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Health

May 16
0

Vision Driven Change

By | Health, The Global Is Local | 2 Comments

A few nights ago my wife and I had a conversation with our friend Peter. In contrast to our method of deciding our fate (last minute panic combined with procrastination and our desire to live in the moment), Peter was describing himself as vision-driven in his decision making process. By coincidence, the following morning I sat among a large group, including my fellow ChangeEngine blogger Scott Burkholder, loosely organized around the concepts of social entrepreneurship and a vague but optimistic vision of a better city.

These conversations have given me pause for thought, and to consider the role of this social innovation/social change blog platform. Our group of authors approaches the challenge of promoting positive social change from a variety of perspectives, and most of us have personal investment in the projects and programs that we write about.

I’ve occasionally thought that the quote attributed to Ghandi on a million self-satisfied bumper stickers — “Be the change you want to see in the world” — might be an appropriate mission statement for ChangeEngine. I looked up the phrase and found that he has been misquoted for the purposes of bumperstickerability. As corrected by the New York Times:

If we could change ourselves, the tendencies in the world would also change. As a man changes his own nature, so does the attitude of the world change towards him. … We need not wait to see what others do.”

Not surprisingly, Ghandi is a smidge more complex and a tad more profound than the sentiment captured on a bumper sticker.

My conversation with Peter and the breakfast group the following morning centered around the potential for individuals and small groups to generate substantial change. Both interactions emphasized the importance of envisioning a better place, even if the precise vision of a better future is vague. In a way, it doesn’t really matter. The effort counts.

Making an effort toward positive change almost certainly shifts the expectations, changes the conversation, and re-frames the possibilities for a community in need of transformative positive change. If Ghandi were a statistician, he might have talked about shifting or weighting the mean, if he were a talk show host, he might have talked about seeding the audience, but since he was an agent of transformative change, he talked about changing ourselves in order to change the world.

Hasdai Westbrook, our editor extraordinaire and Change-Monger-in-Chief, regularly reminds me to consider the social innovation components of the various issues that I address in my columns, and often this is a challenge for me when writing about burgeoning pandemics in Saudi Arabia. Today, however, I am struck how the health of the city is affected by all of its residents and their activities. Planting community gardens and socially responsible investment are both contributers to the same vision, and are relevant to the health of the greater community.

Barton, H.; Grant, M., 2006. A health map for the local human habitat. The Journal of the Royal Society for the Promotion of Health

My beat is Public Health, with local and global implications. At its core, Public Health is concerned with trends and interventions at the population level. While those in the research and analysis end of the field must be driven by process and procedure, those engaging in interventions must be driven by vision.

No public health intervention is undertaken without a vision of a better future for the population, but I believe that the definition of health intervention should be broadened considerably. From urban farms to the Mayor’s public safety initiatives to public art projects, there are a great number of activities taking place in Baltimore (and around the world) that directly and substantially impact population health. These activities impact the education, nutrition, economics, safety, and appearance of our neighborhoods, which can have a profound impact by shifting the mean toward a healthier city and and a healthier world.

Next time, The Gluten Wars, A Health-Conscious Society Loses Its Mind

May 13
0

Started from the Bottom

By | Health | One Comment

For the past nine months I’ve had the pleasure of working with kids through a nutrition education program called Food as Medicine at a local Baltimore middle school. Twice a week, once after school and once in the 6th grade classroom, volunteers help students think critically about the food they eat and teach them how it affects their body. We’ve had such success in the first year the kids are planning to get a salad bar for the school and have already made a commercial promoting healthy choices (soon to be released on YouTube, it’s a rap to the tune of Drake’s “Started from the Bottom“).

As an AmeriCorps VISTA, you live in poverty and fight poverty through program development and capacity-building. If you know me, you know that I hate using the words “poor” or “poverty” because they create a one-dimensional view in peoples’ minds. Being “poor” doesn’t only mean that you don’t have enough money; it means a much more fundamental lack of resources and opportunity. Yes, the middle school I work at in Waverly is Title I, meaning that about 76 percent of students are low-income and 98 percent of them receive free lunches. But it is the lack of access to society’s institutions and opportunities that creates the true detriment to their health and to their success later in life.

