I’ll be on a panel with Dimitry, Amy Hughes from Cisco and several non-bloggers talking about new media, blogs, podcasts, etc, etc in healthcare
Date: Thursday, September 28, 2006Time: 8:00 a.m. to 10:00 a.m. (includes light breakfast)Location: Jack Morton, 560 Pacific Avenue, San Francisco, CA 94133
For more info see here. It’s slanted towards PR. Which as you know is the world’s most important industry as those things that are perceived to be real are real in their consequences…..
The NY Times has a fairly jaw dropping article which basically says that whatever we spend on health care, it’s all good! It basically goes down the David Cutler/Mark Pauly line of “we wouldn’t spend all that money if the free market wasn’t working, and so the real outcome is the economically best outcome.” And it has this gem of a quote from a Nobel laureate, and this guy, unlike a rather more interesting Nobel laureate Kerry Mullis, is not copping to hallucinogenic drug use
By 2030, predicts Robert W. Fogel, a Nobel laureate at the University of Chicago Graduate School of Business, about 25 percent of the G.D.P. will be spent on health care, making it “the driving force in the economy,” just as railroads drove the economy at the start of the 20th century. Unless the current system is changed, most health care costs will continue to be paid by insurance, especially Medicare, which means that the taxpayers will foot the bill. But Dr. Fogel says he is not alarmed. Americans can afford it, he says, because the nation is so rich.
Now there is a huge difference between “we can afford it” and saying that it’s the driving force in the economy like “railways”. Thinking back to your high school economics class, you were taught that there were two types of economic activity—those that assisted in making stuff (usually called “manufacturing”) and those that didn’t directly assist in making stuff (“services”). Railways (and telecommunications and power and all the other utilities) are infrastructure that directly assist in the support of making stuff, usually by allowing producers to access new markets, and those markets to access new producers. That’s basically the logic whether it was railways opening Kansas wheat fields to East Coast markets, or the Internet allowing American software companies to access Indian programmers.
Health care, though, is a consumption good. Despite David Cutler’s best efforts it’s a total stretch to imply that the delivery of more health care results in more “health” — in fact the Wennberg group has pretty conclusively shown that the reverse is true (as Vic Fuchs showed over the years). Additionally “health care delivery” doesn’t have much to do with the improvements in health for the younger (productive) population overall that we care about—that’s down to better sewers, clean drinking water and immunizations. But beyond that it’s also a fallacy to suggest that greater “health” has the impact that railways or fiber-optics have. Better health for a start doesn’t directly impact production, and the marginal amount of better health we are creating via increased use of health care services is largely concentrated amongst those who have retired and are consuming society’s resources not adding to them.
So the extra spending on health care, as Fuchs points out in the article, is both discretionary and a redistribution of wealth from the young to the old (or actually to the industry that provides those services to the old):
Victor R. Fuchs, also an economist at Stanford, notes that buying health care is fundamentally different from buying a television or a car. “Most of it involves transfers from the young to the old,” he said. “Down the road, most medical care will be for people over age 65, and most of the payments will be from taxes on younger people.”
So if it’s discretionary, most health care spending is not for the equivalent of infrastructure or productive capacity, it’s for marginal consumption—meaning that health care is not like the railways, instead it’s just like the Frappachinos I told you all about last year.
But the best line is Cutler’s. When asked about more spending,
He added, “Are you willing to do that? Yes, it costs a lot, but we’re rich enough where the alternative use of the money isn’t as valuable.”
That one wins today’s Mark Pauly award for blind economic idiocy. Cutler seems to think that we’re spending money on health care because we want to. There’s clearly no chance that the actors in the system have somehow captured the body politic to ensure that ever growing health care spending is the result. No, no chance of that at all. After all health care is a pure free market Adam Smith would love–yes it is!
And then given the total lack of problems this nation and the world faces, spending our marginal resources on more flat of the curve medicine is by definition the best way to allocate resources. I for one can think of no better possible recipients for the money.
Up over at Health IT World, there’s an interview I did with Ivo Nelson, the Healthcare Industry Leader of IBM Global Business Services. Suffice it to say that Ivo doesn’t think we’re very far along in the transformation of clinical practice, even on the hospital side. He thinks his shop will be plenty busy for the long-term, and he’s almost certainly right!
No, I’m not offering a one-way trip to Baghdad. This sounds a whole lot better.
A colleague in the recruiting world is looking for 3 senior nursing directors and 3 medical directors to work in the United Arab Emirates. Salaries (not including a whole lot of ex-pat benefits) are around $93,000~$142,000 for the nursing directors and $351,000~$547,000 for the medical directors. First $82,400 is tax free, worth around $25,000 ($82,400 * .3 tax bracket). If you’re interested ship me a resume and I’ll put you in touch.
Sadly I have no RN or MD degree…..
Quiz time at THCB this morning, where you get to pick the odd one out from this list
1 —Hospitals2 —New Jersey3 —Fraud4 —The Sopranos
The answer? Maybe Number 4, but I doubt it. Anyway, here’s the NY Times on the story of St Barnabas raping the taxpayer.
