is a licensed pharmacist with nearly 20 years of clinical experience. The author of The 24-Hour Pharmacist (HarperCollins, July '07), she is "America's Most Trusted Pharmacist," and has helped millions of patients in various clinical settings, such as retail, hospital, nursing home pharmacies, and through  her nationally syndicated column, "Dear Pharmacist." A former spokesperson for the National Association of Chain Drug Stores, Suzy Cohen is a member of the Institute of Functional Medicine, The Association of Natural Medicine Pharmacists and The American Pharmacists Association. You can subscribe to Suzy's free weekly newsletter or ask her a question at her

Suzy Cohen--

And The Dumberest Award in Medicine Goes To…

Dear Pharmacist,
I know you are a pharmacist who is zealous about natural medicine. So I have to ask you, if you are ever frustrated with all the new medications being promoted? Do you think any of them are useful for us to take? -- KS Tulsa, Oklahoma

Answer: Sure some medications are useful, and very important, like painkillers, heart rhythm drugs, epilepsy drugs, anesthesia and meds used to prevent organ transplant rejection just to name a few. I confess however, that ridiculous stuff does happen in the health industry. So at this time, I’m offering you my First Ever Presentation of Dumb Awards:

Dumb Award: The first ones goes to (drum roll please)…The FDA because they approve recycled drugs. For example, when a prescription medication loses patent, and cheaper generics come onto the market (think of Claritin for allergies), the FDA gets pre$$ure from manufacturers to approve a brand new (and improved?) version of the same drug (called Clarinex). So one drug gets re-birthed into the marketplace with a new name and higher price tag. Cha-Ching!

Dumber Award: We have a tie between birth control pills and Accutane. Let’s start with birth control pills: They prevent pregnancy, of course, but they’re often prescribed to young girls to treat severe acne. The pill has been associated with cancer, heart disease, weight gain, blood clots and stroke. Now for Accutane or “isotretinoin.” It’s been tied to suicide. For real! It has also caused deformities in babies, so today, women of child-bearing are not even allowed to take the drug unless they are also on the pill. I would recommend Clearasil and condoms before I recommended this combination of drugs.

Dumberest Award: (Throw confetti here)… Statins! I don’t think that cholesterol is so bad, and these drugs lower it vigorously. I can’t find one study that proves statins make you live any longer. Inflammation and nutritional deficiencies will continue to damage your heart, even if you have perfect cholesterol. It’s like blowing the smoke out of the house while the fire continues to burn. And statins drugs can cause muscle aches, depression, leg cramps and erectile dysfunction. Dumb or brilliant? Depends what side of the counter you’re on. If you want natural options to prevent heart disease, read Chapter two of my book, The 24-Hour Pharmacist.

Honorary Mention goes to the FCC (Federal Communications Commission) for allowing drug commercials to bombard our airwaves. People used to have to go to the doctor for a diagnosis, now they can just chill out, have a bag of artery-clogging chips and watch TV. Within minutes, you will discover what disorders all of your friends and relatives have… and of course, the newest drug to suggest to them for their bizarre conditions. But tell them not to stress because you also found a way for them to save hundreds by switching to Geico!

Did You Know?
Pau D’Arco supplement or tea may help you with arthritis, diabetes, auto-immune disorders and even cancer.

(This information is not intended to treat, cure or diagnose your condition. Suzy Cohen is the author of “The 24-Hour Pharmacist.” For more information, visit www.DearPharmacist.com)

© 2008 Suzy Cohen, RPh.

Some Pills Make You Pack On The Pounds

Some Medications Increase Skin Cancer Risk

Statins For 8-Year-Olds?

Society for Women's Health Research

The vast majority of Americans recognize the value of medical research and the importance of human subjects participating in studies. But when it comes to volunteering for research, there’s a lot of hesitation.

Less than 10 percent of Americans have participated in a medical research study of any type, according to a May 2008 survey of more than 2,000 U.S. adults by the Society for Women’s Health Research.

