การประชุมวิชาการชมรมคณะปฏิบัติงานวิทยาการ อพ.สธ. ครั้งที่ 8 “ทรัพยากรไทย : ศักยภาพมากล้นมีให้เห็น”

การประชุมวิชาการชมรมคณะปฏิบัติงานวิทยาการ อพ.สธ. ครั้งที่ 8 “ทรัพยากรไทย : ศักยภาพมากล้นมีให้เห็น” จะจัดขึ้น ณ ศูนย์เครือข่ายการเรียนรู้เพื่อภูมิภาค จุฬาลงกรณ์มหาวิทยาลัย จังหวัดสระบุรี ระหว่างวันที่ 29 พฤศจิกายน – 1 ธันวาคม พ.ศ. 2560
ในการนี้โครงการอนุรักษ์พันธุกรรมพืชอันเนื่องมาจากพระราชดำริฯ ขอเชิญหน่วยงานต่าง ๆส่งชื่อเรื่องพร้อมบทคัดย่อและเรื่องเต็มผลงานสำหรับร่วมประชุมวิชาการโดยเรื่องที่นำมาจัดแสดงจะต้องเป็นผลงานที่หน่วยงานได้ร่วมสนองพระราชดำริในกิจกรรมต่าง ๆ ของโครงการอนุรักษ์พันธุกรรมพืชอันเนื่องมาจากพระราชดำริฯ  ตามหลักเกณฑ์ดังต่อไปนี้ 

1. เป็นผลงานที่ดำเนินการในพื้นที่ของโครงการอนุรักษ์พันธุกรรมพืชอันเนื่องมาจากพระราชดำริฯ เท่านั้น
เช่น พื้นที่ปกปักพันธุกรรมพืชของหน่วยงานร่วมสนองพระราชดำริ พื้นที่ปกปักพันธุกรรมพืชเกาะแสมสาร
พื้นที่ปกปักพันธุกรรมพืชของเขื่อน (กฟผ.) เป็นต้น

2. เป็นงานในพื้นที่สำรวจรวบรวมพันธุกรรมพืชที่ อพ.สธ. และหน่วยงานสนองพระราชดำริได้ร่วมสำรวจแล้ว
เช่น อุทยานแห่งชาติหมู่เกาะตะรุเตา เกาะช้าง หมู่เกาะอ่างทอง หมู่เกาะสิมิลัน เป็นต้น

3. เป็นผลงานที่ดำเนินการภายใต้กรอบ/กิจกรรมของ อพ.สธ. โดยสถาบันหรือหน่วยงานที่ร่วมสนองพระราชดำริ
โครงการอนุรักษ์พันธุกรรมพืชอันเนื่องมาจากพระราชดำริฯ เท่านั้น

4. ต้องเป็นผลงานใหม่ที่ไม่เคยนำเสนอที่ใดมาก่อน

ติดตามรายละเอียดเพิ่มเติมได้ที่เว็บไซต์  การประชุมวิชาการชมรมคณะปฏิบัติงานวิทยาการ อพ.สธ. ครั้งที่ 8

72 thoughts on “การประชุมวิชาการชมรมคณะปฏิบัติงานวิทยาการ อพ.สธ. ครั้งที่ 8 “ทรัพยากรไทย : ศักยภาพมากล้นมีให้เห็น”

  1. AngeloStilt says:

    Do you feel like you have tried everything possible in order to lose weight? You are not alone–many people have the same problem. The following article is designed to give you tips that you may not have even known existed. By following these tips, you will reach your weight loss goal in no time.

  2. Terrygam says:

    Doctor Who is now considered a British Institute and has come a long way since it first aired on November 23rd 1963. The very first show saw the Doctor travel 100,00 years into the past to help some dim cavemen discover light. After 26 seasons and seven Doctors later the series came off our screens in 1989 much to the disappointment of the huge devoted fanbase. In 1996 an attempt was made to revive Doctor Who but it wasnt until June 2005 when it came back with a vengeance with Christopher Eccleston as the ninth Doctor that put the series back on the map as it were. It then went on for 5 years with David Tenant portraying the Doctor until 2010 when Matt Smith took over the role. Today it is still a great family show and has attracted many new fans.

