Editor's Note -
The only comment I can make about the preceding clipping is "Res Ipsa Loquitur".
-SPC
New health indicators for America: aiming to shift practice
Editorial - The Lancet - Published:February 01, 2020
Life expectancy, levels of disability and
mental health, prevalence of adverse childhood experiences,
immunisation rates, and the proportion of people voting as a measure of
civic engagement are among a set of new health indicators proposed to
monitor the health of Americans in the next decade.
34
indicators in total—including 15 novel ones—have been recommended by
the National Academies of Sciences, Engineering, and Medicine (NASEM) in
a new report
published on Jan 22. The document aims to inform the US Government's
Healthy People initiative, which each decade sets national goals and
objectives for health promotion and disease prevention. The final
version, Healthy People 2030, is due to be released by the Department of
Health and Human Services later this year.
The
new health indicators focus specifically on wellbeing and equity, and
examine “poverty, racism, and discrimination as root causes of health
inequalities”. They move away from directly measuring the health-care
delivery system's capabilities and associated metrics, to quantifying
how “people live their lives in the US—shaped by the broad context of
policies, systems, social structures, and economic forces”.
Interestingly, and in clear contrast with the current US
administration's beliefs about the climate emergency, two of the novel
indicators encompass measures relating to the health effects of climate
change.
Improving the health and
wellbeing of 327·2 million Americans equitably will require a quantum
shift in thinking: moving from a disease, intervention, and
hospital-based mindset to one rooted in improving the social
determinants of health—including education, housing, and the
environment. Such a change would undoubtedly bring improvements in the
health of many marginalised US residents who are currently unable to
afford costly treatments. NASEM's recommended health indicators will
provide a long-overdue and much-needed improvement in tracking US health
outcomes. They will provide a long-overdue impetus to bring the US
Government in line with the rest of the world's thinking about health.
These indicators should be adopted without question.
Most Iowa Democratic caucus-goers support a single-payer health-care plan
ByJeff Stein - Washington Post - February 3, 2020
Sanders has campaigned on a Medicare-for-all health-care system in which every American would be placed with a single government insurer, regardless of whether they want it or not.
Medicare-for-all supporters say their plan would give Americans security by guaranteeing that they have a government health plan, even if they get fired or lose their job.
Results from the Iowa Democratic Caucus were beset by delays on Feb.
3, but candidates still took the stage to talk about the fight ahead.
(Zach Purser Brown/The Washington Post)
The debate has proved to be a
defining fissure throughout the Democratic presidential campaign and led
to repeated clashes at the debates, with the moderate presidential
candidates accusing Sanders of adopting a dangerously unpopular position.Several Democratic presidential candidates backed Medicare-for-all at the outset of the race but eventually backed off amid heavy criticism and polling suggesting people like the private insurance they have.
The preliminary exit polls, conducted by Edison Research, found that 57 percent of Iowa Democratic caucus-goers support a single-payer plan, and 38 percent oppose the proposal to eliminate private health insurance, leading some single-payer supporters to claim they were vindicated.
“The conservative wing of the Democratic Party has been telling us voters won’t swallow Medicare-for-all once they learn they will lose their insurance,” said Matt Bruenig, founder of People’s Policy Project, a socialist think tank. “But these results show voters are ready for Medicare-for-all. What more is there to say?”
About 4 in 10 Democrats also said health care was the most important issue for them, making it the leading issue, followed by climate change. Health care also rates consistently as a top issue for voters in a general election.
Sanders led among supporters of single-payer health care, with about one-third of this group saying he was their first choice. Sen. Elizabeth Warren (D-Mass.) was in second position, with about one-quarter of their support.
Three years ago, several top Democratic lawmakers threw their support behind Sanders’s single-payer proposal. Sens. Kirsten Gillibrand (D-N.Y.), Cory Booker (D-N.J.) and Kamala D. Harris (D-Calif.), who all ran for president, appeared at a news conference backing Sanders’s legislation.
One by one, however, each of the Democratic senators who had co-sponsored the Medicare-for-all legislation distanced themselves from its least-popular provisions, such as the elimination of private health insurance. Harris, who faced accusations that she flip-flopped on the issue, has dropped out of the race, as have Booker and Gillibrand.
