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After 12 months of recession, whither health reform?

We’re in a recession; actually, we’ve been in one for the past year, but no official agency decided to tell us. Perhaps "they" wanted to wait until after the November ’08 Presidential election?

The declaration of recession is the official news from The National Bureau of Economic Research (NBER), whose mind-numbingly-titled press release, Determination of the December 2007 Peak in Economic Activity, provides the following important details:

    * The Business Cycle Dating Committee of NBER met by conference call on 11/28 to discuss whether the U.S. economy was in recession.

    * The group figured out that the U.S. economy "peaked" in December 2007.

    * They calculated that the 12/07 peak ended the economic expansion that started in November 2001, lasting 73 months.

    * The previous expansion in the 1990s lasted 120 months (that would include, but not be limited to, The Clinton Era).

    * Other measures of a declining economy — including personal income less transfer payments, real manufacturing and wholesale-retail trade sales, industrial production, and employment estimates based on the U.S. household survey — also peaked some time in the past 13 months.

It’s not only the NBER that’s yielding to the recessionary declaration. The 50 Governors are meeting in Philadelphia to discuss their fiscal outlooks for 2009 and beyond. They want their piece of the stimulus package, perhaps as much as $176 billion. At least 43 of them have arrived with deficits on their mind — and the big challenge of how to balance their budgets.

We know already that increasing co-payments for Medicaid enrollees will be standard benefit fare for 2009, among other cuts to services as Medicaid rolls grow. Remember the Kaiser Family Foundation calculation: every 1% unemployment yields 1.1 million uninsured, a large percentage of whom enroll in Medicaid.

So, now that we know what we already knew — that the U.S. economy has been in recession for some time — whither health reform?

It’s become clear in the past several months that many forces are aligning toward a consensus for some kind of universal coverage. Monday’s Los Angeles Times, for example, featured a piece on the topic that highlighted the areas of agreement along with some of the fine print of disagreement–differences between, for example, the Heritage Foundation versus Families USA.

The Divided We Fail campaign continues to beat the drug for consensus on health reform. Their PR was splashed across broadcast ads over Thanksgiving weekend. This group brings together once-disparate political rivals such as the National Federation of Independent Business (the small business lobby) and the Business Roundtable (representing Big Business) with the Service Employees International Union (that would be Labor to those of you unfamiliar with the organization) and the AARP (representing people over 50–those would be the citizens who use more health care than Americans.

Jane’s Hot Points: Can the differences in the fine print between those who seek universal care be bridged? Any reform must firmly focus on addressing costs in the system. Many have pointed out that we spend more than enough money on health care in the U.S., more than any other nation in the world.

The point is to become as value-based purchasers in health care as we have become this holiday season with dwindling 401(k)’s and a manically depressed stock market, higher food prices, and employment insecurity. I’ve argued for some time that the Target’s and Costco’s of the world deliver consumers value with a strong base in design, service, and back office technology.

I saw an ad for Target on TV last night (during the great annual showing of How the Grinch Stole Christmas). It featured kids putting on a holiday show, singing about the joys of value-based shopping: toys under $20, family time at home, enjoying simpler gifts. The retailer got it right this season: it wasn’t about more stuff; it was about right-sizing and right-buying. They’ve also tapped into the Good Corporate Citizen bandwagon this season with the company’s "Nice Twice. Gifts for a Cause" effort. If consumers are going to spend money this season, they feel a bit better about it when there’s some charitable or good cause involved.

In health care, that equivalent is found in paying for what works across the entire continuum of an illness, or constellation of conditions. This is evidence-based purchasing. Smart health buying is based on real data on real lives on what really works. This means medical practice must be armed with the right information technology and systems that make clinicians more productive and enable them to make best decisions at the point of care. It also means gathering that data and analyzing clinical effectiveness, the wisdom of which can then inform health decisions and payment.

For one take on how to accomplish this in a recessionary period, see my column in iHealthBeat this month, Health IT in an Obama World: Questions Emerge About What We Do and Don’t Know.

In the commentary, I write, "With bipartisan support for health IT for the past few years, shepherding standards and EHR adoption is a no-brainer. If there was ever a time to think out of the proverbial box, it would be now. That’s the point in creative thinking: Now that we’re essentially fiscally broke as a nation, we must analyze investment in health IT in light of the total value that connectivity brings in health care. Think creatively like Leonardo da Vinci; about value like Warren Buffett; and like Eric Schmidt when it comes to the connectivity of Google."

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I am an IT veteran with 25 years of systems deployment, support and generational replacement, and I can tell you that I.T. IS the box. Nothing that computer systems can do will help re-energize a bloated healthocracy. A computer can add numbers and remember what you’ve typed in. If you’ve typed it in right, it can find something for you again. Oh, and it can make lists. The best benefit for EMRs so far has been the ability to kinda-sorta collect and display a patient’s history, current complaint and billing status. Any current EMR is nothing much more than a… Read more »