American Medical Association is again led by a Lexington doctor

June 30, 2015

Steven Stack, a 43-year-old Lexington emergency room physician, recently became the youngest president of the American Medical Association since 1854.

He will need all of the youthful energy he can muster.

The nation’s largest physician organization has some ambitious challenges, from helping sort out health care reform laws to rethinking medical education and trying to stem epidemics of diabetes and high blood pressure.

Stack is the second Lexington doctor to head the AMA in three years. Ardis Hoven, an infectious disease specialist, was AMA president in 2013. She now chairs the council of the World Medical Association.

“We live in the same Zip code,” Stack said. “But we never see each other in Lexington.”

Dr. Steven Stack, a Lexington emergency room physician, recently became the youngest president of the American Medical Association since 1854.  Photo provided

Dr. Steven Stack. Photo provided

Stack and his wife, Tracie, a physician and University of Kentucky graduate, moved to Lexington in 2006 to be closer to family in Ohio. He is from Cleveland and got his education from Holy Cross and the Ohio State University.

He is director of emergency medicine at St. Joseph East and St. Joseph Mt. Sterling hospitals. Before moving here, he directed emergency medicine at Baptist Memorial Hospital in Memphis.

When I caught up with Stack by phone Monday, he was relieved that the U.S. Supreme Court had rejected a technical challenge to the Affordable Care Act, popularly known as the ACA or Obamacare.

“If it had come out the other way,” he said, “there was the risk of over 6 million Americans losing their health insurance that they had just recently gotten and throwing the entire delivery system into a whole new type of chaos with no clear path forward.”

The AMA has been generally supportive of the ACA, especially its goal of increasing insurance coverage. That doesn’t mean doctors don’t think the law needs improving.

“But you have to be willing to want to correct it and make it better as opposed to just ripping apart and destroying it,” he said. “If we want to make some things better about it, then we need to focus on those things and not on trying to cut the whole law.”

The ACA has both good and bad aspects, Stack said. A bigger issue is how it and other health-reform laws do or don’t work together. Insurance companies also have regulation and bureaucracy that makes doctors’ jobs more difficult and interferes with patient care.

“We spend too much to provide care to too few people with results that are not as good as they need to be,” he said.

In 2012, the AMA identified several broad areas where it hopes to have an impact over the next decade.

One is medical education. Stack said the AMA has invested $11 million in 11 medical schools around the country to pioneer ways of incorporating new technology, new learning methods and new leadership skills in the training of doctors.

Another big initiative is addressing the diabetes and hypertension (high blood pressure) epidemics through early diagnosis and prevention.

About 86 million Americans are thought to be pre-diabetic, “and nine out of 10 of them do not know they are,” Stack said. With better diet and more exercise in proven intervention programs led by partner organizations such as the YMCA, many pre-diabetic people can be prevented from developing Type 2 Diabetes.

Early diagnosis and disease management also are critical for hypertension, which affects 70 million Americans, or 1 in three adults.

“Those are two of the most prominent and prevalent conditions of chronic health in the United States, and they cost over a half-trillion dollars a year in healthcare expenditures,” Stack said.

“If we can improve the care of those conditions … then we could profoundly improve the health and wellness of the nation, improve their capacity for work and fulfilling lives, and improve the economy of the nation all at the same time.”

Kentucky’s diabetes and hypertension rates are some of the nation’s highest, but Gov. Steve Beshear’s embrace of the ACA, by creating a state insurance exchange and expanding Medicaid, has helped get more Kentuckians treatment for a variety of health problems, Stack said.

Another AMA goal is to help “restore the joy to the practice of medicine,” he said.

Doctors “have so much intrusion from governments and private payers and other regulators in their lives,” he said. “If we want to have a healthier, happier nation, we have to have healthier, happier physicians to partner with patients to make that possible.”


Best Friends seeks more male volunteers for Alzheimer’s care

January 13, 2015

150108BestFriends0012 Helmut Graetz, left, sits with Best Friends participant Velma Beatty as Tom Green performs. Graetz, 88, has been a Best Friend volunteer for many years, as have his wife and son.  Below, Graetz as a 16-year-old German paratrooper in World War II. Photos by Tom Eblen

 

Conventional wisdom used to be that caregivers could do little to intellectually and emotionally reach some people with Alzheimer’s disease, who can get anxious, frustrated and angry.

Then, three decades ago, the Best Friends Day Center in Lexington began pioneering new approaches that have been copied in more than 30 countries around the world. Along the way, the center’s caregivers have challenged gender-role stereotypes, too.

“Care-giving has usually been looked on as a woman’s role,” said Best Friends director Sherri Harkless. “I don’t think men have necessarily felt that they were needed or wanted.”

But they are at Best Friends, which has found that male volunteers can be especially successful at forming breakthrough relationships with participants — mainly men, but also some women.

“Our men volunteers are invaluable,” Harkless said. “They are very compassionate, and they bring a lot of ‘men skills’ with them that can be key.”

The Best Friends approach was started in 1984 by Virginia Bell, then a graduate student at what is now the Sanders-Brown Center for Aging at the University of Kentucky. After 20 years at Second Presbyterian Church, the center moved in 2013 to larger quarters at Bridgepointe at Ashgrove Woods, an assisted living facility in Jessamine County.

Bell has co-authored several books about Alzheimer’s therapy, and remains the driving force behind Best Friends at the energetic age of 92. She said she found that people with dementia respond well to a volunteer who learns the person’s life story, listens and uses respect, patience, empathy and humor to develop a friendship.