    If youre a new or old fan of the show there are Tours and museums you can go and see some of the locations and memorabilia of this classic show. The Doctor Who Tour of London will take you on over 15 locations from the show, some from the new series and some from old sites like the location of The Invasion and Resurrection of the Darleks. The tour also takes you to the TV museum in London where you will get to see some of the cosumes worn in the show and props used. Also you can buy gifts and memorabilia from the shop.

    You will learn all about how the shows were made so the tour is also educational. If you want to take pictures of the locations thats not a problem. Remember the front door of 10 Downing Street in Aliens of London? Well you can get up and close to this and get your picture taken in front of the door. Rose Tyler fans will love the tour as you get to drop by her home in the show.

    Why not go that extra mile and actually meet a Doctor Who star. Well this is possible with private or group tours. You will get the general tour but included will be a pre-arranged meeting or lunch with a celebrity from the show. This will obviously depend on availability of the celebrity and the cost will reflect the popularity of that celebrity.

    There are tours in London and also Wales. The Wales tours take you to Cardiff where you will see lots of location which were featured in shows since 2005. You can leave from London or at Leigh Delamere services station on the M4. There is a Doctor Who exhibition in Cardiff which you get to see. At the end of the Doctor Who tour you get a souvenir group picture sent you by email which is a nice touch.

    For seriously devoted Doctor Who fans there is a 3 day tour which takes you to all the locations in both London and Cardiff. You will see locations from the past 45 years as well as recent sites from the lasted Doctor Who series. Day one is based in London where you get to see 15 sites. Day two takes you to Cardiff where you get to mean the real life owner of the to see we have an Gothic property used as the location of the school in Human Nature. The final day is partly spent in Cardiff with a walking tour at Cardiff Bay, then you head back to London but a stop at Stonehenge to see the site of the Pandoica. Then its dinner at The Cloven Hoof pub in Devils End b efore you taken back to central London.

     

  3. CaseyAgepe says:

    Some people, especially those running on busy daily schedules tend to use the pills to help maintain weight since they can not afford to follow all the diet programs. This is not advised. It is recommended that one seek advice from a professional in this field before using the pills. This can save one from many dangers associated with the misuse.

    The diet pills should always be taken whole. Some people tend to divide the pills to serve a longer period of time. This is not advised and can lead to ineffectiveness. If it is required that one takes a complete tablet, it means that a certain amount of the ingredients are required to achieve the desired goal. It is also recommended that one does not crush the pill and dissolve it in beverages. Chemicals found in beverages have the potential of neutralizing the desired nutrients in the pill thereby leading to ineffectiveness. The best way to take the tablets is swallowing them whole with a glass of water.

    The diet pills speed up the metabolic processes. This is the key factor that leads to the burning of all the fats in the body. This means that one passes out lots of urine, which subsequently leads to dehydration. It is imperative that the user take lots of water round the clock. This will help curb dehydration, which can lead to health problems. In addition to that, water offers the required medium for the function of the nutrients and elimination of the fats.

    When buying the review of diet pills, it is imperative that one gets the most recommended dose. People tend to compromise the quality and effectiveness of the tablets due to the variation in cost. The low priced pills depict poor quality, which means their effectiveness is not reliable. Some have also been found to cause health problems. The dose should also be taken as recommended. Over dose will not speed up the process but rather lead to complication. This will increase risk of side effects. If the taking of the pill is forgotten, do not take more to compensate for the lost time.

    The diet plan enclosed with the diet pills has also to be followed. According to the requirements, the termination of the diet must be done even with no results. This means your body is irresponsive.

  4. Felixhem says:

    Writing a medical thesis or dissertation is a task done by almost all postgraduate and master’s medical students. Dissertation is derived from the Latin word disserto which means discuss. It is essential to write successful medical papers such as medicine essays and medical thesis papers. There are several reasons as to why students write medicine essays. One of the reasons is to promote enhancement of critical judgment, research skills as well as analytical skills. Moreover, medicine essay writing produce students with the ability to 4evaluate and analyze data critically.

    The initial step for writing medicine essays is to choose a topic. A writer should have at least three topics to choose from. The topic has to be interesting, feasible and relevant. It is essential to write quality medicine essay. Hence, students need to have analytical skills and perfect writing skills. The writing skills will enable them write outstanding essay papers that can be highly regarded by instructors and professors. Teachers often require a lot and expect a lot from their students in terms of medicine essay writing. for this reason, students find essay writing to be an extremely difficult task and hence resort to buying custom medicine essays.

