My lefty friends at Moveon.org emailed me (and a few million others) appalled that Rick Scott’s group is going to be spending $1 million running ads attacking the as yet officially non-existent Baucus/Daschle/deParle/Obama health plan. Now that’s not exactly a surprise. Rick Scott has been on the offensive for a while now and in the spirit of inclusiveness (or the more cynical among you might say, to start a fight in an empty house) THCB ran his op-ed a while back. Frankly it was pretty tough to figure out what he was “for” but it’s clear what he’s against—the evils of Canada and the UK.
Yesterday I had a little fun teasing some Norwegians over here to learn about the US health care system. I asked them what they wanted to learn about, and one of them said “what about the 48 million uninsured”. I told her that Americans were a kind and generous people, and that there couldn’t possibly be anyone here uninsured or suffering because of it, and obviously the twoMichael’s at Cato and the nutjob prof at Harvard prove me right about uninsurance being a) voluntary and b) the fault of three Medicaid clerks in New York state who forgot to print the enrollment forms in Spanish. OK, OK, I changed my tune a little a few seconds later.
But that remains basically the screed of the Canada bashers. They say that those evil Stalinists in the UK and Canada are the same (even though they’re not), and no one gets any care. Whereas here it’s all sweetness light, teddy bears, puppies and all the MRIs you can eat.
However, I am beginning to tentatively that the lack of mainstream industry support for Rick Scott signals a couple of things—besides the fact that the mainstream is somewhat nervous of being led by an unconvicted fraudster man whose company settled with the government for $1.7 billion after it fired him.
The job is fraught with difficulties, which Dr. Blumenthal has readily acknowledged. His recent New England Journal of Medicine (NEJM) Perspective, “Stimulating the Adoption of Health Information Technology,” is a concise, clear and honest appraisal of two of these challenges, namely how to interpret and act upon the key terms used in the legislation, “meaningful use” and “certified EHR technology.” Dr. Blumenthal gets to the heart of the matter by identifying the tasks on which the National Coordinator’s success will most depend, and which will foster the greatest controversy.
The country needs Dr. Blumenthal to succeed. The issues are complex and, with huge ideological and financial stakes involved, politically charged.
One of the important decisions before Dr. Blumenthal and his colleagues at ONC and HHS is whether the national health information network will be one of closed appliances that bundle together proprietary hardware, software, and networking technology, or one of open data exchange and management platforms in which the component parts required to do medical computing can be assembled from different sources. If the former direction is chosen, power and control will be concentrated in the hands of a very few companies. If the latter, we could see an unprecedented burst of disruptive innovation as new products and services are developed to
create the next generation of e-health services in this country.
Separating the data from the devices and applications, and maintaining a certain degree of independence of both from the networks used for transmission, is far more than a technical quibble. It can determine the economics of technology in stunning ways.
In a blog piece called Why Republicans Should Back Universal Health CareRegina Herzlinger says something that I more or less agree with. Switzerland’s system isn’t a bad option. Neither for that matter is Holland’s. Now of course Maggie Mahar has debunked Herzlinger’s notion that there isn’t state regulation of insures and providers in those systems. And Regi also talks a lot of tosh about Medicare, the UK and the evils of the government in the same piece. But I guess she feels she has to do that to keep whatever’s left of her audience (that would be the four Republicans who care about health care, rather than the health care business types who have moved on in pursuit of who now holds the purse strings).
But I’m just left with one little question. Where’s Herzlinger’s mea culpa to Alain Enthoven? After all he’s been promoting the Dutch answer (he basically designed it) since 1978 or thereabouts. And I don’t recall Herzlinger mentioning that in the numerous times she’s been slamming managed competition and its father.
Anyone who’s been following along on THCB will realize that there’s a huge divide about whether the HITECH act should pay for and dictate a specified, certified type of EMR product use OR pay for data and outcomes and not specify how providers get there. The “cats” support certification and EMR mandating (more or less). The “dogs” think that existing EMRs are often counterproductive and that a mix of other data sources, processes, and patient outreach technologies will get us where we need to in terms of improving outcomes much quicker. And now there’s an extra $20 billion in the mix, just to add some fun.