Why they would be hesitant to participate? Many say they don’t have the time. That’s not surprising when you consider that Americans increasingly say the length and quality of their leisure time is on the decline.

Participating in research involves personal sacrifice, including time—time spent traveling to and from a research facility or doctor’s office and time spent participating in the study. 

Thanks to the Internet, there are now opportunities to participate in research online. Some studies, which only need patient responses on their behavior patterns or experiences, can take place entirely online. That’s good news for patients who want to volunteer for research, but feel they can’t because of work, family and other time consuming commitments.

For example, patients are now being recruited for an online study that is measuring cognitive limitations of women breast cancer survivors who return to work. The study is being led by Lt. Lisseth Calvio, M.S., of the U.S. Navy, who is a doctoral student in clinical psychology at the Uniformed Services University of the Health Sciences in Bethesda, Md.

The study is looking for female breast cancer survivors, one to 10 years after primary treatment, such as surgery, radiation or chemotherapy, and women who have never had cancer. The women should be working full time and be between the ages of 18 and 65.

“The study is trying to verify the best way to measure cognitive limitations,” Calvio said. “A lot of breast cancer patients are expressing changes in their cognitive function. First, how do we measure that?  Once that is determined, we can develop strategies to treat or help cancer survivors.”

Over 80 percent of breast cancer patients return to the workforce within a year of their primary treatment. There is growing evidence that some breast cancer survivors show impaired cognitive performance after treatment, which could impact their ability to resume a normal and full functioning life, including work.

Participants in the study will take a short online questionnaire and a test of memory, attention and organization that takes 60 to 75 minutes to complete. The study can be taken by anyone with a computer and an Internet connection greater than dial-up.

There are advantages of an online study for both the researchers and participants.

“It allows us to cast a wider net and obtain a larger sample size” Calvio said. “Online studies can attract more diverse populations.  People of different backgrounds are going online more and more.”

That’s an important point, considering that residents in rural areas or cities without major medical facilities are less likely to participate in research because of the distance they must travel.

A study published in the July 10 issue of the Journal of Clinical Oncology examines research participation in Maryland and finds the state’s rural and minority residents are underrepresented in federally funded cancer treatment clinical trials. 

“Without adequate diversity, it may be difficult to generalize about trial results because you don’t know whether new treatments or preventive strategies have comparable effects” for different groups of patients, according to Claudia R. Baquet, M.D., lead author of the study and director of the University of Maryland’s Center for Health Disparities Research and Outreach.

As research techniques evolve and computer access grows, the Internet may play an increasing role in closing those gaps.

To find out about other research participation opportunities, including online opportunities, visit http://clinicaltrials.gov/, a Web site from the National Institutes of Health. Information tailored for women about the process of participating in research is available from the Society for Women’s Health Research at http://www.womancando.org/. Individuals can find out if they’re eligible for the breast cancer cognitive function study by answering nine short questions at this Web site: http://cim.usuhs.mil/cancerstudy

The Top Three Hospitals For 2008

The Breast Cancer Survival Manual

A Doctor Shortage in the United States?

_{RTI International conducted the annual U.S. News & World Report's Best Hospitals rankings, which named Johns Hopkins Hospital, Mayo Clinic and Ronald Reagan UCLA Medical Center as the top three "honor roll" hospitals for 2008.}

_{Researchers at RTI collected and analyzed the data and survey information behind the rankings using a respected and well-established methodology, which combined original survey data with secondary analyses of data from various sources, primarily the American Hospital Association and the Centers for Medicare and Medicaid Services.}

_{This year's version ranks hospitals in 16 different specialties, ranging from cancer to ophthalmology to geriatric care. The pediatrics rankings were published separately in an issue dated June 9.}

_{For the first time, data for all eligible hospitals, not just those printed in the magazine, are available on the U.S. News & World Report Web site.}