Warren initially aligned herself more closely with Sanders, saying “I’m with Bernie” when pressed on eliminating private health insurance.
Later, she released a plan that would first create an optional government public option and not advance a single-payer system for three years. That alleviated criticisms from centrists who said she wanted to move too aggressively, but garnered new attacks claiming she had waffled on the issue.
For conservatives, the move away from Sanders’s position remains a smart one regardless of the results from Iowa. A Washington Post-ABC News poll this summer found support for single-payer drops significantly, to less than half of Americans, when respondents were told that it would mean eliminating private insurance.
Another poll of Iowa voters by CBS News/YouGov last summer found that two-thirds of Democrats said they preferred a government health program that competed with private insurance instead of getting rid of it outright. Polling among all Americans has found that an optional government public option would be more popular than a single-payer plan.
“There is always a danger in listening to one half of one party when trying to win a general election. The lessons of 30 years of health-care reform are that incrementalism is really the only path,” said Brian Riedl, an economic policy expert at the Manhattan Institute, a right-leaning think tank.
A big chunk of the Democratic Party appeared to agree. Among those who opposed single-payer, former vice president Joe Biden and former South Bend, Ind., mayor Pete Buttigieg led, with each garnering support from about 3 in 10 among this group. Sanders and Warren received support from fewer than 1 in 10 in this group.
Opponents have also argued that single-payer would require prohibitive tax increases, with some think tanks finding that the government would have to raise an additional $30 trillion in revenue over 10 years to pay for the program.
Sanders’s plan proposes moving every American in the country to a single government-run insurer that charges no deductibles or premiums. Doing so would significantly increase government expenditures, while offering health insurance to Americans who lack it and preventing millions more from being forced into medical bankruptcy.
Sanders has said that his plan would be paid for in part with higher middle-class taxes but has said any tax increases would be offset by savings on insurance premiums, deductibles and out-of-pocket costs.
https://www.washingtonpost.com/politics/most-iowa-democratic-caucus-goers-support-a-single-payer-health-care-plan/2020/02/03/de4fe0f2-45f4-11ea-8124-0ca81effcdfb_story.html?itid=hp_hp-bignews7_storya-singlepayer-850a%3Ahomepage%2Fstory-ans
Would Your Wages Rise Under ‘Medicare for All’?
Research suggests the answer is yes, but not in all cases, and with significant differences across jobs and labor markets.
by Austin Frakt - NYT - February 3, 2020
Hidden in the larger debate over “Medicare for all” is a
fundamental economic question: Who pays for work-based health insurance?
For the 157 million Americans who get health insurance through their work — or through the job of a spouse or parent — the answer may seem obvious, evident right on pay stubs. Employers pay most of it, and workers pay some.
Last year, work-based coverage per person cost $7,188, with employees directly contributing 18 percent on average. Family coverage cost $20,576, of which employees paid 30 percent.
But what seems obvious isn’t always what’s correct. Regardless of what’s on your pay stub, many health economists believe that your employer’s contribution toward health insurance comes out of your wages.
For the 157 million Americans who get health insurance through their work — or through the job of a spouse or parent — the answer may seem obvious, evident right on pay stubs. Employers pay most of it, and workers pay some.
Last year, work-based coverage per person cost $7,188, with employees directly contributing 18 percent on average. Family coverage cost $20,576, of which employees paid 30 percent.
But what seems obvious isn’t always what’s correct. Regardless of what’s on your pay stub, many health economists believe that your employer’s contribution toward health insurance comes out of your wages.
So
will Medicare for all cause wages to rise if employers have to spend
less on benefits? Research suggests the answer is “yes,” with the caveat
that it may not be matched dollar for dollar for everyone. The precise
relationship depends on the nature of the labor market, which varies
across markets and jobs.
The economic theory that explains why employees foot the bill for health insurance is this: Whether it’s in dollars or health insurance, what matters to workers is the total value of their compensation for work. (There are other workplace benefits, but none anywhere near as costly and important as wages and health insurance.)
