What We Worry About Least in the Health Policy Debate

You shouldn’t have to worry about anything during vacation season.

So this column is my vacation gift to you. It is about all the health policy matters we seem to worry about the least. 

I have written close to 150 columns.  If you look down the right side of the page, you will find links to the ten most-read ones.  The subjects won’t surprise you – fairness in mental health treatment, Obamacare and private insurance, and cursed football players lead the way.

But do you ever wonder about the columns with the fewest readers?

Based solely and unscientifically on my numbers, here are a half dozen or so health policy matters we seem to care about the least.

Long Term Care. 

Are you worried about continuing high unemployment rates, taxes on small businesses, or another stock market crash ruining your family’s financial security?   If so, you should redirect that worry.  Because US Trust CEO Keith Banks called long term care costs “the biggest risk to family wealth” during a June 27, 2013 CNBC interview.

That’s because neither regular health insurance nor Medicare covers them.

So you can either pay $80,000 or more per year for long term care, or hope states continue to spend billions of dollars to expand Medicaid, or wait for Congress to create a national private long term care insurance program– something a new national Commission on Long Term Care has just been given three months to do.  That should get anyone’s anxiety level up.  But chances are – if you are still reading this column – your mind is wandering already, and you are ready to move on.

Medicare.

Whenever I write about Medicare, I lose 30 percent of my readers that week.  For example, I wrote two columns earlier this spring about something I found really intriguing and have never read anywhere else – that Medicare regularly pays more for men with depression than it does for women.  To me, this is blockbuster news about disparities in care.  But not to my readers. Maybe we need to be eligible for Medicare before we really start thinking about it?

Research.

Without research, there would be no modern healthcare system.  There would be no effective cancer treatments and no once-deadly communicable diseases – like polio – that ruined more than just children’s summers as recently as sixty years ago.  But the one time I wrote about why research matters – just two weeks after I wrote my most popular column ever – it was one of my least-read ones ever.

Child health.

Everybody loves children, but my columns on child health – even ones with sensational headlines – don’t seem to attract much attention.  It may be that we feel that we have solved most of our child health problems over the last few decades.  But as a brand-new Annie E. Casey Kids Count report points out, while we’re trending in the right direction, we still have a way to go.

Personal Responsibility and Wellness. 

This is another subject I have shied away from, after dipping a toe in the water two years ago.  I wrote about the way in which Connecticut, a liberal state, added a component of personal responsibility, a historically conservative concept, to its state employee health plan.  The state believes that it has saved money by doing this, and the approach has proved popular with employees.  But the column wasn’t popular with readers.  Why not?  We all want to be healthier. But maybe we don’t want health insurance to be tied to health!

Environmental health. 

While environmental health is a huge part of public health, environmentalists and public health officials often go their separate ways in policy advocacy.  I wish it were different.  But even when I wrote about the environmental devastation in the immediate aftermath of the Japanese nuclear disaster in March 2011 and put it in a broader public health context, not too many people paid attention.  The column drew fewer readers than almost every other column I wrote that spring.

Eric Cantor.

Don’t ask me why, but the least-read of my 150 columns was the only one that used the words “Eric Cantor” in the title.  If you have forgotten who Eric Cantor is, I am not going to remind you.  But once upon a time, he was actually relevant to the health policy debate in this country.

Lately he seems to be taking a vacation.  A long one.  As we all should be!

Paul Gionfriddo via email: gionfriddopaul@gmail.com.  Twitter: @pgionfriddo.  Facebook: www.facebook.com/paul.gionfriddo.  LinkedIn:  www.linkedin.com/in/paulgionfriddo/

Florida's Shame is Connecticut's Gain

The next time Florida’s Governor tells you that the only way to create private sector jobs is to cut public sector health spending, don’t believe him. 

According to news reports, the Governor’s Office is already warning state health agencies to expect more budget cuts in 2012.  He wants the dollars to implement his 7-7-7 plan to create 700,000 jobs in 7 years.

source: US DOL data, 2011

How’s the plan working out for Florida so far? Dismally, by two different measures.  The first is the 2011 state unemployment claims data.  The second is the story of why Florida just lost another 7,500 jobs in health research.

The 2011 unemployment data show that Florida’s Governor has been more effective at killing jobs than creating them.  The week before Governor Scott took office, 14,139 Floridians lost their jobs and filed new unemployment claims.  In 36 of the 37 weeks since then, the number has been higher than that.  Another 15,713 Floridians filed new unemployment claims during the most recent September week for which data are available. 

To add insult to injury, there was a press conference a thousand miles away in Connecticut last week that explained why Florida’s job creation performance has been so dismal this year. 

 Jackson Laboratory, a Maine-based company, announced that it will build a new, $1.1 billion research lab on University of Connecticut Health Center property in Farmington, Connecticut.  The lab will produce over 661 new research jobs, support 842 construction jobs,  and create an estimated 6,200 spinoff and indirect jobs.

Jackson carries out cutting edge research in the genetics of Alzheimer’s disease, cancer, and diabetes prevention.  Landing the company was a huge victory for Connecticut.  A source close to Connecticut’s Governor reportedly proclaimed that it “will make Connecticut a world leader in the science of genomics.” 

This was all supposed to happen in Florida, as a part of that highly-touted 7-7-7 plan.   But in June, Jackson announced that it had “withdrawn” its request for $100 million from Florida to locate in Sarasota.  In its June release, its Executive Vice President was gracious, but clear, about why it went elsewhere.   “We respect that the state had to make difficult priority decisions in order to balance the budget this year,” he said.  But the lack of dollars “and the uncertainty of future funding made such a venture too speculative to undertake responsibly.”

