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The Massachusetts Question

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By Robert Laszewski

Two years ago lawmakers in Massachusetts made the state the first in the nation to mandate that residents purchase health insurance. The proposal quickly caught on, inspiring similar efforts on the state level and eventually becoming the blueprint for the national health reform efforts of Democratic presidential candidates Sen.  Barack Obama and New York Sen. Hillary Rodham Clinton.

More than a year into the experiment the first returns are in.  And reviews are mixed. Not surprisingly, the program is costing far more than backers had initially predicted. On the other hand, the ranks of the uninsured in the state have dropped sharply. (See Matthew’s podcast with Jon Kingsdale, executive director of the Massachusetts Connector, the agency created to administer the program, for more on the back story.) The Massachusetts experiment  is clearly not something to be dismissed — nor is it something to
defend for the sake of argument.

In brief, the Massachusetts health care reform law appears on its way to:

  • Covering two-thirds of those who did not have health insurance on the day it was enacted — about 400,000 people by the end of 2009.
  • Covering most of those who were uninsured in households with incomes below 300 percent of the federal poverty level–below which the plan pays all or most health insurance premiums.
  • Offering health insurance plans to middle-income people that are still largely unaffordable for those families making less than $110,000 a year –– people for whom the state has generally canceled the individual mandate that they must buy coverage.
  • Racking up costs well above what was first estimated. The plan looks to be coming in 38 percent higher than originally estimated for its first year and the Governor is now estimating second year costs 50 percent higher than the original estimate –– from $725 million to $1.1 billion for the 2008-2009 fiscal year.
  • Developing an annual cost trend for the program’s insurance programs, Commonwealth Care and Commonwealth Choice, in the 10 percent to 15 percent range.

So, lots more people, particularly lower-income residents, are covered but the program’s costs are unsustainable.

Continue reading…

Information Therapy time (again)

By Matthew Holt

The Center for Information Therapy has—in a move aimed at upsetting me personally—moved its conference from Park City, Utah, to Washington DC. Today along with some other THCB regulars like star Health 2.0 Ranger Jen McCabe Gorman, and Craig Stoltz, I’m in the Newseum — the new Museum of news media and the First Amendment. Here the Center for Information Therapy is literally and figuratively moving the Information Therapy debate into the core of the Washington Policy process.

The Center’s President, Josh Seidman, drew parallels between the development of news media in the US and what we’re seeing in health care. Here compared the Royal Mail in the UK with the pony express, and noted that some American innovations were “so democratic as to be regarded as subversive.”

Me, Jen & maybe Craig will be back with more later. Here’s the agenda.

Podcast with Marston Alfred, founder and architect of SugarStats

By Jen McCabe Gorman

Marston Alfred, founder and chief architect of SugarStats.com chatted recently with me about his relatively new, Web-based program that allows diabetics to track their health statistics online.Sugarstats_2

Alfred described SugarStats as a portable PHR specifically for diabetics. He hopes diabetics use it to share their progress with others, such as family and doctors, and that by doing so it will improve their adherence to diet, exercise and medication schedules.

SugarStats launched publicly a year ago. It currently has about 4,000 users and gets an average of 10,000-20,000 unique visitors each month.

A diabetic himself, Alfred talks about the need for SugarStats and his hopes for the company’s future. Listen to the podcast.

Kaiser tiptoes into HealthVault & tells THCB about it, with UPDATE

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By Matthew Holt

Kaiser Permanente signed on this morning for a pretty extensive pilot with Microsoft,
allowing its 159,000 employees to copy their online health records into HealthVault. This is a big coup for Microsoft and a fairly ambitious move for KP which to this point hasn’t said much publicly about the data transferability it was going to provide for its members. This is a clear signal.Kp

Assuming that the pilot is a success, presumably all Kaiser members using My Health Manager (over 2 million now and heading to 3 million at years end) will soon be able to move their data to HealthVault. We are potentially seeing the first real example of mass scale data interoperability onto a platform not connected to a health care organization. And obviously, Google is playing in this same space too.

Once the data is collected in HealthVault, there are lots of possibilities for what can be done with that data, and what services can be offered.