Connecting with memories and experiences locked deep in the brain can help a person with dementia become calmer and happier. That is one reason old popular music is often used as therapy.

“Under the dementia, there’s a real person,” Bell said. “People have had amazing lives, and if you know their story you can relate to them. A person may not know what day it is, but they can intuitively sense if you care.”

Caring is the main job of Best Friends’ volunteers, who spend at least two hours a week with one of the center’s 32 participants, 12 of whom are men. Volunteers range in age from high school students to people in their 80s and 90s.

Only 18 of current 88 volunteers are men, and Best Friends would like to have more. Bell said men are especially helpful with male participants, who sometimes have no interest in the center’s arts and crafts activities but enjoy talking about sports, their careers or their military service.

“We’re always looking for men volunteers,” Bell said. “They’re harder to find. But we have found some special ones.”

Tom Meyer, 72, started volunteering four years ago after moving to Lexington from Virginia. He spent his career in the Army and as a military contractor, and he thinks his experiences help him relate to participants who are veterans.

Volunteer Helmut Graetz, 88, a retired IBM engineer, also can relate to some participants’ wartime experiences — even though he was fighting on the other side.

Photo by Tom Eblen | teblen@herald-leader.comGraetz was 16 when he became a German Army paratrooper. He fought in Italy, was captured in 1944 and spent four years in a British POW camp in Egypt. He then married Goodie, his wife of 62 years, in Germany and they eventually made their way to Canada and the United States. IBM brought them to Lexington.

After years as a volunteer riding instructor for Pony Clubs, Graetz got bored in retirement. His wife has volunteered at Best Friends for 22 years, so she suggested he try it. That was more than a decade ago. Now their son, Michael, 57, also volunteers.

“It’s wonderful to try to communicate with someone and try to make them feel better,” Graetz said. “I fought against the Americans and British, but I come over here and see that everyone is the same.”

Bill Tatman, a UK staff retiree, started volunteering two years ago after the death of his wife, who had been a Best Friends participant.

“I felt guilty the first day I brought her here, but I didn’t realize what a good place this was,” he said. “Now, being a volunteer is the best day of my week.”

 

Want to volunteer?  Best Friends Day Center needs volunteers, especially men. For more information, call volunteer coordinator Bobby Potts, (859) 258-2226.

 

150108BestFriends0016
Musician Tom Green performs for Best Friends participants and their volunteer helpers.

New book: diabetes epidemic should be treated like one

November 11, 2014

Diabetes is often called an epidemic, and no wonder. Over the past half-century, the disease has exploded.

In 1958, fewer than 1 in 100 Americans had diabetes; now, it is 1 in 11. Virtually all of the increase has been in obesity-related Type 2 diabetes, which can cause complications such as blindness, kidney failure and the need for limb amputations.

The problem is especially serious in Kentucky. The Centers for Disease Control reported in 2012 that the number of diabetes cases rose 158 percent in Kentucky over 15 years, outpacing every other state except Oklahoma.

A flu epidemic of this magnitude would create public alarm and swift official response. Ebola? If there were even a couple of cases in Kentucky, politicians and health officials would be running around like their hair was on fire.

141111DiabetesBook0002But diabetes — a slow-moving, chronic disease — is not being treated like an epidemic. That must change, two Lexington health policy experts argue in a new book, The Great Diabetes Epidemic: A Manifesto for Control and Prevention (Butler Books, $24.95)

The authors are Dr. Gilbert Friedell, former director of the Markey Cancer Center at the University of Kentucky and founder of the Friedell Committee, a statewide health care policy organization; and Isaac Joyner, a public health policy analyst who has worked on a variety of issues in Kentucky, Texas and the Carolinas.

They will speak about the book and sign copies at 5 p.m. Friday, which is World Diabetes Day, at The Morris Book, 882 E. High Street. They also are scheduled to testify Nov. 18 in Washington before the Congressional Caucus on Diabetes.

The authors say a major public health response is needed to stop diabetes’ rapid growth, deadly consequences and huge cost. Their book outlines specific steps that individuals, communities and the government could take.

“If we continue to treat diabetes on a one-patient-at-a-time basis, we can’t deal with an epidemic,” Friedell said. “Unless you take a public health approach to an epidemic, it doesn’t work.”

141111DiabetesBook0003

Gilbert Friedell

At its current rate, the authors say 40 percent of Americans alive today — and half of people of color — will eventually develop diabetes. The first step in changing that, they say, is widespread, routine screening.

“You have to find cases early, which means you have to screen people who seem well,” Friedell said. “The symptoms of diabetes come on maybe 10 years after the disease starts. But nobody knows they have the disease. We’re wasting 10 years that we could be doing something good for people.”

More than one-fourth of the people who have diabetes have not been tested or diagnosed, according to CDC studies. That means that while 370,000 Kentuckians know they have diabetes, another 137,000 may have it and not know it.

In addition to that, officials estimates that 233,000 Kentuckians have a condition called prediabetes, which means they will eventually develop the disease if they don’t take steps to stop it.

Health officials now recommend diabetes screening for people with high blood pressure, or anyone over the age of 45. Friedell and Joyner think everyone over age 20 should be screened.

One big problem with fighting diabetes is that it is viewed as an individual problem, rather than a societal problem. That despite the fact that the federal government alone spends $90 billion fighting the disease, mostly for treatment.

