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Above the Fold

POLICY: A National Disgrace By John Irvine

Mar 5, 2007• 11

When the story first came out, it didn’t look like much.
Just a few problems that needed correction: a little mold here, a few repairs
there, the inevitable complaints from disgruntled patients. But two and a half
weeks after the Washington Post ran a little story by reporters Dana Priest and
Anne Hull titled “Soldiers Face Neglect, Frustration At Army’s Top Medical
Facility“ the Walter Reed scandal has become without question the top story in the country.

Today, Priest and Hull return with another lengthy piece examining
conditions in the military healthcare system in other parts of the country titled
“Walter Reed Not an isolated case.” The two reporters say that after their initial story ran they were contacted by "literally hundreds of soldiers" from around the
country with similar stories to share. The pair writes:

Nearly 4,000
outpatients are currently in the military’s Medical Holding or Medical Holdover
companies, which oversee the wounded. Soldiers and veterans report bureaucratic
disarray similar to Walter Reed’s: indifferent, untrained staff; lost
paperwork; medical appointments that drop from the computers; and long waits
for consultations.

That appears to answer a question that many people had been wondering about. As New York Democrat Charles Schumer put it over the weekend “if it’s
this bad at the outpatient facilities at Walter Reed, how is it in the rest of the country?” On Sunday,
Schumer called for a bipartisan commission – possibly to be headed by former
secretary of state Colin Powell – to examine conditions facing returning
service men and women.

Predictably, conservative critics around the blogosphere are
pointing at the debacle as evidence that any government run healthcare system
would be a disaster. Kevin MD writes: “What’s happening at Walter Reed is small
sample of how government-run health care would turn out. Does the public understand
the implications of a nationally-run health care system?”

"Will the Bush-bashers join with free-market critics to effect real change and
help the troops who need and deserve better care? We’ll see," writes Michelle Malkin.

POLICY: In Defense of the VA System

Mar 5, 2007• 24

Like fellow contributor Eric Novack, THCB alum Maggie Mahar has been following the Walter Reed story closely. Maggie doesn’t buy the criticism that the problems at the facility are due to the fact that Walter Reed is a government run hospital. She’s also unhappy about the fact that critics are using the occasion to target the VA system in general. Maggie is the author of the critically acclaimed “Money Driven Medicine: The Real Reason Health Care Costs so Much.”

By MAGGIE MAHAR

Too many news reports about the scandal at Walter Reed use the story to malign the VA hospital system–and to suggest that when government gets involved in health care, the result is disaster.

First, Walter Reed is not part of the Veterans Administration Health Care System. It is a U.S. Army Medical Center.Secondly, while not every VA hospital is perfect, overall, the VA is one of the very best health care systems in the U.S.–thanks to a major overhaul by undersecretary of health Kenneth Kizer in the 1990s. Its electronic medical system has done an extraordinary job of co-ordinating care and all but eliminating medication errors.

As Business Week reported last year (July 17th, 2006) , “if you want to be sure of top-notch care, join the military. The 154 hospitals and 875 clinics run by the Veterans Affairs Dept. have been ranked best-in-class by a number of independent groups on a broad range of measures, from chronic care to heart disease treatments to the percentage of members who receive flu shots. It offers all the same services, and sometimes more, than private sector providers.”

A string of studies published in published in medical jouranls back up these claims. For the full story of the VA’s transformation. see Philip Longman’s “The Best Care Anywhere” in Washington Monthly, January 2007.

That said, the Bush administration has steadily cut funding for the VA hospital system, and as a result, access and waiting times have suffered. By 2005 the number of patients the Veterans Administration was treating had doubled over 10 years to roughly 7 million. Meanwhile, the VA had cut costs by half. Such efficiency is admirable– but at that point, the budget was too tight.

And that was 2005. As the war in Iraq dragged on, the number of wounded multiplied.

Yet just as this administration failed to provide fighting soliders with the armor they needed, it has failed to give the VA the resources it needed to keep up with the carnage.

HOSPITALS: VA perfection revisited By Eric Novack

Mar 5, 2007• 16

THCB contributor Dr. Eric Novack has been following the unfolding scandal at Walter Reed Medical Center very closely. Eric feels the problems discovered by the Washington Post are indicative of deeper institutional problems at the VA. And deeper problems with government run healthcare systems in general. And as usual, he’s got something provocative to say about it.

When the topic of quality health care has come up at THCB, the 2006 study from Harvard touting the VA as providing the ‘best quality’ care in America gets regularly mentioned.