School budgets are determined by enrollment, with schools receiving about $5,000 for each child and a little bit more for special education and advanced students. That is the school’s entire budget that goes to food, toilet paper, teacher’s salaries, projectors and everything else. That leaves little extra for programming or even what many people consider basics. So this school of 6th – 8th grade students cannot afford languages, arts, P.E., health or science education. Aside from our program, the students have no other opportunity for after-school clubs or sports.

Ten years ago, all these students were zoned to Roland Park Middle School, which is one of the best in Baltimore but then were re-zoned to Waverly which didn’t even have a building for these kids to go to. The School Board promised the community a school equal to the quality of Roland Park, but instead gave them an old community center that was scheduled to be shut down and no funding to build it up. The community worked very hard for donations and to get the building suitable for children. Now the building looks nice, but the kids are left with no gym, equipment, playground or drinking water. Want to wash that apple you brought to school for snack? You can, but you will get lead all over it.

So it’s no surprise that these kids don’t know how much sugar is in soda or cereal or even chocolate milk. They don’t know that whole milk, Cheetos and fries have a whole bunch of fat in them. They didn’t know that you can die from strokes, heart attacks and diabetes which all are diseases mostly dependent on diet. Thanks to our program, students can identify what are healthy fats, that hydrogenated oils are bad for you and that too much sugar can cause diabetes. They know why vegetables are healthy and not just that they should eat them. Most importantly, they are more willing to try new foods. Before, students only ate things because they tasted good (and they still do) but now they know how to make healthy choices on their own because we told them how to read food labels and what nutrients are essential, and opened their eyes to all the dirty secrets of processed foods.

Luckily, things are looking up for the Waverly community. They worked very hard to get a brand new $30 million building — the first new school building for Baltimore in 15 years. Next year they will actually have a gym, science labs and enough room to fit 900 kids — more than double the enrollment now. With a building that has safe drinking water they can actually get a salad bar and wash their fruit. They will have an actual kitchen that doesn’t just re-heat food but will be equipped with real cooking utensils. They will have a real gym and a real playground to run around in. With more than double the possibility for funding, they will be able to hire science, health and P.E. teachers and finally will have the resources and opportunities to excel in life.

A picture of the after school club, self-named “The Healthy Society,” cooking with Chef Ty from Bon Appetit.
May 02
0

I Bike, You Bike, We Bike, He/She Bikes!

By | Health, The Global Is Local | 2 Comments

(The third in a Spring series about bicycling in Baltimore: Who should do it, how, and why?)

Welcome back, whether you are bike-aholic, bike-curious, or bike-phobic! I hope you have enjoyed following the biking series as much as I have enjoyed researching and writing it. Today’s post will be the final in this series, but don’t worry, there will be additional bike-related commentary in this space in the future.

First, Who should bike in Baltimore?

Leading by Example: Mayor Stephanie Rawlings Blake, courtesy of her Twitter feed

Well, if you have read the previous posts in this series, B’more Bike Friendly and Bikemore in Baltimore, you may have gotten the sense that I advocate for more biking by more people. If that hasn’t come through, let me take this opportunity to state clearly that I think everyone ought to bike in the city. If you feel like you want to be connected and informed and involved with the place you live and work, it’s important to experience it outside the sterile environment of your car.

You may or may not already be pedaling your heart out, but that doesn’t mean you can’t be convinced. According to Chris Merriam of Bikemore, there are some accepted statistics about who is and isn’t likely to bike.

The 1%: These people will bike anywhere, anytime. Fearless, possibly a little obsessed, they probably have a giant stash of bikes in their hallway.

The 9%: Confident but Cautious. We in this group, while glad to bike most places most of the time, are willing to admit that there are times and places that biking is not appropriate. Some roads are not safe, some weather isn’t worth it, and sometimes we’re tired and don’t feel like it.

The 60%: Interested, but Concerned. You know how, you may own a bike, you may bike on protected bikepaths in parks, but there are some barriers to making the jump to occasional bike commuter or city cyclist- concerns about safety, for instance.

The 30%: Not Interested. No thanks, no matter what. Chris tells me that he thinks this is OK, not everyone needs to bike, he is interested in focusing on the 60%. Education about sharing the road and biker awareness are his interventions for the 30%.

Second, How should people bike in Baltimore?

