healthcare | Open Source with Christopher Lydon

This Week's Show •

Hacking ‘Affordable Care’

On this Kickstarter-launch week we’re diagnosing America’s healthcare woes with the meta-journalist and heart patient, Steve Brill. In a new book he calls the Affordable Care Act “America’s Bitter Pill“, a rationalizing redo of health insurance ...

On this Kickstarter-launch week we’re diagnosing America’s healthcare woes with the meta-journalist and heart patient, Steve Brill.

In a new book he calls the Affordable Care Act “America’s Bitter Pill“, a rationalizing redo of health insurance that ignored cost control and served everybody but the taxpayer. But it looks as if we’ll be living with so-called ‘Obamacare’ — at sky-high prices, no public option, and another Supreme Court case notwithstanding, in all its complexity and confusion. We know it didn’t solve every problem with American care, so the question is: what’s next?

We know Vermont’s experiment with a Canadian-class single-payer system washed out this winter, after the tax burden started to soar. It raised the question of whether and how that particular progressive dream can be achieved in a country where health care is big business. So we’re on the lookout for the Next Big Idea in healthcare: the one that will get costs down to earth, or lead us away from last-minute ‘sick care’ toward a healthier hands-on model.

How would you hack your healthcare back into shape? Can the patient be saved?

Podcast • March 1, 2014

“Street Rounds” with Dr. Jim O’Connell

We’re walking from the Massachusetts General Hospital on a crooked path to South Station, meeting people that our eyes and yours might normally never see. These are Friday morning “outdoor rounds” with Doctor Jim O’Connell of Boston Health Care for the Homeless, an esteemed Boston doc giving every one of his needy patients the same claim on his time and skill, treating, touching, and comforting people that the rest of us can manage not to see at all.

Ten homeless men in “Mousey Park” in 2000. Only one of these men is still alive today.

We’re on a short Open Source field trip to someplace between Boston Noir and Boston the medical mecca. We’re walking from the Massachusetts General Hospital on a crooked path to South Station, meeting people that our eyes and yours might normally never see. These are Friday morning “outdoor rounds” with Doctor Jim O’Connell of Boston Health Care for the Homeless, whose patients are mostly alcoholic men with other mental and bodily afflictions, very sick people who often say they prefer the street to shelter living. Jim O’Connell has been at this work for 30 years. He made a habit early on of washing the feet of his patients – as a gesture of his servant-hood – but also as a sort of diagnostic device: what paths have his patients been on? When you’re looking for models of the doctor – patient relationship, it’s a pleasure to watch an esteemed Boston doc giving every one of his needy patients the same claim on his time and skill, treating, touching, and comforting people that the rest of us can manage not to see at all.

Podcast • February 20, 2014

Cuba’s Healthcare Revolution

Cuba’s revolutionary vanguard: US medical students Keasha Guerrier, Kereese Gayle and Akua Brown Three winters ago our Open Source trip to Cuba turned around on an astonishing moment of serendipity. At a bus stop in Havana ...

Cuba’s revolutionary vanguard: US medical students Keasha Guerrier, Kereese Gayle and Akua Brown

Three winters ago our Open Source trip to Cuba turned around on an astonishing moment of serendipity. At a bus stop in Havana my colleague Paul McCarthy heard a laugh he recognized from high school in California. “Only Akua Brown laughs like that,” he blurted. And Akua Brown it was, the friend he hadn’t seen for a decade, now finishing her fourth year at the Latin American Medical School in Havana.

Over the next few days, Akua Brown and her friends poured out their four-year immersion in Cuban life and language, Cuban magic and slang, the Cuban versions of sexism and racism, Cuban boyfriends and families, drums and faith, bureaucracy and student volleyball, and by the way, this strange Cuban thing about toilet seats and toilet paper: the revolution doesn’t seem to believe in either.

But the core of our long conversations is medicine, the Cuban way. This is aggressive, free, hands-on health care that makes house calls, and lingers for the feel of emotions and homelife. Doctors’ training like doctors’ care is free: the payback required of the students here from all over the hemisphere is only that they return to underserved areas of their home countries.

