Letters to the Editor: December 18, 2013

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

You can reach at .

comments powered by Disqus