The Health Care Blog – Page 1034 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

California not really uber alles

Dec 26, 2007• 9

Late last week Brian Klepper stirred things up around here calling California’s health care bill Business As Usual. Over at Spot-on earlier this week I was a little more simplistic. I call the California approach The Last of the Old Solutions, largely because it keeps intact the employer-based health insurance system and doesnt include an effective individual mandate because that needs a real tax increase. (My original title of "California not really uber alles”was somehow vetoed over there—but here I’m in charge!)

As I say over there

If the goal is universal coverage, the pay-or-play system in which employers have to offer coverage sounds good – as well as familiar – but it doesn’t really get us there. Hawaii passed something similar in the 1970s and several other states have tried some variant and still no one’s really got close to universal coverage.

Please go there and read the rest and come back here to comment if you’re feeling bored at the end of the year!

Health 2.0 San Diego Spring Fling Agenda

Dec 24, 2007• 1

So for Christmas we’re announcing our first cut of the agenda for our next Health 2.0 conference, to be held at the Westin San Diego on March 3rd-4th. Health 2.0 User-Generated Healthcare in San Francisco sold out a month before the event, so if you are planning on attending you may want to act now to reserve your spot. Early bird registration is now over, but a limited number of spots remain available. To register, visit http://www.health2con.com . For updates on Health 2.0 related news sign up for THCB UPDATE and be sure to check out the Health 2.0 blog. We hope to see you there!

My Nomination For Health Care Quote of the Year – Brian Klepper

Dec 22, 2007• 6

I was reading through other peoples’ blog posts yesterday when amazingly enough, I was here on THCB and came across this straightforward statement by Paul Levy, the CEO of Beth Israel Deaconess Medical Center in Boston.

Of course, many readers are aware that Paul has made news by establishing a blog called Running a Hospital. I think he’s probably taken some good-natured ribbing by his more straightlaced colleagues. But I admire that fact that he’s broken the bounds of decorum and speaks openly about the many tremendously difficult issues that face hospital executives.

Tiny Tim Health Care By Michael L. Millenson

Dec 21, 2007• 4

Dickens3 Every year at this time, millions of Americans turn their attention to a much-beloved story about health
care reform. I refer, of course, to Charles Dickens’ A Christmas Carol.

While this is not the traditional plot summary, it aptly describes a story rooted in the plight of a crippled young boy whose father cannot afford the care his son desperately needs. The prospect of Tiny Tim’s eminently preventable death finally breaks through Ebenezer Scrooge’s bitterness, causing the old miser to abandon his hard-hearted ways. Alas, we Americans still seem inclined to treat the demand for universal health coverage like the Scrooge of old. His dismissive cry, “Are there no poorhouses?” is echoed by our smug assertions that those in dire medical need can “just go to an emergency room.”

Would-be reformers have responded with statistics about 18,000 preventable deaths each year and stories about the real-life Tiny Tims in our midst — to no avail. A new report from the American Cancer Society concluding that those without health insurance are 1.6 times more likely to die of their disease than those with private insurance came just a few days before Christmas and a few days after President Bush’s latest veto of the State Children’s Health Insurance Program, which would help millions of children living in near-poverty.

So this holiday season, rather than tugging on heartstrings, I’d like to take the opposite approach. Forget about the waifs: let’s talk about your wallet. The Cratchit families of this country are costing you and me money.

Business As Usual: California’s Reform Proposal – Brian Klepper

Dec 21, 2007• 18

Brian_klepper In the world of health reform wonks – the writers on this blog qualify in spades – all eyes
are on California at
the moment. His Republicanism notwithstanding,
Governor Schwartzenegger has developed a generous $14 billion bill that
would extend universal coverage to all Californians by 2010.

Now
that the plan is set, the special interests are lining up. Most of the
health care groups – the physicians, hospitals, the health plans (with
the interesting exception of Wellpoint) – are supportive, fully aware
that if more money can be found for health care, they’ll be the
recipients. Also in the mix are two prominent unions: SEIU (the Service
Workers’ International Union) and the American Federation of State,
County and Municipal Employees. They are both key supporters, each with
health care workers who would benefit from the deal.