Isaac Joyner

Isaac Joyner

“There’s a tendency to blame the victim,” Friedell said. “If you don’t eat right and exercise and if you’re fat you’re going to get diabetes. That attitude doesn’t help. We need individuals to change their behavior, but it’s easier to do when the whole community says diabetes is our problem. It’s the way that we make change.”

Friedell and Joyner want the government and communities to invest more money and effort in proven programs for preventing or minimizing the damage of diabetes. It also would require changing insurance company reimbursement policies. But the long-term payoff would be huge.

“Your investment up front has a return that’s perhaps eight times,” Friedell said. “But you have to accept that it’s going to be over a few years.”

The biggest issue, though, is public awareness — and urgency.

“There has to be a sense of urgency, and there is no sense of urgency about diabetes,” Friedell said. “We need to do something to get the public involved, and the public has to feel that it’s important.”


Eastern Kentucky jobs outlook: health care and more broadband

August 11, 2014

crouch1Ron Crouch is the director of research and statistics for the Education and Workforce Development Cabinet in Frankfort. He says a growing health care industry in Eastern Kentucky should help offset jobs lost to coal’s decline. Photo by Mark Mahan

 

There is more talk than usual about the need to create jobs and a more diverse economy in Eastern Kentucky because of the coal industry’s decline.

It made me wonder: what are the latest trends? For some answers, I called Ron Crouch, director of research and statistics for the Education and Workforce Development Cabinet. He previously headed the Kentucky State Data Center for two decades and is better than anyone I know at analyzing this sort of information.

People are alarmed because coal-industry employment in Eastern Kentucky has dropped to about 7,300 — half what it was five years ago. Coal-mining jobs have been important to the region because they pay well: about $65,000 a year.

President Barack Obama’s critics have blamed stricter environmental regulations for the sudden drop in coal employment. But the biggest factors have been cheap natural gas and the fact that Eastern Kentucky’s best coal seams have been depleted over the past century; the coal that is left is more costly (and environmentally damaging) to mine.

But Crouch notes that coal employment in Eastern Kentucky has been declining steadily for more than six decades — even accounting for periodic booms and busts — mainly because of mechanization. Coal production peaked in 1990, but coal employment peaked in 1950, when there were 67,000 miners.

Some Eastern Kentucky leaders have pursued manufacturing as a source of new jobs. But Crouch says the long-term prospects for manufacturing aren’t too good, either, also because of automation.

“Manufacturing is coming back to the United States, but not necessarily manufacturing jobs,” he said. “We’re producing far more goods, but with far fewer workers.”

Still, Crouch sees hopeful signs for Eastern Kentucky.

While the region still lags the state in college degrees, high school graduation rates have improved significantly, as have the number of people completing other levels of training between high school and a bachelor’s degree. Many new, good-paying jobs are for people with that level of education.

Those areas include health care as well as professional, scientific and technical services. Some of these jobs pay well. For example, the number of registered nursing jobs, which pay about $55,000, is growing significantly.

Eastern Kentucky’s health care industry should see big growth in coming years. One reason is demographics. Baby Boomers are now entering their 60s and 70s and will require more health services. Another reason is the Affordable Care Act.

“You’re going to see a huge increase in the number of people in East Kentucky who have health insurance,” Crouch said.

Because Eastern Kentucky families are smaller than in the past, there will be less pressure for young people to leave.

“You now have a population with more people in their 40s, 50s and 60s than in their teens and 20s,” Crouch said. “If those young people can get the education and training they need after high school, there will be jobs for them in East Kentucky.”

But many of the growing economic sectors in the region, such as health care, have traditionally been dominated by women, while shrinking sectors, such as mining and manufacturing, have been mostly male. In some Eastern Kentucky counties, women now have higher employment rates than men.

“The good news is the economy has been transitioning to a broader economy,” Crouch said. “But how do you transition a population of males who have been involved in mining and manufacturing to jobs in professional, technical services and food services and health care, which have largely been female?”

Crouch said improving broadband service in Eastern Kentucky, which has the state’s poorest connections to the Internet, is vital.

“That would accelerate the growth in higher-skilled jobs,” he said.

Crouch is troubled that many Eastern Kentucky counties have high percentages of working-age people not in the formal labor force. He thinks many are “getting by” in the cash and barter economy, some of which is illegal.

He also is concerned that much of the job growth has been in low-wage service industries. Because the legal minimum wage hasn’t kept pace with inflation, full-time work in many low-wage jobs doesn’t produce a living wage for a family.

“The good news is that East Kentucky is not having a brain drain, despite what people think; it’s having a brain gain,” he said. “But, as the saying goes, we’re halfway home and have a long way to go.”


Baby Health Service celebrates 100 years of caring for kids

May 12, 2014

140407BabyHealth0038Alivia Cooper, 3, coughed so Dr. Tom Young, a pediatrician who has volunteered at Baby Health Service for 30 years, could listen to her chest with his stethoscope. The child’s mother brought her in because of respiratory problems. Photos by Tom Eblen. Old photos courtesy of Baby Health Service.

 

Baby Health Service has spent a century caring for some of Central Kentucky’s most vulnerable residents — and outgrowing its name.

A group of Lexington women started the Baby Milk Supply Association in 1914 to provide free milk to infants and toddlers of poor families, regardless of race. But Margaret Lynch, the first chief nurse, was soon making thousands of home visits and overseeing a free weekly clinic with volunteer doctors in an old downtown house.

