• Submitted by: manso
• Editorial Articles
• 12 / 13 / 2010

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BLAINE - When business people attending the Association of Washington Business policy summit at Semiahmoo Resort were asked if they were considering dropping medical coverage for their employees, perhaps a dozen of the more than 100 in attendance raised their hands.

And that was early in the summit's Wednesday, Sept. 22, program on the impact of the health care reform legislation that President Barack Obama signed six months ago - before the audience had a chance to hear most of the dire warnings about runaway costs and crushing regulatory burdens under the new law.

Much of the critique of the new legislation came from Grace-Marie Turner, president and founder of Galen Institute, a nonprofit organization that advocates a free-market approach to health care and gets some of its financial backing from for-profit health-related companies.
    
Hoping to erase a troubling legacy of preventable infections and deaths, most U.S. hospitals on Jan. 1 will begin reporting the number of patients who contract bloodstream infections following their treatment in intensive-care units.

The information about infections involving catheters will be made public on a government website later in 2011, giving consumers a fast, easy way to see which hospitals best protect patients from one of the most lethal, yet avoidable medical conditions.

Catheters are tubes used to draw blood or provide fluid or medication to patients. They're commonly inserted into a patient's large vein, usually in the chest, neck, arm or groin, and can remain in the body for several weeks. Infections result if bacteria or germs travel through the line and into the bloodstream.
    
Four years after Massachusetts embarked on the nation's most ambitious health care overhaul, Gov. Deval Patrick and legislative leaders are stepping up efforts to rein in spiraling insurance costs.

Those costs are threatening to undermine the 2006 health care law, which mandated nearly universal health coverage and provided a blueprint for the national health care overhaul pushed by President Obama.

The next big goal, supporters say, is to find a way to slow surging premiums while maintaining or improving the delivery of health care services.
   
BELLINGHAM — The day following her husband’s painful death from esophageal cancer on April 21, Audrey Roll-Shapiro learned of the new state law that would have allowed him to obtain a lethal dose of medication to hasten his dying.

Outraged, the Bellingham resident sent a letter to Whatcom Hospice — the agency had come to their home in March to care for Norman Shapiro in his final days — asking why information about the law, called Death With Dignity, was not mentioned to them.

“The efforts of the very attentive, loving hospice staff did not alter his extreme discomfort and pain as he died. It simply went on too long,” she wrote in her April 29 letter to Richard Hammond, manager of Whatcom Hospice. “Why were we never made aware that we/he had a choice of a more mercifully quickened ending? … He was unquestionably in pain, severe discomfort, ready to leave, fighting to leave.”
    
A gray-haired woman, her eyes sunken and unfocused from dehydration, stumbles up a dirt path slumped on the shoulder of a young man, heading to a rural clinic so overcrowded that plastic tarps have been strung up outside to shade dozens who can't fit inside.

On the path to the clinic, another cholera victim lies dazed, her head bleeding because she couldn't stay atop the motorcycle taxi that carried her along the twisting country roads to the treatment center on the front line of Haiti's sudden battle with cholera.

Nearby, a 16-month-old girl wails as a nurse prods her with a needle, trying to find a vein for the intravenous fluids she needs to save her life.

It was nighttime in a downtown hotel in a foreign country when Bellingham resident Naida Grunden came down with a sinus infection.

That recipe for trouble in Havana instead became a real-life lesson about health care in Cuba.

Grunden went to another room to meet the hotel nurse, a woman with a white nurse's cap.

"It had the most frayed edges on it," Grunden recalled, "but she wore it with such great pride."

The nurse said a doctor would be there within 20 minutes. Sure enough, the doctor soon arrived, checked out Grunden and prescribed some medication. The medicine was free, but Grunden had to pay $10 for taxi fare so it could be brought from a pharmacy.

Grunden's experience wasn't unusual. Most Cubans have ready access to a doctor-and-nurse team in their neighborhood. Such ground-level service is a key part of Cuba's system that provides free and accessible health care to all of its citizens.

Cuba spends a small fraction on health care, per capita, compared to the U.S., yet many measures of good health in the two countries are dead even, or close to it.

"We have plenty to learn from them," Grunden said.

She traveled to Cuba for 10 days in November with several people from Global Links, a nonprofit outfit in Pittsburgh that gathers medical gear for countries in Latin America, including Cuba.

Grunden lived in Pittsburgh when she worked for a regional effort to introduce Toyota-inspired management methods to area hospitals. The goal was to save money and lives with smarter, more efficient ways to treat patients.

Grunden later wrote a book on the subject, "The Pittsburgh Way to Efficient Healthcare," which has been translated into Spanish and distributed in Cuba.

Six of Cuba's main medical institutes are pursuing certification from the International Organization for Standardization, a stamp of approval akin to accreditation for hospitals in this country. Being certified would show Cuba's institutes meet the same standards as ones in much wealthier countries in Europe.

To help Cuba in its effort, Grunden and the others with Global Links visited the six institutes and explained efforts for greater efficiency in U.S. hospitals. While some U.S. hospitals have balked at the ideas in Grunden's book, Cuba has long recognized the need for efficiency.

The ongoing U.S. blockade against Cuba has limited resources there, a situation that worsened dramatically in 1991 when the Soviet Union, crumbled. Despite that one-two punch, Cubans' health didn't plummet, thanks in part to the emphasis on primary care and to the government's willingness to spend more of the national budget on medical care, according to a report by Medical Education Cooperation with Cuba, a nonprofit group in Oakland, Calif.

Cuba's need to watch its pennies has resulted in some smart practices, such as extensive screening and testing of patients to reduce the chance of surgical infections, Grunden said.

"Readmissions in Cuba are disastrous because they suck up resources," she said.

She plans to return to Cuba this spring to lead some seminars. Any changes adopted in Cuba could help others, because Cuba provides and trains thousands of health-care professionals who work in poor countries.

"If you want to change health care in Latin America, you want to change health care in Cuba," Grunden said. "It's a leverage point."

Source: www.thenewstribune.com/2010/12/12/1458952/bellingham-woman-learns-first....