_{The honor roll includes 19 hospitals that ranked high in six or more specialties. Altogether 170 different hospitals were ranked in at least one specialty.
To qualify for ranking consideration, hospitals in 12 of those specialties had to satisfy at least one of three requirements: membership in the Council of Teaching Hospitals, affiliation with a medical school, or offer at least six of 13 important advanced services. Of 5,453 community hospitals in the United States, 1,559 qualified for consideration.}

_{Once accepted for consideration, hospitals had to meet a series of progressively tougher standards to be ranked in those 12 specialties. In the other four specialties, where procedures are often performed on an outpatient basis or Medicare data are unavailable, a hospital's reputation with specialized physicians was the only criterion.}

_{For consideration within a specialty, a hospital must have performed a significant number of defined procedures, or had to have been recommended by at least one physician in the U.S. News & World Report surveys for any of the past three surveys.}

_{Hospitals received a score based on three key components: care-related considerations such as technology and nursing, reputation and mortality. These three components represent the three key aspects of quality hospital care: structure, process and outcomes. Hospitals were ranked by their scores.}

_{"We are very happy to continue collaborating with U.S. News & World Report to provide these rankings for consumers," said Joe Murphy, project director and research methodologist at RTI International. "With data on all eligible hospitals now available on the web, the rankings provide an even more useful resource for making comparisons and informing the health care decision process."}

_{In addition to compiling the rankings, RTI conducts an ongoing evaluation of the study methodology. More information about the methodology is available at www.rti.org/besthospitals .}

Mayo Clinic Trustees Launch Public Phase of $125 Billion Philanthropy Campaign

Aimee Liu is the author of over 10 books, the most recent being <Gaining>The Truth About Life After Eating Disorders.

Aimee Liu--

If you want to help make a real difference in the fight against eating disorders, please read the action alert below, and call in support of Mental Health Parity this Wednesday.

Use your power!

*****
National Call-In Day for Mental Health Parity Wednesday July 9th! Your help is urgently needed to help pass Mental Health Parity this session!

Click Here for the link to National Call-in Day Online Advocacy Action Center

On the website you will see background information, a script for the call and a tool you can use to punch in your zip code and get your Member of Congress and Senator' names and phone numbers.

The US House of Representatives and the Senate negotiators have reached a final agreement on all the remaining mental health and addiction parity issues. However, approximately $4 billion over 10 years in offsets is needed to pay for the bill and must be found before parity can be brought to the floor in both chambers for final passage. Once an offset has been
found, there is commitment from leadership in the House and the Senate to bring the bill up for a vote as quickly as possible.

Although House and Senate leaders have not decided yet where they will find almost $4 billion over 10 years to pay for the cost offsets required by Congressional rules, negotiations have successfully concluded on the key policy provisions.  This compromise is the result of long negotiations and advocacy of organizations all across the country. The compromise
includes many key provisions that were included in the House-passed bill, the Paul Wellstone Mental Health and Addiction Equity Act and would be an important step in ending insurance discrimination facing people with addiction and mental illness. Here are some key points in the compromise:

- The compromise requires parity in insurance coverage for addiction and mental health treatment for both in-network and out-of-network coverage. This does not mean that the bill requires that insurers cover addiction and mental services, only that if they do cover these services, there must be parity with medical/surgical benefits.  This of course would be a very
positive development both in requiring fairness in insurance coverage and taking a strong stand against discrimination toward people in recovery or still suffering from addiction and mental illness.

- The compromise requires plans to disclose their medical necessity criteria and reasons for any denials of coverage.  This would be a major breakthrough, as many plans refuse to disclose medical necessity criteria or reasons for denial,
especially when addiction treatment is sought.