Reality, however, has finally reached the MSM and the public. This is not a Republican problem. This is not a Democrat problem. It is a non-partisan problem. It is a bipartisan problem. The problems have existed through Republican and Democratic Congresses and Administrations. And legislators and bureaucrats have been made aware of some of these problems for years and years.

And yet, nothing significant has changed. The missing interpretation: the absolute fundamental inability for government-run organizations to escape convoluted, bureaucratic, non-meritorious based hierarchies. Anyone still for VA care for all of the USA now?

CODA: From Matthew Holt While I believe that the VA still has its issues, apparently those in the private sector appeared to be convinced by the turnaround in its clincal quality indicators. Or at least Managed Care Magazine has been fooled into thinking that, if of course things are as bad as the WaPo’s collection of anecdotes tells us.

BLOGS: Technical note

Mar 5, 2007

I’ve just discovered that RSS can only handle one podcast per post. So for those of you who get your podcasts via RSS, I’ve republished the HIMSS interviews that I bundled in one post last week. If you’ve linked to the original then I’m afraid you’ll have to re-set.

POLICY: The Not So Common Good

Mar 5, 2007• 3

Catching up from when I was gone….this article on health reform went up at Spot-on a couple of weeks back. It’s called The Not So Common Good.

We’ve been hearing a lot about the problems of the uninsured. We’ve
been hearing more how the cost of healthcare is making it harder and
harder for individuals to afford insurance, and for employers to
provide benefits to employees. Those are the drivers for why health
care reform has suddenly emerged as a political force – even if the
governor who once led discussion of the topic, Mitt Romney, is
backpedaling away from his "liberal Governor of Massachusetts" pro-gay,
pro-big government stance so that he can appear sufficiently
conservative to win a Republican primary or two.

But the train is out of the station on the reform message. Even though the chances of real reform are slim,
everyone and their dog has a plan. Most of these plans are
self-serving. And even the ones that aren’t are generally built on
continuing the employment-based health care system that got us into
this mess in the first place; Senator Ron Wyden, economist Vic Fuchs
and the single payer crowd being the honorable exceptions. Continue

POLICY/HEALTH PLANS: The individual market is screwed

Mar 5, 2007• 33

Whenever you hear some “free-marketeer” complaining that people with incomes over $50K don’t buy health insurance and so uninsurance is voluntary, think about this woman, featured in the NY Times, who would love to buy health insurance but has cancer and so cannot—unless she comes up with $27,000 a year out of her $60K income.

The individual market is corrupt and evil, and inherently unfair. And the organizations that make their living there (hello HealthMarkets, Assurant, Golden Rule et al) are the kinds that you find on the bottom of your shoe. (I’m awaiting Jon Cohn’s book coming out next month to tell you more…).

It is of course not strictly speaking the insurers’ fault. They live in a world where they’re selected against by both sick people and the competition—so it is a collective race to the bottom. Just to remind you for the one millionth time, individual choices of health benefit plans can only be effective and fair within a universal single pool system that needs its rules and boundaries set very carefully, and has risk adjustment built in the back end. And don’t let the libertarians tell you that if you take away all the rules and regs natural pooling will sort it out, unless they’re prepared to move to N.Carolina, get cancer and see how they get on.

POLICY: Breakfast of Champions By Brian Klepper

Mar 3, 2007• 8

THCB welcomes back frequent contributor Brian Klepper. Brian is the president of the Center for Practical Health Reform in Baton Rouge Louisiana. Brian has something to say about economist Daniel McFadden’s recent OP-ED piece in the Wall Street Journal. If you like this post, you may enjoy his most recent post: "Can Consumerism Save Healthcare?"

Several people dropped me notes last Friday, asking for comments on a WSJ piece
by Daniel McFadden, a Nobel Laureate in Economics at the University of
California Berkeley. Dr. McFadden provided an eloquent view of the
crisis and its necessary solutions, and also argued that Medicare D
was, according to his research, working well.

This
is an interesting problem. After all, Dr. McFadden IS a Nobelist and,
well, I’m not. And he’s a formally trained and obviously highly
respected economist while, again, I’m not.

On
the other hand, he’s not really a health care professional. So it may
not be unreasonable to point out that some of his assumptions are naïve
and – how do I say this – exactly wrong.

INDUSTRY: THCB Job Board

Mar 2, 2007

After a good deal of pestering email from readers, I’ve finally decided to offer a healthcare job board on THCB. If you have a health care related job you’d like to advertise to a readership of 35,000 plus industry people, you can send it to us. For a reasonable fee, your posting will be available to job seekers from around the country and up until you ask us to take it down. You can mail John for details.