    A custom medicine essay has to be written by professional writers who are qualified in the field of nursing. Moreover, the custom medicine essay has to be original and plagiarism free. This means that it has to be written from scratch by experts with many years experience. The many years experience should enable a writer to write any form of medical paper including medical thesis, medicine essay and even medicine research paper. Moreover, experience will enable a writer to write a medicine essay that can guarantee academic success.

    Students get custom medicine essays from custom writing company. It is essential to choose the best company so that one can get the best custom medicine essay. The best and the most reliable medicine essay writing company should have some unique characteristics such as affordability and the ability to provide original and superior quality medicine essays. The other quality is that the company has to hire expert writers who can write quality medicine essays and other types of medical papers. The essays should not only be quality but also plagiarism free and free of grammatical and spelling mistakes.

    A custom medicine essay has a similar structure to any other academic essay assignment. It has an introduction that introduces the topic and tells the reader what the essay is all about. The second section is the body that has many paragraphs supporting the main topic. Finally there is the conclusion that briefly summarizes what has been discussed in the body section of the essay. Students should choose reliable writing companies so that they can get quality custom papers on several fields such as technology, sociology and law in addition to medicine field.

    Our custom writing company is the best company that all clients should rely on when in need of any given type of medicine paper. We provide quality papers that not only plagiarism free but also original. Moreover, our custom papers are affordable and able to guarantee academic excellence at all times. All our medical papers are reliable and sure of satisfying clients at all times.

     

  5. Danielbor says:

    Why are Americans so worked up about health care reform? Statements such as “don’t touch my Medicare” or “everyone should have access to state of the art health care irrespective of cost” are in my opinion uninformed and visceral responses that indicate a poor understanding of our health care system’s history, its current and future resources and the funding challenges that America faces going forward. While we all wonder how the health care system has reached what some refer to as a crisis stage. Let’s try to take some of the emotion out of the debate by briefly examining how health care in this country emerged and how that has formed our thinking and culture about health care. With that as a foundation let’s look at the pros and cons of the Obama administration health care reform proposals and let’s look at the concepts put forth by the Republicans?

    Access to state of the art health care services is something we can all agree would be a good thing for this country. Experiencing a serious illness is one of life’s major challenges and to face it without the means to pay for it is positively frightening. But as we shall see, once we know the facts, we will find that achieving this goal will not be easy without our individual contribution.

    These are the themes I will touch on to try to make some sense out of what is happening to American health care and the steps we can personally take to make things better.

    A recent history of American health care – what has driven the costs so high?

    Key elements of the Obama health care plan

    The Republican view of health care – free market competition

    Universal access to state of the art health care – a worthy goal but not easy to achieve

    what can we do?

    First, let’s get a little historical perspective on American health care. This is not intended to be an exhausted look into that history but it will give us an appreciation of how the health care system and our expectations for it developed. What drove costs higher and higher?

    To begin, let’s turn to the American civil war. In that war, dated tactics and the carnage inflicted by modern weapons of the era combined to cause ghastly results. Not generally known is that most of the deaths on both sides of that war were not the result of actual combat but to what happened after a battlefield wound was inflicted. To begin with, evacuation of the wounded moved at a snail’s pace and this caused severe delays in treating the wounded. Secondly, many wounds were subjected to wound care, related surgeries and/or amputations of the affected limbs and this often resulted in the onset of massive infection. So you might survive a battle wound only to die at the hands of medical care providers who although well-intentioned, their interventions were often quite lethal. High death tolls can also be ascribed to everyday sicknesses and diseases in a time when no antibiotics existed. In total something like 600,000 deaths occurred from all causes, over 2% of the U.S. population at the time!

    Let’s skip to the first half of the 20th century for some additional perspective and to bring us up to more modern times. After the civil war there were steady improvements in American medicine in both the understanding and treatment of certain diseases, new surgical techniques and in physician education and training. But for the most part the best that doctors could offer their patients was a “wait and see” approach. Medicine could handle bone fractures and increasingly attempt risky surgeries (now largely performed in sterile surgical environments) but medicines were not yet available to handle serious illnesses. The majority of deaths remained the result of untreatable conditions such as tuberculosis, pneumonia, scarlet fever and measles and/or related complications. Doctors were increasingly aware of heart and vascular conditions, and cancer but they had almost nothing with which to treat these conditions.

