Please know that one person’s “ad hominem attack” (a phrase that’s oh-so-popular with the bourgeois) is another person’s civil right to speak the truth and expect some accountability.

Now retired, i am quietly developing my own views on how to drastically change the healthcare system. I hope that soon I can become an active participant in change, at least as a writer. Besides healthcare, I was an executive in a retail company, an academic and now I a neutral as a labor arbitrator. I can attest first hand to the myriad of individual self-interests.

If we could just think backwards from what is best for the patient and the public rather than make modifications on the base of what we have now. I will give myself and others the benefit of the doubt that we have felt our mission has been to protect our interests and if we did that, it would work in the best interest of the patient. I am afraid that this micro approach does not add up to the patient’s best interest.

The healthcare system is too complex with too many contradictory interests for that to be the outcome. It is amazing how concepts that seem to have value on the surface work against the patient’s best interest. We talk about consumer-driven healthcare and that people should have skin in the game as they access healthcare services. So we charge them for a portion of their prescriptions, this makes them unaffordable, and they suffer the consequences of not purchasing them at all. We say that , as with the private sector, there should be competition among providers in a free market. Then we listen to a Blue Cross executive state that sure, we pay more to Partners because they have more “clout.” What does this mean for a patient in a commumity where the hospital is not a member of Partners, gets substantially lower rates, and cannot provide the latest technologies, appropriate staffing levels, and an electronic medical record? I cannot blame Partners for developing “clout” to get what it needs for its patients. However, should “clout” be accepted as the right market model and inevitably produce a variation in the quality of care provided to patients in different communities in Massachusetts?

For three decades I have watched changes take place in all aspects the healthcare system. Concepts such as state regulation of rates, capitation, managed care, the formation of healthcare systems to balance power in the market place, deregulation, the use of quality measure to determine payment rates, physicians becoming competitors in ancillary services, for-profit hospitals, etc., etc. I have gone back and forth on whether we practically can expect to make a major overhaul such as having a single payer with private providers. Gradualism always seems to win the day because there are so many separate interests to be satisfied, many of which cannot be necessarily defended as being in the best interest of the patient.Historically, major changes in an aspect of life in America have not come until we have a crisis. I now believe that the crisis of this moment must drive us to major change in our healthcare system.

I am worried whether the State’s efforts will be successful. As I look at the participants, I wonder if they will be able to step back from their own separate interests and be willing to make major change on behalf of patients and the public.

“Annually, the US health care system leaves more than 40 million of us without access to health care; another 15 to 20 million with inadequate access to health care. This translates into untold anguish, fear, pain, unnecessary disability,
and early death. Men, women and children. All day, every day. Anyone raised in a low income or working class family would have more or less known this from childhood; would have remembered the hushed parental discussions about whether to keep a doctor’s appointment or buy shoes for the kids; to have that leg looked at or to hope its nothing and buy the groceries.

I have early onset heart disease and have had a heart attack in my life. I went through a period without health insurance afterwards. During that period, I awoke in the middle of the night on several occasions with chest pain. Knowing I would
be admitted through the ER if I went to the hospital, knowing the costs associated with
that stay and the resulting workup…I took two aspirins, turned back over and went to sleep hoping for the best. A few months later, with health insurance in hand, I had the same symptoms and had them checked. A major artery was significantly blocked; I needed and received my third stent implant. One more bullet dodged.

Middle class health professionals, after many years of study, just seem to be discovering this truth: that if people don’t have health insurance, if they can’t pay for health care, then they don’t seek it and they don’t get it. They defer
making appointments, arranging for hospitalizations, pharmacy refills, follow-up visits to the doctor–whatever–and they use what funds they have for the other more pressing
costs of daily living. And this produces the anguish, fear, pain, unnecessary disability, and early death. Like any other condition leading to fatalities, the US healthcare system ought to have a death rate calculated for it and reported on an annual basis by the US Center for Disease Control (CDC).

Those of us who spend careers in health care making “good money” off the system; those who have never once thought about why and how it needs to change; who have spent professional lives more or less knowingly moving the chairs around on the
deck of a Titanic; those who have never taken a step in any direction to help bring about
any change, are completely, utterly and irrevocably complicit in all of this human pain and suffering. We are the only western, industrialized country remaining that treats its own people like this and we do it because we are the only western, industrialized country where it is still socially acceptable–and even
praiseworthy–to make the very last buck possible off of human pain, suffering and death. This is where the fearless moral inventory of ourselves
should come in, for we are the ones who know enough of the system to dissent from this, to
scream of its injustice, to challenge its social acceptability, and for the most part, in very large numbers…we do not. “

Please know that one person’s “ad hominem attack” (a phrase that’s oh-so-popular with the bourgeois) is another person’s civil right to speak the truth and expect some accountability.

Interstingly, in this entry Ms. Turnbull apparently wants to have it both ways as she continues in her lucrative role as a “Player” in the state’s corrupt health policy arena. In this blog and many other writings, Ms Turnball seeks to present herself as a champion of the people (with her repeated use of “we”) while she conveniently omits any reference to the fact that she herself has been for many years–and continues to be–feeding at trough of greed-driven corporate healthcare in Massachusetts. Ms TUrnbull’s central role in the creation and implementation of a state law that mandates purchase of private health insurance and, additionally, siphons almost a billion dollars in new public spending to subsidize purchase of those private insurance products is something she herself seems to be in denial about. Does this raise a concen of questionable ethics at play? Is wbur culpable, too?

As a fellow researcher recently pointed out to me, one simply needs to do a Google search on Ms Turnbull and you’ll see evidence of her years on the payroll of Blue Cross and Blue Shield of Massachusetts (see partial results at this link http://www.google.com/search?q=%22Nancy+Turnbull%22+blue+cross+blue+shield+medicaid+policy&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a ) Ms Turnbull’s corporate health care connections have brought in lots of Blue Cross and Blue Shield money to her current employer, the Harvard School of Public Health. Back to the central issue.

There actually is a “we” grassroots-driven health reform movement underway in Massachusetts. I have just learned that this group Mass-Care is comprised of over 100 organizations representing a half-million MA residents. Sadly, it seems that Mass-Care’s work gets scant media coverage. This is likely due to them not buying ad space in said media outlets.

A recent Mass-Care project was written about on this wbur blog in November. You can read about it here http://commonhealth.wbur.org/wbur-posts-and-stories/2008/11/single-payer-question-on-the-ballot-in-10-districts/

On their website I read that Mass-Care’s coalition has crafted a universal health care bill that uses streamlined financing called “single payer” seeking to create affordable universal coverage. They are busy educating the public and elected officials about it. The bill is to be introduced in the state legislature this session. Learn more about the bill and if you think it makes sense then contact your legislators to sign on. Details can be found at http://www.MassCare.org.