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Category: Matthew Holt

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.

Modest step in the reform journey shows the idiocy of our political system

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By Matthew Holt

It does seem to take a health care bill to remind us all how incredibly screwed up the political process is in these here United States. The Medicare Modernization Act was railroaded through by Tom Delay and friends using all their charm and finesse. And last night the House passed its version of the health reform bill. It includes employer mandates, exchanges, subsidies, public option and taxes on those earning more than $500,000 to close the cost gap. And CBO in its wisdom says that it doesn’t increase the deficit.But it didn’t pass by much. 40 Democrats opposed it. These were the Blue Doggers who needed some political cover to be able to say in 2010 that they were against the bill before they were for it. Their expected course of action is that a less liberal bill comes back from final conference with the Senate which they can support. Apparently out there in purple state land uninsurance and egregious health plan behavior are not a problem—at least not compared to the desire of the people to protect the incomes of those earning over $500,000 a year.

But in order to stop even more Democrats opposing it at the last moment Pelosi had to let some previously unheard of Congressman called Stupak become the mouthpiece of the Catholic Bishops who decided that they needed to impose their views about reproductive medical care into the debate. Cynics like me may wonder about the validity of views on that issue from a bunch of old men who’ve allegedly never been married or had sex with a woman, and whose main contribution to child welfare over the past few decades has been to ignore and assist in flagrant abuses of it by their colleagues. But no matter, over recent days they started putting pressure on various Democrats to tighten restriction on Federal funding of abortion.Continue reading…

“The possible” vs “what we want,” resumed

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By Matthew Holt

Not so long ago (actually less than 2 weeks), there was quite the spat on THCB between the Four Horseman (Klepper, Kibbe, Lazewski & Enthoven) and Maggie Mahar. Essentially it came down to this question:

Is there enough in the current House & Senate bills to restrain spending and remake the health care system? Or is the whole effort so bought off by the health industry as to be a waste of time?

I put myself in the camp of agreeing with both the Four Horsemen (that the bills were pretty much emasculated) and with Maggie (in that at least we’ll get some significant improvements in coverage for the uninsured).

And don’t they need it. In fact I wonder how many of the 50–odd million uninsured and the 50–odd million Americans who don’t have enough to eat are the same people.

But today the chorus of “fiscal responsibility through health reform” being orchestrated by the Administration got a little louder. It started about a week ago with Peter Orzsag banging the drum for health care reform being deficit neutral. He pointed to a letter from a group of moderate to liberal economists supporting HR 3962.

Today many of that same group (although not all and without the non-economists) were joined by some heavy hitters on the health economics side supporting many of the tenets of the Senate bill. This new group includes many of the same liberals but also some sensible Republicans (well Mark McClellan) and some real big guns including Uwe Reinhardt, Victor Fuchs, Joe Newhouse,  Laura Tyson, Henry Aaron, Alan Garber and Kenneth Arrow. Alain Enthoven (one of the Four Horsemen) is notable by his absence.

However, the economists probably wouldn’t disagree with the Four Horsemen about how limited the changes in the Senate and House bills actually are, and they appeal for an independent Medicare Commission and serious delivery system reform—all of which will be emasculated in Congress. But nonetheless they are providing valuable intellectual cover for the Administration—no one on the other side will be able to put a crew like this together! Meanwhile over on the Health Affairs blog Jack Wennberg (with Shannon Brownlee) is giving an assist by stepping up his counter-attack against the Academic Medical Centers who are complaining that their patients are sicker.

So the “realists” are coming out in support—all believing that once we get the legislation out of Congress and into sensible hands within the Administration there’s a chance that we might be able to do some good in terms of delivery system change.

Stay tuned. This is a good reason to keep reading THCB for the next decade.

 

 

Time to put aside the intellectual disputes for now

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By Matthew Holt

It’s always fun to see my friends beating each other up in public….and if you read down in the comments on the post published yesterday you’ll see a significant dispute between Maggie Mahar and the Klepper/Kibbe/Lazsweski/Enthoven team (who I’m calling the Four Horsemen from now on). But I think that right now we need to change what we’re talking about.

