Once again, politicians are rushing to judgment on a plan that the public will not support.   Senators Ron Wyden, D, Oregon and Senator Bob Bennett, R, Utah, have co-sponsored a bill to move the responsibility of health insurance away from employers and over to individuals.  Does the public want that?  No.  Data from the Kaiser Family Foundation clearly show there is significant resistance to this idea (See Drew Altman’s essay on their research). CodeBlueNow!’s data clearly show this, as well. 

It would not take rocket science to build a health care system – it does take political will.  What we have found is that more public consensus on health care reform exists than either the parties or the candidates will admit. 
That’s why we have to get elected officials out of the center of attention to create a proposal.  They can’t do it.  We the people have to create our own Voters’ Health Care Platform.  I think our Declaration is as good a place to start as any. 

Stay tuned!  Cheers and more later.

Kathleen

Can they find common ground in health care reform?

Seattle, WA.  June 18, 2008.  CodeBlueNow!, a nonpartisan, nonprofit based in Seattle, issues a Health Care Challenge to the McCain and Obama campaigns. CodeBlueNow!'s grassroots polling reveals broad agreement on important issues of health care reform. CodeBlueNow! challenges both candidates to create a bi-partisan platform for reform based upon what a majority of Americans want, by adopting CodeBlueNow!’s Declaration for the Health of America.  http://www.thethecodebluenow.org/DeclarationWithStatisticsFINAL.pdf

Kathleen O'Connor, Founder and CEO of CodeBlueNow! states: "The public is tired of negative campaigns and attacks.  They seek a vision for a positive future. With more consensus among the public than we realized, we have asked the candidates not to fight each other on health care but rather to work to find elements they can both support. After the election they will need each other’s support to move toward successful reform.” 

Between now and the November election, CodeBlueNow! will survey the candidates on their proposals, report their responses to the press and the public, and launch a Voters' Health Care Campaign to hold the Administration and Congress accountable to the public on health care issues.

About CodeBlueNow!
CodeBlueNow! is a nonpartisan, national grassroots nonprofit organization dedicated to giving the public a voice in shaping a new health care system.  The Seattle based organization conducts research, forges partnerships, builds consensus and creates a positive vision.  CodeBlueNow! formed in October 2003 from ideas that emerged in a national contest to Build an American Health System and is actively working to build consensus on key principles and core elements for a new system.  www.thethecodebluenow.org

The Senate Finance Committee met yesterday for a daylong bipartisan symposium to lay the groundwork for next year’s health care legislation.  Senator Charles E. Grassley of Iowa, the senior Republican on the Finance Committee, was cited in the New York Times as impatient with the process:

"Health care is 'the No. 1 economic issue in our country,' Mr. Grassley said, but 'Congress does not seem to have the political guts to do anything about it.'”

When a senator of Grassley’s stature thinks that Congress does not have the political guts to do anything about health care, it is time to take health care out of the clutches of Congress and demand change ourselves.  That is why this week we are issuing a challenge to the candidates to adopt the elements of our Declaration for the Health of America in both their health care platforms.  This Declaration not only identifies key values and core elements, but it also take statistically valid research data to validate those points.

The Senate Finance Committee discussed reform, agreed that everyone should be covered and that we should keep a private insurance market and keep the employer involved. 

We could not agree more with Senator Grassley.  Please sign and send our Declaration today to your elected officials. 

Cheers and more later. 

Kathleen

We will jump continents now to Japan and look at their health care system.  Having lived in Japan, I have actually seen how the Japanese deal with health care.  The Japanese did not get universal coverage until the 60s when small businesses revolted and demanded the government do something so their employees could have coverage as well as the large employers. They argued that they contributed as much to the economy as the large employers who could afford to offer coverage, and that led to universal coverage.

Everyone is covered and everyone is required to pay into a national health insurance fund.  Fees are set by the national government.  All providers are paid the same fee for each service.  Employers pay 50 to 80% of the health insurance premiums.  Individuals and dependents pay for premiums out of their salary—at about 8.5%. In addition they have co-payments. Co-payments account for about 20 to 30% of individual health care costs.

Health insurance companies are required by law to offer a basic benefit package that includes medical consultation, medications, as well as home health care and nursing care. 

Individuals are assigned to a private insurer, according to their employment situation.  The government funds the National Health Insurance which insures the unemployed, the elderly and the self-employed, such as lawyers and doctors.
Health care providers largely have their own private practices and it is quite common for a doctor to own a hospital.  In fact, nearly 80% of all hospitals in Japan are owned by doctors.  By law all hospitals are required to be nonprofit.  The other 20% are large, public, state owned and managed teaching hospitals. 

