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Tag: Michael Millenson

Genetic Testing, Fact or Fiction: You Be the Judge

Which of these two events is fact and which is fiction?

  • Organizations representing employers and health plans call for a moratorium on implementation of the Genetic Information Nondiscrimination Act, asserting that the new rules could have a “significant and adverse impact…on wellness and prevention efforts” in the workplace.

  • One of the largest companies in America begins matchmaking its employees based on their genetic compatability, hoping to save on the health insurance bills associated with imperfectly bred children.

Answer: No. 1 is a Dec. 2 press release from the Disease Management Association of America. No. 2 is a description of the Dec. 8 episode of the ABC-TV comedy, “Better Off Ted.”

Coincidence? You be the judge.

GOP to Uninsured: Drop Dead

“We are now contemplating, Heaven save the mark, a bill that would tax the well for the benefit of the ill.”

No, that’s not Senate Minority Leader John Boehner, Rush Limbaugh or any of the other usual suspects complaining about the cost of health care reform. Rather, it’s the beginning of an editorial in the Aug. 15, 1949 issue of The New York State Journal of Medicine denouncing attempts to provide every American with health insurance. Sure, 90 percent were uninsured then, versus around 15 percent, today. But what’s amazing is the way the overheated arguments by conservatives have changed hardly at all in six decades, as evidenced by an op-ed in the July 15, 2009 Wall Street Journal entitled “Universal Health Care Isn’t Worth Our Freedom.”

Here’s the August, 1949 New York State Journal:

Any experienced general practitioner will agree that what keeps the great majority of people well is the fact that they can’t afford to be ill. That is a harsh, stern dictum and we readily admit that under it a certain number of cases of early tuberculosis and cancer, for example, may go undetected. Is it not better that a few such should perish rather than that the majority of the population should be encouraged on every occasion to run sniveling to the doctor? That in order to get their money’s worth they should be sick at every available opportunity? They will find out in time that the services they think they get for nothing ­– but which the whole people of the United States would pay for – are also worth nothing.

And here’s Dr. Thomas Szasz from the July 15, 2009 Wall Street Journal:

The idea that every life is infinitely precious and therefore everyone deserves the same kind of optimal medical care is a fine religious sentiment and moral ideal. As political and economic policy, it is vainglorious delusion. Rich and educated people not only receive better goods and services in all areas of life than do poor and uneducated people, they also tend to take better care of themselves and their possessions, which in turn leads to better health….We must stop talking about “health care” as if it were some kind of collective public service, like fire protection, provided equally to everyone who needs it….If we persevere in our quixotic quest for a fetishized medical equality we will sacrifice personal freedom as its price. We will become the voluntary slaves of a “compassionate” government that will provide the same low quality health care to everyone.

Of course, there’s been some progress. Six decades ago, the kind of views expressed by Szasz and the New York Journal represented the medical mainstream. Today, even the most troglodyte are not suggesting the repeal of Medicare and Medicaid.

On the other hand, in those “pre-spin” days so long ago the health-insurance-for-all opponents of the past were forthright about the consequences of their principles for others. Today’s conservative fulminators prefer to forego mentioning the 20,000 preventable deaths each year – about 55 people each and every day – among those without insurance coverage.

The other great difference sixty years has made is the racial and ethnic composition of the uninsured. The uninsured today are disproportionately minority. Nearly one in four (36 percent) are Hispanic, 22 percent are black, 17 percent Asian/Pacific Islanders and just 13 percent white. The impact of those figures is clear. While nearly one third of Texans have no health insurance, the Republicans who dominate its Congressional delegation have shown no particular urgency to address a problem primarily affecting low-income Hispanics. (Fifty-eight 58 percent of the uninsured in the state are Hispanic, according to Kaiser Family Foundation figures.)

