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Above the Fold

POLITICS: President Obama’s Health care head fake

Dec 7, 2007• 6

So unlike Paul Krugman who’s just being critical of Obama’s lack of a mandate, over at Spot-on I think I see the political brilliance behind it–or am I just deluding myself? Come back here to comment of course:

It’s a perplexing time to be a liberal. A Martian arriving on earth,
having seen the Republicans pandering hard to their base in the
primaries would assume the Democratic base would be rallying behind the
candidate who held the correct positions in 2004, and be apologizing
for ignoring him last time.

SNIP

Getting to voluntary universal coverage by trying to lower encourage
lower costs and hoping everyone will join in will not work, and even
Obama’s main health care adviser admits it.
But this irrationality has got me thinking. Why is Obama trying to promote something he knows won’t work?

Read the rest at Spot-On

Meanwhile, there’s an almost companion piece also at Spot-on from Deborah Klosky. Interestingly, both pieces focus on misinterpretations of how our society
actually functions – Deb notes that assuming women will care for the old and
sick is as out-dated as assuming they’re able to stay home and care for their
children. Some are but many – most are not. She writes:

It’s the same problem as with caring for a child; our current
system relies on a mythical, anachronistic view – there’s a big happy family
living all together, with mom in the kitchen running the home front all
day.

Kind of like Obama – a little wishful thinking might go a long way. Read Deb’s piece also at Spot-on

UnitedHealth Customers Speak With their Feet, and it’s Time for Everyone to Listen by Miriam Bookey

Dec 6, 2007• 14

Miriambookey_2

This week’s sobering news from UnitedHealth serves as a wake-up call to anyone in healthcare services. For better or worse, a consumer-driven health economy has put individual consumers in the driver’s seat when it comes to how, when and with whom they spend their healthcare dollars. They will leave in the hundreds of thousands if they’re not satisfied (315,000 from UnitedHealth, to be exact).

It’s clear that service providers are no longer working with passive ‘patients’ who ‘receive care.’ Instead, the patients are compelled to be active consumers, responsible for investigating their personal healthcare options, arranging their own care as well as that of children and aging parents, understanding what is or isn’t covered by health plans, utilizing HSAs, selecting responsive and responsible service providers, and taking the initiative to follow up with doctors and health plans after appointments. It’s a big, complicated and thankless job. And it’s a world in which patients can and will leave their insurers and select care providers based on service, not on health plan.

Continued at the Health 2.0 Blog

Annals of Journalism

Dec 6, 2007

"With the holidays and being taken hostage, they are likely off the stress chart." — Rochester psychologist Anita Remig, reflecting on the likely current psychological state of the six Clinton campaign workers taken hostage last Friday in New Hampshire by 48-year old Leeland Eisenberg.

The Pipeline: Vaccines v.s. Antibiotics by Dov Michaeli

Dec 5, 2007• 3

In 1796 Dr. Edward Jenner performed an experiment that today would have
got him expelled from his Medical Society, and maybe even landed them
in jail. He vaccinated a boy against smallpox by pricking his arms with
pus taken from the sores of a milkmaid with cowpox, a closely related
but milder disease. He based this audacious experiment on his astute
observation that milkmaids, who had been exposed to cowpox, never
contracted smallpox. Let’s not forget what smallpox meant in those
days—it meant an almost 100% chance of death. Could anybody have
guessed that this observation would become the first harbinger of the
field of Immunology?

It took over 200 years before another vaccine was created; in 1914 a
vaccine against whooping cough was introduced. But then, the pace
picked up: in 1928 a vaccine against diphtheria, in 1933 against
tetanus, and so on. Five years ago a vaccine against varicella, causing
chickenpox and shingles was approved. Last year a vaccine against human
papilloma virus (HPV) was introduced. This virus causes endometrial
(lining of the uterus) cancer, and immunization of prepubertal girls
should protect them for life. This is the first successful vaccine
against cancer.

Rating Doctors Like Restaurants, by Bob Wachter

Dec 4, 2007• 19

Robert Wachter is widely regarded as a leading figure in the modern
patient safety
movement. Together with Dr. Lee Goldman, he coined the
term "hospitalist" in an influential 1996 essay in The New England
Journal of Medicine. His most recent book, Understanding Patient
Safety, (McGraw-Hill, 2008) examines the factors that have contributed
to what is often described as "an epidemic" facing American hospitals.
His posts appear semi-regularly on THCB and on his own blog "Wachter’s World."

So Zagat will now be rating doctors, using the methods it perfected helping you find the best sushi in Brooklyn Heights. What’s next, Consumer Reports rating grad schools? Fodor rating auto mechanics?

Whatever you think of Zagat’s cross-dressing, it again demonstrates
the bottomless market for doctor rankings. HealthGrades, the Colorado
company that breathlessly delivers its “200,000 Americans died from
medical errors in 200X!” pronouncements every year (grabbing a bunch of headlines, despite the fact that this report is based on measures that were not intended for this purpose and really aren’t measuring deaths from errors), appears to be doing quite well,
thank you, largely fueled by its doctor ratings. And every metropolis’s
city magazine has its “[Your City’s Name Goes Here]’s Best Doctors”
issue, based almost entirely on peer surveys. Most docs scoff at these
ratings (particularly docs like me who haven’t made their city’s list),
but they clearly move magazines. [I’ll discuss hospital rankings,
especially US News & World Report’s Best Hospitals list, in a future posting.]