The Japanese are truly conscientious about their health.  Many large companies start the day with employee tai chi type of exercise. In the winter and the flu/cold season nearly everyone wears a white surgical style mask over their nose and mouth.  During the same season, when we lived on a Japanese Air Self-Defense Force base, we had to wash our hands in something like ammonia before we could enter the base.

As for malpractice in Japan, it tilts in the favor of the doctor, but with a real kicker.  All the member of the Japanese Medical Association, or a little over 40% of all Japanese doctors , have a collective insurance pool they pay into. Private doctors and hospital employees can buy insurance in the private market, but it is not required by law.  The professional liability program reviews out of court claims, but the system is biased toward the doctor rather than the patient. The review board’s decision is binding, but patients who disagree may go to court.   In Japan, injury or death from a medical error is a criminal offense. 

Read more about Japan’s health care system: Japan Factsheet.

There is no cookie cutter approach to health care. All systems reflect the values of their country of origin. 

Cheers and more later.  Kathleen

Thinking productive workers meant healthy workers, Bizmarck introduced the first national health insurance system in Germany in 1883. The US was close to adopting this model, but with advent of World War I, the US backed off. 

Like France, everyone participates--the employer, employee and the government.  Like the US, it is a public/private system.  Everyone pays for health care which is organized around the employer who contracts with private insurance companies to manage the care.  The employer must pay at least half the premium and the other half is deducted monthly from the employee’s salary.   The government covers the health care contribution costs of the unemployed and the low income.

Now this is an interesting thought.  Everyone in Germany—wealthy or poor—has the same benefits. If the individual cannot pay, the government pays his or her premium contribution.  Think what this would save if we did that here? So, instead of having 50 different Medicaid programs with 50 different benefits and premiums, the government simply paid the premium and the individual could use the same services as everyone else.

This is not a government-run, centralized system.  Each of Germany’s 16 states share responsibility with the federal government for the upkeep and maintenance of hospitals and clinics.  State regulated insurance companies oversee cost controls.  The insurance companies are both public and private.

There are over 200 private insurance companies that over 400 different plan options.  Doctors have private practices. Some doctors are hospital employees and of the 2,030 hospitals in Germany, 790 are public; 820 are private non-profit and 420 are private, for profit.

As for malpractice, initial claims are sent to mediation with expert panels set up by the physicians’ guild.  Patients are free to reject the mediation results and take their cases to court, very much like the US system.

So much for “socialized medicine.”

For more on the German health care system, see our factsheet.

Cheers and more later. Kathleen

France is consistently rated number one in health care from the World Health Organization to OECD (Organization for Economic Cooperation and Development).  So we will continue with our project of outlining how other countries approach health care. 

In the months ahead, we will be hearing a lot about socialized medicine and how other countries pay more in taxes for “government run health care.” So, we will look at these systems and post outlines that cover:  management; doctors and hospitals; role of the employer; role of the individual; role of the government; who decides benefits and services; universal coverage (cover everyone); financing and health care insurance premiums.

What seems to be the case in most of these economically developed nations is that they cover everyone; the doctors have private practices; hospitals are both public and private; the government steps in for the poor; employers participate and pay and can add additional coverage for their employees.

In France, health care is funded by workers’ salaries, indirect tax on alcohol and tobacco and direct contribution of all revenue proportional to their income (including retirement pensions and capital revenues).   Individuals and employers often have private insurance to cover the portion the government does not cover, typically 20% of the charges. 

What seems to be the critical difference is that these nations have one common set of benefits that everyone gets no matter if they are employed or their employer size.  Because everyone is covered, the other nations are spared the “eligibility, authorization and referral” paper nightmare we suffer from here in the United States. They have one standard claim form. Everyone knows what is covered.   This would make a huge difference to the practice of American medicine, where physicians’ overhead accounts for over 50% of their income.

Read our factsheet on the French Health Care System

In France, they also treated malpractice claims as we do here in the US. However, they recently abandoned that approach and now instead have moved to an out-of-court , no fault system where the patient brings claims to their region’s government appointed review board, which decides the case and the compensation. Compensation comes from a national compensation fund that gets its money from insurance premiums from doctors and hospitals (Learn more about malpractice around the world).

So, please read on. 

