Obama's vision for Health Care: Version 1

Earlier today, President Obama outlined his vision for Health Care reform in the US to the American Medical Association (AMA).
Pretty good start so far. Now let's only hope Congress doesn't bloody it up too much as it works its way through each House ...

~BH


Below are the highlights, as summarized by Jesse Lee.

For the Full Text of the speech, visit:
http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-to-the-Annual-Conference-of-the-American-Medical-Association/


Why Reform, Why Now

This afternoon the President gave a landmark, sweeping speech on health care reform to the American Medical Association in Chicago. More so than at any time before, he explained his vision for comprehensive reform that addresses every weak point in our health care system. It is a vision that implements best practices that have allowed some towns and companies to cut costs by as much as half compared to others. It is a vision that makes sure everybody has access to quality, affordable coverage, whether your family hits a rough patch or you have a pre-existing condition. It is a vision in which patients’ and doctors’ interests are aligned. And it is a vision where Americans’ choices of doctors and coverage are maintained, and they also have a choice of a public option that can help keep private insurers honest. It is a vision that focuses on prevention, making sure Americans stay healthy throughout their lives.

It is well worth the while to read through the entire speech, but here are a few key excerpts, including some key points you may not have heard before:

On the costs of inaction:

If we fail to act -- (applause) -- if we fail to act -- and you know this because you see it in your own individual practices -- if we fail to act, premiums will climb higher, benefits will erode further, the rolls of the uninsured will swell to include millions more Americans -- all of which will affect your practice.
If we fail to act, one out of every five dollars we earn will be spent on health care within a decade. And in 30 years, it will be about one out of every three -- a trend that will mean lost jobs, lower take-home pay, shuttered businesses, and a lower standard of living for all Americans.

And if we fail to act, federal spending on Medicaid and Medicare will grow over the coming decades by an amount almost equal to the amount our government currently spends on our nation's defense. It will, in fact, eventually grow larger than what our government spends on anything else today. It's a scenario that will swamp our federal and state budgets, and impose a vicious choice of either unprecedented tax hikes, or overwhelming deficits, or drastic cuts in our federal and state budgets.
So to say it as plainly as I can, health care is the single most important thing we can do for America's long-term fiscal health. That is a fact. That's a fact. (Applause.)

On incentives for doctors:

There are two main reasons for this. The first is a system of incentives where the more tests and services are provided, the more money we pay. And a lot of people in this room know what I'm talking about. It's a model that rewards the quantity of care rather than the quality of care; that pushes you, the doctor, to see more and more patients even if you can't spend much time with each, and gives you every incentive to order that extra MRI or EKG, even if it's not necessary. It's a model that has taken the pursuit of medicine from a profession -- a calling -- to a business.

That's not why you became doctors. That's not why you put in all those hours in the Anatomy Suite or the O.R. That's not what brings you back to a patient's bedside to check in, or makes you call a loved one of a patient to say it will be fine. You didn't enter this profession to be bean-counters and paper-pushers. You entered this profession to be healers. (Applause.) And that's what our health care system should let you be. That's what this health care system should let you be. (Applause.)

Now, that starts with reforming the way we compensate our providers -- doctors and hospitals. We need to bundle payments so you aren't paid for every single treatment you offer a patient with a chronic condition like diabetes, but instead paid well for how you treat the overall disease. We need to create incentives for physicians to team up, because we know that when that happens, it results in a healthier patient. We need to give doctors bonuses for good health outcomes, so we're not promoting just more treatment, but better care.

On making sure doctors and patients have all the right information:

A recent study, for example, found that only half of all cardiac guidelines are based on scientific evidence -- half. That means doctors may be doing a bypass operation when placing a stent is equally effective; or placing a stent when adjusting a patient's drug and medical management is equally effective -- all of which drives up costs without improving a patient's health.

So one thing we need to do is to figure out what works, and encourage rapid implementation of what works into your practices. That's why we're making a major investment in research to identify the best treatments for a variety of ailments and conditions. (Applause.)

