Category: Uncategorized

Health Care Reform: What Do Americans Want? (Or Think They Want?)

Nov 30, 2007• 22

By MAGGIE MAHAR

On the surface, it seems that American voters have made their will clear. Poll after poll shows that they are calling for a major overhaul of our health care system. But when you look closer, their responses bristle with contradictions and discrepancies that I think the reform-minded presidential candidates will have to consider when deciding how to approach health care reform.

In a poll reported in Health Affairs at the end of last year, sixty-nine percent of respondents rated the US system as “fair” or “poor.” Yet in the same survey, when asked about their own experience with receiving medical services or with their own physician, 80 percent who had received care in the last year ranked their care as “excellent” or ”good.”

Other polls reveal the same pattern.

According to a survey released by Greenberg Quinlan Rosner in July, voters express doubts about the quality of the American health care system (with 49 percent dissatisfied), while 74 percent were dissatisfied with the cost. Yet, “at another, more personal level,” the pollsters note, “a slightly different picture emerges. Fully eight in ten (82 percent) describe themselves as satisfied with the quality of the health care they receive personally. This number jumps to 90 percent among seniors (64 percent very satisfied), but includes impressive majorities of nearly all groups…”

HEALTH 2.0 UPDATE Dyson, Kibbe join advisory board

Nov 30, 2007

We’re pleased to announce that Esther Dyson of Dyson EDventure Holdings has agreed to serve on the Health 2.0 advisory board. Esther’s tech background is well known and second to none. Esther has been watching, leading and guiding innovation in the technology industry for more than two decades. In 1983, she purchased a small and relatively obscure industry newsletter called the Rosen Electronics Letter, renamed it Release 1.0 and made history with a series of bold forecasts on the impact of the pc and computer networks. Her predications included some of the first warnings that American dominance in R&D might be on the decline and that the American universities might fail to produce adequate numbers of students trained in the sciences. From 1998 to 2000 Esther served as the chairman of ICANN, the Internet Corporation for Assigned Names and Numbers. In 2003, in response to public criticism of ICANN, she played a key role in driving reforms at the organization. Companies where she has served on the board or as an early stage investor include include Flickr, Del.icio.us, Orbitz, Medscape and Medstory, as well as many, many others. We are delighted to welcome Esther and look forward to her contributions.

We also welcome David Kibbe MD MBA. A highly regarded figure in Washington and in healthcare information technology circles, Dr. Kibbe has served as director of the American Academy of Family Physicians’Center for Health Information Technology of the and played a leadership role at a number of companies. David is perhaps best known for his work in the fight to encourage physicians to adopt electronic medical records. He is currently involved with the ASTM CCR standard for health data and information exchange. When not busy with his other projects, David writes for the Health 2.0 Blog, where he has recently contributed posts on Health 2.0 and identity and Computable Data Exchange and Sparse Information Model.

INTL: Market invisible hand forces Canadian death rate numbers public!

Nov 30, 2007• 8

In a valiant effort to stop Canadians storming the borders and leaving their home health care system bereft of their health care dollars, the Canadian government has yielded. It’s made death rate numbers at Canadian hospitals public. The probably futile hope is that Canadian citizens will believe that the competition of transparency will lead to improvements in the current situation in some Canadian hospitals, such as the Scarborough Hospital mentioned in the article, which kills 124 out of every 100 patients admitted.

Now that the Canadian dollar is so strong, buying some 45,000 American Lire to the northern Peso, it’s cheaper for a Canadian to sneak across the border and pay cash for open heart surgery than it is to pay the tax on the Canadian cigarettes that caused the heart disease in the first place.

The combination of renowned treatment from private American hospitals that kill far fewer than 1 in every 1 patient (and sometimes less than that), and the strength of the Northern Peso have now resulted in the desperate situation of empty waiting rooms, and no queues for surgery in America’s northern neighbor.

The collectivist Marxists who run things in Canadian health care from their command center in the bunker of the UBC health care economics department have been horrified at this development. A spokesman who sounded a lot like Morris Barer was (or maybe wasn’t) overheard saying, “it’s our right as Canadian elitists to make the rest of our citizens wait forever for hospital care that will probably kill them if they don’t die waiting in line first. The overwhelming transparency and easily demonstrated quality of the now dirt cheap American health care system is not fair.”

Reports that the WTO was investigating were unconfirmed at time of writing.

Unrepentant free-marketeer Canadian exile David Gratzer was reportedly seen crowing, “See how Adam Smith has kicked those loonies in the ass! The market triumphs again!”

