I wanted to call it “Hillary Clinton meets Ann Rand,” but my Spot-on Editor decided that she really liked the notion of privatizing the fire department. So I’m up over there dissing on the The Garden Hose Health Care Brigade.
As ever come back here to comment.
I began teaching health policy almost thirty years ago with Odin Anderson at the University of Chicago
Graduate School of Business. Like me, Odin was a sociologist, and one
of his hobbies was tracking the sociology of our nation’s “healthcare
crisis”. He found that the health care “crisis” waxed and
waned (as measured by press mentions and journal articles), but never
disappeared. It had been going on for twenty years by then,
so I guess we’ve now been in “crisis” for fifty years. The
American health care “crisis” is not acute illness – rather it is
like a chronic disease which flares up periodically, accompanied by
fresh prophecies of impending doom and calls for someone on a white
horse to fix the problem.
From 1970 to 1993, health costs
roughly doubled as a percentage of GDP. All the way along, prophets
of doom forecast that the country would simply fall apart when
health costs exceeded 8%, then 10%, etc. . Our economy somehow
continued growing and innovating, and the health system got steadily
more capable at managing our illnesses the entire time. No-one
I know would trade our present, very expensive health system for the
cheaper one we had in 1965 or 1980.
Then, during the mid- 1990’s,
a remarkable thing happened. For the first time since people began
tracking the statistic, health costs remained dead flat as a % of GDP
for eight years in a row. It is remarkable how little attention
this flattening got from the “crisis” mongers. When we finally
get this year’s spending numbers from the CMS Actuary, my forecast
is thathHealth costs will have been flat as a percentage of GDP for
the past five years if you include 2007. Five years isn’t “momentary”,
as Brian Klepper characterized this latest pause.
"Managed care plans earn higher margins today than they ever have before, and operate at lower medical loss ratios than at any time in their history….There are a lot of reasons for this, like enrollment growth, new products and acquisitions, but the bottom line is that isn’t exactly a sympathy-inducing state of affairs."
CIBC World Markets analyst Carl McDonald tells AIS’s Health Plan Week
Of all the participants at Health 2.0, Esther Dyson may be the best known outside the world of healthcare. Esther was one of the earliest backers of Health 2.0 and it is far from an exaggeration to say that the conference would not have been possible without her support and encouragement. Together with Steve Brown of Health Hero, David Kibbe of AAFP, Lee Shapiro of Allscripts, Jay Silverstein of Revolution Health and CommerceNet’s Marty Tenenbaum, she anchored the day’s closing reactor panel: "Health 2.0: Looking Ahead." Today she offers her reactions to what she saw and experienced on September 20th. This post first appeared on Esther’s blog at the Huffington Post, from where it has been repotted, as Esther might put it.
Last week I participated in Matthew Holt’s and Indu Subaiya’s Health 2.0 conference,
which attracted more than twice the number of people they had
anticipated (about 500) and left many more turned away. So, clearly,
something’s in the air.
People
are excited. There were two drug-interaction companies – DoubleCheckMD
onstage and PharmaSurveyor at a booth – that allow individuals (and
doctors) to mine huge amounts of information to assess heir own drug
combinations. There were countless social networks, self-monitoring
services and other harbingers of the new, user-controlled world of
health online. [Disclosure at the end.]
First, a quick summary of the Sermo-Medgadget battle. A week ago Medgadget runs a post claiming that anyone using publicly available (if somewhat obscure) information can impersonate a doctor on Sermo’s site. A huge fuss breaks out. See the more than 130 comments at Xconomy here and a new article interview with Daniel Palestrant here. Medgadget’s journalist/doctors have spent a lot of effort defending themselves in comments at Xconomy and apparently on Sermo, too. And they’ve met lots of anger from Sermo users. Sermo employees (Sermo’s CEO Daniel Palestrant has told me and others) are not posting on this topic on Sermo or elsewhere. They must be pretty pleased about the loyalty they’re seeing from their members—who remind me a little of Mac users decrying Bill Gates!
Most recently, Medgadget went further. Turning up an old PDF and claiming that Sermo is turning over physicians’ identities to its clients—who are financial institutions, the FDA, AMA and (at some point in the future) pharma companies. To Medgadget’s credit they printed a clarifying comment from Sermo’s CEO which made it clear that this was a mock up and no such information had been passed on to clients.
