Today’s Los Angeles Times features a story in their health beat called, “In healthcare debate, ‘reality’ is in dispute.” All-comers have arrived on the ever-more populated health reform opinion stage, from Sarah Palin (calling President Obama’s plan “downright evil”) to Nancy Pelosi calling town hall protestors “unAmerican.”

To counter the disses and naysayers, the White House has put online its own reality-checking website at http://www.whitehouse.gov/realitycheck/.
Two perspectives must tether said ‘reality’ and our underlying principles for health reform: putting and keeping the patient/citizen in the center, and getting real about health care costs.

Well-timed and highly relevant as usual, the New England Journal of Medicine (a key source for those of you who want to Get Real about health reform) has two pieces in this week’s issue that speak to People at the Center and Costs.

On the cost front, health economics guru Henry Aaron writes a short and smart opinion titled,
Why Paying for Health Care Reform Is Difficult and Essential — Numbers and Rules. In a short few paragraphs, Dr. Aaron elegantly simplifies and quantifies why finding the $1 trillion for universal coverage is so difficult. He concludes, realistically, soberly,

“The challenge of finding acceptable ways of paying for near-universal coverage is formidable and may prove insurmountable. For reasons that President Obama has forcefully stated, health care system reform is vital. But the full reform agenda may be beyond immediate political reach. It is therefore essential to identify elements of the full plan that would set the stage for later reforms and that can be financed at a politically digestible price — and find a way to ensure their passage.”

In a companion column in the NEJM, Dr. Pamela Hartzband and Dr. Jerome Groopman write about Keeping the Patient in the Equation-Humanism and Health Care Reform. In this piece, the doctor-authors point out that, while the World Health Organization ranks the U.S. as #37 in the world in terms of overall health care delivery, the nation is “first in responsiveness:”

“That is, in providing patients with choices that are meaningful to them. We scored poorly on the variables related to economics and fairness in distribution of services, and these factors will be addressed through the reform measures that are now in the works. Retaining our hard-won advances in shared decision making will allow us to ethically combine the contributions of medical humanism and evidence-based guidelines while addressing the imperatives of cost containment and universal coverage.”

Hartzband and Groopman urge reforms to incorporate shared decision making — making health citizens central in health reform and care delivery.


Health Populi’s Hot Points:
The notion of “humanism and health reform” as explained by Hartzband and Groopman seems so obvious, yet so absent from the basis of the current “dialogue” (used loosely) in town hall meetings, TV talk shows, stump speeches and op-ed pages.

Checking the facts seems an activity in short supply. In the “deathers” camp, as Christopher Beam wrote in Slate.com, people seem convinced that President Obama’s plan is thinly veiled genocide-for-cost-containment. But Factcheck.org went to the source of this concern: they found that, “Page 425 does deal with counseling sessions for seniors, but it is far from recommending a ‘Logan’s Run’ approach to Medicare spending. In fact, it requires Medicare to cover counseling sessions for seniors who want to consider their end-of-life choices –- including whether they want to refuse or, conversely, require certain types of care. The claim that the bill would ‘push suicide’ is a falsehood,” the organization found.

As Aaron says in his straightforward way, we must contain costs in health care. Most Americans seem to agree on this concept, particularly with an approach that will not add to the already ballooned deficit. At the same time, keeping the patient-citizen central to the health financing and delivery equation is key to an American solution to health reform.

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