As we said over the past two columns, there are some safety concerns about biking in an urban environment, so my answer to this would be: Carefully. If you aren’t biking often or at all, but are willing to give it a shot, there are a few ways to try it in a safe and supported environment.

– Bike To Work Day is on May 17th, and there are convoys that will meet at points all around the city to bike in to the downtown area in the morning. They are listed on the Baltimore Metropolitan Council site, join up and ride in! Throughout the city will be stations offering bike maintenance, breakfast and coffee, and educational materials.

– RecRide and BikeJam is a Bike MD event on May 19th where bikers can get out and see the city before coming together for music and food in Patterson Par.

– Bikemore Homebrew Tour is this Saturday, go register, we can bike together and sample local beers!

– Baltimore Bike Party will almost certainly be on May 31st, since it’s always the last Friday of every month.

After you try one of these group events, some recreational cycling is just a short psychological leap, and after that you are well on your way toward joining the happy bike commuters of Baltimore.

Finally, Why should you (or anyone else) bike in Baltimore?

We’ve touched on this before, and I won’t belabor the point. There are substantial physiological, psychological,  and economic benefits to exercise in general. Biking or walking to work magnifies those benefits while contributing to the health of the neighborhood, city, and world. Taking cars off the road during commuting hours is extremely important for local emissions reductions and global environmental sustainability. With billions more people in the developing world joining us in clogging up the roads with lungs and our lungs with their toxic emissions, the global and local truly come together at the spokes of a bicycle wheel.

It’s Spring, go out, get connected, and save the world!

By the way, the new banner by Hasdai is awesome, isn’t it?

Also, shameless self promotion- Pottery Sale in Annapolis on Saturday.

Apr 29
0

What’s in a Name?

By | Health | No Comments

One of the biggest criticisms of the Affordable Care Act is that health insurance premiums will rise. The cost of premiums has already increased up to 4 percent in the past year. So is the ACA living up to its name? Let’s take a closer look.

Last Tuesday, the Maryland Insurance Administration released rate proposals from insurers for the new exchange in October. In the proposals, from a wide variety of insurers, new plans are the only ones that see a rate increase. This is because insurers are expecting the newly insured people in 2014 to be sicker so they plan to charge more. This also represents one of the major faults of our current health care system — those who are sicker are less likely to have access to care. Fortunately, many of the people who will be buying new plans (about half of the newly eligible in Maryland) will be able to receive subsidies to help pay for care.

Though insurers are saying the additional 12 percent of currently uninsured Marylanders is going to cost them more, the individual mandate was what insurance companies negotiated for in the first place in return for accepting people with pre-existing conditions and giving up recessions of coverage. Plus, the current rate proposals are not just estimates, but they also must be approved by the insurance administration. A major regulatory rule of the ACA (also known as the Medical Loss Ratio) requires 85 percent of group plan costs (80 percent for individual) must be spent on medical coverage or quality improvements instead of administrative cost. If they don’t follow this, they must give customers a rebate.

The newly 32 million people who will be getting health insurance in 2014 may be sicker yes, but that doesn’t mean they won’t be relatively easy to care for. Most of these people don’t have insurance because their job doesn’t provide them with it, not because of deathly pre-existing conditions. Most of these people will most likely be sick with diabetes or cardiovascular disease — two of the most common causes of morbidity and two illnesses that are relatively easy to control with proper medication. This thinking just comes from my experience as an EMT and as a volunteer with Charm City Clinic.

What’s more is that the ACA has provisions that target increases in premiums. For the first three years of the exchanges, the reinsurance program will help pay for the higher cost of newly insured sicker patients and the temporary risk corridors program will help protect inaccurate rate-setting. The law also sets limits on cost-sharing or charging healthy young people more to pay for the sick older people. Previously, the difference had been 6-to-1 but now will be at most 3-to-1. It’s true that some people may start paying more for health insurance, but they are also more likely to receive better insurance too since Obamacare mandates minimum required benefits.

As I’ve said before, Obamacare focuses on access to care rather than cost control, which makes its official name  — the “Affordable Care Act” — very misleading. In addition to increasing medical prices, the biggest obstacle so far for Obamacare is getting the word out about eligibility for insurance and subsidies. The exchanges are supposed to ready to go in October, so pretty soon we better start seeing some kind of major outreach. So much of what Obamacare promises is still just speculation; it’s hard to know where it will end up. But we do know one thing is for certain —  Obamacare gives the opportunity for millions more of the neediest people to have access to care when they otherwise wouldn’t.