I’m with Maggie in that there is potentially more in terms of changing the payment system in the current bills than nothing, but it’s not that much more than nothing. However, pressure from the the Four Horsemen and their fellow travelers on payment reform may increase that section of the bill as it gets worked out on the floor and in the Congress conference committee. Their pressure will also serve notice that aware, sensible people are looking at the issues of payment and delivery reform.

And at the least, the proposals in the bill don’t make the current delivery system any worse (other than the exemption from taxes for self-insured groups which clearly discriminates against integrated systems and must go).

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What’s got lost in the public option kerfuffle

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By Matthew Holt

Not so long ago, July this year in fact, PhRMA boss and former Dem Blue Dog & Republican Billy Tauzin told the Aspen Health Forum that a straw poll of Democrats at dinner with him in DC all said that they didn’t think there’d be a public option in the final bill arriving on Obama’s desk. By the way Tauzin, Dashle, and the rest all said that there would be a health care bill passed in 2009 even though the summer of “death panels’ was just getting under way.

Now Jonathan Cohn at TNR is reporting (along with others) that Harry Reid is going to include the public option with an opt-out for states that don’t want it (think Red states), rather than the trigger (public option to come later if health care costs go up) or the co-op (moving the rest of the US to Seattle) alternatives.

This is a turn around—no question. It’s apparent that the summer of death panels actually hurt the anti-reform crowd. It’s also clear that the recent barrage from AHIP actually hurt its stated case against the public option—although as I’ve said on THCB I think that AHIP will do better with one in place.

But the problem is that this all disguises the real questions about the minor insurance reform we’re about to pass.

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Health 2.0 Tools: The power of Twitter

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Picture 31

The power of Twitter is real kids, and not for what you think. Used properly Twitter is an information filter. Exhibit A is what happened to the Von Schwebers who run PHARMASurveyor. They were a huge part of the Tools Panel which featured interoperation among 8 members of the Health 2.0 Accelerator at Health 2.0 a couple of weeks back. Then last week they were at an AHRQ conference on Drug Interactions when this happened. Erick von Schweber’s email picks up the story ..

The Chief Medical Officer of Express Scripts is doing his talk, about halfway through, and then tells this rather academic audience of scientists and researchers that there’s something new they need to attend to. It’s called Health 2.0, he says, and he puts up a PowerPoint slide with screen captures from WebMD, HealthVault, Healthline, DoubleCheckMD, etc. Then he tells the audience that the prior week he saw tweets about something new in the space, so he checked it out. He says this is the next major leap ahead in drug safety. So up comes a series of four slides, all screen grabs of PharmaSURVEYOR. And he calls us the Accelerator and explains what we do, disclaiming that he had no knowledge that we’d be there at the conference (I had moderated that morning’s session on making DDI evidence more relevant to patients and physicians; Hansten and Horn were my speakers, the guys who introduced the term “drug interaction” in the mid-sixties). He tells the audience that they must go to PharmaSURVEYOR as well as begin thinking in terms of consumer generated healthcare.

Now it just so happens that the Chief Scientist of Express Scripts but not the Chief Medical Officer had been to Health 2.0 and (I assume) seen the Tools panel demonstrations. But, and this will amaze no one, busy executives at big corporations don’t always immediately communicate all of their learnings with each other. So how did the Chief Medical Officer find out? He probably saw a re-tweet of the #health2con hash tag. That, ladies’n’genelmen, is how our kids is learning these days.

And do you want to see the incredible tools panel from Health 2.0 which contained both the accelerator integration project (in two parts), the debut of Keas, and Eliza showing the first Health 2.0 marriage? Funny you should ask.

Why AHIP needs the public option

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By Matthew Holt

It’s been a fun week. After years of THCB explaining that neither could AHIP do genuine research nor could its venerable President open her mouth without lying, the rest of the world has caught on. I won’t rehash the blow by blow here—Jonathan Cohn is among many who’s done that already—but essentially AHIP commissioned PWC to include the half of the analysis about the Baucus bill that was favorable to them and leave the rest out. And the fall from grace has been particularly fun to watch. Even the whores from PWC who wrote the report criticizing the bill have been backing away from it. And some astute commentators think that the debacle has helped the likelihood of a more liberal bill’s passage.

