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Is John Goodman joking or just mean?

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By Matthew Holt

The uninsured numbers went down a touch because in 2007 Medicaid expanded. In 2008 they’ll go up as unemployment increases and S-CHIP coverage is cut. Really this doesn’t change too much.

Right-wing nut jobs all over the Internet are saying that uninsurance doesn’t matter. It’s surprising that one of the more sensible right-wingers has joined in and now says that the uninsured don’t exist.

But the numbers are misleading, said John Goodman, president of the National Center for Policy Analysis, a right-leaning Dallas-based think tank. Mr. Goodman, who helped craft Sen. John McCain’s health care policy, said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort. (Hospital emergency rooms by law cannot turn away a patient in need of immediate care).

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Cisco’s Frances Dare talks about Congressional action on health IT

By Matthew HoltFrances_dare_2

Frances Dare is someone I’ve know for a long time in the health care IT world (sorry, Frances!). That means that she’s seen the painfully slow developments in many aspects of health IT since the 1990s, and has an experienced view of what’s coming along at what pace. These days Frances is a Director at Cisco focusing on health care, and more recently she’s taken an active role in Cisco’s health care lobbying efforts on Capitol Hill.

Given that we don’t spend much time on THCB talking about the impact of the Federal sausage-making process on health care IT, telemedicine, et al, I thought that getting the view of a major IT vendor about what they expect to come out of the current Congress would be pretty interesting. And it was. Here’s the Interview.

BTW, in the interview I get the name of Frances’ division at Cisco wrong, Frances is a Director in the ISBG which stands for Internet Business Solutions Group. (FD, I have done consulting work for Cisco in the past, even if I didn’t know the name of the group I was working for!).

A few socialist musings for Monday

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By Matthew Holt

I just watched the closing ceremony of the Olympics, and the word is that state sponsorship of little known or cared about sports like swimming, gymnastics and cycling gets more medals and so should be encouraged. Bob Costas told me that China spent $40 billion on the games, even if London is going to spend less than half that. So it got me thinking about socialism.

Kevin Pho, blogger of KevinMD fame, and usually reliably anti-government in his views, asks for more socialism, at least directed in the direction of him and his fellow MDs. In this USA Today op-ed he suggests rightly that cutting doctors fees in itself saves little in health costs..

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The first one’s always free….but will you buy a kid a bike?

By Matthew Holt

Many times because I’m an independent consultant, blogger or general self-appointed health care know-it-all people want to talk to me. And I’m always happy to talk. Sometimes these conversations turn into business for me or THCB or Health 2.0, but sometimes they don’t. What I tell anyone who wants my time is that the "first one is always free."

Saigon

Meanwhile, as part of her return from a back injury my wife Amanda has bought a bike and is training for a triathlon later this Fall. It’s also renewal time for our favorite cause the Saigon Childrens Charity. Much of its resources are spent buying rice for poor families so that they don’t need to send kids out to work, and so the kid can go to school instead. With the price of rice doubling this year, things are getting tougher for the charity and the kids.

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Who’d be a pollster, eh

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By Matthew Holt

HSC says that the number of Americans going online for healthcare goes way up:

In 2007, 56 percent of American adults—more than 122 million people—sought information about a personal health concern from a source other than their doctor, up from 38 percent, or 72 million people, in 2001, according to a national study released today by the Center for Studying Health System Change (HSC).

Harris Interactive says it’s gone down ;

Ten years ago, in 1998, the Harris Poll began measuring the number of people going online for health care information. At that time we reported that 54 million people had done so at least once. Since then the number of those people, whom we labeled “cyberchondriacs,” have increased almost every year, reaching 110 million in 2002, and 160 million in 2007.

This year, the Harris Poll finds only 150 million who claim to have gone online to obtain health care information. Of course, 150 million is still a huge number and includes 66 percent of all adults and 81 percent of those who are online.

Extra points if you can spot the flaw in my reasoning. (Yes, it’s easy but I’ve been up late watching the Olympics….even though I said I wouldn’t)

Health IT policy: the fur is flying

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By Matthew Holt

Some fur is flying in the rarefied world of health IT policy geeks this morning. Health Affairs has three articles. The first from Markle’s Carol Diamond, writing with Here Comes Everybody author and Internet guru Clay Shirky, more or less says that obsessive attention to rigid standards is not helping and actually may be hindering the IT adoption process. And yes, in case you were wondering they do mean CCHIT and ONCHIT’s current policies and agenda which has been going for four years and which they’re accusing of “magical thinking.” Instead, we need new policies which target desired outcomes measured in improved patient care, instead of assuming that creating new technology standards will get us there. And by policies I think they mean money, and its redirection by current payers. After all, if putting in a RHIO costs hospitals operating revenue in reducing admissions and tests, why would they do it?

