In this issue:
- Perspective: Health reform & why we vote the way we do, by Leo Greenawalt, CEO, Washington State Hospital Association
Perspective: Why we vote the way we do (or “Health Care Reform. Quality. Availabilty. Price. [PICK 1″]
By Leo Greenawalt, CEO, WSHA
Charles A. Pilcher MD FACEP, Editor
Editor’s Note: This month’s guest“Perspective” comes from Leo Greenawalt, CEO of the Washington State Hospital Association, and appeared in a WSHA newsletter November 10. It is republished with his permission. For further reading, I recommend “The Healing of America” by TR Reid. The first two chapters claim that the major issue for America is to acknowledge that our problematic health care system represents a moral challenge. The middle chapters describe the author’s personal experience with health care systems in other developed countries, and the latter chapters offer ideas for change. Currently, we have quality and access for only certain population groups, and prices are unsustainable.
Following the November 2 elections, one might wonder what will be the effect on health care reform. The Kaiser Foundation and the California Hospital Association have each completed a poll of American voters’ opinion on health care reform and how it affected their vote. Both surveys showed similar results: After straight “party voters,” the candidates themselves, and the economy/jobs, health care ranked fourth at 17 percent as a determining reason for their vote.
Confusion. More than half (56 percent) had an unfavorable view of reform legislation. But this is where it gets tricky. Why they don’t like it and what lawmakers should do are totally unclear. About one quarter of voters favor each of these options:
- Repealing the entire health reform law
- Repealing parts of the law
- Expanding the law
- Leaving it as is
Who says the voters have spoken on health care reform? And if they have, what the heck did they say?
Far From a Mandate. Voters split sharply along partisan lines. Two-thirds of those who voted for Democratic candidates want the law expanded or left as is, while 80% of those who voted Republican support full or partial repeal. For Congress and the President, the results could not be worse. The left is angry and feels the legislation did not go far enough. The center seems to blame Democrats for creating a mess. The tea party appears to be equal opportunity fault-finders – blaming anyone who took part in the voting – on either side.
What Next? The race for the presidency in 2012 began last week. Mitch McConnell (Senate Republican leader) announced his principle goal was to remove President Obama from the White House – no compromise. Democrats have begun to lay out to Americans what they foresee when Republicans take over the House: seniors will lose the doughnut hole funding, the insured will lose insurance if they get sick, and college-age kids will no longer be covered on their parents’ policy.
Gridlock? Once again, a rational discussion of health policy will likely get relegated to the junk heap. This, despite universal agreement what we have is an unsustainable system of finance and delivery. Maybe we are near the final step in the process that Winston Churchill described when he said, “Americans can always be counted on to do the right thing…but only after they have exhausted all other possibilities.”
OK to delay surgery for appendicitis
Following up on an earlier article in Medical Malpractice Bulletin, an article recently published in Archives of Surgery goes into further detail regarding the results of appendectomy with immediate or delayed appendectomy. Key takeaway: Delay of surgery for even 12 or more hours made no clinical difference in outcomes. There is also a summary of the paper published by Medscape.
Death rate from strokes in US hospitals falls 26%… REALLY???
According to data from the US Agency for Healthcare Research and Quality, the death rate from strokes declined 26% between 2002 and 2007. According to Roxanne Andrews, a senior researcher at the agency, the numbers reflect advances in the care that patients receive in hospitals. However, a closer look reveals that there were 125 deaths per 1000 stroke patients in 2002 and 92 deaths per 1000 stroke patients in 2007. So, in the “old days,” 12.5% of patients died of a stroke. Now 9.2% of people die. If one subtracts 9.2 from 12.5, the result is 3.3. While stroke care has significantly improved over the past decade, these numbers suggest the benefit is less dramatic than reported. The first figure is “relative benefit.” The second is “absolute benefit” (a subject of a previous “Perspective” in this Bulletin.) While stroke centers have proven effective, there is still debate, according to a study from the Mayo Clinic, on whether they are “cost effective.”
ABCD3-I Score May Improve Risk Stratification After Transient Ischemic Attack.
A recent Irish study in Lancet Neurology by Dr. Aine Merwick et al. reports that addition of the results of carotid artery imaging following TIA gives a better predictive model for stroke risk stratification. The new 13 point scale might replace the ABCD-2 score if follow-up studies confirm the findings.
Medical care guidelines are good, but only if the docs agree they’re good
Peter Orszag thinks that physicians following evidence-based guidelines might reduce the incidence of malpractice, or at least immunize those physicians from liability if the guidelines were followed. Problem: Even doctors can’t agree on what practices truly are “evidence-based.” Look at the stink caused when mammography recommendations were changed earlier this year. Many disagreed, and nothing changed. Or PSA testing for prostate cancer. Again, little agreement. If docs can’t agree amongst themselves on what is good practice, malpractice attorneys should not have to worry about unemployment.