There’s a meeting called HealthCamp about Health2.0 in San Francisco on Saturday. Many of the usual suspects will be there, but I suspect there’s room for lots more. You can add yourself to the list at the wiki.
Above the Fold
BLOGS: A great Health Wonk Review
Michael Cannon is hosting Health Wonk Review #21 up at the Cato@Liberty blog. And unlike some HWR hosters (i.e. me) Michael does a great job of not only steering you to the posts, but summarizing them and giving you his views on the legitimacy of the arguments. And just because he’s wrong most of the time, doesn’t mean that he’s not doing a fabulous job! This is one of the best HWRs yet. (And apparently I’m James Brown!)
And if you’re not reading the Cato blog regularly you’re missing out on among other things a) some of the best argued views from free market advocates on health policy (which I usually disagree with), b) drug policy and human rights (which I’m with all the way), and c) traffic (which will at the least surprise you in a Heinlein fashion, and those ideas comes from those terrible socialists in Europe!)
QUALITY/POLICY/TECH: Quick notes from the road
Apologies to those who’ve missed me. I’ve been lost in the mid-west taking part in some scenario planning about the big picture future of health care. I can’t give you any details (at least not yet) but it did involve me spending lots of time with a bunch of business association lobbyists who’s views on health care, shall we say, the average THCB reader wouldn’t expect me to share.
In the informal conversations, across the board there was, however, one huge topic of agreement amongst the boomers I met. They wanted themselves and their parents to die at home with palliative care; they felt that current end of life care verges not only on the irrational in terms of resource use, but also on the inhumane. And they think that within a decade, we will be having that conversation and forcing that set of opinions onto our medical providers. Who presumably will be rather more willing to hear us out, rather than insisting on engaging in those heroic measures that, the group felt, todays providers feel they must perform.
One other quick thing. Wednesday, Intel, BP and WalMart announced a PHR initiative, which I believe is being largely led by JD Klienke’s group in Oregon. On that topic I’m giving a talk to HIMSS N.California in San Ramon on Tuesday on the topic of PHRs. Also talking will be Kate Christensen from Kaiser Permanente, and Holly Miller from the Cleveland Clinic. I personally think this should be an interesting opportunity to hear a range of views and understand some developments in major PHR deployments from providers (and of course I’ll be witty and brilliant, just as soon as I’ve put my talk together). But apparently according to at least one other blogger, I’ve misunderstood it all, and really I’m just being a PR flack for the devil worshipers at KP central. I’ll report back as to whether the place still smells of sulphur.
POLICY: New York Trans Fat Debate Heats Up
The Wall Street Journal reports that McDonalds and other
fast food businesses are engaged in a last minute drive to convince health
officials in New York City to “soften” the proposed ban on trans fats in restaurants
in the five boroughs. According to the Journal, McLobbyists have approached city council member Peter Vallone and asked him to sponsor a competing measure
that would give the industry more time to make the switch over to healthier
cooking oils. Quoting from WSJ’er Janet Adamy’s piece:
The city’s board of health is scheduled to vote Tuesday on
whether to force city restaurants, from fast-food outlets to servers of haute
cuisine, to eventually remove all but a trace of artery-clogging trans fat from
the food they cook. It’s not certain yet how the board will vote, but people
following the process say the board appears likely to approve the measure.A New York City ban would place the most significant
restrictions yet on trans fat in the U.S. since health officials began warning
of its dangers years ago. Restaurant chains will feel pressure to more quickly
replace oils in their outlets across the country, since the companies get the
most efficiency and consistency by cooking with a single recipe. Other cities
probably would follow New York.
— John Irvine
HOSPITALS: Panel Said to Call for Closing 9 New York Hospitals
Somehow I think this will be rather difficult! Panel Said to Call for Closing 9 New York Hospitals
Welcome to the governorship, Mr Spitzer!
UPDATE: Anonymous Coward writes in to say: "The Commission’s proposals actually serve as political cover for the all but certain cuts to Medicaid, and this is actually a good thing for Spitzer. The closing recommendations have to be approved as a whole (or rejected as a whole, unlikely) before he’s even in office. Also, dealing with cuts through a more rational, analytical framework, actually enables the new governor to stay completely out of the business of closing hospitals, and to scale back on what otherwise would have been more devastating cuts to Medicaid for all hospitals. The public relations around this are tricky, but the process is already being closely watched (and followed) in other states."