Let’s hear it for Kaiser Permanente and Microsoft.  Kaiser just entered into a pilot project with Microsoft and its Health Vault personal health record service to see that consumers are more active in managing their own care as well as seeing how Microsoft and Kaiser can meld Kaiser’s Electronic medical record with Microsoft’s consumer based health record. 

This is a fabulous step in the right direction.  This country has struggled with adopting an Electronic medical record since at least 1991 when George H. W. Bush appointed a group—Workgroup on Electronic  Data Interchange, which was charged with having an electronic medical record by the end of his term in January 1992.  We are still years away from achieving this.  Having an electronic medical record will not only improve the quality and accuracy of information, but it will save entire forests now used in filing paper files. 

Our take is that this is moving the push for electronic medical records up a huge notch.  Please also see our interview with Dr. Bill Crounse, MD, of Microsoft at: www.codebluenow.com/vital-signs

Kudos to Microsoft and Kaiser.  We will resume our reporting on health care around the world tomorrow. 

Cheers  and more later.  Kathleen
Key words:  Microsoft, Kaiser Permanente, electronic medical record, google, patient centered health care

We are starting a series today on health care systems around the world.  We will use the same template for each country, touching on many of elements in our snapshots of health systems and outcomes.  In order to put these systems in context, however, we are starting with a summary of the United States. 

After having taught a short course on other health care systems, I’ve learned that there are a few critical things other countries do that we could actually do here without falling into a system of “socialized medicine.”

Summary of the U.S. Health Care System

The American Health Care System is a hybrid of private and public funding.  Unlike other industrialized nations, it does not cover all of its citizens.  There are numerous, different public programs.  Medicare for people over 65 and the disabled; Medicaid, for low income women and children, long-term care for qualifying seniors, the blind and disabled; Veterans Health Care; Champus and Tri-care for active and retired military; Indian Health Service; workers compensation programs for on the job injuries.  The majority of private health insurance is provided by employers or individuals who purchase individual private insurance policies. Most hospitals are nonprofit; most physician practices are for profit.  47 million people have no health insurance. 

Follow this link for more information on the U.S. health care system and topics of Management, Hospitals and Doctors, Roles of Employers, Government, and Individuals, Financing, and Premiums.

Shirley Bridge died Monday morning. She was my friend, soul mom and role model.  We had known each other for 40 years.  Her service was on Wednesday.  Nearly 1,000 people attended in her honor and memory.  Here are my remarks about her and her life.

Kathleen

Remembering Shirley, June 4th, 2008
Shirley may have only been five feet tall, but she was a giant. She was a giant as a leader; as a community activist, a generous philanthropist, a wife and mother, and a giant as a friend. 

I first met Shirley in 1972, when she was the president of the Seattle Women’s Commission.  We bonded instantly when we learned that we had each been denied credit in our own names because we were married, even when we had our own jobs and our own incomes. Shirley had wanted to borrow some money to help a friend, and the bankers said “We’re sure Herb won’t mind.” Well Herb did not mind, but Shirley did. So, to make a long story short--in 1973, Washington became the first state in the nation to ban discrimination in credit and insurance based on sex or marital status.  We’ve been making trouble together ever since.

I had never seen a woman so bold before! And, like all of us, I wanted to make a difference.  So, Shirley loved to take on causes and I was at her side for the adventure. She became my role model, mentor, soul mom, and ultimately my dearest, dearest, sweetest friend of nearly 40 years.

But, what you may not know with all these daring roles is—Shirley did not drive. So those of us who are fighting for women’s rights are calling each other... “I can pick her up, can you take her home?”  When the movie came out about the same time, we coined the expression “Driving Miss Shirley.”  And we drove her with pride and honor. 

She was an unassuming woman.  When she volunteered every week at the League of Women Voters at their office near Madison Valley, she always took a bus, not a cab.

Shirley was truly a giant as a friend.  Yes you often ‘paid’ for being a friend, because you always got the call for this candidate or that cause, and of course it is always easier to say yes to Shirley than say no. But if she knew you could not afford it, there was always space at the table and you were always included.

And she had a wealth of friends. There was a group called the Nertzes, all professional working women, who met frequently for breakfast at the Georgian Room at the Olympic Hotel, and other places, where they would have breakfast and drink champagne before they went to work.  They also took frequent trips to Las Vegas. Shirley loved to play poker, and blackjack and she won.