Now to be fair (or overly fair as they’d never concede this to the other side), the insurers have a point. They loaded Baucus up with lots of cash and put a former Wellpoint exec in as his chief of staff. They romanced the White House and kept quiet when Pelosi and the rabble criticized them. The deal they thought they’d cut was that they would give up the way they currently make money by underwriting and risk skimming in individual-small group and being overpaid for Medicare Advantage, and in return they’d get 45 million more customers, all forced to buy insurance and subsidized by the government to do so.

But somehow along the way the Democrats, despite lots of tough talk about “bending the curve,” lost the cojones to find even a mere $100 billion a year to redistribute from the probably $1 trillion waste in our $2.5 trillion health care system.

Continue reading…

The ugly, the bad, the very good and the great at the Health 2.0 Conference

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By Matthew Holt

So the Fall Health 2.0 2009 conference in San Francisco at the Concourse Exhibition Center is over. The bunting is down, the cocktails are drunk, and everyone can get back to the sanctity of the WiFi enabled office or home. (Yes, we’re sorry about that problem and need to stress that it was NOTHING to do with AT&T who graciously sponsored the conference but were NOT providing Internet access).

But it doesn’t detract from the fabulous experience of seeing perhaps the most amazing line-up of health technology ever in one hall together–not to mention some of the biggest names in the Health IT world going toe to toe. Health 2.0 had over a hundred speakers and nearly 80 live demos and technologies on display on stage–not to mention 30 more in the exhibit hall. We featured Health 2.0 Tools for doctors, ePatients telling us what they needed, and a stirring address from CTO of the US, Aneesh Chopra. Then there was some remarkable integration over unplatforms in the tools panel–(I don’t know how often Esther Dyson gives standing ovations but that was great to see). And there was so much more.

Congrats to Remedy Rx Ventures and Unity Medical–joint winners of Launch! But honestly we believe that everyone who presented had something important to show and say. Thanks to everyone who came, demoed, sponsored, spoke, volunteered and worked so so hard (especially the volunteers who stayed late on Wednesday to move tables and chairs).

We had a great time and we made a difference. There’ll be videos and more up here next week. For now, take the weekend off!

My more detailed comments are below the fold.

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Olberman, hysterical hypocrisy expose

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By Matthew Holt

A really fun piece from Keith Olbermann as he shows how the entire Gang of Six and more voted for fully socialized flood insurance and yet seem to have a problem with an independent government run public option.  

Of course, now that a bill has finally left Baucus committee, our meandering towards a relatively inconsequential tinkering at the edges of the health insurance market is a little further down the path. But can we somehow arrange it that the bozos at the NY Times (yes I’m talking about Robert Pear and David Herzenhorn) please stop saying things this dumb:

the Democrats are trying to restructure one-sixth of the economy, writing a bill that will affect almost every American, every business and every doctor and hospital in the country.

The level of exaggeration in that statement is simply unworthy of the paper of record. Would that it were true.

JSK (national treasure) on data liquidity, and how it fits into Health 2.0

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By Matthew Holt

Given that she taught me most of what I know about health IT I don’t know why I ever need reminding about how great Jane Sarasohn-Kahn is at keeping her finger on the pulse of health care, and how consistently good is her one daily post on Health Populi.

Yesterday was no different. She gave a great overview of a new PWC study on data liquidity. You’re going to hear lots from me and others in the coming days about data liquidity, substitutability, intermingling of applications, and unplatforms. But what’s happening on the edges of health care IT in the Health 2.0 movement is a combination of tools, content and transaction data beginning to flow between applications. More and more this is both enabling better management of the consumer (and clinicians) workflow experience and better ways to aggregate these new data sources for clinical decisions and research.

On day Two of the Health 2.0 Conference next week we’ll be showing this both in our panel on Data Drives Decisions, but also on the Tools panel which will feature a series of inter-operable applications sharing data. And we’ll also be showing the big players (Google, Microsoft & WebMD) as they move their offerings to a world where other service providers can use their platform.

Truly exciting times, but Jane points out that there are lots of barriers. She calls the PWC report

a sober analysis of what stands between transactions and raw data, and the ultimate goal of using that information: clinical transformation that benefits people.

And those barriers all center around the workflow, payment structure and institutional inertia of our current health care establishment.

 the health industry en masse needs to shift the focus of data from transactions to quality and outcomes. This will require – surprise, surprise – incentives to, as PwC puts it, “induce all stakeholders to collect, report and use the data.”