On America’s relationship with doctors:

But my signature on a bill is not enough. I need your help, doctors, because to most Americans you are the health care system. The fact is Americans -- and I include myself and Michelle and our kids in this -- we just do what you tell us to do. (Laughter.) That's what we do. We listen to you, we trust you. And that's why I will listen to you and work with you to pursue reform that works for you. (Applause.)

Together, if we take all these steps, I am convinced we can bring spending down, bring quality up; we can save hundreds of billions of dollars on health care costs while making our health care system work better for patients and doctors alike. And when we align the interests of patients and doctors, then we're going to be in a good place.

On the Health Insurance Exchange and a public option:

Now, if you don't like your health care coverage or you don't have any insurance at all, you'll have a chance, under what we've proposed, to take part in what we're calling a Health Insurance Exchange. This exchange will allow you to one-stop shop for a health care plan, compare benefits and prices, and choose a plan that's best for you and your family -- the same way, by the way, that federal employees can do, from a postal worker to a member of Congress. (Applause.) You will have your choice of a number of plans that offer a few different packages, but every plan would offer an affordable, basic package.

Again, this is for people who aren't happy with their current plan. If you like what you're getting, keep it. Nobody is forcing you to shift. But if you're not, this gives you some new options. And I believe one of these options needs to be a public option that will give people a broader range of choices -- (applause) -- and inject competition into the health care market so that force -- so that we can force waste out of the system and keep the insurance companies honest. (Applause.)
Now, I know that there's some concern about a public option. Even within this organization there's healthy debate about it. In particular, I understand that you're concerned that today's Medicare rates, which many of you already feel are too low, will be applied broadly in a way that means our cost savings are coming off your backs.

And these are legitimate concerns, but they're ones, I believe, that can be overcome. As I stated earlier, the reforms we propose to reimbursement are to reward best practices, focus on patient care, not on the current piecework reimbursements. What we seek is more stability and a health care system that's on a sounder financial footing.

And the fact is these reforms need to take place regardless of whether there's a public option or not. With reform, we will ensure that you are being reimbursed in a thoughtful way that's tied to patient outcomes, instead of relying on yearly negotiations about the Sustainable Growth Rate formula that's based on politics and the immediate state of the federal budget in any given year. (Applause.)

And I just want to point out the alternative to such reform is a world where health care costs grow at an unsustainable rate. And if you don't think that's going to threaten your reimbursements and the stability of our health care system, you haven't been paying attention.
So the public option is not your enemy; it is your friend, I believe.

Perhaps the most rousing moment of the speech came about half way through, as he stated the underlying moral basis for health reform:

We are not a nation that accepts nearly 46 million uninsured men, women and children. (Applause.) We are not a nation that lets hardworking families go without coverage, or turns its back on those in need. We're a nation that cares for its citizens. We look out for one another. That's what makes us the United States of America. We need to get this done. (Applause.)

70.3

http://www.youtube.com/watch?v=-3vcn-9yI_Q


27 degrees outside. Talk of Sporting Life, Mississauga & Ottawa in the air. Looks like race season is upon us folks.

Grabbed some new kicks after my home girl kicked ass at Boston this week (nice job SPE). Bike tires are pumped again and itching to get back into some ‘non spinning’ rides. Started a new weight-routine on Wednesday. And my front crawl can no longer be described as ‘Pheobe-like’=)

All in all, it’s time to snap out of the random winter routine and into a proper program again. This Sunday marks 20 weeks until the big test of ’09 - the Suburu Muskoka Ironman 70.3 (the ‘half’ IM ... http://www.ironmanmuskoka.com/intro.htm). While I may be comfortable on my feet, I’ll be attempting swim and bike distances I’ve never come close to touching before. Basically - It’s gonna be a hard but fun four and a half months, and I gotta shoutout in advance to all the good people I’m running and riding with for both pushing and putting up with me ... these might be individual events, but we’re definitely in ‘em together!

On that note – fire me a message if anyone out there’s looking for people to run or bike with ... we’ll be plotting short, medium, and long workouts all summer long with fun peeps, and definitely embrace strength in numbers!

