Cultural Competency: Using A Case-Based Approach for Teaching and Learning was the title of today’s Health Policy Forum. The presenters, Lisa Hark, PhD, RD, Project Manager for Online Medical Education at Wills Eye Institute and Horace M. DeLisser, MD, Associate Dean, Spirituality and Cultural Competency at the University of Pennsylvania, used compelling real-life scenarios to illustrate cross-cultural issues that arise in clinical encounters. They discussed communication strategies for handling difficult situations and challenged the audience to examine their own perceptions.
Some Questions to Consider:
What does cultural competency mean to you and your work ?
What kinds of experiences have you had providing care to populations that you were unfamiliar with? How did you approach this? What kind of assistance did you need?
As a provider or patient do you feel that you had a negative interaction in a health care setting as a result of your culture, race, gender, language, age, sexual orientation, appearance, etc? How did you handle this?
Have you heard of any interesting programs or resources related to cultural competency?
Share your thoughts and keep the conversation going!
Wednesday, December 9, 2009
Tuesday, December 8, 2009
Guest Commentary: President Obama visits Pennsylvania
Photograph and Blog entry by
Patrick Monaghan
Director of Communications
Jefferson School of Population Health
There we sat, maybe a thousand of us, gathered in a small gymnasium on the campus of Lehigh Carbon Community College, nestled into a bucolic setting just outside of Allentown, Pa. The Pledge of Allegiance had been recited; the Star Spangled Banner sung. The Presidential Seal had been secured to the podium. An air of anticipation hung in the rafters that I have perhaps felt a handful of times.
Ticket holders had waited outside well over an hour, patiently filing through security as if boarding a flight home.
“Ladies and gentlemen, the President of the United States of America.” A modest roar and raucous applause from the crowd. Cameras flashing. I don’t recall hearing “Hail to the Chief,” but there he was, Barack Obama, probably the most recognizable person on the planet, walking to the stage. As he prepared to begin his remarks, he stood just a long jump shot from my seat in the bleachers.
I certainly didn’t expect to be here. Did anyone? An e-mail had been circulated earlier in the week notifying me and my colleagues at the Jefferson School of Population Health that there was an opportunity to see the President speak in our area. Six tickets – first come, first served. By the time I retrieved the message, an hour had passed. Opportunity missed, I thought.
I called anyway, and here I was, face-to-face with my first Presidential address. Regardless of your political leanings, it’s one of those events that makes you feel more connected to the Democratic Process. I’m a bit of a news junkie, and you didn’t have to be Walter Cronkite to know that this was going to make a few headlines. Welcome signs hung from businesses and schools leading to the college. Protestors at the entrance; “Don’t Tread on Me” flags; rows of news vans sprouting a small forest of satellite uplinks.
Given the setting, I had a feeling the President would focus his comments on jobs and the economy. As a JSPH staffer, I had come in hope of hearing some inside information on the health care bill. Would it come to a vote soon? Is the public option a deal breaker? What’s the story with Joe Lieberman?
As those of us vested in the health care debate understand, our nation’s fragile economy will only truly flourish when our dysfunctional health care system is mended. Health care expenses are bleeding our country dry – medical care now absorbs 18 percent of every dollar we earn.
It’s a connection that is not lost on Mr. Obama.
“What has happened is a lot of the debate in Washington has been around health care, so people think, well, I guess they must not be working on jobs,” Mr. Obama said. “No, we’ve been working on jobs the whole time. Health care is part and parcel with where we need to take our economy.”
The President began his remarks just before noon. His oratory skills are on full display in a live setting, but I was somewhat surprised by his reliance on a TelePrompTer for his formal comments. It forces him to look side-to-side (to the prompter panels) instead of straight ahead. Before concluding, he took a few questions from the audience, and it was during this unscripted segment that he seemed most at ease.
He worked the crowd on the way out, shaking hands and posing for the obligatory photo-with-a-baby. By 1 p.m. he had left the building.
We remained somewhat sequestered, momentarily suspended behind closed doors, presumably until the motorcade was out of sight. By the time we emerged from the gym, there was barely a trace he had been there.
Except for the protestors.
Ticket holders had waited outside well over an hour, patiently filing through security as if boarding a flight home.
“Ladies and gentlemen, the President of the United States of America.” A modest roar and raucous applause from the crowd. Cameras flashing. I don’t recall hearing “Hail to the Chief,” but there he was, Barack Obama, probably the most recognizable person on the planet, walking to the stage. As he prepared to begin his remarks, he stood just a long jump shot from my seat in the bleachers.
