OpenForum – a blog by the Health and Human Rights community

Many medical professionals and politicians looking toward alternative methods of providing health care are finding examples of communities within the US and in the developing world that have been able to give quality care without skyrocketing costs.

A June article in the New Yorker by Atul Gawande, which is reportedly required reading at the White House, examines the costs of health care by looking at the most and least expensive health-care markets in the US. In particular he studies McAllen, Texas, which has one of the highest costs of medical care per person in the country, and Rochester, Minnesota (home of the Mayo Clinic), which has among the lowest. Rochester also provides some of the best quality health care in the nation. Gawande’s findings led him to conclude that the Mayo Clinic system, which pays doctors an annual salary to keep them from treating their practices like “profit centers”, and emphasizes a peer-review process to improve quality of care, are the best hope for improving American health care. This requires breaking the “untenably fragmented, quantity-driven” systems that are becoming the norm in US medical care.

Gawande notes at the end of his piece that the decisions that need to be made about America’s health care system are greater than the public versus private insurance debate; rather, they involve a total reorganization of the health system. Enacting the principles already in place in the lowest-cost, highest-quality medical institutions in the country – removing any financial incentive for doctors to order unnecessary procedures and taking collective responsibility for patients – require a significant reordering of our priorities.

Others are also looking outside of the political discussions that focus on either “raising taxes or cutting care,” instead seeing a better way: “redesign.” Medical professionals from ten communities across the country with below average health spending and above average health outcomes recently traveled to Washington DC to discuss how changes they have implemented have lowered cost without reducing quality. Gawande, one of the meeting’s organizers, explained that change in these communities occurred quickly, as “[h]alf of these communities used to be high cost and transitioned to low cost over the last decade,” suggesting that national reform is also possible. Read more

Now that the President has officially designated the ongoing health care reform efforts as “health insurance reform,” we can stop the charade that this debate was ever about “care.” Or about health, for that matter. Oddly enough, the obsession with “coverage” – a potential mechanism to facilitate access to care – has not led to a serious consideration of the private insurance industry’s raison d’être, at least not beyond the community of single payer advocates whose voices are drowned in the constant drumbeat about a supposedly American – read: “market” – solution.

How are the current proposals for health insurance reform treating an industry that siphons off roughly $10 billion in annual profits? We now have two health reform bills reported out of congressional committees (”America’s Affordable Health Choices Act” in the House and the “Affordable Health Choices Act” in the Senate – using terminology pushed by Democratic pollsters, no doubt). Neither of them meets key human rights standards, and both cast private insurance corporations in the role of gatekeepers that control people’s access to care. At the same time, opposition is mounting against all and any reform measures.

Yet there continues to be great hope among many long-time health policy advocates that will we see meaningful health reform later this year. Advocates count on this reform to solve or at least alleviate the current health care crisis, which results in an estimated 22,000 preventable deaths due to lack of insurance each year, as well as skyrocketing costs that bankrupt families and public budgets alike. Pundits optimistically point to the many new measures the reform bills introduce: reining in the “free” insurance market through tougher regulation, including through a so-called Exchange mechanism; setting up a public insurance plan; expanding Medicaid; requiring employers to contribute to costs; and mandating everyone to buy insurance. All Americans (though not all immigrants – documented or not) will get health insurance – or so the hopeful want to believe.

Their hope is born out of desperation. Most advocates are painfully aware that health care is treated as a market commodity in the United States, and that market rules are stacked against those with little purchasing power. And these are usually the very people who need health care the most: poor people and people with serious health issues. In a blatant affront to the basic human rights principle of equity, minority groups and poorer communities in rural and inner city areas suffer disproportionally from market barriers to health care. Read more

Even after the media reported that health insurer Blue Cross rewarded employees for canceling policies of individuals with serious illnesses, executives from the nation’s three largest health insurance companies refused to stop this practice, called rescission. Also known as post-claims underwriting, rescission occurs when insurers cancel a person’s coverage, often after that person has paid thousands of dollars in premiums. The practice is ostensibly a means of recourse for companies in instances of fraud, when an applicant has intentionally failed to disclose pre-existing conditions. However, insurance companies increasingly use it to cut costs by searching for insignificant or irrelevant errors on policyholder’s initial applications. Los Angeles Chief Assistant City Attorney Jeff Isaacs, part of the legal team fighting these practices, explains: “[The policy of rescissions] appears to have evolved into a cost-savings method. It’s a systematic, institutional process to flag and pull anything that looks costly to the company.”

A hearing by the House Subcommittee on Oversight and Investigations on June 16 brought up criticism of the policy, reporting that in the past five years, over 200,000 people have had their coverage cancelled by three of the largest US health insurers, WellPoint Inc., UnitedHealth Group, and Assurance Inc. The hearing also found evidence that employees of these insurers had been encouraged and rewarded for terminating policies of people who had serious medical expenses, saving the companies over $300 million (see the performance reviews of these employees here and here, and the complete findings of the hearing here). Read more

“Airborne” Highlights MDR-, XDR- TB Cases

Airborne: A Journey into the Challenges and Solutions to Stopping MDR-TB and XDR-TB is a powerful new book written by John Donnelly that features interviews and images to put a human face on the TB epidemic across the world. In her foreword, WHO Director-General Margaret Chan wrote, “I urge you to read the personal stories collected in AIRBORNE. These are human tragedies that should never have happened. But these are also stories about the uplifting success possible when the right elements are in place.”

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Australian Abortion-Aid Ban Lifted

A thirteen-year ban in Australia on providing foreign aid for abortions has been lifted and Australia will provide  funding of up to $15 million for reproductive health activities to help reduce maternal deaths across the world.

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$50 Million US Contribution to UNFPA

President Obama has recently signed legislation to provide $50 million to the United Nations Population Fund (UNFPA) to improve the health of women and children and reduce poverty throughout the world.

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US Capital Blighted by HIV/AIDS

The U.S. Capital has an HIV/AIDS rate on par with or worse than some African nations the city’s health department reports.

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US Urged to Fix Iraqi Refugee ‘Mess’ It Created

As the Iraq war enters its 7th year, the United States is urged to provide aid to Iraqi refugees displaced by the fighting.

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Read more

Mother and Child in Bolivia

According to the World Health Organization (WHO), if you are a young Bolivian, you have a 6 percent chance of dying before your fifth birthday. Diarrhea and malnutrition, conditions rooted in poverty, are the leading causes of child mortality in the South American country. Against this background, a UNICEF-funded government health insurance plan will allow doctors to provide unrestricted care to children under the age of five as well as pregnant women. Bolivia’s health services still have much work to do to ameliorate the underlying causes of childhood diseases. UNICEF estimates that 2.5 million Bolivian children are living in poverty, leading to the compounded problem of chronic malnutrition.

While the UNICEF program, which covers the costs of the medical treatment of children, is an important step in making care readily available to Bolivians, the government still needs to reach out to the destitute rural and indigenous populations. Prohibitive distance and cost are not the only factors that separate these Bolivians from medical professionals. The systemic degradation of trust may stem from a communication barrier: Many doctors and nurses do not speak Quechua or Aymara (indigenous Bolivian languages). Cultural traditions, such as keeping a male child’s umbilical cord long to symbolize masculinity, or the association of white walls, such as those in hospitals, with the burial of babies, exacerbate the already dangerously poor health outcomes for these individuals. UNICEF’s health insurance program, while a critical first step in improving child life expectancy, will be unable to achieve lasting change in the most under-served populations until cultural dynamics, along with endemic poverty and rural inequality, are addressed.

More information on Bolivia below the fold. Read more