And if not – watch out for deets of a big September party in cottage country if that’s more your thing-;)



NCFC's 'Running Against Crime' marathon team, ING Ottawa Marathon 2008 (above)
TNRL crew, Scotiabank Toronto Waterfront Marathon 2007 (below)

BOSTON MARATHON

Any runner's in a position to webstream while at work - can catch today's Boston Marathon at the following link:

http://www.universalsports.com/SportSelect.dbml?DB_OEM_ID=23000&KEY=&SPID=13048&SPSID=105671

If there are any friends/fam or other runners you wanna track online, receive live updates on etc - you can do so by entering their last name and bib # via the Boston Athletic Association's site at:

http://www.baa.org/2009

GOOD LUCK STEPH!

TAPPING INTO THE STRENGTH, COURAGE AND TENACITY OF STREET-INVOLVED YOUTH

This story first appeared in the Winter 2009 publication of the YOUTHLINK Connector ...

As the new manager for YOUTHLINK’s Inner City programs, I have been deeply impressed with the passion and commitment shown by my new co-workers, whether they be direct service support workers, counselors, administrative support people, or managers.
Woven through every conversation and every program update has been an excitement about what we can offer to youth.

There are many words used to describe the youth for whom we provide support services – street-involved, homeless, vulnerable, atrisk, marginalized, system shy – and while these terms are useful to help people understand a bit about the circumstances that may have led the youth to our doors, none describe the strength, courage and tenacity they have demonstrated in order to survive.

The social exclusion faced by many of the youth because of generational and/or situational poverty, mental health issues, racism, abuse, neglect, cognitive and/or developmental challenges, family conflict, substance use, and/or conflict with the justice system is profound.

Many youth have a history filled with reasons to be wary of service providers. And yet, every day I see youth opening up, trusting in the staff at Inner City and Youth Skills Zone, accessing support and creating the links they need to move from simply surviving, to thriving. The youth are compassionate, intelligent, caring people whose lives have often been filled with heart-breaking challenges.

The dynamic support flowing through all aspects of services provided by the staff members of Youth Skills Zone and Inner City Drop-In makes a huge difference in the lives of the youth.

At Inner City, our message to youth is, “you don’t have to leave your past at the door—it is a valuable asset in building your future.”

The Peer Educator Program is just one example of how Inner City programs honour the youths’ pasts and help them use the skills developed through crises as
strengths they can build on to move forward in their lives.

I believe strongly in our ability to reach young people through our Inner City programs with this message and to provide real opportunities for them to develop these strengths. We are providing essential services for youth who have rarely, if ever, found the support and acceptance they have needed through mainstream systems.

As we continue to enhance our programming through computer training curriculum development, health promotion programs and new partnerships to support youth living with mental health issues, we will be reaching out to public, non-profit and private sectors for support.

We want to show street-involved youth that there is a wider community that believes in them as much as we do.

--Sabina Chatterjee, Manager, Inner City Drop-In and Youth Skills Zone


http://www.youthlink.ca

BLUESLINK

On May 14th I'll be attending Blueslink - a Toronto fundraiser in support of some wonderfully effective inner-city programs supporting street-involved youth.

If you're going to be in the city, it's gonna be a fun night of Blues, giveaways and live music in support of a great cause. Check out the link for more info ...

~Bryan

http://www.youthlink.ca/BluesLINK09_eflyer.pdf

Army suppressing PTSD diagnoses?

Salon.com's Mark Benjamin & Michael de Yoanna break the first of a string of stories stemming from the tape of a US Army Dr acknowledging the pressure he has faced to not diagnose PTSD in soldiers & veterans coming to him for health assessments, and the investigative journey and roadblocks that have since ensued with Military officials and the Senate Armed Services Committee.

http://www.salon.com/news/special/coming_home/2009/04/09/ptsd/

Food Insecurity

Paul Caron, a former food inspector with the Canadian Food Inspection Agency (CFIA) began speaking out this week about the weakness of our nation's food security, specifically regarding our vulnerability to cases of bioterrorism or future outbreaks of naturally occurring diseases (eg Salmonella, Lysteriosis).

