Care System

FOUR A.M. at Miami International Airport. I'm surrounded by people with enormous black duffel bags stuffed with clothing, gifts and medicines. Their carry-ons are filled with over-the-counter supplies: aspirin, Tylenol, Imodium and Citrucel.I'm on my way to Havana to take part in a public-health study tour organized by the Center for Cuban Studies in New York. Most of the other people on my flight are going to visit family members in "extreme humanitarian need," one of the few circumstances under which the U.S. government allows its citizens to travel to Cuba.

Cuba's health system reaches out to help citizens in needIn his May 15 article on the visit by Baltimore health professionals to Cuba ("Health system in Cuba praised"), Scott Shane wrote: "[We] heard about coercive health policies of President Fidel Castro's government, such as a requirement that pregnant women not caring properly for themselves be moved to group homes until their babies are born."This is a misrepresentation of what we really heard.Pregnant women at high-risk because of inadequate nutrition, or other medical conditions, are encouraged by their family doctor (but never coerced)

WASHINGTON -- At an ice-breaking budget summit today, President Clinton and congressional leaders are expected to begin to try to figure out how to repair the damage they did two years ago to Medicare.As part of the Balanced Budget Act of 1997, changes in the popular health care program for the elderly and disabled slashed Medicare spending almost twice as deeply as anticipated -- producing $200 billion over five years and much of what is now projected as the federal budget surplus.The squeeze is being felt throughout the health care system -- from hospitals to doctors, nursing homes, home health care agencies, managed-care insurance plans and manufacturers of medical equipment.

Eisner Communications has been named the advertising agency of record to promote Johns Hopkins Medicine, an account that in past years has been valued at $2 million to $3 million in annual billings."

ACROSS THE country, there is a surge in complaints by physicians against health maintenance organizations, and increasing numbers of doctors are quitting managed care altogether. Meanwhile, patients seem equally perturbed, fretting about everything from restrictions on medical coverage to the actual denial of care. Everyone, it seems, has a complaint. Yet no one is leading the charge to find a solution to the crisis in managed care. The question is why.Though it may come as a shock to the hordes currently besieging the managed care industry, the truth is that much of our predicament is not the fault of monopolistic HMO executives.

ZHENJIANG, China -- In the good old days of socialism, the state paid for everything when Comrade Lu got sick, including the medicine he consumed and the hospital bed he used."

New positionsMcCormick's McCafferty gains development postMcCormick & Co., the Sparks-based spice and flavorings manufacturer, appointed Denise W. McCafferty director of global product development in the company's corporate research and development laboratories. An MBA graduate of Loyola College, the Sparks resident joined the international company as a lab technician in 1975. She is a member of several professional groups, including the American Chemical Society and the Institute of Food Technologists.

WASHINGTON -- Republican leaders, facing a party revolt driven by an outcry against managed health care, are rushing to win agreement this week on legislation that provides new protections for patients while making health insurance more affordable.Working against them is a united business community and a long GOP tradition of resistance to regulation of private industry. But many rank-and-file Republicans are anxious to set philosophy aside to answer their constituents' anxieties about managed-care insurance plans, which cover 80 percent of the American work force.

WASHINGTON -- The dinner party gossip here these days is about what legacy President Clinton would like to leave when he completes his term three years from now. The evidence seems contradictory.The president used his press conference the other day both to take a victory lap celebrating the success of what he called "the vital center" and to spell out an agenda for the rest of the year. But Mr. Clinton has always been an extremely ambitious politician, so it is hard to imagine he doesn't have some grand design for the history books.

This article is based on a report on the quality of U.S. health care that was commissioned by the National Coalition on Health Care. The report was prepared by Mark A. Schuster, Elizabeth A. McGlynn and Robert H. Brock of the RAND Corp. WHILE MANY consider the United States to have the finest health care in the world, a large and growing body of evidence indicates that widespread problems exist with the quality of much of America's health care.Although a trillion dollars is spent on health care in the United States annually, many people receive the wrong kind of care.

In the six months since President Barack Obama's health forum, hundreds of millions of dollars have been spent encouraging Americans to support or oppose reform. Meanwhile, 14,000 Americans per day have lost their health insurance. And we're no closer to fixing a "sick care" system that threatens the health security and financial future of all Americans. We must not lose sight of the need to cover the 47 million uninsured Americans. But merely giving them publicly funded insurance won't help them - or the other 255 million Americans - get well, stay healthy and spend less.

