to be or not to be

I am torn, as this week winds down, between desperately wanting some health reform to go through and realizing that without a public option, some cost controls and expansion of Medicare, I will be supporting a bloated and insolvent system into the future. The insanity of the politics right now lead me to believe that a bill needs to go through no matter what since the arguments opposing health reform are so circular. The same folks that oppose government health care, oppose any cuts to it.

So, I am leaning toward passing the reform measure, complicated and more than a compromise, because it opens the door to continuing the movement toward real change. If the door closes now and there is a move to scrap and start over, I believe that history shows that it takes about 10 years to get it back on the table. The public is usually so confused and forgets until the next economic crisis how difficult the healthcare structure is to maintain.

I sound like a progovernment liberal. I am liberal, but having been in healthcare and more importantly having lived for almost 25 years in Illinois, I am not blindly pro-government. I am however, pro- getting the goals right and then the charter language that ultimately drives the design right and get to the details later. Right now I don't think the private sector can take the high road on having the goals or the guiding principles right. So it is a toss up and I am tossing my cards toward "the beginning of change is better than none".

Trends I hate

This is just personal venting. I hate camera phones being everywhere. Its creepier than the satellite mapping my front door (big brother!). It seems that everywhere you go and everything you say has to be screened - forget spontaneity. Every audience has a potential coward who wants to catch your thoughts for sound bites- not to have a legitimate debate or respectful discussion but as a gotcha. Every party has an opportunitst that would love to catch you talking with your mouth full! It just seems so intrusive - a technology gone awry! I feel the most sad for my teens where every thought is on facebook and every mistake is caught on camera for all the world to enjoy...

And I hate the self righteousness of those who throw them in your face and act surprised and superior when you are defensive and unresponsive. So next time you think its your "right" to capture what is being said, maybe you should think about listening to the speaker instead and keeping your phone in your pocket.

Luckily this is not about me....its bad enough watching it happen to others! So what do you do...as one of the Sisters I used to work with said to me....always speak from the heart and you don't have anything to worry about.

2009 Countdown!

The Top 10 most memorable moments of 2009


Number 10 -Ironic moments in reform: Medicare recipients marching on townhalls protesting Government run healthcare with slogans like "Keep your hands off my healthcare". (Anti abortion activist (Rep Michele Bachman) use "keep government out of your healthcare decisions".

Number 9 - Bizarre moments in healthcare reform: Public option taken off the table in favor of the private system that has left 44 million people uncovered.

Number 8 - Sad moments in reform: Senator Kennedy's death during this historic debate.

Number 7 - Illogical moments in reform: Republican deficit hawks complain about "rationing" (evidence based medicine) as Medicare sinks deeper into insolvency. And Kathleen Sebelius can't support evidence based mammogram screening.

Number 6 - HINI declared pandemic - pictures of lines to get vaccines and people wearing masks in Mexico.

Number 5 - "Hellohealth" model and e patient healthcare getting attention from big players.

Number 4 - Senate approves economic stimulus bill which focuses attention on health IT incentives

Number 3 - Health bill passes house; first since Medicare

Number 2 - Bills make it out of Senate finance committee and Public Option is scored neutrally.

Number 1 --Hopefully we will see it in the next 15 days!

"The only thing I know for sure.....

is that we will be paid less." The quote by Jim Skogsbergh of Advocate Health In Crains Chicago Business seems to hit the nail on the head. Are your key strategies driving to significant cost efficiency?

More on e-patient

http://www.slideshare.net/NCurse/practicing-medicine-in-the-web-20-era-1207689?src=embed
RSS feed, google calendar, google health, pharmasurveyor.com, medting.com, webicina.com, pubmed searches, podcasts, hellohealth.com, ozmosis, linked-in physician searches, twitter, wordpress virtual education, genomic data, skype and webcam communication.

If there is anything on that list that you are not familiar with, sit down with a medical student and get an orientation.

The link is a great introduction and the most important comment in that slideshow is that the epatient will drive use of technology! Not your systems or your physicians. Check it out.

Ambulatory Care....its the patient stupid!

Trinity just reorganized their top staff to focus on ambulatory care. Ascension assigned a Senior Executive several years ago. Advocate has moved aggressively to organize their physicians. So what will all this effort, geared toward the new health reform agenda (or the old managed care model) need to focus on.
Ask the patient....as noted on his blog and on Health Leaders Media renal cancer patient David deBronkart took control of his healthcare in partnership with his doctor. He was an e-patient...finding his own answers and questions. What do epatients do? According to epatient David:
They look at their medical records online
They may share medical records with family and friends who know medicine
They use e-mail to correspond with their doctors
They are active partners with the various physicians involved in their care
They're often active in patient communities
They may become active researchers

and they walk if they can't get that kind of access!

This time it really is about the patient, not the institution. This may be the first real market the healthcare industry has ever really faced. And we do not know how to be patients as much as we try. We need to ask.