By Gary Erickson, Owner and Founder, Clif Bar, Inc.

This paper was originally published as a part of the CodeBlueNow! Papers series in November 2005 in the Seattle Post Intelligencer.

About 15 years ago, from a garage I shared with my dog, assorted outdoor gear and a couple of trumpets, I founded the business that would become Clif Bar, Inc. Back then, it seemed natural to combine my passion for endurance sports with a lifelong love of food and pleasure at the table.

Today, Clif Bar is the leading maker of organic and natural energy foods and beverages.  You may wonder what I have to add to the discussion about health care. Truth is, I think a lot about the health and well being of my Clif Bar colleagues and our consumers. At its very core, this company is about health.

Clif Bar makes energy products for active people to enjoy while they’re out pursuing their passion. We make healthful products, based on sound nutritional science. Unlike most of the chemically-laden products in the sports nutrition field, Clif and Luna bars, gels and beverages are made without artificial ingredients and harmful trans fats. We’ve converted many of our products and ingredients to organic because we feel that this form of agriculture is better for our planet. We are proud to sponsor athletes of all ages and abilities because we model healthfulness in all aspects of our business.

A focus on health also translates to the way we treat our employees. I’ll give you some examples. In our Berkeley, Calif., headquarters, home to about 100 employees, there’s a full gym offering about 25 fitness classes, all during business hours. We have four personal trainers working full time to help our employees stay strong. We keep a couple of loaner bikes tuned up and ready to go, so that employees can pedal, rather than drive, to complete local errands. Employees can take part in company sponsored bike rides, ski trips and other outings – strictly optional activities, but you may be surprised at how popular they’ve become.

Continue reading. . .

By Steve Case, Co-founder of AOL and CEO of Revolution, LLC

This paper was originally published as a part of the CodeBlueNow! Papers series in November 2005 in the Seattle Post Intelligencer.

I’m often asked why I chose to enter the health care industry, and become an advocate for sweeping change, even though I have no real background in the field. The answer comes from personal experience. Even a family as fortunate as mine isn’t immune from the problems that everyone else faces in dealing with the health care system. In its most extreme form, I saw caring doctors and nurses trapped in an inhumane bureaucracy when my brother, Dan, died from a brain tumor in 2002. And, on the more run-of-the-mill side of things, as a parent, I’ve been frustrated when a child has developed a fever or a twisted ankle on a weekend – and the only choices were waiting until Monday to see a doctor, or going to a hospital emergency room.

In these experiences, and others, I’ve seen a system that fails to put the patient first. I’ve seen waste we wouldn’t tolerate in other industries. And I’ve seen doctors and nurses unable to spend time doing what they do best: taking care of patients, not filling out forms or dealing with paperwork. It doesn’t have to be this way. At Revolution Health, I’m putting my money where my mouth is, so to speak, by investing in ideas fall into three categories: content, coverage, and care.

By “content,” I mean that every person should have access to the information and tools needed to help make the best health care decisions for your family. Right now, you can pick a restaurant online – why shouldn’t it be just as easy to find the right doctor on the Internet? Right now, your kids can research their homework online – shouldn't you have equally easy access to the latest fact-checked information about an ailment that you or a loved one has contracted? Right now, you can manage your financial records or bill paying online – shouldn’t you be able to do the same for your personal health records and health care finances? Right now, you can easily connect online with folks who share your interest in needlepoint, or motorcycle riding, or baseball teams – shouldn’t there also be a place to connect with those who share your health concerns, when you need support, information, or comfort? At Revolution Health, we’re building an online portal that will meet these needs, and many others.

Continue Reading. . .

By Elizabeth A. McGlynn, PhD, RAND Health

I work at the RAND Corporation, a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world.

At RAND Health, where I am the associate director, we study problems related to the costs of health care, access to the health system and the quality of medical care.

For nearly 20 years, I've been investigating how well the U.S. health care system delivers services that are consistent with professional standards and good science. I've found that most people assume they are already getting top-quality medical care – but unfortunately, this is often not the case. People are dying needlessly as a result.

A major RAND study I led found that American adults on average get only about half of the health care services they need to prevent, diagnose and treat common medical problems that are the main causes of death and disability. The study found that the average adult needed about 16 health services – specific types of tests or treatments – over two years, but usually received only eight of those services.

Continue Reading . . .

