Seriously, health policy can be interesting, even to non-wonks. Really.

All it takes is a moving narrative. The journal Health Affairs knows this; soon you can too.

Familiar to -- and much admired by -- policy devotees across the nation, the journal is celebrating the 10th anniversary of its feature Narrative Matters. What that means is: Even non-regular readers can brush up on very important, crucial, even, health policy issues without being bored. Or feeling guilty for being bored.

Here's an explainer of the significance of that anniversary, plus a taste from the July-August issue:

Alexander McCall Smith, creator of the "No. 1 Ladies’ Detective Agency" series, writes about the AIDS epidemic in Botswana. He begins "In the Midst of Sickness" with:

"He is standing before me, this man whom I barely know, the employee of somebody I have met. It is a cold day — cold, at least, by the standards of Botswana, although the sky is clear and the air is bathed in sunlight."

Julia Alvarez, author of "How the García Girls Lost Their Accents" and "In the Time of the Butterflies,"  begins "On The Southern Front" with:

"After forty-two years in this country, my parents announced that they were returning to their native country to live. Of course, we, their four daughters, understood the verb 'to live' as a euphemism. My parents were going back to the Dominican Republic because that’s where they wanted to die. But my sisters and I were all too upset to be thinking of that eventual future."

Then there's Abraham Verghese, an author -- plus physician and professor at Stanford University -- who writes in "A Touch of Sense" about the physical art of doctoring, based on the sense of touch and what's been lost in this country.

And Fitzhugh Mullan, the original editor of the feature, writes with reflection and perspective in "Still Closing the Gap" on the persistent inequalities in healthcare.

And there are other essays, as well, from previous editions -- no less moving, no less relevant. (Among them, Jane Pauley writes of her bipolar disorder.)

-- Tami Dennis
 

Boosting health and the economy

Public health advocates are praising the $1 billion for disease prevention and wellness programs included in President Obama's economic stimulus package but say that it is only a fraction of the billions needed to keep the country  healthy.

The United States spent about $35 billion a year on disease prevention in 2008, or about $17 per person, according to Jeffrey Levi, executive director of Trust for America's Health, a Washington-based advocacy group. That compares with $2.4 trillion spent on treatment.

According to the ounce-of-prevention argument, spending on the former would help whittle down the latter.

Public health spending covers a wide variety of programs, including inspecting restaurants, tracking tuberculosis cases, providing vaccines, preparing for disasters and promoting exercise and nutrition.  Such services are intended to counter, among other things, food poisoning outbreaks, the spread of infectious diseases and the surge in chronic conditions such as obesity and diabetes.

But faced with a financial crisis, local and state governments are cutting public health spending. More than 11,000 public health jobs were eliminated in 2008, Robert M. Pestronk, executive director of the National Assn. of County and City Health Officials, said during a teleconference this morning. That, he said, is the equivalent of two states completely shutting down their public health departments.

The teleconference was called to publicize the release of a report called "Shortchanging America's Health: A State-By-State Look at How Federal Public Health Dollars Are Spent," produced by Trust for America's Health and the Robert Wood Johnson Foundation.

"It's essential that as the country considers ways to reform its health system, we not only think about providing quality healthcare to everyone but that a strong public health program has to be the cornerstone," Pestronk said.

-- Mary Engel

FDA releases inspection report on peanut butter plant

The U.S.Food and Drug Administration today released its report, called a "483," on inspections of the Georgia plant that makes peanut butter and peanut paste and has been linked to a nationwide salmonella outbreak.

The report provides a detailed account of inspections done once the FDA linked the Peanut Corp. of America plant to the outbreak. Federal officials on Tuesday talked about problems they found at the plant.

Among the allegations in today's report, inspectors noted that "the peanut paste line was not cleaned after the bacterium Salmonella typhimurium was isolated from the peanut paste manufactured on Sept. 26, 2008." The report says Peanut Corp. continued to make paste on that line until Jan. 9.

The company's products are used by companies around the country as ingredients in cookies, nutrition bars, dog snacks and other items.

-- Mary MacVean

Your own health ID number

It's been a decade since federal legislation called for the creation of a unique patient identifier -- a number carried by each American linking patients to their individual health records -- but concerns about privacy and security, reported way back in the July 21, 1998, Los Angeles Times, have stalled efforts to put the proposal into use.