When probing for details, it's hard not to agree with him that the status quo is inadequate and embarrassing, especially given the high level of awareness generated during last year's Maple Leaf Foods fiasco. Examples of vulnerabilities cited, in the context of meat, include:

- Where the US inspects all meat entering their borders, Canada not only pre clears meat imports before they're even at the border, but gives exporters at least three days notice whether their shipments will be checked or not checked.

- Once crossing the border, it's not just that only 1/10 shipments are sent to inspection facilities for a closer look, but of that 1/10 - the foreign company that sends its meat to Canada can hand pick which specific facility will 'inspect' their product. Pretty independent, huh?

Moral of the story, in the absence of new measures, one can smuggle just about anything into Canada via meat shipments.

-BH-

What happens to seized contraband?

On Monday, The Canadian Press shed some light on the findings of a recent audit of the Canadian Border Services Agency (CBSA) and specifically, what the heck happens to the guns, drugs, and other contraband that are seized.

Most seizures end up in Quebec or Ontario (Toronto, Windsor regions). Among the more ridiculous findings ...

- Meth, hash, steroids, blow, etc are all ending up in landfills because guards don't know that they are supposed to be destroyed

- In addition to drugs, guns & ammuno are sent to storage facilities/warehouses with either substandard or non-existent inventory controls

- Of 68 inspection sites, physical security was substandard for half of the interior facilities and for all of the exterior facilities. For example: 70% of warehouses were not continuously monitored (by guards, camera's or motion detectors); 15 sites, there was no control of access by non-government persons; and 23 sites had no inventory controls whatsoever.

Recognizing the potential goldmine this is for organized crime - I would love to also read a similar report of what happens to goods seized by police officers, to see if security or destruction practices are just as shotty. Both CBSA and police forces love to report on how much contraband they "remove" from the streets - but given reports like this, how certain can we be that they are actually staying off of the streets! While they often receive endless credit for removing such items from the market, rarely ever do we think about those numbers critically and ask for them to be put into a more meaningful context.

Going forward, it's time we start demanding much more transparency and accountability from our police and border services about the proportion of seized contraband that are actually being destroyed, and/or being stored in high security facilities with low risk of finding their way back to market.

-bRygUy-


Link to CBSA audits/evaluations: http://www.cbsa-asfc.gc.ca/agency-agence/reports-rapports/ae-ve/menu-eng.html

Tobacco & Health, v2: CTCRI Funding Cuts

A letter from Dr Roberta Ferrence, in response to news that the Canadian Tobacco Control Research Initiative will no longer accept applications after 01 April 2009:


Dear Colleagues,

We were all deeply disappointed by the recent news that the Canadian Tobacco Control Research Initiative will not be accepting new applications after April 1. We are grateful to Roy Cameron, Cheryl Moyer, Marie Chia and numerous other staff, as well as the funding partners, CIHR, NCIC (CCS), Health Canada and the Heart and Stroke Foundation, who brought CTCRI into being and nurtured it for the past decade. During that time, we have grown from a small community of researchers and a few students to several hundred active and committed tobacco control researchers, practitioners and decision makers. We are optimistic that this community will continue to contribute in a major way to public health in Canada.

At this week's Ottawa Workshop, Best Practices to Target 12% by 2011, sponsored by Health Canada and CTCRI, we heard from Marie Chia about the implications of the CTCRI decision and potential next steps. At that time, OTRU offered to coordinate efforts to ensure that tobacco control research and capacity building will continue to garner funding from alternative sources that understand its importance.

To support this process, we will pull together information on alternative sources of funding for investigator and student research, conference travel and workshops, and identify specific programs that may provide support for the specific initiatives funded by CTCRI. This will be distributed shortly as an OTRU update.

We will also bring together contact information for key individuals and suggestions for content to support individual letter writing, so that you can communicate your own stories about the benefits of tobacco specific funding programs.

