A conventional look at The Speech: Obama over-learned the lessons of Hillary-care; he gave Congress too long a leash; he lost control of the message; the wacko’s attacked with a barrage of Socialist/Nazi/Plug-Pulling-on-Grandma-isms; not only was health reform on the ropes but the entire Obama Presidency was in danger of imploding (taking the Dems down with him in the mid-terms); Obama had his back against the wall, a make-or-break moment. Then last night, the President gave a great speech that staked out a thoughtful middle ground; Joe Wilson went rogue, horrifying nearly everyone; this led to real sympathy for Obama and the Dems and a shift in the political landscape. In the end, a mild version of health reform – with nearly-universal coverage, some regulatory protections against the most heinous insurance practices, fee hikes to pay for it all, and a little movement toward improving quality and efficiency – passes.
Another look at The Speech:
Obama, a student of history, realizes that health reform is a near-impossible sell since every special interest will come out swinging; he gives Congress the ball knowing that whatever plan emerges from their sausage factory will simply be red meat for demagoguing Republicans and special interests worried about preserving their Gravy Train; Congress obliges by developing plans that overpromise and under-resource, or that push predictable hot buttons (immigrant coverage, palliative care); the Right and its attack dogs go berserk throughout the Wacko Days of August; the left hunkers down, drawing a line in the sand on the Public Option, kyboshing malpractice reform, and avoiding the hard questions about financing.Continue reading…
Academy-award-winning documentary film producer Alex Gibney (Enron: the Smartest Guys in the Room, and Taxi to the Dark Side) has made a 90-minute documentary based on THCB contributor Maggie Mahar’s book Money-Driven Medicine. Bill Moyers will be showing a shorter 55 minute version of the film on his PBS show, Bill Moyer’s Journal, Friday, August 28 (Check local listings for time.)
Institutions can buy the DVD of the 90 minute version here or by calling 877-811-7495. Individuals can rent a digital version of the film for home use anytime after August 28 for $2.99
“Money-Driven Medicine is one of the strongest documentaries I have seen in years and could not be more timely. The more people who see and talk about it, the more likely we are to get serious and true health care reform.”—Bill Moyers
“Few Americans appreciate how the health care system is gamed against physicians’ professional commitment to focus only on their patients’ best interests. This outstanding film helps us all understand why reform is essential.” – Elliott S. Fisher, MD, Director, Dartmouth Center for Health Policy Research
This is the second of a 3-part series, where we dig a little deeper into the questions of medical data in the Internet “cloud.” In the first part, we reviewed issues of data safety – how to guard against loss of data. In this second part, we will review data security – how to guard against data theft. The third part will focus on privacy and ensuring that only the right people can access the right data.
A review of issues around medical records ownership and protection shows that medical records are the property of those who prepare them (medical professionals), and not the property of those about whom they are concerned (patients), although patients generally have a right to review them, demand copies of them and demand their confidentiality. With limited and specific exceptions, consent is required in order to disclose such information to others. So, how does one create a framework of security that protects the confidentiality of such records against unauthorized breach?
Continue reading "Medical Date in the Internet "cloud" (part 2) – Data Security"
The question of data security
in a “brave new world” of cloud-based Electronic Health Records (EHRs),
Personal Health Records, and iPhone and other smartphone apps that
could transmit personal health information, has attracted the attention
of many. Web-based services – so-called “cloud computing” – are not inherently secure.
Such technology is focused more on widespread reach and
interconnectedness rather than on making sure that the connections and
the data are foolproof. Yet much of our personal information, such as
banking information, is housed electronically and accessed through the
web – we have become so accustomed to it that we seldom think very much
about it. Personal health information, moreover, is protected by law:
HIPAA, which is focused around physician and hospital-centered
recordkeeping, and now ARRA, which extends HIPAA-like protection to
patient-centered Personal Health Records as well.In a previous blog post,
we reviewed (at a high level) the ways in which special attention to
security and privacy can create what is needed to house personal health
information in a hosted, “cloud”-based setting. In this series of
posts, we will dig a little deeper into these questions. This first
part addresses the issues of data safety, and protection against loss
and “down-time.” The second part will address the question of security
between connections (making sure “the pipes don’t leak”). The third
part will focus on privacy and ensuring that only the right people can
access the right data.
