Author Archive for Jim Molpus

Must-Read from Paul Levy Blog

A couple of summers ago I was doing my usual run in the neighborhood on a hot, muggy weekend afternoon.  I came to a turn where I usually go to the left. For some reason that day I turned to the right. I had never turned that way before.

I came across an elderly gentleman in the middle of the street. “Excuse me,” he said. “Which way is the entrance?” I thought it was an odd question since our neighborhood does not really have one, but I pointed him to where I thought he meant. I resumed the run before my conscience turned me around. I found him again wandering through a front yard. I asked him if he knew where he was. “Well, not at present,” he said. It became clear this fine gentleman had Alzheimer’s and was wandering. We called the sheriff, who after a few calls was able to find his home and return him there safely.

One of my neighbors who helped me entertain the gentleman while we waited for the sheriff told me that there was a reason why I went right instead of left, and that reason was not a coincidence.

I usually leave such questions of fate and existence to better storytellers than I, but was reminded of the delicate chains that often mean so much to our lives when I read a post in Beth Israel CEO Paul Levy’s Running a Hospital blog. The wrenching, poignant “My son’s story” post is from a friend of a friend who recounts his teenage son’s heart attack during a cross-country meet, and the hands at work that saved him, from the landscaper who happened to be on a part of the course where he had never been before, to the surgeon who happened to be at the meet that day. It’s a wonderful example of what can happen in healthcare, to be sure. But it also reminded me that sometimes we can’t explain why the hands that need to be with us in a crisis can somehow be there.

Healthcare Reform in the Wind

A decade ago in my home state of Tennessee we were faced with state government deficits that seemed to be irreconcilable. The problem was that we have no state income tax, and our revenue model is based on a relatively high base rate of state income tax, which when combined with the local options can be as high as 8.75%.

So then Gov. Don Sundquist broached the one option you did not want to ever bring up in the state: a state income tax. In an ideal world the debate would have been a respectful discussion of the merits and demerits of having so much state revenue tied to consumer spending, but in the real world of political reality the debate was quite literally drowned out by protesters who staged noisy, active rallies mere feet away from the state house steps.

It worked. The idea has never been revisited.

I started to get that same feeling again as I read reports of the same scene being repeated in Congressional districts across the country, as protestors seized on the public option as the philsophical hill they will die on. Policy has cut too close to their core beliefs, and when that happens politics get very, very messy. It has to make the public option as envisioned by the liberal Democratic core impossible now.

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In Healthcare, the Last 20 Percent IS the Tough Part

You have to openly question how close the House Democrats truly are to a unified bill on healthcare. Speaker Nancy Pelosi says “we will move forward” while the conservative Blue Dog Democrats continue to say whoa.

The only part of agreement seems to be that the original administration deadline for agreement on the bill by the August recess is not going to happen, though the White House is hopeful that overall momentum will continue.

Anyone who has ever been to a healthcare conference has no doubt heard the “80-20 rule” applied to any number of intractable difficulties in healthcare, the most general being that 80% of the costs come from 20% of the population. The White House made the rounds of the talk shows this week to say that agreement on a Democratic healthcare reform bill is 80% done. “Now, we are at that final 20 percent. We are trying to work through those details,” White House Senior Adviser David Axelrod  said on CBS’s “Face the Nation.”

I doubt the White House was thinking of Pareto, but it still continues a longstanding divide between the reality of healthcare reform and the blow-by-blow of the legislative wars.  Whatever the quantifiable magic they used to reach the 80% figure, it also seems clear that on the key issues of how to pay for reform and how to control the upward slope in costs remain unsolved. Presumably those answers are in the remaining 20%.

Hospitals Make a “Side Deal”

In any negotiation it never hurts to give up what you never had coming anyway, which may explain why a trifecta of America’s Hospital organizations–including the AHA, FAH and the Catholic Health Association–now appear willing to part with$155 billion in concessions over 10 years , as the Washington Post and Politico report.

What makes this such an unsurprising “sacrifice” is that $100 million of the savings would come from “lower than expected Medicare and Medicaid” payments to hospitals over the time period. The greasy question  is what was the expected rate of payment supposed to be for a program that is actuarially out of whack and projected to be exhausted in eight years? What we can read into the math is not the idea that there would be a tigher reimbursement future but where a tolerable pain level was for the hospital industry. The figure floated by the administration of $200 billion was a deep wound, but the pain stops at about $45 billion less, or so it would seem.

The juicy nugget is that the administration was apparently willing to give the industry was a phase in of the cuts, as well as an agreement that if there is  public plan, it would pay at higher rates than Medicare and Medicaid.

Is this a significant deal? Maybe. Getting any peice of the gangly confederation that is the healthcare industry to “agree not to disagree” is a step. But hospitals were never going to be the public plan killers anyway; that role is reserved for the health plans and the Republican party.

Still Too Fat in Dixie

I am a proud son of the South. I have a 1961 Chevrolet pickup truck. I know how to separate good barbecue from plain  roasted pork. I accept no green bean that has not been cooked for at least a day in bacon. I can make buttermilk biscuits from scratch. I know the difference between fudge pie and chocolate pie.

I am fortunate, however, that what I see as heritage too many others see as a daily diet. My beloved South is once again the fattest place in the country, which means it is undoubtedly the fattest region in the world. The annual survey by the Trust for America’s Health and the Robert Wood Johnson Foundation found no real progress in America’s collective battle against the waist line, with obesity rates increasing in 23 states, and no states reporting a decrease. Even more troubling is that only Colorado had a percentage of obese adults less than 20%, with four states above 30%. So much for the national goal of all states being below 15% by next year. No amount of berating by Dr. Phil is going to get us to lose that much, that soon.

The overall survey is bad news from a nationwide perspective, but the regional picture for the South is especially troubling to me. Of the top 10 states with the highest rates of adult obesity, eight were in the South. Mississippi led the nation both in the rate of adult obesity and childhood obesity, where a heartbreaking 44% of children ages 10-17 are overweight or obese.

I grew up in the last vestiges of the genteel South, where ladies were not fat but “big boned.” But back then people still grew their own vegetables, did their own manual labor and mostly cooked their own meals. Now the same problems that afflict the nation are near fatal here. Cheap, easy fast food is on every corner. And if you ain’t drivin’ then you ain’t going to work. [more]

Scrushy Judgment Anti-Climactic

Somehow I feel certain there are a lot more hotheads in Alabama today about the University of Alabama’s textbook cheating scandal with the NCAA than there is over a federal judge’s ruling that former HealthSouth CEO Richard Scrushy be ordered to pay $2.87 billion in re-compensation to HealthSouth for accounting fraud.

Lot of good it will do. They’ll race latte-powered, three-wheeled cars at Talladega before what’s left of HealthSouth sees a check with that many zeroes in it. The company pledges to aggressively pursue collection, but with Scrushy already in federal prison on another charge it is unlikely that much is left. I am just grateful that through some commendable leadership since the Scrushy affair that HealthSouth even still exists to issue a statement.

So (hopefully) ends one of the  sorriest healthcare events of this or any decade. Greed will never go away. Values and ethics are the DNA of good healthcare leadership, but there is no screening process to guarantee their presence in those who are trusted with giant sections of the industry. You can’t legislate around it. You can’t regulate greed tightly enough to scratch its existence away. One can only hope we will look back with abject sadness that a mission to provide health could be so frivolously squandered.