This week Hillary Clinton met with Newt Gingrich and together they declared
unity and agreement on America’s health care future —  at least as far as the
role of information technology goes in it. 

The author of "The Great Right Wing Conspiracy" cosying up with the woman who dreamed up "HillaryCare?" 

That surprising sight led to an immediate media
freakout. What could it all mean?  Could some sort of earth-shattering political announcement be about to follow? 

The New York Times sheds some light on things:

"As it turns out, Mr. Gingrich and Mrs. Clinton have a lot more in
common now that they have left behind the politics of the 1990’s, when
she was a symbol of the liberal excesses of the Clinton White House and
he was a fiery spokesman for a resurgent conservative movement in
Washington."

Both Clinton and Gingrich seem to agree that government should help fund the technological transformation of the healthcare industry.  Historically, the implications of this kind of bipartisanship are big indeed.  Well, sort of.  Providers and payers can expect more legislation impacting information
technology, but realistically probably not much more
money from the feds.   

Health
care veterans may recall the last time significant legislation affecting health
care IT was passed: in 1996, when the Senate voted 100-0 in favor of the
Kennedy-Kassenbaum legislation. That law is better known today as HIPAA. Ten
years later payers and providers are still struggling with the implications.  So cast
a jaundiced eye when you hear that Washington is preparing to intervene. 

As if the US fast food industry didn’t have enough worries with new labeling rules under discussion at the FDA and the campaign for healthy school foods being led in California by the Governator, there is more bad news on the way. Morgan Spurlock’s Super Size Me has been edited down and re-released so that it can be shown to middle school and high school audiences.  The film, which shows Spurlock’s physical deterioration over the course of a month as he consumes a steady diet of Big Macs, fries and sodas, has won praise from nutritionists for its depiction of the health problems junk food can lead to.  Perhaps objectionable segments, like the moment where Spurlock’s vegan chef girlfriend discusses the impact of his fast food diet on his penis with almost eery clinical detachment have been edited
out.   What sort of impact could the film have? According to a
report in Newsday, students in New York went on strike last week after watching the film, demanding healthier food. Could this mean a wave of radical civil disobedience might follow at school cafeterias and vending machines across the country? 

Last week a young Florida child sank into a coma. Due to recent cutbacks, he
wasn’t eligible for the state CHIP program and with no health insurance and
precious little money available from her job at Wal-mart, his mother had skipped
on taking him to the ER until it was too late. With a sudden realization that
American health care was in crisis, late last Saturday night Congress passed a
bill completely changing the nation’s health care system. President Bush flew in
from yet another vacation to sign the new law, saying that the health care
system ought to preserve the culture of life. Evangelical religious groups
picketed Congress holding banners denouncing the impact of the lack of health
insurance and the high cost of health care for poor and middle class Americans.
Self-appointed moral values spokesmen denounced the nation’s courts for doing
nothing to improve the infant mortality rate, claiming that it was below that of
Cuba. Finally, all the cable news channels turned their networks over 24 hours a
day to covering the crisis. Even though there were bitterly opposing sides in the dispute and polls seemed
to show that most Americans didn’t agree with Congress or the President, the
politicians insisted that the moral imperatives made their action necessary. Sage editorials in the major newspapers explained that the Florida
tragedy had at least had the virtue of having families in the nation discuss
whether or not they wanted access to health insurance. Sadly the young boy died unaware that his fate had transformed a nation.

It’s incredible what a useless governor Arnie has been. Here was a guy from way outside the political establishment who had the chance to really change politics in California, so what has he done?