Michael Moore and our friend the Nobel Prize cardiologist Bernard Lown knew the results in Cuba all along. “I have been to Cuba 6 times,” Dr. Lown emailed me, “and learned much about doctoring in Cuba. Their thinking on social determinants of health, on the primacy of public health and the vital role of prevention strategies are unmatched in the world. With spending of less than $200 per person per year for health care, they have achieved health outcomes no different than in the USA where expenditures now exceed $7000 per person annually!”

Keasha Guerrier, a science major from the New York Institute of Technology, knew about Cuban medicine because “my father’s from Haiti, my mom is from Guyana.” But her brother teases her about “blackouts” in Cuba, and she has other relatives and friends who don’t know why she’s there, or ask her to “pick up a box of cigars on the way out.”

Keasha Guerrier

Am I just a pawn in a game the Cuban government is playing? I push back hard against that idea. There are a lot of things that the Cuban government has done that some people might not agree with. But medicine with a community base in training and practice — that is one the things they got right on the nose. They hit the nail on the head. The people who instituted this program saw how it works in Cuba… and they compared Cuba’s situation to countries in Central and South America or third world countries, Africa, Haiti. And they saw how they can make a difference. Here, you do a lot with a little bit… What they are trying to teach us is that you don’t have to be confined to working for a paycheck. But using all the things that you know, you can help a broad base of people. In that respect, I think that the intentions are pure.

Keasha Guerrier in conversation with Chris Lydon over roast chicken with rice and beans at the restaurant El Ajibe in Havana, December 19, 2008

Kereese Gayle grew up in Lousiana and Florida. She was a Spanish major at Georgetown who could see herself coming out of medical school in the US with crushing debts. “My family is Jamaican,” she says, “so we knew about the quality of the Cuban medical system. To this day I know I’m where Im supposed to be.”

Kereese Gayle

We’re here at a very important time in the history of the world. We’re getting the type of education that I think people are looking for. More and more people are thinking very seriously about the idea of universal health care, about the idea of rights for everyone to basic access to health care. I think we’re going to be a huge part of that…

We learn how to diagnose our patients with our hands, our ears, our eyes more so than with technology–X-Rays, CT scans– because you don’t end up doing those kind of really costly labs as often here. So we definitely have that as an advantage… We learn how to interview our patients thoroughly, and how to do a really thorough physical exam and do it well, and be comfortable with that… Doctors here not only do house visits but they go into homes: they have a form that you fill out to check off what risk factors the person has [in their home]. Is their water contained properly? Do they smoke? We get that kind of first hand view. In the United States, you can ask someone if they smoke or if they have a pet and they easily can lie to you. But here, as someone’s primary physician, you can see not only the physical medical aspects but the psychological medical aspects as well. Do you feel tension the minute you walk into the room? Are people in a mentally healthy environment, or do we need to get [them] to a psychologist. There are so many advantages to the system that we can take back and apply to the communities where we live.

Kereese Gayle in conversation with Chris Lydon sipping lemonade at El Ajibe in Havana, December 19, 2008

Akua Brown minored in Spanish at San Francisco State University, and spent most of her first two years in Havana learning the Cuban vernacular and testing her Bay Area ideal of the Revolution.

Akua Brown

The education system here is excellent; there is very little homelessness. Everyone has a right to free health care… up to the most specialized needs. Neurosurgery, open heart surgery, cost nothing to the people. And the fact that a government with so little financial resources is able to do this says that the United States can do so much more… And without the debt that most medical students graduate with, we won’t be afraid to start our own projects and programs without necessarily needing the money to pay back the loans and the things hanging over our heads. Living here for six years, I think we have learned to live a simpler life with bare necessities. I ride the bus, I hitchhike, I buy from the community market. I’m not complaining–home is comfortable, but this is livable.

