Futurist Jeff Goldsmith’s analysis of issues that could cause problems for any health reform effort that eventually emerges from the foodfight in Washington this summer provoked a wide range of reader replies.   (“No Country For Old Men“)  Goldsmith wrote in response:

“The fun part of this blog is how much you learn about an issue when you post something.  Several learning points: 1) How big a deal this is.  $1.6 trillion sounds like a lot of money, but over ten years, it’s less than 1% of the cumulative GDP over those ten years (which I grew to $16.8 trillion from its present $14t in 2019).  In other words, it’s peanuts.   Cumulative health spending over this time looks like over $40 trillion, so  even $600 billion in Medicare cuts looks like peanuts.   These are small numbers made to look big because of the ten years.  Plus ten year numbers are BS anyway because you never get a linear increase over that type of time span.  $1.6 trillion actually sounds like  Dr. Evil’s ransom demands in Austin Powers. . .”

THCB Reader Margalit offered this response to Dr. Rick Weinhaus’s open letter to former Harvard professor Dr. David Blumenthal, the man charged with masterminding the Obama administration’s ambitious health IT push (“An Open Letter to Dr. David Blumenthal“), urging the administration to rethink support for the current EMR certification process …

“Maybe Dr. Blumenthal should come up with two separate “certification” suggestions similar to the auto industry.

1) A minimal set of standard security and safety items. Nothing too fancy and complicated. Something like car emissions and inspection that products have to pass every year in order to “stay on the road”.  Once the criteria are set, the inspection and certification body should be distributed, just like the inspection centers for cars, and multiple private bodies should be able to apply for the status of “Certification Center”.

2) This should be in the form of funding a Consumer Reports like entity, that is completely and totally unbiased, for evaluating EMRs and other health care applications. The Healthcare Consumer Reports should have very strict regulations regarding who it can receive funding from. Maybe the folks at the real Consumer Reports would like to take this one on. I would be inclined to trust them more than anything else that comes to my mind right now.”

Reader Candida also chimed in on the thread on usability prompted by Weinhaus’s proposed EMR design (“The EHR TimeBar: A New Visual Interface Design“), but posed a slightly more provocative question.

“The HIT and CPOE devices out there are an ergonomic failures and that alone renders them unsafe and not efficacious. But that is not the only defect harbored in these CCHIT “cerified” devices that causes injury and death to patients. There are many that are worse and they are covered up. The magnitude of patient injury and endagerment is hidden. The fact is that these are medical devices and as such, none have been assessed for safety and efficacy. CCHIT leadership, when asked about what it does if they get a report that a “cerified” device malfunctions in the after market and results in death, stated that they do not consider after market surveillance in their domain. One can take this a step further. How is it that medical devices are being sold without FDA approval?”

Dr. Evan Dossia wrote in to challenge critics who blame rising malpractice rates on physician attitudes and – in some cases – their ties to the insurance industry, in the thread on Dr. Rahul Parikh’s post looking at how the American American Medical Association is viewed one hundred and fifty years after the organization’s founding. (“How Relevant is the American Medical Association?“),

“Physicians began to be abandoned by big name insurance companies in the mid-1970’s so instead of “going bare” we started our own companies. As we continued to have ups and downs in the malpractice insurance market, more physician oriented companies appeared. Doctors now prefer companies started by other doctors and run by other doctors because these companies fight for their share holders rather than settle with plantiffs attorneys in order to avoid court room battles.”

Fellow reader Tcoyote agreed with industry analyst Robert Laszewki’s criticism of the rumored exemption that the Obama administration may give to labor unions, exempting them from any tax on health benefits for a period of five years. (“Unions May Get a Pass on Health Benefits Tax.”)

“Of course, this is politics, and the Democrats must throw the unions, whom they are stiffing on the “Employee Free Choice Act”, some kind of bone to get health reform financed. True enough, unionized workers’ after tax income isn’t protected by collective bargaining, but if unions knew it could fall by 5-7% because of a benefits tax, they would have asked for more in wages to cover the cost. I completely agree with the Chrysler/GM analogy. Those gold plated benefits are a major reason why our manufacturing sector is in trouble …”

Sarah Greene of the Group Health Center for Health Studies had this to say in response to Weinhaus’s take on a new and more usable electronic medical record design …

“It’s curious to me that human-computer interaction does not seem to have much traction in the EHR world, and yet in the consumer-centered Personal Health Record community, it is a guiding principle. While some might wonder if this suggests that doctors are super-human compared with patients (grin), it strikes me that the EHR developers of the world could take their cues from patient-focused efforts such as Project Health Design (www.projecthealthdesign.org)”

9 replies »