    This very basic review of American medical history helps us to understand that until quite recently (around the 1950’s) we had virtually no technologies with which to treat serious or even minor ailments. Here is a critical point we need to understand; “nothing to treat you with means that visits to the doctor if at all were relegated to emergencies so in such a scenario costs are curtailed. The simple fact is that there was little for doctors to offer and therefore virtually nothing to drive health care spending. A second factor holding down costs was that medical treatments that were provided were paid for out-of-pocket, meaning by way of an individuals personal resources. There was no such thing as health insurance and certainly not health insurance paid by an employer. Except for the very destitute who were lucky to find their way into a charity hospital, health care costs were the responsibility of the individual.

    What does health care insurance have to do with health care costs? Its impact on health care costs has been, and remains to this day, absolutely enormous. When health insurance for individuals and families emerged as a means for corporations to escape wage freezes and to attract and retain employees after World War II, almost overnight a great pool of money became available to pay for health care. Money, as a result of the availability of billions of dollars from health insurance pools, encouraged an innovative America to increase medical research efforts. More Americans became insured not only through private, employer sponsored health insurance but through increased government funding that created Medicare and Medicaid (1965). In addition funding became available for expanded veterans health care benefits. Finding a cure for almost anything has consequently become very lucrative. This is also the primary reason for the vast array of treatments we have available today.

    I do not wish to convey that medical innovations are a bad thing. Think of the tens of millions of lives that have been saved, extended, enhanced and made more productive as a result. But with a funding source grown to its current magnitude (hundreds of billions of dollars annually) upward pressure on health care costs are inevitable. Doctor’s offer and most of us demand and get access to the latest available health care technology in the form of pharmaceuticals, medical devices, diagnostic tools and surgical procedures. So the result is that there is more health care to spend our money on and until very recently most of us were insured and the costs were largely covered by a third-party (government, employers). Add an insatiable and unrealistic public demand for access and treatment and we have the “perfect storm” for higher and higher health care costs. And by and large the storm is only intensifying.

    At this point, let’s turn to the key questions that will lead us into a review and hopefully a better understanding of the health care reform proposals in the news today. Is the current trajectory of U.S. health care spending sustainable? Can America maintain its world competitiveness when 16%, heading for 20% of our gross national product is being spent on health care? What are the other industrialized countries spending on health care and is it even close to these numbers? When we add politics and an election year to the debate, information to help us answer these questions become critical. We need to spend some effort in understanding health care and sorting out how we think about it. Properly armed we can more intelligently determine whether certain health care proposals might solve or worsen some of these problems. What can be done about the challenges? How can we as individuals contribute to the solutions?

    The Obama health care plan is complex for sure – I have never seen a health care plan that isn’t. But through a variety of programs his plan attempts to deal with a) increasing the number of American that are covered by adequate insurance (almost 50 million are not), and b) managing costs in such a manner that quality and our access to health care is not adversely affected. Republicans seek to achieve these same basic and broad goals, but their approach is proposed as being more market driven than government driven. Let’s look at what the Obama plan does to accomplish the two objectives above. Remember, by the way, that his plan was passed by congress, and begins to seriously kick-in starting in 2014. So this is the direction we are currently taking as we attempt to reform health care.

    Through insurance exchanges and an expansion of Medicaid,the Obama plan dramatically expands the number of Americans that will be covered by health insurance.

    To cover the cost of this expansion the plan requires everyone to have health insurance with a penalty to be paid if we don’t comply. It will purportedly send money to the states to cover those individuals added to state-based Medicaid programs.

    To cover the added costs there were a number of new taxes introduced, one being a 2.5% tax on new medical technologies and another increases taxes on interest and dividend income for wealthier Americans.

    The Obama plan also uses concepts such as evidence-based medicine, accountable care organizations, comparative effectiveness research and reduced reimbursement to health care providers (doctors and hospitals) to control costs.

