Last week Newt Gingrich and John C. Goodman, two fulsome but thoughtful conservatives wrote an op/ed in The Wall Street Journal, “Ten GOP Health Ideas for Obama."

Hats off. They offer serious and helpful recommendations—ideas that could be bandied about at the President’s health care summit next week. But even their good ideas are at best half a loaf in the face of America’s health care famine and if they are serious (and if Democrats are), they should re-tool their recommendations to make them more in line with reality.

Here are their proposals (ripped from The Journal, with my invaluable editing) and my comments. Love to know what you think.

• Make insurance affordable (Gingrich and Goodman say).” The current taxation of health insurance is arbitrary and unfair, giving lavish subsidies to some, like those who get Cadillac coverage from their employers, and almost no relief to people who have to buy their own… A step in the right direction would be to give Americans the choice of a generous tax credit or the ability to deduct the value of their health insurance up to a certain amount.”

The Democrats made a similar point and that’s why some are eager to tax so-called Cadillac health care plans. But Gingrich’s and Goodman’s proposal offers little to those without any health care insurance or low-income Americans.


• Make health insurance portable… “Employers should be encouraged to provide employees with insurance that travels with them from job to job and in and out of the labor market. Also, individuals should have the ability to purchase health insurance across state lines. When insurers compete for consumers, prices will fall and quality will improve.”

I don’t know how or why employers would offer insurance that workers can take with them after they leave a job. And government “encouragement” smacks of the regulations conservatives loath. GOPers talk endlessly about purchasing insurance across state lines. That’s not a bad idea but someone has to regulate these policies and as I’ve said, conservatives want less, not more regulation.

• Meet the needs of the chronically ill. “Most individuals with chronic diseases want to be in charge of their own care. The mother of an asthmatic child, for example, should have a device at home that measures the child's peak airflow and should be taught when to change his medication, rather than going to the doctor each time.”

Good for Newt here; he and Goodman are on to something. But they must acknowledge that patient and family education is costly and will add another digit to the federal health care tab. It’s not wrong, it’s just expensive.

“…Having the ability to obtain and manage more health dollars in Health Savings Accounts is a start.”

Liberals say that health saving accounts benefit mainly the well to-do. But with a commitment to educating consumers, encouraging health savings is a good idea.

• Allow doctors and patients to control costs. “…Medicare pays by task—there is a list of about 7,500—but doctors do not get paid to advise patients on how to lower their drug costs or how to comparison-shop on the Web. In short, they get paid when people are sick, not to keep them healthy. So long as total cost to the government does not rise and quality of care does not suffer, doctors should have the freedom to repackage and re-price their services. And payment should take into account the quality of the care that is delivered. Once physicians are liberated under Medicare, private insurers will follow.”

Ah, the catch here is that costs will rise. Then what? And by the way, moderate and liberal Democrats have been talking about improving “quality” at least since Bubba was in the WH.

• Don't cut Medicare. “The reform bills passed by the House and Senate cut Medicare by approximately $500 billion. This is wrong. There is no question that Medicare is on an unsustainable course; the government has promised far more than it can deliver. But this problem will not be solved by cutting Medicare in order to create new unfunded liabilities for young people.”

What conservatives (who in their heart of hearts never liked Medicare in the first place) do not mention is that the cuts to Medicare that congress has proposed are in reality cuts to Medicare Advantage programs, which pay doctors a hefty premium over plain vanilla Medicare. The Obama administration has tried to rein-in costs to pay for HC reform, for which conservatives should be applauding. And I’m sorry, if “unfunded liabilities for young people” mean that individuals—including children—currently without health insurance have some health security, well, just call me a bleeding heart.

• Protect early retirees. “More than 80% of the 78 million baby boomers will likely retire before they become eligible for Medicare. This is often the most difficult time for individuals and families to find affordable insurance. A viable bridge to Medicare can be built by allowing employers to obtain individually owned insurance for their retirees at group rates; allowing them to deposit some or all of the premium amount for post-retirement insurance into a retiree's Health Savings Account; and giving employers and younger employees the ability to save tax-free for post-retirement health.”

This seems like a good idea and one that could be discussed at the White House health care summit next week. But this type of plan must ensure that benefits are available to all employees, not just the better off ones.