I certainly didn’t expect to be here. Did anyone? An e-mail had been circulated earlier in the week notifying me and my colleagues at the Jefferson School of Population Health that there was an opportunity to see the President speak in our area. Six tickets – first come, first served. By the time I retrieved the message, an hour had passed. Opportunity missed, I thought.
I called anyway, and here I was, face-to-face with my first Presidential address. Regardless of your political leanings, it’s one of those events that makes you feel more connected to the Democratic Process. I’m a bit of a news junkie, and you didn’t have to be Walter Cronkite to know that this was going to make a few headlines. Welcome signs hung from businesses and schools leading to the college. Protestors at the entrance; “Don’t Tread on Me” flags; rows of news vans sprouting a small forest of satellite uplinks.
Given the setting, I had a feeling the President would focus his comments on jobs and the economy. As a JSPH staffer, I had come in hope of hearing some inside information on the health care bill. Would it come to a vote soon? Is the public option a deal breaker? What’s the story with Joe Lieberman?
As those of us vested in the health care debate understand, our nation’s fragile economy will only truly flourish when our dysfunctional health care system is mended. Health care expenses are bleeding our country dry – medical care now absorbs 18 percent of every dollar we earn.
It’s a connection that is not lost on Mr. Obama.
“What has happened is a lot of the debate in Washington has been around health care, so people think, well, I guess they must not be working on jobs,” Mr. Obama said. “No, we’ve been working on jobs the whole time. Health care is part and parcel with where we need to take our economy.”
The President began his remarks just before noon. His oratory skills are on full display in a live setting, but I was somewhat surprised by his reliance on a TelePrompTer for his formal comments. It forces him to look side-to-side (to the prompter panels) instead of straight ahead. Before concluding, he took a few questions from the audience, and it was during this unscripted segment that he seemed most at ease.
He worked the crowd on the way out, shaking hands and posing for the obligatory photo-with-a-baby. By 1 p.m. he had left the building.
We remained somewhat sequestered, momentarily suspended behind closed doors, presumably until the motorcade was out of sight. By the time we emerged from the gym, there was barely a trace he had been there.
Except for the protestors.
Refined carbs, sugar, and cholesterol: My own experience
A few years ago I went to the doctor for a routine appointment, and I was told that my LDL cholesterol was elevated. I was in my early 40s. My lipid profile was the following - LDL: 156, HDL: 38, triglycerides: 188. The LDL was calculated. I was weighing about 210 lbs, which was too high for my height (5 ft 8 in). My blood pressure was low, as it has always been - systolic: 109, diastolic: 68.
My doctor gave me the standard advice in these cases: exercise, lose weight, and, most importantly, reduce your intake of saturated fat. I was also told that I would probably have to take statins, as my high LDL likely had something to do with my genetic makeup. Again, this is quite standard, and we see it all over the place, particularly in commercials for statins.
I told my doctor that I would do some research on the topic, which I am going to save for other posts. Let me get to the point, by telling you what my lipid profile is today - LDL: 123, HDL: 66, triglycerides: 46. Again, the LDL value is calculated. I am weighing about 152 lbs now, with about 13 percent of body fat.
The HDL and triglycerides numbers above are shown in bold font because my research convinced me that these two numbers are the ones most people should really worry about when trying to address what is known as dyslipidemia. Here I am assuming that only standard lipid profiles are available; there are better alternatives, such as particle type analyses, which are not yet standard.
Many people who suffer from cardiovascular disease have low LDL cholesterol, but very few of those have high HDL cholesterol, which is one of the best predictors of cardiovascular disease among lipids. More specifically, if you have an HDL higher than 60, you have a very small chance of developing cardiovascular disease. (It can happen, but it is very unlikely, with a percentage chance in the single digits.)
Interestingly, low HDL cholesterol is also associated with the metabolic syndrome. This syndrome is characterized by the following:
- High fasting serum glucose (hyperglycemia), which is one of many signs of insulin resistance, a precursor to diabetes type 2;
- High blood pressure;
- Abdominal obesity (also known as pot or beer belly);
- Low HDL cholesterol; and
- Elevated triglycerides.
Now, you may ask, how did you increase your HDL? Well, I tried a number of things - diet and lifestyle changes - and had a blood test every 3 months. After a while I was able to put all of the measures in a spreadsheet table, and correlate them using a statistical software that I developed, to give me an idea of what was going on.
