Matthew Holt

Matthew Holt
Matthew Holt is the founder and publisher of The Health Care Blog and still writes regularly for the site. He is also the co-founder of the Health 2.0 Conference, as well as a Founding Principal of the associated consulting firm Health 2.0 Advisors.

Heritage & Roberts decree, all the world be taxed

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The Supreme Court’s decision upholding the ACA is deliciously ironic. The “individual mandate”–an idea promoted for everyone in the 90s and for Massachusettians (?) in the 2000s by the arm of the Republican party known as the Heritage Foundation–was found to be legal. But not as a mandate, instead as a tax.

Put aside for a minute the dreadful political contortions required to get this quasi-universal health insurance bill past Congress in the first place. Put aside the fact that the supposedly non-political Supreme Court hands down decisions time after time that are a pure reflection of the exceedingly public extreme political views of its justices. Put aside for a minute the fact that the ACA has undeniably kickstarted a round of changes in the health care delivery and insurance system that at least has the potential to lower costs and improve care, and that the luncay of politics meant we nearly lost that momentum.

Instead focus on what the Supremes have done. They’ve cut through decades of rhetoric about how we pay for health insurance and clarified it thus: we pay for health care via taxes–whether they are private taxes on employers and employees (and now individuals) or public ones on citizens.

What’s wrong with Cannon, Halbig & King in 5 tweets

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When the latest post from Michael Cannon–he who seeks to sink the subsidies attached to the Federal exchange–hit my inbox, I wondered, “Why don’t his opponents stop arguing the specifics, and instead explain what the Supreme Court ought to do. I also don’t see why Mark Andreeseen (@pmarca) should have all the fun with long Twitter essays. So in only 5 tweets complete with misspellings and other contortions to get my thoughts into 140 characters, this is what I sent back

Samsung Throws Kitchen Sink onto the Wrist

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Yesterday phone and electronics giant Samsung rushed out its next step in health related hardware. Samsung was clearly trying to get this out the door and in the press before Apple’s forthcoming announcement of something health-related –or I assume that’s what their industrial espionage told them Apple was about to reveal (just kidding guys!). And some people (well, Techcrunch) were clearly unimpressed.

The most compelling moment which I captured (poorly) in the video above was the demo of the new SIMBAND–albeit a concept rather than an available product. (In fact a couple of their partners told me that no-one outside the company has one). In the SIMBAND are a stack of new sensors which attempt to use the wrist to monitor not only heart rate, but blood pressure, temperature, EKG and do it all continuously. You can see a rather better video of the demo from Gizmodo, which I cued up to start at the right place.

They also announced a fully open platform (what at Health 2.0 we dub the Data Utility Layer) called Samsung Architecture Multimodal Interactions (SAMI) to accept and spit out all types of health related data.

This is all potentially very impressive. Samsung’s first two attempts at Smart Watches have fizzled, but they tend to keep coming back, and now are pretty much the best at Smart Phones. (You fan bois can keep your teeny iPhone screens!) But can they make the health related smartwatch work? I’ve three quick assessments/questions.

Interview: TR Reid on healthcare reform around the world

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TR Reid is a former foreign correspondent with the Washington Post. He spent two years (partly funded by the Kaiser Family Foundation) looking at health care systems across the world and has been featured heavily in many media venues lately asking the simple question, if everywhere else can cover everyone at half the cost, how do they do it?  I had a great and not too long interview with him last week.

His book is called The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care and here's an interview he did as part of Frontline's Sick Around The World.

Funnily enough I'm posting this from Barcelona, Spain where hopefully I won't have to use the healthcare system unless I get carried away with the late night Sangria…

TV stardom (well, sorta…)

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It’s just possible that you weren’t glued to the France24 cable channel (yes there is a French 24 hour news  & chat channel broadcast in English). Well yesterday they had a “debate” about healthcare hosted by the very smooth Francois Picard.