We will in touch soon and look forward to working with you.


Best regards,
Roberta

--

Roberta Ferrence, PhD,
Executive Director,
Ontario Tobacco Research Unit
University of Toronto and Centre for Addiction and Mental Health

MAC

I had a nice little visit to good 'ol H-town yesterday ... always feels like a fun homecoming when i step on campus! minus the TP and kegstands, of course=)

In all seriousness - it was great to have the opportunity to drop in on a couple classes, which in more ways than one helped inspire some of my own thoughts about how to develop a class or two in the not too distant future.

A big shoutout is in order to KT and the the students of 4JJ3 & 4TT3 - you all have enormous futures, and I can't wait to hear about what's next!

~BH

I VOTE TORONTO

Just spreading the word about I Vote Toronto's campaign to extend municipal voting rights to non-citizen permanent residents.

Check out the Maytree Foundation's think piece for the argument's in favour @
http://www.joemihevc.com/WriteFolder/pics/Maytree%20policy%20in%20focus.pdf

and visit http://www.ivotetoronto.org to learn more about the campaign and how to get involved.

26 countries so far, including the United Kingdom, Portugal, Germany, Israel, New Zealand, Chile, Barbados and Australia have to date enacted similar laws, which have been considered an important step in better engagement of newcomers in civic life.

~BAAH

VANNIS

Latest endorsement for some good Toronto eats is VANNIS - a midtown (mostly) italian eatery at 672 St Clair Avenue West near Christie. It's only been open for about half a year now, but being in the old 'hood I couldn't help but pay attention to so many fam & friends vouching for this new little spot sandwiched between my old convenience shop and movie store.

So tonight was the night - dinner party for the Grand Sacki 60 - and it didn't disappoint. Server was fast, owner was friendly in full mingling spirit, and most importantly the food kicked ass and was in abundance. And the prices ain't bad either!

Moral of the story - I'll be back.

B

Ps - Order the Salmon or the Gnocci for an entree without regrets.

One year ends, Another begins

While I won’t quite call it a holiday letter, the new year seems an appropriate time to resurrect the old bryguy blog=) So why not make post #1 a statement about the year that was, and what’s on the horizon for the year that is ...

Like many, 2008 had seen its ups and downs – for family, for friends, for myself. For all of you who were around for the highs, thank you for the memories - it’s been an extraordinary ride. For everyone adjusting to new realities, my thoughts are with you and let us look onwards and upwards as the sun rises on the new year.





Though it doesn’t feel like I got away too much this year, a quick glance back saw the bags being packed for a couple great visits to the nation’s capital, the west coast, the sun and sands of Cayo Sol Santa Maria (Cuba) - and a truly breathtaking hike of Peru’s Inca Trail to Machu Picchu and fly-by of the famed Nazca Lines with Dad, Jen, Shaki, Sasha, and Ryan.

On the fitness front - the marathon with Regina’s NCFC gang was something I did not attempt to repeat (I know I’m a slacker Ben!).
While I still love pounding the pavement (or snow in this bloody cold country), I’ve been getting in some regular bike and swim sessions in pursuit of next year’s Ironman 70.3 (the half IM) competition in the Muskoka Lakes.

As I continue shedding grad school to official acceptance of the real world - I look forward to continued involvement with UNA-Canada’s Ripple Effect initiative, to teaching my first classes at McMaster, and to progress through the ever slow federal recruitment with the Public Health Agency & Department of Defence.

Should the latter effort be successful, there will certainly be one more far off adventure before buckling down. Location still TBD, but a visit to the Middle East tops the current list, with Russia coming in as a close 2nd – not to worry folks, not planning to conflict with the gamut of weddings that will no doubt keep the domestic travel circuit at capacity=) On a smaller and more immediate scale, Paul, Janice, Winy and I are kickstarting the year in style with a January road trip to D.C. to help roast the Obama’s in their new hometown!

Ok signing off for now – time to make it all happen! ‘Till next time - may peace, health, happiness and good people find you all in ‘09.