Thursday, September 24, 2009

A Reason for Change: Letter to Dan Henninger Wall Street Journal

Dear Mr. Henninger,

I agree with your view “From Bismarck to Obama” except you did not include the big reason for change that would rally America to support meaningful health care reform. As you correctly asserted the reasons for change are not in misinformation that Obama refers to. The reasons for change are contained in what is not being shared by those who have useful information to influence the national discussion about health. All of us contribute to making our own health problem worse and we are not aware of the adverse impact of these actions on ourselves as individuals and collectively on the communities where we live.

First and foremost any strategy for containing runaway health must reduce the size of the pipeline of preventable financial and emotional catastrophic medical events that are bankrupting our country. Less than 50% of Americans undergo early detection of cancer even when they have insurance coverage, and similarly less than 50% of diabetic patients receive recommended care for their condition even when they too have insurance coverage. According to the Institute of Medicine an average of 5000 dollars of every hospital admission is spent for treatment of non identified adverse drug reactions. Similarly we waste enormous sums of money treating and diagnosing symptoms of adverse drug reactions on an outpatient basis that occur among as many as 20% of our population taking medications.

Cancer, diabetes, and adverse drug reactions relate to about 1/3 of our national medical bill.

The information to disseminate the gaps in care required to prevent advanced disease should be made available to every Medicare, Medicaid and privately insured person in America. Although available, this information has not yet been distributed. All the President and government administrators at the state and a federal level need to do is to require this personal health information to be shared with America. The impact of this information transfer will unify our country on a successful consensus driven course for health care reform. The conflicts of interest of those who benefit from the status quo will be eliminated. Dissemination of personalized accurate information will make us realize as a country that any citizen without access to care raises health expenditures for all of us.

I would be pleased to share with you very low cost available methodologies for making such information available.

The Health Gadfly

Health Care Can be Equal

N. Gregory Mankiw’s article “Why Health Care Will Never be Equal” describes only two legs of the three legs of health in America. He excludes from his equation the fact that compliance by individuals and their physicians with known guidelines for care can reduce medical risk and increase longevity at dramatically lower cost. These efforts can reduce as much as a third of the money spent today for health in America. This amount of money is more than enough to pay for everyone and even leave a little over for other items to reduce our national debt.

We are overweight, comply with recommendations for diabetes management less than 50% of the time, and do not get screened for cancer when we should. These low cost non compliant behaviors insure the continuing supply of patients who wastefully consume our health dollars. We have become dependent on the bail out of expensive medicines and treatments instead of taking actions to avoid their use in the first place.

In addition, significant proportions of Americans who take multiple drugs have adverse drug reactions (not drug interactions) and are not aware of them. These idiosyncratic (Specific to each individual person response to medicines) reactions often lead to unnecessary tests and hospitalizations. In fact, the Institute of Medicine has reported on average five thousand dollars of every hospital admission is spent on the clinical presentation of adverse drug reactions.

Dr. Mankiw does not address the contributions to society that result from the investment in life years gained from treatment.

We could avoid the ethical dilemma raised by Dr. Mankiw, if our culture changed to simply follow a more logical approach to health using available information technology correctly.

The Health Gadfly