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Code Blue! Republicans leaning left on healthcare! Craig Stoltz

Health08Craig Stoltz is a web consultant working in the health
2.0 space. He has previously served as health editor for the Washington Post and editorial director of Revolution Health. He blogs at Web 2.0 … Oh really?
I recently had a hand in a project, called the Healthcare08
PoliGraph

, which seeks to find meaningful
distinctions among the presidential
candidates’ healthcare policies. This was tougher than it sounds.

This being the primary season, each party’s contenders are pretty
much sticking with the approved script. The Democrats are trying to outbid each
other for cradle-to-grave healthcare for all humans treading on U.S. soil. The
Republicans are quietly uttering free-market shibboleths to avoid alienating
their big contributors until the fall, when they’ll probably have to promise to
do something or other.

The PoliGraph project plotted each candidate’s stances on
six healthcare issues on big graphics. We plotted their positions along two
axes: from left (i.e., federalphilic) to right (federalphobic), and from most
important to least important (to the candidate, not us). 

By parsing the data carefully, we were able to find some
daylight between candidates, even within each party’s tight ideological clusters.

For instance, for all the fuss over comparing Clinton’s and
Edwards’s personal “mandates” that
people have insurance, when we dug into her plan we found her solutions more inclusive
of market forces than either Edwards’ or Obama’s. (This gets wonkish, but Hillary
gives small businesses incentives to
offer private insurance coverage to employees;  Edwards and Obama depend more on mandates and
expanding public programs to fill that gap. Hey, it’s something.)

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POLITICS/TECH: Theocratic fascist scumbag rears ugly head in health care

Joe Paduda points us towards the latest adventures of the scummiest holier than thou corrupt theocratic fascist in recent American political history, who’s now raking it in overseeing corruption “prevention” in the implant business. Zimmer has been forced by one of his former colleagues in the US attorney’s office to hire his law firm at a just outrageous rate. Joe raises legitimate points about the culture of pay-offs all round in the implants/devices business which are now infecting the regulators.

But I just can’t get past seeing that man and all the pain he caused, not to mention his shredding of America’s tradition of civil liberties. For more on his raking it in, see earlier THCB explosions. Sometimes I hope there is that afterlife that he preaches about, because if there is I know where Ashcroft is going.

 

POLICY: Why you shouldnt be interviewed over the phone…

Apparently in an interview I had with journalist Thomas Day from Medill reports news service which showed up in this article I said:

If you look at California and Blue Cross-Blue Shield, their biggest provider, they came out against the Schwarzenegger bill because it essentially said the same thing [as Democratic proposals],” said Matthew Holt, a San Francisco-based health-care advocate.

What I hope I meant to say was this:

If you look at California and Blue Cross-Blue Shield, their the biggest provider, insurer in the small group market they came out against the Schwarzenegger bill because it essentially said the same thing [as Democratic proposals], such as limiting underwriting in the individual market and limiting the amount of money insurers could make” said Matthew Holt, a San Francisco-based health-care advocate.blogger/consultant/wise-ass

There’s that’s better!

PHARMA: Talking of gotcha’s…

Schering Plough is coming under multo criticism the last two days for sitting on data for up to a year that shows that the anti-cholesterol drug Zetia, when combined with Merk’s Zocor in the combo drug Vytorin, not only didn’t work but may have caused harm. Here’s the story in the NY Times and here’s the op-ed in the same paper saying:

It was still very disturbing to learn this week that a heavily promoted cholesterol-lowering drug had flunked a clinical trial of its effectiveness in reducing fatty deposits in arteries. The two companies that reap billions from the drug had been cynically sitting on the results for more than a year.

But trust Peter Rost to find the wrinkle—Schering-Plough’s President dumped $28 million in stock before Vytorin controversy erupted. 

So where is the SEC investigation (and for that matter, what about their investigation into similar activity at Wellcare)?

POLICY: Do mandates matter? with UPDATE

Former Labor secretary Robert Reich has appealed to Democrats (in other words Paul Krugman and Obama’s
camp) to stop squabbling over healthcare mandates. Basically he says that Clinton would have to let some people who couldn’t afford health care out of the mandate (as is happening in Massachusetts) and that Obama’s plan would get us close enough to universal coverage that the difference isn’t worth arguing about.

Writing in THCB last week Robert Laszewski pointed out that the cost of buying insurance is sufficiently high that a subsidy would have to be so large and go so high up the income scale that it wasn’t politically realistic — and certainly wasn’t working in Massachusetts. So in his view Obama and the Republicans (Robert is actually generous enough to give some of them credit for having thought about this) are right not to push for a mandate.

