Opinion: The Nation's Health -- And Ours

It's hard to go anywhere without seeing a "going green" logo. I'm all for saving the planet -- this is a good thing. What's missing, however, is an equally energetic effort for saving our own health. As we focus attention on making our planet healthier, isn't it at least as important that we begin making ourselves healthier as well?

President Barack Obama has placed reforming health care among his highest priorities and bringing down costs as job No. 1. Recently, Gov. Beverly Perdue hosted a regional forum on health reform, and it drew almost 1,000 attendees. Governmental health care reform initiatives will likely address key issues such as decreasing the number of uninsured, improving information technology, decreasing bureaucratic waste and rationalizing reimbursement -- all necessary, but only part of the solution.

To truly improve the health of our state and nation, we must also focus on preventing disease and promoting health and well-being. Our current health care system must be transformed from its current ineffective, expensive and reactive "sick care" approach to one that is proactive, personalized, preventative, cost effective and appropriately focused on enhancing health as well as rationally managing disease.

Treating events of late-stage chronic diseases consumes nearly three-quarters of health care expenditures. Many of these conditions can be minimized by effective and far less costly prevention. We each have our own inherited tendencies for disease susceptibility, but how we manage what we inherit is largely up to us.

So why don't we harness the momentum of health reform and do something big and bold -- spur a North Carolina "going healthy" movement to help us deal more effectively with disease prevention and health enhancement? If "going healthy" were as front of mind as "going green," we would make great strides toward health care reform.

Improving health requires better nutrition, exercise, stress reduction and health risk avoidance -- it isn't as though we've not heard this before. But healthy living is not easily adopted in our environment, which inundates us with a culture of sloth, overeating and high stress. The "going healthy" movement would change this by making what's good for us easier to attain and by empowering us to do what's good for our health.

This initiative requires collaboration among businesses, restaurants, grocery stores, schools, communities, media, government and others who could play major roles by providing, for example, accurate education and nutritional information at the point of purchase; making wholesome foods easily accessible; increasing the ability to exercise at work, in our communities and schools; providing stress reduction and smoking cessation programs; and facilitating walking and bike paths (a good use of stimulus funds).

The media, with the help of sports teams, could encourage fitness and activity rather than watching others do this. Appropriate interest groups could be convened to coordinate the movement to emphasize health and well-being. Most importantly, the "going healthy" initiative would articulate the value of health and well-being as critical resources that we can control. By striving to improve our health and well-being, we would not only live healthier lives, we also would consume fewer health care resources and feel far better about ourselves and those around us.

So where does it start? It begins with us, our state and federal governments, communities, organizations, workplaces and schools. An example of a creative endeavor is at Duke University, where a group of students formed the Duke Prospective Health Care Club to educate undergraduates about how they can improve their health. The club just kicked off a yearlong health care competition for which students team up with university employees to meet healthy goals. The winners will get the ultimate prize -- tickets to next year's Duke/Carolina basketball game at Cameron. The club is working to expand efforts across college campuses nationally. Many business and communities have similar initiatives, but what is needed is a coordinated focus to create a groundswell leading to a state then a national movement.

As Perdue and Obama have indicated, health care costs are a major factor driving our economic tailspin. With appropriate focus on "going healthy," we would help save the economy and, even more importantly, ourselves. Why shouldn't North Carolina set an example for the nation by leading the "going healthy" initiative? We have the opportunity to create a truly healthier, happier and economically sound state and to show the nation another example of North Carolina's vitality and creativity. All we need now is to get started, then a logo!

By Ralph Snyderman

Dr. Ralph Snyderman is chancellor emeritus at Duke University, chairman of Proventys Inc., former CEO and president of the Duke University Health System and former chair of the Association of American Medical Colleges.

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Association for Healthcare Philanthropy Opposes Limits on Charitable Tax Deductions

/PRNewswire-USNewswire/ -- The Association for Healthcare Philanthropy (AHP) today issued the following statement regarding limits on tax deductions for charitable donations proposed in the Obama Administration's budget:

The Association for Healthcare Philanthropy (AHP) opposes the proposal in the President's budget that would impose new limits on charitable tax deductions.

AHP applauds the President's overall efforts in the budget to revive the economy, reform health care, revise energy policy and tackle other important issues affecting the country.

However, the budget also contains a proposal that sends the wrong message at the wrong time to those who support charitable causes. It puts forward a scheme that would effectively devalue charitable gifts made by the very people who are in a position to make substantial donations at a time when they are sorely needed. For those who earn more than $250,000, the proposal would limit the federal tax deduction they may take for their generosity to 28 percent. Currently, they may claim up to a 35 percent deduction.

In these challenging economic times, charities and nonprofits already are finding it difficult to fulfill their altruistic missions because of reduced donations and resources. Yet, in times of economic trouble, it is charities and nonprofits that do much to augment the work of the federal, state and local government in meeting the needs of the American public through their vital programs and services. In fact, charities currently are being asked to provide even greater levels of assistance. The federal government, therefore, should seek ways to bolster charitable giving--as opposed to requiring charities to do more with less.