The clinic was seeing 1,600 children a year by 1928 and 5,800 a year by 1957. The charity’s mission had grown so far beyond “milk supply” that the name was changed to Baby Health Service in 1959.

140407BabyHealth0006That name only begins to cover the scope of the organization that will celebrate its 100th anniversary May 31 with a fundraising dinner at Keeneland.

“The staying power of Baby Health speaks volumes, that we have been around for 100 years providing a service that is unique in our community,” said Kathleen Eastland, who chairs the organization’s board. “We can’t find another service quite like this in the United States.”

While America’s social safety net for low-income families has expanded over the years, most recently with the Affordable Care Act, there are still many children and teens who fall between the cracks. They include many refugees and immigrants.

Baby Health Service tries to fill those health care gaps. Last year, the organization served about 2,100 young people, from infants through age 17. Patients’ families must be low-income and not covered by private or government health insurance.

140407BabyHealth0002“You have a lot of people in between,” said Dr. Tom Young, a 30-year volunteer pediatrician at Baby Health who is now the organization’s chief executive. “We’re kind of a safety valve.”

Working on a shoestring budget, the mostly volunteer organization provides an impressive array of health services from basement space in an old office building beside Saint Joseph Hospital on Harrodsburg Road.

A small paid nursing staff and eight regular volunteer doctors have a clinic each weekday morning to treat sick children and do well-child exams. Several physician specialists donate their services when needed. Through various arrangements, the clinic also can provide free X-rays, lab tests and medications.

Baby Health’s 59 board members — all of whom are women —volunteer at least 12 two-hour shifts each year to do all of the clerical work and patient scheduling.

“It’s not written in the bylaws ‘no men,’ but in my years on the board it’s been all women,” said Eastland, whose mother was on the board before her. “I think it would be interesting to see if any men would break the barrier.”

Baby Health’s offices have a stash of clothing for children and adults and a book giveaway and lending program. The book program was started by a board member’s daughter and has been supported by the University of Kentucky law school.

Donations following the death of a board member allowed Baby Health in January to restart a monthly dental clinic with help from volunteer dentists and dental hygiene students at Blue Grass Community and Technical College.

Through a partnership with Save-a-Lot Food Stores, patients’ families can get $10 monthly vouchers for fresh fruits and vegetables. Baby Health nurses and volunteers do a lot of health education with families, including a fitness program for children and teens identified as in need of physical activity.

Baby Health soon hopes to start a telephone triage service, staffed by on-call nurses, to advise patients after-hours so they don’t just go to a hospital emergency rooms.

Thanks to all of the donated time and services, Baby Health’s annual budget is only $191,000, Eastland said. The organization gets no federal funding, and this year didn’t receive city support as it has in the past. Most of its funds come from grants and donations solicited by board members.

Although Young has been with Baby Health for 30 years, the senior volunteer physician is Dr. William Underwood, who has been a regular since 1966. Young said he introduced several of the other regular volunteers to Baby Health when they were residents working under him.

“Anybody who starts here usually continues here,” Young said. “That’s why we go into pediatrics, to take care of kids. And the families here really appreciate what we do for them.”

IF YOU GO

What: Baby Health Service’s 100th anniversary celebration

When: 6 p.m., May 31

Where: Keeneland

Cost: $125

More information: Babyhealthlexington.org, (859) 278-1781

Click on each image to see larger photo and read caption:


Lexington brothers, classmate win international design contest

April 14, 2014

MTCA rendering of the design for a mobile rural health care clinic for Southeast Asia. The design won Building Trust International’s Moved to Care competition. Below, designers Patrick Morgan, left, Simon Morgan, center, and Jhanéa “Jha D” Williams. Photos provided

 

The email from London looked genuine, but it arrived before dawn on April 1.

“Everybody we told thought it was an April Fool’s joke,” said Patrick Morgan, a young architect from Lexington. “I don’t think Jha D believed me. She just wanted to go back to sleep when I called her at 6:30 in the morning.”

The email was from Building Trust International, a London-based charity that works to improve life in developing countries with good shelter design. It told Morgan that he, his brother, Simon, and his architecture school classmate, Jhanéa “Jha D” Williams, had won the organization’s fifth international design competition, to create a mobile health clinic for use in Southeast Asia.

Their design was chosen from among more than 200 entries by student and professional architects. The best student entry won a small cash prize. “Our prize is that it actually gets built and used,” Simon said.

There were nine professional runners-up in the competition, from India, South Korea, Australia, Italy, Denmark, Ireland and Malaysia.

“It’s still a shock that we won,” Patrick said.

Patrick, 26, has a master’s degree in architecture from the University of Pennsylvania and works for Interface Studio Architects in Philadelphia. Simon, 24, has a master’s in public health from Columbia University and works for a firm in Washington, D.C., analyzing health policy.

The brothers have been interested in design and construction since they were boys, helping their parents, John Morgan and Linda Carroll, restore historic houses in downtown Lexington.

“That was quite a bit of it,” Patrick said with a laugh. “Having a wheelbarrow in my hands at 6 months old.”

For their Eagle Scout service projects, they built a patio and landscaping at St. Paul Catholic Church.

As an architect with the Lexington firm Thought Space, Patrick designed the interior of an early 1800s cottage his parents restored on East Third Street. It is beside the offices of their company, Morgan Worldwide, a consulting firm that specializes in reducing the environmental impact of mining.

MTCteamPatrick said he saw Building Trust International’s Moved to Care competition advertised on an architecture blog and suggested developing an entry with his brother and Williams, who works for the architecture and planning firm Sasaki Associates in Boston.

