This is one reason I love my job!
One of my students last year, a young physician from Serbia named Dr. Predrag Stojicic, came to Harvard to learn how to help Serbians and Serbian physicians to stand up for themselves.
Like many nations, Serbia has a publicly-financed health system that promises universal medical coverage for everyone. Because Serbia, like many nations regardless of system, has a shortage of medical professionals, many physicians take bribes from patients before they provide services covered by law. Because there is no alternative, most people are afraid to report corruption, fearing that doctors might deny them care.
To address this, a dedicated group of Serbian physicians and citizens, including Predrag, organized under the organization called Serbia on the Move, have launched a new national website called "What's Your Doctor Like?" (The U.S. Agency for International Development -- USAID -- finances it, in part.) The purpose of the website is twofold: first, to allow Serbian patients to share their experiences with health services -- backed up by 40 teams of 230 activists who will pressure health institutions to deal with doctors who are poorly evaluated; and second, to personalize responsibility for the system by allowing patients to evaluate individual physicians.
Here's the site: www.kakavjedoktor.org and the new front page photo:
Whenever critics (like me) assert that the U.S. health care system is worse than mediocre despite spending about 50% more per person than the second most expensive system, counter-critics assert that we do have the best health care system in the world. Their evidence -- the U.S. has the best survival rates for breast and prostate cancer on the planet. That's exhibit A.
What if it's not true?
That is one of the compelling conclusions one may reach from last Thursday's research published in the New England Journal of Medicine: "Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence" by Archie Bleyer, M.D., and H. Gilbert Welch, M.D., M.P.H.:
"Despite substantial increases in the number of cases of early-stage breast cancer detected, screening mammography has only marginally reduced the rate at which women present with advanced cancer. Although it is not certain which women have been affected, the imbalance suggests that there is substantial overdiagnosis, accounting for nearly a third of all newly diagnosed breast cancers, and that screening is having, at best, only a small effect on the rate of death from breast cancer."
Less than two weeks into the new post-election phase of Affordable Care Act implementation and a clearer picture is emerging. Republican-controlled states are beginning to decide whether to launch their own health insurance exchanges and whether to embrace the ACA's expansion of Medicaid. These two charts -- courtesy of Sarah Kliff at the Washington Post and the Wall Street Journal -- give a useful snapshot of how things looked midway thru this past week:
By my count, Tuesday's national election was the third near-death experience faced by the Affordable Care Act (aka: Obamacare, ACA). The first was the election of Scott Brown to the U.S. Senate in late January 2010, denying Senate Democrats their vital 60th vote -- leading most commentators to declare the drive for health reform dead. The second was the Supreme Court decision released in late June of this year -- again, most commentators thought the law was going down, and it almost did except for a change of mind by Chief Justice John Roberts.
Having been through more than a few national and state health reform campaigns, I can attest that being in a health reform campaign often feels like an Indiana Jones movie -- frequently, we are inches away from doom, and sometimes it happens. We now may be over the "giant boulder chasing us down a hill" phase, but we are far from out of the woods regarding full and effective ACA implementation. Here are some upcoming key challenges and processes:
Health reform (Affordable Care Act, ACA, ObamaCare) did not re-elect President Barack Obama tonight. So much else went into this victory that had nothing to do with health reform. And at the same time, health reform, most certainly, did not bring down President Obama tonight. Nor did it bring down any member of the U.S. Senate.
Sen. Scott Brown, who won election to the U.S. Senate in 2010 promising to defeat health reform, lost re-election tonight to Elizabeth Warren who is strongly committed to implementing the ACA.
Just like on June 28th, when the U.S. Supreme Court upheld the constitutionality of the ACA, tonight does not guarantee full and effective implementation of the ACA. There are big challenges ahead, notably the budget and tax fights of the next few months.
Still, tonight, America stands for health justice and health equity, and for the ACA.
And tonight, I feel good about America.
A little bit of catch up here -- but I like the combo. In the past month, the Patrick Administration has made two important health policy appointments and, characteristically, they made high quality and smart picks.
First, Dr. Lauren A. Smith MD MPH has been chosen to be the new commissioner of the Department of Public Health to replace John Auerbach who resigned last month in the wake of the State Drug Lab mess. Lauren has been the Chief Medical Officer at DPH since 2007. She was responsible for the Department's response to the H1N1 influenza outbreak and led development of standards for sports head injuries and school nutrition. She was responsible for community level obesity prevention and other key prevention initiatives.
Let's start with the proposition that the Affordable Care Act (ACA, ObamaCare) is far from perfect. So were the 1935 Social Security Act and 1965 Medicare and Medicaid Act. Given the chance, the ACA will be revisited repeatedly to be improved, fixed, expanded, and trimmed. Given the chance -- and that's what next Tuesday's election is about.
Like no time I can remember, Tuesday's election is a national referendum on the ACA. Most American voters will not cast their ballots for or against the ACA -- yet the impact of their votes will determine the fate of U.S. health reform more than anything else. Mitt Romney's election will guarantee dismantling the ACA in whole or substantial part, and Barack Obama's re-election means implementation of the law he signed on March 23 2010.
What's at stake? Of the 25 most advanced nations on our planet, the United States is the only one without some form of national health insurance, public or private, the only one that permits its citizens to suffer financial ruin because they get sick. If this is what is meant by "American exceptionalism," you can have it. When nations such as Mexico, Taiwan, South Korea, and Thailand can do it, what's our excuse?
No more excuses, America.