Never Settle

Earlier this month I returned to Philadelphia for the capstone of my Eisenhower Fellowship, which took me to Germany and Mexico last year.  The highlight of my days in Philly was a meeting and dinner with General Colin Powell, the chairman of Eisenhower Fellowships. He related how his own parents had come to the United States from Jamaica, pursuing the promise of a better life for themselves.  America made good on that promise, and in return it received a true patriot, a loyal soldier, and an accomplished diplomat.

General Powell remains a strong advocate for comprehensive immigration reform, noting that “our country couldn’t function without them.” He’s right, of course.  As a recent article from the Brookings Institution argued, “Immigrants generate dynamism and aspiration… where this [immigration] debate ends will tell us a great deal about the trajectory of the nation. An America that closes its doors will be an America that has chosen to settle rather than grow, that has allowed security to trump dynamism.”

America has never settled, and it shouldn’t start now. We must continue to welcome these New Americans, and part of that is providing good healthcare. While the Affordable Care Act has provided some relief, the uninsured rate for the foreign born still hovers around 27%, with Hispanics faring the worst at over 30%.  That needs to change, and it will when we remember that, as a nation of immigrants, when we care for them, we care for ourselves and our future.

By All Means, Let's Make America Great Again

I saw this graphic the other day on vox.com.

It occurred to me that when I read about folks who say they want to make America great again, or who want to take back their country, they seem to mean the post-war United States of the late 40s and 1950s, extending into the 60s and perhaps even the early 70s.  Looking at the Vox graph, that time coincides nicely with the period where the income of the top 1% of earners was at its lowest point.  In fact, it's only as income inequality really takes off that we move into the era where, apparently, America lost its mojo. 

So count me in.  Let's close the loop holes, end carried interest, return the estate tax to its pre-Bush levels, raise taxes on investment income, and increase the top marginal rate on wage income.  Heck, let's get rid of the FICA cap while we're at it.  By the very admission of these folks who seek greatness, the United States was never better than when there was less income inequality and more social mobility. Let's give them what they want.  America will be better for it.

Innovation + Accountability

One thing I'm certain of: Health is intricately interwoven with social determinants. Of course, sometimes illness strikes randomly, but you can read myriad studies that show if you're poor and uneducated - to name just two elements - you are much more likely to have health problems.

So I was very excited to read the announcement that the Centers for Medicare & Medicaid Services (CMS) will explicitly test whether addressing the social conditions that affect health can lower healthcare costs and improve the quality of care.

Those who know me are aware that I have long advocated a move away from fee-for-service healthcare and towards models that incentivize providers to focus on prevention. This new effort by CMS represents a move in that direction. Moreover, it attempts to directly link social factors to the overall health of a community, with the premise that, according to CMS, "systematically identifying and addressing the health-related social needs of beneficiaries impacts total health care costs, improves health, and quality of care."

The program is called the Accountable Health Community Model.  It will have three different program tracks, one of which particularly caught my attention.  This track focuses on community navigation services to ensure that a patient's needs are met after a referral. I can tell you from direct experience at Casa that navigations are a valuable tool to improve outcomes for patients who might otherwise not access care due to barriers like language, poor health literacy, and - sometimes, unfortunately - by organizations that aren't eager to assist self-pay patients.

I also like the name of the model - Accountable. It speaks to the shared responsibility all of us have to keep our communities healthy and whole. That's an attitude that would go a long way to curing what ails us.

Small Things Matter

May is the most diminutively named month, and yet it is the time when spring bursts forth, and it is the harbinger of the summer. It reminded me thatsmall things matter.

This can be hard to appreciate because we live in the age of Big: companies that are too big to fail, ideas that have to be scaled. And in such a time, it's difficult to remember that not only does the small matter, it can have quite an impact.

In the face the seemingly intractable problems, especially around access to care for the poor and dealing with the social determinants of health, it's easy to forget that something as straightforward as taking the time to listen to a patient and treating them with compassion actually makes a difference. At Casa, I've seen how a smile from our receptionist can positively affect a medical appointment, not to mention the effort our medical providers make to put patients at ease.

In the larger healthcare Safety Net, I've seen Dwayne Butler, CEO of People's Health Centers, go through his facility and say hello to everyone waiting to be seen. And Elaine Ottenlips at SLU Cancer Center, personally greeting at the entrance of the clinic the patients scheduled for their mammograms.

 

Yes, these are small things, and we shouldn't expect them to yield dramatic results. After all, a hurricane doesn't occur every time a butterfly flutters its wings. But that doesn't mean we aren't having any effect. And if you put enough small things together, you could be surprised by a mighty breeze starting to blow.