“This sounded perfect for what Simon and I wanted to do together,” he said. “We had always been thinking about trying to work together on projects that would combine our skill sets.”

The idea is that health care services and education can be more effectively delivered in rural areas by bringing small clinics to people rather than asking them to travel to clinics for medical treatment, vaccinations and hygiene education.

“We had been talking about doing something like this for two years,” Simon said. “I studied in South Africa as an undergraduate, and I thought something like this was a much better way to deliver care.”

Patrick said several things about their design seemed to impress the judges. It is easily portable, folding out from a standard tractor-trailer bed. It uses a lot of color, which makes the clinic look welcoming and provides visual clues for usage in a region where dozens of languages are spoken. The design also allows outdoor deck space to be customized for each location.

“The idea is they would fold down from the trailer, but then the community could come in to use their knowledge to build the sun shading and the railings,” Patrick said. “So the local community would feel involved with it.”

Patrick and Simon said they hope to stay connected to the project as it is built and put to use in Cambodia in a pilot project late this year.

“We definitely want to get to Cambodia and stay as involved as possible,” Patrick said. “We’ll get to test the ideas we had in the design and see how they work in the real world, and then be able to tweak it for future models. The idea is that this won’t just be one clinic, but over time they will build more and more of them.”

The Morgan brothers hope to do many more projects together, combining aspects of public health and innovative design.

“It’s just really nice that the first time Simon and I worked together, doing something we plan on doing for a long time, that we were able to win,” Patrick said. “It shows that our ideas meld together nicely.”

 


Two days shadowing doctors offers eye-opening look at medicine

September 24, 2012

I’m not a doctor, and I don’t play one on TV. But I did spend two days last week shadowing doctors and talking with them about what they do and the environment in which they do it.

I was one of seven people who participated in the Lexington Medical Society‘s Mini-Internship Program. Since 1994, nearly 30 groups of community “interns” have been given a two-day, close-up look at the working lives of physicians.

One of the things I have always enjoyed about being a journalist is exploring other people’s worlds. Journalism is a license to be nosy, ask questions, observe others, and discuss issues with people who have unique expertise.

That’s how I found myself in a locker room at Central Baptist Hospital, changing into scrubs so I could spend the morning in an operating room. I watched as Dr. Kaveh Sajadi, a second- generation orthopedic surgeon, performed shoulder replacements on two patients suffering from severe arthritis pain.

With help from a skilled team, Sajadi replaced two worn ball-and-socket joints with precisely fitted new ones made of high-tech metal and plastic. If you assume this is a difficult and messy process, you would be correct. But for Sajadi and his team, it was a well-choreographed ballet.

Sajadi explained each step of the operation as I stood and watched from a distance. I had to sit down a couple of times when my knees got wobbly. But soon I was able to focus on the miracle of medicine taking place before my eyes rather than, well, you know.

I spent the afternoon with Dr. John Kitchens, an ophthalmologist who specializes in the retina, the light-sensitive tissue that lines the inside of eyes. Digital imaging technology allows him to find and treat microscopic leaks in blood vessels that can reduce a person’s vision.

His most common treatment that day was injecting medicine into eyeballs. It was a process slightly painful for the observer, though not the numbed patient. But after watching shoulder- replacement surgery, I was ready for anything.

Kitchens was a busy man, dashing from one examining room to another. But he never seemed rushed when he was with patients. He carefully explained diagnoses and treatment options. He even took time to ask about patients’ families, impressively recalling many personal details about people he had seen before.

I spent the next morning in St. Joseph Hospital’s emergency room with Dr. William Wooster, an emergency-room veteran who has seen it all, sometimes in the same day. But this was a slow morning. A middle-aged man with a history of heart trouble came in with chest pains. An elderly man came in suffering from dizziness. A young man came in with an infection from a mouth full of rotten teeth.

Like more than one-quarter of all Kentuckians, the young man and several other people Wooster saw that day had no health insurance. What people forget when they debate the cost of universal coverage is that society already pays for treating uninsured people, often at high-cost emergency rooms.

I spent that afternoon making rounds at Central Baptist Hospital with Dr. Andrea Lyons, an internal medicine “hospitalist.” The young mother of two examined patients — many of them elderly and sick with a variety of issues — and worked to coordinate care with their primary physicians and specialists.

Those two days confirmed several things I already knew: Doctors have demanding jobs and exhausting schedules. They spend a lot of time updating and consulting patients’ medical records. They depend heavily on nurses, other skilled professionals and staff. And they care deeply about their work.

Like everyone else, the doctors I met had a variety of opinions about health care reform. But they all said the nation will never curb rising costs without legal tort reform. Fear of lawsuits forces physicians to pay huge sums for malpractice insurance and practice costly “defensive” medicine.

As I shadowed these physicians, I kept thinking how much of their patients’ pain and suffering could have been avoided if they had taken better care of themselves — if they had eaten better, gotten more exercise, and avoided cigarettes and substance abuse.

I wondered how we will continue to manage not only our health care system, but our rising expectations. As people live longer and get sicker, we may need to focus more on quality of life rather than simply extending it at all costs.


Amid ‘Obamacare’ fight, another vision for health insurance reform

August 6, 2012

Medicare turned 47 years old last Monday. Bill Mahan celebrated by setting up a booth on Main Street to try to convince passersby that America’s health insurance crisis could be eased considerably if everyone had Medicare.

