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Matthew Holt is the founder and publisher of The Health Care Blog and still writes regularly for the site and hosts the #THCBGang and #HealthInTwoPoint00 video shows/podcasts. He was co-founder of the Health 2.0 Conference and now also does advisory work mostly for health tech startups at his consulting firm SMACK.health.

Why Hillarycare failed…and what we need to learn from that failure

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By MATTHEW HOLT

In July 2005 George W Bush had relatively recently won a Presidential election in which the Republican won the popular vote (something that will likely never happen again) & the Republicans controlled all three branches of Government. Those of us liberals at the bottom of a dark trench were wondering if and how we’d get to health reform. So in another reprint to celebrate THCB’s 15th birthday, here was my then take on what went wrong in 1994 and what would happen next–Matthew Holt     

There are lots of versions about what killed the 1993-4 health care reform effort.  Hillary Clinton has now decided that the problem was the lack of incrementalism in her plan.  Last week the New York Times said that since becoming a Senator:

“She has deliberately avoided the major mistake she made as first lady, namely trying to sell an ambitious plan to a public with no appetite for radical change. <SNIP>. She summed up her approach in the first floor speech she delivered in the Senate about four years ago, when she unveiled a series of relatively modest health care initiatives. “I learned some valuable lessons about the legislative process, the importance of bipartisan cooperation and the wisdom of taking small steps to get a big job done,” she said, referring to the 1994 defeat of her health care plan.”

On the other hand, some people are still claiming victory for the plan’s defeat even if they were at most modest bit players.  Here’s what one fawning bio says about former New York Lt Governor Betsy McCaughey

“A 35-year-old senior fellow named Elizabeth McCaughey…wrote an article for The New Republic on what she discovered in a close reading of the 1,431-page document containing the Clinton Health Care Plan: Namely, that it would put every citizen in a single government-operated HMO. That one article shot down the entire blimp, and Betsy McCaughey became a 35-year-old Cinderella. One of the richest men in America chose her as his wife, and George Pataki made her lieutenant governor of New York.”

Ignoring the fact that McCaughey spent her time thereafter putting poor New Yorkers into those HMOs she so despised, and then went off the deep end en route to divorce from Pataki, the rich guy, and reality (not necessarily in that order), it’s not really true that one article in The New Republic can be quite that influential. (Sorry Jon!).  Even if the overly geeky Clintonistas in the White House did feel that they had to come out with a point by point rebuttal. And anyway, the article only came out in January 1994 by which time the die was more or less cast the other way. Again we have to look elsewhere for the explanation.

If you want to go back and spend a few minutes wallowing in the era of trial balloons and secret task forces, there’s a very interesting time line of the whole process on the NPR website, as well as a briefer information over at the Clinton Health Plan Wikipedia site.Continue reading…

SMACK.Health–Getting Clear on the Concept

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I’m going to be announcing some big changes on THCB and with my overall services in the next little bit. So to prepare for this, here’s a rather good explanation I did last year in Australia of what I mean by SMACK.health — randomly the interviewer was Jessica DaMassa with whom I now do #Healthin2pt00 — Matthew Holt

THCB Exclusive–Trump appoints Holt to run VA

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By THCB STAFF

Today Donald Trump pulled a big surprise. He changed the much criticized appointment for his new VA head from over-effusive physician Rear Adm. Ronny Jackson to well known lefty health blogger Matthew Holt. When asked why he wanted Holt to run the VA Trump said, “Look, I’m pretty smart and I’ve appointed now only the best people like John Bolton and Mike Pompeo to run our foreign policy. If I appoint someone else I like, how can I fire him quickly? That Holt guy seems to hate me, and he’s never stayed in one of my hotels, so he’s perfect for the VA–I hear that the accommodation is a bit rough, not exactly a ten.”

When THCB asked Holt why he agreed to take the job running the VA, he suggested that it had a lot to do with his English roots. “As most of my followers know I grew up in England and like the concept of everyone suffering together in a government funded and provided socialized National Health System. The VA and its fellow traveler the DOD is the only health system like that in America and it’s a brilliant place to start”. When asked about his likely future polices for the VA, Holt suggested that massive expansion was the key initiative. In a written statement, his VA spokesman noted “Given the utter lunacy of the Trump Administration and the crazy warmongers now running the show, the chances of total war versus North Korea and Iran are very high. So essentially everyone in the country will soon be called up to the military, which means that soon eventually everyone will be a Veteran. And if Trump loses in 2020, by 2021 we’ll be at war with the Russians so either way my theory pays off.”

Holt was on the Charlie Rose show last week when he told Rose about his philosophy for the future. “When everyone in the country is part of the VA, we can shut down that ineffective and expensive private health system, and instead everyone can get their care the way I think is best. And if they don’t like it Rasu Shrestha will send them their records using the Lighthouse Blue Button Carrier Pigeon system, and we’ll give them a row boat to head to Nepal or somewhere.