Seeking Sustainable RHIO Forest; View Obscured by Non-profit Trees by Martin Jensen

Dec 21, 2007

Martin_jensen Health Affairs just published a study by a team of Harvard
researchers that has cast a pall on the
sustainability of Regional
Health Information Organizations (also referred to as Health
Information Exchanges). The report, The State Of Regional Health Information Organizations: Current Activities And Financing,
by Julia Adler-Milstein, Andrew P. McAfee, David W. Bates, and Ashish
K. Jha, seems to imply that the maladies suffered by RHIO efforts
around the country might be fatal, at least if you read the many news stories and blogs
that are talking about it. I say "seems to" because our analysis
suggests that the industry echosphere is still missing quite a bit of
the big picture. Let’s take this step by step, starting with the
Harvard study and moving into the invisible economy and the nature of
the RHIO challenge.

First, the "scary facts" presented by the researchers:

25% of previously-listed RHIOs seem to be "defunct"
Only 20% of the remainder reported exchanging significant volumes of clinical data
Most of the data they were exchanging falls into the categories of lab results, inpatient data and medication history
A majority reported receiving in-kind donations, about half
reported grants or financial contributions and slightly less than half
reported no financial contributions

Read the rest at the Health 2.0 Blog

Say it Ain’t So, Joe by Paul Levy

Dec 20, 2007• 1

I heard a great presentation this morning by Joe Newhouse,
from the Department of Health Policy and Management at Harvard Medical
School. There was one point that he made that really caught my
attention. It was a cite to a 2004 article in the Journal of the American Medical Association
(Dimick, et al, JAMA 2004; 292: 849) that presented the issue of how
many cases you would need to collect of a certain clinical procedure to
be able to make a determination that a given hospital’s mortality for
that procedure was twice the national average. It turns out that only
for CABGs (coronary artery bypass grafts) are there enough cases
performed to have statistical confidence that a hospital has that poor
a record compared to the national average. For other procedures (hip
replacements, abdominal aortic aneurysm repairs, pediatric heart
surgery, and the like) there are just not enough cases done to make
this assessment. (By the way, if you just want to know if a hospital is
say, 20%, worse on relative mortality, you need even a bigger sample
size.)

HEALTH 2.0 UPDATE

Dec 20, 2007

If you missed Health 2.0 User-Generated Healthcare this September you are now officially in luck. The 4 DVD box set of conference highlights is now available for
purchase. And just in time for Christmas! Starring Dr. David Brailer,
Sermo’s Daniel Palestrant, Esther Dyson, Google, Yahoo! Healthline,
Microsoft, Cisco, WebMD, Patients Like Me, Daily Strength, Organized
Wisdom, Enhanced Medical Decisions, Health 2.0 founders Matthew Holt
and Indu Subaiya and many many more.

POLICY: Overtreated gets huge plaudit

Dec 20, 2007• 4

OK. It’s official. David Leonhardt is a convert, even one who can’t quite leave his past behind. In is NY Times selection for Economics book of the year he picks Shannon Brownlee’s Overtreated. (If you want to hear me and Shannon having a good gossip about the American health care system, see here).

Leonhardt can’t quite shake his Stephen Colbert-like past (the market has spoken so it must be true). He still says this:

As I’ve written before, there is nothing wrong with devoting a large chunk of our economy to medical care. Since the 1950s, doctors have made incredible progress against diseases that were once inevitably fatal. That progress is probably the finest human achievement of the last half century. If we weren’t wasting so much money on overtreatment, it would be a lot easier to repeat the achievement over the next half century.

Of course, and it’s been pointed out ad nauseam here, those results were achievable at a much lower cost than we’ve paid, and the difference could have been spent on something with a higher economic return (or in invading any middle eastern countries we haven’t got to yet).

But it’s great to have Leonhardt on board, at least for the Wennberg thesis. Now he just has to convince the rest of the NY Times editorial board.

POLICY/QUALITY: Uninsurance does indeed kill you quicker

Dec 20, 2007• 2

I’m not going to go into the whys and wherefores of what’s wrong with cancer care in this country. But when the IOM said that people die early because of uninsurance, people scoffed. The same people (and you know who you are David Gratzer) say (pretty disingenuously) that we do cancer care much better than countries with universal insurance, and for at least partly that reason universal insurance is a bad idea.

So presumably they have a good answer for this new report from the American Cancer Society, which essentially shows that–whatever the state of American cancer care maybe overall–you’re much more more likely to have a good outcome if you’ve got insurance. Some tidbits from the release:

For all cancer sites combined, patients who
were uninsured were 1.6 times as likely to die in five years as those with
private insurance.The
relationship between access to care and cancer outcomes is particularly striking
for several cancers which can be prevented or detected earlier by screening and
for which there are effective treatments, including breast and colorectal
cancer. At every level of education, individuals with health insurance were
about twice as likely as those without health insurance to have had mammography
or colorectal cancer screening.