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Plan B

• 17

By ROBERT LASZEWSKI

Robert Laszewski

With word that the House is likely to take up the repeal of the health insurance industry anti-trust exemption it  is now clear the Democratic leadership has begun Plan B.

It is also clear that this is much more a part of a political Kabuki dance then any substantive effort at even piecemeal health care reform.

The House probably has the votes to pass the repeal. The Senate does not. I doubt that even all of the 59 Senate Democrats will vote for it if and when it does come up on the floor of the Senate.

The base of the Democratic Party, as well as many “progressive” Dems in the House and Senate, are rabidly mad about not being able to ram their health care bill through. That is why you continue to hear all of the talk about reconciliation options even though there is no chance such a scheme would pass either the House or Senate.

But what to do? The apparent answer is to bring up a few smaller health care bills the Democratic leadership views as popular back home and expect the Republicans will vote against them. Right now health care is a big negative issue for the Dems given the unpopularity of their effort to date. But if they can be seen trying to pass a few smaller measures “we can all agree on” only to be thwarted by Republican opposition their hope is they can turn the table on this issue to their advantage—well before they get to November.>

Interesting politics but no hope for any real progress while these games play out.

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When the Democrats say they believe they can still pass a health care bill are they bluffing? That’s my opinion.

Here is a first rate story from Politico on their options and the dismal political reality each faces.

Autism and the MMR: Finally a Retraction

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By NAOMI FREUNDLICH

Are we finally ready to close the door on the much-disputed link between the MMR vaccine and autism?

On January 30, Britain’s General Medical Council ruled that Andrew Wakefield, a gastroenterologist, had acted “dishonestly and irresponsibly” in conducting his research that established a link between autism and the MMR vaccine. And yesterday, the British medical journal Lancet finally retracted the resulting 1998 study authored by Wakefield that helped drive MMR vaccination rates in the U.K. down to the point where in 2008, measles was officially declared “endemic” in the country.

The Lancet’s editor, Richard Horton, told The Guardian “It was utterly clear, without any ambiguity at all, that the statements in the paper were utterly false,” he said. “I feel I was deceived.”

The GMC investigation, entailing 197 days of evidence, submission and deliberation  between July 2007 and  January 2010, exposed an unscrupulous researcher who falsified data, used sloppy laboratory techniques and subjected children to painful and potentially harmful medical tests like lumbar punctures and multiple colonoscopies to try and prove his notion that MMR vaccinations cause bowel disease and autism. Wakefield even went so far as to offer children attending his son’s birthday party £5 to donate blood samples.

The investigation of Wakefield and his shoddy and unethical research methods began in 2004 when British journalist Brian Deer began talking with parents of the 12 children involved in Wakefield’s study and reviewing medical records. Since then, Deer has dedicated countless hours and words to setting the record straight about Wakefield’s work—including the finding that his research was funded by lawyers representing parents who planned to sue vaccine makers for damages.

Continue reading…

The Health Assurance – Disease Insurance Plan

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By NORTIN M HADLER, MD

Hadler_nortin The American health care delivery system is reprehensible for the degree to which it tolerates the under-treatment of those in need and supports the over-treatment of those who are entitled. It invests vast wealth in its own entropy. I don’t want to belabor all this shamefulness. The best we can do is to superimpose rationality on the current system—iron clad, science supported, and patient driven rationality with the goal of assuring health and providing recourse when that assurance falls short. We are advantaged by a cadre of physicians who are culled from the ranks of the best and the brightest and who would like nothing better than to do what is right by their patients. The moral charge to our society is to design a system that exists for no reason other than to provide for the wellbeing of both the sick people and the sick peoples amongst us1. To begin to do so demands confronting 3 of the current system’s most intransigent and least recognized moral lapses: licensing overtreatment, institutionalizing conflictive relationships, and promoting perverse incentives.Continue reading…

Coming Short with Thinking

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By ROB LAMBERTS

I am mad at congress.

I don’t care if they are Democrats or Republicans, I am sick of healthcare being treated as a political football. How much more of a crisis do we need before we actually start working on a solution? Why does each party have to sit on its side of the aisle shooting spitballs at the other? Each side has its pet issues that are tied to contributors, supporters, and lobbyists. Each side will work to see the other side fail even if the other side is right. Each side seems unable to do anything unless there is political value in it. Power is more important than service, and power is a short-term project.

The real problem is that congress is thinking of short-term political gain while sabotaging the long-term. It’s like the publicly traded company that works to maximize quarterly profits even if it damages the corporation in the long run. Our society thinks in the short not in the long, and our congressmen are doing so in a way that harms all of us.Continue reading…

Todd Park speaks: Free the data!

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By Matthew Holt

Todd Park is definitely one of health care IT’s good guys. Todd was the brains (though not the mouth!) behind athenahealth. After he left athenahealth, he spent a year back in California doing angel investing (Ventana among others) and being a dad. But despite his desire to stay on the west coast, he was dragged into the vortex known as Washington DC, and for the last 5 months he’s been the (first) CTO of HHS. (By the way, he cashed out his investments, and politely turned down my proposal to “care for” his cash while he was being a public servant!)

Todd gave the keynote yesterday at the Health IT Summit for Government Leaders. He describes his job as unlocking HHS’ “inner mojo” in terms of data use and technology innovation. So what are the big deals he sees? These are my notes on his fast talking!