IMAGE CREDIT. www.business2community.com.
Apr 18
0

Bikemore in Baltimore!

By | Health, The Global Is Local | No Comments

(The second in a Spring series about cycling in Baltimore: Why planning for strictly vehicular travel makes pedestrians and bicycles an unwelcome nuisance rather than a welcome expectation.)

In my last column, we began discussing the bicycle culture of Baltimore. Recently, I had the chance to continue that discussion with Bikemore Executive Director Chris Merriam and Board Member Dave Love. I asked Chris to frame the relationship that bicycling has with public health, how one impacts the other, and how Bikemore’s efforts are designed to improve both the health of the community and the acceptance of bicycles on Baltimore streets.

“There’s a huge public health aspect to what we do,” says Chris, who was recently award an Open Society Institute Fellowship to further Bikemore’s mission of advocating for cycling and cyclists’ rights in Baltimore. “Cycling is a means of addressing the obesity problem in Baltimore — and all over the country of course. This is a working class city, though. It’s not like Washington D.C. or San Francisco. Not everyone belongs to a gym or eats healthy food all the time. The corner store diet of chips and soda is such a pervasive issue here.”

Chris has a background in urban planning, which informs his perspective. He agrees that our transportation system is a major component of public health, and a major obstacle to improving it. “We have a substandard [public] transportation system. For instance,  I’ll see people waiting for hours at a time for buses that will take them to work. A lot of the job sprawl in the area is such that many jobs for lower income people are in suburban malls, in Towson or Whitemarsh. Using public transit, depending on where people live, can take a long time: take one bus, take another bus, take the light rail, and there’s a lot of waiting around in between.”

And yet, despite the obvious advantages of a more bike-friendly city, Bikemore and other bicycling advocacy groups are trying to counteract 80 years of car-based engineering on our cities. Designing both vehicles and cities for strictly vehicular travel makes pedestrians and bicycles a nuisance rather than an expectation, and that is reflected in driver attitudes. Often the relationship between bikers and drivers is fraught with animosity.

Dave thinks that this may change due to sheer volume of bikes on the road, remembering his time in Berkeley, California: “Regardless of where I’m going, there would be three or four people on the same path, at a stop light five or six bikes back up. We wait just like traffic…If we got enough people on the roads, we could be looking at a sea change.”

But getting Baltimore drivers not to see red when they see a skinny person in spandex “in the way” is more than just a matter of numbers. Culture has to change too, and Bikemore realizes that Baltimore is a city with its own needs, and certainly its own culture.

People cite Portland as the ultimate case study. But remember, Portland is largely homogeneous, doesn’t have a lot of conflict, has a lot of taxpayers, is relatively young, etc. We can learn lessons from other cities, but we need to be wary of the ‘if they can do it, why can’t we?’ game.

Chris and Dave believe that these problems can be solved, but it will take effort on three fronts: education, infrastructure, and policy. They are leading in all three of these areas, but if you see the Bikemore sign around town, you are seeing education in action. Whether it’s a Bike Valet stand at the Food Truck Gathering or a presentation to a group of innovators at a conference like Reinvent Transit, Bikemore is constantly encouraging awareness and mutual respect between bikers and drivers.

Housekeeping: I wanted to address a couple of questions that came up in comments last time. First, the marked gender gap in bike commuters. I have two thoughts on factors that might be contributing to the disparity:

  1. It seems likely that there are safety-related differences in male and female biking behavior, as there are in many other activities. These safety concerns are related to both the perceived and actual intrinsic dangers of the activity itself and the external threats associated with being a single woman without a protective (vehicular) barrier. This study here comes to some similar conclusions, but I welcome any comments.
  2. There is reporting bias of some sort. This study from Stanford refers to a bias on survey forms that minimize or aggregate the kinds of trips that women tend to make (leaving aside the 50’s housewife stereotype slathered on the surface of the whole premise).

Second, how to get involved:

There are a number of groups that are active in the City, Bikemore being today’s obvious example. Velocipede and other bike shops and coops are all educators and advocates worth knowing, and of course join the Bike Party on the last Friday of each month.