 - On the issue of protection of state laws, the compromise bill language is silent.  The House bill explicitly protected state laws, and in earlier versions the Senate bill explicitly preempted state laws.  Silence is a victory for those of us who agree with the House approach that state laws should be protected, since in most situations Congress must take explicit action to overrule a state law in order for state laws to be preempted. However, to make protection of state laws even more ironclad, we will be working to ensure that the legislative history of the bill makes clear that the sponsors' intention is to protect all state laws.  That way, as important as the passage of a federal parity law would be, stronger state laws would remain in effect and states would be free to enact additional stronger protections in the years to come.

Wednesday July 9th is National Call-in Day, so please call your Member of Congress and Senators on July 9th and tell them that now that an agreement has been reached between the House and the Senate, Congress must find the money to fund this historic mental health and addiction parity legislation and pass parity now.

Thank you for supporting Mental Health Parity and for taking a few minutes
to make these important calls. With your help we can get this done!

Kitty Westin
President
Eating Disorders Coalition for Research, Policy & Action
westin.kitty@gmail.com
www.annawestinfoundation.org

David Jaffe
Executive Director
Eating Disorders Coalition for Research, Policy & Action
djaffe@eatingdisorderscoalition.org
(202) 543-9570

Further Reading: 

Barack Obama Dares Us To Recover

An Eating Disorder Is Not An Identity

Sandeep Jauhar--

Medical residents learn on patients. It is a rarely acknowledged but ethically problematic fact of medical training.

I'll never forget learning the morning that Steve, my resident, taught me how to insert an arterial line. I put on a sterile gown while he threw a sterile sheet over the patient. Then he tore open a procedure kit and spilled its contents onto the drape. His long fingers started moving rapidly, opening packages of needles, drawing up saline flushes, arranging the instruments we were going to use with the meticulousness of a sushi chef. After he was done, he taped the patient’s right arm to a bedside table so it wouldn’t move. Then I cleaned it with antiseptic soap. With a needle I stabbed a small vial of lidocaine he held up in the air, drawing some of the medicine into a syringe. I injected a tiny bleb into the patient’s arm to numb it up. “Go deeper,” Steve advised, and I did. Then I took a longer “finder” needle and poked it through the skin, trying to locate the artery. The patient winced.

“Go in at more of an angle,” Steve suggested. “Okay, pull back a little bit, I think you went through the artery. A bit more. Pull back. Pull back.” A burst of maroon filled the barrel. “Okay, perfect. Now take off the syringe. No, leave the needle where it is—” but I had already pulled it out of the artery. “That’s okay, just put the syringe back on and try again.”

I tried again, but this time with no luck. “Go in at the same angle,” Steve said, making a jabbing motion with his hand, but I was unable to draw back any blood. “Okay, sharpen the angle…sharpen…sharpen…” With each attempt, the patient groaned, and I started to sweat. I was reminded of a patient I had tortured as a third-year medical student trying to get an arterial blood gas. Dean Dowton had told us to come up with a code of ethics in his commencement address; my first rule was that I was only going to allow myself three attempts at a procedure before asking someone more experienced to take over. But now I found myself wanting to try again and again.

“Let me give it a shot,” Steve finally said. I was hoping he’d miss, at least once, but he hit the artery on his first attempt. When he removed the syringe, blood spurted out the hub of the needle, splattering red dollops onto the table and the tile floor.

“Okay, hand me the wire,” he said. My hands were shaking so badly that the wire, which resembled a guitar string, kept flopping about wildly. Perspiration was trickling down my face. He inserted the wire through the bore of the needle and into the artery. Then he pulled out the needle, leaving the wire inside the vessel. With a scalpel, he made a deep nick in the arm, and forced a stiff plastic catheter, a dilator, through the soft tissue to create a track for the catheter that was going to follow. The patient groaned but did not move. Blood started gushing. Steve slipped the catheter over the wire and tried pushing it into the artery, but it buckled. He tried again but it still wouldn’t go. I looked on nervously as the wire protruded unnaturally out of the man’s forearm, like a nail askew in a thick plank. “It’s probably bent,” Steve said. He turned to the nurse who was with us and politely asked her to bring him another wire. Then, with his finger pressed on the wound, he casually turned to me, like a man waiting for a train. “Never let go of the wire,” he said, and I nodded nervously. I couldn’t believe that even at that moment, Steve was still trying to teach me something.

