This morning John McCain’s team will be talking about health care. There are some interesting ideas in McCain’s plan, which is the Bush tax deduction idea morphed into a tax credit, plus changes in Medicare payments. The best quick explanation is from our friends at ICYou.
Matthew Holt
McCain to talk about healthcare costs this week …
Health industry executives have few reasons to worry about the so
called health care reforms, or health insurance industry reforms, being
proposed by the presidential candidates.
Sen. John McCain, the presumptive GOP presidential nominee, is focusing his attention on heath care cost containment this
week, but a report in yesterday’s Wall Street Journal shows that he
doesn’t understand the problems any better than Senators Clinton and
Obama. Americans need regulatory changes (no laws are “reforms") that
make health insurance something consumers can use to protect themselves
against catastrophic losses and let individuals buy their policies
directly from insurers instead of buying policies selected by their
employers. And consumers should pay for their primary care and
preventive care services out of their pockets, or, at the least, buy
unbundled insurance for those services instead of buying bundled
insurance that is unaffordable for so many.
The real question is how much could a President McCain do about
health insurance costs with a Congress controlled by Democrats, and
would he pay much attention to the problem if it were clear that
Congress would mark his proposals dead on arrival?
Fortunately, the presidential candidates’ wild and undeliverable
promises of comprehensive health insurance reforms and universal health
insurance are being questioned by Congressional Democrats
as well as by the policy wonks quoted by the wsj.com. No wonder health
industry executives aren’t worried about who’s elected in the fall.
They apparently have decided it won’t make a difference for them or
their stocks.
A detailed new study from the Economics Policy Institute confirms what many of us suspect but haven’t had the data to easily nail down. This weightily-titled report by Jared Bernstein and Heidi Shierholz – A Decade of Decline: The Erosion of Employer-Provided Health Care in the United States and California, 1995-2006 – provides more granular information about the enrollment dynamics over time in employer-sponsored health coverage than we’ve seen in a while. Based on an analysis of the March 2007 Current Population Survey, the numbers reported here are mostly in sync with (but deeper than) similar studies that have attempted to size the enrollment and erosion characteristics of the employer-sponsored coverage market. Strap yourself in; this isn’t pretty.There are two important points here. The first is that, in the six years between 2000-2006, the percentage of American workers with employer-sponsored coverage fell from 51.1 to 48.8 percent, a 2.3 percent absolute or 4.5 percent relative drop. 6.4 million workers (and presumably, another 7.6 million of their family members) lost their health coverage in the process. These losses exceeded gains made between 1995-2000, when the percentage of workers with coverage rose from 49.6 to 51.1 percent.
If elected president, U.S. Rep. Ron Paul, R-Texas, promises to shrink the government’s role in health care. Government intervention, he says, is the cause of today’s high costs, inefficiencies and lack of personal responsibility.
“We can hardly expect more government to cure our current health care woes,” says the Texas OB-GYN’s Web site. “As with all goods and services, medical care is best delivered by the free market, with competition and financial incentives keeping costs down.”
Here’s the outline of Paul’s health reform plan:
About 1990, I was a member of something called the Task Force on Genetic Testing at the then Health Insurance Association of America (HIAA). The health insurance industry realized that, with the Human Genome Project in its early stages, we weren’t far away from genetics being a part of everyday health care and the Orwellian implications on us as insurance underwriters were not lost.
The task was to think about all of this and develop an industry policy for dealing with it. Here’s the headline: In 1990, there was no disagreement among the many insurance executives on the panel that it should never be the insurance industry’s policy to use genetic information to underwrite or otherwise use the information in a way that disadvantaged the people we either insured or could insure.
People
— citizens, patients, caregivers, "consumers" — are early adopters of
social media i
n health,
compared to other industry stakeholders
including providers, plans, payers, and suppliers such as pharmas and
medical equipment companies.
This is but one of many findings in my report, The Wisdom of Patients, which was published yesterday by the California HealthCare Foundation.
The
report covers the origins of social media in the morphing of Web 1.0 to
2.0; the current state of social media in health; business models,
opportunities and obstacles; a glimpse into the fuzzy future of Health
2.0; and, profiles several of the most pioneering figures in
health/social media including Amy Tenderich of DiabetesMine; Matthew Zachary of the I’m Too Young For This! Foundation; Jack Barrette, founder of WEGO Health and formerly with Yahoo! Health; Neal Sofian of Resolution Health; Dan Hoch, MD, of the Harvard Medical School; and, Ben Heywood, CEO of PatientsLikeMe.
Jane’s Hot Points: So
many people informed this report. I interviewed over 30 people to
listen to a broad range of perspectives, and benefited from the peer
review of people like Matthew Holt, Scott Shreeve, and Dmitriy Kruglyak.