Now can I get a job in the Giuliani administration?

If Grady Fails By Brian Klepper

Nov 29, 2007• 6

In an extraordinary move earlier this week, the politically-appointed Fulton-DeKalb Hospital Authority, the governing body over Atlanta’s Grady Health System, unanimously and voluntary stepped aside, to be replaced by a new non-profit corporation. Projecting a $55 million deficit this year, the hospital had just three weeks of cash on hand. It needs $300 million immediately for sorely needed renovations, and must deal with $63 million in accumulated debt to its biggest creditors, Emory University Medical School and Morehouse School of Medicine. New oversight was the predicate for a hoped-for financial bailout from business, philanthropies and financial institutions.

Other Atlanta hospitals are undoubtedly concerned that Grady will fail, and will probably do everything possible to support a bailout. The last thing they want is for Grady’s patients to come to their facilities. Now would be a good time to rally business leaders and legislators, who nearly always go to fancier hospitals, which of course has been a big part of the problem.

Grady’s turmoil should be recognized as the first small shock of much larger seismic event, long in the making, a concrete sign of America’s relentlessly intensifying health care crisis. The wrath falls on our most vulnerable – those with health problems or with few financial resources – as well as on the institutions and professionals that care for them.

Physicians: Can Computerized Decision Support Get Docs to Toe the Line on Quality? by Robert Wachter

Nov 29, 2007• 7

Robert_wachter_3 Robert Wachter is widely regarded as a leading figure in the modern patient safety movement. Together with Dr. Lee Goldman, he coined the term “hospitalist” in an influential 1996 essay in The New England Journal of Medicine. His most recent book, Understanding Patient Safety, (McGraw-Hill, 2008) examines the factors that have contributed to what is often described as “an epidemic” facing American hospitals. His posts appear semi-regularly on THCB and on his own blog “Wachter’s World.”

A humorous and telling story about quality measurement, decision support, and human nature:

I was visiting professor at a very good academic medical center a year or so ago. On these trips, one of the fun things I get to do is meet with the residents. Sometimes they present a clinical case to me, but this day they wanted to talk about healthcare policy. So I thought I’d check out what they knew about the new world of quality measurement and transparency.

“Who admitted a patient with pneumonia last night?” I asked the bleary-eyed, overcaffeinated group of 20 somethings, each looking only slightly older than my kids. Three interns hesitatingly raised their hands.

“If I wanted to figure out whether you provided high quality care,” I continued, “what should I look at?”

“I think we saved this guy’s life,” one beamed. “Yeah, and I had a lady who was confused, hypotensive, and hyperglycemic,” said another, “and we did a really good job taking care of her. She’s much better this morning.”

HEALTH PLANS: Tracing this all back to the vine….

Nov 29, 2007• 4

Eric Schlosser, author of Fast Food Nation, has an op-ed in the NY Times about how Burger King has basically singlehandedly scuppered a meager pay rise for some of the poorest immigrant workers in America. It’s searing stuff and he relates it all back to the owners. Who are they?

Three private equity firms — Bain Capital, the Texas Pacific Group and Goldman Sachs Capital Partners — control most of Burger King’s stock. Last year, the chief executive of Goldman Sachs, Lloyd C. Blankfein, earned the largest annual bonus in Wall Street history, and this year he stands to receive an even larger one. Goldman Sachs has served its investors well lately, avoiding the subprime mortgage meltdown and, according to Business Week, doubling the value of its Burger King investment within three years.Telling Burger King to pay an extra penny for tomatoes and provide a decent wage to migrant workers would hardly bankrupt the company. Indeed, it would cost Burger King only $250,000 a year. At Goldman Sachs, that sort of money shouldn’t be too hard to find. In 2006, the bonuses of the top 12 Goldman Sachs executives exceeded $200 million — more than twice as much money as all of the roughly 10,000 tomato pickers in southern Florida earned that year. Now Mr. Blankfein should find a way to share some of his company’s good fortune with the workers at the bottom of the food chain.

Why is this appearing in a blog about health care? Because the same kind of corporate bad behavior happens here too, and the same type of private equity groups are behind it.

Who’s the worst behaved actor in the list of not exactly angelic characters in American health insurance? THCB regulars know that I’m talking about: Mega Life & Health.

Who owns HealthMarkets, Mega’s parent company? Yup, the biggest and richest private equity group, Blackstone, and Lloyd Blankfein and his colleagues at Goldman Sachs.