In a competitive and fluid labor market — where there are many similar employers and workers, and little difficulty in hiring or switching jobs — an employer that tries to undercut the prevailing market rate risks losing workers to competitors. Likewise, a worker who demands more could well be passed over for another who will accept the prevailing rate for total compensation.
“Yes, an individual worker might get a little more or less than market compensation from time to time,” said Steven Pizer, a health economist at the Boston University School of Public Health. “But if employment is fluid, there’s just no way, according to the theory, for that to happen consistently.”
One option under Senator Bernie Sanders’s Medicare for all plan would reduce employer spending on health insurance by $9,000 per employee and raise taxes on the wealthy. Senator Elizabeth Warren’s plan would also raise taxes on the wealthy, but would aim to tax employers an amount intended to match what they would have spent on health care anyway.
The economic theory that explains why employees foot the bill for health insurance is this: Whether it’s in dollars or health insurance, what matters to workers is the total value of their compensation for work. (There are other workplace benefits, but none anywhere near as costly and important as wages and health insurance.)
In a competitive and fluid labor market — where there are many similar employers and workers, and little difficulty in hiring or switching jobs — an employer that tries to undercut the prevailing market rate risks losing workers to competitors. Likewise, a worker who demands more could well be passed over for another who will accept the prevailing rate for total compensation.
“Yes, an individual worker might get a little more or less than market compensation from time to time,” said Steven Pizer, a health economist at the Boston University School of Public Health. “But if employment is fluid, there’s just no way, according to the theory, for that to happen consistently.”
One option under Senator Bernie Sanders’s Medicare for all plan would reduce employer spending on health insurance by $9,000 per employee and raise taxes on the wealthy. Senator Elizabeth Warren’s plan would also raise taxes on the wealthy, but would aim to tax employers an amount intended to match what they would have spent on health care anyway.
In a Democratic debate in September, Mr. Sanders differed with Joe Biden
in saying wages would rise if employers were no longer involved with
health benefits. Many Americans are skeptical; in a Kaiser Family
Foundation poll, 63 percent said their wages would stay the same if
their employers’ health costs fell.
Some studies in economics support the theory that employers trade off health insurance premiums for wages almost dollar for dollar. A study in the Southern Economics Journal examined salary and benefits data from the New York Department of Education in the 1970s. Controlling for confounding factors like teaching experience, education, school budget and other benefits, the study found that a dollar increase in the value of health benefits was associated with an 83-cent reduction in salary on average.
But other studies of public-sector employees find little to no evidence of a comparable trade-off between wages and health insurance premiums. One, in the Journal of Health Economics and based on data from over 6,000 school districts, found that a dollar increase in benefits was associated with a reduction in wages and salaries of only 15 cents.
Another from the same journal, in which the Harvard health economist Michael Chernew is a co-author, used national surveys of public-sector workers and employers’ data and produced similar findings.
Why might premium and wage changes not perfectly offset each other in public-sector jobs? One possibility is unionization, which is more likely in the public than in the private sector. Unionized workers are better able to bargain for higher compensation than individual workers, who are more easily let go and replaced with others. Negotiated contracts could end up with health insurance benefits increasing without offsetting reductions in salary.
“One reason unionized public-sector workers may be unwilling to fully pay for premium increases with reduced wages is that the higher premiums reflect things they do not fully value,” Mr. Chernew said. “For example, workers may want not be willing to sacrifice already low wages for higher health care prices that don’t reflect better health care.”
So much for the public sector; what about the private one? Here, many studies suggest closer to a one-to-one trade-off between workplace health insurance premiums and wages. Some of these studies focus on specific benefits, like maternity care, or on different populations, like those with obesity, finding that their higher costs to employers are offset by lower wages.
Some studies in economics support the theory that employers trade off health insurance premiums for wages almost dollar for dollar. A study in the Southern Economics Journal examined salary and benefits data from the New York Department of Education in the 1970s. Controlling for confounding factors like teaching experience, education, school budget and other benefits, the study found that a dollar increase in the value of health benefits was associated with an 83-cent reduction in salary on average.
But other studies of public-sector employees find little to no evidence of a comparable trade-off between wages and health insurance premiums. One, in the Journal of Health Economics and based on data from over 6,000 school districts, found that a dollar increase in benefits was associated with a reduction in wages and salaries of only 15 cents.
