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What’s wrong with individual health insurance mandates by Claudia Chaufan

Individual health insurance mandates have lately been hailed as the solution to the health care crisis in America. Mandates to buy health insurance have been included in legislative proposals at the state level – for instance, by Gov. Schwarzenegger and Speaker Nunez, in their “Health Care Security and Cost Reduction Act”, or at the federal level, by Hillary Clinton in her “American Health Choice Plan”. Can mandates achieve universal access to health care and control rising costs of medical care? This article explains why they can’t.

Lately, legislation including a universal mandate – a legal obligation that everybody purchase a health insurance policy – has been hailed as the solution to the health care crisis in America. At the state level, mandates have been included, for instance, in Gov. Schwarzenegger and Speaker Nunez’s “Health Care Security and Cost Reduction Act”, and at the federal level, by Hillary Clinton in her “American Health Choice Plan”. Yet many of us remain skeptical. Why? After all, if everybody is forced to buy a health insurance plan – maybe with a subsidy if you are “poor enough” – would this not resolve the problem of uninsurance? Maybe so. But the real question is: would mandating universal health insurance guarantee universal access to medical care? And the short answer is no. 

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Healthcare and The Gathering Storm – Brian Klepper

Here are two very interesting and frightening charts that my good friend Warren Brennan, the CEO of SMA Informatics in Richmond, passed along this AM, with this question, aimed at the CFOs of hospitals and other health care organizations:

What do these mean for bad debt and for the health care sector’s future financial performance?

Earnings_change

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Clinton v. Obama on Healthcare, by Bob Laszewski

This is a repost of an original that addresses Hillary Clinton’s claim, repeated in last week’s Texas debate, that only her health plan accomplishes universal coverage because it has a individual mandate and Barak Obama’s does not. Senator Clinton goes so far as to say she would garnish wages to enforce her mandate that everyone buy health insurance. Hillary Clinton has gone on the attack in recent days criticizing Barack Obama’s health care plan. She charges that his plan would not cover everyone and hers would.

Is she right?

Senator Clinton has an individual mandate in her plan. That means
that everyone would be required to purchase coverage or suffer a
penalty she hasn’t defined. Senator Obama does not have an individual
mandate in his plan although he would require all children to be
covered. Both candidates would require employers to cover their
employees.

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An Analysis of Senator Hillary Clinton’s Health Plan Proposal by Robert Laszewski

This is nothing like the Clinton Health Plan from 1993.

Senator Clinton has so far been running a smart campaign for President — at least on the policy side — and her health care reform strategy is no exception. She waited until after all of the leading Democratic, and most Republican, candidates had announced their plans and then stuck her plan right in the ideological middle of where her Democratic opponents put theirs. It also looks a great deal like a bipartisan plan enacted in Massachusetts and a bipartisan compromise in the works in California. So on the day it was released, it was correctly identified as being relatively centrist.

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TECH: Fred Trotter meets Dr. Peel

I was on my way to see Deborah Peel’s talk yesterday when I was waylaid by a previous engagement that I’d mischeduled in my calendar. Given I had 4 people waiting for me I couldn’t break it but I was very disappointed to not be there.

Fred Trotter was there and had some of his questions answered. Unfortunately he didn’t ask the ones that I am getting so worked up about.

Now I’m off to see Newt Gingrich. Perhaps I’ll get a chance to ask him about his views on it. (And for the record the Google party was fabulous!)

TECH/PODCAST: ICW’s Jeremy Coote

ICW is a German-based  consumer facing record company, that is dominant in Germany and several Eastern European countires. Over here they decided that their skills lie in integrating data from disparate systems, very much a Health 2.0 trend (which is why they’re a Health 2.0 Conference sponsor).

They also announced a major open source initiative with Agfa and Sun this morning–which will hopefully give a boost to open source in health care (which thus far has been a somewhat small and lonely community)

I spoke to ICW America CEO Jeremy Coote today.

PODCAST/TECH: The new Virtual Palomar West

My first interview at HIMSS is with Orlando Portale, CIO and Michael Covert, CEO of Palomar Pomerado Health in the San Diego area. They’re planning a new hospital and are working with Cisco and have put together a fun video about their new Virtual Palomar West in Second Life. They both had some really interesting things to say about how to build a large new hospital and how to plan for its use for a long, long time ahead. Here’s the interview.

(FD, Orlando and I are both on the advisory board for HIMSS Community for Connected Health, sponsored by Cisco, and I have done consulting work for Cisco in the past).

Health 2.0 – Patient-oriented Health Care, by Dan Kogan

Dan Kogan is a veteran IT developer who built some matching systems now prevalent in financial institutions. He’s now turned his attention to healthcare and has started Health World Web. I (Matthew that is) have been advising him as he gets going, and have therefore (as I allways want good material) bullied him into writing about his view of why health care is ripe for this technology and a little about what his company plans to do. (Don’t forget that the same offer is open to anyone who wants to write on the Health 2.0 Blog)

When exactly did the power of healthcare move out of the hands of the people and into the hands of the doctors? Historically, patients do not take the upper hand when it comes to choosing the proper healthcare. Choosing the right doctor becomes a nerve wrecking game of cross referencing the insurance listings with yellow pages, the general listings of a Google search inquiry with proprietary knowledge or word of mouth. Finding a good doctor often reminds a patient of a game of dice. The chances of rolling two 6’s are equal to 1/36 or about 3%. What comes into the equation is the patient’s insurance, the insurance a doctor will accept, the potential path to the specialist through the gatekeeper (if one is required), locale and then, just pure randomness in getting to one of the more than 700K licensed MDs.

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More on Google and the Cleveland Clinic

For a start, as I said in my last post  and many times, and at least one of these commenters has written at length, the benefits of sharing health data in clinical situations massively outweigh the risk. So that should be the focus of the discussion.

I am NOT saying that there shouldn’t be privacy protections and there is no reason in my mind why, for all HIPAA’s flaws, it cannot be extended to PHR providers as covered entities.

However, as far as I can tell nothing that is happening here violates HIPAA. Showing you keyword based advertising may not to everyone’s taste, but it does not mean your private health data is being transferred to anyone. And presumably your data will only end up in these services if you give them permission to accept it, which will include consent to provide whatever services and advertising you’ll see.

And that’s assuming that either company does advertising based on records rather than search terms (which is Google make that 98% of their money).

But exactly where are Microsoft and Google suggesting that they’re going to be selling private identified data? Nowhere. Microsoft has bent over backwards to demonstrate that they have no intention of allowing themselves or anyone else to access your health records without permission. And Google will likely do the same when it announces its plans officially.

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TECH: HIMSS Today

Today it’s HIMSS. Yesterday I spoke to the CHIME CIOs and had a good time. Today I’m talking to the Cisco Community for Connected Health and the rest of the time I’ll be accosting people with a microphone. Come back over the days to come to see.

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