Re-forming Health Care: It's About Health, Not Just Insurance

With health care reform fixated on financing, costs, and coverage, there has been too little discussion of people and what reform might actually do for their health. President Obama says he doesn't want the new system simply to deliver more of the same; he wants better care and better outcomes. To that end, it's critical to refocus the conversation on proven, cost-effective ways to improve people's health, particularly for one crucially important -- and costly -- group: the chronically ill.

America spends $2 trillion annually on health care, and today 75 percent of that money goes to chronic disease. There are 133 million Americans with one or more chronic illnesses, such as heart disease, arthritis, hypertension and diabetes. They are often vulnerable, and they consume the most health care. Yet a recent survey by the National Council on Aging, Re-Forming Health Care: Americans Speak Out bout Chronic Conditions and the Pursuit of Healthier Lives, underscores that, despite massive spending, our health care system is not meeting their needs.

Conducted by Lake Research Partners, this study of 1,000 Americans age 44 and older with one or more chronic conditions, found that many of the problems associated with chronic diseases are not getting addressed. Too many -- 71 percent -- report living with pain, 65 percent are stressed, and 50 percent are depressed. We must do better by these people and the answer is not just about access to medical care or even how medical care is delivered.

Experts note that 99% of chronic care is self-care. People, even those with multiple conditions, are in the clinician's office just a few minutes a month. All the other hours and days, they and their families are doing self-care. Coping successfully with chronic disease requires a high degree of self-management, of the person, by the person, for symptom control, staying on a medical regimen, and following a healthy lifestyle. This in turn requires that people to be well informed, confident, and well supported in developing self-management skills that fit their own lives.

This is particularly hard for people to do on their own: it requires help. Yet 45 percent of people with chronic illness in our study say they have rarely or never been referred to a resource like a group class, health educator or counselor, or dietician.

It will come as no surprise that cost also stands in people's way, with 38 percent of respondents saying they can't afford to do things that will improve their health. These numbers rise alarmingly among Latinos (63 percent), African Americans (58 percent), people with incomes below $20,000 (65 percent), and people with four or more chronic conditions (59 percent).

That's why we believe national health reform must include support for self-care for the chronically ill. There are several evidence-based programs with a proven national record of improving people's health, function and communication with physicians, while reducing distress and lowering use of the hospital and/or emergency room. These initiatives -- such as Stanford University's Chronic Disease Self-Management Program designed by Dr. Kate Lorig, RN, DrPh -- operate in community settings and are led by highly trained peer leaders, many of whom are also living with chronic disease. Importantly, these programs include group and peer support that helps people pursue the health and lifestyle goals most important to them.

Along with improvements in primary care, we must make a national investment in the Stanford Chronic Disease Self-Management Program and other evidence-based models. If we reshape how we address the health problems of millions of people with chronic conditions and expand self-care, we could save money, empower patients, and enrich lives. Now that would be real health care re-form.

More information about the self-care study and chronic disease self-management programs can be found on the National Council on Aging website.

Comments

[BJD4]

On the flip side of all this is the basic fact that most of us just DON'T take care of ourselves -- that's a lot of our problem in a simple nutshell.

If we would take the time to educate -- and I mean REALLY EDUCATE -- our young people while they're still in junior high and high school about all they can do to really, truly keep themselves healthy, this would go a long way. Provide information about nutrition that they can REALLY USE in their daily lives -- that they can relate to.....not just in theory.

AS WITH PRETTY MUCH EVERYTHING, IT ALL STARTS WITH EDUCATION, EDUCATION, EDUCATION.

I know we're all going to get old(er) -- that's just a fact, obviously. But when you have the knowledge to actually REALIZE what you're doing to your body when you constantly, every day, ingest crap food from McDonalds, Burger King, KFC, Hardy's, and Pizza Hut, well, seriously, WHAT OUTCOME DO YOU EXPECT IN THE END, HUH? Not to mentio the fact that we need to seriously get off the couch, put away the computers and Gameboys for a few moments, and GET OUT AND EXPAND YOUR LUNGS WITH SOME SERIOUS EXERCISE!

[Deborah Calvert]

It has been said that the true character of a people is shown by how they treat their most vulnerable: the very young, the sick, and the old. By that standard, the richest country in the world looks positively vicious for its treatment of the sick and the old compared to the "undeveloped" and "underdeveloped" countries I have been to. In those places, the old and sick do not have shiny high tech equipment or the latest cure all from Big Pharma or a trained nurse let alone a doctor to attend them. But the sick have someone there all the time to give them water or a bit of food, to turn them or adjust a pillow, to listen or talk or just sit with them. The old are treated with respect, provided good and often the best food as well as first choice of what other comforts are available, and listened to for their wisdom. Yes, of course, people die younger and often of easily curable diseases in those places. But what value is there in living longer if your pain is magnified by neglect and isolation? If your caretakers are under-trained, under-respected, underpaid, and so overworked they can't give your the care they know you should have? If you can be "transferred" away from family and friends without warning on the "business decision" of some faceless, nameless corporate bureaucrat? If you are little but a profit source to be discarded without compunction when you "underperform"?