UPDATE 2: You can read the actual report here. (pdf) Check the New York State Commission for Health Care Facilities in the 21st Century web site for additional materials.
ED’s NOTE: Link fixed to NYT piece.
PHYSICIANS: Pity the poor radiologist
They are “frustrated” by Liability and Lifestyle Issues, only 7% them are truly happy—although 70% would do it all over again if they had the chance (more than most other doctors). And only 25% of them make more than $400K a year and 40% have to struggle by on less than $300K.
But pretty clearly these are the good old days for radiologists. Methinks that if they don’t like it now, the average radiologist may be in for a rude shock in the next decade or two, as technology will make their skills increasingly exportable to other cheaper radiologists abroad and replaceable by computers reading images. Of course, they’ll not be quiet in defending their lucrative turf, and demand for imaging will just keep going up, so their future isn’t quite that of the steel worker in the 1980s.
But this is one place to watch in the coming years.
CONSUMERS/POLICY: Real people really travelling
Via HISTALK, a really interesting column about people traveling to India for surgery. Essentially the total cost slightly exceeds the co-insurance for those with insurance and of course the cost is remarkably lower for the uninsured. The people featured are those in the 50-65 age group who are pre-Medicare and finding it harder and harder to get health insurance are the obvious candidates.
And of course they are the ones for whom the health insurance crisis is biting home, and the ones who will be the swing voters about this issue. I for one cannot believe that this group of Americans will accept that they all need to travel to India and pay out of pocket, over and above whatever catastrophic coverage they are also buying. So when a politician comes up with a believable universal solution, this type of story will be behind what gets it through the Congress.
QUALITY: The herniated disk story
Medpundit has a pretty good explanation of the recent study about herniated disk surgery. Basically it works, but if you wait two years, then the results are about the same as non-surgical treatment—roughly 70% of people get better, and there doesn’t appear to be any long-term harm from delaying surgery. As I have someone very close to me with a current case of extreme back and leg pain from a herniated disk, I’m very interested in the study, and actually more inclined to suggest surgery (especially arthroscopic) sooner rather than later. But in this case the patient, doctor and other advisors are more in favor of waiting it out.
So on a global level it’s more cost-effective not to do the surgery. But on an individual level it probably lessens the pain—and the pain is close to unbearable, and if you have to put up with it for several months, then surgery is probably an option the patient will want.
Note that this is only the case for herniated disks and not lots of the other back issues for which surgery is probably ineffective–but still done at a very high rate.
The good news is that ten years after AHCPR (the forerunner to AHRQ) was decimated by daring to discuss back surgery, we’re getting studies out about this type of issue. Even, as Medpundit points out, it’s not a great study and it’s very, very hard to do studies about this type of intractable medical problem.
CODA: One slightly disquieting anecdote. I asked a local back specialist (non-surgeon) what the best way of doing surgery was (open or athroscopic). He said that the choice depended mostly on the training of the surgeon! Er…shouldn’t the surgeon be trained in the most advanced manner? (I expect those who know to chime in here)
POLICY/POLITICS/PHARMA: PhRMA sends the D out on the field
Even thought the White House will likely veto any change to Part D, the WSJ has started playing desperate defense on behalf of PhRMA.
Apparently if we impose government price controls, it’ll cripple R&D and no new drug will ever be developed. On the other hand, they also trot out the “fact” that Part D as constructed now means that the private sector has the ability to lower prices below those that the government could get. Of course we’ve heard all this before, and we all know who wrote Part D and in whose interests it was written.
But what I wonder is how can the WSJ’s Jane Zhang hold those two contradictory thoughts in her head without smoke coming out of her ears?
Meanwhile, here’s the NY Times on big Pharma’s attempts to buy its way out of the problem. It’ll certainly make some former Democratic staffers much richer!
PHYSICIANS: The New York Times–desperate to fill column inches
When I think about all the problems in American health care, many of them the result of the political and clinical choices made by “older and middle-aged physicians (like myself)” (“Myself” being the author of the piece, Dr Erin Marcus from Miami) I can’t say that the non-formal attire worn by some young doctors is exactly in the top 5000. In fact wearing a tie, as she (I think Erin is a she) points out, is actually harmful as they collect bacteria—so the chippie with the low cut top is better for the patient than the stuffy old doc wearing the tie!
But honestly, has the paper of record got nothing better to say about physicians, and no one more interesting than Dr. Marcus to invite to write about them? I’m reminded of open sores…..
Happy Thanksgiving!
