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We’ve done some heavy dipping into the world of policy recently. In mid-September, I spent a day in Washington, D.C., with friend and advisor Tom Scully meeting researchers, senators, and a congressman. We heard from “ONCHIT” that “CCHIT”—which, as you know is an “ATCB”—granted us Stage 1 MU! This is great news for me, mostly because some competitors didn’t get it! (How’s that for starting a policy blog with some serious ABCs?!)
I met with some amazingly smart and engaged reporters who now (I think, get called “researchers,” since their newspapers can no longer afford them) work for the Henry J. Kaiser Family Foundation or NPR. They’re the real deal. They needed much less initial grounding in the problems we try to solve than most of the journalists we meet. They had taken on board the assumption that the move toward ACOs means less waste (which it could for some) and can get everybody in the clinical supply chain on one system (which has been seen to work at times).
But none of them appears to have considered the idea that there is a relationship between a healthy integrated health information ecosystem and a health information exchange marketplace. It’s still surprising to me, but precious few people correlate sustainability of any social good with the existence of a healthy marketplace with enough room for flexibility to allow innovation over time. It’s like the single economic condition responsible for ALMOST ALL of the social progress of this nation since inception, but in health care it’s still kind of a new idea.
It was the same when I met with the Senators and a member of Congress. I got together with folks from both sides of the aisle (okay, just one Democrat) and they all rightly wanted to know one thing before anything else: Is there anything in current law that might actually HURT us? Since the answer was mostly NO (after a small gripe about how I wish there were no HITECH incentives), they moved on to ask: Is there anything in the law that might HELP. Here again, I was mostly in the thanks, but no thanks camp, but I tried to plant the seed of flexibility around exchange of market information.
It seems to me that:
A) We have the technology to create a confederated chart across many providers on many systems.
B) Regardless of how many systems anyone is on, maintaining a single set of information to be used by many different players takes ongoing care and feeding.
C) There are advantages to society in having the keeper-of-information function separate from the biller-for-services using that information.
Just a thought.
Jonathan Bush co-founded athenahealth, a leading provider of internet-based business services to physicians since 1997. Prior to joining athenahealth, he served as an EMT for the City of New Orleans, was trained as a medic in the U.S. Army, and worked as a management consultant with Booz Allen & Hamilton. He obtained a Bachelor of Arts in the College of Social Studies from Wesleyan University and an M.B.A. from Harvard Business School.
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Centralizing insurance, as it has in every other Western notian, will help contol out of control medical costs.And the way that happens is by rationing care. There’s a limit to how efficient medicine can be, and a floor to how much you can artificially reduce costs without being forced to ration what people get in terms of services.And your whole market fundamentalist thing is silly. If you’re going to come out of the gate accusing anyone who doesn’t see things your way of being a fundamentalist you’re not really interested in really debating the issues, are you?Read the . The system we have is already not fiscally sustainable over the long term. There’s no magic pixie dust that government can wave that makes healthcare suddenly so efficient that a centralized system can be effective. The way they keep costs under control is the way that all universal single-payer systems do by rationing care.You can’t compare France and Germany to the US because those countries have significantly smaller and less diverse populations. Again, a system that works in a small, homogenous population won’t necessarily work in a country with 400 million people, many of whom are recent immigrants from countries with poor healthcare to begin with.Your whole conceit is that government is somehow vastly more efficient than the private sector in allocating resources which the entire history of the 20th Century says is manifestly not the case. Yes, government can control costs, but they way they do so is by telling patients that if they want an MRI or an experimental cancer treatment, they’re out of luck.There’s a reason why such a plan has not passed in the United States, and that has to do with the fact that given the choice no one wants to substitute one massive bureaucracy for one that’s even larger and even less responsible.
There are a lot of perks to having a system of electronic health records that can communicate with each other, but at the same time I think there are a lot of patients that don’t want their personal health history to be shared with anyone but their own doctor. I work with self-pay patients and I hear that a lot more than I had ever expected to. It is viewed as another step to “Big Brother is watching” when our health history gets turned over to records systems that sell or share that information with any number of other groups. Privacy is a part of freedom.
Sustainability just makes sense. Whether it is your environment, your food source, or your medical care, you have to wonder if the cure is worse than the disease. Sure, we’re living longer, but I’ve got to ask… What is the quality of that life.
I try to live by the rule… “Only eat it if my grandmother would recognize it.”
Life’s short. Play to win.