The nurse returned with a new wire and Steve quickly inserted it into the artery. The catheter passed over it easily. He pulled out the wire and connected the catheter to a manometer. Soon a blood-pressure waveform was prominently displayed on the monitor above the bed. “Okay, sew it in,” Steve said. While I made stitches, he gathered up the needles, discarding them into a sharps box, threw away the procedure tray, and stripped off his gown. “Congratulations,” he said. “You just put in your first arterial line.”

“You did it,” I replied, not wanting to be patronized.

“Yes, but you’ll do it next time,” he said encouragingly. “See one, do one, teach one.”

A Doctor's House Call Leaves a Lasting Impression

A Doctor Shortage in the United States?

Resource: Mayo Clinic News Release

Mayo Clinic Trustees Launch Public Phase of $1.25 Billion Philanthropy Campaign

Jim is frequently quoted in articles about issues affecting senior citizens and has been featured in numerous high profile publications, including Time magazine, USA Today and The New York Times. In addition, he has made multiple appearances on CNBC, CNN, Retirement Living Television and national public television.

Guest Blogger Jim Miller--

Most people don’t give much thought when it comes to choosing a hospital, but selecting the right one can be as important as the doctor you choose.

Choosy or Choice-less

Hospitals are not all alike! Most people realize that, but they may not know that the differences among them amount to much more than just size and location. While you may not always have the opportunity to choose your hospital, especially in the case of an emergency, having a planned procedure may offer you a variety of choices.

When shopping for a hospital, the most important criterion is to find one that has a strong department in your area of concern. A facility that excels in coronary bypass surgery, for example, may not be the best choice for a hip replacement. Research shows that patients tend to have better results when they’re treated in hospitals that have extensive experience with their specific condition.

In order to choose a hospital that’s best for you, it is important to discuss your concerns and alternatives with the doctor who is treating you. Some doctors may be affiliated with several hospitals from which you can choose. Or, if you’ve yet to select a doctor, finding a top hospital that has expertise with your condition can help you determine which physician to actually choose.

Another important reason to do some research is the all too frequent occurrence of hospital infections (see www.hospitalinfection.org ). Each year 2 million patients are infected in U.S. hospitals and more than 90,000 die because of it. So checking your hospital’s infection rates and cleanliness procedures is a wise move.

Research Your Hospital

The Internet is your best tool to research hospitals. Today, a variety of resources exist that offer user-friendly databases to help you investigate and comparison-shop. Here are some sites to help you get started:

· Hospital Compare ( www.hospitalcompare.hhs.gov ): Operated by the federal Centers for Medicare and Medicaid Services, this is probably best known source for hospital data. It lets you search by city, state or other criteria, as well as look up a variety of statistics comparing more than 5,000 hospitals against one another and to state and federal averages.

· The Joint Commission on Accreditation of Health Care Organizations: An independent nonprofit group that accredits most of the hospitals in the U.S. At www.qualitycheck.org , you can search by hospital, location or type of service and get reports on individual hospitals or compare several. They also list hospitals that have certification for various medical specialties.

· Health Grades ( www.healthgrades.com ): A private company, they compare more than 5,000 hospitals on 32 conditions and procedures, including complications and death rates. Much of the information is available free on the site, which is searchable by state, procedure and other criteria. Or, for $18, the group will provide more elaborate reports, including average-length-of-stay data and price comparisons.

· Leapfrog Group ( www.leapfroggroup.org ): They provide comparisons of how 1,300 hospitals follow 30 different practices that helps insure quality care. For example they provide data on whether hospital procedures consistently encourage hand-washing, whether specialized doctors and nurses staff intensive-care units, and whether doctors enter orders electronically in an effort to avoid errors.