It’s important to remember that none of the Republican presidential candidates in either the primary or general election presented a serious plan to cover all the uninsured, nor have any of the Congressional GOP critics of Obama’s plan done so. In other words, the difference between the Democrats and the Republicans on universal access to health care, then, is not a difference on government should help accomplish this goal but whether the goal itself is worth pursuing.

Put differently, for those Americans who can’t afford medical care (or are afraid that they won’t be able to in the future), the GOP has a clear reply: drop dead.

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Fantasy League Baseball — Beltway Series Edition

Millenson_122k_3Bob Laszewski’s Health Care Affordability Model has the same connection to the reality of the current  battle over health care reform as a Fantasy Baseball League does to the actual outcome of a major league baseball game; i.e., none.

 Actually, while those who play Fantasy Baseball – might we call them “baseball wonks”? – are affected by what happens in the real world to the players they have selected, they have no illusions of reciprocity. Laszewski is a brilliant analyst whose examination of the various political proposals for health-care reform have become a “must-read.” But in making his own proposal, Laszewski, a strategy consultant based in Washington, has managed to completely ignore the fact that reform is an intensely political process.

 “The Health Care Affordability Model…could be attached to virtually any health care reform plan now on the table,” he writes.

 No, it couldn’t. Just like managing a Fantasy Baseball team has no connection to managing real major league players. Given Laszewski’s timing, his proposal is somewhere between almost irrelevant and completely so. Which is not to say his ideas are wrong.

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A Second City Warning to Obama

MillensonFor all those Obama-ites confident that they won’t make the same
mistakes pushing health care reform  that the Clinton administration
did, might I suggest a trip back home?

Just a few minutes into the Second City comedy troupe’s latest show, America: All Better!,
the usual japes about the Jesus-like hopes projected onto our 44th
president gave way to a quick bit about health care reform. A doctor
was telling a woman that her diagnosis gave her only three months to
live. When she pleaded for help, he told her that the good news was
that Obama’s health reform plan meant she was scheduled for her next
visit just six months from now.

Bad news for Obama — the audience laughed.

Conventional wisdom says that the shopworn distortions and
deceptions that killed health care reform in the past have lost their
sting due to combination of middle-class economic worries and soothing
on-message reassurances. Perhaps. But comedy works only when it
connects with real anxieties. The fact that Second City comics in the
heart of Chicago are successfully playing to GOP-fueled fears of
rationing should raise a bright red warning flag at the White House.

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Bringing the Prius into American Medicine

6a00d8341c909d53ef0115702ff0f9970b-pi President Obama has repeatedly promised
that providing every American affordable access to quality health care
won't cost more money than we'll save through reform, but he's recently
raised the stakes even further. Health care reform, he has said, would
"foster economic growth" and "unleash America's economic potential."

Is that realistic?

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Humor: Voluntary Cost Control? Never Mind!

Michael Millenson

Health Care Stocks Hurt as “Promise” Spooks InvestorsNEW YORK – Major health care stocks plunged today as investors worried that a series of voluntary actions the industry pledged in order to control costs represented a serious threat to profits.“Leaders of drug, device and health insurance companies gave their solemn word to the president of the United States that they will cut costs,” said Pinocchio Paparazzi, an analyst with Bear, Bulle and Morbull.  “Simple math says if you trim two trillion dollars from spending, that’s two trillion dollars lower revenue. That reality should be reflected in stock prices.”Merck and Edwards Lifesciences, two companies whose CEOs personally attended a White House briefing announcing the coalition’s goals, led the decline with double-digit drops. Health insurance giants Wellpoint and UnitedHealth Group also slumped, as did the for-profit hospital sector, as investors decided that making the health care system “more affordable and effective for patients and purchasers” might be good politics but was bad for the bottom line.

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RFID EMR Pioneer Says “RIP”

When Harvard Medical School and CareGroup CIO Dr. John Halamka agreed to place his medical  information on an RFID chip and have it implanted it in his arm, he triggered an instant global spotlight on this unusual form of portable electronic medical record. The decision, made in December 2004 and disclosed in early 2005, captured worldwide attention from places a diverse as Fox News, the BBC and the New England Journal of Medicine (where Halamka contributed a commentary ).

