Military medicine is key to healthcare
I have a rather unique perspective on American healthcare having spent more than 33 years working as an Armed Forces clinician — an optometrist — and health care administrator, serving everywhere from remote battlefield hospitals to the nation’s capital.
It has become almost fashionable of late to bash our healthcare system. American healthcare however, is world class in many respects, featuring the best-trained doctors, dentists, optometrists, nurses, health scientists and support staff. We have the finest university-based teaching hospitals and lead the world in healthcare research, which results in generally better outcomes. The FDA’s comparatively shorter drug approval processes lead to having availability of leading-edge drugs and treatments faster than elsewhere. That’s my short list of attributes.
Unfortunately, we are not always the picture of best practices from that point forward. Data reveals Americans spend approximately 17.6 percent of GDP on healthcare, which equates to $8,233 per year and is more than 2.5 times more than most developed nations in the world. Life expectancy increased by almost nine years between 1960 and 2010 in the U.S., in contrast to an increase of over 15 years in Japan and more than 11 years in other developed countries.
In 2010 the average American lived to 78.7, more than one year below the average of 79.8 years; not a great return on our healthcare dollar investment. Of the 40 developed countries surveyed by a leading international non-governmental agency for life expectancy, the U.S. ranks 29th. This is unacceptable.
I believe that among our most significant institutional shortcomings is that too many healthcare systems lack integration, access, adequate case management assets and the proper emphasis on maintaining fundamental health and wellness. This is compounded by the fact that the majority of the American population has grown accustomed — and not by choice — to seeking care only when they get sick rather than focusing on wellness and disease prevention. While there are no quick and easy solutions, I strongly suggest we look to the Military Health System (MHS) for guidance and improvement.
The MHS, which collectively dwarfs most health systems (it includes a network of 65 hospitals, 412 clinics, and 414 dental clinics) provides healthcare to both active duty and retired U.S. Military personnel and their dependents. It provides health support for the full range of global military operations and sustains the health of all entrusted to MHS care. This extraordinary international effort involves medical testing and screening of recruits, medical treatment of troops involved in hostilities, and the maintenance of physical standards of those in the armed services.
The MHS patient-centered, multi-disciplinary, prevention-focused delivery model works very well, and I believe can also succeed outside the military. Long before the Affordable Care Act (ACA) was proposed, the MHS was working to manage expenses and improve clinical outcomes by creating efficiencies through combining like services such as Information Technology, Facilities Management, Education and Training, and others under one administrative entity.
In contrast, the non-military American healthcare system is neither integrated nor designed to promote wellness and sustainable good health. It is driven by incongruous incentives for reimbursement and an antiquated medical tort system that tends to inflate healthcare costs and has the potential to drive down overall quality. Countries such as Japan and France, that tend to spend the least for healthcare, use a common fee schedule so that hospitals and health services are paid similar rates for most of the their patients . In the US, hospital reimbursement depends on the patient’s insurance type. Healthcare organizations can choose patients with an insurance policy that pays them more generously than other patients with lower-paying insurers, such as Medicaid.
That is the current reality we face. To ensure better access, integration, and change the culture from intervention to prevention and wellness, I strongly support a shift to the Patient-Centered Medical Home (PCMH) model. As our military medical experience demonstrates, we can do this if we focus on putting the patient first. We also need to develop an integrated approach to professional, health science education to train our next generation of providers. At Salus, we’re squarely focused on efforts to develop such a model.
Michael H. Mittelman, OD, MPH
A recently retired Rear Admiral and Deputy Surgeon General in the United States Navy and the newly appointed President of Elkins Park-based Salus University, formerly the Pennsylvania College of Optometry.
City must rein in spending
Council President Clarke just came out advocating for trying to solve the School District funding problem by raising taxes, again, and performing accounting tricks, again. Not surprisingly, he essentially presented the same failed playbook that Democrats have used for generations and that made Philadelphia the poorest big city in America.
For a repeated time, Council President Clarke is coming out for raising the Sales Tax, while adding a $2.00 a pack cigarette tax. The last thing that Philadelphia needs is a tax increase, even for “sin” taxes, to fix a problem that doesn’t require taxes to be raised. The “temporary” sales tax increase from several years ago was enacted as an emergency and temporary stop gap in response to the economic problems of 2008 and is set to expire. Instead, as they did with the “temporary property tax” increase, they want to make it permanent to take more from Philadelphians to increase spending on waste and unimportant programs.