Next Time: Who should bike in Baltimore, how, and why?

IMAGE CREDIT. Benson Kua
Apr 15
0

The Perils of Step-by-Step Healthcare

By | Health | One Comment

Medicare represents some of the greatest and worst qualities of our health care system. The positive is that it provides coverage for people over the age of 65 no matter what. After your 65th birthday you receive a little red, white and blue card in the mail that guarantees you can go see a doctor for little cost. The program serves many of our most vulnerable populations and has helped to bring many elderly people out of poverty.

On the other hand, Medicare is the foremost example of our fractured, piecemeal health care system that attempts to fix problems after they’ve occurred instead of trying to prevent them. Instead of having a simple, unified health care system, we rely on Medicare, Medicaid, non-profits and other charity groups to fill in the pieces when people don’t have employer health insurance. Medicare was built one part at a time, just as our health care system and just as Obamacare are being phased in year by year.

When Medicare was introduced into the Social Security Act by President Johnson in July 1965, the program consisted of two parts – A and B. Part A covers 80 percent of hospital costs. Part B covers 80 percent of inpatient and primary care. This type of payment is referred to as cost-sharing. President Reagan tried to implement catastrophic coverage (Medicare paid for services up to a certain amount, depending on your income). So many protests resulted that he switched back to cost-sharing.

But, as you can imagine, paying for that extra 20 percent can get pretty costly. So Part C was introduced in 1997 to help both the elderly and private insurance. If you decided to enroll in part C, or Medicare Advantage, you would choose to pay a higher monthly premium instead of that 20 percent. During this same time, the Sustainable Growth Rate was implemented, which was intended to limit the increase in cost of doctor’s services, but has been suspended every year since 2002.

This lack of control added to Medicare spending, and so did the last part of the program, Part D, which covers drugs. But even this provision left coverage incomplete, with many people trapped in a “doughnut hole” with high out-of-pocket costs. So even with these four parts in Medicare coverage, you’re still paying quite a bit for your comprehensive coverage. Fortunately, if you’re low-income you can apply for more assistance or even qualify for Medicaid which will pay that 20 percent.

If you’re living with a disability, you also qualify for Medicare, but if you have a work history you may have to wait for up to two years. If you don’t, you will also qualify for Medicaid. Either way, you’ll need to lawyer up.

Yet, one of the greatest parts about Obamacare, is minimizing the out-of-pocket costs for Medicare beneficiaries. The law phases in rebates for drug costs, free primary care services and ways to improve quality of care. The biggest benefit is drug coverage as eventually, it will be 75 percent covered and will save people a lot of money since those pills can add up.

Nonetheless, since the law was enacted, Medicare has still been subject to changes because of sequestration by capping reductions to payments and limiting out-of-pocket expenses.  Fortunately in Obama’s plan, the “doughnut hole” will be closed by 2015 instead of 2020 and (unfortunately for hospitals) teaching hospitals and hospital debts will be paid less. Another controversial new provision is having wealthier Medicare beneficiaries pay more. Others have proposed Medicare changes but none offer Obamacare’s biggest addition to the program – the elimination of the “doughnut hole.”

All these changes and back-and-forth make it even harder for Medicare beneficiaries to understand. Drug coverage for this vulnerable population could mean saving an extra few hundred dollars a month, or more importantly an ER scare. I doubt most Medicare beneficiaries follow health reform closely and if they do, I bet they’re still confused about what pieces are going to be implemented that will affect them. Like our health care system, we need a concrete plan that will curb costs and improve quality of care in place of making changes step-by-step as things go wrong. Step-by-step, day-by-day doesn’t work. What we need is a fresh start!

IMAGE CREDIT. seniorjournal.com.
Apr 02
0

Happy Birthday, Obamacare!

By | Health | No Comments

Happy Belated Birthday Obamacare! In just three little years the Affordable Care Act has made some big changes but has a whole lot more to do. All of the law’s provisions won’t be in full effect until around 2020 but that doesn’t mean the law hasn’t made a big impact already.

Most of us have heard that the law has put a tax on using tanning beds, provides free preventative services, lets young adults stay on their parent’s insurance until the age of 26, will require everyone to buy health insurance, and will create health insurance marketplaces called “exchanges.” Most people don’t know the bulk of what the law has done, so in celebration of the birth of Obamacare, here’s just some of what this ambitious law has accomplished. A full list of the ACA timeline can be found here.