As this community has won from her gambles on supporting causes few others would touch.  Whether it was women’s rights; political candidates; health care reform; cutting edge or seemingly impossible causes.  She championed them and pretty soon, so was everyone else.  And suddenly you have a Bailey-Boushsay House, an Endowment at the Jewish Federation; legally binding equal opportunity in employment, credit and housing, a Basic Health Plan and insurance plans that covered contraceptives as well as Viagra.

In her heyday, phones of her family and friends were ringing off the hook, sometimes at the most amazing times—like 5:30 or 6 AM.  “Okay. Either someone died or it’s Shirley.”

And if she succeeded as a community activist, she also succeeded in family. She and Herb celebrated robust 60 years of marriage. And as we have seen what Jon and his wife, Bobbe, and Dan now with his wife, Sim, have brought to this community, we all know that apples don’t fall far from the tree.

While Shirley and I become friends from a joy of political plotting, our friendship deepened when my son was killed in a car accident in 1991.  Shirley simply would not let me quit.  She made me come to dinners, breakfasts, projects. I could never say no, it was Shirley.  I have no idea that first raw year where we went, what we did or who we met.  But, she kept me going, because she knew that you can’t quit. Because of her, I didn’t quit.  Because she never quit on a friend, on a cause, or fighting cancer. 

When her colon cancer returned in the late 90s, she had chemotherapy since they found cancer in her lymph nodes.  But, we kept going out for dinner, and since she could not drink on chemo, she would order a martini for me and a side of olives for her, so she could stuff them in my martini and eat them for the taste.  To this day, there are restaurants in town who would see us coming and have a martini with a side of olives ready to go.

Because of her, I am who I am today.  Because of her, I have learned you really can make a difference and make seemingly impossible changes that dramatically affect people’s lives.  But most of all she was the sweetest friend.  She would take me to dinner. We would gossip and giggle. I would take her on drives to the country. She would tell me of her childhood. I would bake her berry pies and soda bread. 

So if I would leave you with any legacy of Shirley. It would be two things: serve and be a good friend.  

Can you imagine the holes we would have in this community if Shirley had said:  this is too big a project; this will cost too much money; this will take too much time; I won’t get anyone to help. I can’t do this. I am only one woman.  Shirley’s life demonstrated without a doubt the power of one and the power of love and devotion to family and friends.

I ask you all to hold her family in your hearts and prayers. And if this one small woman can be a giant in so many things, challenge yourself to be the same. 

Shirley, there is a hole in my heart a mile wide.  Thank you for being you.

I attended a conference in May and heard Dr. Bill Crounse, MD, Senior Director of Microsoft’s Worldwide Health Division speak.  I was fortunate enough to be able to interview him later about some of Microsoft’s activities.  I was stunned with the implication of these new tools and technologies and their potential major impact on the practice of medicine.

Dr. Crounse believes improved technologies will provide solutions that make health care dramatically more available and at lower cost.  Additionally, a more consumer-centric model will give people more control and better tools to manage their care.

“People want good, reliable information, when they are looking for it.  More than 60% of search inquiries on the Internet now are related to health and healthcare,” Dr. Crounse observes.  “People need to have a range of tools to help them find and manage this information for themselves and their families.” 

A range of tools developed by Microsoft, Google, Revolution Health and others are creating more refined ways to search for health information and create secure, central repositories for personal healthcare data, working in partnerships with provider systems.  In addition, Microsoft and its partners are working on technologies that will make it possible for providers to deliver health information and certain kinds of medical services into the home.  Dr. Mike Magee, MD, of Health Commentary blog (http://healthcommentary.org/), and author of Home-Centered Health Care: The Populist Transformation of the American Health Care System, makes one of the most persuasive cases for how home-centered health care could actually work.

Continue reading this article. . .

I have lost a dear friend and the world has lost a great soul.  Shirley Bridge, a CodeBlueNow! Honorary Board member, died Monday at age 86 after a 53 year battle against five different primary cancers.  In 1955, when they first discovered her first cancer, she was given a year to live.   She was a tireless advocate and the first to put her name on the line when it came to an important, yet risky cause.   Thanks to Shirley, Washington state was the first in the nation to ban discrimination in credit and insurance based on gender or marital status,  which we started when we met in 1972 when I was a new board member and she was president of the Seattle Women’s Commission.  The Commission went on to write the Fair Employment Practice Act for the Seattle of Seattle, the Affirmative Action program for the City of Seattle and Seattle City Light. 

Most of all she was a devoted and sweet friend for 36 years.   I always called her my ‘soul mom.’

She was a mitzvah.  A true blessing.  To me, to the community, and to the world.   Remember her in prayer and praise.

Kathleen