This morning John McCain’s team will be talking about health care. There are some interesting ideas in McCain’s plan, which is the Bush tax deduction idea morphed into a tax credit, plus changes in Medicare payments. The best quick explanation is from our friends at ICYou.
Matthew Holt
A few months ago, the two of us – both long-time advocates for
transparency and accountability – posted separate comments on Secretary
Mike Leavitt’s blog. Brian asked Secretary Leavitt to square his
support of "Chartered Value Exchanges” with the attempt to block
release of physician-specific Medicare claims data to Consumers’
Checkbook, which wants to rate doctors. After a court ruled that the
data should be provided to the group, HHS appealed. Michael urged the
secretary to go beyond supporting Consumers’ Checkbook and use his
“bully pulpit” to promote sophisticated data analysis that could be
used to create national quality comparisons.
Secretary Leavitt graciously asked us to consider and comment on the
department’s proposed "Medicare trigger legislation" calling for the
release of physician performance measures. We are delighted to continue
the conversation.
First, let’s give credit where credit is due. We agree that the proposed legislation is a major step in the right direction.
We asked THCB contributor Maggie Mahar for her quick take on the health care policies of each of the presidential candidates. We were pretty much expecting one of Maggie’s trademarked dissertations – a meticulously researched critique of each politician’s views on various important substantive issues. Instead this entertaining reply turned up in our email inbox.
“If Clinton wins we have real national health care reform.
If Obama wins, I’m not so sure, given that Cutler thinks we’re getting value for our dollars, and healthcare doesn’t seem to be a big priority for Obama (although his plan seems a lot like hers).
If McCain wins, we all move to Canada. Northern Canada, where will not only have healthcare, but may be able to avoid the fall-out from the nuclear war that he starts.”
Or so the thought is by many in the health care world.
Thus, the motivation for chronic care management programs was born.
CMS, the august government body charged with overseeing Medicare (and Medicaid), instituted a 3 year, $360 million, test program to see if these programs would have the effect of saving the system money.
The conclusion after the 3 years:
Using regular phone contact to check on the health of chronically ill U.S. Medicare patients appears to cost more than it saves the system.
More from the article: "[t]he problem is that the fees paid to the companies make the program uneconomic." (Note that a longer version is available at the NY Times website here.)
My favorite part of the UPI brief: "Sens. John Kerry, D-Mass., and Lamar Alexander, R-Tenn., are pressing for its continuation. Companies involved in the program are based in both of their states."
The methods proposed to clean up the health care mess in the United States that leading voices pitched to hundreds of journalists Friday unsurprisingly were as varied as their Birkenstocks and patriotic tie.
David Himmelstein, co-founder of Physicians for a National Health Program and Birkenstock-wearing Harvard Medical School professor of medicine, unrelentingly pushed a single-payer system. "We need a reform that helps the insured as well as the uninsured," he said, adding that the system should "get rid of the insurance companies that provide no added value."
At the other end of the spectrum, Tom Miller, resident fellow at the American Enterprise Institute conservative think tank, wants more tax credits to put consumers in the driver’s seat and deregulation of the individual market.
Between those two ideologies, were Karen Davis, president of The Commonwealth Fund, and Julie Barnes, deputy director of the New America Foundation‘s health policy program.
Among its many less-noticed accomplishments, this Administration has strangled funding for comprehensive sex education. Instead, it has thrown the immense weight of the US government behind abstinence-based education, an impractical ideological approach rooted in religious zealotry and a romantic notion of social mores that no longer exists for most young Americans. In 2005 and 2006, the Bush Administration spent $170 and $178 million, respectively, more than double the 2004 expenditure, much of it allocated to mostly conservative Christian organizations, to encourage children to refrain from sex without explaining the fundamentals of contraception and sexually-transmitted disease (STD). In 2004, a Minority Staff Special Investigations report prepared at the request of Rep. Henry Waxman (D-CA) found that more than 80 percent of federally funded abstinence programs contain false
or misleading information about sex and reproductive health.
Last weekend I heard several great presentations at a meeting convened by Jeff Goldsmith, but one contained a point I hadn’t heard nailed down before. Kaveh Safavi MD JD, from Thomson Healthcare’s Center for Healthcare Improvement, detailed the results of several large sample surveys on consumers’ attitudes toward web-based health care information.
One of Dr. Safavi’s opening slides came from Solucient’s HealthView Plus 2006 data, and was focused on "Quality-Driven Consumers," people who are "likely to research ratings information on hospitals or doctors," and likely to change providers if the one they originally preferred received a low rating. Strikingly contrary to the conventional wisdom, this group makes up only 19%, or one-fifth, of American adults.
I’m a card carrying member of the ACLU. I oppose the Patriot Act. And I absolutely oppose the current Administration’s decision to ignore the FISA law that already bends over backwards to help the government spy on Americans whom it suspects of criminal activity. I’m also appalled when I read stories like this one—in which the FBI has been illegally abusing its power by issuing “National Security letters” willy nilly.
