Prodding Families into Divorce & Taking a Life Every 30 Minutes

Another great article in the New York Times by Nicholas Kristof. It is a sobering story supporting why there should be health care reform in the U.S.A. Here are some points from it. Kristof points out that the critics of health care reform argue that it would undermine American family values, not least by convening the Palinist expressed death panels. I wish the negative argument would stick to logic rather than emotional fear mongering. Kristof tells the story of a married woman whose husband is diagnosed with dementia. Upon considering the financial toll of what is to come she is advised to divorce her husband. Unless she does so the expenses will whittle away their combined assets, and then her husband can go on Medicaid – but by then their children’s inheritance would be gone, as would her retirement savings. She would be left with a bleak retirement with neither her husband nor her savings. Also for 5 years after any divorce, under U.S.A. law her assets could be seized – precisely because the government knows that people sometimes divorce spouses to escape their medical bills. Then he sets out the statistics – 62% of American bankruptcies are linked to medical bills. This has increased nearly 50% in just 6 years. But get this – 78% of these people actually had health insurance, but the gaps and inadequacies left them unprotected. The lack of health insurance causes 18,000 unnecessary deaths a year. That’s one person slipping through the cracks and dying every half an hour. This article is very much worth your reading. It can be found at http://www.nytimes.com/2009/08/30/opinion/30kristof.html?_r=1&scp=1&sq=kristof%20until%20medical%20bills%20do%20us%20part&st=cse

To recover from U.S.A. health reform malaise, take a dose of Canada Health Act

I am absolutely amazed that the American health care reform is bogged down in partisan politics. It doesn’t hurt for us Canadians to be reminded of the underpinnings of our system as we watch this inertia south of us. With respect to the U.S.A., it seems to me that in the 21st century it should be recognized by all that health care is a basic human value, just as we have come to recognize freedom of speech, freedom of association, etc. It sounds like there is a lengthy and detailed bill before the legislators. Why not just agree on the principles – which should be fairly straight forward, pass that as law and then implement it, working out the details at that time.

I think that is what happened with health care in Canada. And contrary to what some Republicans and other related interest groups are saying and advertising, the Canadian health care system does work. Why does it work? Because it is based on five principles which sustain its operation, have stood the test of time, are not enshrined as values of the health care system, and mirror the values of Canadians:

First, the provincial and territorial health care plans must be publicly administered – on a non-profit basis by a public authority, which is accountable to the provincial or territorial government. Its records and accounts are publicly audited.

Second, the provincial and territorial health care plans must be comprehensive – i.e. they must cover all insured health services provided by hospitals and physicians.

Third, the provincial and territorial health care plans must be universal – i.e. all residents of a province or territory must be entitled to the insured health services provided by the provincial or territorial health care plan on uniform terms and conditions.

Fourth, the provincial and territorial health care plans must be portable – i.e. residents moving from one province or territory to another within Canada must continue to be covered for insured health services by the area they left during any waiting period (not to exceed three months) imposed by the new area of residence. After the waiting period the new area of residence assumes responsibility for health care coverage.

Fifth, the provincial and territorial health care plans must be accessible – i.e. all persons shall have reasonable access to insured hospital and medical services on uniform terms and conditions, without having to pay user charges or extra-billing and unimpeded by other means (e.g. discrimination on the basis of age, pre-existing conditions or financial circumstances). The provincial and territorial health care plans must provide reasonable compensation to physicians for all the insured health services they provide and provide payment to hospitals to cover the cost of insured health services. Reasonable access in terms of physical availability of medically necessary services means access to insured health services at the setting where the services are provided and as the services are available in that setting.

The Canadian health care system allows for reasonable access to medically necessary hospital and physician services, on the basis of funding by government. It is a national program composed of thirteen provincial and territorial health plans, all of which share certain common features and basic standards of coverage. Based on the provinces and territories fulfilling the basic principles, they receive federal cash contributions to fund their health plans. The provinces and territories are responsible for the management and delivery of the health services.

It just seems so straight forward. People should be able to receive health care without having to worry about mortgaging their homes, or losing coverage when they change jobs or they develop certain medical conditions. I would hope that reason will prevail and the U.S.A. will be able to provide health care similar to what we enjoy in Canada.

Playing It Safe in Cancer Research

I recently read an article entitled “Playing it Safe in Cancer Research” published in the June 28, 2009 issue of the New York Times. If you want to read the full article you can find it at:

http://www.nytimes.com/2009/06/28/health/research/28cancer.html?_r=1&scp=1&sq=kolata%20%22playing%20it%20safe%20in%20cancer%20research%22&st=cse

This article is based on the system in the USA and it would take someone with more knowledge of science than I to compare it to the system in Canada, but it did raise in my mind some fundamental philosophical points.

The subtitle of the article is “Grant Money Goes to Projects Unlikely to Break Much Ground” but it does make the point too that grant money in the USA is often not going to projects that are likely to break much ground. It talks of the grants going to projects which are only likely to produce incremental progress in the fight against cancer. “The reviewers choose such projects because with too little money to finance most proposals, they are timid about taking changes on ones that might not succeed. … projects that could make a major difference in cancer prevention and treatment are all too often crowded out because they are too uncertain.”

The article goes on to refer to big ideas without a backer. In some cases there is a real catch 22: a project is refused funding because there are not even any preliminary results to support it, but of course the researcher cannot come up with the preliminary results without some grant money to get the project started.

Reference is then made to some angels outside the USA government and the American Cancer Society. Some researchers don’t even bother to apply for government money and instead go for grants from some endowments which can support such grants. But regrettably there are not enough of such angels around to support the many projects which are available.

One researcher, who has reviewed grants for the cancer institute herself, is quoted as saying that she realized that, among other things, those that get financed must have a novel hypothesis that is credible based on what we know already. I have found it instructive to live by the principles enunciated by Stephen Covey in his Seven Habits of Highly Effective People, and some of his other works. In some of his foundational principles he talks of significant breakthroughs being breaks with old ways of thinking. Also, it is often the case that significant problems cannot be solved at the same level of thinking we were at when we created them. Those principles make good sense to me. I wonder if they apply to medical research. The article does talk of the USA National Institutes of Health setting aside some funds for pioneer awards which are for proposals which are exceptionally innovative, high risk, original and /or unconventional research but with the potential to create or overturn fundamental paradigms. If so, that would support I would think taking some risks and going for projects which might produce real breakthroughs. However risks need to be balanced. So it makes sense to me that chancy experiments with novel hypotheses which may provide real breakthroughs will need to be balanced with something. The something I’m sure involves the “bigger picture” including some consideration of where science is at. I leave it to those more knowledgeable than I to figure out that balance.