http://www.chrt.org/home/ http://www.chrt.org/blog/the-berwick-confirmation-and-irrationality/#PageComment_493 Well said, Marianne! Thu, 08 Jul 2010 14:32:29 -0400 Debbie Reinheimer http://www.chrt.org/blog/the-berwick-confirmation-and-irrationality/#PageComment_493 http://www.chrt.org/blog/smorgasbord-anyone/#PageComment_464 I agree with the good Dr. Woll's assessment of health care 'reform'. Although I was initially pleased to see at least something happen, I am not sure if what is before us will represent any real progress, or as Dr. Woll put it, "the attention will now be on the trees and not the forest". I am worried the public will think there has been 'reform' and when nothing substantially changes for the better, the plans for eventual real reform will be doomed. Too bad something that is SO important for our country got lost in politics, spreading of untruths and fear, and an obvious inability of the leaders to come together for the good of society. Thu, 17 Jun 2010 09:06:42 -0400 Karen McGrath http://www.chrt.org/blog/smorgasbord-anyone/#PageComment_464 http://www.chrt.org/blog/the-health-care-industry-in-michigan-staying-on-the-open-road/#PageComment_386 Dr. Pescovitz correctly frames the two paths which health care in Michigan might take. Unfortunately, despite nominal efforts being made toward collaboration, the overwhelming preponderance of evidence indicates that intense competition will be the road actually traveled. One only has to turn on the television, look at the billboards, gaze at the health care facilities being built or marvel at the establishment of all the new medical schools to realize that competition, not collaboration, will be the order of the day. There are at least seven major health systems in Michigan all now vying for the "gold medal" of health care in Michigan (i.e. "come or refer to us because we have the best doctors, the most modern buildings and the most advanced technology!!!"). Given the economic conditions of the State and the ongoing "out migration" of its citizens, the State can probably only support three, or perhaps four, at most. The waste, fragmentation, inefficiency and duplication of this "medical arms race" ultimately contributes to confusion, suboptimal quality and escalating costs. Collaboration appears to be like acetaminophen , it reduces pain and makes you feel better. Competition however, appears to be more like morphine, in addition to really reducing the pain and really making you feel better, it is addicting and we all know how hard that is to overcome. Tue, 25 May 2010 12:42:15 -0400 Douglas R. Woll, M.D. http://www.chrt.org/blog/the-health-care-industry-in-michigan-staying-on-the-open-road/#PageComment_386 http://www.chrt.org/blog/a-new-theory-of-health-insurance-preventive-care-and-health-care-reform/#PageComment_251 Sadly, we continue to miss the obvious, simple (though not easy) solution to the healthcare finance crisis: Tie the individual premium for health insurance to the patient's health behaviors. Smoke, be sedentary, eat unhealthy-pay $1500 a month. eat well, avoid substance abuse, run a mile in 9 minutes, pay $350 a month. Money motivates. Consequenses need to be attached to the individual. preventive health pays only when the individual, not the doctor is responsible for (primary) prevention. the obesity, diabetes and cardiovascular epidemics follow the same exponential increase curves as medical costs, and all pass the apex of the curve in 1985, 15 years past the medicare and HMO acts. just like smoking and lung cancer for men post ww1 and women post wwII Tue, 04 May 2010 21:57:16 -0400 Gary Bullock, D.O., M.P.H. http://www.chrt.org/blog/a-new-theory-of-health-insurance-preventive-care-and-health-care-reform/#PageComment_251 http://www.chrt.org/blog/a-challenge-and-an-opportunity-health-reform-at-the-state-and-local-level/#PageComment_222 Great post, Marianne! Dependence on states and local communities (and of course the IRS) is likely to bog down the bureaucracy associated with implementation of PPACA. I would have preferred to see a single-payer plan (sigh). Jim Wed, 28 Apr 2010 17:11:17 -0400 Jim Mitchiner http://www.chrt.org/blog/a-challenge-and-an-opportunity-health-reform-at-the-state-and-local-level/#PageComment_222 http://www.chrt.org/blog/a-challenge-and-an-opportunity-health-reform-at-the-state-and-local-level/#PageComment_220 Excellent! Wed, 28 Apr 2010 14:37:42 -0400 Suzanne fleming http://www.chrt.org/blog/a-challenge-and-an-opportunity-health-reform-at-the-state-and-local-level/#PageComment_220 