Greetings!

While Congress is actually moving forward with system reform, we need systemic reform in the ways we deliver health care services.

The current issue of Newsweek has a powerful article: What You Don't Know Might Kill You

http://www.newsweek.com/id/218235

Earlier, Atul Gawande in The New Yorker talked about care variations between cities and regions,

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

We also have Shannon Brownlee's wonderful book: Overtreated.

I think we will have significant reform coming our of Congress this year. As our Congressman from Washington State said recently, "What we are building now is the foundation for reform." Which is a good way of looking at what is in the offing. So far, this reform is reflecting our finding of what the public wants.

http://www.codebluenow.org/In%20their%20Voices.pdf

Care Variations

But, if we are to have long-term and meaningful reform, we need to look at the tremendous care variations for the same procedure as Gawande so artfully outlined. Few groups are doing that in any claims data, which one reflects what was coded and billed.

One group in Washington State has been addressing these care variation for years with excellent outcomes: The Foundation for Health Care Quality.

http://www.qualityhealth.org

Their Clinical Outcomes Assessment Program (COAP) just listed the performance of participating hospitals on how their cardiac care met state standards.

http://www.coap.org/public/metrics.html

The Surgical Clinical Outcomes Assessment Program (SCOAP)

http://www.scoapchecklist.org

now has a surgical and ambulatory surgical care checklists in half the hospitals in Washington State. Why these checklists are not in every hospital in the country is beyond me.

Their Washington Patient Safety Coalition now has a Medication Safety Initiative

http://www.mymedicinelist.org

"My Medicine List" can now be shared with all the patient's health care providers from MD to Pharmacy.

While these are not simple steps in all cases, they do have an impact. We should be doing this on a national level.

"Why a patient can put their lives in the hand of a doctor and have no idea of the doctor's prior experience, is totally beyond me," Terry Rogers, MD, CEO, Foundation for Health Care Quality. "Right now, you can't get that information quickly and reliably anywhere."

"What is also true is that there is a 3 to 40% variation in care for maternal deliveries. This is something women have been doing for thousands of years. It is astonishing such a range of variations exists, right here in Puget Sound, one of the most sophisticated medical markets in the country," Rogers added.

Interested in following patient safety issues? Here is an interesting blog:

http://community.the-hospitalist.org/blogs/default.aspx

Compared to Airlines

Two pilots missed Minneapolis by 100 miles. No one died. The plane arrived safely. They will probably lose their jobs. Or fly desks instead of planes. Over 100,000 people die every year from medical errors. That is the equivalent of 400 Boeing 747 crashes every year.

We need a health care FAA and we need it now.

Remember the White House Challenge?

Organizing for America challenged the public to send in 30 second video clips on health care. They have selected the top videos. You can vote!

http://mail.google.com/a/codebluenow.org/#inbox/124977707eb888b3

Finally, while we urge you to urge your Congressional delegation to pass the upcoming legislation, we also want to urge the delegations to start looking at the true transformation of our health care and providing services that are at least as safe as airlines.

Sincerely,

Kathleen.

While words are hand grenades in health care, we need to either change the language or stop focusing on words. Our work over the last six years has shown that more consensus exists on health care than we are led to believe. What has happened is that the health care reform discussion has been held hostage to the diatribes of two extremes. We are a practical people who want to solve problems. We distrust labels and solutions, and we are a lot smarter than we are given credit for when it comes to health care reform. http://www.codebluenow.org/In%20their%20Voices.pdf

I hope we can all cool down and roll up our shirt sleeves and get to work to build a health care system that works for us, not against us.

Best,

Kathleen.

Messaging and Naming and Framing an Issue.  How one frames an issue is how one defines the problem.  Health care is not just about cost and access as we are seeing in the debate now, it is an extremely personal issue that touches numerous concerns.  That’s why fear is so effective in tearing reform apart.

I worked on a leadership team for three years with the Kettering Foundation in Dayton, Ohio.  Kettering is a research foundation that studies democratic practice. The organization is headed by David Matthews who was was the Secretary of Health, Education and Welfare under President Gerald Ford.  www.kettering.org

A critical issue in the success of addressing a problem is how it is framed.  See their overview publication: It is short and to the point. http://www.kettering.org/File%20Library/PDF/NamingandFramingIssues.pdf

In order to engage the public, it is critical to frame the problem in language that the people use to talk about the issue.  “If people don’t see their worries reflected back to them in their words, they back off.” “Security” and “insurance exchanges” are not the public’s words.  “Peace of mind” and “easy to understand affordable choices” would be, for example.

Everyone seems to have completely ignored the final report of the Citizens Health Care Working Group

http://govinfo.library.unt.edu/chc/recommendations/execsumm.html

Ironically, despite the heavy scripting of the Working Group meetings, one issue emerged that was not on their agenda.  It was high enough on the list to be included in the final recommendations:  re-structure end of life care.

This issue was not in the original charge of the Task Force. Was not an issue in their working documents, but emerged voluntarily from the people at these meetings.

This work group was to have reported to Congress and the White House and was to have had a hearing. None was ever held.  It would be useful to go back to that report as we shape the present debate.