Another from the same journal, in which the Harvard health economist Michael Chernew is a co-author, used national surveys of public-sector workers and employers’ data and produced similar findings.
Why might premium and wage changes not perfectly offset each other in public-sector jobs? One possibility is unionization, which is more likely in the public than in the private sector. Unionized workers are better able to bargain for higher compensation than individual workers, who are more easily let go and replaced with others. Negotiated contracts could end up with health insurance benefits increasing without offsetting reductions in salary.
“One reason unionized public-sector workers may be unwilling to fully pay for premium increases with reduced wages is that the higher premiums reflect things they do not fully value,” Mr. Chernew said. “For example, workers may want not be willing to sacrifice already low wages for higher health care prices that don’t reflect better health care.”
So much for the public sector; what about the private one? Here, many studies suggest closer to a one-to-one trade-off between workplace health insurance premiums and wages. Some of these studies focus on specific benefits, like maternity care, or on different populations, like those with obesity, finding that their higher costs to employers are offset by lower wages.
Other studies examine broader markets. A study in the Journal of Health Economics
looked at what happened in Massachusetts after it enacted an employer
health insurance mandate in 2006. It found that the $6,100 annual
employer cost of coverage was nearly perfectly offset by lower wages.
Another study in the Journal of Labor Economics
found that married women with workplace health insurance coverage have
wages that are lower by about the same amount as their employers pay for
that coverage, relative to married women with no such coverage option.
Nevertheless, even in the private sector, there are exceptions, with some studies finding that health care costs for workers are not always perfectly offset by wages. Just as in the public sector, this could happen if the labor market is not perfectly competitive. For instance, to the extent workers cannot find other jobs, they may be forced to pay more for their benefits, either through rising premiums without more pay to compensate for it, or through greater cost sharing.
In other cases, some firms may incur higher health care costs that they cannot pass along to workers without losing them to competitors. Much of the increase in health care costs is because of price growth, perhaps without a commensurate increase in the benefits of care.
“Employees won’t value higher prices without increased benefits,” said Jeannie Fuglesten Biniek, a health economist and senior researcher at the Health Care Cost Institute. “In such cases, employers will be unable to pass along the full increase in health care costs to workers.”
The wage issue is just one of the trade-offs involved with Medicare for all; there are also healthy debates about how much taxes would rise and how much costs would fall.
Ultimately, someone would have to pay for Medicare for all, so not everyone would be better off. But to the extent the cost of health insurance is shifted away from employers and to the federal government under Medicare for all, it seems wages would rise, at least for some people.
https://www.nytimes.com/2020/02/03/upshot/wages-medicare-for-all.html?smid=nytcore-ios-share
Nevertheless, even in the private sector, there are exceptions, with some studies finding that health care costs for workers are not always perfectly offset by wages. Just as in the public sector, this could happen if the labor market is not perfectly competitive. For instance, to the extent workers cannot find other jobs, they may be forced to pay more for their benefits, either through rising premiums without more pay to compensate for it, or through greater cost sharing.
In other cases, some firms may incur higher health care costs that they cannot pass along to workers without losing them to competitors. Much of the increase in health care costs is because of price growth, perhaps without a commensurate increase in the benefits of care.
“Employees won’t value higher prices without increased benefits,” said Jeannie Fuglesten Biniek, a health economist and senior researcher at the Health Care Cost Institute. “In such cases, employers will be unable to pass along the full increase in health care costs to workers.”
The wage issue is just one of the trade-offs involved with Medicare for all; there are also healthy debates about how much taxes would rise and how much costs would fall.
Ultimately, someone would have to pay for Medicare for all, so not everyone would be better off. But to the extent the cost of health insurance is shifted away from employers and to the federal government under Medicare for all, it seems wages would rise, at least for some people.
https://www.nytimes.com/2020/02/03/upshot/wages-medicare-for-all.html?smid=nytcore-ios-share
In the Name of Medicare for All, This Family Doctor Will Vote for Bernie Sanders
It
is at long last time for the United States to move from providing the
world's most expensive sick care to providing the world's greatest
healthcare.