In a story last week, the Hartford Courant, Connecticut’s newspaper of record, offered up a slightly different, and blunter, quotation from a company official.  It reported that a “Jackson source said ‘politicians in Florida took a dramatic, hard turn to the right, and funding dried up.’"  

One local Florida health leader recently said that “we used to just show ‘em a palm tree” to get people to relocate to Florida from the north.  Apparently, Florida can no longer sell itself to actual job creators on good looks alone.

As a result, the University of Connecticut – instead of the University of South Florida – will reap the benefits of a billion dollars of private investment in one of the most rapidly growing areas of health care.  In return for a $192 million loan and $99 million in support of research, Connecticut, instead of Florida, will get over 7,500 new jobs.

CT News Junkie, an online publication, rubbed it in with a headline article on September 30^thentitled “Florida’s Loss is Connecticut’s Gain.”  In the accompanying photo, Jackson Laboratory CEO Edison Liu is shown holding up a UCONN tee shirt as UConn’s President speaks, flanked by the Speaker of the Connecticut House and the Chairman of her Board of Trustees.

This was supposed to be Florida’s photo op.  But opportunity knocked, and no one answered. 

Florida has only its “hard turn to the right” to blame for the clouds over its horizon.  That’s why over 7,500 jobs will begin to fly north this winter.

Florida should be a leader in health research and treatment, especially research and treatment in diseases affecting an aging population.  But Florida can’t lead when its elected officials are running backwards. 

Florida’s Governor and Legislature have been slashing from health and mental health programs – including public health, Medicaid, and – as it turns out – even economic development spending.  And now the Governor, who should be ashamed by what happened with Jackson, wants to slash some more.   

The next time you visit Farmington, Connecticut, take a good look at where over 7,500 would-be Floridians will be buying their homes, paying their taxes, and spending their money for years to come.  You won’t see a single palm tree.

If you have questions about this column or would like to receive an email notifying you when new Our Health Policy Matters columns are published, email gionfriddopaul@gmail.com.

Why Research Matters

A few weeks ago, we were tantalized by the news that a new treatment for leukemia might be on the horizon. 

Three very sick patients were injected with a new drug.  It was made from – of all things – a modified version of the virus that causes AIDS.  After a year, two were disease-free and the third had a 70% reduction in disease tissue.  One researcher was quoted as saying that the results “exceeded our wildest expectations.”

But the rest of the story pointed out that the discovery almost didn’t happen.  There wasn’t enough research money for a full trial.  Neither the National Cancer Institute nor pharmaceutical companies had funding for the research.  A family foundation stepped up, but that’s why there were only enough funds for three patients to participate initially.

The National Institutes of Health (NIH) is the largest funder of biomedical research in the United States.  In requesting a budget of $32 billion for FY2012, it noted that research that it funded has reduced death rates from stroke by 70% and deaths from coronary heart disease by 60% since 1970.  It has also contributed to the amazing results that have been achieved over the last twenty years in HIV/AIDS management, and to a significant reduction in cancer deaths as well.

We spend $2.4 trillion on health care in America.  Shortly after NIH made this request for just over 1% of that, Congress cut its funding to $250 million below 2010 levels. 

On its cover, the AARP Magazine for September/October 2011 trumpets “Amazing Medical Discoveries That Will Change Your Life.”  These discoveries were the result of funded research.  They include artificial retinas, prostate cancer vaccines, and magnets for depression relief – all currently available.  AARP sees new breast cancer drugs and adult stem cells for coronary artery disease treatment in just a few years, and even more exotic treatments down the road.

These discoveries will all make a huge difference in how we live.

Research isn’t just the work of scientists in labs, and doesn’t just result in new drugs and treatments.  Sometimes, it results in safer medical procedures that not only preserve life, but also lower costs at the same time.

NIH says that research advances have saved trillions of dollars.

Here’s one story of money-saving research advances.  Jeffrey B. Cooper, a biomedical engineer at Massachusetts General Hospital, has made patient safety his life’s work.  Though he has labored in relative obscurity – I doubt that more than a thimble full of policy leaders outside of the Greater Boston area have ever heard of him – he played a key role in the development of modern anesthesia “standard of practice” guidelines, developed technology to manage the use of anesthesia in operating rooms, and facilitated the development of simulation training to ensure patient safety.

The bottom line results of his work suggest that there is more than one way to achieve tort reform.  As training and practice standards evolved and improved, there were fewer adverse patient reactions to anesthesia and fewer deaths.  This resulted in lower costs to insurers, which led to lower malpractice rates for physicians.

Research brings about medical advances, improved training, and better patient treatment.  But that’s not all.

The Framingham Heart Study was recently in the news because it released some new research linking poor health habits in middle age to brain shrinkage.  What makes this Study remarkable is that it has been ongoing since 1948. NIH is a partner, along with a number of other public and private institutions.  It is following its third generation of individuals now, and has participated in some of the most important advances in our understanding of cardiac disease risk factors.

We have another federal agency devoted to disease prevention, the CDC.  Its total budget of $11 billion is less than one half of one percent of our annual health care expenditures.

Most of us take for granted or devalue these agencies, and the many hundreds of researchers who have developed cures or treatments for disease, procedures and training that save patient lives, and strategies for preventing chronic conditions. 

The people who settled Jamestown did not yet know that blood circulated in the body, and those who prepared to declare our freedom from England still did not even know what oxygen was.

But our nation’s founders were scientists as well as public officials.  Modern health care is the result of their embrace of the miracle of modern science.

But in today’s United States, not everyone has equal access to advanced prevention and treatments.  Our health care safety net no longer catches everyone.

And we’re forgetting the value of research – that because of it we now live longer, healthier lives.

Research requires funding, and a willingness to embrace the legacy of our parents and grandparents.

If you have questions about this column, or wish to receive an email notice when Our Health Policy Matters columns are published, please email gionfriddopaul@gmail.com.