We understand and agree with addressing funding problems in the School District. We believe education should be a major priority for tax money City Hall collects. We just want to know why the mayor and council aren’t treating it as a priority.
City Hall spends almost $4 billion a year. Are we to believe every dollar of that is more important than sending more money to the schools? Of course it isn’t. Is the yearly $2 million Council slush fund named “Activities Fund” more important than education? No. Is not collecting billions in property taxes more important than education? No. Is $5 million for an ice skating rink in front of City Hall more important than education? No. Is not dealing with the municipal union contract to address pension and health costs to save tens of millions of dollars more important than education? No.
We know City Hall wastes money, doesn’t care about efficiency and only talks about prioritizing spending when it sounds good. In actuality it is “see no evil, hear no evil, speak no evil”.
Every time Mayor Nutter and Council President Clarke talk about raising taxes to pay for important program “X”, it is really a bait and switch. The higher taxes don’t pay for the important programs; they pay for the waste, fraud and unimportant programs for which that they don’t fix or abandon.
And this doesn’t even address the accounting trick they want to pull off. They want to sell capital assets, i.e. school buildings, to then put that money into the operating budget. This is little different than when the School District borrowed $300 million to fill in the operating budget years ago. It is a debt issue being used to pay for operating costs.
This is like selling your house, still paying the mortgage and using the money to buy food.
Sell the buildings, but either pay off debt, which frees up money every year going forward, or reinvest the money into upgrading remaining schools. Don’t take a long term asset to pay off a short term budget. It’s a gimmick that just hurts the long term health of the School District.
It is instructive what President Clarke does not see as possible solutions. He has never even broached the possibility that the city could cut spending in other areas and help fund public education. Instead of raising taxes, again, and misleading the residents about it, again, let’s actually address prioritization of spending the taxes we do collect. Republican City Committee would be more than happy to sit down and help with pointing out what in the budget isn’t more important than education if there is difficulty in figuring it out. Nevertheless, public education and public schools are not synonymous terms. Solutions that could help our children include expansion of charter schools or giving vouchers so that parents could consider private schools, however these are other avenues that we do not expect to see Councilman Clarke embrace.
Joseph J. DeFelice
Philadelphia Republican City Committee, Executive Director
Henon: Manufacturing is the key to the city’s future
At this critical time in Philadelphia’s history, it is imperative that we commit to supporting manufacturing as a way to create family-sustaining jobs, provide engaging opportunities for young people entering the workforce and ensure that our city has the capability to compete on a global stage moving forward.
Manufacturing has always mattered to me on a personal level. I grew up with my father moving from manufacturing job to manufacturing job to help provide for me and my siblings. All the companies he worked for have since closed their doors, leaving hundreds of unemployed workers behind. So I was especially eager to work with Mayor Michael Nutter to convene a task force focused on studying the current status of the manufacturing industry and coming up with a comprehensive set of recommendations to guide us into the future.
In the course of working with dozens of CEOs from manufacturing companies from across the city and region over the last year, I’ve developed a deeper sense of the challenges and opportunities for the sector.
On Thursday, at AgustaWestland, I will be proud to join the task force co-chairs to present the mayor with our final report and an action plan for building a more robust manufacturing sector in Philadelphia and the region.
The report’s bottom line is simple: manufacturing matters to families like mine and thousands of others across the region. It matters to the future of our country and city. The industry supports more than 12 million jobs in the United States — almost 10 percent of the American workforce. Some 23,000 of those jobs are in Philadelphia. For every dollar spent in manufacturing, another $1.48 is returned to the U.S. economy.
But manufacturing isn’t the gritty, smog-filled work that some associate with the sector. Today’s manufacturers are innovators making everything from church robes to beer to ships to ball bearings. Through my work with the task force, I learned that we have to do a better job telling this element of the manufacturing story.
We also need to inspire young people to be interested in and excited about manufacturing careers. By showing kids, parents and schools that manufacturing careers are diverse, well-paying and mostly high-tech, we can open new doors of opportunity for them and supply a homegrown workforce, all in one.
But it’s not as simple as getting kids excited about opportunities. It’s also about preparing them for the work. Our kids are competing in a global economy and they need the education and skill set to prepare for the evolving and highly technical manufacturing jobs of the future. By focusing on STEM (science, technology, engineering and mathematics), we can make an important early investment in making sure our kids are prepared.