Next my disclaimer: Sermo is a sponsor of the Health2.0 Conference of which I am a co-founder and co-owner. Sermo has bought at least one job ad on THCB and its CEO Daniel Palestrant is someone I like and who has bought me dinner on at least one occasion. I also have a guest pass to look into (but not post on) Sermo, which I haven’t used in several months. (I like docs, I just don’t care that much what they think!)
On the other hand, three other physician social networking sites (Within3, iMedExchange & PeerClip) were also sponsors of Health2.0, so if Sermo was to go away, it’s unlikely either that physician social networking will end, or that it’ll be the reason for the conference’s demise or my return to the gutter. I don’t own stock in any of those companies.
Finally, I met Michael Ostrovsky from Medgadget at the party at Health2.0, which by the way he gate-crashed as despite being a top investigative journalist he was unaware until the last minute that a well publicized 450 person conference on a topic directly concerning him was happening in his backyard! He was enjoying a drink paid for in part by Sermo. I haven’t seen his check for $7 yet, but let’s assume that he hasn’t been been financially swayed in their favor by their generosity either!
So let’s look a little at what happened.
Sermo built its community by asking for information that had a relatively low threshold for an MD to provide, but wouldn’t easily be known by a casual web surfer. As is typical for an online community. Sermo says that as it’s grown in numbers it’s added more features to check that doctors are who they say they are, and some of them are not revealed by the original Medgadget article. But of course any security feature can be got around with someone with enough time, patience and money. And any site of any kind has to balance security/authenticity features, with ease of use and cost of access. Sermo could do a full military/FBI clearance background check on every new member (a bit like the AthenaHealth employment interview!!)—it could just let anyone sign up and promise they’re a doctor with no checking. What they are going to do is be somewhere in the middle. The question is in balancing access and authenticity, where is the rational place for them to be?
So let’s look at situation rationally.
Our local paper, the venerable SF Chronicle has a great article by health care reporter Victoria Colliver on the conference and more–including at least one company I’d not heard about! The piece is called (don’t groan) For these startups, patients are a virtue.
Regular THCB readers know that we are big fans of Stratfor.com, the strategic intelligence firm based in Austin Texas. While Stratfor is probably better known for their analysis of international and national security issues (Think The Economist with a wonky American accent and a healthy obsession with non-state actors and special interest groups), the firm also provides very good coverage of domestic public policy issues, keeping an eye firmly trained on Washington. Analyst Bart Mongoven, the author of the Stratfor Public Policy Intelligence Report is a personal favorite of mine. Today he writes on the evolving definition of intellectual property rights in the international arena, examining recent developments that may signal changes that could be felt everywhere from the market for consumer goods to the pharmaceutical industry. If you enjoy this piece, be sure to sign up for Stratfor’s free email report. — John
The World Intellectual Property Organization
(WIPO) will hold its annual meeting beginning Sept. 24, at which time
representatives of its 184 member countries will likely endorse the so-called
WIPO Development Agenda. WIPO rejected the ideas expressed in the Development
Agenda just two years ago, but leading industrialized countries appear rather
suddenly to have changed their positions. As a result, this agenda will
reflect a fundamental change in how intellectual property rights (IPR) will
be viewed globally in the coming decades. \u003cbr\>For the past 40 years, the\nworld's largest economies have enforced their position globally that\nintellectual property rights are sacrosanct. The 1994 World Trade\nOrganization (WTO) agreement on Trade on Intellectual Property Rights (TRIPS)\nadded some exclusions for emergencies, but in general WIPO and TRIPS rules\nhave been reflexively protective of patents and copyrights.\u003cbr\> \u003cbr\>In the\npast 10 years, however, this approach has come under increasing fire from\ngovernments in developing countries (including WIPO members), human rights\nand humanitarian groups, relief organizations and anti-capitalist groups.\nThese entities argue that the system retards the economic growth of\ndeveloping countries and even results in deaths because citizens cannot\naccess medicines and other patented life-saving technologies. Most detractors\nof the current regime argue that the absolute protection of intellectual\nproperty rights is doing far more harm than good — economically and socially\n– and some of them are calling for a radical shift that would essentially do\naway with recognition of IPR entirely. \u003cbr\> \u003cbr\>As production of goods\nbecomes more and more efficient, especially with modern industrial processes\nreaching low-wage countries such as China, goods are becoming less expensive.\nIntellectual property, on the other hand, is coming to be seen as expensive.\nWhether in drugs, music, seeds or even designer handbags, the price gap\nbetween patented products and the raw cost of the materials — that is, the\nprice of the intellectual property — is growing. With that growth,\nintellectual property rights are more frequently being abrogated. Any\ngovernment tax authority will attest that the amount of cheating is directly\nrelated to the perception that the cost of a product is unfairly high.\u003cbr\>\n\u003cbr\>Though change is afoot, the world is nowhere near doing away with\nintellectual property protection. Still, the tide has shifted the WIPO\nstance, as well as the outlook of a number of other players. Most important,\nthe fairly absolute approach to intellectual property protection looks shaky.\nThe coming regime will likely give corporations a rationale for protecting\nIPR in some cases, but not others. In doing so, it will force changes in a\nnumber of industries and business models. “,1]
);
//–>
For the past 40 years, the
world’s largest economies have enforced their position globally that
intellectual property rights are sacrosanct. The 1994 World Trade
Organization (WTO) agreement on Trade on Intellectual Property Rights (TRIPS)
added some exclusions for emergencies, but in general WIPO and TRIPS rules
have been reflexively protective of patents and copyrights.
