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Guest Editorials

To Be Equal

The Five Biggest Problems In Health Care Today

BY LEAH BINDER

Americans are losing patience with our nation's healthcare system. But the reverse is also true—our healthcare system is literally losing "patients."

More than 1,000 Americans die every day from errors, accidents, and infections in hospitals. Many more suffer at the hands of procedures that never needed to be done in the first place.

Consider early elective deliveries, which perfectly embody the five biggest problems in our health system. These are births scheduled without a medical reason between 37 and 39 completed weeks of pregnancy.

Problem 1: Too Much Unnecessary Care

Overuse and unnecessary care account for anywhere from one-third to one-half of all healthcare costs. That's equivalent to hundreds of billions of dollars, in addition to the half-trillion dollars per year that experts attribute to lost productivity and disability.

Early elective deliveries are unnecessary, according to the American College of Obstetricians and Gynecologists. Several other highly respected organizations like Childbirth Connection, the March of Dimes, and the Association of Women's Health, Obstetric & Neonatal Nurses have said the same.

Nonetheless, until recently these deliveries have become much more common over the past 20 years.

Problem 2: Avoidable Harm to Patients

Early elective deliveries harm women and newborns. Babies born at 37-39 weeks' gestation are at much higher risk of death. They are also at a far higher risk for harms like respiratory problems and admission to the neonatal intensive care unit.

Avoidable harm is a problem for patients of all ages. One in four Medicare beneficiaries admitted to a hospital suffers some form of harm during his or her stay.

Problem 3: Billions of Dollars are Being Wasted

A report by the Institute of Medicine Health suggests one-third or more of health costs is wasted. The cost of early elective deliveries was estimated in a study in the American Journal of Obstetrics and Gynecology to be nearly $1 billion per year.

Problem 4: Perverse Incentives in How We Pay for Care

Traditionally, health plans, Medicare, and Medicaid pay providers for whatever services they deliver, regardless of whether the service truly benefits the patient. That's created an epidemic of perverse incentives.

Our payment system encourages early elective deliveries. They generate admissions to neonatal intensive care units, and NICUs are profit centers. Studies suggest that reducing the rate of these deliveries to a reasonable number could eliminate half a million NICU days. That would lower health costs.

States like South Carolina and Texas are trying to reverse the incentives, as are many employers. Unfortunately, they are not the norm.

Problem 5: Lack of Transparency

It's far easier to find information about buying a new car than it is to figure out where to go for lifesaving health care.

Transparency galvanizes change like nothing else. After rising for decades, the rate of early elective deliveries began declining after my organization, The Leapfrog Group, started reporting how often hospitals performed the procedure in 2010. Last year, the rate of early elective deliveries was 4.6 percent—down from 11.2 percent last year and 17 percent four years ago.

Consumers deserve to know these rates for every hospital delivering babies in the country.

A Dose of Optimism

Thanks to public reporting, a growing cadre of providers, policymakers and consumer advocates are uniting to end early elective deliveries. The Department of Health & Human Services declared the issue a top priority. Regional coalitions are vowing to do the same.

Businesses and consumers must work together address these five big problems in health care. They all have a direct impact on their financial—and physical—health.

Leah Binder is President and CEO of The Leapfrog Group (www.leapfroggroup.org), an organization that works to improve the safety, quality and affordability of healthcare for Americans.


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Don't Politicize Education Standards

BY KRISTEN AMUNDSON

The U.S. education system recently received a report card from the OECD, a think tank for developed countries. America's grades weren't pretty.

Twenty-nine countries out-performed the United States in math. Nineteen did better in reading. America fared even worse than the last time the survey was conducted in 2009.

Clearly, America needs higher educational standards. But instead of working with state education leaders to implement such standards, some state legislators are waging a turf war over who decides what kids should learn.

This pointless infighting must end. Rather than politicize academic standards, lawmakers should collaborate with state education leaders to raise them -- with the ultimate goal of improving student achievement.

Our country's stagnating performance has serious economic consequences. In 2009, consulting firm McKinsey & Co. found that closing the international educational achievement gap would increase U.S. GDP by $2.3 trillion. McKinsey concluded that America's underperformance represents "the equivalent of a permanent, deep recession."

Fortunately, several states are working to close the achievement gap.

Massachusetts has implemented high academic standards over the past decade. As a result, the Bay State's performance on the NAEP, a federal measure of student achievement, jumped 35 points. Among low-income kids, the gains were even bigger—more than 47 points.

In other words, while all students are improving, the kids who face the steepest challenges are improving faster.

How did Massachusetts do it? First, they set high college- and career-ready standards—benchmarks for what students should know in reading and math—for all students. Then they invested in teacher preparation and professional training. Finally, they stayed the course through changes in political administrations. Their bipartisan effort is now paying off.