  1. Republicans are so entertaining. They seem to have no ideas and no creativity unless they’re attacking our new president or someone who supports his agenda.
    They seem to be everywhere, waiting to pounce on a pro-Obama comment online, surfing the web and planting nasty, often blatant lies about dems every time there’s some new news to report.
    And their response is always the same. Never- wow, America, we really screwed up voting for George Bush twice, what we’re going to do now instead of bashing everything the new president tries to do, is come up with some creative ideas to help get this country out of this mess.
    You don’t hear that, instead they go into elaborate explanations about how the dems did it or why the current guy on the job is the reason we are so currently screwed.
    I guess that is to be expected. They get it from their leaders. When Bill Clinton was running a smooth ship and roaring economy they were told, “Oh he just inherited the genius policies of Ronald Reagan. This surplus and booming economy has nothing to do with that godless heathen.”
    I always wanted to ask and finally got my chance one day, if it’s true that Bill Clinton’s prosperous years were the byproduct of Reagan’s political and financial super powers, doesn’t that mean that Reagan’s boom years were really the great and tremendous results of the highly ridiculed Jimmy Carter?
    Of course, the Republican laughed. Oh no, that scenario didn’t apply.
    For years, while Bush was driving us into what Jon Stewart calls the Closterf*** to the Poorhouse, his followers were being told that the president doesn’t employ people, the president doesn’t control the economy, business does.
    But now that our new president is installed all we hear about is how Republicans are catching conniptions about the escalating deficit, the unpaid for programs, and the skyrocketing unemployment. Oh- the stimulus to help the struggling, investment in public education, reforming the decrepit health care system and stopping the foreclosure- all that won’t work, it’s no good, it’s draining us.
    As though the CEO and Commander and chief of this country were responsible for that.
    I recently went online to leave a message and let the public know about The 5 Dollar Revolution, a way to pay for health care without raising taxes. Before I could even finish typing two very nasty comments lit up my inbox.
    Who criticizes a plan that doesn’t penalize people who already love and have insurance and won’t cost them anything? Only a person who uses their time and energy to tear down others so much the reflex to condemn shoots out like pus.
    I have a tip for my republican brethren. Instead of sucking up the venom that is Rush and Sean, why don’t you come up with a way to get us out of this mess? So you think everything the president has to offer is just poo-poo. So where’s your idea?
    Where’s your plan? How do we fix health care? How do we improve education? How do we cut the deficit?
    I’m still waiting.
    And that, my friends, is the problem. When we- republicans- or anyone else, are so concerned about what someone else is doing we can’t focus on what we can and should do.
    Republicans are perfectly capable of blasting some woman who doesn’t want to bring another child into the world (I’m not for abortion but I see why in some cases it looks like the best option), and they’re capable of telling people to snap out of their whining and pull themselves up by the bootstraps.
    So hear ye, hear ye, downtrodden and heavy hearted republicans: Get some balls and take your own advice. If you really love this country like you say you do, get some ideas and help get us out of this mess. After all, you started it.

  2. With the word trillions being used when you hear about funding health care we often overlook some basic games people can play with numbers.
    This year Medicare will spend a little over 400 billion dollars to cover the elderly, the very sick and those (so I heard) in congress.
    That’s including the Prescription health care scam- I mean plan, passed by George Bush which added over 100 billion dollars a year to the plan, mainly because the government was barred from negotiating a more competitive price for drugs covered under the plan!
    Think about that.
    It only takes 300-400 billion a year to cover the most sick, unemployed elderly and those with chronic conditions that cost the most.
    So why are we being told that it will take a few trillion to cover the uninsured?
    Because that’s what the lobbyist and crooked pols want us to think.
    I have researched the health care issue and was shocked by these numbers.
    *Less than 1 million people have a heart attack each year.
    *Less than 1 million people have a stroke each year.
    *There are a little over 1 million new cases of cancer each year (not including skin cancer).
    So what does a plan like The 5 Dollar Revolution do?
    When the uninsured put 5$ a week into a national health care fund that will raise 5-10 billion dollars.
    With that amount you can:
    Compensate doctors, hospitals and specialist @ 5,000 facilities @$500,000 per yr/per center. That’s:
    60 Dr’s offices per state
    20 Specialist per state
    20 Hospitals per state
    They must see a set number of patients per day and cover basic services.
    Total Cost: 2,500,000,000
    Note: 6-7 million people may not be able to contribute anything so we must have a plan that isn’t dependent on 100% participation.
    And The Five Dollar Revolution does not rely on everyone to fund its goals.
    The plan also raises funding from employers who don’t currently cover their employees. Most importantly, funding emergency care and serious conditions is addressed by an underutilized system that:
    Raises money
    Invest in retirement
    Is as safe as a bank and safer than the stock market
    Will reduce the deficit
    Will improve our national savings rate
    Will strengthen the value of the dollar
    This plan also addresses mental health, prescription drugs and most important of all, preventive care.
    It’s affordable for employers and can make mandated coverage a possiblity.
    We can make a difference in this debate by backing a plan that meets all the president’s criteria and leads to coverage for everyone at a price they can afford.
    Check out The 5 Dollar Revolution.com for more details. There are even simple ways to cut cost and at the same time give patients the quality of care they deserve.