I also learned that Philadelphia is blessed with many inherent advantages for manufacturers: prime location, natural resources and extensive transportation systems. So, we need to fight for wholesale investment in transportation and energy infrastructure, including the maintenance and development of our current surface transit systems, bridges and roadways, ports, water and wastewater systems, along with modernizing our electrical grid, developing natural gas resources and encouraging private sector investment in high-speed communications and broadband infrastructure.
Here’s just one example: with the Panama Canal expansion set for completion in 2015, only two of the 15 East Coast ports are equipped to handle the megatankers that will move through the widened canal — and neither is in Philadelphia. According to the Philadelphia Regional Port Authority, deepening the Delaware shipping channel will allow our ports to handle 98 percent of all ocean-going ships. Packer Marine Terminal’s location south of the Walt Whitman Bridge also means taller ships can offload in Philadelphia, giving us an advantage over New York, where the Bayonne Bridge will have to be raised in order to handle these taller vessels.
Manufacturing matters, and this report is just the beginning. I plan to work hard in the weeks, months and years ahead to implement the task force’s recommendations so we can keep our factory doors open, and open new ones. Together, we can and will make it in Philadelphia.
Bobby Henon
Councilman — 6th District
Boyle: Gov. Corbett is trying to outsource the lottery, again
Just when you thought the struggle against outsourcing Pennsylvania’s lottery was over, it has returned.
Rumors are circulating in Harrisburg and among my colleagues in the Capitol that Governor Corbett intends to pursue lottery privatization before the holiday break. This is just another attempt to sneak his scheme through, right under the noses of Pennsylvanians. Let’s not forget that this past summer, the governor tried to pass his lottery outsourcing plan during the waning evening hours of the final days of budget negotiations.
Prior to that attempt, Governor Corbett had to be stopped by Attorney General Kathleen Kane.
The latest rumors shouldn’t be surprising at this point, but what is shocking is the total disregard Governor Corbett has for the benefits provided by our lottery system. It has contributed more than $22.6 billion in assistance for low-cost prescription drugs, free and reduced transit fare, property tax and rent rebates, long-term living services and senior centers.
You may ask, “Who benefits from Governor Corbett’s outsourcing scheme?” Clearly, it’s not the people of this commonwealth. In fact, the biggest winner is the UK-based firm that he is trying to hand the lottery to.
Despite the gossip that the governor is making backroom promises and indicating he will protect lottery jobs, we can’t relax based upon his word.
He is telling people across the state, including organized labor, that the jobs of the working people of our lottery will be protected; and yet we know that there is a significant possibility — perhaps even a likelihood — that there will be job losses, especially for those not currently represented by the union.
We can’t walk blindfolded into a situation because Tom Corbett says, “Trust me.” If we lose those jobs, and such a vital and fully funded program, there’s no going back. The Pennsylvania Lottery has been a source for good. The truth of the matter is that it has never been more profitable.
Governor Corbett’s plan, on the other hand, has been a shambles and already cost the people of Pennsylvania $4.4 million in payments to consultants. What’s more is that his administration already has conceded that its plan is a risk because of the recent expansion of small games of chance, which will make it harder for the lottery to expand and thrive under private management.
Throughout the last two years, this outsourcing process has been anything but transparent; and despite our success in stopping him this summer, we knew it was not the last underhanded attempt at passing his unpopular agenda.
Governor Corbett clearly is ignoring the interest and will of the people of Pennsylvania. We deserve a more transparent process from our elected officials.
This deal hurts seniors, it hurts families, and it hurts our state. The only people this deal helps are Governor Corbett and his corporate pals. I am asking my friends in organized labor to stand with me and say no to the governnor’s plan to destroy the vital services that assist our seniors. In a time when our state faces a revenue crisis and our communities are feeling the pain of Governor Corbett’s slash-and-burn politics, we cannot hand him a victory. We cannot allow him to do away with a fully funded program that does so much for us.
We must resist the governor’s boogeyman schemes yet again. We must tell him that his sneak tactics did not work in the past and it will not work now.
Prior to the holiday break, let’s stand up and give Pennsylvanians a gift. Let’s make sure that we have a transparent process, rather than allowing the governor to sneak his political agenda through during another busy time. Let’s make sure we protect the interests of the families of this commonwealth.
Brendan Boyle
State Representative — 170th District