Over a period of 10 weeks in the fall 2005, the Seattle Post-Intelligencer ran a series of guest editorials, “The CodeBlueNow! Papers.” In preparation for our Health Care Town Hall on September 18th, we would like to publish some of these papers again.  Although written three years ago, this was the beginning of our discussion which has now led to our upcoming Voters’ Health Care Platform we will be announcing on September 18th.

Please read and share: 

Re-creating the Health Care System

by Arne Carlson, R, Minnesota and Booth Gardner, D, Washington (September 2005)

By way of introduction, both of us served as Governors for eight years: Minnesota and Washington. As Governors, we created MinnesotaCare and the Basic Health Plan in our states—programs to provide health care for hard working, decent people whose employers did not or could not pay for it. But that was ten years ago. Now these plans are being significantly altered, our economy has changed, and our political climate has eroded.

It is not just Minnesota and Washington. State after state is dismantling similar programs. In
Tennessee alone this year--to balance the state budget—over 191,000 adults will be cut from the
TennCare program. It will also cut benefits for hundreds of thousands of others because it cannot afford the $8.7 billion program. Missouri intends to completely dismantle its Medicaid program by 2008. Now, instead of working together to build programs, hundreds of thousands of people are without health insurance with precious few places to turn. This is not inconsequential—one of every five Americans under 65 has no health insurance.

Couple this with changes in the economy and it spells trouble. Jobs are being outsourced to other countries largely due to costs such as health care. This leaves even more people without health insurance, because under the current system when you lose your job, you lose your health care.

Continue Reading. . .

Special thanks to the Editorial Page of the Seattle Post-Intelligencer for their leadership and vision in publishing this unprecedented series originally.

Much of the health care reform debate now will be negative campaigning.  All the other various reform groups will be focused on their ads and negative press, but CodeBlueNow! and a few other groups are bringing new possibility to the table.

Or country has had enough negativity – it’s time we rally around a fresh vision and take health care out of a partisan political fight. We are working on a health care platform for the people, a template we can then present to Congress. Another group is doing things in a positive way, also.

Faithful Reform in Health Care is trying to raise 100,000 voices to bring compassion, value and vision to health care.  Click here to support their campaign.

Faithful Reform, like CodeBlueNow! is a national, nonpartisan, 501(c)3.

This coming Tuesday, July 22, the American Health Insurance Association (the folks who brought us Harry and Louise), are starting their Campaign for American Solution, a “listening tour” combined with an advertisement and recruitment campaign.

The first event is a conversation with the uninsured in Columbus, Ohio. They are not saying how much money they are putting into this, but we are sure it is as much, if not more than the Health Care for America Now campaign which launched Tuesday, July 8th and makes no bones about the fact that they have a campaign chest of $40 million.

The steering committee consists of groups that gave half a million dollars to the campaign, something that most organizations could never afford no matter how good their work is. This Tuesday, July 15th, the National Coalition on Health Care launched its campaign to put aside partisan politics and act on reform. Their principles are outlined in their letter to Congress, and are very similar to our own.  Consumers Union has a bus tour on health care reform, Cover America Tour.

Clearly health care reform is a hot issue and lots of new groups are trying to tackle it in their own way. Well, we’re doing things differently. We aren’t collecting stories, we aren’t launching ads, and we do not have $40 million.

We have a quiet campaign, which has been spending its time doing very important work in the background. What we bring to this myriad of health care groups, is the Declaration for the Health of America and solid market research, two ways we are spreading our message that Americans do largely agree on what reform should look like. CodeBlueNow! knows the public is not as conflicted as all these different groups and politicians make it seem. Our good work is publicity such as our July 2nd op-ed in the Seattle Post-Intelligencer and our upcoming Town Hall, and ongoing research to prove that reform does not have to be a divided process.

Don’t let both politics and the grass roots be dominated by big money. Support the campaign that knows the American public is vastly smarter than they are given credit for when it comes to health care. Support CodeBlueNow! today.

Cheers and more later. Kathleen

We don’t usually focus on the negative aspects of health care because nearly everyone else does.  But, this particular episode from a friend caught our attention on some of the idiocy that happens.  This from Mary Koch in Omak, Washington. 

Lady Liberty Reigns: A Widow Bit

My mother slipped her halo just in time to avoid the rockets’ red glare.
           