This week our country formally begins the election process to
determine who will be our next president come January 2021. There are so
many critical issues that face our nation as we look to the future.
When it comes to the general well-being of our country no issue is more
important than health and the access to medical care for all. It is
estimated there are approximately 90 million people in this country who
have either no insurance or who are underinsured. To remedy this issue
there is really only one option that guarantees universal coverage to
everyone and that is Medicare for All. This program is promoted by Senator Bernie Sanders who has championed universal single payer healthcare for decades.
As a family physician I am faced with a daily dilemma of trying to care for individuals who have no insurance or who are underinsured and are unable to purchase prescriptions, let alone pay deductibles or significant copayments required to get the care they need. This is particularly true in both my working poor families and impoverished elderly patients living off their Social Security checks. It often boils down to buying groceries and paying the rent versus paying for their prescribed treatments. This insane choice often affects the outcome of disease management and can even be life-threatening. This is especially problematic in dealing with conditions like diabetes management and the cost of new insulins, therapies for common life-threatening heart arrhythmias with the exorbitantly priced blood thinners necessary to prevent strokes and death, and the newer biologic agents for various types of rheumatologic and arthritic conditions where prescription costs can be in the thousands of dollars a month.
The excessive drug costs across the entire healthcare spectrum can be overwhelming for families with limited means. This often results in the need to prescribe older and often substandard therapies or even having patients make the choice themselves, typically unknown to me, to go without therapies or to take these therapies on alternate days often resulting in disastrous outcomes. The further reality is that these families often find themselves one illness or injury away from bankruptcy.
As a practicing physician, the delivery of healthcare is increasingly burdensome and costly from the authorization and referral work and redundancy required to coordinate and direct patient care to the billing, referral, authorization and coding staff required to process and justify the necessary care. These add costs, burdens and delays to the process of care provision. Even with insurance, our role as physicians in recent years has added the component of patient advocate to navigate the system.
As a family physician I am faced with a daily dilemma of trying to care for individuals who have no insurance or who are underinsured and are unable to purchase prescriptions, let alone pay deductibles or significant copayments required to get the care they need. This is particularly true in both my working poor families and impoverished elderly patients living off their Social Security checks. It often boils down to buying groceries and paying the rent versus paying for their prescribed treatments. This insane choice often affects the outcome of disease management and can even be life-threatening. This is especially problematic in dealing with conditions like diabetes management and the cost of new insulins, therapies for common life-threatening heart arrhythmias with the exorbitantly priced blood thinners necessary to prevent strokes and death, and the newer biologic agents for various types of rheumatologic and arthritic conditions where prescription costs can be in the thousands of dollars a month.
The excessive drug costs across the entire healthcare spectrum can be overwhelming for families with limited means. This often results in the need to prescribe older and often substandard therapies or even having patients make the choice themselves, typically unknown to me, to go without therapies or to take these therapies on alternate days often resulting in disastrous outcomes. The further reality is that these families often find themselves one illness or injury away from bankruptcy.
As a practicing physician, the delivery of healthcare is increasingly burdensome and costly from the authorization and referral work and redundancy required to coordinate and direct patient care to the billing, referral, authorization and coding staff required to process and justify the necessary care. These add costs, burdens and delays to the process of care provision. Even with insurance, our role as physicians in recent years has added the component of patient advocate to navigate the system.
There have been alternative proposals to address these health
disparities and access. These include providing a public option which
ultimately is simply an extension of our current dysfunctional
piecemeal, non-uniform tiered system. This is represented as allowing
individuals greater choice to determine their own healthcare needs.
Unfortunately, no one can know what their future health needs will be.
When will tragedy or illness hit? Individuals will invariably purchase
the lowest cost program assuming they have coverage only to find huge
deductibles, copayments or inadequate drug and pharmacy coverage. In
addition, employer based programs are moving similarly to these
bare-bones options.
Only through universal coverage of every person in this country through a comprehensive Medicare for All program will people obtain the preventive and follow up medical care services that is their right and should be afforded to everyone in our country.
