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POLICY: The liberal media maliciously tells the truth about Rudy, again

There’s more Giuliani bashing going on in the liberal media. First in the NY Times Frank Rich goes after him via the seedy route of the forthcoming tell-all lawsuit from Bernie Kerik’s ex-girlfriend. (It’s good stuff–I’d recommend a full read). Now the LA Times‘ Ricardo Alonso-Zaldivar points out the modest fact that cancer patients who would luxuriate in Rudy’s free market health care concept would not (and cannot in most of today’s American health care) guarantee that they would get access to health coverage or of course the care that Rudy is so happy about. In fact the American Cancer Society has been feeding Bob Herbert a steady series of terrible stories of cancer patients who got financially and medically shafted by the current system.

Of course Rudy was at the time of his cancer treatment enjoying socialized insurance, at least insurance socialized across the group known as NY City employees. Of course since 1970 he’s largely been a Federal or city employee, so apparently social insurance is OK for him, if not for the rest of us.

And all of this is a great pity. As David Brooks suggests, there have been times when Rudy was not merely playing to the most unthinking elements of the conservative primary voters. Maybe we’ll see that again if he wins the Republican nomination, but he’s giving the Democrats plenty of ammunition for the general election.

CODA Uwe has a great zinger about Giuliani’s use of the socialized medicine system he controlled to help out an old friend in a letter to the NY Times Saturday.

And the Health 2.0 Design Award Goes to … by Indu Subaiya

I’d
like to dedicate my Thanksgiving post to the people who are working on,
have worked on and most importantly, ought to be working on issues of
design and usability in healthcare.

I seem to be joined by Sohrab Vossoughi, Founder of Ziba Design who wrote a viewpoint article in this week’s Business Week, Designing the ‘Care’ into Healthcare.

What do I mean by design? To quote Joan Osburn, who runs Osburn Design,
a well-known architecture and design firm in San Francisco, with her
husband Steve, "design is not decoration." Design to me is a philosophy
and an intentionality behind creating things, be they physical
structures, gadgets, websites or services, that translate into an
optimal user-experience. Optimal, in turn, has elements of both
functionality and beauty i.e., (1) were you able to do what you needed
to do and, (2) did you enjoy doing it?

    > Continue reading this post on the Health 2.0 Blog

HEALTH 2.0: In mourning, meanwhile over at Health 2.0 Blog

Like every proud American I’m spending the day paralyzed by the effect of way too much excellent food and wine yesterday. And like every other Englishman (ex-pat or Blighty-based) I’m also mourning the national team’s appalling performance in losing at home to the mighty Croatia and hence missing out on going to the European Championships finals next summer.

So while THCB sleeps forlornly over the weekend, Health 2.0 Blog is up and humming with Indu Subaiya’s superb thanksgiving for excellent design in health care.

POLICY: Someone else beats up on Herzlinger

Here’s Maggie’s takedown of Herzlinger’s WSJ column, with a heavy dose of Uwe included. And as far as I can see the most important thing about any regulated individual insurance system is consistency of benefits across plans—which means the plans then have to concentrate on improving care rather  than gaming risk selection. And then there’s risk adjustment between them. (At least that’s the original Enthoven model).

I haven’t felt the need to torture myself enough to read the latest Herzlinger book—given that I suffered through the previous two, I awarded myself time off for good behavior. However, she appears to want to allow plans to offer personalized benefits “for consumer choice” and then somehow do back end-risk adjustment between them later. Funnily enough that’s roughly what Wellpoint’s California lobbyist said when I asked how they justified selling Tonik et al. At the least it sounds very complex (after all, risk-adjustment between plans with identical benefits is hard enough), and in reality it’s probably just more destruction of the risk pool.

So in other words the part of Switzerland that does work (the uniform benefits) is the part that Reggie wants to destroy. No doubt Maggie will be looking forward to lots of incoherent comments and accusations of plagiarism and poor research skills on her blog.