Concerns still exist, but it may be an idea whose time has come, according to a Rand Corp. study released online today. It turns out that the compromise fashioned to adhere to the 1996 Health Insurance Portability and Accountability Act mandating the creation of a system to accurately identify patients has resulted in a system in which privacy is at risk, while not doing enough to prevent errors.

Short of a new system with a new number for everyone, most hospitals and health systems instead rely on what's called statistical matching, based on multiple personal attributes, such as name, address, birth date, gender and Social Security number, to accurately match a given patient with his or her MRI results, blood records or medical history.

That's why, when you call your insurance company, the representative might think nothing of asking, "What's your soch?" -- translation: social security number. The statistical matching system now in use is more likely than a new unique patient identifier system to result in errors, repetitive tests and unnecessary care. Rand researchers, led by senior principal researcher Richard Hillestad, found that the system now in place returns incomplete medical records about 8% of the time and exposes patients to privacy risks because of the large amount of personal information needed to do a search.

"Our research suggests that it's easier to safeguard patient privacy with a records system that makes use of a unique health ID rather than a system that uses statistical matching," Hillestad said in a news release. One way to begin the process, he says, is to allow people to volunteer for a unique health identifier, giving researchers an on-the-ground way to measure a new system's ability to protect privacy while reducing errors against the current system.

Researchers estimated that implementation of a new system in which everyone has a health number would cost up to $11 billion. But once implemented, would save about $77 billion in increased efficiency and reduced errors.

Even if determined hackers could get into a new system of patient identifying numbers, they'd come away only knowing when someone is due for the next colonoscopy or how high that person's blood cholesterol is. But because they'd get no Social Security number, name or other identifying information, they wouldn't be able to steal that person's identity.

--Susan Brink

Photo: Will they pull the right medical record? Credit: Myung J. Chun / Los Angeles Times

Radio: McCain and Obama healthcare plans on NPR

Still parsing the health reform plans of Sens. Barack Obama and John McCain? Here's one more useful synopsis, courtesy of NPR's Oct. 20 Day to Day.  It features an interview with Trudy Lieberman, head of the graduate journalism program in health and medicine reporting at City University in New York.

(And, of course, you can find lots of links to the candidates' proposals on health insurance in our online guide, here.)

-- Rosie Mestel

McCain, Obama health plans critiqued

Don't say you didn't know, or can't understand, the presidential candidates' plans for dealing with America's healthcare crisis. Don't say you don't get how they might affect you. It's all out there, analyses from independent, nonpartisan groups as well as from very partisan groups. You can have a quick, thumbnail, side-by-side peek at how each candidate sees the future of healthcare. Or you can dig into papers examining the economic and societal impacts of each plan.

A starting point might be where each candidate stands, from his  own  point of view. Sen. John McCain's  site talks about "Straight Talk on Health System Reform." And Sen. Barack Obama's site proposes a "Plan for a Healthy America."

But you might want to see the two plans side by side, comparing and contrasting such things as the candidates' stated goals, overall approach to expanding access to healthcare, changes to private insurance, cost containment, what it'll cost and who will pay. The Kaiser Family Foundation, a private, nonprofit health policy and communications organization, has just what you need.

On Sept. 16, the journal Health Affairs offered a web exclusive with a critique of the Obama healthcare plan, saying its costs are unsustainable, and one of the McCain plan, saying the number of uninsured could grow from 45 million to 60 million in the next five years. Another article in the journal suggests that America's healthcare system could benefit from a mixing and matching from each of the plans.

The bottom line from the healthcare economists who examined each candidates' proposal is that the Obama plan won't curb the escalating costs of healthcare in the U.S., the most expensive system in the world. And McCain's plan won't reduce the number of uninsured, and likely would increase their ranks.

If that's too much to read, you can always go to a Sept. 16 L.A. Times story summarizing the Health Affairs articles.

Even if you've got a job with health insurance, don't think this debate isn't about you. The Segal Co., an actuarial and consulting firm, has put together a report on how the candidates' health reforms will effect your benefits.

If it's issues you want, healthcare is a good one. Don't say we didn't tell you.

