Category: Uncategorized

Health Care Reform: What do People Really Want?

Aug 20, 2009• 101

By HUMPHREY TAYLOR

Humphrey Taylor is Chairman of The Harris Poll. Prior to joining Harris, Taylor worked in Britain where he conducted all of the private political polling for the Conservative Party and was a close adviser to Prime Minister Edward Heath in the 1970 campaign and subsequently to Margaret Thatcher.

What do people really think about health care reform? When political issues are difficult and complicated, published polls sometimes confuse rather than enlighten the debate. And health care reform is fiendishly complicated, with many different issues and many different proposals for addressing them. No wonder that the debate is generating more heat than light. This is surely one of the times when political leaders should lead rather than follow public opinion. As Winston Churchill once said, “The problem with politicians who keep their ear too close to the ground is that it is difficult to look up to them in that ungainly posture.”

While policy makers have to address the details of the proposed policies, most people do not. They know what they want, or don’t want, but have only a very limited understanding of which policies will actually achieve their aims. They are often strongly influenced by political rhetoric that varies from the accurate to the simplistic to the completely false. Many different words and phrases are used to describe different policies. It is unreasonable to expect the public to understand the details of the proposed reforms or how they work in practice.

However, if you study all the polls, as opposed to cherry picking them as many politicians do, a clear picture of public opinion emerges:Continue reading…

Are Cooperatives a Reasonable Alternative to a Public Plan?

Aug 20, 2009• 10

By TIMOTHY S. JOST

Jostt First, a word about history. We have tried cooperatives before.
During the 1930s and 1940s, the heyday of the cooperative movement in
the United States, the Farm Security Administration encouraged the
development of health cooperatives. At one point, 600,000 mainly
low-income rural Americans belonged to health cooperatives. The
movement failed. The cooperatives were small and undercapitalized.
Physicians opposed the cooperative movement and boycotted cooperatives.
When the FSA removed support in 1947, the movement collapsed. Only the
Group Health Cooperative of Puget Sound survived. Over time, moreover,
even Group Health, though nominally a cooperative, has become
indistinguishable from commercial insurers-it underwrites based on
health status, pays high executive salaries, and accumulates large
surpluses rather than lower its rates.

The Blue Cross/Blue Shield movement, which also began in the 1930s,
shared some of the characteristics of cooperatives. Although the Blue
Cross plans were initiated and long-dominated by the hospitals and the
Blue Shield plans by physicians, they did have a goal of community
service. The plans were established under special state legislation
independent from commercial plans. They were non-profit and, in many
states, exempt from premium taxes. They were exempt from reserve
requirements in some states because they were service-benefit rather
than indemnity plans and because the hospitals and physicians stood
behind the plans. They were exempt from federal income tax until the
1980s. In turn, they initially offered community-rated plans and
offered services to the community, such as health fairs. In some states
their premiums were regulated and they were generally regarded as the
insurer of last resort for the individual market.

A Town Hall Meeting 3000 Miles from Washington, DC

Aug 19, 2009• 3

By BILL KRAMER

Seaside, Oregon, is about as far away from Washington, DC, as you can get in the continental U.S. Not quite 3000 miles, but almost (2860 to be exact). And it seemed very far away from the sound and fury of the health care debate in the nation’s capital when I attended a Town Hall meeting last Friday. Sen. Ron Wyden was the speaker at the event, which was attended by over 400 people crowded into the Seaside High School cafeteria.

As we waited, the crowd was calm and polite, but there was a murmur of anticipation and an undercurrent of tension. We had all seen the stories about disruptions and threatened violence at similar Town Hall meetings across the country. Would it happen here? We could see people standing at the back with signs opposing health reform. Would they interrupt the proceedings and cause problems? We all respect freedom of speech, but somehow it wouldn’t seem like “freedom” if someone else was shouting us down and disrupting our attempts to learn about the health reform proposals.

Barney Frank deals with the loonies

Aug 19, 2009• 15

By Matthew Holt

This is just too funny not to show you all.

Announcement: Money-Driven Medicine on DVD

Aug 18, 2009• 3

Academy-award-winning documentary film producer Alex Gibney (Enron: the Smartest Guys in the Room, and Taxi to the Dark Side) has made a 90-minute documentary based on THCB contributor Maggie Mahar’s book Money-Driven Medicine. Bill Moyers will be showing a shorter 55 minute version of the film on his PBS show, Bill Moyer’s Journal, Friday, August 28 (Check local listings for time.)