    The insurance mandate covered by points 1 and 2 above is a worthy goal and most industrialized countries outside of the U.S. provide “free” (paid for by rather high individual and corporate taxes) health care to most if not all of their citizens. It is important to note, however, that there are a number of restrictions for which many Americans would be culturally unprepared. Here is the primary controversial aspect of the Obama plan, the insurance mandate. The U.S. Supreme Court recently decided to hear arguments as to the constitutionality of the health insurance mandate as a result of a petition by 26 states attorney’s general that congress exceeded its authority under the commerce clause of the U.S. constitution by passing this element of the plan. The problem is that if the Supreme Court should rule against the mandate, it is generally believed that the Obama plan as we know it is doomed. This is because its major goal of providing health insurance to all would be severely limited if not terminated altogether by such a decision.

    As you would guess, the taxes covered by point 3 above are rather unpopular with those entities and individuals that have to pay them. Medical device companies, pharmaceutical companies, hospitals, doctors and insurance companies all had to “give up” something that would either create new revenue or would reduce costs within their spheres of control. As an example, Stryker Corporation, a large medical device company, recently announced at least a 1,000 employee reduction in part to cover these new fees. This is being experienced by other medical device companies and pharmaceutical companies as well. The reduction in good paying jobs in these sectors and in the hospital sector may rise as former cost structures will have to be dealt with in order to accommodate the reduced rate of reimbursement to hospitals. Over the next ten years some estimates put the cost reductions to hospitals and physicians at half a trillion dollars and this will flow directly to and affect the companies that supply hospitals and doctors with the latest medical technologies. None of this is to say that efficiencies will not be realized by these changes or that other jobs will in turn be created but this will represent painful change for a while. It helps us to understand that health care reform does have an effect both positive and negative.

    Finally, the Obama plan seeks to change the way medical decisions are made. While clinical and basic research underpins almost everything done in medicine today, doctors are creatures of habit like the rest of us and their training and day-to-day experiences dictate to a great extent how they go about diagnosing and treating our conditions. Enter the concept of evidence-based medicine and comparative effectiveness research. Both of these seek to develop and utilize data bases from electronic health records and other sources to give better and more timely information and feedback to physicians as to the outcomes and costs of the treatments they are providing. There is great waste in health care today, estimated at perhaps a third of an over 2 trillion dollar health care spend annually. Imagine the savings that are possible from a reduction in unnecessary test and procedures that do not compare favorably with health care interventions that are better documented as effective. Now the Republicans and others don’t generally like these ideas as they tend to characterize them as “big government control” of your and my health care. But to be fair, regardless of their political persuasions, most people who understand health care at all, know that better data for the purposes described above will be crucial to getting health care efficiencies, patient safety and costs headed in the right direction.

    A brief review of how Republicans and more conservative individuals think about health care reform. I believe they would agree that costs must come under control and that more, not fewer Americans should have access to health care regardless of their ability to pay. But the main difference is that these folks see market forces and competition as the way to creating the cost reductions and efficiencies we need. There are a number of ideas with regard to driving more competition among health insurance companies and health care providers (doctors and hospitals) so that the consumer would begin to drive cost down by the choices we make. This works in many sectors of our economy but this formula has shown that improvements are illusive when applied to health care. Primarily the problem is that health care choices are difficult even for those who understand it and are connected. The general population, however, is not so informed and besides we have all been brought up to “go to the doctor” when we feel it is necessary and we also have a cultural heritage that has engendered within most of us the feeling that health care is something that is just there and there really isn’t any reason not to access it for whatever the reason and worse we all feel that there is nothing we can do to affect its costs to insure its availability to those with serious problems.

    OK, this article was not intended to be an exhaustive study as I needed to keep it short in an attempt to hold my audience’s attention and to leave some room for discussing what we can do contribute mightily to solving some of the problems. First we must understand that the dollars available for health care are not limitless. Any changes that are put in place to provide better insurance coverage and access to care will cost more. And somehow we have to find the revenues to pay for these changes. At the same time we have to pay less for medical treatments and procedures and do something to restrict the availability of unproven or poorly documented treatments as we are the highest cost health care system in the world and don’t necessarily have the best results in terms of longevity or avoiding chronic diseases much earlier than necessary.