Cheers,

Kathleen

We need to change the language of the health care reform debate, or we will lose the chance for meaningful reform. We need to use words the public uses, or the reform debate will remain trapped by the two opposing forces of public vs. private. That is a Beltway frame, not the public's concerns.

Sure the public cares about costs, but they also care about accountability, responsibility, choice, fair play and efficiency. http://www.codebluenow.org/In%20their%20Voices.pdf

We have spent six years working in the field. We know the public will not move unless they think their concerns have been heard. They will only believe they have been heard if we echo their concerns back to them in their own language.

Remaining mired in single payer/public insurance vs. marketplace, or slinging accusations of "socialized medicine" will only turn the public off when it comes to reform. That fight erodes the areas of consensus and common ground that now exist. We need to build on that common ground with new language, otherwise, I fear, we will watch reform die still born, because we did not nurture a positive vision.

Cheers and more later.

-Kathleen

Greetings!

Sunday's New York Times led with news that Obama is taking the lead on health care.

 external-link

This is wonderful news because we need to bring to the health care reform debate the same clarity and integrity Obama brought to his presidential campaign: change and hope and vision of a positive future.

Changing the health care system will be a battle for the hearts and minds of the American public. If we are to win their hearts and minds the public will have to believe in their hearts of hearts that their wishes have been heard.

That's why we put the report in their words.

 external-link

No other group in the country has been asking the American public what they want and value in a health care system. We have been doing that for over five years. We have valid data:

• We held a contest
• Worked on messaging and public will building
• Sponsored editorial series and town hall meetings
• Tested values and principles with market research surveys
• Partnered with other nonpartisan nonprofits

We ask you now to send our report to the White House, your senator and representative. Just copy and paste it into an e-mail.

Write a letter to the editor of your local paper, urging them to focus on reform by using the key values in our report: ACT (affordable, accountable, accessible, choice, equity, efficiency and transparency/information).

If we can build reform around these values, we can cut across party lines and industry stakeholders and build a meaningful, sustainable health care system.

So, please share this information and ACT now!

-Kathleen

It’s Time to Talk Values

What we are not hearing in the health care reform debate is a discussion of values.   The debate gets mired down in whether health care is a right or a responsibility; whether it is government run or privatized.   These are all off the mark.  What the public cares about are simple things like accountability, affordability, protection and the assurance  they can get care and that the care they get is based on some care guidelines and standards.  They want choice and they think we need to get rid of useless redundancies and the tsunami of paperwork. 

They are a practical people who want practical solutions so they can have a health care system that works for them not against them.  Coming soon:  In Their Voices

As we wait for a Secretary of Health and Human Services to be named, we think it is important to start to shape a fresh direction for a new health care system. We want to paint a positive picture of what that system could look like. So, over the next couple of weeks we will offer some ABCs of a new system.

These elements arose from five years active work on the ground with the American public. These elements can also be used to judge existing legislative proposals:

A

Accountable: No accountability currently exists. Not of insurers to employers; providers to patient outcomes; patients to their doctors.

A Federal Employee Health Benefit Plan type model adds accountability by tying insurers profits to specific performance criteria. (Profit Analyst Factors.)

Accessible: Everyone needs to be covered. Unless everyone is covered the costs of care for the uninsured will continue to be passed along to those of us who have coverage.

The easiest way to do this is to keep the employer-based system. 60% of all the people who have private health insurance have it through their employers. People can keep what they have.

Affordable: Health care will only be come affordable if we cover everyone, have a basic set of benefits for everyone, and electronic medical records.

Having one set of benefits as a baseline for everyone will reduce waste, administrative costs and errors; reduce confusion and reduce the need for eligibility and authorization verification of benefits. Employers and individuals can buy up, if they so choose.

B

Basic Benefit Package: When we all have the same basic package, we will finally have the freedom to take any job we want. We will have more economic opportunities and choices, because our benefits will not depend on where we work. Employers and individuals may buy more benefits, should they wish and add more services, if they are willing to pay for it.

This simplicity will not only give more people peace of mind, it will reduce administrative complexities and lead eventually to lower costs.

Basic Benefits: Several different models exist for a basic benefit package: Federal Employee Health Benefit Plan; Medicare; Medicaid; state plans, such as Washington state’s Basic Health Plan. The critical issue is to select a package—which should include mental health as well as physical health.

external-linkWe’re Back! 

Please pardon our hiatus!  We moved our offices; were stranded in snow;  were terribly snarled up with e-mail and server problems; were traveling to DC and back just before the Inaugural; were swept up in finding an article I wrote in 1959 on the integration of my junior high school in Arlington, VA and having a new article I wrote appear in the February 1^st, Washington Post—nearly 50 years to the day Virginia schools were integrated and Obama became president.

http://www.washingtonpost.com/wp-dyn/content/article/2009/01/30/AR2009013003440.html

This week we will be sending out a new Dispatch thanks to a grant from Democracy in Action.  Nature and politics abhor vacuums, and with Daschle’s withdrawal from the HHS and White House posts, the old advocates and trying to push their “dead ideas” of single payer health care into the current vacuum.  We want to paint a new picture. We will start painting that picture this week. 

Pardon our long silence.  We’re back! 

Cheers and more later.  Kathleen