It is at long last time for the United States to move from providing the world’s most expensive sick care to providing the world’s greatest healthcare. The American College of Physicians, the nation’s largest medical specialty society has recently endorsed single-payer Medicare for All.
For the wellness and health-sake of our nation, will you join me in supporting Senator Bernie Sanders for President of the United States?
https://www.commondreams.org/views/2020/02/03/name-medicare-all-family-doctor-will-vote-bernie-sanders?
Only through universal coverage of every person in this country through a comprehensive Medicare for All program will people obtain the preventive and follow up medical care services that is their right and should be afforded to everyone in our country.
It is at long last time for the United States to move from providing the world’s most expensive sick care to providing the world’s greatest healthcare. The American College of Physicians, the nation’s largest medical specialty society has recently endorsed single-payer Medicare for All.
For the wellness and health-sake of our nation, will you join me in supporting Senator Bernie Sanders for President of the United States?
https://www.commondreams.org/views/2020/02/03/name-medicare-all-family-doctor-will-vote-bernie-sanders?
Why burned-out doctors despise electronic health records
The systems were supposed to improve communication. But they’re really prioritizing insurance billing over patients.
By
The House of God,
my first novel, was about the abuses of medical internships. After it
was published in 1978, it started a conversation that led to significant
real-world reform in the way that first year doctors are treated. Our
schedules had been 36 hours on call, every third night — sometimes,
every other night. The fatigue was hellish. We had no real life outside
our job. Medical interns now are prohibited from working such schedules.
Yet
somehow the medical profession is worse now. We doctors face an
epidemic of burnout. It is estimated that a doctor commits suicide
almost every day in the US. More than half of physicians reported
symptoms of burnout in a 2014 study, and while that rate dropped to 43
percent in a 2017 follow-up, it is still much higher than the rate for
all US workers, which stayed essentially flat in those years. What has
gone wrong with our once beloved profession?
A report in The American Journal of Medicine
last year looked at this question. It defined burnout as 1) lacking a
sense of accomplishment, 2) cynicism, and 3) lack of enthusiasm for our
work. It found that the one thing in medicine that seemed to correlate
with the rise of burnout was the electronic medical record, introduced
in 2008. A Stanford study showed that 71 percent of doctors say that electronic health records contribute to burnout.
Electronic health records were supposed to improve patient care, and the medical system overall. The computers alone aren’t the issue — we doctors are computer literate, and welcome having clear data of diagnosis and treatment, and the ability to share this with other health care workers. But “medical records” is a misnomer. In 2008, if these systems had only been for medical data and transmission of data, all would be well. But the private insurance industry somehow got into them, and linked every bit of medical data to a cash payment. Now, the data part has been consumed by the payment part. These screens have become, for the most part, billing machines, battlegrounds between health care organizations and insurers. Doctors are caught in the middle. I believe this is the main cause of the epidemic of doctor burnout.
For patients, the issue is more than just having to find a new doctor when their old one gets fed up and leaves the field. An examination of studies of physicians found that the odds of patients experiencing a safety incident more than doubled when they were being treated by a doctor with symptoms of burnout. The biggest factor: depersonalization, when doctors start seeing patients not as people, but as objects.
One problem is that these billing systems are agonizingly slow. Prescriptions, which by hand took 15 seconds each, now take several minutes of careful clicking on a series of lists. Next time you visit your doctor, pay attention to how much time his or her back is turned to you, typing into the computer. Research suggests it averages out to be about 60 percent of the time.
For every hour your doctor spends with you, another two hours are spent in front of that screen. Doctors in training spend 80 percent of a shift clicking and only 20 percent of their time with patients, face to face. A study of emergency department physicians found they average 4,000 clicks per shift. There’s even a new diagnosis: “carpal click syndrome.”
Spending all this time with screens means that doctors have lost time to actually be with patients, to “see” them. Most of us become doctors for that sense of “being with” others in their suffering, and helping them. But the human-to-human connection — proven in countless studies to be healing — is mostly gone.
Recently, I met with final year medical students, to hear about their training experience. They were not happy, because doing rounds consisted of walking down the corridor looking at screens. The doctors rarely entered a patient’s room. There was little time for teaching. These students are about to become newly minted doctors. They are computer literate, and have never seen a paper medical record. They should be excited, not grousing about their screen experience. It’s little wonder that younger doctors are more likely to experience burnout than older ones.