[Deborah Calvert]

Today’s quality of care in nursing homes is measurable to the Holocaust.
My mother suffered and was killed by Sun Healthcare Group Inc’s Sunbridge nursing home in Newport Beach, Calif where they refused to repair / replace known broken equipment while under a Calif state injunction for having killed patients in Burlingame, Calif years earlier. The Dept of Justice turned a blind eye. The Dept of Health didn’t fine the usual $100,000 for her death. But their own medical director, Dr Stoney, wrote an opinion SUN killed her and he’d quit due to their disregard to his pleas and other families’ pleas for help.
They produce profits at the cost of elder abuse and manslaughter.
And the reason SUN can’t sue me for telling the truth is SUN didn’t pay me to sign a confidentialty agreement after mediation where my attorney threatened me with bodily harm for SUN’s CEO. I can prove wilful misconduct by SUN’s management and due treble damages (triple the damages for wrongful death, elder abuse, pain & suffering, et al,), but settled on only a fraud charge due to threats and intimidation by my attorney. I sued him, Daniel Leipold, for malpractice and won –he died 2 weeks later. Do you think he was working for Sun Heatlhcare? This is all about money.. SUN also cheated the taxpayers of the State of Calif for millions dollars n fines the DOJ would have fined for five deaths I witnessed.

daughter of the late Evelyn Calvert, Newport Beach,

[hsr0601]

It is untenable that the ailing people who need to take some rest are forced to keep working, due to the employment-based system with no other choice, and overly high health care prices. It may be one of the reasons that America spends over $2 trillion annually on health care, and today 75 percent of that money goes to chronic disease, there are 133 million Americans with one or more chronic illnesses, such as heart disease, arthritis, hypertension and diabetes.
As seen in the case of swine flu, most of the patients who took some rest at early mild stage have got recovery avoiding deadly outcome.
The employment-based system in the U.S. with no other choice and overly high health care prices is similar to an automobile without 'a brake' or 'a safety system', which come at at price, yet is even better than a fatal accident.
Public and private schools across the world help each other, and to date, private insurers have coexisted profitably with Medicare and Medicaid for many years. As we know, public health and education are essential parts of life, in my understanding, health comes first.

[Brittanicus]

My family has a small business in Indiana and cannot afford to give it's employees any kind of health care, that's why we agree with a large portion of Americans on the government single payer system. Born in Europe I paid for our health care with insurance stamps in a little book, so did the employer everybody worked for? Until the mass legal and illegal immigration into my country of birth all citizens had exceptional medical services. It insured us of surgery, eyes and teeth care for all the people. Today Europe is under considerable pressure from the millions of foreign laborers, who poured into my nation and other industrialized countries around us. Why American newspaper always seem to quote that European health care is free--is beyond me? Nothing is free! We paid for it through our employers, but we were--NOT-­-subsidizi­ng for profit insurance companies?

[Brittanicus]

Every health insurance company removes their pound of flesh, their co-pays, deductible, premiums and of course pre-existing conditions. THESE NEFARIOUS BUSINESSES ARE CURRENTLY SPENDING MILLIONS OF DOLLARS, SPREADING RHETORIC AND PROPAGANDA ON TV, RADIO AND IN MAGAZINES. They are truly worried that there mammoth profits are in jeopardy, because for once the majority of the American people are not listening to their lies. Yes! In Europe you do wait for surgical procedures, but no more than three months. Years ago, I had been out of the country visiting relatives in Australia. When I returned their was a letter waiting for me, for an appointment with a nose surgeon. THE RATIONING OF HEALTH CARE HAS ONLY COMMENCED, SINCE THE INFLUX OF FOREIGN NATIONALS NOT PAYING THEIR SHARE IN EUROPE.

[Brittanicus]

We must take into consideration that a American government pool of health care money, far exceeds European standards and would cover every citizen and legal resident--NOT ILLEGAL IMMIGRANTS. Only the well heeled population don't care for it and the for profit trillion dollar business base have issues, because they have so much to lose? If nothing else we should have the ability to choose for ourselves. Those who think that for-profit insurance companies, should know that this avenue is available to them. Then the larger portion of the population should not have to beg, to be covered, as they should have access to government Universal health care. We should all know our enemies in this health care issue, who are right now undermining President Obama's plan. Those politicians who are adverse to any new health care agenda, are without doubt stockholders in hospitals, billing services, insurers or other profit entities. They sold you out to the wealthy special interest lobbyists on E-Verify and a near future AMNESTY. Be ready to throw those political puppets out of office, when their time comes around for re-election. Bombard your Senators and Congressman for a single payer Health care for all AMERICANS.

[tzip]

Being depressed and stressed is a very rational response when you have a cronic illness. Not so much because of the illness or pain but as much because it is so expensive and time consuming to get basic needs met.

Figures for individuals with insurance demonstrate how expensive it is. I put out 16,000-22,000 for health care each year due to a rare disorder and it's associated problems and treatment. I thought that was a lot until I read a few days ago that persons with MS and insurance average almost 35,000 a year.

I agree better management and teamwork with medical professionals are greatly needed but so is the basic right to have a illness and not be facing bankruptcy.