Category: Culture

The United Provinces of Canada (at least on healthcare)

published date
July 1st, 2019 by
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Happy and Healthy?

Happy Canada Day!

We usually think of Canada as a divided nation, with the province of Quebec perennially at odds with the rest of the county and threatening to secede. I was in Montreal over the weekend and it’s fair to say there wasn’t much evidence of enthusiasm for the upcoming Canada Day (the rough equivalent of our 4th of July).

And yet, at least when it comes to healthcare policy, Quebec is very much at peace with the rest of the country.  From the Montreal Gazette (Quebecers united with Canadians on health, divided on language, hockey):

When it comes to stoking national pride, Canadians and Quebecers are united in their appreciation for universal health care and the Canadian passport. They also see eye-to-eye on the importance of the monarchy, Air Canada and Tim Hortons as national symbols, in that they don’t find them particularly important.

A national survey asked the question, “How important are each of the following as a source of personal or collective pride in Canada?”

Universal healthcare scored highest. Seventy three percent of Canadians and 70 percent of those from Quebec ranked it as very important. Anglophones and Francophones responded the same way.

We usually think of the United States of America, but when it comes to healthcare that is certainly not the case. If anything, Americans might be united against the idea of a Canadian-style system.

Kind of odd, then that the people living under that regime are so proud of it.


By healthcare business consultant David E. Williams, president of Health Business Group.

#CareTalk – Riding Amazon’s coattails

published date
February 28th, 2018 by

Amazon is teaming up with JP Morgan Chase and Berkshire Hathaway to create a new healthcare business to serve the companies’ employees. But all we hear about is Amazon’s role, while the other two are barely mentioned. Are they just along for the ride?

In this episode of #CareTalk, CareCentrix CEO John Driscoll and I tackle this question along with other meaty topics including big data, the CDC, Apple and Medicaid.

Enjoy the show -and don’t miss the lightning round!

Overview:

(0:20) How will the partnership between Amazon, JPMorgan Chase and Berkshire Hathaway impact healthcare?

(3:45) Are JPMorgan Chase and Berkshire Hathaway just “along for the ride” with Amazon?

(5:06) Who is looking out for the Medicare beneficiaries?

(8:01) The Economist published a statement that data will drive a revolution healthcare. Is The Economist right?

(10:42) Can we take any solace in the innovations happening on the state level?

(13:06) Was it the right move to force out CDC Director, Brenda Fitzgerald?

(14:20) What should be made of Trump’s description of the opioid crisis as an “emergency”?

(14:51) Will we be downloading Apple’s new Health app?

(15:37) Our thoughts on Indiana’s Medicaid program.

Listen to #CareTalk on iTunes: https://apple.co/2FxbeoX

Listen to #CareTalk on Google Play: http://bit.ly/2EuWHLd

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By healthcare business consultant David E. Williams, president of Health Business Group.

Hospice: Another sad sector of the opioid crisis

published date
August 30th, 2017 by
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Help yourself?

A person addicted to drugs might do anything to get their hands on the next dose. Whether that means ‘borrowing’ painkillers from a relative who had their wisdom teeth extracted, breaking into cars to grab small bills and coins, or stealing their mother’s jewelry –all things I’ve seen myself– there are no real limits. So I was saddened but not surprised to read Dying At Home In An Opioid Crisis: Hospices Grapple With Stolen Meds, which highlights the trouble dying patients face in keeping hold of their painkillers.

The Kaiser Health News examples are only anecdotal, but the combination of high quantities of opioids and homebound patients unable to fend for themselves is an ideal setting for diversion. The problem is two-fold: theft of drugs while the patient is alive, and diversion once the patient passes away. Since many patients die within days or weeks of beginning hospice, the second problem is a major one.

The examples offered in the article are heartbreaking:

  • In Mobile, Ala., a hospice nurse found a man at home in tears, holding his abdomen, complaining of pain at the top of a 10-point scale. The patient was dying of cancer, and his neighbors were stealing his opioid painkillers, day after day.

  • In Monroe, Mich., parents kept “losing” medications for a child dying at home of brain cancer, including a bottle of the painkiller methadone.

  • In Clinton, Mo., a woman at home on hospice began vomiting from anxiety from a tense family conflict: Her son had to physically fight off her daughter, who was stealing her medications. Her son implored the hospice to move his mom to a nursing home to escape the situation.

Some hospices are trying to do something about the problem, but it’s not easy. After all, their primary goal is to ease the pain of dying patients. It’s not really their job to keep track of and control everyone else. Some of the ideas being tried include:

  • Screening families for a history of drug addiction
  • Limiting the amount of meds delivered at any one time
  • Drafting agreements with families about consequences for drugs that disappear
  • Encouraging the destruction and disposal of drugs after the patient dies

None of these approaches is likely to succeed on its own. The country will have to address the broader opioid crisis in order to bring this part of it under control. However, there are a couple additional steps that could be taken now:

  • A few states let hospice employees destroy drugs once a patient dies. That should be expanded nationwide and made mandatory. There is no conflict here with the patient’s needs
  • Some patients, who would otherwise be eligible for home hospice, should be moved to facilities such as nursing homes, where controls can be tighter. (Much as I hate to argue against home care this needs to be part of the discussion)

By healthcare business consultant David E. Williams, president of Health Business Group.

Rerun: We need a liberal immigration policy to support health care reform

published date
January 30th, 2017 by

I went down to Copley Square, Boston yesterday to protest President Trump’s Executive Order on immigration. I’m very concerned about the direction the country is taking. Beyond that, I’m also saddened at the lack of appreciation for immigrants in building our economy and helping health care reform succeed. Below is a rerun of my blog post from 2011.


Over the last decade, the United States has intentionally made itself less attractive to immigrants, forgetting that immigration has been a huge driver of the country’s economic success. In a recent article (America needs a 21st century immigration policy), leading entrepreneurs, executives and investors including Steve Case and Sheryl Sandberg said:

To some, the link between immigration reform and economic growth may be surprising.  To America’s most innovative industries, it is a link we know is fundamental.

The global economy means companies that drive U.S. job creation and economic growth are in a worldwide competition for talent.  While other countries are aggressively creating policies and incentives to attract a highly educated workforce, America has stagnated.  Once a magnet for the world’s top minds, America now faces a “reverse brain drain” and is no longer the first choice for many entrepreneurs creating new companies and jobs.

America needs a pro-growth immigration system that works for U.S. workers and employers in today’s global economy.  And we need it now.

Openness and encouragement of immigration is vital for the success of health care reform. Why?

  1. Immigrants innovate and create economic growth. This growth is how the country gets wealthier and better able to support health care expenses without raising tax rates
  2. Immigrants tend to be younger, so they mitigate the overall aging of the population, making it easier for the country to afford its commitments to older citizens
  3. Immigrants can use their intellectual capital and training –whether acquired abroad or here– to fill health care jobs such as primary care physician, pharmacist, nurse that would otherwise go unfilled

President Obama actually understands this dynamic, but has to tread carefully since immigrant bashing is so popular on the right. But unfriendliness to immigration is all over in the place. For example in Massachusetts the state has decided –for short-sighted financial reasons– to exclude legal immigrants from subsidized health insurance. With luck, that decision will be overturned as unconstitutional by the state’s Supreme Judicial Court.

I agree with the Republican rhetoric of the need for a “pro-growth agenda.” Low taxes and limited regulation can certainly play a part. But policies that encourage immigration, especially of younger, well educated people, are absolutely essential. We need it for the economy as a whole and for the health care economy in particular.