The only real cure for burnout is politically difficult. In the words of The Fat Man, the hero of my new novel, Man’s 4th Best Hospital: “We’ve got to squeeze the money out of the machines.”
To do that, we’d have to unlink the data from the private insurance payments, and make the systems about care, not cash. This Medicare for All approach would have supplemental private insurance that has no billing access through our doctors’ computers. A model already exists, at the Veterans Health Administration. Its electronic records system is clunky, but doctors like it because it’s simple to use and doesn’t impede patient interactions. Most importantly, there is no for-profit billing on the screens. No burnout.
There are efforts all across the country to treat burnout: “physician wellness” programs that teach doctors techniques like meditation, “scribes” to allow the doctor to face the patient, and enhanced dictation-to-text programs. The IT department at New York University Grossman Medical School, where I am a professor, worked with a major vendor of electronic medical record systems to create a patient-focused dashboard for doctors. The dashboard both improved quality of outcomes and reduced costs.
These attempts are useful, but don’t address the root cause. Without something like Medicare for All, doctors will continue to face high levels of burnout — abuse, really — and patients will continue to face unnecessary risks.
Samuel Shem is the pen name of Stephen Bergman, a physician and writer whose new novel is Man’s 4th Best Hospital. Send comments to magazine@globe.com.
https://www.bostonglobe.com/2020/02/05/magazine/why-burned-out-doctors-despise-electronic-health-records/
Electronic health records were supposed to improve patient care, and the medical system overall. The computers alone aren’t the issue — we doctors are computer literate, and welcome having clear data of diagnosis and treatment, and the ability to share this with other health care workers. But “medical records” is a misnomer. In 2008, if these systems had only been for medical data and transmission of data, all would be well. But the private insurance industry somehow got into them, and linked every bit of medical data to a cash payment. Now, the data part has been consumed by the payment part. These screens have become, for the most part, billing machines, battlegrounds between health care organizations and insurers. Doctors are caught in the middle. I believe this is the main cause of the epidemic of doctor burnout.
For patients, the issue is more than just having to find a new doctor when their old one gets fed up and leaves the field. An examination of studies of physicians found that the odds of patients experiencing a safety incident more than doubled when they were being treated by a doctor with symptoms of burnout. The biggest factor: depersonalization, when doctors start seeing patients not as people, but as objects.
One problem is that these billing systems are agonizingly slow. Prescriptions, which by hand took 15 seconds each, now take several minutes of careful clicking on a series of lists. Next time you visit your doctor, pay attention to how much time his or her back is turned to you, typing into the computer. Research suggests it averages out to be about 60 percent of the time.
For every hour your doctor spends with you, another two hours are spent in front of that screen. Doctors in training spend 80 percent of a shift clicking and only 20 percent of their time with patients, face to face. A study of emergency department physicians found they average 4,000 clicks per shift. There’s even a new diagnosis: “carpal click syndrome.”
Spending all this time with screens means that doctors have lost time to actually be with patients, to “see” them. Most of us become doctors for that sense of “being with” others in their suffering, and helping them. But the human-to-human connection — proven in countless studies to be healing — is mostly gone.
Recently, I met with final year medical students, to hear about their training experience. They were not happy, because doing rounds consisted of walking down the corridor looking at screens. The doctors rarely entered a patient’s room. There was little time for teaching. These students are about to become newly minted doctors. They are computer literate, and have never seen a paper medical record. They should be excited, not grousing about their screen experience. It’s little wonder that younger doctors are more likely to experience burnout than older ones.
The only real cure for burnout is politically difficult. In the words of The Fat Man, the hero of my new novel, Man’s 4th Best Hospital: “We’ve got to squeeze the money out of the machines.”
To do that, we’d have to unlink the data from the private insurance payments, and make the systems about care, not cash. This Medicare for All approach would have supplemental private insurance that has no billing access through our doctors’ computers. A model already exists, at the Veterans Health Administration. Its electronic records system is clunky, but doctors like it because it’s simple to use and doesn’t impede patient interactions. Most importantly, there is no for-profit billing on the screens. No burnout.