Weight was a big factor on LDL, and I was able to bring my weight down to 150 lbs and my LDL to below 100 at some point. For me, and many other people, body weight and LDL cholesterol are strongly and positively correlated (the higher the weight, the higher the LDL cholesterol - actually body fat seems to be the real culprit). Moreover, my LDL seemed to decrease more markedly when my weight was on the way down, and not as much when it was stable, even if low.
But the HDL would only increase if I increased my saturated fat intake. The problem is that every time I increased my saturated fat intake my LDL would go up; it reached 162 at one point, when my HDL went up to a modest but encouraging 47. That was my highest HDL until I eliminated refined carbs and sugars (e.g., bread, pasta, cereals, doughnuts, bagels, regular sodas) from my diet.
When I brought my intake of refined carbs and sugars down to zero, my intake of protein and saturated fat went up. Either that would happen, or I would starve, because you have to eat something. (I figured that I would not die by doing a low carb/high fat-protein experiment for 3 months to see what happened.) Also, I dramatically increased my dietary cholesterol - two to four eggs per day, organ meats, and seafood.
That is when my HDL shot up, to 66, and my LDL went down. Yes, my LDL levels seem to be negatively correlated with dietary saturated fat and cholesterol amounts, as long as I do not consume refined carbs and sugars. Moreover, it is very likely that my LDL particle size increased, and large LDL particles DO NOT cause atherosclerosis because they cannot penetrate the artery walls.
So, the bottom line is that, at least for me, an INCREASE in saturated fat and a DECREASE in refined carbs and sugars, happening together, seem to have taken me out of my previous path toward the metabolic syndrome.
Moreover, I feel a lot more energetic than before, my immune system seems to have gotten better at fighting disease, and even my pollen allergies are not as bad as they were before. Admittedly, these benefits may be strongly associated with the weight loss and the related reduction in body fat percentage.
I hope this post is helpful to others. The standard advice that people with high LDL cholesterol receive, which usually focuses on reducing saturated fat intake, has a big problem. When you reduce your intake of a type of food, you usually increase your intake of other types of food. Most people who try to reduce their saturated fat intake invariably increase their carb intake, usually with the wrong types of carb-rich foods (the man-made ones), simply because they go hungry.
My doctor gave me the standard advice in these cases: exercise, lose weight, and, most importantly, reduce your intake of saturated fat. I was also told that I would probably have to take statins, as my high LDL likely had something to do with my genetic makeup. Again, this is quite standard, and we see it all over the place, particularly in commercials for statins.
I told my doctor that I would do some research on the topic, which I am going to save for other posts. Let me get to the point, by telling you what my lipid profile is today - LDL: 123, HDL: 66, triglycerides: 46. Again, the LDL value is calculated. I am weighing about 152 lbs now, with about 13 percent of body fat.
The HDL and triglycerides numbers above are shown in bold font because my research convinced me that these two numbers are the ones most people should really worry about when trying to address what is known as dyslipidemia. Here I am assuming that only standard lipid profiles are available; there are better alternatives, such as particle type analyses, which are not yet standard.
Many people who suffer from cardiovascular disease have low LDL cholesterol, but very few of those have high HDL cholesterol, which is one of the best predictors of cardiovascular disease among lipids. More specifically, if you have an HDL higher than 60, you have a very small chance of developing cardiovascular disease. (It can happen, but it is very unlikely, with a percentage chance in the single digits.)
Interestingly, low HDL cholesterol is also associated with the metabolic syndrome. This syndrome is characterized by the following:
- High fasting serum glucose (hyperglycemia), which is one of many signs of insulin resistance, a precursor to diabetes type 2;
- High blood pressure;
- Abdominal obesity (also known as pot or beer belly);
- Low HDL cholesterol; and
- Elevated triglycerides.
Now, you may ask, how did you increase your HDL? Well, I tried a number of things - diet and lifestyle changes - and had a blood test every 3 months. After a while I was able to put all of the measures in a spreadsheet table, and correlate them using a statistical software that I developed, to give me an idea of what was going on.
Weight was a big factor on LDL, and I was able to bring my weight down to 150 lbs and my LDL to below 100 at some point. For me, and many other people, body weight and LDL cholesterol are strongly and positively correlated (the higher the weight, the higher the LDL cholesterol - actually body fat seems to be the real culprit). Moreover, my LDL seemed to decrease more markedly when my weight was on the way down, and not as much when it was stable, even if low.