· State resources: Many states gather data from hospitals for public-health and other purposes, but only about 20 provide public quality reports for consumers. To locate them visit the National Association of Health Data Organizations at www.nahdo.org/qualityreports.aspx .

Savvy Tips: It’s a good idea to check with all these Web resources to see if the data you’re gathering is consistent. If you can’t find the information you’re looking for online, call the hospital’s quality office or medical staff office. Most facilities will be willing to answer your questions. Also, check out the U.S. News & World Report, 2007 “America’s Best Hospitals” ( health.usnews.com/besthospitals ), which ranks 173 of the nation’s best hospitals in 16 specialties.

Heart Disease In Women: Are You At Risk?

Save Money On Your Medication

How A Local Hospital Reduces The Spread of Bacteria

Ken Terry is a former senior editor at Medical Economics Magazine, the leading business publication for physicians. Terry has received journalism awards from the American Society of Business Publication Editors (2000), the American Society of Healthcare Publication Editors (2001-2002), and the American Business Media. He was a finalist for the latter organization's prestigious Neal Award in 2003 and 2006, and he won a Neal Award in 2007. Ken Terry is the author of Rx for Health Care Reform; Recent-- San Francisco Chronicle
 
Terry has contributed to: The New York Times, The Village Voice, Rolling Stone, Health, Inc., Men's Health, Parenting, Downbeat, The Progressive, and The Nation. Recently he was a presenter regarding health care reform at the National Congress on the Un- and Underinsured (Dec '07) and at the East Coast annual conference of the New York State Osteopathic Medical Society (Apr '07).

Guest Blogger Ken Terry--

Minnesota’s newly enacted health care reform legislation, expected to save 12 percent of the state’s health costs while covering 12,000 more people, sets some important precedents that could influence other states and that should echo loudly in the halls of Congress when it takes up the issue next year.

The culmination of 15 months of work by two bipartisan commissions, the reform measure was trimmed considerably to meet objections from Republican Governor Tim Pawlenty, who had appointed one of the panels. The biggest change made in the bill, after the governor vetoed an earlier version of it, is that the final version reduces the number of uninsured who would receive state-subsidized coverage.

Still, the legislation promises to transform Minnesota health care in ways that could greatly improve preventive and chronic care. Among other things, the measure encourages the creation of primary-care-based “medical homes” to coordinate care for patients with chronic diseases, and it requires both the state and private insurers to pay care coordination fees to physicians. Today, in Minnesota and across most of the nation, primary-care doctors have little incentive to coordinate care, because they’re reimbursed only for office visits.

Equally important, the Minnesota legislation enables physician groups to set their own prices for “baskets of care” for such chronic conditions as coronary artery and heart disease, diabetes, asthma, and depression. These prices have to be the same for all health plans and individuals. To prevent discrimination against sicker patients, the overall payments will be “risk-adjusted” to account for differences in the disease burden of each group’s patient population.

Using published cost and quality data, consumers will now be able to choose among physician groups, rather than just insurance companies. This competitive approach is expected to encourage physicians to take better care of chronic-disease patients, who generate about 75 percent of health care spending.

“There will be much more consumer involvement in choosing providers, based both on cost and quality, when they have a chronic disease,” notes State Senator Linda Berglin (DFL-Minneapolis), one of the bill’s sponsors. “So we think that the transparency piece will provide an incentive for providers to do a good job of taking care of people with these diseases. Because when they do, they can reduce their price,” thereby attracting more patients.

The January 2008 report of Pawlenty’s Health Care Transformation Task Force, on which the legislation was based, recommended even broader changes. Aiming to cut Minnesota’s uninsured rate in half while reducing its health

spending by 20 percent, the task force proposed that “provider groups and care systems…compete for patients by submitting bids on the total cost of care for a given population.” Insurance companies would still take overall financial risk, but wouldn’t negotiate prices or manage care.