1. He ran non-stop adverts all through the recall campaign saying that he would cut the state deficit by having a "full audit" (or in Arnie-speak "Foorl Ordit".  He then increased the deficit by canceling the $4bn increase to the car tax, and when, surprise, surprise, the Foorl Ordit didn’t miraculously find $15bn of waste to get rid of he simply borrowed the money by changing the law and issuing bonds.  Some budget hawk, eh.
2. He ran as an outsider and used at least some of his own money in the campaign. But after  he won he paid his own account back from new political contributions — those are called bribes in less polite society — which came from not "special interests" like the ones from whom that Grey Davis guy used to get his cash from.  Oh no — Arnie’s money came from "powerful interests".  And who might they be?  Well apart from the Spanos real estate family that owns most of central California, it also includes a lot of money from big pharma after Arnie vetoed a bill trying to legalize Canadian imports into California.  No pay-off there
3. And while we’re on the pay-off theme, several of us felt that the most despicable part of the Gray Davis regime was its ownership by the appalling prison guards union.  This is a state where a prison guard earns way, way more than a teacher, and where the CCOA (California Correctional Officers Association) in vehement on insisting that instead of spending money on education now instead of prisons later, we spend on prisons now and prisons later.  So a funny thing happens just before the Nov 2004 election. Arnie takes the prison guards cash, just like Davis did, and then comes out against the modest reform of the worst injustices of the 3-Strikes measure, turning it from a moderate winner to a very close loser — and costing the taxpayer a boatload more in the future.
4. And to confirm his total moral bankruptcy, instead of standing as a decent Republican alternative to the clowns running the nation in DC, he decides to emulate them. While the Bush Administration has been putting out fake news stories and become a laughing stock along the way, now Arnie has decided to copy it.  What does this mean? Yes, you and I the taxpayer are paying for fake news propaganda to oppose the nurse staffing law which was passed with a fair measure of popular support, and was recently reaffirmed by a state judge.  And of course some dumb TV stations have been running the stories, which look like real news (in as much as "real news" is ever seen on local TV station news — I suspect the people who watch that stuff get the "news" they deserve.

There’s more fun stuff from www.Arnoldwatch.org including a fun video of protesters getting thrown out of an Arnie fundraiser.

A long time THCB friend and contributor is back from the big NMHCC show.  He was not impressed at what he heard:

Just got back from NMHCC in DC last night. I was
shocked – shocked! – at the paucity of any kind of original thought at the
conference.  There were a couple of interesting collaborations between payers
and providers (e.g. BCBS of Delaware providing access to its MeDecision database
to allow them to print patient history reports in Christiana Health System’s
ER), but nothing especially compelling or breakthrough to discuss.  No
substanative discussions (beyond CDHP) about the 45 million uninsured (at least
that I heard) or the millions more that will be with the looming Medicaid
cuts.

HHS Sec’y Leavitt outlined 12 strategies for Medicaid
(I wandered off during number 8, I think: his diatribe about how big a problem
lawyers cause helping seniors who are above the poverty level give their assets to
their kids so that they can qualify for Medicaid coverage of LTC).  His
mandate is clearly to eviscerate Medicaid as we know it… I’m all for progress
(i.e. a better Medicaid that covers more people at fewer cost with less waste,
fraud and abuse and chronic disease) but not for removing a vital safety net for
the indigent and working poor (especially children)…

Today’s story about California hospitals suing Medi-cal comes on the heels of a
week of meetings between state governors and the Bush administration about
Medicaid. Medicaid has long been a dog’s breakfast of American health policy
with all types of programs thrown together. It’s a health insurer for the very
poor, it’s a long-term care plan for some of the elderly, it’s a subsidy program
for large inner city hospitals (the DiSH program), and it even pays Medicare
Part B premiums for those "dual eligibles" too poor to afford them. In addition,
in many states the CHIP program for near-poor children is rolled into Medicaid
too. Furthermore, many states use what are now called by HHS secretary Leavitt
"accounting gimmicks" to get more of their program on the Feds’ tab.

The problem is that all these programs tend to be underfunded anyway, and in
a time of state and federal budget squeezes, they come severely under fire.
Taking even another $6 billion per year out of the program, as the
Administration proposes, feels to the states like getting blood out of an
already over-squeezed stone–even if the GAO says its only $5bn a year. A rational system would somehow fold Medicaid into
some type of universal insurance system. But we are not getting that any time
soon, and right now many poor Americans and their safety net providers rely on
Medicaid to keep them from toppling into the abyss. So expect the politics of
desperation to play out in that sector over the next few months.

This is not going to be a fun time to be either a Medicaid recipient, or worse someone who would like to be.  And that includes a lot of young and poor children.  It’s also not going to be fun to be a safety-net provider who relies on Medicaid as one of their better payers.