Three months ago Mom, 91, fell and broke her neck. She ended up in a device called a “halo,” which is literally screwed into the patient’s skull – like Lady Liberty’s crown – to anchor four vertical titanium rods that point into the air several inches above the patient’s head. The halo keeps the neck absolutely stable while the broken bones heal – for three months.         
           
Mother’s beloved granddaughter calculated the timeline and said cheerfully, “Well, Grandma, if you’re still wearing it on the Fourth of July, we can use it to launch bottle rockets!”
           
It was that kind of humor, plus her own faith and determination, that would get Mother through the three-month ordeal. She posted a sign by her bed, pronouncing: “Blessed is she who breaks her neck, for she shall wear a halo.”
           
Late in the afternoon on the Friday before the Fourth, we visited the neurosurgeon. He would remove the vertical rods, send Mother across the street to the hospital for X-rays, and if the bones looked good, the halo itself would go. Problem was, he couldn’t find the proper-size wrench to remove the rods.
           
The tool he had in his office “fidn’t dit,” as my late husband would have said. The doctor excused himself, ran across the street and returned with an automobile tool kit – the kind you get with expensive, luxury cars. Nothing fit. Finally, his nurse called the medical device company that had supplied the halo. Apparently there is only one halo wrench in all of the greater Tacoma metropolitan region, and the technician was loathe to let go of it late on a Friday afternoon. Someone else might need screwing or unscrewing over the weekend. After intense negotiations,  this unique and highly valuable piece of medical equipment was delivered in a brown paper bag and the rods quickly removed.
          
The surgeon put a temporary brace on Mother’s neck to stabilize her for the trip across the street in her wheelchair. Despite the doctor’s specific orders to remove the brace for the X-rays, the technicians said they weren’t “allowed” to.  I don’t know if I was “allowed,” but time was a-wasting, so I took it off. Mother remained in good humor as the technicians posed her in one odd position after another. When they had her raise one arm straight up and cross the other over her chest, she intoned, “I pledge allegiance . . .”

After many communication failures too exasperating to describe, the doctor eventually appeared. By that time, his office was closed, so we couldn’t return to remove the halo. (What!? They don’t trust the surgeon with a key to his own office?!)

BUT, he had the precious wrench, in its brown paper bag, and there, in the radiology waiting room of Tacoma General Hospital, he removed Mother’s halo.

No bottle rockets for Mom, but the brilliant fireworks displays on the Fourth paled in comparison with our pride and joy in her determination and resiliency. 
 
Mary Koch, Freelance Writer & Editor
www.marykoch.com

This Op-Ed written by CodeBlueNow! CEO Kathleen O'Connor, appeared in the Seattle Post-Intelligencer on July 3rd, 2008.

The coming months will be laden with laments on the sorry state of our health care system. Meetings will be held with story after horror story. We don't need more horror stories. They won't fix the system. We need action -- but not rote mindless action on "solutions" that have failed consistently.

Health care reform has been dominated for 80 years by two equal and opposing forces: single payer vs. marketplace. We know the public will support neither of those two polarized alternatives. Data from our CodeBlueNow! Pulse surveys prove that, as does data from Commonwealth Fund and Kaiser Family Foundation, among other national studies. Neither solution is acceptable to the majority of the American public.

A solid majority of Americans think we must cover all our citizens, but until recently there has been no consensus on how. Until recently, precious few groups have tried to build consensus. Reform has been dominated by single-solution advocacy groups and has traditionally been very partisan. But we know from history that partisan solutions to health care will not work. Former Sen. Thomas Daschle, D-S.D., and Sen. Charles Grassley, R-Iowa, agree that partisan political solutions cannot succeed.

In CodeBlueNow!'s research to identify areas of common ground and consensus in health care reform, we found considerable consensus exists on key issues. Our surveys in Washington and Iowa mirror other national surveys that indicate what Americans want in their health system: affordability, accountability, choice, information, prevention over high-tech cures, efficiency, researched treatment outcomes and a shared responsibility in financing and management with employers, the government and the individual.

The challenge in moving forward with that approach is significant. Neither the parties nor the advocacy organizations on both ends of the spectrum want that message told. Consensus must not be considered newsworthy. But in our surveys in Iowa (red state) and Washington (blue state), there was only one statement that had a statistically significant difference: More people in Washington (75 percent) than Iowa (69 percent) thought a basic benefit package should include any licensed health care professional.

