Tag: Policy/Politics

A liberal is a conservative exposed to the NHS

Apr 12, 2009• 31

By Matthew Holt

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.

Ty Markham Torrey

A Self-Fulfilling Prophecy: The Continuity of Care Record Gains Ground As A Standard

Apr 10, 2009• 23

By BRIAN KLEPPER

Brian Klepper 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.”

Kaiser Permanente CEO George Halvorson on reform and life after IT

Apr 8, 2009• 22

By Matthew Holt

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.

So what’s the real usual, customary and reasonable price of care?

Mar 31, 2009• 43

By Matthew Holt

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.

Leave Natasha Richardson out of the health care debate

Mar 29, 2009• 31

By Sarah Arnquist

Please don’t turn Natasha Richardson’s tragic death into a symbol for why Canadian-style universal health care is bad and the United States is better.

In the last six hours, I’ve seen articles from at least a dozen media outlets asking whether Natasha Richardson would have lived, had her skiing accident occurred in the United States instead of Canada, where the quoted commentators say universal health care means insufficient access to high-tech scans and helicopters.

I’m not advocating for or defending Canada’s single-payer health system. Merely, I ask that journalists considering doing this story ask deeper questions that get beyond the anecdote. Consider asking about the trade-offs that go along with providing seemingly unlimited CT scans and helicopters. Ask what would happen if she were an uninsured U.S. resident.

Richardson’s tragedy may represent a larger problem, but those statistics need to accompany the punditry. While not diminishing the tragedy of Richardson’s untimely death, a sample of one is not a good measure of how well a state or nation’s health system performs.

Anecdotes make great stories and can put a face on a problem, but policy should be based on scientific research that reveals truths about the entire population.

Patient-based Health Reform or “Fannie Med?”

Mar 27, 2009• 73

By Richard Scott

Set against the backdrop of the $787 billion stimulus bill and deficit spending that dwarfs the federal outlays of FDR’s New Deal and LBJ’s “Great Society,” the idea of spending hundreds of billions – or even trillions of tax dollars – to buy universal health care coverage for all Americans isn’t much of a stretch anymore.

Faced with $30 to $80 trillion in unfunded healthcare liabilities ($110,000 to $300,000 per American under the age of 65) “health care reform” discussions are underway between President Obama and members of Congress in the 111th Congress to spend even more on health care, and Americans are beginning to hear more and more about “patients’ rights” and similar jargon.

The problem is that “universal health care” and “patients’ rights,” while sounding harmonious, are in direct conflict. The path to effective health care reform must be approached from the perspective of individual patients and their relationship with their doctors, and not from a top-down, big government perspective. Anything that interferes with an individual’s freedom to consult their doctor of choice to make health care decisions defeats the purpose of meaningful health care reform.

True health care reform centers on four “pillars” of Patient’s Rights:

Choice – Any health reform proposal must guarantee a patient’s right to choose their own doctor, and must protect a consumer’s right to choose the health insurance that best fits their needs and budget. Reform efforts should expand the choices without dictating or distorting them..

Competition – In addition to increasing patient choice, eliminating state regulations on health insurance would allow for broader competition and lower prices for consumers. Patients also benefit when doctors are free to run their practices like any other business, competing on the basis of results and price. Requiring health care providers to publicly post their pricing and results so consumers can shop and compare will make our health care system more efficient at delivering quality care at an affordable price. Effective reform must rely on market dynamics, not government controls.

Accountability – Health reform efforts must reward individuals who are accountable for themselves. Those who pay for their own health insurance should get the same tax breaks employers get. Creating one standard reimbursement form, regardless of insurance company, will reduce costs and shift accountability where it belongs – to the individual whose life is most affected by the decisions that need to be made. Rare is the politician who would argue that an insurance executive or a bureaucrat in Washington D.C.is in a better position to make critical health care decisions than individual Americans and their doctors.

Responsibility – Successful health care reform must place responsibility squarely where it belongs: on the shoulders of the patient. Encourage individuals to take responsibility for their personal health by allowing insurance companies to charge lower rates for people who make healthy lifestyle choices. Infusing personal responsibility into health care reform allows us all to maintain our cherished freedom to live our lives without government intrusion. This principle works now: a 40 year-old who has been smoking since he was 16 knows his life insurance policy is going to cost more than that of a non-smoker. A driver with a heavy foot knows his car insurance rates reflect his need for speed.

Any serious discussion of health care reform that does not include choice, competition, accountability and responsibility – the four “pillars” of patients’ rights – will result in our government truly becoming a “nanny-state,” making decisions based on what is best for society and government rather than individuals deciding what is best for each of us..

Because of budget constraints, regulators in the United Kingdom dropped pap smears for women under 25. The result – young women are dying of cancer that could have been treated if the cancer was discovered in its early stages. Many Canadians have to wait months for diagnostic tests to determine whether their tumors are malignant, giving cancerous tumors time to worsen, spread and progress to an irreversible stage.

Some of the ideas being advanced by our leaders in Washington fail to consider patients’ rights , focusing instead on “government oversight boards,” “negotiations” with drug companies, and other bureaucratic solutions that refuse to put the patient-doctor relationship first.

