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The Stimulus Pregame

"Drug Makers Fight Stimulus Provision"
Capital

"Lobbying War Ensues Over Digital Data"

The first was a recent and the second headline comes from the Washington Post. Both refer to what were supposed to be two already agreed on health
care reform ideas–comparative research about which treatments work
best and the creation of a nationwide system of medical records.

The lesson here is that in health care nothing is easy, simple, or widely agreed to.

The stimulus bill will include about $20 billion for computerized medical records. The problem is privacy.
Business interests want more ability to use health care data to market
their products and identify people who can be treated more effectively data mining
for example. Privacy interests want tighter control of that data. Can a
doctor or a hospital make money selling people's medical data? Could
data ultimately be used to discriminate against people? Can drug
companies pay doctors to send a letter to certain patients touting
medications? Where does a system of information that could be used to
alert patients to new treatments and used to track trends in health
care effectiveness become at cross purposes with privacy?

This is not a new debate–a health information technology bill has been bottled up in the Congress for years over these kinds of issues.

Comparative research–which drugs or medical devices work the best–makes a lot of sense. That is especially true in the wake of decades of research that continues to point to wide overuse of technology as the primary cost driver in our health care system.

So
you would think this one was a no-brainer. But wait. In the WSJ story,
"The drug industry is mobilizing to gut a provision in the stimulus
bill that would spend $1 billion on research comparing medical
treatments, portraying it as the first step to government rationing."
And you know, these guys never lose.

The rub for the drug and device industry
is that this kind of research could actually be able to call balls and
strikes–which treatments don't work well and therefore should have
their use subordinated to those that work better. Already, in the
Senate version the industry has been successful in getting language
that added the word "clinical" which has the effect of having any
studies avoid "bang for the buck" kinds of conclusions.

One
billion dollars for comparative research but we aren't allowed to know
which drug or device gives us the best return for our money?

And, these were supposed to be the easy parts of health care reform. I am again reminded of all the reports in recent months about how different the 2009 version of health care reform will be with the special interests really ready to cooperate.

Let
me say it again, there is no consensus about just what any meaningful,
or probably meaningless, health care reform bill will look like.

Can't wait for the main feature.

Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. Before forming HPSA in 1992, Robert served as the COO, Group Markets, for the Liberty Mutual Insurance Company. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog.

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grant application ukManhattan DRX9000 Herniated DiscCynthiaEugene BorukhovichJim Egnor Recent comment authors
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grant application uk
Guest

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Manhattan DRX9000 Herniated Disc
Guest

I was trying to post a comment on your herniated disk post but was unable to. I agree that often times surgical intervention depends on the doctor and the patients pain tolerance. I have been successful in helping people avoid surgery with the DRX9000.
However, it too is not a ‘silver bullet’ and ultimately some patients do require surgery.
Dr. S

Cynthia
Guest

Device Makers Say They Favor Comparisons: http://www.newsinferno.com/archives/4832#more-4832

Cynthia
Guest

New stimulus plan has funds for comparing medical devices: http://www.newsinferno.com/archives/4754#more-4754

Eugene Borukhovich
Guest

Robert, I sat in during a panel on “Wall Street, the new Administration and the Healthcare Economy”. It was a very well organized event with some heavyweight representation from leaders in the Healthcare field across Finance, clinical and policy organizations. I do not want to disclose who said what and will leave that to the WSJ reporters that hosted the conference but one thing stood out for me: “Consumerism in Healthcare” was missing in the initial panel discussions. These thought leaders disagreed (very politely) on a number of issues such as government-control vs. free market forces, but one thing they… Read more »

Jim Egnor
Guest

CJ—read (obviously) your posting. Wow. Will plan to explore your comments further. Have you ever read Ken Silverstein’s “Turkmeniscam”? Your comment represents a generic microcosm of realpolitik…

Jim Egnor
Guest

On December 6, 2008, President-elect Obama mentioned in a weekly address that a key part of his Economic Recovery Plan would: “ensure that our hospitals are connected to each other through the internet. That is why the economic recovery plan I’m proposing will help modernize our health care system – and that won’t just save jobs, it will save lives. We will make sure that every doctor’s office and hospital in this country is using cutting edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes, and help save billions of dollars each year”.… Read more »

Dr. Rick Lippin
Guest

Robert Laszweski says- “The lesson here (referring to the lobbying battles preciptated by the medical provisions in the Obama economic stimulus plan) is that in health care nothing is easy, simple, or widely agreed to”
Au contraire-I would argue there is very wide consensus that the US health care system is terribly broken to the point of crisis?
I would also posit that there is at least public consensus that Big PhRMA- a true miracle industry gone sour- has duped and swindled us at best-harmed us at worst.
Can we all agree?
Dr. Rick Lippin
Southampton,Pa

tl196427
Guest
tl196427

CJ,
That was as comprehensive a BURNING of a group as I have read in 15 years in Healthcare IT!
My lap top is still smoking! Nice!
T

Calvin
Guest
Calvin

Why not pack CCHIT EHR certifications in Cracker Jack Boxes? If folks think CCHIT is a real organization and the certification is anything more then a stamp of approval from the HIMSS Circus they need to think again after looking at the facts. Some facts are known about the Certification Commission for Health Information Technology. The Certification Commission for Health Information Technology (CCHIT) is a defunct Illinois Not-For-Profit 501(c) 3, which operates to take money from the Office of the National Coordinator and Vendors by offering to sell a “Certification”. DID I say DEFUNCT? Yes I said DEFUNCT…please read on.… Read more »

Steve Blackledge
Guest

“The lesson here is that in health care nothing is easy, simple, or widely agreed to.”
The corollary is that *even* if something is widely agreed to, there are vested interests with enough clout to scuttle a good idea, or at least mutate the concept.
I’m not saying there aren’t philosophical opponents to evidence based medicine or comparative research, but if polled, I imagine it would hit 75% or higher. Despite this, PhRMA, medical device makers and others will have something to say about whether we get there.

Greg Pawelski
Guest
Greg Pawelski

Conservatives have been misinforming the public about the health IT provisions of the stimulus package by falsely claiming that it would lead to the government telling the doctors what they can and cannot treat, and on whom they can and cannot treat. The Hudson Institute fellow, Betsy McCaughey, claimed that the legislation will have the government monitor treatments in order to guide your doctor’s decisions. The new language in the bill tasks the (already existing) National Coordinator of Health Information Technology (NCHIT) with providing appropriate information so that doctors can make better informed decisions. The NCHIT provides counsel to the… Read more »

Jim Carr MS ATC
Guest
Jim Carr MS ATC

It seems to me that all this talk about change maybe creating the type of change we dont need in health care! Isn’t interesting how the legislators who have quite the deal when in comes to their own health insurance aren’t so interested in “spreading the wealth” when they are writing laws. Congress seems to forget that they too have families who are aging. That one day the treatment option they want for their loved one isn’t an option as it does not fall into findings of the comparative research. I attended one of the administrations health care reform forums.… Read more »

Richard L. Reece, MD, medinnovationblog.blogspot.com
Guest

Once again, Bob, a beautiful job of capturing the essence of Obama’s reform strategies, which leads inexorably to these lamentable limericks. Using data to create cost-tight federal controls, Based on comparisons and EMRs are reasonable goals. But I would remind our policy gurus, And those who share similar views, Those who stand to be hurt will find exploitable holes. In the health care world of perplexing complexities, Wonks know not of endless concavities and convexities. Health care will never be a data- or leak-proof machine, That can be reduced to some overall routine. Dominated and dictated by absolute objectivities. So,… Read more »

Jayson
Guest

I’m sure the selling of medical data already happens