One of the best commentators around on the issues of patient safety, health care quality and basically everything to do with health care organizations is UCSF Professor Bob Wachter. Bob has been in the trenches as one of the leaders in the hospitalist movement, a major driver behind improving patient safety, and has also straddled the worlds of medical practice as a PCP, academia at UCSF, and been publicizing this all to a wider audience–particularly with his 2005 book Internal Bleeding and his more recent book Understanding Patient Safety. Then of course there are his occasional blog posts both on Wachter’s World and here on THCB.
This was a really fun conversation and somehow Bob remains an optimist. Here’s the interview.
Podcast: Play in new window | Download
Surprise, surprise, the British women who appear in the so-called Conservatives for Patients’ (so-called) Rights” propaganda are complaining that their words were twisted completely out of context. ‘We were duped’: Two British women tricked into become stars of campaign to sabotage Obama’s healthcare reforms. Further the British oncologist featured was told that he was appearing in a documentary, not in a right wing advertising campaign.
And most disingenuously of all—whether you agree with it or not—at no point have the Congressional leaders running the process or Obama introduced legislation calling for either serious single-payer (Canadian-style) or nationalized government provided care (UK-style).
So Rick Scott is conning people to twist their stories to run adverts to oppose something that no one is proposing.
Perhaps there should be $1.8 billion dollar fines for misrepresentation…
From the (UK) Independent. Real quotes from real people attending the free care in LA this week:
“I had a gastric bypass in 2002, but it went wrong, and stomach acid began rotting my teeth. I’ve had several jobs since, but none with medical insurance, so I’ve not been able to see a dentist to get it fixed,” she told The Independent. “I’ve not been able to chew food for as long as I can remember. I’ve been living on soup, and noodles, and blending meals in a food mixer. I’m in constant pain. Normally, it would cost $5,000 to fix it. So if I have to wait a week to get treated for free, I’ll do it. This will change my life.”
She works for a major supermarket chain but can’t afford the $200 a month that would be deducted from her salary for insurance. “It’s a simple choice: pay my rent, or pay my healthcare. What am I supposed to do?” she asked. “I’m one of the working poor: people who do work but can’t afford healthcare and are ineligible for any free healthcare or assistance. I can’t remember the last time I saw a doctor.”
“You’d think, with the money in this country, that we’d be able to look after people’s health properly,” she said. “But the truth is that the rich, and the insurance firms, just don’t realise what we are going through, or simply don’t care. Look around this room and tell me that America’s healthcare don’t need fixing.”
And that last one is the money quote.
The one on the left one protesting against the extension of health care to the uninsured at Sen Arlen Specter’s townhall meeting? Or the one on the right–some of the 1500 un and underinsured queuing for 2 days for care in inner-city Los Angeles (both photos from NY Times)
TV is fascinated by my views on American health reform. Well not American TV (you have to be called Michael Cannon to get on American TV).
Following my record-setting appearance on France 24 TV (record was fewest every viewers for a news show), today I’m going to be on CBC News. That’s CBC as in Canada. I think you can find it here and I should be on at 11.15 PST or 2.15 EST
The strange plot of the national debate over health reform this took another twist over the weekend, after (now suddenly ex- Alaska governor) Sarah Palin posted a statement on her Facebook page on Friday denouncing the Obama administration’s plan to reshape the healthcare system as “downright evil.”
In a statement referencing Ronald Reagan and the economist Thomas Sowell, Palin warned of bureaucratic “death panels” that would decide “if my parents (or yours) or my baby with Down Syndrome” are “worthy of healthcare based on their level of productivity in society.”
The full text of the post:
“As more Americans delve into the disturbing details of the nationalized
health care plan that the current administration is rushing through
Congress, our collective jaw is dropping, and we’re saying not just no,
but hell no.
The Democrats promise that a government health care system will reduce
the cost of health care, but as the economist Thomas Sowell has pointed
out, government health care will not reduce the cost; it will simply
refuse to pay the cost. And who will suffer the most when they ration
care? The sick, the elderly, and the disabled, of course. The America I
know and love is not one in which my parents or my baby with Down
Syndrome will have to stand in front of Obama’s “death panel” so his
bureaucrats can decide, based on a subjective judgment of their “level
of productivity in society,” whether they are worthy of health care.