    I believe that we need a revolutionary change in the way we think about health care, its availability, its costs and who pays for it. And if you think I am about to say we should arbitrarily and drastically reduce spending on health care you would be wrong. Here it is fellow citizens – health care spending needs to be preserved and protected for those who need it. And to free up these dollars those of us who don’t need it or can delay it or avoid it need to act. First, we need to convince our politicians that this country needs sustained public education with regard to the value of preventive health strategies. This should be a top priority and it has worked to reduce the number of U.S. smokers for example. If prevention were to take hold, it is reasonable to assume that those needing health care for the myriad of life style engendered chronic diseases would decrease dramatically. Millions of Americans are experiencing these diseases far earlier than in decades past and much of this is due to poor life style choices. This change alone would free up plenty of money to handle the health care costs of those in dire need of treatment, whether due to an acute emergency or chronic condition.

    Let’s go deeper on the first issue. Most of us refuse do something about implementing basic wellness strategies into our daily lives. We don’t exercise but we offer a lot of excuses. We don’t eat right but we offer a lot of excuses. We smoke and/or we drink alcohol to excess and we offer a lot of excuses as to why we can’t do anything about managing these known to be destructive personal health habits. We don’t take advantage of preventive health check-ups that look at blood pressure, cholesterol readings and body weight but we offer a lot of excuses. In short we neglect these things and the result is that we succumb much earlier than necessary to chronic diseases like heart problems, diabetes and high blood pressure. We wind up accessing doctors for these and more routine matters because “health care is there” and somehow we think we have no responsibility for reducing our demand on it.

    It is difficult for us to listen to these truths but easy to blame the sick. Maybe they should take better care of themselves! Well, that might be true or maybe they have a genetic condition and they have become among the unfortunate through absolutely no fault of their own. But the point is that you and I can implement personalized preventive disease measures as a way of dramatically improving health care access for others while reducing its costs. It is far better to be productive by doing something we can control then shifting the blame.

    There are a huge number of free web sites available that can steer us to a more healthful life style. A soon as you can, “Google” “preventive health care strategies”, look up your local hospital’s web site and you will find more than enough help to get you started. Finally, there is a lot to think about here and I have tried to outline the challenges but also the very powerful effect we could have on preserving the best of America’s health care system now and into the future. I am anxious to hear from you and until then – take charge and increase your chances for good health while making sure that health care is there when we need it.

  6. WilliamPusia says:

    First, let’s get a little historical perspective on American health care. This is not intended to be an exhausted look into that history but it will give us an appreciation of how the health care system and our expectations for it developed. What drove costs higher and higher?

    To begin, let’s turn to the American civil war. In that war, dated tactics and the carnage inflicted by modern weapons of the era combined to cause ghastly results. Not generally known is that most of the deaths on both sides of that war were not the result of actual combat but to what happened after a battlefield wound was inflicted. To begin with, evacuation of the wounded moved at a snail’s pace and this caused severe delays in treating the wounded. Secondly, many wounds were subjected to wound care, related surgeries and/or amputations of the affected limbs and this often resulted in the onset of massive infection. So you might survive a battle wound only to die at the hands of medical care providers who although well-intentioned, their interventions were often quite lethal. High death tolls can also be ascribed to everyday sicknesses and diseases in a time when no antibiotics existed. In total something like 600,000 deaths occurred from all causes, over 2% of the U.S. population at the time!

    Let’s skip to the first half of the 20th century for some additional perspective and to bring us up to more modern times. After the civil war there were steady improvements in American medicine in both the understanding and treatment of certain diseases, new surgical techniques and in physician education and training. But for the most part the best that doctors could offer their patients was a “wait and see” approach. Medicine could handle bone fractures and increasingly attempt risky surgeries (now largely performed in sterile surgical environments) but medicines were not yet available to handle serious illnesses. The majority of deaths remained the result of untreatable conditions such as tuberculosis, pneumonia, scarlet fever and measles and/or related complications. Doctors were increasingly aware of heart and vascular conditions, and cancer but they had almost nothing with which to treat these conditions.