Other than that one issue, there was less than a five-point difference on any statement. When we asked the market research firm what that data means -- to have the two states be mirror images of each other -- the staff replied: "In the absence of action from our leaders, the American public has come to some pretty solid conclusions."

But that consensus has not been reported because many voices want it silenced. So, we have taken our Declaration for the Health of America, a collection of principles and core elements for America's health care system that reflect the views of the American public, and have now documented it with data from our research and the research of others.

We urge you now to read our declaration, send it to your elected representatives and the presidential candidates, and ask that any health care solution address those points. We have some solid, nonpartisan first steps toward a voters' health care platform.

Kathleen O'Connor is founder and CEO of CodeBlueNow!, a nonpartisan, nonprofit based in Seattle that is building consensus on health care reform; codebluenow.org.

Today’s Boston Globe announced Senator Kennedy’s leadership in pressing for bipartisan health care reform.

But a review of the article shows the folks working on this “bipartisan” effort are all the usual suspects looking to flawed ideas.  Congress and key advocacy groups have made up their mind on what we need to do, without consulting the public.

Congress is incapable of finding a bipartisan solution. It is a bitterly partisan institution that doesn’t listen to the other side.  I think the Democrats are hoping they will get a large enough majority in the House and Senate to pass a health care bill in 2009.  But, to pass this bill, they will need some Republican support, especially in the Senate.  The Massachusetts bill is badly flawed.  There are no cost containment measures. 

The public is deeply concerned about the Wyden-Bennett Bill. 

What Congress and/or the Candidates should be doing is building consensus on some core elements of a plan that would have support across party lines. It clearly exists, as CodeBlueNow!’s research shows.

This should be a wakeup call to the parties and the candidates.  What is the definition of insanity? “Doing the same thing over and over again expecting a different result.” 

We can no longer leave health care reform to the candidates and advocacy organizations, they have failed us since 1929. 

Cheers and more later. Kathleen

Here’s a headline you would not see in Germany, France, Canada, Japan, England, Italy, Australia, New Zealand, Spain, Portugal, Ireland, not to mention Norway, Sweden, and Finland:

A day in bankruptcy court would make you sick

In reflecting on what other countries do for health care, it is fascinating the misinformation that is out there.  Germany had private, but nonprofit, insurance companies.  They organize health care around employers, just as we do.  There is one basic benefit package everyone gets; both employers and individuals can buy more. There are over 400 different insurance packages.  Doctors have private practices.  Rates there, like here, are set by the government. 

If someone cannot afford their insurance premiums, the government pays the premium and the individual continues to see their doctor.  There is no major separate public program.

We win the prize as having the best ‘paper care’ system in the world. Rules for what Medicare will and will not cover are thicker than the IRS tax code.  We have the best well-kept paper system in the world. No one knows what they are buying or what it will cover. 

It doesn’t have to be that way.  Think how easy it would be to have one set of benefits and one claim form.  Say goodbye to fleets of rules and regulation that offer no value.  You can do that and still have insurance companies and choices of health plans. 

Save the date: September 18th -- when we launch our Bipartisan Voters’ Health Care Platform.  More consensus exists than we are told by the parties and the press.  We need to act now to tell the candidates what we want and what would work. 

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.codebluenow.org/Declaration%20with%20statistics%20FINAL.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.codebluenow.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

In a recent survey of Western European nations and the US, dissatisfaction is growing with health care systems, but Americans  top the list of the dissatisfied.  Our take on the survey?  The findings come as no surprise. We pay the most with the worst results. I wonder, however, what the survey answers would be in Canada, Norway, Sweden, Finland, Switzerland or Japan. 

There is no cookie-cutter solution to health care.  Aging populations, technology and chronic diseases push up costs for everyone.   One approach might be to have the World Health Organization or US and European Union nations (plus Switzerland), start a task force on our common health care issues, financing and delivery system approaches.  The question to ask, however, is why the French are the most satisfied? 

Here is a quick glimpse of how we stack up to other health care systems, how they are paid for, managed and the role of government.  We think you will find this of interest.

Cheers and more later.  Kathleen

Today’s blog is from Ken Terry, author of Rx for Health Care Reform.  For more information on Ken and to read his blog, visit A Health Reformer's Online Diary.