Rather than write more about that at HIMSS this week I got detailed interviews on film with leading “cats”, Glen Tullman, CEO of Allscripts, and Mark Leavitt, Chair of CCHIT. And then a response from the always highly caffinated dog-lover Jonathan Bush, CEO of AthenaHealth. And no, they don’t agree with each other…..although there is some common ground.
If you’re at all interested in how Health IT & EMRs will play out, these three are must-sees. (I’d view them in the order I took them).
The old adage is that a conservative is a liberal who’s been mugged. So I was much amused by this letter from a Republican to the local paper (Salt Lake Tribune) in the most conservative state in the nation (Utah). I particularly love the line I’ve bolded below because that—not all the right wing BS about effectiveness of cancer care or waiting lists—is the difference between universal health care and what America has—MH
After being laid off, I joined the 300,000 Utahns too poor to pay for health insurance. There are 47 million uninsured Americans and millions more are underinsured. Being a staunch Republican, I always resisted the notion of universal health care. But after having spent time with my son’s family in London, I’ve had an awakening.
My son’s old back injury got prompt and thorough attention. My daughter-in-law received comprehensive care for her challenging pregnancy. My new granddaughter was attended to by skilled nurses and physicians. In virtually every other civilized nation, no one fears losing everything due to some medical catastrophe. (MH emphasis added)
Americans deserve better than what we now have. Choice is an important American tradition. Let people choose between the for-profit insurance they have and a public health-care option like Medicare. A public health-care option is the only way to guarantee health care for all Americans. Any legislation without it is just more of the same broken system.
Insurance companies are afraid of a public health-care option because they will have to provide better service at lower cost to compete. But if President Barack Obama’s health-care plan gets changed to exclude a public option, then it is not health-care reform.
We live in a time of such great progress in so many arenas that, too often and without a second thought, we take significant advances for granted. But, now and then, we should catalog the steps forward, and then look backward to appreciate how these steps were made possible. They sprung from grand conceptions of possibilities and, then, the persistent focused toil that is required to bring ideas to useful fruition.
We could see this in a relatively quiet announcement this week at HIMSS 09. Microsoft unveiled its “Amalga Unified Intelligence System (UIS) 2009, the next generation release of the enterprise data aggregation platform that enables hospitals to unlock patient data stored in a wide range of systems and make it easily accessible to every authorized member of the team inside and beyond the hospital – including the patient – to help them drive real-time improvements in the quality, safety and efficiency of care delivery.”
George Halvorson is the CEO of Kaiser Permanente, and the driving force behind both the HealthConnect EMR implementation and a national player in the health reform debate. I got to talk to him at HIMSS where he’d just finished giving the Monday keynote. We discussed KP HealthConnect, and the impact it’s having internally (good), why KP is making such a high-profile fuss about it (no, they’re not planning on expanding nationally or internationally), what AHIP and the insurers might face in the future (a choice between Canada and Switzerland), whether chronic care management can work without integration (he says yes), and whether the big guys will cast the smaller insurers adrift. You’ll have to watch for that answer.
The Ingenix mess apparently won’t go away. Sen. Jay Rockefeller is now going after the health plans for using Ingenix’ database. Ingenix and some of its customer health plans have already settled with several states, but apparently it’s not enough. Now Rockefeller is after them. And the words are tough. “Fraud”, for one.
Now, health plans don’t exactly have much credibility. And when the politicos find out that Ingenix a) sells tools to help health plans cram down the amount they pay providers, b) sells tools to providers to extract more money from health plans, and c) is owned by the biggest (and not too long ago) baddest insurer on the block, this may get a little more interesting. After all, it’s kind of an arms dealer arming both sides.
But there is one thing that troubles me. I’m quite prepared to believe that Ingenix’s view about what was UCR was different from the local medical society’s view of what was UCR, and therefore that the plans were “under-paying” the consumers and the doctors who serve them.
But let’s remember what Usual, customary and reasonable fees are.