Welcome the New Surgeon General

This week, a new Surgeon General of the United States was named. The man is Dr. Jerome Adams and was President Trump’s nominee for the role. His 4 year term presiding over the U.S. Public Health Service Commissioned Corps, a subdivision within the US Department of Health and Human Services, was approved by Congress. He will also be a part of the National Prevention Council, a department that emphasizes our country’s growing involvement in public health and preventative care. This council primarily focuses on prevention, wellness, and health promotion by utilizing the coordinated efforts of multiple departments. He will take over this post from Rear Adm. Sylvia Trent-Adams who was the Acting Surgeon General after the controversial resignation of Dr.Vivek H. Murthy, who was appointed by the Obama administration.

Prior to taking this position, Dr. Adams served as the state health commissioner for Indiana. He has also worked as an anesthesiologist and assistant professor of Indiana University School of Medicine. Besides having a medical degree, Dr. Adams also has a masters in public health, an education that has helped advise his actions as the state health commissioner. Last year, he notable helped quell an HIV outbreak in Indiana by working with the CDC to establish a needle exchange program in the state. The results have been noted to be a great success but have not reached the root of the problem, which is drug addiction. It has been generally supported that Dr. Adams may have the knowledge and interest in public health necessary to make real, impactful changes in field during his 4 year term.

The new Surgeon General has announced that opioid epidemic, obesity, and issues regarding cost and access to healthcare are his top priorities upon taking the position. His particular focus on the opioid epidemic comes at a most appropriate time as the ongoing, worsening crisis has been urged by many to be declared a public health emergency. In fact, it was noted by the commission that “142 Americans die from drug overdoses every day,” and this figure is a monumental increase from the amounts seen at the start of the millennium. Stories of the impact of this epidemic can be seen littering newspapers and news sites across the country. Examples can be found here, here, and here, to name a few. The stories have even leaked into news centers across the globe, as can be seen in an article published by BBC, a British based news source.

Let us wish Dr.Adams best of luck and informed decision making in his endeavor to reign in the public health issues of our nation. He certainly has large shoes to fill as health care and public health continue to be hot topics of public interest, and the need for definite, firm leadership could not have come at a more opportune moment.

Healthcare Series

So, What is Healthcare? Part 5- Trump Healthcare

After the Affordable Care Act was put into action via the Obama administration, many people were unhappy with the changes that took place. As a result, the drive to change or repeal the new system in favor of other structures gained support. One of the platforms that fueled President Trump’s campaign was the promise to alter the existing healthcare system and undo the changes that were making some of his voters unhappy.

Make note that the plan for the Trump administration and various republican supporters to repeal and replace the Affordable Care Act was seen as a difficult strategy to achieve, even from members within his own camp. As a result, the goal of the administration to change the healthcare system became to simply repeal or alter the current system, as no replacement was widely supported. Additionally, the political requirements to pass such changes were not strongly advocated for amongst the majority, leading amendments and changes to the existing system as the most feasible option. The changes are outlined clearly by CNBC and will be detailed here today.

What changes were proposed to take place in the reported bill to be passed through our legislative branch? According to CNN Money “American Health Care Act goes a long way to fulfilling the Republicans’ seven-year pledge to repeal former President Obama’s landmark health reform law.” The original bill passed in the House of Representatives would have removed the subsidies paid out to enrollees based on their income, a new initiative of the ACA mentioned in last week’s edition of “So, What is Healthcare.” Rather than just ending governmental support of all kinds for enrollees, the plan was to change the support by offering tax credits based on age instead. Additionally, the plan is to remove mandatory enrollment and making health insurance optional. Mandatory coverage was one of the biggest changes instituted by the Affordable Care Act and it has been a hot topic of debate since it’s inception. This would also remove the requirement for businesses to require health coverage to their employees, outsourcing insurance programs or leaving enrollment up to other avenues once again. These changes alter the basis of availability of plans and the requirements for enrollment. Other changes alter the structure of health insurance policies and coverage plans.