Worse, the danger of Washington’s recent willingness to spend inordinate sums of money on anything deemed to be a problem, is that we are conditioning ourselves to believe that our government has unlimited resources – and that any problem can be solved by simply spending vast amounts of cash. What politician wants to be in office when it comes time to admit we can no longer spend for services we have come to expect?

Fannie Mae’s and Freddie Mac’s failed experiment to improve home ownership for “low and middle income families” should be a wake-up call to those who believe more government involvement in American healthcare will help “low and middle income families”. These two initiatives resulted in politicians being accused of receiving favored treatment, low and middle income families being forced out of their homes and a federal bailout that could cost taxpayers as much as $2.5 trillion. We never envisioned politicians receiving favored treatment, the housing meltdown caused by the expansion of these programs, nor the unbelievable number of low and middle income families being evicted from their homes with their life savings depleted. It’s not difficult to imagine similar results under a national health care system.

Given the evidence, now is the time for an investment of political willpower to institute a dramatic shift away from the influence of government, and toward a patient-centric system with the principles of choice, competition, accountability and responsibility powering a revolution in American health care. The shakiness and uncertainty that permeate our economy, some of which is caused by our lack of competitiveness because of healthcare costs, argue vocally for patients’ rights as opposed to government control.

Ultimately, the decision will come down to who we believe will better allocate our limited healthcare dollars: the government or each of us. If we get this right, everyone wins. If we get it wrong, the damage to our economy and our quality of life and the quality of life for our children and grandchildren may be irreversible. The last thing America needs is for Fannie Mae to become “Fannie Med.”

Richard Scott is co-founder and chairman of Solantic Corporation, a Florida chain of 23 urgent care centers which posts prices on the internet and on a “Starbuck’s style” menu board. He’s best known for being the CEO of
Columbia/HCA which grew to quickly being the largest for-profit
hospital chain in the 1990s before he was forced out when the Federal
government investigated allegations of fraud. After Scott left, HCA settled the suits for over $1.7 billion. More recently Scott has become a participant in the national debate over health reform. In 2009, He formed the Washington-based political action group “Conservatives for Patients Rights”, an organization dedicated to market-based reform of the healthcare system.

Health Care Reform: Ideology, Self-Interest and Rhetoric

Mar 24, 2009• 55

By Humphrey Taylor and Ian Morrison

Thirty years ago, one of us asked the retiring CEO of one of the largest drug companies what was the worst mistake he had made as CEO. Without hesitating he said, “Opposing Medicare. We were so ideologically hostile to a big new government program that we lost sight of our own self-interest. All the major drug companies except Syntex opposed it. Luckily we lost. We have made billions of dollars because of Medicare.”

The White House “summit” on health care reform was a nice start but as the as the reform debate unfolds, public and congressional opinion and the positions of the powerful interests involved – pharmaceuticals, insurers, device manufacturers, physicians, large and small employers, and technology companies – will be swayed by their ideology, perceptions of self-interest and the rhetoric used in the debate.

At one level, there is a broad consensus in America that we need to reform healthcare to expand coverage, improve quality, and make healthcare affordable. Public opinion polls show broad agreement and large majorities in favor of fundamental change. Even among specific stakeholder groups, from employers to hospitals and doctors, there seems to be widespread agreement that healthcare needs to change. But, the combination of a deep ideological divide, self-interests that are mutually exclusive, and rhetoric that is capable of turning public opinion against change may end up creating an environment of inaction.

Drug war lunacy–Connecting the Dots

Mar 24, 2009• 9

By Matthew Holt

Next month the Supreme Court will be given the chance to redress one minor the lunacy of the last thirty years of the so-called “war on drugs”. It will get to decide whether in the name of "zero tolerance" a thirteen year old girl can be strip searched in the quest to find some OTC ibuprofen. Oh, and she was an honor student falsely accused by a former "friend". Given the current make-up of the Supreme Court—yes Clarence Thomas still gets a vote—we can probably expect nothing sensible.

On the other hand nothing sensible, and much worse, is going on south of the border. My former colleague Paul Saffo points out that Mexico is on the verge of collapse. He notes a major signal—the cops are wearing masks while a major drug dealer stands proud.

Bluementhal is new health IT czar

Mar 20, 2009• 10

By Matthew Holt

David Blumenthal, known slightly more for being a policy wonk than a geek (or perhaps known best for being a wonk about geek issues!), has been appointed the new Director of the Office of the National Coordinator for Health IT. No official word on Rob Kolodner’s new role, although John Halamka suggests that he’ll stay on to run the stimulus package. Don’t forget that ONC gets $2 billion as part of the HITECH bill, so someone needs to be there to manage the bureaucratic part of that.

And no, none of the five candidates pimped on THCB by Kibbe and Klepper got the job…I’m sure we’ll hear from them about Blumenthal shortly.

Don’t think anything is certain on the reform front

Mar 20, 2009• 5

By Matthew Holt

And in more from the “is it really bad enough out there to guarantee health reform?” front…

Pew Research is out with a poll showing that the numbers in favor of a major health care system reform are growing abut nowhere near as large as they were in 1993.

For those of you who are real survey geeks it’s (almost) worth noticing that Harris, which asks a similar three questions about appetite for reform never got above 40% for its “rebuilding” category back in 1993. I’m not sure why these are different numbers, but the last one I saw from Harris in favor of “complete rebuilding” was at 33%.

But the answer is that support from the public is no more a dead cert than it was in 1993–4.