This is my Homework, not a post that you need to read. I'm just going to be adding to it until I need to turn it in next Friday.

PAC 431

Access to Health Care Discussion Questions

Please come prepared to discuss the following questions in class on Thursday, October 30th. Following the class discussion, I will ask that you submit your personal responses to these questions.

1. Is it possible to have socialized health in the U.S.? Why or why not?

Definitely. According to a recent Henry J. Kaiser Family Foundation poll, "Public Opinion on the Uninsured, January/February 2003 Edition," a majority of Americans agree that everyone should have access to health care. Around two thirds agree that the federal government should guarantee health insurance coverage.

The impetus - or the will of most Americans - is there, but the difficult part is agreeing on a solution. Primarily, who pays and how.

2. Health promotion and health education have traditionally stressed individual responsibility for health. What are your reflections regarding this point of view?

Left on their own, an individual may or may not take good care of their health. But when more people talk about what it takes to be healthy and the means to get there, more people are likely to reflect on their own health. I know just from taking this health class and being forced to think about health, wellness, and disease, my attitudes and actions concerning my own health have changed. Social awareness of health issues makes it more likely that an individual would at least consider their own choices regarding their health, and thinking about it is the first step toward prevention.

Ultimately, it is the individual who has the final choice about their level of health, but to quote Hillary Clinton, "It takes a village." I suggest community responsibility for the individual's health. Each person's sickness effects us all anyway, why not take an interest?

Be responsible for your own health, for you are the only one who can be. My motto is, "If you want to change the world, change yourself." When you better your own health and well-being, other people will notice and may take action upon their health too.


3. What should the role of government (if any) be in the provision of health care?

This question is at the center of the debate. Again, according to KFF research, Americans are split on this question. Half the people would agree to an increase in insurance premiums or taxes in order to increase the number of insured Americans, and the other half would not.

4. Are physician?’s overpaid? Why or why not?

No. Can anyone really be overpaid? Clearly, we need our healers. But then again, maybe they are.

According to the Commonwealth Fund 2002 International Health Policy Survey, U.S. adults who have health problems are experiencing medical errors, care coordination problems, and cost-related access difficulties at high rates.
More than a quarter surveyed said that a medical mistake or medication error had occurred in their care in the past two years, a rate higher than that seen for the four other countries surveyed —Australia, Canada, New Zealand, and the United Kingdom. Nearly one of five U.S. respondents reported an error had caused serious health problems.

Are we are paying doctors such high fees so that when we sue them, they be able to hire a good attorney? Maybe if we paid doctors less they would use more common sense in treatment options instead of giving their patients the treatment that is least likely to come back and bite them in the ass.

5. Do people have the ?“right to die?” when current medical technology has the ability to prolong and sustain life? How does one measure ?“quality of life??”

The Right to Die

Do people have the right to die? Of course. A person determined not to live will die. Living is a choice made by each individual, whether they are conscious of it or not. Do we want to encourage that right? No. We want to focus on life's inate ability towards health and vitality, and the exuberance and wonder of being alive. I agree with the Catholic position that life should be where we concentrate our energy, not in suicide, and especially if you have children or family. Most people underestimate the importance their life has on their family members, and if they removed themselves from this world, the sorrow that would cause.

Longer life - fantastic. More time to make yourself better and grow. Prolonging life with technology is great, but it comes back to the individual. Do they want to live? There are circumstances where life becomes unbearable to live and quality of life is so poor that physical death is an acceptable choice.

I don't feel that death is something to be feared, which to me is at the heart of this "right to die" debate. Also, an individual's social responsibility factors in.

Quality of Life

To measure quality of life, first we have to define it. Quality of life is a measure of an individual's physical, functional, emotional, and social well being. From there we can break it down further. There are questionnaires available designed to take inventory of a person's quality of life. These things are relative to the individual, and any sort of measuring tool must be take into account the person being measured.

In Davis S. Tulsky's June 2001 article, "The State of Quality of Life Measurement in Rehabilitation Research," he makes note of the fact that certain tools developed to measure general quality of life, would miss quality of life indicators in other populations, such as people with disabilities.

Tulsky mentions a specific example of spinal cord injury quality of life measurement and the fact that it is poorly defined. "Rather than focusing on a multidimensional construct, attention has focused on the assessment of a limited domain like functional status." He says that the main measures of functional independence are activity levels, level of handicap, and environmental factors, which does not include an entire range of other important measures.

Quality of life is a difficult thing to measure, because it is so relative to the individual, and cannot be measured generally across large populations. Not only does attitude play a big part, but a persons ideas about there self-worth and purpose factor into quality of life, along with the other physical, functional, emotional, and social well being factors.

6. Do all U.S. citizens have a "right" to health care? Why or why not? If you feel they do, then who pays for that right?

You know, health is mainly in the hands of the individual. Does an individual have a "right" to see the local witch doctor or make an appointment with a doctor in man-made medical system? No. We all have choices. As the administator of a hospital in America I have the right to charge outrageous costs and limit access to people without health insurance and the poor.

Should health be encouraged? Yes, it is in our best interests to make as many people health as possible. Isn't it?

I like to call it the sickness industry, instead of the Health Care industry. They do more to promote sickness and quick fixes than healthy living. But to answer your question, "who pays for that right" to access health care, currently, we all do.

7. Why does health care cost keep rising while the health status of specific segments within the population grow continually worst off?

According to the University of Pennsylvania Almanac's report The Rising Cost of Health Care
(Tuesday, March 5, 2002 Volume 48 Number 25 www.upenn.edu/almanac/), there are five main reasons for increasing health care costs:

* Prescription drugs. This is the fastest growing health care expense, and it is projected to grow at 20 to 30 percent each year over the next several years. There are many newer, more expensive drugs on the market, and the use of these prescriptions is exploding. In addition, with so much television advertising, many consumers ask their doctors for expensive, brand name drugs when there may actually be a generic drug that works just as well.
* Cost of developing new technologies and treatments. Over the past decade, scientists have made significant advancements in the treatment of certain diseases. Unfortunately, just like any new product, the cost of developing these new technologies and treatments is extremely high. Plus, unlike other technology, health technology generally doesn't decrease in price over time.
* Increased demand for health care. More and more people with medical insurance are relying on the health care system as new technologies and treatments become available. This leads to a greater number of claims for payment by insurance companies, the costs of which are passed back to health care consumers.
* America's aging population. The "baby-boom" generation is entering its peak health-care-using period. In fact, over eighty million Americans will turn 50 in the next 10 years. The cost of providing health care to them will be staggering.
* Increase in uncompensated care. There are an estimated 44 million Americans who don't have health care insurance, and the cost of providing care to this group is borne indirectly by the insured consumers.
* New legislation. Proposed government mandates--such as the Patients' Bill of Rights, Medicare reform, and health care tax changes--will continue to drive health care costs up.

I'm going to have to agree with them.


8. How does one measure "quality of care?"

Very carefully. Ha!
*sigh*

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) apply quality and safety of care standards and evaluate the compliance of health care organizations to those standards. They have been doing this for more than 50 years, and are considered the "gold standard" for hospital quality review, so I will defer to some of the quality control standards that they have developed.

According to their website, www.jcaho.org, their standards address quality and safety of care performance areas such as infection control, emergency management, patient rights, human resources and performance improvement.

Billing, insurance, payment disputes, individual personnel or labor relations issues are not within JCAHO's scope.