As recently as 2007, a debate over chip privacy and safety versus having critical medical data instantly at hand (as it were) was featured in a PLoS Medicine exchange.  In it, Halamka asserted, “Implantation of RFID devices is one tool, appropriate for some patients based on their personal analysis of risks and benefits, that can empower patients by serving as a source of identity and a link to a personal health record when the patient cannot otherwise communicate.”

Two years later, Halamka’s chip remains under his skin but he’s ready to turn over the idea that he’s a trendsetter to the undertaker. The technology “has been adopted by no one,” Halamka told me at a meeting on Patient-Centered Computing sponsored by Partners HealthCare’s Center on Information Technology Leadership. “As a technology it’s dead. Use the network, use the cloud to store your personal health records. Or in a pinch, use a USB drive. But the implanted RFID chip is not as a society where we’re going.”

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Commentology:

Microsoft's, Bill Crounse, said this about David Kibbe's article, "The Parable of the Wicked EMR."

"Excellent, well written piece, David.  Thanks for sharing your insights.  It is important to not only meet the regulatory and privacy requirements associated with health data, but also expectations around its intended use.  EMR or PHR data is just data unless it contributes to user knowledge.  EHRs and PHRs don't add value unless they improve our understanding of health status and direct us toward health improvement."

Harvard Pilgrim's, Charlie Baker had this to say about Anne Tumlinson's article, "Reforming Long-Term Care and Post-Acute Care Could Save Billions."

"I've
written about the extraordinary lack of connectivity between Medicaid
and Medicare when it comes to long term care for dual eligible seniors
many times at www.letstalkhealthcare.org.  Medicare & Medicaid are
their own worst enemies – and do senior citizens a tremendous
disservice – when it comes to financing care for seniors who are
eligible for both programs.  There's a problem here that needs to be
solved."

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Medicine’s Missing Foundation for Health Care Reform

Preface by Michael Millenson: Lawrence L. Weed published a seminal article in the Archives of Internal Medicine on using the medical record to improve patient care back in January, 1971.

To give you an idea of how glacially the health care system changes, that same issue contained an article entitled, “Universal Health Insurance is the Wave of the Future,” by New York Gov. Nelson Rockefeller, and another, “What Possible Use Can Computers Be to Medicine?” by a Duke University physician that began this way: “The physician's attitude toward computing machinery has changed greatly in the last ten years. A bright future is predicted for its application within medicine.”

In an era when the autonomy of the individual physicians was nearly unchallenged, Weed boldly asserted that “modern data acquisition and retrieval systems” could help doctors make more accurate diagnoses and provide “proper care” more effectively. Weed has continued that same fight ever since, later joined by his son, attorney Lincoln Weed. In the process he has acquired neither fame, popularity or riches — merely become legendary to a small segment of us familiar with his work.

ABSTRACT:  Medical practice lacks a foundation in scientific behavior corresponding to its foundation in scientific knowledge.  The missing foundation involves standards of care to govern how practitioners manage clinical information.  These standards of care, roughly analogous to accounting standards for managing financial information, are essential to exploit the enormous potential of health information technology. Moreover, without these standards and corresponding information tools, evidence-based medicine in its current form is unworkable.  Medical practice has failed to adopt the necessary standards and tools, because its historical development has diverged from the paths taken in the domains of science and commerce. The culture of medicine tolerates unnecessary dependence on the personal intellects of practitioners.  This dependence has blocked the use of potent information tools, and isolated medicine from forces of feedback and accountability, that operate in the domains of science and commerce.  If the necessary standards and tools are adopted, health care cost and quality could become an arena of continuous improvement, rather than a quagmire of intractable dilemmas.

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