Interesting changes in German health-care financing. Anyone got time to investigate and explain what’s really happening to the rest of us>?
Above the Fold
POLICY: The New York Times cannot leave its pustilent sore alone!
This one is absolutely beyond belief. This time the dog is licking its sore raw and just cannot stop. Two boneheaded articles based on Cutler’s work have run in the NY Times in the last few weeks, and required such smacking down that Joe Paduda gave me the headline Matt 1, NY Times 0. Meanwhile the NY times got a boatload of letters criticizing the second of them.
But does that stop them? Oh, no. Today a libertarian blogger who’s a professor from George Mason University, which prior to today was best known for its basketball team’s Cinderalla NCAA run last year, gets given a full column in the nation’s paper of record in which he actually says that the “American health care system may be performing better than it seems” because our scientists win more Nobel Prizes than those foreigners do! And we have more innovation in developing new treatments here! And more so that because we’re spending more money on health compared to those evil European systems that restrain costs, this is, wait for it, “saving lives.” Yup, apparently while it might look sensible to make an effort to restrain health care costs:
In the short run, this would save money but in the longer run it would cost lives.
Oh, and we’re also doing more tests, procedures and visits with specialists because this is what people want!
If we count “giving people what they would want, if they knew it was there” as one measure of medical value, the American system looks better.
If wing nuts like this want to spout complete garbage on their loony-toons blog, well he has a first amendment right to do so. After all, other than 40 years of health technology assessment research on innapropriate use of medical technology, the Dartmouth/Wennberg school showing massive variation in care where more care leads to worse outcomes, and the IOM reports that show 100,000 annual deaths from medical errors largely from inappropriate overuse of technology, and 20,000 annual deaths directly from being uninsured, there’s almost no evidence he’s wrong!
But why the hell is the NY Times deciding that it must launch this last ditch defense of the American health care system? I think we should be told.
Otherwise they should give an entire week over to rational critics of the system, starting with Jack Wennberg.
UPDATE: The Michigan Independent thinks as I do, but is slightly calmer and performs the line by line rebuttal that I just couldn’t bear to do
The Great Balance Billing Scandal By Eric Novack
In California, the possibility exists that the unelecteddepartment of insurance, under pressure from the insurance industry and
patient advocacy groups, may fundamentally alter the way medicine is
practiced. In an effort to get a work around the
disgraceful- yet very culturally sensitive- single payer bill recently
vetoed by Governor Schwarzenegger, there is a move afoot to ban the
practice of balance billing.
What is balance billing you say? Sounds very wonkish and unimportant. Sounds like those unethical, over-utilizing, quality-unconcerned doctors are just trying another technique to scam the ‘system’. (But I thought the familiar refrain is that we do not have a health system? …) I will explain with an example.
BLOGS: Health Wonk Review is up
Joe Paduda has a just excellent version of Health Wonk Review – the Harvest Moon edition up over at Managed Care Matters…although I don’t remember dis-membering anyone over my keyboard!
PHARMA/POLICY: U.S. Drops Program to Halt Discount Drugs From Canada
U.S. Drops Program to Halt Discount Drugs From Canada
The federal government plans to halt a controversial crackdown on discount drugs mailed from Canadian pharmacies to U.S. customers, removing a significant hurdle to Americans buying cheaper medications from abroad.
So 80% of Seniors support importing Rx from Canada, and the DOJ backs off its crackdown on imports.
Could there just possibly be an election coming up soon? Just possibly, could these two events be related?
TECH:….and talking about 1999 again
Aetna introduces a PHR for its members, only 5 1/2 years after sending me the funniest email of all time, which said that they were spending all their time fixing their IT system and even if the solution (a PHR) that we had for them would fix all their problems, they still couldn’t buy it for 2 more years. Well I guess they meant 5 more! Sadly we were out of business well before the 2 years expired!
Their PHR is an off shoot of Active Care Management’s Care Engine. Aetna bought ACT last year. At that point Empire Blues was the biggest user of Care Engine. They didn’t go with it for their PHR though—they’re using WebMD’s version. Which makes me wonder how good Active Care’s version is. Perhaps I’ll be able to check into it soon and tell you.