  3. I applaud what Obama is doing and for all thw rok you put into carefully outlining your argument you offered NO SOLUTION. But I guess it is easier to spend your time whining about what won’t work instead of getting down to the real work of solving the problem.

  4. President Obama is using the big lie to convince voters that when his government HMO, otherwise known as the “public option” begins cutting their access to high-cost procedures and drugs, they’ll be better off.
    Yesterday, he told a town hall meeting populated with his supporters and supporters of nationalized health care insurance:
    “The biggest thing we can do to hold down costs is to change the incentives of a health care system that automatically equates expensive care with better care,“ the president said. He said the formula system drives up costs “but doesn’t make you better.“
    Yes, like when a doctor tells a patient with bone on bone knees that won’t let her walk to take a few Tylenol™ instead of having her knees replaced for a few thousand bucks. Or when a Kaiser HMO doctor tells a 60-year-old guy that he should wait until he’s 65 and covered by Medicare instead of Kaiser to have his knees replaced. Knee and hip replacements get patients up and walking in six to eight weeks, allowing them to resume their normal, productive lives. Tylenol™ doesn’t make painful bone on bone knees better. Under ObamaCare, if you’re in your 70s or 80s and have comorbidities, you won’t get a new hip or knee. You’ll be told to “live with it” and to “tough it out.“
    Or when an obese patient is facing a lifetime of depression, diabetes and unemployment, and a doctor advises the genetically impaired, virtually immobile patient to “eat right” and “get more exercise” instead of undergoing bariatric surgery. The latter gives a patient a new lease on life, often ends diabetes and makes the patient more confident in dealing with the world and in seeking employment. Dieting and exercise are free cures. Bariatric surgery costs thousands and provides a huge return on investment.
    Maybe it’s better to get more exercise, diet and eat more fish than to take prescription fish oil pills and other expensive remedies such as Lipotor™, but then you’ll die earlier, saving insurers and Medicare a lot of money. I guess that’s what Obama wants.
    Under Obama’s government HMO, if you need a bypass operation when you’re 79, you may not get it. It’s be “better for you” to die painfully and slowly. You can take comfort in knowing that you’re reducing the federal budget deficit by foregoing life-saving surgery.

  5. The Goldsmith thread seems to be closed.
    I’m late to this discussion, which, it seems, we’ve been having for some 30 years, on and off.
    You’ll hate to see this, but I agree with many of your thoughts and have been blogging accordingly.
    A couple of additional thoughts.
    First, as I blogged several weeks ago, I don’t think Congress has ever enacted a successful payment reform. Agree?
    Second, when Congress makes a mistake, it is huge, affects a lot of innocents, makes a few special interests rich, and it takes years to fix the mistakes. Think Medicare, Medicaid, Prospective payments/DRGs, the Balanced Budget Act of ’97, etc.
    Third, Obama talks about health care with the knowledge of someone who’s just written his first term paper on the topic. Ben Bernanke had the same problem when he testified on health insurance last year. So we have the blind (Obama) leading the ideolouges (Kennedy, Waxman, et al) and both of them appealing to the gullibles (single payer dreamers).
    Fourth, Obama seems to believe he can get away with telling big lies. People are calling him on his promise that the public option won’t force people out of their current plans. The media are calling him on planting questions about all sorts of things at his town hall meetings and press conferences. Polls are showing the public doesn’t believe much of what he’s promising, and we shouldn’t, imho.
    Finally, Obama is saying more expensive care isn’t better care. That’s another big lie, as I’ve blogged below:

  6. Hopefully that will improve health for all on this, the government must give force to the health sector, as there are many people who suffer from chronic illnesses and who need help to cover expenses stronger as fibromyalgia, cancer, producing a series very heavy cost to those who suffer as they must take powerful drugs such as oxycodone, Vicodin, Lortab, drugs that are highly controlled and that findrxonline indicate that opioids are very strong and anxiolytics do not know if that can be given life-threatening that consumes, that is why many times the costs are too high to be able to obtain and soothe the intense pain.

  7. Agree w Candida and Marg. HIT will increase the costs of health care for enumerable reasons already stated. Additionally, if the doctors were paid to be accountable, as posted by “Economics 101 Prof” at WSJ Health Blog, the $billions will be there for health care reform without extra taxes, mandates, womandates, and other gimmicks of control by the Feds. Finally, proving HIT gizmos to be safe and effective will only increase the likelihood of acceptance. Why spend $thousands or $millions on machines that a trade group called CCHIT “certified”, but forgot to test if they are safe and usable?