There are efforts all across the country to treat burnout: “physician wellness” programs that teach doctors techniques like meditation, “scribes” to allow the doctor to face the patient, and enhanced dictation-to-text programs. The IT department at New York University Grossman Medical School, where I am a professor, worked with a major vendor of electronic medical record systems to create a patient-focused dashboard for doctors. The dashboard both improved quality of outcomes and reduced costs.
These attempts are useful, but don’t address the root cause. Without something like Medicare for All, doctors will continue to face high levels of burnout — abuse, really — and patients will continue to face unnecessary risks.
Samuel Shem is the pen name of Stephen Bergman, a physician and writer whose new novel is Man’s 4th Best Hospital. Send comments to magazine@globe.com.
https://www.bostonglobe.com/2020/02/05/magazine/why-burned-out-doctors-despise-electronic-health-records/
Ohioans are hurt every day without health care reform
by Ean Bett - Columbus Ohio DIspatch - February 5, 2020
President Trump promised in June 2019 to “produce phenomenal health care.” Even after his recent State of the Union address, I am still waiting to hear how he intends to deliver on this promise to the American people.
As a family physician in Columbus, I hoped to hear how Trump intends to help make health care more affordable and available to my patients at a time when millions of Americans since 2017 have lost health care; simultaneously, prescription drug companies are jacking up prices, rising health care costs are squeezing families and small businesses, and medical bankruptcies are out of control.
Every day, I witness how the Trump administration’s failure to fix health care hurts my patients and many other ordinary Ohioans.
Recently, one of my patients finally came to see me because he could no longer bear the pain in his knee. He is a self-employed small-business owner and cannot afford a monthly health insurance premium, so he worked every day for the past four months with excruciating pain to provide for his family.
Another of my patients had a sinus infection but his insurance would not cover one of his necessary prescribed medications, so he had to pay for it out of pocket or risk far more serious illness. It makes one think about all the people without any insurance at all whose illnesses go wholly untreated.
One of Trump’s first acts as president was to undermine Americans’ access to affordable care, when he signed executive orders ranging from bureaucratic attacks on the Affordable Care Act to stealth efforts to privatize Medicare for seniors.
He continues to support a lawsuit to end the ACA and let profit-driven insurance corporations deny care to people with preexisting conditions. If Trump’s legal fight prevails, more than 4 million Ohioans with preexisting conditions, ranging from asthma and arthritis to opioid addiction and depression, will see premiums skyrocket or get rejected from coverage altogether.
More than 50,000 Ohio children will lose their health care. More than 5 million Ohioans will have to pay for preventive care, including cancer screenings and mammograms. Ohioans will die because of Trump’s actions.
His administration’s decision to support Medicaid block grants is another dangerous step in the wrong direction.
Do not be fooled when Trump announces any health care proposals; they are only backdoor plots to benefit drug and insurance companies. His October 2019 proposal to expand Medicare Advantage was really a handover of Medicare the hugely popular government program that provides health and financial security for 60 million seniors and people with disabilities — to private corporations.
The health care debate takes a new sense of urgency and relevance today, especially around the topic of universal health care, whereupon the United States would make a commitment to its people to provide quality health care to everyone in America. Opponents of providing health care for everyone in America often bemoan its cost. These are the same people who supported a $1.7 trillion tax handout to drug and insurance corporations, big banks and billionaires. None of this benefits ordinary workers even though they’re the ones paying for it!
As a physician, I believe investing in the health and well-being of our fellow Americans is money much better spent than tax handouts to billionaires and endless wars that put lives and our economy at risk. I have seen countless times how patients who have controlled their diabetes live fuller, more productive lives. I witnessed people with depression and addictions turning their lives around with treatment and therapy.
These are the Ohioans I work with every day on their acute and chronic health conditions so they are more capable of caring for themselves and their families while giving back to their communities.
Better health care for all Americans is the best way to build a stronger nation. The time has come for President Trump to take real action that benefits most Americans, not the rich and powerful, and give Americans the phenomenal health care they want and deserve.
Ean Bett, M.D., is a family medicine physician in Columbus.
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