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Tag: Policy/Politics

How Relevant is the American Medical Association?

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By RAHUL PARIKH, MDIMG_1534-leveled

Like most doctors, I was busy seeing a full schedule of patients when President Obama addressed members of the American Medical Association at their annual meeting in Chicago.  The speech was billed as a crucial confrontation over health reform, and anticipation had been building for quite some time.   So I was too busy to learn anything about his remarks and the response until I got home.

Then again, I’m not a member of the AMA.  I never have been.  Neither are very many of my  physician friends and colleagues.  In fact, the odds are that your doctor isn’t a member of the AMA, because at best, only between 25-30% of the approximately 800,000 doctors in country belong to it.  And a good percentage (up to half of members according to one report) of those include residents and medical students, who get big discounts on membership and a free subscription to a journal when they join.Continue reading…

The State of Meaningful Use

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By MICHAEL PAINTER

Is it possible that the State Department is technologically bolder than the HIT Policy Committee?  On Tuesday, that committee convened by the Office of the National Coordinator as required by the American Recovery and Reinvestment Act released some initial recommendations on the definition of meaningful use of HIT.  Then yesterday the New York Times in an above the front page fold article reported that the State Department recognized an internet blogging service could change history–right now.

Compare that report about the State Department to the HIT Policy Committee’s recommended vision for the role of patients and families.  The committee envisions that someone would eventually “provide access for all patients” to populated personal health records and some self-management tools by 2015–about six years from now.  It’s not that this vision is bad; it’s just so underwhelming.  Let’s see–the State Department thinks that the Iranian people might be using Twitter today to regain control of their nation–and in our multi-billion dollar ultimate vision for the patient’s role with health information technology we’re still talking about “providing” a couple of interesting tools to patients by 2015.  Is it me, or are we possibly missing a powerful health reform player here–the consumer?

So, as you can see, I listened to this meeting on “meaningful use” and came away with some distinctly mixed impressions.Continue reading…

Ezra says pusillanimousity has won

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By Matthew Holt

Now he’s no longer a young punk but an insider of the first order Ezra Klein has come up trumps and got an early copy of the latest Senate Finance committee legislation/trial balloon. It’s not going to make the left happy. In order to ratchet down from the $1.3 billion CBO said that their earlier version was going to cost, the Committee has basically taken out the public plan option, cut back the amount of subsidies, and are relying on what looks like an increasingly unenforceable individual mandate.

Now admittedly this is where I said Obama would end up more than 18 months ago. But, given that with the recession we really had a chance to do something here, this is very very weak.

I got a call from Organizing for America (Obama’s grass roots organization) asking me to support the reform bill the other day. This one is barely worth passing. We might be better off leaving the system and having a proper collapse before we start again in the next recession (which at the rate we’re going might be this one).

It’s looking increasingly like the Democrats on the Committee got rolled, and didn’t even care about that. Perhaps they felt that the risk of passage of something significant was greater than the risk of a quick loss of legislation that no one could get behind anyway.

I’m not allowed to call the Democrats a certain word beginning with P any more (even if John Stewart uses it all the time). But I can call them pusillanimous. And in your treat for the evening, here’s Marina from HotForWords to explain what that means.

Rant: THCB transforms the New York Times, makes offer!

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By Matthew Holt

6a00d8341c909d53ef0105371fd47b970b-320wi Just a few years ago The New York Times was on its last legs, printing Judy Miller’s re-mouthing of Cheney’s lies, holding back the wiretapping story until after the 2004 election, and generally spouting a lot of rubbish about health care.

Somehow the leadership there looked to THCB for inspiration.

Continue reading…

Beyond the Beltway – How Most of America Sees Health Reform

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By BILL KRAMERPhoto for website Feb09

What are people saying about health reform beyond the beltway and outside the health wonk debates?  I’ve been meeting with Rotary Clubs and local Chambers of Commerce during the last several months, and they’re talking about different issues than the ones being debated in Washington, DC.  When I talk with these groups about the prospects for national health reform, what are the top three questions they ask?

  • Is this going to lead to a single-payer system with rationing, just like they have in Canada?
  • Why isn’t the malpractice problem being addressed?
  • Will this include illegal immigrants?

These are not the top issues being debated on Capitol Hill.  If you just read Politico.com, the Washington Post, and the pundits’ blogs, you would think that the big issues are the public plan option, the employer mandate, and the cap on the tax exclusion of employer-paid benefits.  There are important, but they aren’t the issues that most small employers and consumers are worried about.Continue reading…

Obama vs Hillary at the AMA

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By Michael L. Millenson6a00d8341c909d53ef0115702ff0f9970b-pi

Sixteen years and two days after then-First Lady and Health Care Czar Hillary Clinton went before the American Medical Association’s House of Delegates to sell her vision of national reform, President Barack Obama is treading the same path. I’m not sure how much greater eventual success Obama will have with the AMA, but having covered the Clinton speech as a reporter for the Chicago Tribune, I have three lingering memories.