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Flacks peddle false “reality”

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By Matthew Holt

Such a pity that the NY Times has been so beaten up by the commies amongst us that it actually now feels that it has to point out where Peter Pitts and Janet Trautwein get their money. Although, as per the last time it let Pitts write an op-ed, it didn’t mention his day job as a PR man for pharmaceutical companies. After all, who could be opposed to “Medicine in the Public Interest” — after all it is in the interest of the public to pay for all and any medicine at any price that PhRMA chooses, right?

And let’s not get started on underwriters (for whom Trautwein is the main flack). After all Grace-Marie Turner thinks that they’re the health care heroes! Perhaps they’re heroes because they drive sick people into the uninsured population so that the under-paid clinical staff working in America’s public and community health system get to show their worth by caring for them —even if they’re less heroic than underwriters.

But that’s OK, Pitts & Trautwein can be printed in the NY Times cherry-picking problems with other countries health care systems. Because as we all know there’s absolutely nothing wrong with ours, eh?

And why should Pitts quote the peer-reviewed 2007 Commonwealth Fund study that showed that waiting times for surgery were longer in the US than in the communist hell-hole of Germany, when instead he was able to cite an 11 year old study about longer waiting lists for one specific type of surgery in the Netherlands, which has completely revamped its health care system since then. Something he and Trautwein have helped stop us doing — preserving a dismal status quo they obviously want to maintain.

Those two wouldn’t last 92 seconds in a debate with Uwe Reinhardt or Hillary Clinton.

On the other hand, there’s no letter from Karen Ignagni to make up the trifecta. Did she negotiate some summer vacation time along with her $1.3m salary?

Omnimedix still fighting Dossia owners

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By Matthew Holt

KleinkeJD Kleinke and Omnimedix are still in business and still fighting a pretty serious lawsuit
about the Dossia breakup. I talked with JD yesterday. The team is working on several super secret client projects, but it’s tough to run a small consulting shop and keep a protracted lawsuit open, so they’re passing the hat! Why keep the lawsuit going?

Well, there’s obviously stuff that JD couldn’t tell me, so this is speculation but it’s clear that this is much more than an a “vendor didn’t deliver/client didn’t pay” dispute. JD was always very vocal about an open nonprofit being the protector of the Dossia members’ employees’ data, so I surmise that contractual disputes about who got access to what data are at the root of this. It would be interesting (if practicably impossible) to compare Dossia’s contact with Omnimedix in their contract with Indivo.

More generally, JD and I talked about whether there’s a need for a Dossia-type entity when there’s Google Health and HealthVault. Here’s what JD said about Microsoft and Google’s privacy stance.

“In both cases they’ve violated their own operating principles as businesses to do the right thing.”

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The result of the primary care crisis

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By Matthew Holt

Over at Spot-on I’m writing about the primary care crisis in partial response to the great stuff from Bob Wachter last week on THCB and also from Maggie Mahar and Brian Klepper. Hopefully, it’s a primer for the politico types over there about the primary care crisis and also what the likely results of it are. Hint, no pay equality, but more retail clinics and online visits.

Meanwhile, my piece at Spot-on two weeks back about the Two Ted Kennedy’s appears rather smarter than it probably was given the long piece in the NY Times today about exactly how risky his surgery was and exactly the level of agreement (i.e. not much) that existed among the wide medical team he convened. Evidence based medicine? Well let’s just say that the oft heard rumors of Medicare’s impending bankruptcy may be truer than I tend to believe if every patient wants that level of service.

At any rate, please take a look at the new piece and the older piece and as ever come back here to comment.

Ask any health care wonk and they’ll tell you that within the larger
health care crisis is a primary care crisis. There is more and more
demand for primary care physicians – the person you probably call your
"family doctor" – but America’s medical schools are producing fewer of
them.


Why? Well in a word, money.

It’s not actually medical school that’s the problem. It’s what happens next. A newly graduated physician, looking a big chunk of debt used to pay for medical school tuition gets to chose their residency and, as such, decides what type of doctor to become.In the U.S. we let medical students choose what to do. Not being dummies, most of them notice that diagnostic radiologists and orthopedic surgeons make three times what primary care doctors make, and choose their career path accordingly. Why the vast difference in compensation? Doing something to a patient – fixing a broken hip, reading an x-ray – has always been better rewarded more than talking to them about their high blood pressure or their son’s excema.

Read the rest.

Interview with Sandeep Agate, REACH Call

By Matthew Holt

We don’t talk much about traditional telemedicine at THCB, but remote care is not just for consumers. There’s also huge possibilities for clinicians to use these technologies to tap into expertise that can make specialty care more available and improve care in dramatic ways.

REACH call, which is a 2-year-old company from Georgia has an interesting and relatively cheap technology that gets vital expert specialty opinion to emergency rooms and enables stroke care to be significantly improved. I spoke to Sandeep Agate, REACH’s CEO last week and it’s a pretty interesting interview.