Despite the radical sound of this proposal, business, insurance, and medical leaders were all represented on the commission, and the medical establishment supported the resultant legislation.

Gov. Pawlenty said he vetoed the initial bill partly because it required too much state money to expand coverage for the working poor. Earlier in the legislative process, he wanted to use some of the state’s Health Care Access Fund—which was to provide part of the money for the reforms—to close a $965 million budget gap. Derived from a tax on doctors and hospitals that Minnesota has levied since 1992, this money was supposed to be used to cover the uninsured. In the end, the governor settled for a $50 million loan from the Health Access Fund that is to be repaid out of the projected savings from the reform program.

What the passage of this bill—and its approval by Gov. Pawlenty, who’s on the short list for Republican vice presidential candidates—shows is that the two parties can work together and make progress on health care reform. But, as Berglin notes, it was the business community that made Minnesota’s reform legislation possible. So, for this kind of reform to occur on a national level, business and consumer groups must put their shoulders to the wheel. If they do, no special interest will be able to stop the momentum of reform.

It's Time For Deep Health Care Reform

How Much Would Universal Coverage Cost Us?

Universal Coverage Is a Three-Legged Stool

Ken Terry is a former senior editor at Medical Economics Magazine, the leading business publication for physicians. Terry has received journalism awards from the American Society of Business Publication Editors (2000), the American Society of Healthcare Publication Editors (2001-2002), and the American Business Media. He was a finalist for the latter organization's prestigious Neal Award in 2003 and 2006, and he won a Neal Award in 2007. Ken Terry is the author of Rx for Health Care Reform; Recent-- San Francisco Chronicle

Terry has contributed to: The New York Times, The Village Voice, Rolling Stone, Health, Inc., Men's Health, Parenting, Downbeat, The Progressive, and The Nation. Recently he was a presenter regarding health care reform at the National Congress on the Un- and Underinsured (Dec '07) and at the East Coast annual conference of the New York State Osteopathic Medical Society (Apr '07).

Guest Blogger Ken Terry--

Mainstream proposals for reforming health care take a superficial approach to the central role of our care delivery system in driving up costs and obstructing change. But some health policy experts suggest much more radical approaches to reform. These ideas, which collectively might be called “deep reform,” address the need for systemic changes in health care that go far beyond insurance coverage or quality incentives. Recognizing the inadequacy of the financing-focused measures that pass for reform today, these thinkers propose alternative methods of structuring the delivery system and reimbursing providers. While their ideas differ in many important ways, they could form the basis for a grand compromise between the left and the right.

Deep reform encompasses the entire political spectrum. For example, Arnold Relman, MD, former editor of The New England Journal of Medicine and author of the book A Second Opinion: Rescuing America’s Health Care, wants us to switch to a single-payer insurance system in which care is delivered by competing group-model HMOs. He rejects the conservative idea of “consumer-driven health care,” regarding it as a way to shift more costs to consumers while motivating poorer patients to skip necessary care. In contrast, Michael Porter and Elisabeth Olmstead Teisberg, the authors of Redefining Healthcare: Creating Value-Based Competition on Results, favor the consumer-driven approach. In their model, specialized teams of providers would compete on the basis of their outcomes for particular procedures or episodes of care. These teams would be independent business units, rather than part of the large, prepaid multispecialty groups that Relman supports. But like Porter and Teisberg, Relman would have his physician groups vie for patients on the basis of published quality reports.

In my own book Rx for Health Care Reform, I advocate replacing competition among insurance companies with competition among primary-care groups, which would set their own budgets for professional services. Similarly, Harvard Business School professor Regina Herzlinger, in her new book Who Killed Health Care?, writes, “In a consumer-driven health care system, providers will be free to create focused factories and to name their own price…[Thus] the doctors will regain the freedom to provide the kind of medical care they feel is appropriate.”

