The New York Times ran an interesting editorial over Labor Day weekend. The writer—anonymous, in the grand editorial tradition—critiqued the healthcare track records of Republican presidential hopefuls Gov. Rick Perry of Texas, and Gov. Mitt Romney of Massachusetts. Both, of course, have promised to undo “ObamaCare” if elected.
 
Gov. Perry’s healthcare strategy more or less amounts to benign neglect, says the Times, citing a 2009 Commonwealth Foundation study that ranked Texas 46th out of 50 states on measures of public health, access to medical care and quality of care. Mr. Perry presides over a state where a quarter of the population is uninsured. Those who have employer-based insurance pay higher proportions of their $14,500 per year average premiums than worker-bees in other states.
 
But hey, Texas has caps—make that Stetsons—on medical malpractice awards. Yee-haw!
 
Gov. Romney on the other hand, an avowed enemy of Obama’s national reform, actually commandeered a miniature state-level version of the very same model—mandatory insurance, universal coverage—several years ago. He’s trying hard to distance himself from the liberal taint of “universal” healthcare, but his MassCare is hard to ignore, so he takes this weird crotch-splitting stance of claiming that mandated universal coverage is good for Massachusetts but would be horrible for the nation.
 
The Times gloats about this contradiction (one I can proudly say I pointed out in this very column almost two years ago) and bets that voters will laugh hard when Gov. Romney’s split results in a big, loud inseam-tear. The editorial practically urges him to man up, own his healthcare accomplishment, and stop ragging on Obama’s. See, according to the Times, Massachusetts’ universal healthcare “works.”
 
The Times likes MittCare because it achieved on a state level, that liberal Goal of Goals: universal insurance coverage. Many people who lean to the left politically never really question that goal. But they should, because having insurance does not and never has equaled access to good healthcare. You can have plenty of insurance, but if the plans deny the services you need/want, well, what good does it do you? And in case you haven’t noticed, plans deny services.
 
Having insurance definitely doesn’t equal having good health, either. But actual health seems to be very low on the political priorities list for either party...hand-wringing about the obesity epidemic notwithstanding.
 
From what I hear, neither Texas nor Massachusetts is a fun place to practice medicine, especially if you’re holistically inclined. The Lone Star State—Gov. Perry’s bastion of free markets and personal choice—has one of the most restrictive and punitive state medical boards in the nation, one that has consistently and viciously targeted doctors who color outside the lines of conventional allopathic medicine.
 
In Massachusetts, doctors are overwhelmed by the work involved in “universally covering” all those newly insured citizens. The state is scrambling to shore up its healthcare practitioner ranks, but in the meantime, workloads are daunting, reimbursement is paltry, and there are back-logs and long waits to see physicians…not exactly a great environment for developing individualized, health-focused therapeutic programs.
 
So much for political solutions to the healthcare problem!
 
Of course, politicians are not the only ones offering a fix. These days it seems like everyone’s got a healthcare “solution,” and they’re getting weirder by the minute!
 
Just this summer, we learned that the happy elves at Disney’s Magic Kingdom have started teaching beleaguered hospital administrators how to apply Disney leadership principles to improve the healthcare experience. A new Disney Institute program, called “Building a Culture of Healthcare Excellence,” schools healthcare leaders in Disney’s “Five Philosophies:” leadership excellence, people management, quality service, brand loyalty and creativity/innovation.
 
Personally, I don’t quite see how theme parks and hospitals have much in common, besides exorbitant prices, long waits, screaming children, harried adults and hi-tech gadgetry…well, maybe they are kinda similar after all. Anyway, I doubt that Disney can turn the nation’s medical centers into “the happiest places on Earth.” But apparently, administrators who follow the “Way of the Mouse” can improve their customer satisfaction ratings.
 
The Disney Institute cites two childrens’ hospitals, one in Arkansas and one in Florida, which vaulted from the lowest percentile on national patient/family satisfaction scores to the highest after implementing Disney best practices. A third hospital in California not only improved its satisfaction ratings, but it also saved more than $200,000 annually in reduced employee turnover.
 
The idea of Disney people training healthcare executives is weird, but cute. The idea of credit rating agencies monitoring peoples’ compliance with pharmaceutical prescriptions is definitely not cute. In fact, it’s pretty disturbing.
 
In a move that underscores just how strongly financial and actuarial imperatives influence American healthcare, FICO—the nation's leading credit rating house—announced that the company has developed a system for monitoring and rating consumers' medication compliance.
 
FICO launched its “Medication Adherence Score” (MAS) in June, with the goals of improving doctor-patient communication, increasing adherence to medical advice, and ultimately reducing healthcare costs by applying predictive analytics to predict an individual’s likelihood of filling a prescription and using the medication(s) as directed. The system is promoted as a remedy for the 3.2 billion annual prescriptions that go unfilled or not taken properly.
 