When the Patient is a pain the doctor blames Google, by Matthew Holt

This article in Time written by an New York-based orthopedic surgeon is called When the Patient Is a Googler. But the problem is not Google, or online health information searching. Most doctors like a better informed patient. The problem is that this patient didn’t respect the doctor and that the doctor in turn didn’t respect the patient.

Trot over to Tara Parker-Pope’s Well blog on the NY Times to see a lot of comments about the surgeon’s attitude. (And no cracks from those of you who know a few orthopedic surgeons!)

Matthew Holt

POLICY: The NY Times Remembers the War on Drugs, but has learned none of its lessons

No one bothers to care much about the war on (some) drugs these days. Sure it’s an $80 billion a year boondoggle for law enforcement and criminals, paid for by the taxpayer at an untold cost in lost civil liberties. But that pales in comparison to the $200 billion a year boondoggle otherwise known as the War in Iraq—a trough in which there are even more snouts. And of course one which has created even more problems than the war on drugs, which may even have a larger effect and last as long. But out of nowhere, the NY Times Editorial page has remembered.

Sadly remembering and understanding are two very different things.

Mexican criminals make money off the criminilization of personal behavior in the US. That money, in the form of cash and guns, flows south. And there’s a terrible inevitability about it, as the Times says, Yet so long as there is demand, the narcotics will always find a route, through Mexico or some other way.

So what, after 90 years of failed prohibition, is the NY Times’ radical answer? Send more money to the Mexicans from the US taxpayer so that the police there can buy more guns.

Did Judy Miller get moved to the editorial department? The NY Times editorial is drinking the kool-aid straight from the futile but endless fundable idiocies of the drug warriors at the DEA. Can it not do better?

 

HEALTH2.0: Personal Genome Management–The Next Big Thing?

There are 160m Americans looking for health information online and
somewhere in the realm of 10–30% of those are viewing and creating
their own content. But that has made moderate impact on the mainstream
press (with Laura Landro being an honorable exception). So it was a
little  surprising to see both the WSJ and the NY Times feature a related issue in the last week—online genetic screening.

Suddenly the concept of getting your genome tested and laid out online is really hot. 23andme (with its Google connection and Esther Dyson on the board) and Navigenics
(with Kleiner Perkins and MDV as blue chip VCs in a $25m round) are the
two best known west coast players. 23andme has already found out that Warren and Jimmy Buffet are not related and you can go to their site and sign up for their service for under $1,000. (And learn lots more about it in this Wired article) But they’re not alone. In Boston, Knome is
gearing up for something similar and Icelandic company DeCODE genetics,
which already has a database with the island’s entire population in it,
has also introduced a similar service called DeCodeMe.

And of course there’s The Personal Genome Project. It’s an effort led by George Church and includes 10 people who are putting all their genetic information online. (One is Esther Dyson of course)

Meanwhile, plenty of other companies are doing genetic testing mostly on genealogy grounds. The Genetic Genealogist Blog estimates that some 600,000 tests have been done and they are worth about $300 each. but for an annual market, that’s only $25m. The Genetic Genealogist Blog also has a long list of those genetic companies.

Finally, while there’s all this excitement about doing comprehensive DNA testing, DNADirect has been offering a direct to consumer service for a couple of years which offers the most common tests. You can see their price list here. One estimate which seems in the ball park is that the total market for that testing is $200m.

But let’s hang on a minute. (Read the rest on Health 2.0 Blog)

When is a Medical Error a Crime? by Bob Wachter

Bob Wachter is one of the nation’s leading experts on medical safety and one of the pioneers of the hospitalist movement. And now he’s descending into the mire of blogging! So we’re pleased to cross post one of the more recent pieces from his (relatively) new blog Wachter’s World.

