Health Care's Checkup: A Brief Visit with One of America's Leading Issues

Whether you are middle-aged or a young adult, Democrat or Republican, a political activist or just counting down the days until your television commercials are free of candidates’ faces, there is one social issue that consistently affects the lives of everyone: health care.

We can all easily agree that the need for health care is universal.  Sometimes you need medicine, a doctor’s visit, even surgery.  We are all similar in that we all require our basic physical and mental health needs to be met in order to live a good quality of life.       

Some other things that we can agree on about health care: 1) the issue of health care is divisive and 2) our nation’s system is flawed.

How about some facts?  The Census Bureau reported today that in 2011 48.6 million people, 15.7% of the United States’ population, had no form of health insurance. 

When compared to 12 other industrialized countries (e.g. Canada, Australia, New Zealand, Japan), researchers show that the U.S. pays the most for health care- nearly $8,000 per person in 2009.   

Increased spending does not necessarily equal increased health care effectiveness or quality of care.  While the U.S. boasts high colorectal and breast cancer survival rates, we also have a higher than average number of preventable asthma-related deaths and diabetes-related amputations.

Once we are aware of these facts, then, the question of health care reform surely changes from “Should we?” to “How and when do we?”

Now, you’re probably thinking, “What rock have you been living under?  Heard of the Affordable Care Act?”  And yes, I too cannot open Yahoo!News without reading about President Obama’s brainchild.  And yes, the coming series of entries on this blog will be focused primarily on what many refer to as Obamacare.  Yet, before we dive into the specific policy, it is prudent to set the general stage.

We’ve talked health care problems; now let’s talk solutions.  Three different teams of researchers suggest different approaches that they believe should be incorporated in our nation’s search for a health care solution.    

      

1)    Pay for Quality of Care, Not Quantity.  In this approach, health care providers would be awarded bonuses for things like preventative care (immunizations and cancer screenings), patient satisfaction (Is my doctor listening to me or rushing me out the door?), and investments in technology (helping to reduce medical errors) rather than receiving payment based on the number of patients seen.  A 2006 Harvard University study encourages this line of patient-centric thinking, while cautioning that the empirical evidence backing this idea is still limited.

2)      End Overtreatment.  Overtreatment includes patients receiving prescriptions for unneeded medications, the ordering of unnecessary medical testing (e.g. MRI’s), precautionary hospitalizations, and surgery before exploring other options.  Researchers Berwick and Hackbarth estimate that overtreatment accounted for anywhere between $158 billion and $226 billion in health care costs in 2011.  If the use of treatments and medicines that hold little to no benefit to patients are discovered and reduced, the savings in health care costs could be immense. 

3)      Look to Other Countries for Ideas.  As we’ve mentioned, the United States’ health care costs are incredibly higher than that of 12 other industrialized nations.  All of the countries (except the United States) examined in the study conducted by the Commonwealth Fund provide universal health care to their citizens.  Of the 12 industrialized nations, Japan spends the least on health care (7% of their GDP in 2009, compared to 17% of the GDP in the U.S.).  It seems our neighbors are doing something right.    

The problems with our nation’s health care system can seem overwhelming or unfixable when thought of too hard or long.  Yet, it is important to remember that with a big problem comes a big possibility for reform.  The opportunities before our nation to change health care for the better are great and the nation is certainly capable.  You and I have even begun the first step of the process by becoming part of the discussion.

Let’s continue the discussion below.  What’s your take on the general system of health care in the United States?  I’d love to hear your opinions!

References 

Berwick, D. & Hackbarth, A. (2012). Eliminating waste in U.S. health care. JAMA, 307 (14). Retrieved from https://sremote.pitt.edu/,DanaInfo=jama.jamanetwork.com+article.aspx?articleid=1148376

The Commonwealth Fund. (2012). U.S. spends far more for health care than 12 industrialized nations, but quality varies [Press release]. Retrieved from http://www.commonwealthfund.org/~/media/Files/News/News%20Releases/2012/Apr/SquiresOECDRelease_FINAL_5312wolink.pdf

Fox, E. (2012, Sept. 12). Fewer Americans uninsured- Census Bureau. CNN Money. Retrieved from http://money.cnn.com/2012/09/12/news/economy/census-bureau-health-insurance/

Rosenthal, M. & Frank, R. (2006). What is the empirical basis for paying for quality in health care? Medical Care Research and Review, 63. Retrieved from http://mcr.sagepub.com/content/63/2/135.full.pdf+html  

Why Social Work: An (Over) Extended Metaphor About Love

People get into social work for a variety of reasons. From an altruistic desire to help others, to a deep belief that a person can make a difference, to a compelling, life-altering internship, different experiences have led many of us to choose the same profession. Yet, despite the relatable nature of the above occurrences, none are the true reason that I want to become a social worker. Though it is direct, and perhaps a tad trite, I can tell you why I want to be a social worker in one declaration: I am in love with social work.

When I first met social work, it was infatuation at first sight. I have always been a people person and have always gleaned happiness from feeling as though I was helping others. So, you can imagine my joy when I realized that there was a profession that not only allowed me to develop these characteristics, but that saw those very characteristics unequivocally as strengths. Though I did not act on it, I would return to the idea of social work throughout my high school years, like that cute older crush that you regularly see in the hallways but never speak to.       

It was my senior year of high school and finally time to pick a college major.  With my love of people and my desire to help others, I naturally chose social work. Right? Well, no. You see, my parents weren’t thrilled with the idea of me being a social worker. Do you want to be heartbroken and poor your whole life, they asked. Now before we vilify my parents, it is important to realize two things. One: It is a well-known fact amongst my family and friends that the presence of a dog and/or small child in anything set to music is enough to make me tear up. Secondly, and more importantly, up to this point in my life, I had never educated myself about the field of social work. If I had, I would have been able to enter into an intelligent discussion with my parents about both the pros and cons of the field. As it was, I chose psychology as my major, setting off to college with the idea of social work far behind me. How realistic are high school crushes anyway?

Fast-forward four years to my senior year of undergrad. I was talking with a mentor/friend, asking for advice in choosing a graduate school program. What I really wanted, I told him, was to find a job that allowed me to work in a place like the domestic violence non-profit where I had been working for the past two years. My friend, himself a graduate of Pitt’s MSW program, gently interrupted my ramblings to point out that I had essentially spent the last half-hour describing my desire to pursue an education in social work. Shocked, I went back to my dorm room to think. Could it be that after all this time I was really reconsidering a profession as a social worker? I began to examine this idea, and the entire field of social work, again. Yet, this time, I met social work not as an inexperienced, shy girl, unsure of her feelings and desires, but as a mature woman who knew her strengths and what she wanted from life. It was during this time of reflection that I realized that social work was truly the right path for me.

Perhaps this time in my life is serving as my engagement to social work. Like planning a wedding, my concentrated, graduate school study of the field can be both dynamic and stressful. Yet, when things get overwhelming, when I begin to doubt my own capabilities, I need only stop, take a deep breath, and remember how much I truly want to be exactly where I’m at right now. When I think of social work, I get that rare, magnificent feeling of peace and rightness. This is truly where I’m supposed to be.

I want to be a social worker because I know that my marriage to social work will be amazing and rewarding. Still, if anyone wants to pass along some silver for my 25^th anniversary, I wouldn’t say no. Student loans are expensive.