http://www.chrt.org/blog/advancing-social-justice-and-equity-the-federal-state-balance-in-health-care-reform/#PageComment_200 Whatever happened to State rights and the ability of individual States to set their own policies, allocate their resources in the way they see fit and develop unique and innovative approaches to complex problems? Some States may do this well and some may not but that is fundamental to how our Country is supposes to operate. Marianne gives us an insightful history lesson but lets go back a bit further, to the establishment of the country. The "Founding Fathers" (i.e. the Constitution) gave the States "power" over everything not specifically delegated to the Federal government. One of the key debates surrounding the new reform law is whether the Commerce Clause can "trump" the rights of States to set their own health care policies, an issue that will ultimately be decided by the Supreme Court. There is an assumption, that the Federal government is better at setting health care policy than the States. Remember that the Federal government has given us a Medicare system that is destined to be bankrupt in the not too distant future and a Medicaid system, which, for all intents and purposes, is already bankrupt, both financially and "spiritually". One should also not forget the almost unbelievable amount of rules, regulations, restrictions, etc. that govern the operation of these programs. Having the States take the lead in setting health care coverage and policy decisions for its own citizens may, in the end analysis, be a more prudent and fruitful approach to improving the health care system and the health of its population. There is a common saying among health care experts and industry leaders, "all health care is local". We should remember this when thinking about this vexing issue. Sat, 24 Apr 2010 09:45:55 -0400 Douglas R. Woll, M.D. http://www.chrt.org/blog/advancing-social-justice-and-equity-the-federal-state-balance-in-health-care-reform/#PageComment_200 http://www.chrt.org/blog/a-new-theory-of-health-insurance-preventive-care-and-health-care-reform/#PageComment_139 As Marianne correctly points out, the nature of insurance coverage has been changing for several years and has more or less now been "institutionalized" with the passage of health care reform. It is also correct to say that despite the intuitive attactiveness of the theory that "more prevention leads to healthier individuals leads to less costs", this notion is probably not true given statistical analysis of whole populations, etc. More to this latter point, unless there is real change toward healthier behaviors and lifestyles among individuals at risk for disease or who are in the early, treatable phase of their disease process, then even the best insurance coverage, with or without coverage of preventive services, will do nothing to improve health or lower costs. Insurance coverage is often necessary but never sufficient in improving one's health. Wed, 14 Apr 2010 16:57:35 -0400 Douglas R. Woll, M.D. http://www.chrt.org/blog/a-new-theory-of-health-insurance-preventive-care-and-health-care-reform/#PageComment_139 http://www.chrt.org/blog/health-reform-and-its-aftermath-time-for-a-civil-and-truthful-dialog/#PageComment_96 Well, well, the wool certainly has been pulled over your eyes ! The Health Care Bill will put everyone into a government run system where all decisions about health care will be made by federal bureaucrats and NOT health care professionals. It will provide for rationing of health care to senior citizens,probably other classes also, free care to illegals and free abortions. The legislation also provides for access to all of your personal health records and personal financial information. If you decide not to have this, or if you have private coverage, there will be a TAX imposed on you!! This Bill has so many violations of the Constitution in it,I can't believe it was passed ! Congress Does not have the authority to legislate ANY of this and hopefully it will be repealed. Wed, 31 Mar 2010 15:12:57 -0400 J. B. Madill http://www.chrt.org/blog/health-reform-and-its-aftermath-time-for-a-civil-and-truthful-dialog/#PageComment_96 http://www.chrt.org/blog/health-reform-and-its-aftermath-time-for-a-civil-and-truthful-dialog/#PageComment_94 The Uncivil Right speaks uncivilly but it is worth a try to communicate about principles. Tue, 30 Mar 2010 21:12:43 -0400 Billips http://www.chrt.org/blog/health-reform-and-its-aftermath-time-for-a-civil-and-truthful-dialog/#PageComment_94