In the
past 10 years, however, this approach has come under increasing fire from
governments in developing countries (including WIPO members), human rights
and humanitarian groups, relief organizations and anti-capitalist groups.
These entities argue that the system retards the economic growth of
developing countries and even results in deaths because citizens cannot
access medicines and other patented life-saving technologies. Most detractors
of the current regime argue that the absolute protection of intellectual
property rights is doing far more harm than good — economically and socially
— and some of them are calling for a radical shift that would essentially do
away with recognition of IPR entirely.
David Kibbe, the doc behind the continuity of care record (CCR), and the spearhead of the AAFP’s effort to get family practitioners using EMRs, gave some great comments on the final "looking ahead" panel at Health2.0. You can see more of David when he keynotes the Center for Information Therapy conference on October 8th in Park City Utah. Indu and I will be running a mini-Health2.0 panel at that same conference (with Revolution, Daily Strength & Organized Wisdom) on Weds 10th. But David didn’t get to say everything in San Francisco, and this is what he wanted to add:
1) What I really, really liked was the way in which so many of these
applications helped the patient/consumer help himself/herself — to be
better informed, to know their options, to take better actions, to hope
and act in their own best interests. This is exciting, and very
necessary, as physicians in primary care are already unable to meet the
demands upon them for care delivery, and this imbalance/shortage is
only going to get worse in the future. And it’s exciting because
empowerment is the key to saving the individual out-of-pocket
spending. As health costs continue to shift to the individual, Health
2.0 can really be helpful.
Healing without information is indistinguishable from magic…..And magic in health care today is unsafe and very expensive!
We need an informed (& empowered) health nation. Health 2.0 is leading that potential.
I won’t mention any specific examples, but all of the search engines,
all of the social media sites, and some of the consumer tools sites are
exciting in this regard, and quite real now. The demand for their use
will only grow.
2) What disappointed me was how much work the applications require of
the patient/consumer with respect to information discovery, data entry,
and interpretation of results/advice. There are two issues here that
I would focus upon:
John Graham at Pacific Research Institute is obviously looking for trouble. So he invited two people who really don’t get on — at least in their online comments on THCB — to come comment about Sicko and the Canada-bashers response. I’ve of course had my say about both Sicko and the Canada-bashers before.
So if you want to see me square up to Logan Clements (who is replacing Stuart Browning, who’s cried off sick) hopefully figuratively and not literally, come down to the Pacific Design Center in West Hollywood (Los Angeles) on Thursday September 27th. Stuart and Michael Moore (by proxy) will be showing why making anecdotal poorly researched movies actually changes health policy for better but mostly for worse, and I’ll be explaining why neither of them would recognize real research if they tripped over it in the street.
The info is here–Sicko and its malcontents
I think I’m supposed to be defending Moore, by the way. But perhaps John will step into that void. Local LA Pol Bill Rosendahl will be refereeing! Should be fun!
Meanwhile see how many ridiculous claims and outright irrelevant rubbish you can find in the trailer in the Sicko reply under construction. It’s up on Clements’ site.
That should get the juices flowing
THCB's Podcasts
Listen to them on Itunes or Spotify