-- Susan Brink

Photos: Presidential candidates John McCain and Barack Obama at recent campaign stops. Credits: Left, Gerardo Mora / Getty Images; right, Keith Srakocic / AP

Democratic platform on health: It's not just the uninsured*

For the first time since healthcare has been written into political platforms, people are proposing ideas that look beyond the bottom line issue of how to deal with the problem of the uninsured. The new U.S. Census Bureau national statistics on health insurance are due out Aug. 26, and many experts believe they will show an increase over last year's 47 million uninsured Americans. (*In fact, the U.S. Census Bureau's figures released today, as reported in the Los Angeles Times, showed a drop in the number of uninsured, to 45.7 million, primarily due to an expansion of government-provided services to children.)

That this year's Democratic platform calls for affordable coverage for all Americans is no surprise. But it also calls for a new emphasis within the healthcare system on prevention and wellness.

"We need to promote healthy lifestyles and disease prevention and management especially with health promotion programs at work and physical education in schools. All Americans should be empowered to promote wellness and have access to preventive services to impede the development of costly chronic conditions such as obesity, diabetes, heart disease and hypertension. Chronic care and behavioral health management should be assured for all Americans who require care coordination. This includes assistance for those recovering from traumatic, life-altering injuries and illnesses as well as those with mental health and substance use disorders. We should promote additional tobacco and substance abuse prevention."

The United States has epidemics of chronic diseases that are largely preventable, including diabetes, heart disease and obesity. "If we're going to deal with the affordability of healthcare, we've got to do a lot more about preventing diseases," says Dr. Ken Thorpe, professor of health policy at Emory University and executive director of the Partnership to Fight Chronic Disease. "About 75% of healthcare spending is associated with chronic disease. This has percolated up to become a center stage issue."

-- Susan Brink

Could they be on some kind of medication?

Healthcare reform is the kind of issue that manages to be both numbingly complicated and rabidly partisan at the same time.

But now a group of senators -- six Democrats, seven Republicans and one Independent -- have gotten behind a bill that would provide private coverage for all Americans, take employers out of the business of directly providing health insurance and generally nudge all participants in the healthcare marketplace to be more thrifty and quality conscious. Note: It would not change Medicare.

Although the sponsors of the Healthy Americans Act (S.334/H.R. 3163) have managed to bridge their partisan differences, the bill is still pretty much of a mind bender. Suffice it to say that it connects something like the financing idea that GOP presidential candidate John McCain espouses with something that resembles the kind of healthcare delivery system sought by Democrats Hillary Rodham Clinton and Barack Obama.

Indeed, Clinton on a campaign swing in Oregon told reporters she'd sign the legislation as president, if Congress put it on her desk.

But what might be even more amazing is that congressional budget estimators recently ruled that the bill would not break the bank. The bean counters agreed with sponsors Sens. Ron Wyden (D-Ore.) and Robert Bennett (R-Utah) that the nation can provide coverage for all at roughly the same cost of the current, much-maligned system.

In fact, the Congressional Budget Office and the Joint Committee on Taxation projected the legislation would be roughly a break-even proposition for the government -- "budget neutral" -- a year after its hypothetical implementation and would help reduce the deficit in future years.

Wyden and Bennett were ecstatic. (How many times can the superlative "historic" be applied to a clunky worded budget estimate?)

"This is the first independent evidence that the healthcare system can be fixed without massive tax increases and boatloads of new federal spending," said Wyden.

"This is the basis for a bipartisan coalition to break the gridlock," said Bennett.

But outside a small circle of economists and healthcare wonks, the cost estimate generated hardly a ripple of interest.

Wyden, as indefatigable as pitchmen come, has set up a website -- careyoukeep.com -- complete with a nifty video (see above) to try to break through into the public consciousness with news about his bill.

The CBO's positive read on costs "is very substantial news for the presidential campaign. It ought to transform the discussion," said Wyden. "The conventional thinking doesn't make any sense any more."

In addition to Wyden and Bennett, the other unconventional thinkers sponsoring the bill are Sens. Lamar Alexander (R-Tenn.), Bill Nelson (D-Fla.), Judd Gregg (R-N.H.), Debbie Stabenow (D-Mich.), Charles Grassley (R-Iowa), Mary Landrieu (D-La.), Norm Coleman (R-Minn.), Joe Lieberman (I-Conn.), Mike Crapo (R-Idaho), Tom Carper (D-Del.), Daniel Inouye (D-Hawaii) and Bob Corker (R-Tenn.).

-- Ricardo Alonso-Zaldivar