Robert_wachterThe first commandment of the modern patient safety movement was “Thou Shalt Not Blame.”
Old-Think:
errors are screw-ups by “bad apples,” and can only be prevented by some
combination of shaming and suing the doctor or nurse holding the
smoking gun. New-Think: errors represent “system problems;” any
attempt to assess blame will drive providers underground, inhibiting
the free-flow of information so crucial to error prevention. Like
most complicated issues in life, the truth lives somewhere between
these polar views. In the main, the “no blame” view is right – most
errors are committed by good, hardworking docs and nurses, and
finger-pointing simply distracts us from the systems fixes that can
prevent the next fallible human being from killing someone.Yet,
taken to extremes, the no blame argument has always struck me as both
naive and more than a little PC. Anyone who has practiced for more than
a month can name docs and nurses who they would never want caring for
their loved ones. And what about the substance-abusing nurse, the
internist who doesn’t keep up with the literature, the
retractor-throwing surgeon, or the provider who refuses to follow
reasonable safety rules. If nobody is ever to blame, who is
accountable?

Continue reading…

Health 2.0 at the CCR Workshop in San Diego and thoughts about Google’s Subauth, by Indu Subaiya

InduYesterday we attended David Kibbe’s CCR workshop in San Diego and learned lots about XML and the
utility of the continuity of care record in many different settings.  For more info about the CCR, read David’s posts on the topic – here and here

Over the course of the workshop, there were presentations by Rick Peters, the chief architect of the
CCR who has recently left a PBM start-up to look at several new
opportunities, Steve Waldren of the AAFP, Michael Rosenthal from Minute Clinic and Google’s
Jerry Lin. In the audience were people from Microsoft (Healthvault),
Qualcomm, Rediclinic, Patients Like Me, Edmund Billings from OpenHealth
and Michael Mee, who is working with Adam Bosworth on his new gig, and
a host of tech companies and provider groups offering or trying to
implement the CCR functionality respectively.

Google’s Jerry Lin sparked a heated debate about security and
authentication and whether username and password based systems were
enough or whether you needed 2 factor or 3 factor authentication.
Google’s subauth was pretty cool I thought although the open source
version known as oauth
is more likely to be relevant to apps outside of
Google.Continue reading this post over at the Health 2.0 Blog

What the Blogs are saying …

Adam Bosworth, describing life post-Google:

"Well, as some seem to know, I’ve left Google. And now that I’ve
left, that old entrepreneurial fever has struck me again and I’m off
working on a startup. Google is a wonderful company and I had a great
time there and had a lot of fun building something I really believe in,
Google Health, which I think has a great potential to change the way
consumers manage their health when it launches. Still, for me, it is
time to start a new company and I’m off and running.

I’ve been dusting off extremely rusty engineering habits and writing
code. Not elegant code to be frank. Just enough to think through my
ideas. Some extremely clear-headed and smart people can work out
everything abstractly in their heads and then just go and implement it.
I’m not one of them. Watching me write code is like watching an
indecisive sculptor work with clay. I shape it. I look. I wince. I
reshape it. I play with it. I wince some more. I ask my friends, nurse
my wounds, and then reshape it yet again. And so on. Constant iterative
development. It takes three tries before it is even close to the way it
should be, best case. I think it is totally worth it. The arguments and
design decisions are just way more concrete and tested."

Continuez

The Download squad on the impending PHR Wars

"This raises an interesting question. Are doctors going to want to sign
up for Microsoft, Google, ZocDoc, and other online services just to
communicate with their patients? It seems more likely that an
individual doctor or medical practice will pick one service and then
stick with it.

For example, if you take your kid to Fluffy
Bunny pediatrics, you’ll find that the doctors are willing to share all
of your child’s medical records with you over Microsoft HealthVault. If
you sign up for Google Health, you’ll have to get old-fashioned paper
records. Because otherwise, Fluffy Bunny doctors would have to spend
time submitting all of their documents to 2 or more different sites,
which would increase their workload, not decrease it. This, of course
would force health consumers to sign up for multiple services if they
want to make sure they have access to the latest information from all
of their doctors, meaning that you’re the one with a disorganized mess,
not your doctor."

assetto corsa mods