Back in the days when Justen Deal was causing havoc with HealthConnect, I had a somewhat unorthodox interview with Permanente’s Andy Wiesenthal — in which (without KP’s PR folks knowing) I called him in a taxi on a cell phone late on a Friday night. Perhaps it’s a mark of how far THCB has come (you decide if it’s good or bad) that in regular business hours on Friday, KP’s publicity machine lined me up for a pre-release interview with Peter Neupert, Corporate VP of Microsoft Health Solutions Group and Anne-Lisa Silvestre, VP of Online Services at KP.

Continue reading…

Sapping VistA’s soul

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By Niko Karvounis

Niko Karvounis tracks the healthcare system for the Century Foundation. This post first appeared on the increasingly influential Healthbeat blog, one of our favorite healthcare reads.

In the past I’ve spoken highly of VistA, the Veteran’s Administration computerized
health records system, — and with good reason. VistA has a lot going for it. In 2006, it won an “Innovations in American Government Award” from Harvard. Studies show that use of VistA has improved VA productivity by 6 percent a year since nationalVa implementation was achieved in 1999. In a time of sky rocketing health care costs, VA care has become 32 percent less expensive than it was in 1996 in part thanks to VistA. The computerized system also has helped the VA reach an amazing prescription accuracy rate of over 99.997 percent. And last — but certainly not least — VistA is a flexible program that allows for much independent tinkering in the name of improvement, both by techies outside of the VA and those within the administration.

Given all these pluses, you’d think that the government would be happily throwing its weight behind VistA and ensuring that the system is firmly institutionalized for the long term. But in fact, just the opposite is happening. VistA is under attack; and it’s the federal government that’s leading the assault.

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Until the middle class truly cares, forget about health reform

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By THCB Staff

Regular THCB contributor Michael Millenson published an op-ed piece in Sunday’s Washington Post, in which he says that until health insurance truly becomes an issue of the white middle-class, politically, nothing will happen.

Michael’s words:

"Here’s a cold truth: Despite much media hand-wringing on the subject, most of us give about as much thought to those who lack health coverage as we do to soybean subsidies.The major obstacle to change? Those of us with insurance simply don’t care very much about those without it. It’s only when health care costs spike sharply, the economy totters or private employers begin to cut back on benefits that the lack of universal health care comes into focus. Noticing the steadily growing ranks of the uninsured, the broad American public — ‘us’ — begins to worry that we’ll soon be joining the ranks of ‘them.’"

"The responses I’€™ve gotten by putting my personal email on the page have certainly been … educational," Michael told us. You won’t get his personal email here — you’ll have to visit the Post for that.

The Long Baby Boom

By Matthew Holt

Last Friday I had a great chat with healthcare futurist Jeff Goldsmith about his new book, the Long Baby Boom. We discussed the policy and cultural issues of retirement, Medicare, Social Security, immigration, end-of-life care and meaning in work.  With 76 million baby boomers heading towards age 65, these issues or of  great importance.

Here’s the interview.

Optimism about the baby boomers

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By Jeff GoldsmithIjeff

Jeff Goldsmith is President of Health Futures, Inc, and a professor of public health sciences at the University of Virginia. His new book, "The Long Baby Boom: An Optimistic Vision for a Graying Generation," will be released shortly, and Johns Hopkins University Press granted THCB permission to print the introduction in full.

Fresh from liberating the world from the Axis powers, America’s Greatest Generation came home from World War II and brought forth a baby boom. Seventy-six million children emerged from this remarkable postwar celebration, almost four children per family. American society has not been the same since.

The baby boom increased the U.S. population 44 percent in just eighteen years! American society had to re-create itself to accommodate the new arrivals. Each social institution the baby boomers touched, from elementary schools to university to the family and the work world, they fundamentally reshaped, not only by the press of their sheer numbers but also by their unique, high-maintenance approach to the world. At each turn in their lives, baby boomers have torn up the script and started afresh.

Today, the advance guard of this generation’s legions is within four years of reaching a bristling societal Maginot Line: age 65. According to many pundits and forecasters, the aging baby boom threatens the U.S. economic future.

Continue reading…

How the mainstream media hypes health news

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By Maggie Mahar

“False Hopes, Unwarranted Fears: The Trouble with Medical News Stories.” If you find the headline alarming, you should read the editorial, published just last week in PLoS Medicine. There, the journal’s editors summarize  what the Health News Review has discovered over the past two years while evaluating medical stories about new products and procedures throughout the mainstream media.

“It’s not a pretty picture,” says Gary Schwitzer, the University of Minnesota School of Journalism professor who publishes the online project.

Continue reading…

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