Jean-Jacques Zambrowski, a professor at Paris Descartes University got to talk about Bismarkcian and Beveridge-type systems (and why Michael Moore was wrong to call French & UK care as being the same). I was sitting in a dark studio in front of a DVD showing the Golden Gate Bridge. On the phone was Tevi Troy from the Hudson Institute (yes those right wingers) who basically spent most of his time agreeing with me—which I found pretty worrying!

Incidentally for a TV novice, I could barely hear the conversation, and couldn’t see anything, which meant that I never knew when I was on camera or not—so hopefully they don’t catch me picking my nose or something on screen!  Here’s the “debate” and here’s part 2.

Jess Jacobs, POTS & her bio

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As part of Health 2.0’s 10 Year Global Retrospective Awards (yes, winners to be celebrated at Health 2.0’s 10th Annual Fall Conference September 25-8), I wrote a bunch of bios. One patient and friend of mine Jess Jacobs has (as many of you know) recently died. Fellow POTS patient Greg Norman didn’t much care for the brief bio I wrote about Jess. So below the fold please read his tweet storm about it! And of course please comment.

Obama-cares (if you’re under 26)

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CDC data just in, reported by Jonathan Cohn at THR, suggests that the impact of allowing young people to stay on their parent’s insurance (or as Michael Cannon would say, forcing employers to cover dependents up to the age of 26) is having a big impact. Up to 2.5 million adults under the age of 26 have moved into coverage. Frankly I’m not surprised. There’s always been a huge group of uninsured young adults moving between high school and college and the workforce. And if you hadn’t noticed, there’s a recession on and good jobs with insurance are hard to find. I know at least three young adults working in the semi-contingent labor force who are on their parents’ insurance. Of course they’d better hope they don’t turn 26 before 2014. But even this little gain is something the Democrats need to punch home about the Republicans: Those bastards want to take your kid’s insurance away! And they do.

What’s the next way PBMs will make money?

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Yesterday Medco offered itself up to smaller competitor Express Scripts, creating an entity with more than 50% of the PBM market. PBMs originated as specialized claims processors that supposedly were able to reduce drug costs. But in the 1990s  drug costs soared. Somehow PBMs didn’t lose employer clients, further confirming that employers are dumb about how they buy health care. Most employers didn’t understand that PBMs made much of their profits on rebates they were paid by drug companies to keep particular drugs on formulary. Almost none of that money went back to the employer. After that game ended, PBMs replaced almost all those profits by making huge margins on generics until Walmart showed that it could make a profit by charging only $4 a fill. Now it looks like extracting a bigger piece of the pie from pharmacies and charging more to employers may be the only game left for PBMs. And that’s probably the driver behind the merger.

Uwe on premium support and vouchers

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There’s a great post on the NY Time Economix blog from Uwe Reinhardt explaining the theoretical difference between premium support and voucher systems (and you thought they were the same thing!). Unfortunately it skirts the real problem that those of us playing along at home know too well. Either a well constructed premium support (Ryan done right), or a well constructed voucher/managed competition (Enthoven) system, a mixed public/private system (Germany, Starr, Reinhardt) or even a decent Medicare for all /Single payer system (PNHP, McCanne) needs to be designed holistically to have a chance of working–especially to ensure that all people are in plans that treat them all equally.

Announcing the Health 2.0 Developer Challenge

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Today, it was a great thrill for us to have Aneesh Chopra (CTO of the Federal Government) this morning in DC at the Community Health Data Initiative Data Forum announce the The 2010 Health 2.0 Developer Challenge, with support from the Department of Health and Human Services (HHS) and the Community Health Data Initiative (CHDI).

With newly opened government data sets and lightweight frameworks for rapid application development, we have a unique opportunity to participate in an ecosystem of data “suppliers” and “appliers” to build innovative tools to improve personal and population health.

Health 2.0 will host a series of events leading up to the final Challenge during the Health 2.0 Annual Conference October 6-9, 2010, the culminating event of Health Innovation Week, October 3-10, in San Francisco CA.

Stay tuned! This is going to be an exciting process of innovation  and we’re really excited to kick it off.

You can go to Health2Challenge.org and see more and register your interest—whether you’re a developer, or you have a data set to contribute, or you want to issue a challenge, or sponsor a prize.