Prevention is worth a pound of cure…

A lot of what Obamacare has focused on in the past three years is preventative services. In its first year the law created the National Prevention, Health Promotion and Public Health Council which passed the National Prevention Strategy and the law required any new health insurance plans to include minimum prevention services. It’s been a good few years for primary care doctors too, as their programs have received billions of dollars in funding and new residencies were added for primary care in an attempt to draw more pre-meds to a sorely under-staffed field. In the past few years the ACA has also focused on workplace wellness as it provided grants to small employers with a wellness program, and tax credits to large employers who invested in certain treatment projects.

While all this has been going on, the only thing that the average person might have noticed is new nutritional info on vending machines and at chain restaurants. But even more monumental changes have been made to the two heavyweights of America’s healthcare system – Medicare and Medicaid. A massive assessment of services is underway with the creation of the Medicaid and CHIP Payment Advisory Board. More immediately, the federal government has allowed states to begin to offer home and community-based services through Medicaid, which means more senior centers, transportation, home health aides, meal delivery or anything else that can help someone remain independent living at home.

Closing the doughnut hole…

As for Medicare, one of the biggest changes was tackling the prescription “doughnut hole.” In 2003, when the Bush administration added Medicare Part D to provide for certain types of drug coverage, the provision did not help pay for annual drug expenses between $2,250 and $5,100. Starting in 2010, Medicare patients started receiving $250 in rebates for brand name drugs, and then the following year they could get a 50 percent discount plus federal subsidies for generics. This year they can receive federal subsidies for brand-name drugs. Doughnut hole closed!

Figuring out how we pay for it all…

A lot of the ways in which the ACA is being funded (about 50 percent of it) is through Medicare and many of these funding changes occurred within the past three years. Some of this is funding received through trying out other models of payment instead of fee-for-service such as bundled payment programs and Accountable Care Organizations, which have recently been piloted. Other funding comes from an increase in Medicare Advantage premiums and a decrease in federal subsidies for this program, as well as a reduction in payment for Medicare patients who have been recently re-admitted to the hospital. This year too, wealthy elderly had a Medicare tax increase of 0.9 percent to help pay for the law.

And what it means for you…

For the future, a big obstacle will be getting the word out! The changes that affect everyone (the individual and employer mandate, exchanges, tax credits, Medicaid expansion) begin next year. Don’t delay! Now’s the time to educate yourself about how you’ll be affected and what your options will be. For all of Obamacare’s limitations, you’re sure to find it’s more than a party favor.

IMAGE CREDIT. Foxnews.com.
Mar 22
0

When Government Lets Us Down

By | Health, The Global Is Local | No Comments

If you have read a few of my posts over the past couple of months, you have probably realized I’m in favor of government; I think it has a place and serves valuable functions. A few of my favorite examples (when done right) are the regulation of pollution, the oversight of food, chemical, and product safety, and police forces committed to protecting our rights.

It is distressing, therefore, when this entity that provides us the space and safety to be here — the government — doesn’t do its job, namely to protect the citizens. Because I spent many hours looking at hopeful and uplifting HIV/AIDS news earlier this month, it was particularly sad to see that the ongoing budget battles will cut funding that provides therapeutic interventions for the most vulnerable AIDS patients in this country — the poor. As we learned last time, HIV/AIDS has a disproportionate impact in Baltimore. Global AIDS funding is being cut as well, despite earlier presidential promises to the contrary. This is unfortunate, since international AIDS funding gets far more bang for the buck, so to speak, and addresses regions where the need is incomprehensible to us here in the U.S.

Just to balance things out, however, there is an initiative taking place in the Oliver neighborhood that is essentially a blitz of Baltimore City services –– filling potholes, installing smoke detectors, offering access to drug rehab services, arresting drug dealers who frequent the area, and removing trash and debris. Whether or not this is what the neighborhood needs to pull out of its perpetual slump is uncertain, and probably a matter of opinion. Clearly, though, the reason for engaging in this effort is at least an attempt to make life better for the residents, which is the role that government ought to provide.