But the HDL would only increase if I increased my saturated fat intake. The problem is that every time I increased my saturated fat intake my LDL would go up; it reached 162 at one point, when my HDL went up to a modest but encouraging 47. That was my highest HDL until I eliminated refined carbs and sugars (e.g., bread, pasta, cereals, doughnuts, bagels, regular sodas) from my diet.
When I brought my intake of refined carbs and sugars down to zero, my intake of protein and saturated fat went up. Either that would happen, or I would starve, because you have to eat something. (I figured that I would not die by doing a low carb/high fat-protein experiment for 3 months to see what happened.) Also, I dramatically increased my dietary cholesterol - two to four eggs per day, organ meats, and seafood.
That is when my HDL shot up, to 66, and my LDL went down. Yes, my LDL levels seem to be negatively correlated with dietary saturated fat and cholesterol amounts, as long as I do not consume refined carbs and sugars. Moreover, it is very likely that my LDL particle size increased, and large LDL particles DO NOT cause atherosclerosis because they cannot penetrate the artery walls.
So, the bottom line is that, at least for me, an INCREASE in saturated fat and a DECREASE in refined carbs and sugars, happening together, seem to have taken me out of my previous path toward the metabolic syndrome.
Moreover, I feel a lot more energetic than before, my immune system seems to have gotten better at fighting disease, and even my pollen allergies are not as bad as they were before. Admittedly, these benefits may be strongly associated with the weight loss and the related reduction in body fat percentage.
I hope this post is helpful to others. The standard advice that people with high LDL cholesterol receive, which usually focuses on reducing saturated fat intake, has a big problem. When you reduce your intake of a type of food, you usually increase your intake of other types of food. Most people who try to reduce their saturated fat intake invariably increase their carb intake, usually with the wrong types of carb-rich foods (the man-made ones), simply because they go hungry.
Monday, November 23, 2009
New Breast Cancer Screening Guidelines and The Value of Breast Self Exams
Since their release earlier this week, there has been extensive controversy over the new US Preventive Services Task Force (USPSTF) recommendations against routine mammograms for women under 50. These new recommendations have raised the ire of women across the US and have been disputed by the American Cancer Society, the Susan G. Komen Foundation and other cancer information and services organizations. USPSTF also questioned the value of breast self examination (BSE), saying it was not recommended because it has led to a high number of false positive results. That recommendation has also been called into question from a wide range of women’s organizations and individuals who have found breast lumps as a result of a BSE.
This latter recommendation hits home for me as my wife was recently diagnosed with Breast Cancer and is being treated here at the Jefferson Breast Center. The cancer was not caught from a routine mammogram but rather through her own monthly breast self exam. As a result of that exam, she visited our family doctor immediately. After an ultrasound and additional tests confirmed her breast cancer, she started treatment.
Without her monthly breast self exam, who knows when she would have seen her doctor, received her diagnosis, and begun treatment? BSE is an important, individual personal health screening that can and should be done routinely. My wife is Hispanic. A study from the University of Arizona’s Zuckerman College of Public Health earlier this year reported that two-thirds of Hispanic women diagnosed with breast cancer discovered it through BSE and not from diagnostic services provided within the healthcare environment. The USPSTF recommendation against BSE, if applied nationwide, could adversely impact early detection of breast cancer, especially among diverse populations, many of whom do not routinely use our healthcare system.
Rob Simmons, DrPH, MPH, CHES, CPH
Director, MPH Program
Jefferson School of Population Health
This latter recommendation hits home for me as my wife was recently diagnosed with Breast Cancer and is being treated here at the Jefferson Breast Center. The cancer was not caught from a routine mammogram but rather through her own monthly breast self exam. As a result of that exam, she visited our family doctor immediately. After an ultrasound and additional tests confirmed her breast cancer, she started treatment.
Without her monthly breast self exam, who knows when she would have seen her doctor, received her diagnosis, and begun treatment? BSE is an important, individual personal health screening that can and should be done routinely. My wife is Hispanic. A study from the University of Arizona’s Zuckerman College of Public Health earlier this year reported that two-thirds of Hispanic women diagnosed with breast cancer discovered it through BSE and not from diagnostic services provided within the healthcare environment. The USPSTF recommendation against BSE, if applied nationwide, could adversely impact early detection of breast cancer, especially among diverse populations, many of whom do not routinely use our healthcare system.