While many more examples could be provided, the point is that deep reform has aspects that transcend ideology. Whether the proposal is coming from Relman, Porter, Herzlinger, George Halvorson, Alain Enthoven, Len Nichols, Victor Fuchs, Arnie Milstein, Donald Berwick, Tom Daschle, Alice Gosfield, Francois DeBrantes, or Kathleen O’Connor of CodeBlueNow, the core message is the same: we need to overhaul health care financing and delivery.

All of these thinkers, regardless of their political orientation, also believe that market competition is essential to reform. In this respect, their analysis differs from that of the “Medicare-for-all” proponents, who maintain that a government takeover of health care would solve our problems. Relman, despite his espousal of the single-payer approach, observes that this is insufficient: “Any reformed system that stands a chance of controlling costs, while still providing universal coverage and improving the quality of care, must change not only the present insurance system but also the organization and style of medical practice.”

Deep reform views our health care crisis from a perspective that stands outside the current political debate. Instead of asking “how do we reach universal coverage?” or “how do we reduce insurance costs?”, deep reform poses a more fundamental question: How do we rebuild the system so that it delivers high-quality care for everyone at a cost we can afford? It might seem that our system is too big and complex to reconstruct it without destroying it. But in fact, it can be done, and there is no other way to save U.S. health care.

This is not to say that significant reform cannot be achieved within the current system. Deep reformers are already busy in a number of areas. The leading example is the work of Donald Berwick, MD, president of the Institute for Health Care Improvement. Best-known for his efforts to improve patient safety in hospitals, Berwick also launched a campaign to reengineer primary-care practices, which led to the currently fashionable “patient-centered medical home.” Berwick’s writings and statements clearly show that he believes in the need for systemic change. For example, he is one of the principal authors of the Institute of Medicine’s epochal Crossing The Quality Chasm, which calls for a complete reorganization of health care around chronic disease management.

Another example of a deep reformer who is trying to change particular aspects of the system is Joann Lynn, author of Sick to Death and Not Going to Take It Anymore! Reforming Health Care for The Last Years of Life. Lynn, who understands end-of-life care as few others do, offers a comprehensive plan to make that care more humane and effective while relieving some of the burden on family caregivers.

So far, deep reform concepts have had little impact on the political establishment. But as the health care crisis deepens, and as it becomes clear that our political leaders don’t know how to halt our system’s slide into chaos, more people will start to discuss these ideas. They might even lead to some legislation that has a chance of being passed and implemented.

One example is the Minnesota health care reform bill that was first vetoed and, in a modified form, is now expected to be approved by Republican Gov. Tim Pawlenty. This enlightened legislation, passed overwhelmingly by the Democratic legislature, allows provider groups to set their own budgets for “baskets of care” for such chronic conditions as coronary artery and heart disease, diabetes, asthma, and depression. They can then compete for patients on the basis of published cost and quality data. (The groups may also be eligible for coordination of care payments from insurers.) Corporate, labor, health care, and insurance leaders supported the measure, which aims to cut the state’s uninsured rate while lowering costs by 12 percent within the next seven years.

A report from a state-appointed panel that helped devise the legislation proposed an even more radical change: Physician groups and “care systems” would take financial responsibility for the total cost of care. Insurance companies would still take overall financial risk, but wouldn’t negotiate prices or manage care. Their role would be limited to helping consumers navigate the system and manage their own health.

Of course, the opposition of the national health care, pharmaceutical, and insurance industries to any change that threatens their profits should not be minimized. It will not be easy to mobilize the kind of public and corporate support that will be needed to overcome the objections of those whose incomes would be imperiled by real reform. But over time, I believe that even these self-interested parties will come around to the view that the biggest threat to them is the continuation of the status quo.

To increase the chances of deep reform ideas being adopted, we reformers should come together, exchange ideas, and find out what we have in common. We might discover that we have a lot to offer one another, and that we can cross political divides that continue to separate politicians and policy makers. This is important work. Let’s get to it.

How Much Would Universal Coverage Cost Us?

Universal Coverage Is a Three-Legged Stool