Meanwhile, if you haven’t had a chance to sign up for THCB UPDATE
yet, you really should. You’ll get a helpful reminder email from us a
few times a week when important posts go up on the site. In the two
and a half months since the service launched more than ~~700~~ 950 people have
signed up, thoroughly surprising me. I’ve pledged not to divulge any details about the people who
sign up, but I can tell you that list reads a bit like a health care
who’s who. Go on: It’s free. It’s useful. And people seem to like it.
Go visit the sign up page.

TECH/HOSPITALS: Voice recognition and instant translation

Mar 2, 2007• 1

Those of you who’ve been listening to the podcasts I’ve been doing and reading the blog will notice quite how excited Cisco’s Jeff Rideout is with the Health Care Interpreter Network, which is a video over IP based network currently being used to share translation services in several safety net hospitals in California. Of course moving human translators by the magic of video telephony is a great advance over waiting for them to show up from wherever they are, and when providers have to deal with patients speaking as many languages as a typical Bay Area, LA, New York or similar facility sees, avoiding getting lost in translation is pretty critical.

But of course this being America there’s another way, and it too is pretty damn clever. I was shown a demo by a company called Spoken Translation which has an English-Spanish automatic medical translation tool. Here’s a cut from their blurb (as I’m too lazy to describe it all) but I’ve seen it and it works as advertised.

Converser for Healthcare provides 24/7 live interpreting. Its initial product will be targeted to the healthcare market and is a Spanish to English, English to Spanish translation. The system allows people who do not speak the same language to hold broad health-related conversations in real time, without a human interpreter.

Converser represents a fundamental advance in Machine Translation (MT) technology. No other system on the market today can provide reliable, bi-directional, real-time, wide-ranging translation via multiple interface modalities including speech recognition. Never before has a commercial product for conversational translation enabled a user to verify in real time that the translation is accurate, and, if not, to correct it on the spot. While Spanish is first out the door, other languages are planned for release later this year. Chinese is planned for the healthcare market, while German and Japanese are currently under development for other markets. Converser can run on Tablet PCs or laptops (full-size or ultra-portable), and release is planned for numerous handheld devices.

The tool allows input via typing, onscreen keyboard, voice (using Dragon Nat Speak 9) and handwriting recognition. It’s a touch cumbersome in that of course each phrase needs approval and potential correction (in case of possible English/Spanish ambiguities) but it appears to be damn clever, and at $1500 a seat, a darn site cheaper than having a human sitting around.

Now, if they just make one in Arabic, that’ll solve a wee problem the US military has in another part of the world.

TECH/CONSUMERS: Internet health use survey, with UPDATE

Mar 1, 2007• 1

For you survey geeks, Cisco sponsored a study of Internet use in health care among patients. Here’s the press release & here’s the detailed results
.
If anything the “demand” numbers look lower than in some other surveys (things like wanting to use email with docs, access lab results, etc). But the “supply” numbers (those doing that) are much lower, of course.

UPDATE: I got a really good comment/question about this from Dirk at Aurora IT. "Those numbers really seem to conflict with most of the other
healthcare-related Internet use surveys I’ve seen. Do you buy it or
rather them?" So here’s my answer to Dirk, given that this type of survey is absolutely in my wheelhouse.

I’m looking into it. Hopefully the Cisco guys will share more data with me. They did this survey through one of their main mkt research vendors who isn’t too well known in the obscure part of the survey world that focuses on consumer health care IT use. I don’t know if they have good data to compare it to historically on the same questions, but I kind of doubt it. My first take is that the numbers saying that they can get services from their doctors are a touch higher than usually reported–but that may be an indication that these services are spreading (finally!!). The demand side numbers seem to be quite a bit lower than I’ve seen from other surveys, especially Harris over the years. (e.g. Harris has reported more than 70% wanting their lab results online both in 2001 and 2002 –I think they did it again more recently but I can’t find it). But that seems to be connected to the way that they’ve asked the questions, and frankly it’s unclear how they’ve done that from the results reported. (multiple choice vs most important on the question "Assuming these services were all available from your primary care provider, which would be most important to you?"). But we’re way down in the weeds of survey methodology here.However, the good news is that this is new data on the right topics, and I’ll ask the Cisco folks if they can share a little more of the results.But kudos to Cisco for researching into this–especially as they don’t sell anything that directly relates to it.! As you can tell, there’s a paucity of good data about the specifics of who does what and who wants what in this arena, and they’re helping to fill those holes. And given the amount of people who are offering solutions in this space, well it’s clear that more needs to be known about what consumers really want rather than less!