It's Time for Deep Reform

Mainstream proposals for reforming health care take a superficial approach to the central role of our care delivery system in driving up costs and obstructing change. But some health policy experts suggest much more radical approaches to reform. These ideas, which collectively might be called “deep reform,” address the need for systemic changes in health care that go far beyond insurance coverage or quality incentives. Recognizing the inadequacy of the financing-focused measures that pass for reform today, these thinkers propose alternative methods of structuring the delivery system and reimbursing providers. While their ideas differ in many important ways, they could form the basis for a grand compromise between the left and the right.

Deep reform encompasses the entire political spectrum. For example, Arnold Relman, MD, former editor of The New England Journal of Medicine and author of the book A Second Opinion: Rescuing America’s Health Care, wants us to switch to a single-payer insurance system in which care is delivered by competing group-model HMOs. He rejects the conservative idea of “consumer-driven health care,” regarding it as a way to shift more costs to consumers while motivating poorer patients to skip necessary care. In contrast, Michael Porter and Elisabeth Olmstead Teisberg, the authors of Redefining Healthcare: Creating Value-Based Competition on Results, favor the consumer-driven approach. In their model, specialized teams of providers would compete on the basis of their outcomes for particular procedures or episodes of care. These teams would be independent business units, rather than part of the large, prepaid multispecialty groups that Relman supports. But like Porter and Teisberg, Relman would have his physician groups vie for patients on the basis of published quality reports.

Continue reading . . .

Let’s hear it for the Tri-Cities Herald!  They have started a civic engagement forum for their community which is a great model for other communities.  We hope to adapt one of their ideas for our use as we move forward. 

Here’s what they do:  Every Sunday they have a Tri-City Forum Page in the newspaper, which links to an open website for comments on virtually any topic.  The newspaper’s opinion page has space for readers’ comments, but the webpage:  www.tricityforum.com is totally devoted to readers’ comments. 

Registered users can start a blog or respond to others comments. 

They have a weekly forum question, and they can comment on the question or start their own conversations.  The letters to the editor require names, but the website discussion can be anonymous with “nicknames.” 

Now they have added an in-person dimension to this ‘conversation.’  They have teamed up with the Benton Franklin Dispute Resolution Center so people can actually sit together and discuss an issue in the same room.  Their next topic is a discussion of the November ballot measure in Washington State on “death with dignity.”

The in-person event is over two evenings so people can reflect on the conversation.  The Dispute Resolution Center focuses on finding common ground among conflicting points of views.  Read more about it here. 

Now this is what we call civic engagement.  

CodeBlueNow! was founded on civic engagement.  Like the Tri-Cities Herald, we have several means of engagement.  We have an online survey tool so people can tell us what they think. We have just started an online discussion forum so people care share their ideas and ‘talk’ with us and each other.  We are just now starting a book group, so we can read a book and comment on its ideas.  These book groups can be virtual or in person.  We also engage the public by partnering with other nonpartisan nonprofits so they can have discussions with us and within their groups.   We also blog and participate and share ideas and comments with other bloggers.  Soon we will be starting an online advocacy campaign.

The point is that the people need to be heard and we have more in common than we are told by the parties and the pundits.  So, our hats are off to the Tri-City Herald for its commitment to civic engagement!

Cheers and more later.  Kathleen

We are starting a series on our blog on what other countries’ health care systems look like.   Significant misinformation exists on other health systems, so we thought we would start by taking a look at a few key countries that operate most like the US.  Anne Kinzel, JD, has been writing about France.  She has one more post on that, but we wanted to start with some other countries as well.  Basically, covering everyone is not rocket science.  It does, however, take political courage and public will.

Before we take a look at these systems, here is what many of them have that we do not:

• One national agency that negotiates rates and defines services
• One standard set of services for everyone
• Employer and individual may add more benefits
• Administrative simplicity
• Standards
• Majority of physicians are primary care
• Private, nonprofit insurance companies
• Mediation prior to litigation for malpractice

The simple act of having one basic set of services for everyone eliminates the vast complexity that drowns our health care system.  If we had one basic set of services that everyone was eligible, we would eliminate probably a third of the cost of our health care system. 

We will look at these issues in greater depth as we move forward.  We invite your comments and insights. 

Cheers and more later.  Kathleen