I’m delighted that they’re being called out personally in the NY Times, and somewhat frustrated that neither Paul Krugman nor Bob Herbert has taken up a similar cause on the health care side. (Incidentally Mitt Romney owes his huge fortune to Burger King’s owner Bain Capital, but that’s another story).

But it’s time to make these connections and to call out some of the richest people in America on what they’re decisions and the behavior of companies they own is doing to some of those significantly less fortunate than themselves.

Genomics vs. Proteonomics: Accessorizing Your Genes By Scott Shreeve

Nov 28, 2007

Scott_shreeve_small_2
I had the occasion this past weekend to be out with my wife doing
some shopping. Apparently, I have
been too busy of late to notice that
my wardrobe had been in some decline. My wife therefore drug me out on
grey Saturday (which follows Black Friday) to hit the local Nordstrom Rack. I was shamed into trying on jeans formerly priced at over $200 (who pay sthis kind of money for a pair of jeans?), gigolo bling-bling shoes (are pointy toes really appropriate for male shoes?) , and a variety of belts and watches (how does wearing a watch “change” my outfit) required to properly “accessorize” my look. We ultimately settled out on some funky 7 Diamonds and Roar surfer shirts to match the now half priced jeans. More on the shoes later.

The experience of “accessorizing” reminded me of a recent post by Matthew Holt regarding Personal Genome Management. Matthew reviews some of the recent buzz surrounding 23andMe, highlights longtime player DNA Direct, and then puts out some thoughts as to where the market is and can go over the next several years (there is some interesting banter within the comments section as well). He concludes with this consideration:

“The genetic test market is very small, and the
management services that these companies offer around it are going to
only be a share of the testing market itself. So the fact that Navigenics
has already raised money at a substantial valuation means that some
very astute people are thinking that genetic testing will turn from an occasional activity for a small minority of patients (usually those going into pregnancy with some type of risk factor) into
a consumer norm that most patients will have as part of the standard
testing they get done and that management of that genetic information
will be part of the new flow of consumer and clinician activity.”

Matthew hints at something that I believe most people have failed to
grasp when considering the genetic market. I actually see three
distinct limitations:> Continue this post over at the Health 2.0 Blog ….

TECH: Tell us about your Health 2.0 company

Nov 28, 2007

We’re
collecting information about companies in the Health 2.0 space. And
have been for some time. Unfortunately what that usually means is that
really interesting companies email us, then email us again to ask why
we didn’t respond to the last email. The result is too many really
great applications we’d love to hear about getting lost in our
in-boxes.

So we’re trying something else instead.

Tell us about your organization using this form,
and you may end up being mentioned in dispatches, featured at a Health
2.0 Conference, or landing the VC meeting of your dreams. Well perhaps
not all or in fact any of those …but if you want us to pay attention
to your company, this will get it into a systematic review process
starring our crack staff. Otherwise you may face the peril of being
lost in the email queue.

Editor’s Note: While the emphasis in the sign up process in the
linked form is very much on start ups and new ventures, we encourage
you to get in touch even if you are working on a small project.

POLICY: Wrong, but wrongly influential

Nov 28, 2007• 13

At the recent PRI meeting, one loony lambasted me for failing to agree with her that all the problems of the US health care system were due to all that care bing wasted on illegal immigrants. I asked her to provide me with photographic evidence of cancer patients swimming the Rio Grande…

But a UCLA study has found that even adjusted for age and health status:

Illegal immigrants from Mexico and other Latin American countries are 50% less likely than U.S.-born Latinos to use hospital emergency rooms in California, according to a study published Monday in the journal Archives of Internal Medicine.

Of course this isn’t news to us wonks, but here’s a quiz for ya; which one of me and the loony will be voting in the Republican primary? That tells you lots about our health care policy options.

POLICY: Me and the Republicans on NPR (no, not really)

Nov 28, 2007

So you can listen to my NPR appearance in Los Angeles on Air Talk hosted by Larry Mantle here (works better in Real Player). The other guest was veteran UCLA Professor Rick Brown, who was playing the lefty here–while I was doing my best to play the straight man and give a vaguely direct explanation of what I thought the Republicans were up to. If you’re as confused by Romney as I am, here’s the weekend headline about wanting coverage for all in 4 years that I’m referring to. That puts him to the left of Obama!

BTW I did this call on a cell phone from a hallway in San Francisco’s most expensive hospital (no prizes for guess which one) so my voice quality is a little spottier even than usual. Still it’s a short and relatively interesting piece.