Rob Simmons, DrPH, MPH, CHES, CPH
Director, MPH Program
Jefferson School of Population Health
Friday, November 13, 2009
Healthcare Reform Needs Patient Adherence
While the debate rages on regarding Healthcare Insurance Reform, several key issues are either severely diminished or completely eliminated from the conversation. Many of the huge costs to the system are associated with the management of chronic illnesses, such as diabetes, asthma and heart disease. Patient compliance or adherence is one of the most critical elements of achieving improved outcomes for patients with chronic illnesses, helping to prevent costly complications and hospitalizations.
Unfortunately, the evidence regarding patient education, behavioral models, care coordinating infrastructure, and perhaps financial incentives to support patients with chronic illnesses lags behind treatment recommendations. While most health professionals are armed with myriad evidence-based clinical guidelines, little is understood or proven on how to engage patients to accept personal responsibility and become active participants in their health care.
Even a coordinated care model runs the risk of failing to achieve improved outcomes if patients do not adhere to recommendations. It is not enough for health professionals to counsel patients to stop smoking, eat a well balanced diet, get screened for markers of cancer and chronic illnesses, take their vaccines, statins, ACE inhibitors, check their blood sugar, etc. Unless there is a funding mechanism to provide the needed resources to support patients in their efforts to comply, we will continue to fail them and add to our ever-increasing cost burden to the system.
Until the system is geared up to support patients and caregivers with the best tools to accept more personal health responsibility and adhere to proper proven recommendations, we will continue to have sub-optimal outcomes no matter what we spend or recommend for healthcare reform changes.
Mike Toscani, PharmD
Project Director
Jefferson School of Population Health
Unfortunately, the evidence regarding patient education, behavioral models, care coordinating infrastructure, and perhaps financial incentives to support patients with chronic illnesses lags behind treatment recommendations. While most health professionals are armed with myriad evidence-based clinical guidelines, little is understood or proven on how to engage patients to accept personal responsibility and become active participants in their health care.
Even a coordinated care model runs the risk of failing to achieve improved outcomes if patients do not adhere to recommendations. It is not enough for health professionals to counsel patients to stop smoking, eat a well balanced diet, get screened for markers of cancer and chronic illnesses, take their vaccines, statins, ACE inhibitors, check their blood sugar, etc. Unless there is a funding mechanism to provide the needed resources to support patients in their efforts to comply, we will continue to fail them and add to our ever-increasing cost burden to the system.
Until the system is geared up to support patients and caregivers with the best tools to accept more personal health responsibility and adhere to proper proven recommendations, we will continue to have sub-optimal outcomes no matter what we spend or recommend for healthcare reform changes.
Mike Toscani, PharmD
Project Director
Jefferson School of Population Health
Friday, November 6, 2009
The “S” Word in the Health Care Reform Debate
Like most of you, I have followed our country’s health care reform debate closely. Unfortunately, the conversation is confusing because the subject is complex and generally not presented in a logical and orderly fashion. The current approach to reform involves tweaking the current “system” rather than starting from scratch to design a rational one. Since the current system evolved in a haphazard fashion, attempts at reforming it will doubtless result in something equally complex.
Because the discussion involves strongly held beliefs about intensely personal and important issues, the discussions around health care reform have become quite heated. Emotions come into play, often vigorously, and can get to a point where objective discussion is no longer possible.
The word that seems to have triggered the most emotional response is socialism (the “S” word). It is used in almost a pejorative fashion, as if it is the worst thing that could possibly happen in America. Students of economics embrace capitalism strongly (others have different reasons) because it has proven unparalleled in raising standards of living for vast numbers of people and for providing innovation in our society.
The “S” word is commonly invoked when the discussion turns to a government-provided public insurance option. Simple definitions can help here. In capitalism, individuals own the means of production for goods and services. In socialism, the government owns them. Curiously, socialism is rarely used to describe Medicare, Medicaid, and the various other government-sponsored plans that account for roughly half of the health care dollars spent in this country, and are bona fide examples of “socialist” services.
My reaction to the use of this word has evolved from frustration to bemusement. First, most people cannot possibly have the facts concerning existing government-funded insurance plans in mind when they drop the “S” word in the context of health care reform. Second, for anyone looking at the matter objectively, it is clear that the United States is not a purely capitalistic country. We have many government-run services such as the military, highways, education, the postal service, social security, Medicare, etc. Thus, the United States contains elements of both capitalism and socialism, a so-called mixed economy.
