When Senate Finance Committee Chairman Daniel Patrick Moynihan (D-N.Y.) introduced a reform plan strikingly similar to President Clinton's Health Security Act, everyone wondered why he apparently had abandoned the bipartisan discussions that had been taking place within the committee in favor of a very partisan bill.
There was speculation he had done so to show how little support actually existed for the Clinton plan. Not surprisingly, Mr. Moynihan denied that. Others argued that Mr. Moynihan was merely showing his real liberal stripes.
Certainly, it has spurred the Finance Committee, which was terribly bogged down, to action. When Outliers asked Mr. Moynihan if that was his purpose all along, he merely smiled his Cheshire cat grin and said, enigmatically, "Now marks the beginning."
On the road.A mobile clinic will take to Maryland streets this August to deliver primary care to residents without health insurance, while spreading the gospel of preventive care.
Dubbed the "wellmobile," the $112,000 unit, equipped with computers and diagnostic equipment, is the result of a partnership between the state and private companies, including Kaiser Permanente, Prudential Health Care Management and Merck & Co. Staffed by nurses, it will be linked with University of Maryland Medical School physicians and dentists, who will rotate serving on the van.
"We will reach out to people who aren't in the (healthcare) system for one reason or another," said Marilyn Goldwater, executive assistant for health to Gov. William Donald Schaefer. "Our objectives are to provide healthcare to people who have slipped through the cracks, and to introduce them to permanent medical services. In cases where such services don't exist, we will continue to provide care until a system is developed locally," she said.
Ms. Goldwater, a former state legislator, is also a former nurse. She has pushed prevention as a state policy since before healthcare reform. The wellmobile is just the latest in a series of efforts coming from the governor's office stressing prevention.
Loco.A keynote address on healthcare changes from a decade ago turned to karaoke earlier this month at the Catholic Health Association's annual assembly in Philadelphia. In an effort to show how hospitals are still working on issues of some 10 years ago, David Anderson, a partner in KPMG Peat Marwick's Chicago-based healthcare strategy practice, sang a different version of the song "The Loco-Motion." The lyrics, which include references to former President Reagan's secretary of HHS, Margaret Heckler, were written in 1984, but Mr. Anderson said they still ring true:
Hospitals are doing a brand new dance, now,
Come on baby, do the Competition.
Heckler says we'll like it if we give it a chance now,
Come on baby, do the Competition.
She says regulations are a thing of the past,
and free market forces are here at last.
So come on, come on, and do the Competition with me.
Outliers encourages Mr. Anderson to keep his day job.
Fast facts.Even as hospitals and medical staffs are struggling to deal with such concepts as clinical practice guidelines and cost-effectiveness factors, a federal agency is setting up a no-hassle fax service that'll make such information available to everyone in seconds, for free.
The Agency for Health Care Policy and Research, a division of the U.S. Public Health Service, is promoting to consumers a new wrinkle called "InstantFax," a multiple-line, fax-on-demand service that can serve up abbreviated versions of agency-sponsored clinical practice guidelines, summaries of its latest medical outcomes and other healthcare research, and announcements of grants it's sponsoring.
The service works on any fax machine with a telephone handset. Instead of dialing out the usual way, pick up the phone and dial (301) 594-2800. A recorded voice comes on and asks for orders. For medical staffs, the laundry list of documents includes a "quick reference guide for clinicians" for each of the agency's 10 clinical practice guidelines established so far.
Not so vital. While healthcare providers think about disease prevention and treatment, they often don't see all the factors that determine global health. Each year since 1984, the Worldwatch Institute has been there to provide that important, and sobering, data.
Vital Signs 1994 is sort of a physical checkup for the world, a compendium of environmental, health and social statistics as well as trends that together paint a picture of how healthy, or sick, we are as a species. This year, it focuses on the huge increase in AIDS cases and injuries and deaths from automobile accidents, cigarette consumption and homicide.
The United States actually comes off as comparatively healthy. For example, while cigarette use has soared in Asia, it has fallen steadily in the United States, to about 2,500 cigarettes per adult annually.
But for every country, a "sense of limits" is beginning to take hold, according to the Washington-based institute. Due to pollution, fish harvests have been static for four consecutive years. As resistance to pesticides has increased sharply in recent years, more chemicals are sprayed on the food supply. The reason for the limits is obvious. While population growth slowed slightly to 87 million net growth in 1993, the world gained the demographic equivalent of a new Switzerland every month.