The proposal originally set out to allow insurers to offer plans that don’t include all of the elements mandated by the Affordable Care Act. These plans would be limited in the scope of coverage, allowing people to opt out of mental health coverage or maternity care. The idea is that people will have more flexible options when choosing an insurance plan that fits their lifestyle and the potential costs could be kept to a minimum for people who do foresee the need to have comprehensive coverage of these areas of treatment. The flip side of this is that it would make comprehensive coverage harder to access, and there is a potential that coverage could be more limited or less protective for people with pre-existing conditions. This is especially true because the proposed system would allow insurance companies to change their premiums based on pre-existing conditions. Limiting care for people with pre-existing conditions is a direct contradiction to Trumps goals of ensuring access to this population.

The proposed changes would also affect Medicaid by providing set allowances of funding per state. The idea is that this gives states more rights and control of the programs in their state and ideally allows for more resources and flexibility. There would be a per-capita cap limiting the amount of money each state has for the Medicaid program and the amount of money allotted for each enrollee. The concern here is that the shift in funding moves primarily to the individual states that not have the ability to support these programs without adequate federal assistance. This would cause a shortage of funds, leading to changes in requirements for Medicaid enrollment, difficulties in payment or benefit distribution and access, and reduce the amount and quality of care for patients using Medicaid.

2 weeks ago, the Senate was planning on voting on the latest version of he Republican health care bill. The perception of the bill at that time was that it would not have enough support to pass through Senate due to the opposition by democratic representatives and division amongst representatives of the republican party. After a number of delayed votes, the Senate rejected the proposal.

Famous Names

Dr. C Walton Lillehei

This month, for the third edition of “Famous Names in Public Health!” This month I will focus on the medical side of healthcare by recognizing a figure who contributed significantly to the treatment of cardiac conditions. I have been reading “The Heart Healers” by Dr. James Forrester and have loved his story telling manner when describing the history of cardiac surgery, so I decided to choose a notable figure outlined in the story as the focus for this month’s segment. This man is Dr. C. Walton Lillehei, the father of open heart surgery.

In the years leading up to modern open heart surgery techniques, the field underwent many changes. Methods that were used in the 1950s are almost unfathomable by todays standards and ethics. However, it was in this time period that truly innovative (and dangerous) techniques were a long standing component in the quest for successful open heart surgery. Dr.Lillehei primarily focused on the yet-unsolved challenges to treating what were known as “blue babies,” or infants and children born with congenital heart defects that could not be repaired through medical treatment or closed heart surgery. These children often suffered symptoms of their disease without relief and were given the equivalent of a death sentence. While doctors could diagnose the conditions, they could do little to prevent the progression of the disease as structural problems in the heart failed to keep up with the demands of the patient’s growing body. Essentially, many of these children died due to an inability to efficiently pump blood to vital organs.

Dr.Lillehei was a pioneer in the development of heart-lung bypass systems and open heart surgery. In 1954, Dr. Lillehei performed the first successful open heat surgery using cross circulation with the father of the patient as the source of oxygenated blood. This method was used throughout numerous surgeries and put the “donor” at great risk of harm or injury, so the method was quickly abandoned as other forms of blood oxygenation developed. Dr.Lillehei was involved in the progression of open heart surgery methods moving forward. He helped implement the bubble oxygenator, hypothermia techniques, cardiac pacemakers and prosthetic heart valves. While some of these techniques are no longer used and the surgical devices he used have since undergone many changes to increase effectiveness, safety, and efficiency, Dr.Lillehei’s early involvement in cardiac care altered the trajectory of cardiac surgery, launching us into the future of medicine.

His career impacted many patients, medical staff, and physicians alike as he was active in academic and hospital administration positions throughout his career. After working as a surgeon at University of Minnesota Medical School , he served as the chairman of the department of surgery at Cornell University Medical Center and surgeon in chief at New York Hospital. He later returned to the University of Minnesota Medical Center and additionally served as chairman of the American College of Cardiology. The American Heart Association notes Dr.Lillehei’s lasting impact by stating, ” First- and second-generation Lillehei trainees have developed important techniques in transplantation, perfusion, coronary artery bypass, prosthetic valves, and congenital heart surgery.” This recognizes the lasting impact he had on cardiac surgery far beyond his own individual practice, research, and years of surgery.