The Lexington retiree collected about 125 signatures for his petition. It asks members of Congress to support proposed legislation that would strengthen Medicare, which now covers more than 47 million seniors and disabled people, and make it the vehicle for providing basic universal health insurance coverage.

But Mahan spent much of his seven hours on Main Street listening to people tell him their horror stories: lack of insurance, inadequate coverage, baffling paperwork, treatment they can’t afford to get and medical bills they can’t afford to pay.

“I’ve heard so many stories, it’s just unbelievable,” said Mahan, 68, who went on Medicare three years ago. “I don’t know what to tell these people.”

What Mahan mostly tells them is that these problems are likely to continue until the United States has a single-payer health insurance system.

Under proposed single-payer systems, private doctors and hospitals would provide health care services, but the government would pay the cost from tax revenue. It is the system used in Canada and most European countries, which the World Heath Organization says offers better care for less cost than the United States does.

President Harry S. Truman proposed a single- payer system after World War II, but business interests fought it. President Lyndon Johnson was able to muster enough political support to create Medicare for seniors, which he signed into law July 30, 1965.

When President Barack Obama and a Democratic-controlled Congress pushed through health care reform legislation in 2010, a single-payer system wasn’t even considered. That was because of opposition from insurance companies, which wouldn’t even allow a “public option” choice.

Instead, we ended up with reform legislation that will cover more people and outlaw the worst insurance industry abuses but still will leave an estimated 23 million people uninsured and do too little to curb rising costs.

Republicans have vowed to repeal “Obamacare” but have proposed no adequate alternatives. Senate Republican Leader Mitch McConnell of Kentucky complains that Obama’s health care law is “Europeanizing” America, but he fails to mention that those European systems provide high-quality, universal care with much less administrative cost and hassle.

The most radical GOP plan, proposed by Rep. Paul Ryan of Wisconsin and endorsed by many Republican leaders, essentially would privatize Medicare. But an independent analysis by the non-partisan Congressional Budget Office found that Ryan’s plan, rather than reducing costs, would increase them dramatically, including almost doubling seniors’ out-of-pocket expenses.

Ironically, Obama’s reform law was based on market concepts developed by the conservative Heritage Foundation. Republican presidential candidate Mitt Romney created a similar — and rather successful — health insurance system for Massachusetts when he was governor.

Single-payer advocates say “Obamacare” is better than what we had, but it just further subsidizes private insurance companies. It reinforces our current system’s fatal flaw: the inherent conflict between businesses trying to make as much money as possible and society’s need to provide basic health care to everyone at an affordable cost.

“Insurance companies don’t improve health care,” Mahan said. “They only add cost and complexity.”

Improving and expanding Medicare would require tax increases, but single-payer advocates think that, on balance, they would amount to far less than we now pay for private insurance that costs more and covers less with each passing year. That has been the experience in countries with single-payer systems.

House Resolution 676, introduced by Rep. John Conyers, D-Mich., to create a single-payer system, has been endorsed by dozens of consumer groups, church denominations and organizations representing thousands of physicians and other health professionals. Advocacy groups include Kentuckians for Single Payer Healthcare (Kyhealthcare.org), Improved Medicare for All (Medicareforall.org) and Physicians for a National Health Program (Pnhp.org).

But without public pressure, the legislation is unlikely to get a fair hearing in the Republican-controlled House of Representatives or the Democratic-controlled Senate. The health insurance industry is just too powerful.

During Romney’s recent overseas campaign trip, the Republican presidential candidate praised Israel for having a healthy population while spending only 8 percent of gross domestic product on health care, compared to 18 percent in the United States.

How does Israel do it? Since 1995, the Jewish state has had a non-profit insurance system heavily controlled by the government that provides basic health care for everyone. Imagine that.

 


Health care political debate needs solutions

June 28, 2012

The U.S. Supreme Court is expected to rule this week on the constitutionality of the Patient Protection and Affordable Care Act, the 2010 law that is often called “Obamacare” but just as easily could be called “Romneycare.”

America’s health care system — if you can even call it a system — is a convoluted mess. Studies show that Americans pay more for health care and get less overall quality than citizens of most other industrialized nations.

Nobody understands our current health care system, and just thinking about it makes a head hurt. Year after year, you pay more for insurance that covers less. You spend more time fighting insurance companies, and you pay more money out of pocket.

We hate the system we have, but we are afraid of change.

It will be interesting to see what the Supreme Court decides, especially if the verdict splits 5-4 along ideological lines. The court’s public approval ratings have been falling amid a series of rulings by the court’s activist conservative majority. A New York Times/CBS poll this month found that 75 percent of Americans think Supreme Court justices’ personal politics influence their legal decisions.

It will be more important to watch how elected leaders of both parties respond to whatever the court decides. Health care, more than any other issue, illustrates today’s poisonous politics. Special-interest money, political ideology and unwillingness to compromise seem to have left that concept we used to call “the public good” in the dust.

The main issue before the Supreme Court is the law’s “individual mandate.” It requires people to buy health insurance from a private company if they can afford to, or pay a penalty to the government to help cover the costs of uninsured people.

Without an individual mandate, almost everyone agrees, a for-profit universal health insurance system won’t work. But few people like the mandate, for various reasons. President Barack Obama was against it before he was for it. His Republican challenger, Mitt Romney, was for it before he was against it.

The conservative Heritage Foundation first proposed the individual mandate in 1989 as a way to create a free- market alternative to government health insurance. An individual mandate was part of the state insurance law Romney signed as governor of Massachusetts.