When TCHB reached him for comment, Cato health spokesman Michael Cannon said, “if you are going to expand this universal health care stuff, you might as well give it a real go. Lucky for me, I have bone spurs…”

Health in 2 Point 00, Episode 8

It’s the end of #HIMSS18 where Jessica DaMassa asks me the end of term questions, while the exhibit hall is being torn down around us. We’ll be back to our weekly schedule next week–Matthew Holt

Health in 2 point 00, Episode 7

More from HIMSS18, it’s episode 7 in which I  get to give a shout out to UPMC, OneView HealthCare, Echo Ventures, & GE Ventures who funded patient travel to HIMSS via the Society for Participatory Medicine. And to HIMSS itself which for the first time let patients in for free. Jessica DaMassa asking the questions and thanks to @HealthTechDan from Digital Health Today for running the camera–Matthew Holt

Matthew Holt’s EOY 2017 letter (charities/issues/gossip)

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Right at the end of every year I write a letter summarizing my issues and charities. And as I own the joint here, I post it on THCB! Please take a look–Matthew Holt

Well 2017 has been quite a year, and last year 2016 I failed to get my end-of-year letter out at all. This I would like to think was due to extreme business but it probably came down to me being totally lazy. On the other hand like many of you I may have just been depressed about the election–2016 was summed up by our cat vomiting on our bed at 11.55 on New Years Eve.

Having said that even though most of you will never comment on this letter and I mostly write it to myself, I have had a few people ask me whether it is coming out this year–so here it goes.

2017 was a big year especially for my business Health 2.0. After 10 years my partner Indu Subaiya and I sold it to HIMSS–the biggest Health IT trade association and conference. And although I used to make fun of HIMSS for being a little bit staid and mainstream, when it came to finding the right partner to take over Health 2.0’s mantel for driving innovation in health technology, they were the ones who stepped up most seriously. From now on the Health 2.0 conferences are part of the HIMSS organization, and Indu is now an Executive Vice President at HIMSS. I’ll still be very involved as chair of the conferences and going to all of them but will (hooray!) be doing a lot less back office & operational work. (Those of you in the weeds might want to know that we are keeping the Health 2.0 Catalyst division for now at least)

That does mean that next year I will have a bit more time to do some new things. I haven’t quite figured out what they are yet but they will include a reboot of (my role at least) on The Health Care Blog and possibly finally getting that book out of the archives into print. But if you have any ideas for me (and I do mean constructive ideas, not just the usual insults!) then please get in touch. You can of course follow me on Twitter (@boltyboy) to see what I’m thinking with only modest filtering!Continue reading…

Cirrus MD — Text Connecting Your Doctor

By MATTHEW HOLT

Last week was HIMSS17, the biggest health IT conference and as per usual I ran around interviewing various techies. I’ll be releasing these interviews over the next few days and weeks–Matthew Holt

First up is a rather fun live demo I did with Cirrus MD‘s medical director Blake McKinney. Cirrus MD is a niche player in the telehealth space, and has spent the last few years building out a text-based tool which is now being rolled out in Colorado and Texas. How does it work in practice? Well funnily enough, I happened to have a medical condition that needed to be checked out by a doctor. So here’s a real impromptu demo that shows how it works and gives a good idea of the user experience.

Let’s Have APIs for Those Provider Directories!

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This was a comment I submitted submitted to this proposed set of regulations on health plans participating in the ACA. (Use ctrl-F to search “provider directory” within the page). HHS is proposing forcing insurers to make their provider directories more accurate and machine readable, and it would be great for consumers if that was made the case–especially if APIs (which means basically giving access for other computers to read them) were mandated–here’s why:

By MATTHEW HOLT

Subject–Immediately updated  provider directories machine readable via APIs should be mandated for health insurers.

Finding accurate information about providers is one of the hardest things for consumers to do while interacting with the health care system. While regulation cannot fix all of these issues, these proposed regulations in section  156.230 can greatly help, But they should be strengthened by requiring (under subsection 2) that health insurers immediately add new information about providers in their networks to a publicly available machine readable database accessible via a freely available API.

Currently companies trying to aid consumers in provider search and selection tell us that the information pertaining to which providers are in a particular network is the least accurate of all data they can receive. For consumers the biggest question for plan selection is trying to find out which provider is in their plan, and at the least this requires searching multiple websites. Worse, particular insurer’s plans can even have the same name but can have different networks (in one instance in our personal experience Aetna in New York state had two different plans with effectively the same name but different networks). This is essentially impenetrable for consumers and that is assuming that the information on the websites is accurate or timely–which it is often not.

Continue reading…

Halbig corpus interruptus

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By MATTHEW HOLT

In more stunning proof that America’s 18th century style governing process just doesn’t work, a subset of a regional Federal court ruled against part of Obamacare. The Halbig ruling is certain to be overturned by the full DC court and then probably will stay that way after it makes it’s way through the Supremes–at least Jonathan Cohn thinks so.

But think about what the Halbig ruling is about. Its proponents say that when Congress (well, just the Senate actually as it was their version of the bill that passed) designed the ACA, they wanted states only to run exchanges and only people buying via states to get subsidies. But that they also wanted a Federal exchange for those states that couldn’t or (as it turned out) wouldn’t create their own. But apparently they meant that subsidies wouldn’t be available on the Federal exchange. That would just sail through Logic 101 at any high school. Well only if the teacher was asleep, as apparently most Senators were.

Now two judges interpret what was written down to imply that subsidies should only be available on state exchanges–even though logic, basic common sense and fairness would dictate that if we’re going to subsidize health insurance we should do it for everyone regardless of geography.

Don’t forget that in the House version of the bill there was only a Federal exchange. Continue reading…

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