1) HITECH/ARRA is not about for paying for software. Its purpose is to incentivize “meaningful use”. He wants to make sure that people understand that the NHIN (National Health Information Network) is not a thing. It’s a set of policies and services that people can use to make health data work over the Internet. It is NOT a parallel network. And at the end of the day, what’s going to make this work is the private sector — including vendors modifying their products to match these policies.

2) Leveraging the power of HHS data for public good. The amount of data HHS has is “ridiculous”. It has a set of sets of data. Todd is a paid up member of Tim Berners-Lee “free the data” club. They’re adding all kinds of data sets to data.gov including every grant, patent et al licensed/paid for by HHS. Todd calls this “data liberation”. They’re also creating community health maps where data on community health performance can be mashed up with other types of maps (real estate, job listings, et al). In addition, they’re doing “smart targeting” — an attempt to combine findings from different/disparate data sets without waiting to do the big database integration. He’s hoping to use techniques that the intelligence community uses to link, say, emails and bank wires, to similarly track, say, disease outbreaks, drug interactions, etc.

Continue reading…

Simple Steps to Meaningful Health Reform

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By KIM BELLARD

Picture 79 Now that health reform at the federal level seems to have hit an impasse, Congress and the Administration are scrambling to see if anything can be salvaged this year.  Although both the House and Senate bills are severely flawed, each falling short both on true health reform and on fiscal responsibility, it would be a shame if we walked away from these efforts with nothing to show for it.

Doing something about those “evil” insurance companies remains a primary target, with brave talk still coming out about removing the ability of health insurers to consider pre-existing conditions in accepting new applicants.

This singular focus ignores two important facts – first, that this problem is primarily in the individual market, since such use of medical underwriting/preexisting conditions exclusions is largely absent from the predominant group health insurance market, and second, that such restrictions will inevitably lead to higher costs.  The latter statement is not fear-mongering; it is Economics 101.Continue reading…

10 Insights on the iPad

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By DOUGLAS GOLDSTEIN

Ipad The iPad got it right and will set the standard for a new and improved way to enjoy our connected lifestyle. The iPhone blazed the way as it shifted mobile phones from something to talk on…to powerful multi-app platforms that solve many problems and just happen to make phone calls, too.

The iPad and soon many similar devices will revolutionize the way we experience life and work from newspapers, t.v. and movies to fitness, personalized health and medical services. Here are 10 insights for delivering person- centered fitness, health and health care inspired by the iPad, iPhone and iPod Touch from Apple, the world’s leading MD (Mobile Device) company.Continue reading…

Collecting Patient Info in Haiti Using the iPhone

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Dr. Elizabeth Cote, from Harvard Humane Initiative collects patient data at Fond Parisien, Haiti using iPhone and iCharts from www.CareTools.com. The developers were kind enough to customize the form in less than a week to support fields and info required to comply with international disaster data collection standards. HT / Dr. Enoch Choi

Job Post: THCB Editorial

THCB is looking for talented interns to assist with editorial, research and web production tasks as our web site undergoes a major expansion. Perfect for a grad or med student with an interest in journalism, public policy, and/or the business of health care.  Work out of a great home office location in the Princeton area, convenient to both Princeton University and UMDNJ. Reasonable train ride from midtown Manhattan. Production and research opportunities may also be available in our San Francisco offices for qualified candidates.

Editorial candidates should have an in depth familiarity with at least one area of the healthcare or tech industries and strong writing and editing skills.  Web production candidates should know their way around content management systems like Typepad (our current platform) and
WordPress, our CMS in the not-too-distant-future.  Basic photoshop /fireworks / gimp or comparable image editing software required.

Send us an email telling us a little bit about yourself and detailing the reasons you’re interested in the position. If you’re a candidate for the editorial role send us a few clips to give us a feel for your writing style.

Responses to THCB  Editor in chief John Irvine jo**@***************og.com. No calls please!

Check Lists and Decision Trees versus Spontaneity and Imagination

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By KENT BOTTLES

The task of health care reform in 21st century America is to decrease per-capita cost of care and to increase the quality of care delivered to patients. It’s complicated.  A famous Rand study concluded that Americans only receive 55% of the care that science dictates. Patients intuitively believe that more health care is always beneficial. Medicare reformers would like to do comparative effectiveness research so that CMS and private insurers could wind up paying only for therapy that actually works. Some estimate that 30% of all care delivered in the United States is waste.  What some call waste, others label revenue, and Atul Gawande becomes famous for identifying waste/revenue in McAllen, Texas (http://bit.ly/ENlli).

Neuroscience tells us that the smartest human can only keep track of seven variables at one time, and physicians tell us that diagnosis and treatment of a complicated patient can involve as many as 100 such variables.  Computers are good at cataloging, organizing, and retrieving information, but physicians are not yet routinely utilizing them at the point of care.  Computers are also good at allowing us to analyze large data sets and learn from experience.   Patients yearn for the warmth and caring of a doctor who really knows and cares about them. Behavioral economics pioneered by Amos Tversky and Daniel Kahneman taught us that human brains are designed with inherent biases that make us less than rational decision-makers.  We now know that human physicians and patients suffer from biases such as Pygmalion complex, confirmation bias, focusing illusion, incorrectly weighing initial numbers, and being more impressed with single cases than conclusions based on large data sets (http://bit.ly/49q4Uy).Continue reading…

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