Such a system is downright evil.
Writing in his blog in the NY Times, Uwe Reinhardt sets out three overarching goals of health reform
1. Financial barriers should not stand between Americans and preventive or acute health care that they sincerely believe will address concerns over a troubling medical condition, in a timely manner, before that condition grows into a critically serious illness.
2. Having received needed health care, no American family should be so financially devastated by medical bills that it cannot meet routine daily living expenses — for example, make utility or mortgage payments on time or finance the education of the family’s children.
3. The future growth in national health spending should be constrained to fall significantly below currently projected spending growth, which has the United States devoting about 40 percent of its G.D.P. to health care by mid-century.
All other goals are subordinate to these three overarching goals, as are the means to reach them.
Last week I posted a very similar “Two rules by which to judge a health reform bill”.
Rule 1 A health care reform bill needs to guarantee that no one should find themselves unable to get care simply because they cannot afford it. Neither should anyone find themselves financially compromised (or worse) because they have received care.
Rule 2 A health care reform bill needs to limit the amount of GDP that is going to health care to its current level, with an overall aim of reducing the share of health care going to GDP.
Uwe is a touch more eloquent in his goals 1 and 2 which split apart my Rule 1, and he’s a touch less aggressive in his goal 3, which is my Rule 2. But other than that these are the same.
Unfortunately in his column of the previous week Uwe created a list of 8 (but it could have been 20) completely contradictory statements about the completely “confused state” of what Americans seem to demand from health reform.
And right now the confusion seems to be winning.
I can’t say that I’ve been fantastically impressed by the Democrats’ choice of this year to go after health reform, or their explanation of what it is. And I understand that the only interest of the Republicans is to destroy any political win in the hope that they get a repeat of 1994…although it is just possible that despite their confidence the voters also remember the 2000–2008 period which will also precede the 2010 election.
However, the amount of crap emanating from the right about what’s in the health bills and the evidence of that by what’s showing up in the “tea parties” now invading Democrat congressional members’ town halls is quite extraordinary and does require at least some notice.
Segway inventor Dean Kamen thinks the wonkish debate over healthcare reform in Washington is largely missing the point. In an interview with Popular Mechanics editor-in-chief James Meigs and deputy editor Jerry Beilinson, Kamen tells the magazine:
“We now live in a world where technology has triumphed, in many ways, over death. The problem with that is that it’s enormously expensive. And big pharmaceutical giants and big medical products companies have stopped working on stuff that could be extraordinary because they know they won’t be reimbursed, according to the common standards. We’re not only rationing today; we’re rationing our future. ““If you project forward these horrific costs of treating everybody and you want to assume we are not going to respond to that by making the therapies better, simpler and cheaper and in some cases completely wiping out the [diseases], well you know what? We might actually get to that situation—if we stop investing in technology, if we stop believing that the future ought to be better than the past. ““If somebody in this country wants to explain to me that we ought to be spending about twice as much supporting sports as on all of our pharmaceuticals, then stop spending.” “I think this debate shows a fundamental lack of vision, a lack of confidence, a lack of understanding of what’s possible.”
We’ve been keeping tabs on Practice Fusion since the early days and THCB regulars will have noticed several comments and an article from CMO Robert Rowley. CEO Ryan Howard’s been hinting for a while that they were going to be getting into bed with a major software player, that shared their SaaS approach, and today they announced an investment from Salesforce.com, who we also know has been sniffing around health care too. This will include Practice Fusion becoming part of the Force.com (kind of an app store for the Salesforce.com ecosystem, although my guess is that few physicians are going there right now to look for records (not sure they’re going to Wal-mart either, though)
Practice Fusion is claiming that 19,000 users are already on its system which includes basic practice management, as well as a pretty complex EMR workflow. Coming soon will be a greater ability to share information with patients and other physicians over the platform—which allows it to spread via viral marketing. i.e. I’m referring you this patient, click here to get their data and sign up for this free EMR too. It’s not yet CCHIT certified, but Howard is aiming to be eligible for “meaningful use” money when the criteria are finally established.Continue reading…