How do you put a state with abysmal overall health and very bad health care on an even more grisly trajectory?
You can do it by sparking hysterics and forgetting the history of the last rounds of big change in US domestic policy. You can also get to the new badlands by failing to understand the mathematics of the new Affordable Care Act package and it's huge, unambiguous benefits for a state with lots of uninsured people, armies of unhealthy folks and not much extra cash.
When Social Security, and later Medicare and Medicaid came into play, there were howls that America was on a socialist path -- a road packed with despotism, regimentation and the death of enterprise. This in a half-remembered time in US history, marked by routine poverty, even misery among huge fractions of our older population.
Wildly, what we have now, in early 21st century America, is an epoch remarkably free of old age poverty: Older Americans are as vibrant, as free and as empowered as any cadre of aging people in human history. A radiant consequence of the triumph of a public old-age pension system (Social Security) and legislation (Medicare and Medicaid) that helps older people (and a small set of other Americans) secure key parts of their medical needs.
As UTW readers surely know, the US Supreme Court has upheld the constitutionality of the Affordable Care Act. Will we (via Governor Mary Fallin and her team) set up a "health care insurance exchange" and craft an expanded federally funded Medicaid plan that would allow over 600,000 Oklahomans to use the new health care initiative?
Bo! It's Here Already Here
"More than one of every four Americans last year received a free mammogram, colonoscopy or flu shot thanks to a federal law that many of them despise. Roughly 3.6 million Medicare recipients saved an average of $604 as the same law began closing a gap in their prescription drug coverage.
"And 2.5 million young adults were allowed to remain on their parents' health insurance plans until their 26th birthday. For two years, even as a debate has raged over what Republicans deride as ObamaCare are, the new health-care law has begun benefiting consumers and refashioning a $2.6 trillion industry."
From "ObamaCare Has Already Transformed U.S. Health Care" Bloomberg BusinessWeek/March 2012 by David J. Lynch.
What is generally not well understood is that a surprisingly large part of the nearly 2,800 page "Act" is devoted to a bevy of large-scale cost containment and quality/preventive demonstration projects. They are in place because we don't really fully understand how to reduce the cost of American medicine. This huge bundle of experiments at hospitals, university medical centers and at some public health centers are designed to help us get a much better handle, on the cost, quality and power of data driven health care, prevention, intense patient engagement and a slew of novel medical service payment strategies.
And here is the thing: Several Tulsa area hospitals/university operations are already deeply engaged in the new pathways encouraged by the "Act" and the Tulsa medical communities intense, collateral interest in superior health care practices. Fee for service payment, unnecessary tests, scientifically dubious but long-standing interventions, abysmal use of information/mobile technologies, a shortage of gifted general medicine practitioners and a failure to focus on preventive care are all core to the crisis in American/Tulsa medicine.
But there are fervent, well crafted Tulsa efforts to address these problems including a move toward using "hospitalists" -- salaried docs with core compensation and bonus plans tethered to how well they keep their patients. The challenge, going forward, making sure that Oklahomans benefit from some of these new practices in care even if we foolishly elect to "opt" out of full participation in the new "ObamaCare" package -- and while many Tulsans don't know it, we are well on our way to being agile participants in the world of ObamaCare -- even leaders in some facets of this new world.
Dr. David Kendrick of OU is a public health maven, infotech master and medical doctor. Kendrick leads the My Health project, a multimillion federally financed state-of-the-art electronic medical records initiative: one of ten US pilot efforts. My UTW colleague Jaime Adame has written recently on this game-changing project.
The Kendrick effort is part of a national scope transformation that may save many billions of dollars in health care outlays, ratchet up the quality of care and give Tulsa area docs/patients unrivaled access to their health status and dynamics.
The work of the new OU/TU School of Community Medicine (SOCM) gets underway with its first "next stage" entry class in 2014. The place will be a model physician "production" spot focused on an array of breakout practices. A striking new focus and a different kind of curriculum will be heavily in play at the new medical school -- the "Acts" technological, new med team organizing notions, cost containment and quality objectives, plus a fevered rethink of many other parts of conventional medical practice will be at the heart of this re-imagining of the doc factory.
Lead by OU-Tulsa president and medical systems guru Dr. Gerard Clancy and his terrific team, the project has attracted outsized national attention and over $100 million in philanthropic "investments." And a big loan/financial support system, founded by the Kaiser folk, will allow many students to elect general medicine, diagnostics and family practice -- as opposed to better compensated, but less strategic specializations -- a development badly needed in Oklahoma.
Be Stupid Now, Pay Big Later
The mid-run and long-range consequences for any state that won't accept the resources to properly provide decent, regular healthcare to its people are enormous and will grow. Absence inclusion in the new federal Medicaid expansion Oklahoma will continue to spend huge sums on emergency room care and so-called uncompensated care (absorbed and passed on to insured patients via higher hospital and doc payments) and in the future without traditional federal reimbursement payments. This is hugely problematic -- it means we will have fewer state funds for infrastructure, common education, higher education, labor/workforce development -- things that drive quality of life and economic development in the 21st century.
Saying yes to the new era means that Oklahoma would be the beneficiary of billions of dollars of additional federal money for quality healthcare. This means mitigating much misery, doing justice for people with terrible maladies and providing many millions in new, in-state, health/biomed-related business opportunities.
And by saying "yes" folks -- no one, I'm betting no one, will have to wear serf suits or prostrate themselves at the throne of a "FedMed" god.
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