Continue reading "Medical Data in the Internet "Cloud" (part 1) – Data Safety"
Today Stephen Hawking gets the Presidential Medal of Freedom. Not bad for a guy the British NHS had its “death panel” kill off in the 1960s. Meanwhile the real star of the day is not the guy who was on Canadian TV yesterday, but instead it’s The New Republic health care guru (and blogger at The Treatment) Jon Cohn who was just great on the Colbert —even revealing to Colbert that his insurance policy included death panels too. Colbert of course thought that this meant he could have his staff put to death.
TV is fascinated by my views on American health reform. Well not American TV (you have to be called Michael Cannon to get on American TV).
Following my record-setting appearance on France 24 TV (record was fewest every viewers for a news show), today I’m going to be on CBC News. That’s CBC as in Canada. I think you can find it here and I should be on at 11.15 PST or 2.15 EST
Most biomedical research is framed by an outdated view of disease, a linear mind-set that focuses on simple causes rather than complex relationships within dynamic systems. If we are to achieve President Obama’s audacious goal of “a cure for cancer in our time,” we must radically alter the way we think about biology and disease.
Physicians and medical researchers are traditionally taught to consider disease in terms of simple causes and isolated linear pathways. This one-gene-one-disease approach also informs the way most animal models of disease are developed. Technology readily enables researchers to engineer mice with specific molecular defects in one or a small number of genes as an experimental proxy for human disease. While some of these models are informative and reasonably predictive, most are not.
The limitations of animal models are highlighted by results emerging from powerful genomic studies of human diseases ranging from Type 2 diabetes to pancreatic cancer. For these and many other conditions, the cause is not a single defect, or even a handful of defects, but rather, combinations of hundreds of possible defects, each contributing slightly to the overall risk of disease.
Health reform that focuses exclusively on health care finance — that
is, how we pay for universal access to insurance coverage — will not
produce successful reform. Reform must be holistic, with a focus on
the entire system, as well as its component parts, including whether
the system is structured to deliver the right kind of health care
services in the most appropriate setting, whether we have sufficient
quantity and kind of health care professionals and technology
geographically dispersed to provide the health care services that
people will presumably have insurance to access, and whether the system
properly incentivizes health care professionals to make decisions that
are efficient, effective, and in patients’ best interests. This is a
massive undertaking, with a tremendous risk that important components
will be overlooked precisely because of the size of the undertaking.
The Stark Law represents the kind of on-the-ground healthcare delivery
problems that healthcare reform must tackle.
The American Health Lawyers Association’s Public Interest Committee today released a Whitepaper entitled: “A Public Policy Discussion: Taking Measure of the Stark Law” analyzing the ” Ethics in Patient Referrals Act” (and its progeny), more commonly known collectively as the “Stark Law“, after its primary sponsor, Congressman Pete Stark,
who now counts himself among the many who believe that while the
problem the law aimed to address is real, the statute and its
multitudinous exceptions have become a nightmare.
Boston University’s Metropolitan College (MET)
recently announced a scholarship for those currently in the care of Dana-Farber
Cancer Institute (DFCI) which will offer patients and survivors an opportunity
to jumpstart their educational initiatives. Starting with the Fall 2009
semester, The Boston University Metropolitan
College Dana-Farber Cancer Institute Scholarship will enable
patients to either begin or continue their undergraduate studies and resume
their interaction with the education community while working toward future
personal and professional goals. The scholarship is offered to any current or
recent (within 18 months) DFCI patient toward any full-time, part-time, or
non-degree MET classroom program at the undergraduate level.
Thus far, MET has raised over $25,000 in scholarship
funds for the program and is working to engage the local community in an effort
to fund the program for years to come. Donations can be made through the
scholarship website: bu.edu/met/scholarship/dfci/.