But then of course, with no mandate you’re not getting everyone into the pool. So what do you end up doing with those who don’t have insurance when they need care? You end up with what happened in Hawaii, where universal pay or play ended up in 90% insurance.

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QUALITY: Mental health–any ideas?

I was highly struck by something Dr David Sobel said in his great speech at the Ix Therapy conference last October—he suggested some 50% of primary care office visits are the result of background mental health issues. That sounds intuitively right. After all a British GP once told me that his most frequent symptom was “TATT” (tired all the time”).

Meanwhile I’ve been getting to know a homeless childrens’ organization in San Francisco, which specializes in mental health services for those families. And not surprisingly those kids have issues that result in wide social and health problems later on (but not too much later on) in life.

Then today a reader asked me if there was any evidence on whether more care overall, and specifically more specialty care, would help those with mental illnesses? And whether providing more treatment manages to save money down the line (presumably in other areas).

Mental health has not been an area we spend much time on at THCB, other than perhaps to acknowledge that we over-medicate some populations. But Vic Fuchs did say to me once, “remember, the head is connected to the body”.

So does anyone have any data or conclusions about whether specialty mental health care is a) effective and b) a good investment? Please comment below.

HOSPITALS: Sunshine is the best disinfectant by Paul Levy

Our mail room staff called today to say that over 500 letters had arrived from the SEIU to doctors in
the hospital. One of the doctors was kind enough to share his with me,
a letter from Mike Fadel, Executive Vice President. I’ll spare you most
of the details, but I will give you a small quote:

"BIDMC’s CEO
recently has complained that he has been singled out for public
criticism on the ‘question’ of whether hospital workers should be
promised that they will not be threatened by executives on the decision
of unionizing. Be he has singled out his own institution by essentially promising to fight against BIDMC’s own caregivers as if they were adversaries."

Those
of you who are regular readers of running a hospital know that all of the above
is not true. You know the high regard and respect I have for our
employees, and you know of my personal efforts to improve the work
environment at this hospital — both for their sake and in support of
providing better care to our patients. You can also see exactly what I
have said about union organizing in general and the tactics of this union in particular.

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HEALTH 2.0: Health 2.0 NorthEast Networking Meeting

The Health 2.0 movement continues to grow and in the north-east it now has a new "chapter"!  Mark Modzelewski, from Bang Ventures & Vince Caprio, from NYNBA, are organizing its first networking meeting on January 23rd! The meeting is from 5.30 to 8.30pm on Jan 23 at the Cambridge Marriott.

Indu Subaiya & Matthew Holt will be there along with other familiar names from the Health 2.0 world, there’ll be some brief remarks and a panel Q&A but this is intended to be a networking event. (There’s a small charge to pay for the drinks, but all the money will stay in the chapter to pay for drinks at the next one.) So bring your colleagues working in Health 2.0, Web 2.0 or anywhere else, and sign up on this form!

And of course feel free to forward this to anyone who might be interested

QUALITY: CNN’s Glen Beck–not a delighted patient

Looks like CNN’s Glenn Beck won’t say what his local hospital’s CEO would like to hear when Press-Ganey call him! He accuses the staff there of not caring.

At the hospital I was often treated more like a number than a patient. At times, staff members literally turned their back on my cries of pain and pleas for help. In one case a nurse even stood by tapping his fingers as if he was bored while my tiny wife struggled to lift me off a waiting room couch.

So far he hasn’t named names, but I suspect that when it gets out, it’ll be worse for the hospital than it having a bad overall mortality rating in some obscure state report. After all when Don Berwick and David Lawrence wrote about their wife and mother respectively, they went out of the way to praise the staff, while castigating the care system. Beck is not so kind.

I’m not sure Beck’s solution is too constructive.

That’s why I don’t want to hear anymore about universal health care or HMOs or the evils of insurance companies until each and every hospital in this country can look me in the eye and tell me that they their staff is full of truly compassionate people who treat their visitors like patients, not products. Hire and train the right people, and then and only then come talk to me about everything else you need.

But his complaints are echoed in a series of videos from Health care for All in Massachusetts which also start talking about problems with care quality. I wonder if Paul Levy will name names about the hospitals in the last two videos—Both prominent Boston teaching hospitals that both screwed up big time with medical errors

Final thought: perhaps Michael Millenson is finally influencing people….while he’s even still alive!