Akua Brown in conversation with Chris Lydon savoring the coffee at El Ajibe in Havana, December 19, 2008

The practical visions of these blessedly gifted women brought to mind Ralph Waldo Emerson‘s indomitable “world spirit.” Entering the second half-century of both the black freedom movement in the US and the Socialist revolution in Cuba, each with its ups and downs, these very American young women would remind you that grand ideals, the best we have, can prevail. “Things seem to tend downward, to justify despondency, to promote rogues, to defeat the just,” as Emerson wrote at the end of his essay on Montaigne; or the Skeptic. “Although knaves win in every political struggle, although society seems to be delivered over from the hands of one set of criminals into the hands of another set of criminals, as fast as the government is changed, and the march of civilization is a train of felonies,- yet, general ends are somehow answered. We see, now, events forced on which seem to retard or retrograde the civility of ages. But the world-spirit is a good swimmer, and storms and waves cannot drown him…”

Podcast • February 9, 2010

Ghana Speaking (II): Village Living in Kwabeng

I’m going “home” here with my friend Kwadwo Opoku-Agyemang to “where my belly button is buried,” to the seat of his fondest memories and his first great love, his grandmother. And I’m concluding presumptuously, on ...

The burdens on ten-thousand villagers in Kwabeng, in Ghana’s Eastern Region, begin with infectious diseases: malaria, typhus, HIV. They have no hospital, no resident doctor. Listen and you will hear a village leader tell me: “people over here are not feeling fine at all.” Another: “when someone falls ill, sometimes you lose the person on the way to finding help.” The gold digging company that skipped town two years ago left a contaminated water supply and no benefits. The leading farmers in Kwabeng fret openly about backward methods and bad markets. They should be planting more trees. They are not sustaining their own environment.

But it’s the robust strengths of the village that astonish and stick. Handsome men gather and gab in the breezy open air at their own self-started NGO, the Kwabeng Development Foundation. Some in work clothes, some in traditional robes, they all glow with calmly Emersonian self-reliance. “It is now generally understood,” one farmer explains, “that government by itself cannot solve the problems of life. We need to depend on ourselves.” Projects like the village hospital “have to start with us.”

“Our life is good,” says a man in the chief’s council of elders, and the supporting evidence is all around us in Kwabeng, whose name means literally “the forest that was cooked red.” A host of little children and teenagers play noisy games at the heart of town. The air is familiar, confident, safe without a second thought. Kwabeng seems delighted to meet a stray American. “It’s as if the government of America is here,” a woman marvels. She has heard I do radio, and when I ask “if we had our own radio station in Kwabeng, what would we talk about?” she says: “farming, and education!”

These are people of breathtaking physical beauty, and twinkling humor, too. The name Barack Obama brings out affection and a touch of mischef. “He is our brother,” says an elder. “He’s our friend. He’s our son. He’s everything to Ghanaians.” So why did they all laugh when I first mentioned our president? Because, they explain, Obama had handed Ghana a sweet victory with his first sub-Saharan visit, a score as delicious as Ghana’s futbol win against Nigeria just before I arrived. “If Obama can send some American doctors to this district, and help us build a hospital, we will be pleased.”

We’re all in on the irony that Ghana, in fact, exports medical doctors to England and the US. I was shocked to hear reliably that there are more Ghana-trained doctors working in London and New York than in Ghana. Can it be? Ghana’s home network of healthcare is held together, just barely, by a couple of hundred Cuban doctors. It is one of Kwadwo Opoku-Agyemang’s assignments, as a local boy made good at the University of Cape Coast, to get a Cuban doctor assigned to Kwabeng for one day every weekend.

It comes clear, as teenagers drift up to Professor Opoku-Agyemang with their college applications and their test scores, that he is also the village’s higher education chief. All afternoon he is giving students discreet advice and encouragement, showing me how the village works, and aspires. Kwabeng, with an immemorial past, looks to the future, too. Of course, the fantasist in me is scheming: how do I get back here — to live?

Podcast • September 28, 2009

James Morone: What healthcare politics lays bare

From FDR to Barack Obama, James Morone’s revelatory history of presidents and healthcare policy lays out some basic rules — the conditions, in short, that Lyndon Johnson met to pass Medicare in 1965, but that asked too much of Jimmy Carter and Bill Clinton in the losing campaigns of 1977 and 1994 for universal insurance.