A  couple of updates in the “You Heard It Here First” category:

SARS Redux? recalled the Severe Acute Respiratory Syndrome (SARS) epidemic of 2003 and drew an uncanny parallel to an emerging coronavirus that has been causing an alarming respiratory condition in several patients in the Middle East. Several recent news items have called attention to this condition, confirmed that it has the potential to spread from person to person, and traced the spread from the Arabian Peninsula to the United Kingdom.

Outbreak discussed the nationwide fungal meningitis outbreak linked to contaminated pharmaceutical products made by the New England Compounding Center.  The outbreak is expected to continue to cause illness and death across the 20 states affected. The supply chain that provides us with the medicines we rely upon should remain under close public scrutiny or be expected to fail again.

Next time: Biking in Baltimore: awesome, terrifying, or obvious choice?

Unrelated sidebar: If you are interested in trying your hand at pottery, and possibly discussing health, politics, food, and the environment with yours truly, check out the Mesh Baltimore site this week.

IMAGE CREDIT. Library of Congress Flickr Photostream.
Mar 19
0

A Brief History of Belt-Tightening

By | Health | No Comments

When Barack Obama announced health reform as a part of his first presidential campaign, the cost of healthcare was never a major priority. Expanding coverage was always the main intent despite the fact that the United States spends more on health care than any other country in the world, reaching almost three trillion dollars or about 17 percent of the nation’s GDP. So if you’re going to attempt comprehensive health reform, why wouldn’t you have cost control included? If you take a look at other attempts of cost control in the past, you can see how the piece-meal attempts have not gotten close to fixing the problem.

The last time a president directly controlled health care costs was in 1971 under President Nixon with his executive order to freeze wages and prices. His Cost of Living Council allowed physician’s fees to increase by only 2.5 percent a year but its authority expired in 1974. The council however, did spark in interest into looking at how hospitals were paid, which were at that time on a per diem basis. The department of Health, Education and Welfare then came up with a payment system based upon diagnosis, now called the Diagnosis Related Grouping (DRG) system and widely used throughout the world. In 1984 Medicare adopted DRG, which is based upon the average cost of treating a patient per a particular diagnosis. During Nixon’s time in office Medicare also changed to have a regulated room and board cost to all hospitals and limited the per diem cost, which was not regulated. Yet, eight states at that time decided to control the rates that Medicare paid to hospitals, and today Maryland is the only state left standing.

After Nixon sparked the idea of health reform and cost containment, President Ford attempted a unique approach. Under the National Health Planning and Resource Development Act, local planning agencies were created to approve new facilities or buy expensive equipment. The agencies were presented with Certificates of Need (CON) to determine if spending was appropriate. The program was inefficient as CONs sometimes were too hard to get, and was eventually eliminated under President Reagan.

Then we have President Carter who was ambitious with his attempt at cost control. Twice during his presidency his proposals for limiting hospital’s total revenues were defeated. At this time, congress must have been feeling pretty optimistic as they agreed to have hospitals voluntarily contain costs. And that policy is still in use today.

The next attempt at cost control was under the Balanced Budget Act of 1997 that proclaimed physicians’ fees would decrease in the future if they exceeded a targeted amount set the previous year. It was enacted for the first two years, but since 2002 congress has postponed the decrease each year and has even allowed small increases. So much for that!

From past attempts at controlling costs, it was obvious a total re-haul of health care spending would be difficult. Obama knew he had to start (somewhat) small to pass something. Though it was an absolute battle to pass, it was a walk in the park compared to what could have been, or what could have never happened at all.

Nonetheless, Obamacare has a few provisions that will feebly attempt to control costs, mostly through regulation of insurance company administration costs by adopting a set of standards (all effective by January 2016) and through Medicare. Medicare Advantage plans have been greatly subsidized in the past, but will be greatly reduced by 2019. Also, the Independent Payment Advisory Board (IPAB) will establish growth spending rates by 2018 and will decrease funding if Medicare exceeds this target.  The other provisions allow for tests or trials to control, such as centering care around primary care physicians, which is why many preventative services are free of cost.

Most of the cost control attempts in Obamacare are experimental. And USA Today claims that in the past three years Obamacare has slowed health care spending growth. Others would strongly disagree. Considering we spend the most on health care in the world, and have the 38th best health system (it makes me cringe to say this), Obamacare is better than nothing.

IMAGE CREDIT. Emory University.