Meanwhile all care will soon be delivered at home by clever in-home dialysis and monitored by Health Buddies. It must be true because it says so in Business2.0. Yes I know that’s an unfair slam on Health Hero Network (who I know and love), but their new direct to consumer model is, shall we say, a brave business innovation, given that it demands $50 a month from the chronically ill.
Good luck to them and I’m sure they’ll keep me appraised on the models success while the rest of us are waiting for Medicare funding for remote monitoring.
TECH: Search, and EDW and BI
Yesterday I had two articles in the former Health IT World, which is changing its name to Digital Healthcare and Productivity. The first for you Googleheads is about Vertical search in health getting sexy, but it doesn’t say much about U no Hu. The second is rather more complex and is about Enterprise data warehousing and Business Intelligence.
Please feel free to comment back here.
HEALTH PLANS/POLICY: Emily Firedman rips the individual market a new one
Nothing that you haven’t already seen on THCB many time before, but in taking on (and slightly misrepresenting but not much!) the Mass concept that we should just tell all the uninsured to buy into the individual market, veteran commentator Emily Friedman has created a wonderful blistering critique of the individual market and the parasites that dwell in it.
PHARMA: But this is how it’s done
The NY Times has an article about how a biotech drug that basically is no better than a generic is selling off the shelves at $4,200 a Dose. Doctors think it’s better, patients believe it’s better and payers are too wimpy to stand up to them. Of course they haven’t got a government agency to help them, as exists in the UK.
Interestingly enough this is exactly what happened nearly twenty years ago with one of the the first major biotech drug, Genetech’s Activase (tPA) for the immediate treatment of heart attacks. it cost about ten times what the competing drug (streptokinse) cost, and basically had no better results. At the time there was lots of murky stuff including a positive NEJM article written by scientists with close (and undisclosed) ties to the company. (If you want to know much more about that ugly debate, look at the debate starting at page 3 in this link and particularly the far right column of page 9). And then after a study showed incredibly small relative and absolute benefits in survival from using Activase, allegedly Genetech sent lawyers to lots of hopsitals explaining what a jury might say now that a lawyer could "prove" they weren’t using the best possible drug. Pretty soon everyone switched over.
Sounds like despite lots of talk about cost-benefit analysis, cost controls, and pharmaco-economics, nothing has changed.
POLICY/POLITICS: Personal angst on research
There are sometimes when two contradictory thought streams start charging through my brain and I can’t cope. This is one.
I got an email from a PR person for this website http://www.yourcandidatesyourhealth.org/ which tells you your local candidates record essentially for or against embryonic stem cell research. As you might guess, the idea from Research!America and the Lasker Foundation is to encourage people to vote against candidates opposing stem cell research (or at least get them to change their mind. The Research!America folks are a cross-section of business and academic types who like medical research.
And honestly how can any rational person be against them? When the choice is between them and the creationists who were only happy when we all lived in the dark ages, and don’t believe in the Enlightenment, personal liberty, the scientific method, et al. (Not of course that they won’t use the technological fruits of the movements they despise, particularly Talk Radio!).
But on the other hand, any really rational assessment of the health care system shows that we are spending way too much on medical research. The NIH alone is $30 billion a year, and that’s about doubled by private industry. Now we’re adding billions more at the state level. The problem is that the application of the products of that research is downright shoddy, and we’re spending almost nothing comparatively to figure out how to make it better.
It would be much better for the country and the health care system if we took the $30 billion spent on the NIH and the $300 million spent on AHRQ and flipped them. Then we’d really figure out how to apply the stuff we already know evenly and appropriately. We just don’t need more me-too cancer drugs at $4,000 a pop, when we can’t figure out how to get an Rx for aspirin in to the hands of discharged cardiac care patients (or whatever the appropriate cheap therapy is).
I’m convinced that if we put a ten year moratorium on all new medical research today, and spent all the money figuring out how to apply—and then actually applying—our medical knowledge across the board, we’d be much better off. Of course that’s never going to happen, and we need to save science from the hands of the anti-Enlightenment Philistines. But I remain to be convinced that the Research!America folks are applying their scientific resources in the most appropriate way possible.
Meanwhile, Steve Parker tells me about the launch of a new site called www.BreastCancerAwareness.com which is pretty self-explanatory and looks like it’ll be a useful resource.