Even if lawmakers can agree on how to overhaul the nation's health care system, the hope of universal coverage could crumble if individuals can't afford their share. Take Howard County. Less than five months into an innovative program to give low-income people access to medical care for as little as $50 a month, nearly one in 10 participants is at risk of being cut off because they can no longer afford the cost. Howard officials say their fledgling program, called the Healthy Howard Access Plan, provides a cautionary lesson for federal policymakers battling over how to re-imagine the nation's health care system and extend insurance to some 47 million Americans.

SALISBURY --Barely halfway through his first year in office, Rep. Frank Kratovil of Maryland is caught in the middle of the biggest legislative fight in recent memory: the national brawl over health care. On one side are his party's leaders in Congress and President Barack Obama, whose supporters helped Kratovil become the first Eastern Shore Democrat elected to the House in 20 years. On the other side are many, if not most, constituents in his conservative district, where opposition to overhauling the health care system is widespread and many aren't shy about predicting that he'll be a one-term lawmaker.

Watching the news during the past week became a daily exercise in rubbernecking at the train wreck that was town hall democracy. At a certain point, it beame impossible to determine, and maybe immaterial, who came to meetings congressmen and senators held to discuss health care reform out of genuine concern and who came as part of an orchestrated show of force by one side or the other. Supporters and opponents of the Democratic reform plans said they felt insulted and misunderstood by the other side, and it was clear that little real debate or dialogue was going on. That's what happened Monday night when Sen. Benjamin L. Cardin held a town hall meeting at Towson University.

HAGERSTOWN - -There were two different town hall meetings in Western Maryland on Wednesday afternoon, but Sen. Benjamin L. Cardin only made it to one of them. That was his question-and-answer session in a packed Hagerstown auditorium. It included loud, red-faced rants by angry voters who wanted the Democratic lawmaker to know that they don't trust him or, for that matter, believe a word that he says. But there was another civic gathering, too, which took place just outside and got little media attention.

Like so many primary-care providers strapped for time, Tricia Angulo-Bartlett crams as much as she can into a 15-minute patient visit. At one last week, she counseled Amy Tucker about her coming surgery, evaluated her chronic sinusitis and scribbled a few prescriptions, taking time to explain the side effects and directions of each one. Along the way, she managed to ask about Tucker's twin boys. Then Angulo-Bartlett was off to dictate her notes and on to the next patient. She'll see 26 in a typical day. Such is the life of a busy nurse practitioner, a group of providers that is increasingly helping deliver primary care amid a national shortage of family doctors.

In his press conference last week focusing on health care reform, President Barack Obama stated, "If we do not control these costs, we will not be able to control our deficit." I could not agree with him more. Our economy is buckling under the weight of a health care system that has us spending nearly twice as much per capita than other industrialized countries. Health care already represents 17 percent of our gross domestic product, and that figure is projected to rise to 25 percent by 2025 if action is not taken.

WASHINGTON - - With many Americans doubtful about his plans to overhaul the U.S. health care system, President Barack Obama sought Wednesday to lay out in personal terms how they stand to gain from the legislation that he has made one of the top goals of his presidency. Acknowledging that Americans had become skeptical of proposals now being debated in Congress, Obama defended his push to move quickly on legislation that aims to give more people health insurance coverage and control health care costs.

Why not single payer? In a Q-and-A recently posted on the Web site Crooks & Liars (http://crooksandliars.com/node/29667), House Speaker Nancy Pelosi responded to one of the questions by saying, "For 30 years I have supported a single-payer plan, but our next best choice is to support an exchange and a public option." The question that her response prompts from me is, why are we giving up on the best solution and settling for something that, from all appearances, is a whole lot less than "next best?"

Whether on prime time television or in a Rose Garden news conference, President Barack Obama makes a convincing case for health care reform. The public seems interested in it, too: Polls show a healthy majority of Americans believe greater government involvement is needed to control the feverish rise of medical costs. But while the White House may be optimistic that such reforms can be achieved this year, there's big money being invested in maintaining the status quo. Insurance companies, physicians and other providers, hospitals, the pharmaceutical industry and others who make a living off the nation's bloated and woefully inefficient health care system are spending hugely where it counts.