As has become abundantly clear through our recent financial crisis and the government-sponsored rescue of our financial system, government spending when the private sector couldn’t (or wouldn’t) shortened what otherwise would have been an extended economic downturn. Having a little government (read socialism) mixed in with our capitalism can be a good thing. The flaw in the premise of most peoples’ assumption about capitalism is that free markets are inherently self-correcting. They are not. Simply having a capitalistic system does not guarantee a good outcome.
Similar reasoning can be applied to health care. Let’s examine the facts. The United States occupies 37th place in the World Health Organization’s ranking of healthcare quality in industrialized nations, despite the fact that we pay almost twice as much for health care. Perhaps our “capitalistic” healthcare system could use some “socialist” guidance, since it did not find an optimum outcome on its own. If not the government, who will provide guidance toward better outcomes in health care? As has occurred many other times in health care, the government (in the form of CMS) is leading the way to cost and quality reform through various demonstration projects and programs. Private insurance companies are following the government’s lead.
If we take the possibility of a government provided public insurance option to its extreme, is it so crazy to consider a government run health insurance system?
Let’s examine the premise of how insurance works. With a large number of people in a risk pool, the cost for any one individual is reduced. The larger the pool, the broader the risk is spread, the lower the cost.
How could we spread the risk as broadly as possible? A federal government provided public insurance option covering all Americans would do the trick. In point of fact, many Medicare services are administered by the Blues and other private insurance companies. Combining a single large insurance pool with private administration is a nice mixed economic insurance solution. Certainly not as crazy a scheme as what we endure now as a nation with regard to cost and quality…
Richard Jacoby, MD
Associate Professor
Jefferson School of Population Health
Because the discussion involves strongly held beliefs about intensely personal and important issues, the discussions around health care reform have become quite heated. Emotions come into play, often vigorously, and can get to a point where objective discussion is no longer possible.
The word that seems to have triggered the most emotional response is socialism (the “S” word). It is used in almost a pejorative fashion, as if it is the worst thing that could possibly happen in America. Students of economics embrace capitalism strongly (others have different reasons) because it has proven unparalleled in raising standards of living for vast numbers of people and for providing innovation in our society.
The “S” word is commonly invoked when the discussion turns to a government-provided public insurance option. Simple definitions can help here. In capitalism, individuals own the means of production for goods and services. In socialism, the government owns them. Curiously, socialism is rarely used to describe Medicare, Medicaid, and the various other government-sponsored plans that account for roughly half of the health care dollars spent in this country, and are bona fide examples of “socialist” services.
My reaction to the use of this word has evolved from frustration to bemusement. First, most people cannot possibly have the facts concerning existing government-funded insurance plans in mind when they drop the “S” word in the context of health care reform. Second, for anyone looking at the matter objectively, it is clear that the United States is not a purely capitalistic country. We have many government-run services such as the military, highways, education, the postal service, social security, Medicare, etc. Thus, the United States contains elements of both capitalism and socialism, a so-called mixed economy.
As has become abundantly clear through our recent financial crisis and the government-sponsored rescue of our financial system, government spending when the private sector couldn’t (or wouldn’t) shortened what otherwise would have been an extended economic downturn. Having a little government (read socialism) mixed in with our capitalism can be a good thing. The flaw in the premise of most peoples’ assumption about capitalism is that free markets are inherently self-correcting. They are not. Simply having a capitalistic system does not guarantee a good outcome.
Similar reasoning can be applied to health care. Let’s examine the facts. The United States occupies 37th place in the World Health Organization’s ranking of healthcare quality in industrialized nations, despite the fact that we pay almost twice as much for health care. Perhaps our “capitalistic” healthcare system could use some “socialist” guidance, since it did not find an optimum outcome on its own. If not the government, who will provide guidance toward better outcomes in health care? As has occurred many other times in health care, the government (in the form of CMS) is leading the way to cost and quality reform through various demonstration projects and programs. Private insurance companies are following the government’s lead.
If we take the possibility of a government provided public insurance option to its extreme, is it so crazy to consider a government run health insurance system?
Let’s examine the premise of how insurance works. With a large number of people in a risk pool, the cost for any one individual is reduced. The larger the pool, the broader the risk is spread, the lower the cost.
How could we spread the risk as broadly as possible? A federal government provided public insurance option covering all Americans would do the trick. In point of fact, many Medicare services are administered by the Blues and other private insurance companies. Combining a single large insurance pool with private administration is a nice mixed economic insurance solution. Certainly not as crazy a scheme as what we endure now as a nation with regard to cost and quality…
Richard Jacoby, MD
Associate Professor
Jefferson School of Population Health
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