In fact, research published by the Congressional Budget Office from 1997, the Urban Institute from 2001, the Association for Healthcare Philanthropy from 2008 and the Center on Philanthropy at Indiana University from 2009 all state that giving is sensitive to price incentives provided by after-tax costs. The question that remains is: by how much?

A report by Indiana University "suggests that had these proposals been in place in 2006, total itemized charitable giving by households would have dropped by 2.1 percent." And that number fails to take into account the current large decline in America's personal wealth. Americans' generosity in support of nonprofit hospitals and health care systems is substantial, totaling $8.35 billion last year according to AHP's Report on Giving 2007. This report reveals an important insight concerning the importance of public backing for the nonprofit health care community: Almost 83 percent of all donors last year were individuals. Individuals provided 61 percent of all donations. Can American hospitals afford to lose 2.1 percent or more in contributions from these families?

Probably not. And, unfortunately, the growth rate of giving to the health care sector is slowing down and the number of donors is flat. According to a 2007 Chronicle of Philanthropy article, "Contributions to health-care institutions rose last year (2006) by 8.3 percent, adjusted for inflation, compared with a 12.9-percent rise from 2004 to 2005." The same conclusion was drawn from an AHP-sponsored study released in September 2008, by John Volpe, Ph.D., collegiate professor at the University of Maryland University College. In Economic Cycles and Charitable Giving Volpe concludes that a slowing of the growth in Gross Domestic Product and disposable personal income, as well as uncertainty over the economy are likely to contribute to weakness in charitable giving through 2009.

Yet such charitable giving is and will remain vital to the hospitals and systems to which it flows. According to the American Hospital Association (AHA) November 2008 Report on the Economic Crisis, the capital crunch is making it difficult and expensive for hospitals to finance facility and technology needs. The AHP Report on Giving indicates that more than 45 percent of charitable giving was put to use to upgrade infrastructure, including often long-overdue construction and renovation projects and equipment purchases. An additional 25 percent supported important functions such as community benefit programs, charitable care, research and teaching, and hospice, long-term and nursing care. About 14 percent went to general operations.

These accomplishments were achieved through fundraising and its outreach efforts to grateful families. While the Nation's health care needs are increasing, we must avoid creating obstacles that will diminish and discourage philanthropy.

The steep decline in personal wealth, especially if coupled with proposed limitations on tax deductions, make the outlook for philanthropy over the next 18-24 months bleak. For philanthropy to continue to fulfill its role in the American health care system, this is not the time to drastically change standards for fundraising.

Given the potential devastating impacts of this budget provision on charitable giving, AHP strongly opposes any provision that would impose new limits on charitable deductions. AHP is joined in this opinion by the Association for Fundraising Professionals (AFP).

FactCheck.org Gets It Wrong on Stimulus Package

/PRNewswire-USNewswire/ -- The following is a statement from Betsy McCaughey, Ph.D., Chairman/Founder of Committee to Reduce Infection Deaths:

Americans need to know how the health provisions hidden in the recently enacted stimulus package will affect them. To inform the public about these provisions and the dangers, especially for seniors, I wrote an analysis for Bloomberg.com on February 10th. Lori Robertson, an employee of FactCheck.org, challenged the accuracy of my analysis in her February 20 critique posted on Newsweek.com. Readers of Robertson's critique should consider these facts.

Robertson begins by portraying me as a Republican politician out to score partisan points. I am a Democrat and a patient advocate leading a national campaign to prevent hospital infections.

Robertson also states that I am not a journalist and therefore lack the qualifications to analyze the stimulus package. In fact, I am a widely published author who has won three prestigious journalism prizes, including a National Magazine Award, an H.L. Mencken Award, and the 2003 Media Award from the American Association of Anesthesiologists. In addition, I earned a Ph.D. in constitutional history from Columbia University, wrote two books on the U.S. Constitution, and served as Lt. Governor of a large state. What are Robertson's credentials to analyze this legislative document? She holds a B. A. in advertising.

Robertson interviewed me by telephone and writes that "throughout our conversation McCaughey spoke of an 'unprecedented' award of authority to the secretary (of Health and Human Services). That's a matter of opinion on which we won't weigh in."

But that is the most important issue. And it's a matter of fact, not opinion. How much power is given to the HHS Secretary over your health care, and what choices are left to you and your doctor?

The goals of the National Coordinator for Health Information Technology are to ensure that "all individuals in the United States" have their medical treatments entered into an electronic database and to guide physicians "at the time and place of care" so as to reduce costs and eliminate "inappropriate care".

Are these guidelines voluntary? Hardly. Physicians and hospitals that fail to meet the HHS Secretary's standard of "meaningful use" will be subject to financial penalties from Medicare. How much leeway will there be to use experimental treatments and off label drugs? Will doctors be able to meet the needs of the atypical patient or provide more care than the guidelines recommend? It's hard to say, because the HHS Secretary is empowered to determine what "meaningful use" means and to make the definition more "stringent" over time.

"Perhaps so," writes Robertson. "But the fact remains that the law does not impose any federal treatment guidelines or require the government to do so." Robertson concedes that "perhaps" such interference with the doctor-patient relationship "will indeed come to pass some time in the future. Who knows?" she says. "But the law doesn't require it."