• Inform consumers. “Patients need to have clear, reliable data about cost and quality before they make decisions about their care. But finding such information is virtually impossible…”

Fine enough. But doctors also need “clear, reliable data.” The Democrats’ plan includes money for comparative effectiveness studies to examine the effectiveness of some treatments. But conservatives have resisted funding these studies. You can’t have it both ways!

• Eliminate junk lawsuits. “Last year the president pledged to consider civil justice reform. We do not need to study or test medical malpractice any longer: The current system is broken…”

Tort reform is fine as long as individuals seriously wronged or injured can recover reasonable damages. The caps Republicans suggest are simply too low. And “loser pays laws” which Messrs. Gingrich and Goodman advocate would be devastatingly effective in closing off any suits to begin with.

• Make medical breakthroughs accessible to patients. Breakthrough drugs, innovative devices and new therapies to treat rare, complex diseases as well as chronic conditions should be sped to the market. We can do this by cutting red tape before and during review by the Food and Drug Administration and by deploying information technology to monitor the quality of drugs and devices once they reach the marketplace.

I am for faster access to new therapies (after all, pharma companies are my clients). But no one has an appetite for shortcutting the FDA’s safety and effectiveness review process (which some label “red tape.”). And if we are monitoring the quality of drugs and devices post-approval, aren’t we also interested in measuring their effectiveness relative to earlier products?

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Checklist: Check.

I haven’t read Atul Gawande’s new book, “The Checklist Manifesto,” but I am anxious to do so—maybe as soon as I finish David Ploffle’s congratulatory “The Audacity to Win.” But I like the idea Dr. Gawande discusses, as reported on the PBS Newshour (http://www.pbs.org/newshour/bb/health/jan-june10/gawande_02-08.html) and elsewhere. His premise is that in a world of rising magnitudes of complexity, professionals should revert to the most basic of management tools, the simple checklist, to ensure success.

It’s a great example of how something oh so simple can have a major impact on events. An example: in Michigan every hospital adopted a “cleanliness checklist to help control infections. The result: a 2/3 reduction in hospital-acquired infections, the saving of 1,500 lives and a cost savings of more than $200 million.

(The late great television program “ER” incorporated checklists in the surgical settings in one of its final episodes.)

Now down the food chain to health care public relations. The importance of checklists struck me when I was reliving some old business plans account teams developed for p.r. clients. Many were awesome, but others were, well, less so. Two of sand traps public relations executives fall into are the allure of developing everything from scratch or piling one idea (good or bad) on top of another, as if a bigger pile of recommendations is necessarily a better pile.

The most successful teams and agencies may or may not have a new business or a new year planning processes—sometimes I think the “proprietary” processes are so much hooey. But what they will do is ensure that each issue the client faces is addressed and that each audience is accounted for. In order not to go crazy in the business development process, these winning teams will generally follow established checklists mandating when each task must be achieved and who is accountable for it. (I’ve created several such checklists. Let me know if you’d like to see them.)

Checklists: it’s such a simple concept it is amazing that it take a surgeon of Dr. Gawande’s stature to remind us of their importance.

Surgery-related dementia in elderly

Over chardonnay and port Sunday, two friends who are anesthesia experts told me of an interesting observation: Health care professionals are anecdotally reporting that there is a very high rate of dementia in elderly patients following surgery. We are already aware that open-heart surgery patients often have memory lapses and “chemo brain” is a known though not inevitable consequence of chemotherapy.

But this is a newly reported phenomenon and despite being whispered about in hospitals, there are no clinical trials to map out its legitimacy and severity. In fact, my friends say there’s little incentive to fund research in this area since the patients are typically very old and do not have long lives ahead of them.

But as our population becomes hoarier, post-surgery dementia, if confirmed, could become a roadblock to good quality of life in later years. Elderly individuals now are participating in activities undreamed of a generation or two ago. Long distance running, working, gee, even dating, are activities not uncommon even among people in their 80’s. Will they be as eager to go under the knife if they believe that medical procedures designed to help them may in fact hobble their ability to reason, socialize and live independently?

As health care communicators, how will we allay their fears and help them weigh the risks of surgery with possible consequences?