Now, though, conservatives call the individual mandate “socialism.” Liberals don’t like it, either, because they think it simply props up a fundamentally flawed private insurance system. Many of them would prefer a government-run “single-payer” system, which they say would provide universal coverage with much lower overhead costs and less paperwork.

One way to create a single-payer system would be to open Medicare to everyone. That federal health insurance program, created in 1965, now covers 48 million Americans, most of whom are elderly.

The corporations at the heart of our current health care industrial complex hate the idea of a single-payer system because its efficiencies would cut into their profits — or put them out of business. Republicans and even many Democrats don’t like it, either, because they get huge amounts of campaign cash from those corporations.

Thanks largely to health care industry lobbying, single-payer proposals have gone nowhere in recent years. Instead, congressional Democrats passed the controversial law now before the Supreme Court over the solid Republican objections.

The Affordable Care Act will greatly expand affordable coverage and curb some of the insurance industry’s worst abuses, such as canceling coverage when people get sick or denying it for pre-existing conditions. But nobody is completely satisfied with the reform law.

In addition to hating the individual mandate, conservatives complain that the law is too complex and won’t do enough to contain rising costs. But they have offered no credible alternatives that would provide universal coverage.

Liberals complain that Obama and congressional Democrats made too many concessions to the drug and insurance companies. They say the law amounts to a huge taxpayer subsidy for industry.

But after years of political posturing, Americans need solutions. More than 750,000 Kentuckians have no health insurance, and the coverage most of the rest of us have loses value every year.

Whatever the Supreme Court decides, this is the question each Kentuckian should ask his or her representative and senators: How will you work with members of the other party to create a system that gives all Americans access to good, affordable health care? How will you provide us with access to insurance coverage as good as what the government provides for you?

 


At new UK hospital, art helps with the healing

December 11, 2011

A loved one is in surgery, and all you can do is worry and wait. Unless, that is, you are at the University of Kentucky’s Albert B. Chandler Hospital.

In that case, you can soothe yourself by admiring original works by some of Kentucky’s best painters, sculptors, photographers and other visual artists.

In the surgery waiting room alone, there are equine paintings by Andre Pater and Peter Williams; blown-glass vessels by Stephen Rolfe Powell of Danville; a wood carving by Wolfe County native Edgar Tolson; interactive three-dimensional works by Steve Armstrong of Versailles; fiber art by UK professor Arturo Sandoval; a sculpture by John Tuska; Lexington painter Robert Tharsing’s fascinating landscape, A Natural History of Kentucky; and much more.

The huge room has just a sample of the more than 300 pieces of art that fill the 1.2 million-square-foot hospital addition, which opened in May. The medical center has become, in effect, one of Kentucky’s notable art museums.

“We wanted to make the public spaces empathetic and relaxing,” said Dr. Michael Karpf, UK’s executive vice president for health affairs. “And we wanted to make it uniquely Kentucky. It’s not all from Kentucky, but most of it is.”

UK has raised about $5 million in private donations to purchase art. The idea is about much more than making the new $532 million building pretty. Art can have a transformative effect on the human spirit. It makes people feel better, from reducing stress to inspiring hope.

“There’s a fair amount of research that shows art will improve moods and make people heal faster,” Karpf said. “So it makes financial sense for us to do this. People feel better and get out of the hospital faster.”

It is common in many cities for major new buildings to invest 1 percent of the construction budget on art. With this huge project, the results are impressive.

As soon as visitors enter the covered walkway over South Limestone from the parking garage, they see glass cases displaying folk art sculptures. Outdoors beneath the walkway is a landscape and water feature with curving fences made from traditional Kentucky dry stone.

Also outside is Second Breath, a bronze figure by Maurice Blik, a Holocaust and cancer survivor. “It ended up being controversial because it’s a nude,” said Jacqueline Hamilton, who coordinates the hospital’s art program.

At the end of the walkway is the education center, where patients and the public can research medical information. It is decorated with cityscapes by Louisville folk artist Anthony Mulligan, other paintings and a case of folk-art sculpture.

Ginkgo, a stainless-steel and fabric sculpture by Warren Seelig, is a focal point in the long lobby that connects the hospital’s wings. Elevator bays feature mosaics of paintings by Versailles glass artist Guy Kemper.

On the lobby’s second floor is the 90-foot-long Celebrate Kentucky wall. Tim Broekema, a Western Kentucky University photojournalism professor, created the wall using photographs and videos of Kentucky scenes taken by dozens of photographers. The wall is constantly changing with images that reflect the current season.

Karpf said the wall has been extremely popular, perhaps because it offers glimpses of home. About 40 percent of the hospital’s patients come from small-town and rural Kentucky.

There are landscape photographs in patient rooms, and paintings and sculpture in halls and reception areas throughout the hospital. Near the emergency room is a video installation called Mine-Control that changes shape as the viewer interacts with it. The pediatric emergency room has art that appeals to children.

The hospital tried to buy at least three pieces from each Kentucky artist it selected. “We’ve done a lot to stabilize the Kentucky art community during the recession,” Karpf said.

Two long corridors have become galleries for temporary exhibits. One now has drawings by Alabama’s Thornton Dial, and the other displays cut-and-paste photographic panoramas of Lexington and New York City by Albert Moser.

The UK hospital is a busy place, but only one piece of art has been damaged — a canvas was accidently ripped but is being repaired. “If you present it as art, people tend to respect it,” Hamilton said.

