Some fur is flying in the rarefied world of health IT policy geeks this morning. Health Affairs has three articles. The first from Markle’s Carol Diamond, writing with Here Comes Everybody author and Internet guru Clay Shirky, more or less says that obsessive attention to rigid standards is not helping and actually may be hindering the IT adoption process. And yes, in case you were wondering they do mean CCHIT and ONCHIT’s current policies and agenda which has been going for four years and which they’re accusing of “magical thinking.” Instead, we need new policies which target desired outcomes measured in improved patient care, instead of assuming that creating new technology standards will get us there. And by policies I think they mean money, and its redirection by current payers. After all, if putting in a RHIO costs hospitals operating revenue in reducing admissions and tests, why would they do it?
Health reform for ordinary folks
When it comes time to vote in November, will Americans know what they’re voting for in terms of their health care futures? Will they understand what Barack Obama or John McCain’s health proposals mean for them?
Over at Columbia Journalism Review, Trudy Lieberman says they won’t given the current media coverage of health reform. The journalism professor critiques the mainstream media’s coverage for basically
transcribing the candidates’ pitches, and says the blogosphere is overly wonky.
"Exactly how will all these economic and political calculations and
pronouncements affect those who struggle daily to fill their
prescriptions, find a competent doctor, or pay their medical bills?"
she asks. "These are the people whose stories the media have yet to
tell."
In a series called "Health Care on the Mississippi," Lieberman examines how the presidential candidates’ health proposals will affect ordinary folks.
In Part 1, she goes to Helena, Arkansas, a town of 6,300 along the Mississippi River to talk with the working-class residents about health care. Currently, most knew "nothing of the coming health care battle being waged in their name," she wrote.
In Part 2, Lieberman examines how Helena’s head jailer and his diabetic adult son would fair under McCain and Obama’s health plans.
Flacks peddle false “reality”
Such a pity that the NY Times has been so beaten up by the commies amongst us that it actually now feels that it has to point out where Peter Pitts and Janet Trautwein get their money. Although, as per the last time it let Pitts write an op-ed, it didn’t mention his day job as a PR man for pharmaceutical companies. After all, who could be opposed to “Medicine in the Public Interest” — after all it is in the interest of the public to pay for all and any medicine at any price that PhRMA chooses, right?
And let’s not get started on underwriters (for whom Trautwein is the main flack). After all Grace-Marie Turner thinks that they’re the health care heroes! Perhaps they’re heroes because they drive sick people into the uninsured population so that the under-paid clinical staff working in America’s public and community health system get to show their worth by caring for them —even if they’re less heroic than underwriters.
But that’s OK, Pitts & Trautwein can be printed in the NY Times cherry-picking problems with other countries health care systems. Because as we all know there’s absolutely nothing wrong with ours, eh?
And why should Pitts quote the peer-reviewed 2007 Commonwealth Fund study that showed that waiting times for surgery were longer in the US than in the communist hell-hole of Germany, when instead he was able to cite an 11 year old study about longer waiting lists for one specific type of surgery in the Netherlands, which has completely revamped its health care system since then. Something he and Trautwein have helped stop us doing — preserving a dismal status quo they obviously want to maintain.
Those two wouldn’t last 92 seconds in a debate with Uwe Reinhardt or Hillary Clinton.
On the other hand, there’s no letter from Karen Ignagni to make up the trifecta. Did she negotiate some summer vacation time along with her $1.3m salary?
Healthy Howard coverage expansion could inform future reforms
Howard County, Maryland is set to launch an ambitious universal health coverage, and the county’s top health officials says the effort will provide valuable lessons for future reformers.
Starting next month, 2,200 of Howard County’s 20,000
uninsured residents can enroll in the Healthy Howard Plan,
which will provide them access to primary, specialty and hospital care, and
prescriptions drugs for $85 or less a month.
Dr. Peter Beilenson, Howard County health commissioner and former Baltimore City health commissioner who ran for Congress in 2006, said this is the most ambitious local effort at universal coverage since San Francisco launched a universal coverage plan in April 2007.
Like Healthy San Francisco, Healthy Howard is not portable health insurance but rather health coverage for local treatment. Instead of levying a "pay or play" tax on businesses like San Francisco, however, Healthy Howard’s funding comes from individual premiums, county general fund dollars and substantial amounts of charity. (The Golden gate Restaurant Association is battling San Francisco in court over its tax.)
Beyond the grand ambition to provide universal health coverage, what Beilenson says distinguishes Healthy Howard is its emphasis on personal responsibility, mandatory health coaching and a forthcoming rigorous evaluation.
NICE job. Cost-effectiveness in the UK
Yesterday I went to a high powered lunch put on by HealthTech, with a high powered crowd attending (including the head of the California Dept of Managed Health Care, lots of Kaiser Permanente people, Arnie Milstein from Mercer, et al).