I say all this because it’s now a couple of weeks since Google announced it’s health initiative and during that time we held the second Health 2.0 conference. And all the mainstream press can write about is the potential for privacy violations in online health sites, and PHRs, whether it’s been in the San Diego Union Tribune, ZDNET, USA Today or Modern Healthcare.
So even this balanced article in the Washington Post leads with Deborah Peel from Patient Privacy Rights and you have to wade through her incendiary rhetoric before you get to some sense from John Rother, while David Kibbe’s rational applauding of electronic health records only appears towards the end. Here’s what Peel says:
Many online PHR firms share information with data-mining companies, which then sell it to insurers and other interested parties, Peel said.
Well I’m still waiting to see the proof about this. Essentially she’s saying that consumers’ identifiable data is being sold and used against them, and so PHRs are bad.
Much data is of course sold in health care, but as far as I’m aware it’s all de-idenitifed. Whether PHR companies are systematically selling data is unclear. Whether they are selling identifiable data (the thing HIPAA bans and everyone agrees is a bad idea) I severely doubt.
And the problem is that this type of allegation gets the conversation completely off track. The biggest problem with the US health care system and its use of technology is not privacy violations. It’s inefficient use of data causing harm (and costs and poor quality care).
I am getting more than a little annoyed with this focus on the wrong thing. As my commenter JD paraphrased in my earlier piece on the topic (5th comment down here), do the Deborah Peels of the world not use bank accounts or credit cards? Do they not buy houses or have credit scores? Do they not know about what is already known about them in the real world? People understand this data flow and they accept it because it brings them a return that they value. And the same will be true for health information—if health information technology produces valuable results
So what are the nay-sayers going on about? Well I actually suffered and read the World Privacy Forum report on PHRs by Robert Gellman. It’s a hash of conjecture with its main complaint being that HIPAA doesn’t explicitly cover PHRs. Well, no shit Sherlock. HIPAA passed in 1996. It was actually was prepared years earlier and it’s about the automated transactions that existed then. No one had heard of a PHR in 1995, so why should the law cover them? What will happen is that PHRs will start being provided by covered entities and will be under the aegis of HIPAA (in this country at least—it’s called the “World” privacy forum but in reading the report Gellman only has heard of one country apparently).
But even if PHRs are not covered by HIPAA, what are the terrible consequences? Well let’s see. I’ve taken a few excerpts from the report. In the first Gellman says:
Regardless of the PHR’s policy on marketing disclosures, advertising can provide a method for a consumer’s health information to escape into marketing files. Marketers already have millions of names of consumers categorized by specific diseases and diagnoses. Most of the information comes from consumers who provided it in response to “consumer surveys” or through other stealthy methods for collecting health information for marketing use. Health records maintained by health care providers have been unavailable to marketers directly, but commercial PHRs operated outside of HIPAA offer marketers the promise of more and better health information from consumers.
So the problem is not PHRs. It’s consumer surveys taken over the years by marketers. But let’s blame PHRs because they might potentially be used for the same thing.
But hang on, if I’m a transparent PHR vendor won’t I drive out the scummy guys who are secretly selling data which will be used to harm their customers? And aren’t Microsoft and Google and many others being transparent about that? Yes they are, and why won’t consumers vote with their data?
The controversial and not-shy-with-his-opinions former speaker of the House Newt Gingrich has been very active in recent years promoting the automation of health records and EMRs. But he’s never been a great pains to stress how that would get done from a policy perspective.
I was glad to get a few minute with him because I was able to get straight to that question. And on that topic it appears that Newt has become a fan of government mandates and directed government spending. I think you’ll find this podcast fascinating, although it’s short.
Individual health insurance mandates have lately been hailed as the solution to the health care crisis in America. Mandates to buy health insurance have been included in legislative proposals at the state level – for instance, by Gov. Schwarzenegger and Speaker Nunez, in their “Health Care Security and Cost Reduction Act”, or at the federal level, by Hillary Clinton in her “American Health Choice Plan”. Can mandates achieve universal access to health care and control rising costs of medical care? This article explains why they can’t.
Lately, legislation including a universal mandate – a legal obligation that everybody purchase a health insurance policy – has been hailed as the solution to the health care crisis in America. At the state level, mandates have been included, for instance, in Gov. Schwarzenegger and Speaker Nunez’s “Health Care Security and Cost Reduction Act”, and at the federal level, by Hillary Clinton in her “American Health Choice Plan”. Yet many of us remain skeptical. Why? After all, if everybody is forced to buy a health insurance plan – maybe with a subsidy if you are “poor enough” – would this not resolve the problem of uninsurance? Maybe so. But the real question is: would mandating universal health insurance guarantee universal access to medical care? And the short answer is no.
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