Institutions can buy the DVD of the 90 minute version here or by calling 877-811-7495. Individuals can rent a digital version of the film for home use anytime after August 28 for $2.99

“Money-Driven Medicine is one of the strongest documentaries I have seen in years and could not be more timely. The more people who see and talk about it, the more likely we are to get serious and true health care reform.”—Bill Moyers

“Few Americans appreciate how the health care system is gamed against physicians’ professional commitment to focus only on their patients’ best interests. This outstanding film helps us all understand why reform is essential.” – Elliott S. Fisher, MD, Director, Dartmouth Center for Health Policy Research

The Town Hall Effect

Aug 18, 2009• 21

By HARRIS MEYER

We’ve all been reading a lot about the congressional town hall meetings around the country, where protesters rail about President Obama’s health reform plan. News reports and video clips indicate that half or more of the protesters yelling about socialism and a government takeover are of Medicare age.

I’ve wondered about these senior citizens and other protesters. They look like ordinary working- and middle-class people who probably have the same problems with the U.S. health care system as millions of other Americans. How can they just say no to legislation that would help them personally, or that would give others the kind of guaranteed coverage they already enjoy?

Ditching the Public Option

Aug 18, 2009• 53

By ROBERT LASZEWSKI

It looks to me like the popular objections to a health care bill being expressed by voters this month are concentrated in two primary areas:

A concern about “government control of the health care system”—mostly around the public plan option.
The trillion-dollar cost of a health care bill at a time deficits are swelling and worries about who will really end up paying for it.

As a result of the first concern, we are getting the first indications that some Democratic leaders are ready to ditch the robust Medicare-like public option and are beginning the process of talking the party out of demanding it be included in a health care bill.

This from Politico today:

After the toughest week yet for health reform, leading Democrats are warning that the party likely will have to accept major compromises to get a bill passed this year – perhaps even dropping a proposal to create a government-run plan that is almost an article of faith among some liberals…"Trying to hold the president's feet to the fire is fine, but first we have to win the big argument," former President Bill Clinton said Thursday at the Netroots Nation convention, a gathering of liberal activists and bloggers who will prove most difficult to convince. "I am pleading with you. It is OK with me if you want to keep everybody honest. . . .But try to keep this thing in the lane of getting something done. We need to pass a bill and move this thing forward."

It has been clear to me for months, and I have been saying so on this blog, that the public option has not had the votes even among Democrats to make the finals. With all the heat “a government takeover” of health care has attracted from those at the town hall meetings either the Democrats ditch it or get used to the idea they have no chance of passing health care reform.

EHRs and Multi-Provider Use: Lessons from the VA

Aug 17, 2009

By AUSTIN FRAKT

With billions of dollars of stimulus funds available and the President and state governors promoting them, electronic health records (EHRs) are likely to become commonplace in the U.S. health care system. To be sure the transition will be complex and costly, but incentives provided by insurers and the federal government for quality improvement tied to EHR use will encourage providers to enter the brave new electronic world and bring their patients with them. While EHRs are praised for their promise to increase efficiency and safety, it is still an open question how much of those benefits will be realized or when.

There is one clear threat to the fruition of EHRs’ potential for quality improvement: the inability of various EHR systems to share information with one another. This potential limitation is highlighted prominently in a new Congressional Budget Office (CBO) report Quality Initiatives Undertaken by the Veterans Health Administration (August 2009), principally authored by Allison Percy of CBO’s National Security Division.

Medical Data in the Internet “cloud” (part 2) – Data security

Aug 17, 2009

By ROBERT ROWLEY, MD

This is the second of a 3-part series, where we dig a little deeper into the questions of medical data in the Internet “cloud.” In the first part, we reviewed issues of data safety – how to guard against loss of data. In this second part, we will review data security – how to guard against data theft. The third part will focus on privacy and ensuring that only the right people can access the right data.  

DATA SECURITY

A review of issues around medical records ownership and protection shows that medical records are the property of those who prepare them (medical professionals), and not the property of those about whom they are concerned (patients), although patients generally have a right to review them, demand copies of them and demand their confidentiality. With limited and specific exceptions, consent is required in order to disclose such information to others. So, how does one create a framework of security that protects the confidentiality of such records against unauthorized breach?

Continue reading "Medical Date in the Internet "cloud" (part 2) – Data Security"

Why Standards Matter (1): The True Meaning of Interoperability

Aug 17, 2009

By DAVID C. KIBBE and BRIAN KLEPPER

Americans are generally skeptical of words that otherwise intelligent and articulate people can’t pronounce. “Interoperability,” like nu-cu-lar, is one of these. After a while, these words can take on a mystique all their own.

But interoperability is a hugely important word in the context of today’s ongoing debate about the use of EHR technology by physicians, hospitals, and patients too. The federal government is going to provide billions of dollars to encourage today’s fragmented health care providers to convert from mostly paper to mostly computerized information systems. It is critically important for these systems to talk with one another. We want health data to flow between and among these systems and to be, well, interoperable. And it isn’t now.

So how can this word be so difficult to put into action? Here’s a clue: a lot of people are confused about its meaning.

Continue reading “Why Standards Matter (1): The True Meaning of Interoperability”