The speaker was Andrew Dillon, the head of the National Institute for Clinical Excellence (NICE), the UK’s technology assessment agency. But unlike the late and somewhat lamented Congressional OTA that the Republicans killed in 1995, NICE has teeth. NICE is only well known in the US as being the agency that stops new wonderful treatments getting to blighted Brits who are instead left to die in the streets.
The way this works, as Dillon explained to the somewhat incredulous head of the California Dept of Managed Healthcare (and I paraphrase) was that if NICE says something’s off limits (such as a new drug) a doctor won’t prescribe it. And if they did, the pharmacy wouldn’t fill it. And if they tried to, well they wouldn’t find it because the hospital wouldn’t have bought it. Such power! And I’m sure the envy of the many regulators and payers in the room.
However, Dillon explained that contrary to popular belief there isn’t a straight cut off point for approving new technologies.
Health Reform is Possible; Voters Still Hold the Power
In a post originally published here on The Health Care Blog and reprinted Health Care Policy and Marketplace Review health care analyst Brian Klepper asks: “Is Meaningful Health Care (Or Any Other Kind Of) Reform Possible?”
His answer: “I’d be surprised. Delighted! But surprised.”
Klepper believes that the lobbyists are just too strong. Always incisive, he pulls no punches: “In a policy-making environment that is so clearly and openly influenced by money,” it’s just not likely that “Congress will be able to achieve health care reforms that are in the public interest.”
I disagree. I believe economic pressures are pushing us toward a political turning point. (If you want to understand what is happening in history or in politics, follow the money.) The Bush administration has been thoroughly discredited. Americans are ready for change. Health care reform will not happen tomorrow; it will require a bare-knuckled political fight. But it will happen, and this is why: Although lobbyists are powerful, so are voters. And they realize that we are approaching a flashpoint: middle-class Americans are being priced out of our health care system.
The $2,500 question
There’s some peculiar numerology going in the presidential candidates’ health reform plans.
John McCain proposes that every American receive a $2,500 tax credit ($5,000 for families) to help them afford health insurance bought in the private market.Barack Obama says his health care plan will save the average American family $2,500 per year.I mean, what are the chances?I suspect both campaigns are shrewd enough to know that "a couple hundred bucks a month" [middle-class citizen’s translation of $2,500 per year] is likely to get a voter’s attention. The fact that both campaigns came up with an identical figure is eerie, however. It’s enough to make you wonder whether anti-trust laws should apply to political campaigns.
SEIU’s questionable election strategy
Several months ago, I mentioned the large sum of money being spent by SEIU on political races throughout the country. Now, an editorial in the Wall Street Journal questions the legality of the manner the SEIU is collecting these funds from its members. (By the way, the sum I mentioned was $75 million. The WSJ raises this to $150 million.)
I am not qualified to make a judgment on the legal issues raised by the Journal’s editorial writer, but I want to raise a related political issue. SEIU concludes one of its publications with the following depiction of the future:
SEIU’s health care profile — and power — will only continue to grow. After we help elect a pro-worker president and stronger pro-worker majorities in Congress, we will take all our energy, idea, organizing strength, grassroots lobbying and political muscle and make it happen. Next year, 2009, we — all of us — will make history. We will achieve quality affordable health care for every man, woman, and child in America.
The math is wrong
I have great respect for Jim Stergios and the Pioneer Institute he heads. The Institute has been an important force in Massachusetts public policy debates for many years. But I think Jim has the wrong policy prescription in an op-ed published in the Boston Globe.
Citing the higher than expected costs of the Massachusetts Healthcare Reform Act of 2006, Jim proposes that there should be a reduction in payment to Boston Medical Center and Cambridge Health Alliance, the two largest hospital providers of care to the poor in the Boston metropolitan region. To be fair, Jim is not the first to propose this. Over the years, there have been periodic attacks on BMC and CHA for their special payments. Several years ago, for example, many of the community hospitals complained that they were subsidizing these urban safety net facilities.
Beyond ignoring the history of these hospitals in our city and the special role they play in the health care system, Jim’s proposal puts the focus of the financial problem in the wrong place.
Obama health plan, silliness
Enter David Cutler. Result is more silly meaningless numbers
<sigh>
It is truly worrying when the single most sensible quote in the whole damn article comes from AEI’s Joe Antos.
How is this worth the NY Times’ attention? And what happens when the Obama bill comes up in Congress and somehow there isn’t a $2,500 check to be mailed to each household?
I thought this guy was going to treat us like grown-ups. After 8 years of insanity that would be nice.
If Cutler, who doesn’t exactly strike me as a major league populist, thinks that Obama has to “find a way to talk to people in a way they understand” how about he steers him to talk more about some insurance reforms that are both possible and very understandable. Like stopping this.