I thank them all. I am fortunate to have had the California HealthCare
Foundation sponsor this research. They are a visionary organization
that supports and celebrates new thinking in health, particular in the
area of patient self-care and technology.
I look forward to learning from THCB
readers’ own perspectives on this topic. Please comment on this blog
and we can have ongoing dialogue here on the present and future of
social media in health.
There
are many good reasons to deplore Wikipedia, not the least of which is
its authors’ cultish smuggery
about the righteousness of their cause
and the rightness of their content.
Of course there is also its internecine complexity of processes. The
documentation tracing the petty bitchery about an entry is often longer
than the entry that is produced. The international collectivist
negotiation over matters of “fact” is beginning to remind me of the
United Nations, but without the fancy New York headquarters.
A recent post by e-health blogger John Grohol left me steaming anew about the nature of the entire enterprise.
The piece details a series of exchanges between a Wikipedia editor
and Gilles Frydman, head of the non-profit cancer support community ACOR. The issue was the collective’s refusal to permit links to health-related support groups.
The post includes only one side of the story, and that filtered
through the articulate vitriol of Grohol. So I can’t vouch for the
details of the exchange. But it is accurate that Wikipedia does not
permit links to support groups. [See relevant policy excerpt at end of entry.] On reflection, this astonishes me:
1. Wikipedia is designed to harness the
collective intelligence of many individuals, an example of the the
classic web 2.0 “wisdom of the crowds.”
2. Online support forums are designed to
harness the collective intelligence of many individuals, the classic
web 2.0 “wisdom of the crowds.”
Wikipedia leverages the wisdom of the crowds one way. Online
support forums do so another way. But Wikipedia won’t assign value to
the other–in fact as a matter of policy it pointedly excludes it. Which
is to say: The power of the many is a powerful force to disseminate
knowledge–except when it’s not.
The hypocrisy is remarkable. To cite just one sad example: The
Wikipedia entry on amyotrophic lateral sclerosis (Lou Gehrig/Stephen
Hawking disease) is workmanlike. It includes references to mainstream
groups like the ALS Foundation. It even includes, god help us, a link
to that font of scientific dispassion, the Ride for Life.
Confidence in the FDA has hit bottom.
The latest survey on trust in the FDA comes from Harris Interactive, who regularly surveys the public’s faith in the regulator.
Consumers
see the FDA’s #1 job as "ensuring the safety and efficacy of new
prescription drugs," cited by 61% of the public; however, 58% of people
have a negative view of the FDA’s role in this job, compared to only
35% who think positively about the FDA’s performance in this key role.
This latest drop in confidence in the FDA is driven by the Heparin scare, blogged about here.
Other factors eroding confidence in the FDA include toy safety, food safety,
the recent toothpaste scare, and perceived lags in approving necessary
drugs.
Personalized Medicine
As I have mentioned in several of my posts, I have been working on a
couple of health care finance reform initiatives over the last six
months. After banging away now for awhile, I am starting to see some
emerging ideas that are starting to bring out that old revolutionary
feeling of doing something that can have an industry changing impact.
The opportunity lies in the ongoing pace of innovation, with new forms
of health care delivery, with new models of health care financing, and
that fact that eh American public and politicians are slowly waking up
to the fact that our health care system is headed toward radical surgery (not the cosmetic kind).
So lets start this out by talking about the personalization of medicine.
This is typically thought of in a genetic sense, wherein people are
customizing medications and therapies based on your individual genetic
profile. Said in other words, the “Right treatment for the right patient at the right time”.
However, most consumers already assume Right/Right/Right is happening,
and more likely consider personalized medicine as a type of practice
delivery style. This is where the physician knows the patient
intimately, their social and demographic context, and the correct
diagnostic or therapeutic approach given the patient’s preferences that
have been learned throughout the relationship. The only physician I
have ever had whom I had this type of relationship with was Dr. Richard Jones who took care of me from age 6-21 (when the front office lady finally told me that I “really should find another doctor“).
A few months ago, the two of us – both long-time advocates for
transparency and accountability – posted separate comments on Secretary
Mike Leavitt’s blog. Brian asked Secretary Leavitt to square his
support of "Chartered Value Exchanges” with the attempt to block
release of physician-specific Medicare claims data to Consumers’
Checkbook, which wants to rate doctors. After a court ruled that the
data should be provided to the group, HHS appealed. Michael urged the
secretary to go beyond supporting Consumers’ Checkbook and use his
“bully pulpit” to promote sophisticated data analysis that could be
used to create national quality comparisons.
Secretary Leavitt graciously asked us to consider and comment on the
department’s proposed "Medicare trigger legislation" calling for the
release of physician performance measures. We are delighted to continue
the conversation.
First, let’s give credit where credit is due. We agree that the proposed legislation is a major step in the right direction.
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