The claims were compelling.

“This bill will touch the lives of every American.”  “No one will ever go broke because they got sick.” “Never again will anyone die because they can’t afford the treatment they need.”

Such were the bold promises from America’s elected leaders concerning the much-heralded healthcare legislation. Confronted with such a grandiose sales pitch, I was curious about the actual contents of the legislation. Most importantly, would it address the true enemy of our healthcare system: inefficiency, waste and errors?

I consulted multiple resources to explore this question. My conclusion? The hope for the health system lies somewhere other than Washington … somewhere much closer to home. MORE....

After arriving in the Kanawha Valley in 2000, a major preconceived myth I held about health care delivery within West Virginia was dispelled by my public health and medical peers throughout the State.  The State faces enormous social, educational, behavioral, cultural and other barriers to improving health delivery and status. However, basic geographical and economic access to early primary and preventive care - by and large - is not a major impediment, although such access to specialty care remains a major challenge. MORE.. 

Historically, physicians –respecting the autonomy of each individual to direct his or her own destiny - focused on maintaining and improving the health status of their patients, not providing services. Patients, the public and policy makers aver physicians should continue – or refocus – on doing so. In reality, many initiatives over the last few decades (including the current reform proposal) promote the opposite. More...

Probably the greatest opportunity for elevating the public’s health status and saving resources centers on a group of individuals who participate in the health system only when they are acutely ill or injured. Some opt not to participate by choice for many reasons. Others fail to do so because of barriers beyond their control.

The end result is usually reduced health status and increased costs for these individuals or society, probably partially avoidable if they had altered their life-style behaviors and received recommended services in a timely manner.  This group represents the greatest challenge to society but we have elected to ignore many aspects of this challenge. More... 

I have no problem with what President Obama stated in his health reform speech to Congress. My concern is with what was not stated.

Current system reform efforts involve three major issues: payment reform, insurance reform and system (delivery) reform. The first two – upon which the President focused - are likely to be addressed “centrally” and certainly will have some impact upon the system, i.e., delivery. However, they will not reform the delivery system.

The delivery system will either be reformed – or not – primarily at the local level. The proponents of reform proposals appreciate the above distinction and try to address it by proposing a myriad of “top down”, disjointed, theoretically worthy initiatives (many of which have been tried with marginal success over the last several decades), e.g., preventive programs including training, comparative-effectiveness research, automation, to fix the delivery system. They also overstate the impact insurance and payment reform will have on improving the delivery system. However, they present few numbers or details and little evidence, that the proposed massive expansion in government programs and expenditures will improve the delivery system. They refuse to entertain the idea that a better approach might be to provide funds or incentives to local communities to carry out this phase of reform. MORE...

July 1, 2009

I congratulate the Legislature and Governor (Senate Bill 414) for their leadership to institute meaningful health system reform.  As a frequent critic of past efforts, such applause does not come lightly. This modest first step – launched without massively expanded regulatory authorities and expenditures – could hold great promise to realign positively the structures and processes of  health care delivery systems where they exists – local communities. This effort is in stark contrast to the circus underway 300 miles east, where the national system reform effort consists of a high tech, expensive media blitz to justify massive new centralized spending, insurance coverage, and regulatory authority activities. These - purposely vaguely described - activities allegedly will assure tremendous cost-savings and health status gains.

I could quibble with certain aspects of the State legislation, e.g., too much emphasis on State versus local authorities, mechanisms, and incentives; preoccupation with the mechanics versus concepts of a medical home. However, this effort embraced meaningful deliberation by a broad, grassroots’ segment of the population to develop an approach to address substantive organizational and behavioral health system issues and barriers contributing to substandard health status and skyrocketing costs. Implementation will not be easy and there is no guarantee of success. More....

July 2009

Lauding the use of YouTube, Twitter, pod casts and other high tech modalities to disseminate information about the “swine flu” situation, newly sworn-in HHS Secretary Sebelius said, “Our administration believes in using new methods to engage the American people and ensure they can speak directly to their public officials.”  Meanwhile, commenting on the capacity of local communities to respond to the situation, Dr. Richard E. Besser, the acting director of the federal Centers for Disease Control and Prevention, stated the public health system was in “a tough situation”. How well can the American public engage and speak directly to their public officials about the current situation or the next inevitable public health “surprise”? More.....

CHARLESTON, W.Va. - Dr. James Felsen got his start as a physician making house calls on horseback at the bottom of the Grand Canyon.

He treated elderly American Indians as a doctor with the Indian Health Service in Arizona in the late 1960s. At the time, he realized the tremendous potential of community public health programs. He was making a difference.

So he abandoned plans to become an orthopedic surgeon or emergency medicine doctor, and dedicated his life to public health.......