POLITICS: Jonathan Cohn confesses on the Obama 15 million problem

Dec 4, 2007• 2

Apparently the 15m uninsured in Obama’s plan are all Jonathan Cohn’s fault. At least the picking up on that number by Hillary and Edwards in the debates, that is.

I’m still struggling with how Obama is correctly to the left of those guys on the only foreign policy that really matters but in a foolish place on health care. Anyone relying on David Cutler for advice on health care must be seriously internally conflicted over what the aim is! After all Cutler seems to be too.

More on that to come later this week; but my explanation is that Obama shares my belief that health reform is impossible in 2009—so why bother?

POLICY: The Proper ASD Policy Begins with Listening to Parents, By John Whitmer

Dec 3, 2007• 3

On November 24, 2007 Senator Clinton announced her "Plan to Help Children and Families Affected by
Autism." While the Senator should be commended for finally paying attention to the
issue in her presidential campaign and while other candidates should take note, her plan isn’t really a plan at all.

The "plan" calls for spending 700 million dollars to primarily fund research "to identify
causes of autism and monitoring its impact across the country. The Combating Autism Act of 2006, which Clinton co-sponsored, appropriates 500 of that 700 million. Therefore, the plan really only calls for an additional 200 million. Meanwhile, not one penny of that original 500 million has been spent. Perhaps the Senator needs
to look first into seeing that her original policy gets implemented.
In fact, Senator Clinton should lead the charge in Congress to fully fund the Individuals with Disabilities Education Act(IDEA); this would go a long way in solving the issue of "encroachment" that
school districts across the nation are facing.

POLICY: What next in the fight against AIDS?

Dec 3, 2007• 2

Susan Blumenthal updates us on World Aids Day which was last Saturday.

PODCAST: Overtreated, Shannon Brownlee explains all

Dec 3, 2007• 14

I am so so far behind getting my transcripts of podcasts up here that it’s not funny. But this was one of the most recent and one of the most fun that I’ve ever done. It was a discussion with Shannon Brownlee. author of Overtreated, of which everyone in America should be forced to read at least the Cliff Notes version. (Warning, it’s long and the two of us had far too much fun talking with each other….)

Matthew Holt: It’s Matthew Holt with the Health Care Blog, and I’m back with yet another podcast. This time I’m talking with Shannon Brownlee. Shannon is a senior fellow at the New America Foundation and, more importantly, has just written a great book called "Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer." Shannon, first of all, thanks for coming on The Health Care Blog. I’m really excited to have you here.

Shannon Brownlee: Oh, I’m delighted to be with you.

Matthew: My feeling about reading this book is that I thought I knew all this stuff. I’m sure in the last 15 years of hanging out in healthcare, I know all the Wennberg stuff, and I’ve known all this and I’ve known all that. I pretty well read all the studies. I’ve got to confess that when I read the first chapter, and you can introduce the first chapter in a little bit, it’s kind of like a homage to Jack Wennberg. You went and hung out at Dartmouth and it’s kind of almost like a folksy introduction to his character.

And I guess I started reading this and going, yeah, but is this is a serious way to treat a health policy issue. So why did you go about starting in that fashion?

Shannon: I started it that way because I found Jack Wennberg to be one of the most interesting people I’ve ever met, and the fact that he kept plugging away at this idea that started, oh gosh, almost 40 years ago, now 40 years ago, that he saw this enormous variation in practice patterns in the state of Vermont, and sort of puzzled over it and puzzled over it and puzzled over it. And then he finally started to say, "Yeah, this is real, there’s a variation in practice patterns. It’s not driven by how sick patients are. It’s driven by what the doctors are doing."

Health Care Reform: What Do Americans Want? (Or Think They Want?)

Nov 30, 2007• 22

By MAGGIE MAHAR

On the surface, it seems that American voters have made their will clear. Poll after poll shows that they are calling for a major overhaul of our health care system. But when you look closer, their responses bristle with contradictions and discrepancies that I think the reform-minded presidential candidates will have to consider when deciding how to approach health care reform.

In a poll reported in Health Affairs at the end of last year, sixty-nine percent of respondents rated the US system as “fair” or “poor.” Yet in the same survey, when asked about their own experience with receiving medical services or with their own physician, 80 percent who had received care in the last year ranked their care as “excellent” or ”good.”

Other polls reveal the same pattern.

According to a survey released by Greenberg Quinlan Rosner in July, voters express doubts about the quality of the American health care system (with 49 percent dissatisfied), while 74 percent were dissatisfied with the cost. Yet, “at another, more personal level,” the pollsters note, “a slightly different picture emerges. Fully eight in ten (82 percent) describe themselves as satisfied with the quality of the health care they receive personally. This number jumps to 90 percent among seniors (64 percent very satisfied), but includes impressive majorities of nearly all groups…”