Surgery News - February 2008 - (Page 6)

SURGERY NEWS • F E B R U A RY 2 0 0 8 THE VISION Evolutionary Changes in Surgical Practice Insurance Poll Grassroots Movement Envisions Finds Majority Equitable Health Care Reform 20/20 BY DOUG BRUNK T that their allocation benefits all of our citizens, not just some of them; that it does not leave 47 million people behind.” As an example, he said that people who wish to buy an he way Dr. John A. Kitzhaber sees it, Americans can’t expensive brand name drug when a much cheaper generic afford to sit back and wait for the future of health care is just as effective clinically, and just as safe, should be able to unfold before them; they should assume an active to do so with their own personal resources. Public resources should not be used to subsidize the difference in cost. Simrole in shaping its future. “If people are unable or unwilling to agree among them- ilarly, he said that expectant parents who want an ultrasound selves on a vision for the future, the political process cannot to determine the sex of their unborn child when the proand will not do it for them––and we will be destined to con- cedure is not indicated clinically for a normal term pregtinue to be shackled to the failed policies of the past,” he nancy should be able to get that—but again, the cost should not be subsidized with public resources. warned at the November 2007 annual meeting of To date, the Archimedes Movement has conthe Society of Clinical Surgery in Portland, Ore. ducted public forums and vision-sharing meetings “By default, we will be allowing our future to bewith more than 3,000 Oregonians in 30 chapters, come a matter of chance rather than a matter of 13 hospital CEOs, 11 insurer and health plan exchoice. I think we are better than that.” ecutives, dozens of physicians and nurses, leadIn January 2006, Dr. Kitzhaber, the former govers of national state and labor organizations, ernor of Oregon, founded the Archimedes Moveand representatives of more than 50 non–healthment, a grassroots organization that takes a “we related businesses in the state. can do better” approach to health care. The The resulting consensus led to the Oregon Betmovement is “committed to providing a safe foter Health Act, which was introduced in the 2007 rum in which citizens and stakeholders alike can ‘We cannot solve Oregon legislature as Senate Bill 27. It proposes be brought together to create a shared vision of this crisis by that Oregonians have access to a “core benefit” a new health care system, a space in which we relying solely on of essential health services, and seeks to realign can ask, ‘If anything were possible, what would our current financial incentives to ensure fair and reasonable a better system look like?,’ ” he said. legislative payment to providers, value-based cost sharing The name refers to Archimedes, the Greek institutions.’ for consumers, and a transition to a more efficient mathematician who invented the lever and is reDR. KITZHABER delivery system. puted to have said, “Give me a lever and a place Although SB 27 did not pass in the 2007 session, the ento stand, and I can move the Earth.” A key strategy of the effort is to agree on what a new thusiasm it generated propelled the Archimedes Movement health care system should look like, and to expose the con- into the limelight. It also produced three documents that oftradictions and inequities of the current system and create fer a conceptual framework for a new system in the state and a “tension” between the status quo and a vision for a new that may serve as a foundation for bringing about national reform. The documents––a Statement of Intent, Principles, system. Dr. Kitzhaber, an emergency physician who governed Ore- and a Framework––are available at www.wecandobetter.org. Nowadays, Dr. Kitzhaber and his associates are working gon from 1995 to 2003, said he believes there should be a different standard for the part of health care that is financed to expand the movement to other states, especially Washby public resources and the portion that is financed by pri- ington and Montana. This strategy stems from the fact that vate resources. “We must demand that we get an actual the committee that has jurisdiction over health care in the health benefit for the public dollars we allocate for health U.S. Senate is the Senate Finance Committee. Both of Orecare, a positive return on investment, [and] the effective and gon’s senators (Democrat Ron Wyden and Republican Gorefficient use of public tax dollars. And, since these are pub- don Smith) are members of this committee, as is Sen. Maria lic resources––resources held in common––we must demand Cantwell (D-Wash.). The committee is chaired by Sen. Max Baucus (D-Mont.). Dr. Kitzhaber pointed out that the discourse on health care DATA WATCH reform he has heard from the 2008 presidential candidates convinces him that the Archimedes Movement is peaking at Who Pays for Personal Health Care? the right time. He said that although each candidate has proposals for health care reform, they are all defining the challenge narrowly as a financing problem related to insurance. 36% 4% “No candidate of either party has stepped up to honestly Private health insurance Other private acknowledge the reality of fiscal limits, to address the longterm financial stability of the Medicare program, to chal8% lenge our current definition of a health care ‘benefit,’ or to Other public* 20% discuss the difficult changes that will have to be made in our Medicare 15% delivery system,” he said. Out of pocket “The very fact that none of these issues are a central part 17% of the national political debate is evidence of the underlyMedicaid ing failure in our current governance structure, of the diminishing capacity of our political system to allocate and Total spending: $1,551 billion manage public resources in a way that serves the larger public interest. It is an affirmation of the fact that we cannot *Includes SCHIP spending. Note: Based on 2004 data. solve this crisis by relying solely on our current legislative Source: Health Affairs 2007 Nov. 6 institutions.” ■ Else vier Global Medical Ne ws ELSEVIER GLOBAL MEDICAL NEWS For Mandate B Y M A RY E L L E N S C H N E I D E R Else vier Global Medical Ne ws Americans a continuation of the employer-based health Mostand say thatfavor believeinsurance system they health insurance costs should be shared among individuals, employers, and the government, according to the results of a survey conducted by the Commonwealth Fund. More than two-thirds of Americans who took part would favor a mandate for individuals to obtain health insurance in an effort to provide universal health coverage. These findings indicate that on certain health reform issues Americans’ views may be more closely aligned with the proposals put forth by Democratic presidential candidates than those of Republicans. The leading Democratic candidates would require employers to offer health coverage to employees or pay for part of their coverage. Most Republican candidates are proposing changes to the tax code that could reduce the role of employers in the health insurance market, according to a Commonwealth Fund analysis. Sen. Hillary Clinton (D-N.Y.) and former Sen. John Edwards (D-N.C.) would support an individual insurance mandate, while Sen. Barack Obama (D-Ill.) would mandate coverage for all children. No Republican candidates are proposing an individual insurance mandate, according to the Commonwealth Fund. The findings come from a telephone survey of 3,501 adults aged 19 years and older conducted from June to October 2007 as part of the Commonwealth Fund’s biennial health insurance survey. About 81% of respondents said that employers should either provide health insurance or contribute to a fund in order to cover all Americans. Support for this idea was high regardless of political affiliation, race, gender, age, and income. Support for an individual insurance mandate to ensure coverage for all was lower; 68% of the respondents said that they strongly or somewhat favor such a requirement, while about 25% said they strongly or somewhat opposed the idea. About 7% said they didn’t know, or refused to answer. When asked who should pay for health insurance, 66% of respondents favored cost sharing by individuals, employers, and the government; 15% favored government financing; 8% said it should be paid for mostly by employers, and 6% said individuals should pay. Another 5% said they did not know, or refused to answer. ■ http://www.wecandobetter.org

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Surgery News - February 2008 Contents IOM Committee Looks Into Safety Of Work Schedules Expertise Can Extend Liver Resectability Report Faults Specialty Hospitals' EDs Meeting Expectations Silver Lining HOD on Health Longer Liver Life?

Surgery News - February 2008

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