The first was the invocation given before Clinton arrived. Its gist was, “Oh, Lord, you have taught us it is impolite to boo our guests, particularly in front of hordes of reporters.” The second memory was that Clinton finished her speech to a standing ovation. And the third is that she spoke fluently and passionately for 50 minutes without a prepared text, much to the chagrin of a national press corps accustomed to being spoon-fed a follow-along text before filing their stories. Fortunately, being a mere “regional reporter” (as the White House called us), I had taken notes.

Obama’s visit promises at least a few contrasts. He runs virtually no risk of being booed. He’s not only the President of the United States, and a very popular one, he’s also a president who has eschewed the perceived doctor-bashing engaged in at times by President and Mrs. Clinton. Obama most assuredly will not be speaking from notes, being as attached to the teleprompter as Ronald Reagan was to his 3×5 cards, but in the Internet Age anyone who cares to will be able to hear him live, anyway. A standing ovation? We’ll have to see.

To the amazement of her audience in 1993, Hillary went out of her way to hit all their hot buttons. For example, she praised the doctor-patient relationship and lashed out at the “excessive oversight” of insurance company reviewers and government bureaucrats who second-guess medical decisions. She talked sympathetically of the need for reforming malpractice laws and amending antitrust laws to allow medical professional societies to discipline poor-quality doctors on their own. (Here, I’m relying on a copy of my story I grabbed from an electronic archive.)

Obama, by contrast, prides himself on seasoning the obligatory political pandering with a soupcon or two of hard, cold reality. While reducing red tape and the need for defensive medicine are sure to be high on his list of promises, I don’t think he’ll hesitate to invoke the harsh global economic challenges that make health care reform so urgent. Look for Obama to remind the doctors how many more uninsured patients they’re seeing today and how much more involved Medicare has become in setting doctor pay scales.

One more contrast: in 1993, the AMA shoved forward Nancy Dickey, the one woman on their nine-person executive committee, to be its public face during the Hillary visit. Today, the organization’s elected president is Nancy Nielsen, the second woman to head the group (Dickey went on to the top job) and, though not publicized, the first who came to the post after holding a senior position in one of those dread health plans.

Quick Sunday roundup or “OMG I agree with Tyler Cowen”

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By Matthew Holt

6a00d8341c909d53ef0105371fd47b970b-320wi I can’t say that I often agree with libertarian Tyler Cowen and I think it’s pretty appalling that the New York Times gives someone with such, as Republicans used to say, “out of the mainstream” views a regular place to air them. Like this column saying that our health care system is better than those of other nations because we’ve got more Nobel prizes for example.

But today in his column Cowen basically says the we should pay for the expansion to the uninsured through reallocating current government spending (mostly on Medicare).

Continue reading…

David Gratzer is Nice. Dennis Kucinich is not.

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By Matthew Holt

6a00d8341c909d53ef0105371fd47b970b-320wi I had David Gratzer on THCB a while back. He was so nice, that it was really hard for me to get mad with him—even though his book was basically a pack of lies. He seriously suggested that the UK under Blair was NHS was going to covert into an American-type system, and he couldn’t answer why he allowed his wife to come here and be uninsured!  (Of course my father the gynecologist always told me that all psychiatrists are nuts anyway)

Then last week the single payer crowd finally got to appear before a Congressional committee, and for some bizarre reason Gratzer was there too (I guess he provided balance).  And the very nice David Gratzer finds that Dennis Kucinich is not quite so nice. Watch this…

Op-Ed: How I’ve Missed the AMA….

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By MATTHEW HOLT

6a00d8341c909d53ef0105371fd47b970b-320wi Over at Dr Val’s Get Better Health site Evan Falchuk from Best Doctors is very grumpy about Steve Pearlstein’s column in the WaPo. Pearlstein rewrites Gawande’s rewrite of Shannon Brownlee’s Overtreated. Not much surprise here—everyone is doing it and despite my cynicism Gawande’s piece in The New Yorker has hit a nerve, not least because Obama told everyone to read it—showing that he’s way more influential than Orszag in the White House despite what we wonks all think. Orszag by the way has been hammering on about the Dartmouth stuff for years and even dragged me into his office at CBO back in 2007 to suggest THCB kept plugging away about practice variation. But obviously no one in the White House was heeding his back reading of THCB, until the boss came and told them all to read Gawande.

Continue reading…

A Special Reform Edition of Health Wonk Review

by BRIAN KLEPPER

Over at Managed Care Matters, the always thoughtful and energetic Joe Paduda has, once again, done us all a service. Tasked with hosting this edition of Health Wonk Review, he has assembled a great range of pieces on the current reform process, which make for enlightening, entertaining and sober reading. This one is useful, provocative and very educational. Check it out!