schools, has established "Trans Fat Help Center" and a telephone help line for depressed food professionals for whom patience may be shortening as their once-delicious donuts droop.
You can learn more at www.notransfatnyc.org (Best grab a hot dog and a beer while you can at Yankee and Shea stadiums. Who knows what'll be illegal next year when the baseball teams move into their new digs.)
|
-
The grass has turned to straw. The darkened building has a foreclosure sign taped to the door. Past-due notices are scrunched into the jamb.
That describes houses in my Clovis neighborhood. It soon may well describe some California hospitals.
Members of the California State Rural Health Association gathered recently in Reedley, and one take-away from the panel discussion was what might be called a Doomsday scenario should the 10% proposed reductions in Medi-Cal be converted into law.
The recap document uses Sierra Kings District Hospital as a "what if?" example:
- "If" the cuts go ahead -- particularly the delays in Medi-Cal payments -- a cash-flow issue may imperil the $1 million Sierra Kings monthly payroll and other operating expenses.
- "If" those outlays can't be met, the hospital might consider closing for a period of time.
- "If" the hospital closes however briefly, it might be unable to retain its nurses and other skilled professionals, particularly if there is no guarantee that the problem of a broken state budget won't recur.
- "If" the hospital can't provide services, emergency patients would likely be transported to crowded Community Regional Medical Center in Fresno. The cost to the Medi-Cal program of that ambulance transport alone is estimated at $18.7 million. No word on what it might cost Community.
- "If" any of the frayed safety-net care system closes, illnesses will magnify and costs of care will rise for everyone.
"If" that synopsis isn't enough, just Google what's happening to ambulance companies around the country as gas and diesel prices go stratospheric. In some locales, well, the whirring lights and sirens of smaller ambulance companies are being silenced.
A Hollywood writer couldn't infuse more "what if" pathos into California's draft health-care disaster script.
|
-
So, how did the president of the Philippines wind up visiting Community Regional Medical Center on the sultry Sunday morning of June 22?
It began about nine days earlier when a Community physician of Filipino heritage stopped by the hospital's administrative offices seeking help for the visit. Within 72 hours, the Philippines consul general in San Francisco and a half-dozen aides were touring the hospital campus.
A couple of days later, a dozen press, protocol and security officials did more site selection -- and insisted that President Gloria Macapagal-Arroyo be welcomed only by Community staff and physicians of Filipino heritage. And that they have the names in hand well in advance of the visit.
Did I mention security? There was Community's security working with Fresno PD, with Philippines presidential security and the U.S. Secret Service. There were scads of eagle-eyed women and men, some of considerable size, with earpieces at hospital entrances and exits.
And then there were 80 to 100 physicians, nurses, pharmacists and other staff filling the hallways, and later the Sequoia rooms, with a joyful buzz reminiscent of a wedding.
Cameras created a nearly white-out of flashes at the hospital patio door as the president and her party arrived -- running an hour or so late. Formal greetings came from Phyllis Baltz, CRMC's chief operating officer, Drs. Dominic Dizon and Orly Dyoco, Community nurses Imelda Gamboa and Norlina Dela Vega and me.
The real "Wow!" moments occurred as the president was swarmed by well-wishers in the Sequoia rooms. The Fresno Bee called it rock-star treatment. Cell phone camera were hoisted, film crews stood on tables. Wall-to-wall smiles.
And after 15 minutes, she whisked away to a downtown Mass and reception and a flight to DC to meet President Bush (and also apparently Barack Obama and John McCain).
One question surfaced repeatedly: Why did she stop at Community?
Dr. Dizon was quick with an answer: Why not?
It was a history-making moment for Community and a fitting honor to our hundreds of dedicated Filipino staff.
|
-
Sometimes a dinosaur will unearth an insight or a smile. Or, more directly put, occasionally a newspaper will publish snippets of compelling college commencement addresses. That's what the New York Times did on Sunday, June 15.
I don't remember anything said by the big-name (what was her name?) speaker in 1972 when I graduated from New York University, along with thousands of others, in a ceremony on the floor of Madison Square Garden just after the circus completed its last performance there (where was incense when you really needed it?).
But here's an excerpt from an address given by actress Jessica Lange at Sarah Lawrence College that helped me focus on the passing of time and the power of sharing one's time with others.
"If, from my vantage point now, I could tell my 22-year-old self what I now believe is the most important thing in life (and one I didn't embrace fully at the time because I was young and willful and reckless), it would be—to be present.
