The Bluegrass and Beyond

It’s no wonder people are frustrated by the debate over health care reform.

The issues are complex. None of the proposed solutions is perfect. And, more often than not, the arguments seem to dissolve into emotional oversimplification.

Besides, there’s a lot of money at stake. Whole business models have been built around the inefficiency of America’s health care industrial complex.

Last Thursday, the Lexington Forum hosted one of the better discussions I’ve heard on the subject.

The panelists were Dr. Michael Karpf, the University of Kentucky’s executive vice president for health affairs; Dr. John White, president of the Kentucky Medical Association; and Melodie Schrader, executive director of the Kentucky Association of Health Plans.

Some points of view weren’t represented, and the discussion lasted only an hour — not nearly long enough to do the subject justice. Still, it was enlightening.

Here’s what I took away:

The key issues are access, cost and quality. Some people want to change the entire health care system. Others want to preserve the status quo — or at least their current coverage or company’s profits.

But the key is figuring out how to control costs, maintain the quality of care and provide access to more of the millions of Americans with little or no access to affordable health care.

Karpf noted that a significant portion of uninsured Americans are young working people. That’s because employer-sponsored health insurance is becoming more scarce because of costs.

America has too few doctors, especially in small towns and rural areas. White estimated that Kentucky needs 2,300 additional doctors to meet national standards.

Many of us will have to give up something. Increasing access and controlling costs will mean people who have insurance now will have less freedom to choose expensive procedures that have little proven effectiveness.

They also won’t be free to forgo coverage. Schrader said the only way to guarantee that everyone can get access to insurance is to require everyone to have it.

Health care companies and insurers must give up some profits. For example, White said, Medicare Advantage programs — enacted during the Bush administration and criticized as government subsidies for insurance companies — should be eliminated, with the money going directly to pay for more Medicare patient care.

Malpractice litigation must be addressed. Republicans see tort reform as a panacea; Democrats dismiss it as insignificant. But the fact is many doctors feel compelled to order expensive tests and treatments of questionable value for fear they’ll be sued if they don’t.

A better balance must be found between protecting patients from medical malpractice and forcing doctors to practice costly “defensive” medicine.

We can’t be distracted by sideshows. For example, some reform critics warn that government bureaucrats will overrule doctors’ medical judgment. White said that is done too often now by insurance-company bureaucrats.

Another sideshow is the debate over coverage for illegal immigrants. As Karpf said, they’ll be treated one way or another to some degree — and somebody will pay for it. They’ll come to emergency rooms after accidents, when they are about to deliver babies or when suffering with serious illnesses or communicable diseases.

We must take more personal responsibility. Karpf noted that the health care economy now is based on fee-for-service, rather than prudent management. That encourages more spending.

Plus, he said, there’s not enough incentive for patients to live healthy lifestyles and make wise choices.

One key to lowering health care costs is to make the cost structure more transparent — and personal. People will use health care services more wisely if they see it’s in the best interest of their own pocketbooks.

With Second Sunday a little more than a month away, 100 of Kentucky’s 120 counties have plans to participate.

Each county plans to close a street or highway for a few hours Sunday afternoon, Oct. 11, and invite residents to come out to walk, bike, run or jog — and to think about how regular exercise could make them healthier and happier.

That was the basic idea used to launch Second Sunday last year, when 70 counties were involved. This year, though, many communities have more ambitious plans.

“It’s becoming a platform for all kinds of health-related events,” said Diana Doggett, a county extension agent in Lexington who is coordinating the statewide effort.

Dogget said many counties are planning health fairs, “fastest kid in town” races and even arts events.

Lexington will close a mile-long loop downtown — Main to Mill to Short to Deweese streets — from 2 p.m. to 6 p.m. Related events include bike polo demonstrations, health screenings and martial arts and yoga classes. A bike valet service will be available for cyclists to check their bikes while participating in other activities.

Jessamine County plans similar events downtown, plus a 6k run between West Jessamine and East Jessamine high schools to memorialize a popular coach and student athlete who recently died, Dogget said.

Elliott County’s events include speeches by House Majority Floor Leader Rocky Adkins, a cancer survivor, and a local man who lost 140 pounds without surgery. Festivities end with a concert by bluegrass star Don Rigsby.

Allen County citizens are building a two-mile bike and walking trail on property surrounding a Civil War site, Dumont Hill. Second Sunday activities there will include canon ball bowling.

Newport plans to close Monmouth Street between Fifth and 10th streets. Taylor County will include canoeing on the Green River. Franklin, Scott, Green and Adair counties all have big festivals planned around Second Sunday events.

UK’s Cooperative Extension Service is coordinating Second Sunday plans across the state, and some counties haven’t gotten involved because of vacancies in their extension offices, Dogget said. But anyone can step up and organize local events in those counties — and she hopes people will.

But the point of Second Sunday isn’t to get people outside exercising one day each October; it is to inspire them to start a regular exercise habit.

“What we need to do is change people’s lifestyles,” said Jay McChord, a Lexington councilman who helped create Second Sunday.

McChord also wants Second Sunday to attract national attention — and money — to Kentucky’s effort to shed its ranking as one of the nation’s least-healthy states.

He hopes exposure will attract millions in grant and foundation money to build a trail system throughout Kentucky so communities large and small won’t have to close streets for their citizens to have safe places to walk, run or bike.

Dr. Rick Lofgren, a physician at the University of Kentucky Hospital, appeared with McChord, Legacy Trail organizer Steve Austin and UK Agriculture Dean Scott Smith at the Lexington Forum’s monthly meeting Thursday to talk about trails, better health and Second Sunday.

Lofgren said he practiced in academic hospitals in many parts of the country before coming to UK five years ago. He noted that Kentucky ranks high nationally in obesity, diabetes, heart disease, strokes and lung cancer — all of the health problems nobody wants.

“This is the sickest group of patients I’ve ever taken care of,” Lofgren said. “Much of what I see is preventable. It has to do with the lifestyles we have around here.”

Lofgren said regular exercise would help a lot — on Second Sunday, and every other day of the year.

Here’s a piece of my interview with bourbon industry legends Elmer T. Lee, Jimmy Russell and Parker Beam that I didn’t have room for in today’s column:

Considering their combined 150-plus years of experience in bourbon distilling and tasting, I wanted to know how they judged one bourbon to be better than another.

They said individual taste plays a big role, so the question of whether one bourbon is better than another is often subjective. Russell said it’s like how some people prefer Coca-Cola and others like Pepsi. “If they all tasted the same, we’d just need one (distillery),” he said.

Beam said his tastes were shaped by the tastes of his father, who was Heaven Hill’s master distiller before him. “But Elmer and Jimmy are going to have a little different palate than what I’ve got,” he said.

All three agreed that one of the most important characteristics of a fine bourbon is a good “finish.”

“It just kind of lingers on the palate and gets better the longer it lays there,” Beam said. “I like that.”

“What he’s telling you,” Russell said, “is that it’s so good he wants another one.”

The national debate over health care reform is clouded by ideology, distortion, old myths and misinformation, especially when it comes to the way health care works in other countries.

T.R. Reid, who for many years was a foreign correspondent for the Washington Post, tries to cut through some of those with solid reporting in his timely new book: “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.”

Click here to read a Washington Post op-ed piece by Reid that gives an overview.  Click here to read Business Week magazine’s review of the book. Click here to listen to an extended interview Reid did with National Public Radio.