    This very basic review of American medical history helps us to understand that until quite recently (around the 1950’s) we had virtually no technologies with which to treat serious or even minor ailments. Here is a critical point we need to understand; “nothing to treat you with means that visits to the doctor if at all were relegated to emergencies so in such a scenario costs are curtailed. The simple fact is that there was little for doctors to offer and therefore virtually nothing to drive health care spending. A second factor holding down costs was that medical treatments that were provided were paid for out-of-pocket, meaning by way of an individuals personal resources. There was no such thing as health insurance and certainly not health insurance paid by an employer. Except for the very destitute who were lucky to find their way into a charity hospital, health care costs were the responsibility of the individual.

    What does health care insurance have to do with health care costs? Its impact on health care costs has been, and remains to this day, absolutely enormous. When health insurance for individuals and families emerged as a means for corporations to escape wage freezes and to attract and retain employees after World War II, almost overnight a great pool of money became available to pay for health care. Money, as a result of the availability of billions of dollars from health insurance pools, encouraged an innovative America to increase medical research efforts. More Americans became insured not only through private, employer sponsored health insurance but through increased government funding that created Medicare and Medicaid (1965). In addition funding became available for expanded veterans health care benefits. Finding a cure for almost anything has consequently become very lucrative. This is also the primary reason for the vast array of treatments we have available today.

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    The Obama health care plan is complex for sure – I have never seen a health care plan that isn’t. But through a variety of programs his plan attempts to deal with a) increasing the number of American that are covered by adequate insurance (almost 50 million are not), and b) managing costs in such a manner that quality and our access to health care is not adversely affected. Republicans seek to achieve these same basic and broad goals, but their approach is proposed as being more market driven than government driven. Let’s look at what the Obama plan does to accomplish the two objectives above. Remember, by the way, that his plan was passed by congress, and begins to seriously kick-in starting in 2014. So this is the direction we are currently taking as we attempt to reform health care.

    Through insurance exchanges and an expansion of Medicaid,the Obama plan dramatically expands the number of Americans that will be covered by health insurance.

    To cover the cost of this expansion the plan requires everyone to have health insurance with a penalty to be paid if we don’t comply. It will purportedly send money to the states to cover those individuals added to state-based Medicaid programs.

    To cover the added costs there were a number of new taxes introduced, one being a 2.5% tax on new medical technologies and another increases taxes on interest and dividend income for wealthier Americans.

    The Obama plan also uses concepts such as evidence-based medicine, accountable care organizations, comparative effectiveness research and reduced reimbursement to health care providers (doctors and hospitals) to control costs.

    The insurance mandate covered by points 1 and 2 above is a worthy goal and most industrialized countries outside of the U.S. provide “free” (paid for by rather high individual and corporate taxes) health care to most if not all of their citizens. It is important to note, however, that there are a number of restrictions for which many Americans would be culturally unprepared. Here is the primary controversial aspect of the Obama plan, the insurance mandate. The U.S. Supreme Court recently decided to hear arguments as to the constitutionality of the health insurance mandate as a result of a petition by 26 states attorney’s general that congress exceeded its authority under the commerce clause of the U.S. constitution by passing this element of the plan. The problem is that if the Supreme Court should rule against the mandate, it is generally believed that the Obama plan as we know it is doomed. This is because its major goal of providing health insurance to all would be severely limited if not terminated altogether by such a decision.

    As you would guess, the taxes covered by point 3 above are rather unpopular with those entities and individuals that have to pay them. Medical device companies, pharmaceutical companies, hospitals, doctors and insurance companies all had to “give up” something that would either create new revenue or would reduce costs within their spheres of control. As an example, Stryker Corporation, a large medical device company, recently announced at least a 1,000 employee reduction in part to cover these new fees. This is being experienced by other medical device companies and pharmaceutical companies as well. The reduction in good paying jobs in these sectors and in the hospital sector may rise as former cost structures will have to be dealt with in order to accommodate the reduced rate of reimbursement to hospitals. Over the next ten years some estimates put the cost reductions to hospitals and physicians at half a trillion dollars and this will flow directly to and affect the companies that supply hospitals and doctors with the latest medical technologies. None of this is to say that efficiencies will not be realized by these changes or that other jobs will in turn be created but this will represent painful change for a while. It helps us to understand that health care reform does have an effect both positive and negative.