"I would encourage you, with all my heart, just to be present. Be present and open to the moment that is unfolding before you. Because, ultimately, your life is made up of moments. So don't miss them by being lost in the past or anticipating the future. Don't be absent from your own life.
"You will find that life is not governed by will or intention. It is ultimately the collection of these sense memories stored in our nerves, built up in our cells. Simple things:
- A certain slant of light coming through a window on a winter's afternoon
- The sound of spring peepers at twilight
- The taste of a strawberry still warm from the sun
- Your child's laughter
- Your mother's voice
"These are the things that shape our lives and settle into the fiber of our beings. Don't take them for granted. Slow down for them, they will take root.
"And someday 20-30-40 years from now, you may be going about your day when by chance the smell of bread baking or the sound of a mockingbird singing will stop you in your tracks and carry you heart and soul back to yourself.
"Moments of pure happiness, bliss—if you feel comfortable using that word—come upon you unexpectedly. Don't be too preoccupied to experience them."
(Lange's complete address is at http://www.slc.edu/news-events/Jessica_Lange_Commencement_Address.php )
|
-
A Rubik's Cube of laws must be changed to secure any flexible and functional change in American health care. That's the drawdown message of a concise, thoughtful assessment in the June issue of the Journal of the American Medical Association.
"Innovation will not occur if each novel way to organize and pay for care needs to be adjudicated case-by-case or is threatened with legal proceedings," say the authors, Timothy Jost, a lawyer, and Ezekiel Emanuel, a physician.
Among the points they cite:
- Patients visit doctors offices 1 billion times a year, with the average Medicare client seeing 7 different doctors -- most of whom are not linked electronically, clinically or otherwise. Fee-for-service reimbursement is an impediment to coordinated care.
- Some states require hospitals to meet a variety of certificate-of-need laws before establishing delivery systems. Some states, like California, prohibit corporations (hospitals like Community Medical Centers) from hiring physicians.
- Assorted tax laws limit for-profit, non-profit ventures. Federal anti-kickback and self-referral prohibitions create another level.
- Several federal jurisdictions have oversight of the same health arrangements, but different interpretations of how to exercise those rights.
While wisely citing the current banking crisis with respect to the perils of innovation, the authors conclude by suggesting:
"A federal commission with authority to permit delivery system innovations that are time limited and contingent on period evaluations demonstrating cost savings and improved quality could facilitate the necessary reforms."
Sure might save a lot of legal time trying to repeal or rewire existing laws governing a dysfunctional system.
|
-
Yippee. The ludicrous price of gas means more shipping businesses may relocate to the Valley 'cause it's a great halfway point to lots of somewhere else's.
I got to thinking outside "the Valley as a call-center megalopolis" box while touring the new Holiday Inn downtown and viewing the unveiling of a snazzy web site redesign by the Fresno Economic Development Corporation. The site reminded me how much we need to elevate our aspirations.
A medical school. Biomedical research. Might more six-figure salaries translate into the kind of political clout that could blow out the Valley's bad air? Can we replace jeans from the Gap with Fresno-based genetic re-engineering? Cutting edge needn't only describe the sharp blade of a pruning knife.
Community Medical Centers is the region's safety net, the only burn and Level 1 trauma centers between LA and Davis. It's got the kind of high-tech gear and top-notch medical professionals to rival what Stanford and others offer. We educate hundreds of doctors and medical students on our campuses each year, in cooperation with the University of California, San Francisco.
And, as local economic developers unwind their come-hither sales pitches, they should tap into the fact that Community is major economic engine for the region. It's fast approaching a one BILLION dollar annual budget. It pays out more than $400 million in salaries and benefits to its more than 6,000 employees.
Community is nonprofit and locally owned -- and it invests whatever it earns back into the local community. Community annually buys about $115 million in goods and services from vendors in Fresno and Clovis ALONE.
Each hospital job supports two or more jobs elsewhere in the economy, according to an American Hospital Association (AHA) survey released in April. One out of every 10 private-sector jobs is supported by hospitals.
Yet too often the good that hospitals do is taken for granted. "When investors, policymakers and the public think about industries that promote economic stability and growth, most do not think about hospitals," AHA said in its report.
Any group that's seriously trying to grow the Valley toward a healthier, more prosperous future would do well to incorporate hospitals like Community into its strategic plans.
|
|
|
|