Require it? No. Allow it to happen? Absolutely. The point of analyzing legislation is to understand what could happen once the law is passed. In this case, there is a transfer of power from patient to government. Robertson fails to address that.

In the early 1990s, HMOs used a financial penalty called a "withhold." HMOs would withhold as much as 10% of a physicians' reimbursement until the end of the year and give it back only to physicians who met stringent targets for limiting how many diagnostic tests, referrals to specialists, and days in the hospital their patients got. What a doctor ordered for a patient came out of the doctor's own pocket. Patient advocates like me acted quickly to demand that the withhold be outlawed. Now the HHS Secretary would be permitted to do virtually the same thing by withholding Medicare reimbursements.

Robertson also concludes that the creation of a Federal Council on Comparative Effectiveness Research should not alarm seniors. Comparative effectiveness is code for limiting care based on a patient's birth date. Treatments for the elderly, who have fewer years to benefit, are likely to be deemed too costly. This is already happening in England and several European countries. Numerous recent articles in Health Affairs, the inside-the beltway manual for health policy makers, describe comparative effectiveness research as the tool to reduce Medicare spending.

U.S. Senators were so concerned about the meaning of comparative effectiveness that the Senate version of the stimulus replaced that term with "clinical effectiveness". However, the change was overturned when House and Senate conferred on a final version. Representative Charles Boustany Jr. from Louisiana, a heart surgeon, told The New York Times he feared the research would be used to "deny life-saving treatment to seniors and disabled people."

Finally, Robertson fails to explain why these health provisions were slipped into a stimulus package with no expert testimony and no opportunity for input by patient advocates, seniors, or physicians' groups. If these provisions are so good for patients, why avoid public scrutiny and debate? Secretary of HHS nominee Tom Daschle advised the president to do just that, even if it meant "attaching a health plan to the federal budget."

Americans should demand that these health provisions be repealed and offered as separate legislation so their impact can be further assessed.

Betsy McCaughey, Ph.D., is Chairman/Founder of Committee to Reduce Infection Deaths and former Lt. Governor of New York State.

Don't Believe What You Hear on Countdown: Keith Olbermann's Factual Errors

/PRNewswire-USNewswire/ -- The following is from Betsy McCaughey, Ph.D., the author of the recent Bloomberg.com article, "Ruin Your Health With the Obama Stimulus Plan."

I am requesting that MSNBC and Keith Olbermann apologize and issue a correction.

Mr. Olbermann charges that I, Betsy McCaughey, Ph.D. was paid, directly or indirectly, by the pharmaceutical industry, the biotech industry, the Hudson Institute, or Cantel Medical Corp. to write my analysis of the stimulus bill or speak about that issue. All these charges are false.

I have shown all these charges to be false in a previous statement except the new charge regarding my board membership at Cantel Medical Corp. I serve on the board of Cantel Medical Corp. as a patient advocate and infection prevention expert. No one at Cantel Medical has ever asked me about the stimulus bill or requested that I address the issue. I have not discussed the issue with anyone in the company. I urge those who are interested to contact Cantel Medical directly (973-890-7220).

I have purchased no stock in Cantel Medical. Like all board members, I am routinely issued options. The options cited by Keith Olbermann were not issued to me in payment for my work on the stimulus bill. They were issued to all Cantel board members at the same time. They are issued routinely and periodically. Unlike the other board members, I have never exercised any options to purchase stock. I do not use those options to make money. The same is true for other boards on which I have served.

Sincerely,

Betsy McCaughey, Ph.D.

Economic Stimulus Bill Mandates Electronic Health Records for Every Citizen without Opt-out or Patient Consent Provisions

/PRNewswire-USNewswire/ -- The Institute for Health Freedom (IHF) warns that the economic stimulus bill mandates electronic health records for every citizen without providing for opt-out or patient consent provisions. "Without those protections, Americans' electronic health records could be shared -- without their consent -- with over 600,000 covered entities through the forthcoming nationally linked electronic health-records network," says Sue A. Blevins, IHF president.

"President Obama has pledged to advance freedom. Therefore the freedom to choose not to participate in a national electronic health-records system must be upheld," Blevins says. "Unless people have the right to decide if and when their health information is shared or whether to participate in research studies, they don't have a true right to privacy."

IHF calls on Americans who care about health privacy to contact their members of Congress and President Obama to voice their own opinions about the need for opt-out and patient consent provisions, to ensure true patient privacy rights.

Some provisions of the economic stimulus bill include:

-- "The utilization of an electronic health record for each person in the United States by 2014."

-- "The National Coordinator shall perform the duties...consistent with the development of a nationwide health information technology infrastructure that allows for the electronic use and exchange of information and that...facilitates health and clinical research..."

The federal medical privacy rule promulgated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) already permits the disclosure of personal health information without patient consent for treatment, payment, and oversight of the healthcare system. IHF has long called for modification of the HIPAA rule to restore patient consent in order to preserve the confidential doctor-patient relationship. The stimulus bill fails to restore patient consent, while at the same time, mandating electronic health records and facilitating the electronic exchange of every American's health information.