    Finally, the Obama plan seeks to change the way medical decisions are made. While clinical and basic research underpins almost everything done in medicine today, doctors are creatures of habit like the rest of us and their training and day-to-day experiences dictate to a great extent how they go about diagnosing and treating our conditions. Enter the concept of evidence-based medicine and comparative effectiveness research. Both of these seek to develop and utilize data bases from electronic health records and other sources to give better and more timely information and feedback to physicians as to the outcomes and costs of the treatments they are providing. There is great waste in health care today, estimated at perhaps a third of an over 2 trillion dollar health care spend annually. Imagine the savings that are possible from a reduction in unnecessary test and procedures that do not compare favorably with health care interventions that are better documented as effective. Now the Republicans and others don’t generally like these ideas as they tend to characterize them as “big government control” of your and my health care. But to be fair, regardless of their political persuasions, most people who understand health care at all, know that better data for the purposes described above will be crucial to getting health care efficiencies, patient safety and costs headed in the right direction.

    A brief review of how Republicans and more conservative individuals think about health care reform. I believe they would agree that costs must come under control and that more, not fewer Americans should have access to health care regardless of their ability to pay. But the main difference is that these folks see market forces and competition as the way to creating the cost reductions and efficiencies we need. There are a number of ideas with regard to driving more competition among health insurance companies and health care providers (doctors and hospitals) so that the consumer would begin to drive cost down by the choices we make. This works in many sectors of our economy but this formula has shown that improvements are illusive when applied to health care. Primarily the problem is that health care choices are difficult even for those who understand it and are connected. The general population, however, is not so informed and besides we have all been brought up to “go to the doctor” when we feel it is necessary and we also have a cultural heritage that has engendered within most of us the feeling that health care is something that is just there and there really isn’t any reason not to access it for whatever the reason and worse we all feel that there is nothing we can do to affect its costs to insure its availability to those with serious problems.

    OK, this article was not intended to be an exhaustive study as I needed to keep it short in an attempt to hold my audience’s attention and to leave some room for discussing what we can do contribute mightily to solving some of the problems. First we must understand that the dollars available for health care are not limitless. Any changes that are put in place to provide better insurance coverage and access to care will cost more. And somehow we have to find the revenues to pay for these changes. At the same time we have to pay less for medical treatments and procedures and do something to restrict the availability of unproven or poorly documented treatments as we are the highest cost health care system in the world and don’t necessarily have the best results in terms of longevity or avoiding chronic diseases much earlier than necessary.

    I believe that we need a revolutionary change in the way we think about health care, its availability, its costs and who pays for it. And if you think I am about to say we should arbitrarily and drastically reduce spending on health care you would be wrong. Here it is fellow citizens – health care spending needs to be preserved and protected for those who need it. And to free up these dollars those of us who don’t need it or can delay it or avoid it need to act. First, we need to convince our politicians that this country needs sustained public education with regard to the value of preventive health strategies. This should be a top priority and it has worked to reduce the number of U.S. smokers for example. If prevention were to take hold, it is reasonable to assume that those needing health care for the myriad of life style engendered chronic diseases would decrease dramatically. Millions of Americans are experiencing these diseases far earlier than in decades past and much of this is due to poor life style choices. This change alone would free up plenty of money to handle the health care costs of those in dire need of treatment, whether due to an acute emergency or chronic condition.

    Let’s go deeper on the first issue. Most of us refuse do something about implementing basic wellness strategies into our daily lives. We don’t exercise but we offer a lot of excuses. We don’t eat right but we offer a lot of excuses. We smoke and/or we drink alcohol to excess and we offer a lot of excuses as to why we can’t do anything about managing these known to be destructive personal health habits. We don’t take advantage of preventive health check-ups that look at blood pressure, cholesterol readings and body weight but we offer a lot of excuses. In short we neglect these things and the result is that we succumb much earlier than necessary to chronic diseases like heart problems, diabetes and high blood pressure. We wind up accessing doctors for these and more routine matters because “health care is there” and somehow we think we have no responsibility for reducing our demand on it.

    It is difficult for us to listen to these truths but easy to blame the sick. Maybe they should take better care of themselves! Well, that might be true or maybe they have a genetic condition and they have become among the unfortunate through absolutely no fault of their own. But the point is that you and I can implement personalized preventive disease measures as a way of dramatically improving health care access for others while reducing its costs. It is far better to be productive by doing something we can control then shifting the blame.

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