Some healthcare pundits claim non-adherence to drug regimens leads to thousands of unnecessary deaths and preventable disabilities each year, and accounts for $300 billion in wasted healthcare spending. Thus the need for a system like FICO’s, which can predict who’s a bad bet and guide clinicians and administrators to take appropriate corrective action.
 
If the entry of a credit risk rater into the doctor-patient relationship creeps you out, you’re not alone. FICO’s move has generated a lot of criticism. One of the strongest critiques—and relevant for our industry—is the fact that the system fails to recognize that someone’s “non-compliance” with a drug prescription could reflect his or her conscious choice to go with a non-pharma, non-prescription alternative (herb, nutraceutical, homeopathic, etc.) to manage a particular disorder.
 
In other words, this system could unjustly penalize people who seek legitimate healthcare options outside conventional drug-based medicine. FICO has not stated any intention to link peoples’ MAS ratings to their credit ratings, but some critics believe it’s only a matter of time.
 
Corporate America has clearly gotten active—to the point of psychosis if you ask me—about trying to deal with healthcare. But their “solutions” have more to do with corporate fiscal well-being than with actual public health.
 
Fortunately, there are some very creative, health-focused and ultimately more viable solutions emerging from the ground up, as clinicians and their patients take it upon themselves to reform healthcare.
 
Case in point: Dr. Pamela Wible, a family physician based in Eugene, OR. Dr. Wible is at the forefront of a movement toward community-based clinic design.
 
By 2005, Dr. Wible had worked in a wide variety of clinical settings and found herself utterly despondent over the constraints, conflicting incentives and heartlessness of conventional insurance-based practice. Rather than resign herself to more years of misery, she began envisioning her own “ideal” clinic.
 
Moreover, she shared that vision with her community in a series of town-hall meetings. She also gathered a hundred pages of input from community members about what they actually wanted and needed from a primary care clinic.
 
The result? A thriving, patient-friendly health center offering a range of holistic options at affordable prices. Dr. Wible keeps her overhead low, her accessibility high, and her attention on the main goal: helping people get well. Most importantly, she’s eliminated the frustration factor for her patients and herself.
 
“The evolution of this clinic happened so effortlessly, so simply and so easily. People hear my story, and say things like, ‘That’s great! Keep up the good fight!’ But in reality, it hasn’t been a fight. I’m not fighting against any system, or any other doctors, or any other mode of practice. It’s about bypassing what we know doesn’t work, and dreaming into being what does work,” said Dr. Wible, who will be a featured speaker at Holistic Primary Care’s upcoming “Heal Thy Practice” 2011 conference, Nov. 4-6, in Long Beach, CA.
 
Her experience in Eugene is not a fluke. Since starting her clinic, Dr. Wible has been working with physicians, clinics and even hospitals all over the country to help them restructure based on the actual needs and wishes of the communities they serve—not the demands of health insurance plans.
 
“Our community clinic has sparked a movement in which patients are designing ideal clinics and hospitals nationwide. Our model is now taught in graduate medical curricula and featured in Harvard School of Public Health’s newest edition of Renegotiating Healthcare: Resolving Conflict to Build Collaboration, a textbook examining major trends with the potential to change the dynamics of medical care,” said Dr. Wible, who describes herself as “a very pragmatic person, as well as a dreamer.”
 
She’s definitely not alone. There’s also Dr. Mark Logan in Rutland, VT, who’s embrace of nutrition-based approaches to managing serious disorders like diabetes and cardiovascular disease led to the creation of a fantastic artisanal restaurant called Roots, where Dr. Logan’s patients—and the general Rutland community—can enjoy delicious meals made from locally sourced produce, while also sticking to their eating plans.
 
Then there’s Dr. Vern Cherewatenko, a Seattle-area doctor who founded a system called SimpleCare, which frees both doctors and patients from the burdens and costs of insurance-based medicine. This reduces the costs of care by a huge margin and enables physicians to actually focus on the needs of the person in the room—the patient—and not the imperatives of his/her insurance plan.
 
There are literally thousands of practitioners all over the country who are saying “No, thanks” to the protocol-bound, actuarial approach to medicine promoted by the health plans, and who are working directly with their communities, small businesses and with other practitioners to develop practice models that actually meet peoples’ healthcare needs. These are the approaches we feature at the Heal Thy Practice conferences, and they’re our nation’s best bet for real, lasting healthcare reform.
 
We’re not going to improve the health of our country by counting pills or teaching amusement-park management skills to the people that run our hospitals. Nor will we get there by shouting each other down over “moral principles,” all of which, in practice, amount to corporate protectionism. We arrive at the solutions we need when ordinary people of goodwill—and that includes practitioners—put their heads together, dream up better systems, and figure out ways to make those systems work.
 
It’s happening all over the country—politics be damned—and there’s no better time to be involved in the process.