The Lucille Caudill Little Performing Arts in HealthCare Program and an endowment by Dr. Ronald Saykaly will sponsor performances by UK music students and faculty, as well as other performing artists. Performances can be in the hospital lobby or a new high-tech auditorium. When the violinist Midori was in town in September to perform with the Lexington Philharmonic Orchestra, she also played for hospital patients.

“What has been rewarding is that as we tried to humanize the building for patients, we also humanized it for staff,” Karpf said. Physicians have been big donors to the art program, and nurses have helped choose pieces for areas where they work.

When a pipe burst several months ago, filling an emergency room hall with water, doctors and nurses first made sure there were no patients in danger. “Then they started grabbing art off the walls and putting it on gurneys to take it to safety,” Karpf said. “They saw it as their art.”

Click on each thumbnail to see complete photo:

 


First look at UK’s new $532 million hospital

February 23, 2011

The University of Kentucky is racing to complete its new Albert B. Chandler Hospital. A curved atrium lobby connects the new hospital with two existing buildings. A water feature with Kentucky stone fences and native trees and plants is being built, above, where Rose Street used to be.

The hospital is scheduled to open with a ribbon-cutting May 15. The first patients will move in on May 22.

“We have not missed a single deadline and we will not miss this one,” said Dr. Michael Karpf, UK’s executive vice president for health affairs, who gave media tours of the construction project Wednesday.

The $532 million project is on time and 1 percent under budget, Karpf said. The project is being paid for by money generated from hospital operations, bonding and private philanthropy. “There is not a single nickel of federal money” in the project, he said. “There’s not a single nickel of state money.”

The 650-bed hospital is being designed with the idea that it will be used for 100 years. Additional sections will be built over the next 30 to 50 years, eventually replacing the older Chandler Medical Center.

“This is a world-class facility, but it will be uniquely Kentucky in the art and landscaping,” Karpf said. The hospital will display a wide variety of original work by Kentucky artists, and a 305-seat auditorium with a studio-quality sound system will feature performance art that can be televised in patients’ rooms.

“This is a serious collection of Kentucky art,” Karpf said, as well as some pieces by artists from elsewhere. The idea is that art will help patients and their families feel more comfortable.

(Click on photos to enlarge them.)

Dr. Michael Karpf, right, shows the atrium construction to Ed Lane, left, and Mark Green of The Lane Report magazine. Photos by Tom Eblen


Group helps citizens improve Kentucky health care

June 13, 2010

Just thinking about America’s health care and insurance system can make your head hurt.

Our system costs too much, doesn’t work well enough and leaves too many people out. The new reform law includes more people, but it doesn’t do enough to improve care or rein in costs. It was little more than a first step in what is sure to be a long journey toward making health care more effective and affordable.

What should the next steps be? That is what the Friedell Committee for Health System Transformation is trying to help Kentuckians figure out.

The committee is named for and headed by Dr. Gilbert Friedell, director emeritus of the University of Kentucky’s Markey Cancer Center. It hopes to do for health care reform in Kentucky what the Prichard Committee for Academic Excellence did for education reform: engage Kentuckians, not just experts, in finding better ways to do things.

Part of the problem is that, unlike education, health care isn’t so much a system as a disjointed collection of business sectors. Many profit by exploiting the system’s inefficiencies or by providing services, not by making the system more efficient or improving health. Medicaid and Medicare, the government programs for the poor and elderly, have a huge influence on everyone’s care — and cost of care.

The Friedell Committee is a non-partisan, non-profit group of 50 people from across Kentucky. Some are health care or social service professionals, but most come from other walks of life. Many are retirees who have expertise, but no vested interest that they must represent. They research problems and possible solutions and urge community education and action.

The Friedell Committee began in 2008, but its creation goes back to 1992, when state and national leaders first started talking seriously about health care reform. Public hearings in each of Kentucky’s 15 area development districts attracted 5,000 participants; their recorded comments were collected into a 2,000-page transcript.

Friedell said an analysis of that transcript led to the group’s 10 value-based principles for health care reform. Those include making health systems accountable to the public, and making health professionals responsible for providing safe and effective care.

Among the committee’s other principles: Individuals and families should have fair and equal access to high-quality, high-value and affordable care. Patients should be treated with respect. Individuals and communities must share responsibility for health and the cost of care.

As with education, Kentucky has many health-care challenges. Kentuckians eat too much, smoke too much and exercise too little, putting the state at or near the top of national rates for cancer, heart disease, diabetes and premature death. The challenge isn’t just treating illness, but promoting healthier lifestyles.

Because this is a relatively poor state, one in five Kentuckians is on Medicaid. Because of changes in federal legislation, that number is expected to be one in four, or about 1 million Kentuckians, by 2014.

I attended part of the committee’s semi-annual meeting last week in Lexington, where working groups discussed issues they are investigating. One group is working with Kentucky hospitals to track hospital-acquired infections, which kill many patients. Another is looking into team approaches for providing primary care at lower cost. Federal legislation provides incentives for developing such new models of care; 44 states now have demonstration projects, but Kentucky isn’t one of them.

The committee just launched an effort to find at least one “success story” from each Kentucky county for improving health care, fitness or nutrition. The hope is that publicizing those stories will inspire other counties to copy or adapt them.

For more information, go to the committee’s Web site: www.friedellcommittee.org.

“We don’t claim to have all the answers,” said Carolyn Dennis, the committee’s executive director. “We just want to empower citizens to ask the right questions.”