That's what really works. In most states, boards of education—comprised of volunteers from the business, medical, educational, and even farming communities—articulate academic standards as well as a long-term vision for public education. Because they're insulated from political pressure, state boards are able to focus solely on improving education for all students.

Massachusetts isn't the only state where lawmakers and education boards are cooperating to improve children's educational opportunities.

Kentucky has led the movement to raise academic standards. Many state officials worried that tougher standards would lead to lower student test scores and spark a backlash. But the state board of education and legislators pre-emptively cautioned communities across the state not to panic if test scores declined—as they did initially.

Holding students to higher standards generated positive returns. College and career readiness among Kentucky's high school graduates increased almost 25 percent after the math and reading standards were implemented.

In Maryland, officials paired rigorous evaluation of teachers with individually tailored professional development to help them improve. More effective teachers have yielded better-performing students. On the NAEP, Maryland posted the second-biggest gains for all students between 2003 and 2011. The state's low-income students made the most improvement in the nation.

Yet too many lawmakers are ignoring results like these. In the last 18 months, legislators in more than 20 states introduced 50 bills that would circumvent the authority of state boards of education on matters such as academic standards—thereby adding more bureaucracy to the policymaking process.

The American educational system has been mediocre for too long. Fighting over who should have the power to fix it only distracts from that reality.

Lawmakers and independent state boards of education must work together to set high standards for our children and empower them to succeed.

Former state legislator Kristen Amundson is now the executive director of the National Association of State Boards of Education (NASBE).


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Michael Brown’s Death: A Wake Up Call To An Apathetic Community

Michael Brown, Trayvon Martin, Eric Garner, Reneisha McBride and many, many others…

We hear their stories and are outraged, heartbroken, overwhelmed, shocked and filled with dismay. The demonstrations over the past few weeks indicate that the community wishes to be heard about these tragedies. The community cares about the killing of unarmed men and women; folks are concerned about how to obtain justice when these events occur; mothers, fathers, aunts and uncles want someone held accountable for what has happened. However, do we care enough to use one of the most important tools in our arsenal for solving problems? Are we willing to become informed, educate others and VOTE?

Admittedly, the issues raised by these recent shootings are complex and multi-faceted. There is not just one global answer. How do we make the world value the lives of persons who are demonized and stereotyped in the mass media? What do we do to prevent the proliferation of guns in our neighborhoods? What are we to do about police brutality, racial profiling, mass incarceration of people of color and the misuse of “Stand Your Ground” laws? How do we make our children feel safe in an environment filled with violence? What are those steps that we take to help them become the best that they can be when they are “under siege” and “under suspicion?” I don’t pretend to have the answers for these gut wrenching questions. What I do know is that apathy is not the response.

We must participate in the process of electing those persons who make the decisions which affect our everyday lives; whether it is the school board member who hires the superintendent who is responsible for educating our children or the prosecutor who decides what cases to bring and suggests the sentences to be handed down or the judge who decides who stays locked-up, who gets custody of children and how persons who violate the public trust are punished?

It is said that “All politics is local.” This is particularly true when it comes to determining who is hired to “protect and serve” our communities. Whether you live in a city where the Mayor leads the day-to-day operations of that city, or a city where a city manager or administrator runs the city, the persons whom you elect as Mayor, City Council person or County Commissioner recruit and hire your chief of police.

That chief hires and supervises your police officers. If we did not learn anything else from these recent events, we should have learned that it matters who the police officers are who have the day-to-day contact with the public. These decisions are not made by the President of the United States or members of Congress. Your local elected officials are the ones who make the decisions about the folks who impact your everyday lives. As a voter, you determine who your local elected officials are.

When you fail to vote, you essentially leave that decision to other persons who may not represent the concerns of your community. As you have seen, these types of decisions can determine life or death. We cannot afford to remain silent or to be inactive.

We are told that the numbers of people who vote in local elections is significantly less than those who vote in the elections for the President of the United States. The predictions for the November mid-term elections are for that pattern to continue. However, we as a community cannot abdicate our right and duty to vote. Our quality of life and the safety of neighborhoods depend on our action. More importantly, our children’s ability to realize the “American dream” depends upon adults voting for responsible and proactive people who will make the right decisions and the same adults calling elected officials to task when they do not.

We should never forget the many sacrifices made for this cherished right to vote. Shame on us if we do! Not only is the health and well-being of our communities at stake, but the future of our precious children and generations to come depend on you and me. How will we respond?

Attorney Nina R. Hickson is a former juvenile court judge. She is Chair of the Legislative Issues and Public Affairs Committee, Buckhead/Cascade City (GA) Chapter of The Links, Incorporated.