The bare essentials: Passion, personal and sustained. Speed in the legislative drive. Keep-it-simple engagement of the public. Suppression of economists, wonks and budget numbers. An opportunistic mix of muscle and deference with kingpins in Congress, who must inevitably write the final law. And the foresight, in case of defeat, to leave the issue in good shape for the next try, as Harry Truman did for Johnson, and Bill Clinton entirely failed to do for Barack Obama.

Obama hasn’t flunked any of the core tests so far, in Jim Morone’s judgment. But then, he’s a long way from a victory that would have been automatic in a parliamentary system and may actually be impossible in the American labyrinth of a special-interest Congress.

We will repair early and often to Jim Marone, a born color commentator on politics and chairman of the political science department at Brown, for reviews of the Obamacare scorecare. Meantime, Morone the story-teller is letting us in on some of the striking original themes of his new book, with David Blumenthal of the Harvard Medical School, The Heart of Power: Health and Politics in the Oval Office.

Health policy, Marone argues persuasively, lays bare the soul as well as the working temperament of presidents as almost nothing else does. Our presidents tend to be “sick men,” he writes, with complex medical histories and poorer health than American males in general. But in fact they all have two health stories: first of their own submerged afflictions (FDR’s polio, Eisenhower’s grave heart problems, Kennedy’s wrecked adrenal system and drug dependency) and then: the family memories of health and medicine (Ike’s agitation about his mother-in-law’s ruinous bills for years of round-the-clock nursing care, or JFK’s devastation by his father’s major stroke in 1962). Surprise: it’s not their own medical charts but rather the imprinted stories of near-and-dear exposure to medicine that drives our presidents on healthcare. It may not matter much that, on and off the basketball court, Barack Obama looks like the healthiest president we’ve ever had. The well of his passion is the tearful memory of his grandmother’s battles with insurance companies before she died of cancer just as he got elected.

“Every president changes the conversation about health care in America,” Morone and Blumenthal write in The Heart of Power. It’s a point that leaves me less impressed than Jim Morone is with the Obama drive so far. Obama’s opposition has made it a conversation about socialism and death panels. The media coverage has made it a conversation about Obama: will he bend, or be broken by, the lobbies? Can he dominate the Congress as Lyndon Johnson did? Can he win the big one? Even people who love Obama as I do have doubts that he has addressed the exclusions from care, the fee-for-service racket or the ruinous rise of costs to the whole economy. So we root more for him than for his plan, which is not the way it’s supposed to be.

This is the start of a continuing conversation with Jim Marone, about a battle just well begun:

If you talked to the Obama people ahead of time, they would have said “Oh, we’re girded, we’re ready, whatever they throw at us, we know it’s going to be ugly” — but not this ugly. Why is it so deep? That’s the interesting question here, really. What does this touch? I’ve got two answers…

One, this is the thing that Franklin Roosevelt never fought for in the New Deal. He gets unemployment compensation, he gets welfare, he gets Social Security, he gets the whole list of good welfare-state stuff, but he pulls back on healthcare. So for Democrats this is the lost reform that the New Deal never won. And for the Republicans, this is what distinguishes the United States from all those other welfare states, like Denmark, like Canada, like France. So that this is in the DNA, in the genetic code of each party. Ask a Democrat, and they’ll say, shamefully, “we are the only industrialized country without national health insurance.” Republicans: “We’re the only country without national health insurance!!” So this is a battle about America.

That’s one level. That’s bad enough. Add to that, this is the battle for the high ground in Washington. If Obama wins something significant — if he wins, if it’s significant, two very big ifs — he has done something that Truman, that Carter, that Kennedy, that Clinton couldn’t get done. He emerges from this a star. If the Republicans manage either to make this a very weak bill, or to defeat it, Obama becomes Carter. He’s defeated. This is Waterloo. James DeMint, Senator from South Carolina is absolutely right. But remember, Waterloo had both Wellington and Napoleon: there’s a winner that comes out of this, and the winner is dominating the Washington conversation for the next year. So we are met on the great battlefield. Of course it’s ugly. Of course it’s bloody. Control of our politics is at stake.