Roy Poses at Health Care Renewal keeps up his attack dog stance on the United HealthGroup board. Although I can’t exactly agree with all of his criticisms—for instance Mary Mudlinger’s attempt to increase the use of NPs is probably a good thing—he is the only person out there pointing out the inherent difficulty for academics being on a corporate board that has, at the least, potential conflicts of interest with their academic missions.
Of course the real dirt is that the UHC board including McGuire contributed to Thomas H. Kean’s son’s political campaign while Kean (the ex-NJ governor and chair of the ineffectual 9–11 commission) was on the compensation committee. Yup, that committee which agreed with the options backdating (or at least had it happen on its watch).
Anyway, I’m glad Roy’s on this, so I can slack off!
The NY Times asked. Have you ever suspected that a physician had financial incentives for recommending a medical treatment to you? One day later they have 236 comments from readers. almost all uniformly going after doctors and dentists for overtreatment. If you think some TCHB regulars are susicious of doctors…well they’ve got nothing on this bunch!
Meanwhile I have a gem of a story about psychotherapists overcharging desperate parents that I’ve been dragged into which I’ll share with you later.
Today contributor John Irvine reprises his role at FierceHealthcare with a guided tour of some of last week’s top healthcare stories. Go have a read and I’ll be back tomorrow with more.
The FBI’s Upgrade that wasn’t
Five years ago the FBI announced it
would spend $170 million upgrading the paper filing system it had used to track cases and suspects since J.
Edgar Hoover’s day. The result was the Virtual
Case File (VCF) a snazzy system developed by SAIC that looked as though it
was going to solve everybody’s problems. There was only one thing: the Virtual
Case File produced an error rate that was one of the worst experts had ever
seen. A year later the project was
dead. The Washington Post takes a look back at a debacle that may have helped
set the stage for the intelligence failures leading up to September 11 and
assesses SAIC’s responsibility for the project’s failure.
Annals of Generic Medicine
It is beginning to look as though
the Plavix debacle could cost Bristol–Myers
Squibb CEO Peter Dolan his job, the Wall Street Journal reports. The company’s board pointedly chose not to
“reiterate previous statements of support” for Dolan last week. By allowing the
right to produce the blockbuster to
slip into the nefarious hands of another unscrupulous generic drug maker in a
lawless and faraway country (Canada), Dolan has cost his company dearly, the doubters say. How dearly? Dearly indeed. According to some
estimates, the loss of Plavix could BMS cost $3.8 billion, more than a third of
its revenues.
Fast times at the Cleveland Clinic
The Cleveland Clinic is “severing” its relationship with the
cardiologist who has led its technology transfer and commercialization division
since October 2005. The Cleveland Plain Dealer reported on Friday that an
internal review found that Dr Jay Yadav failed to disclose his continuing
involvement with Angioguard, a stent
company he sold to Johnson & Johnson before joining the hospital system. The Clinic has faced heat over its conflict of interest policies since a
Wall Street Journal story last year focusing on its relationships with outside
investors. According to the Plain
Dealer, Yadav continued to receive 1 % of Angioguard’s annual revenues even
after joining the healthcare system, as the inventor of Angioguard’s key
product.
Great moments in Cardiology
The Plain Dealer story on Yadav
includes mention of a classic snippet
of healthcare history most people don’t know about, describing how the owner of Fuddruckers, known for its giant
burgers and massive artery clogging portions of various fried delacies, helped finance research on the
first commercially successful stent in the 1980s. Critics argue that isn’t a coincidence that a maker of a popular
product known for its artery clogging ways helped fund a medical device used by
cardiologists to prop them open again. Hamburgers? Stents? By god, there really are conspiracies everywhere you
look.
Java for Java
In the past, it has often taken
weeks for reports of new cases of bird flu to make it to Jakarta from outlying
provinces. With Indonesia one of the most likely places for an influenza
pandemic to gain strength, that’s simply not good enough say critics. The Wall Street Journal reports that In October Indonesian authorities will test
a reporting system developed by D.C. based Voxiva that allows health
workers to send reports of suspected
H5N1 infections to Jakarta with their cell phones using text messaging. Those using Java enabled phones will be able
to input information directly into a database. Instead of relying on incident reports tallied by officials in Jakarta
on a monthly basis, supervisors will be able to call up a real time map showing
outbreaks. Very cool. And probably not a bad idea, either.
Eye on Elyria
Unless you’re from certain parts of
northwestern central Ohio, you probably haven’t heard of the small town of Elyria, which sits a little bit to the
left of Cleveland on the map. Officials at the Centers for Medicare and
Medicaid Services apparently hadn’t either: at least until recently when
somebody pointed out that the rate for angioplasties in Elyria is about three
times the national average. A little
swift detective work by the New York Times traces the odd little statistical
anomaly to its source: the dedicated cardiologists at the North Ohio Heart
Center. Another example of doctors
guiding patients towards more lucrative procedures or simply an outlier? Critics
argue the former. Nay, say the cardiologists, we’re simply being aggressive.
Could we have another Redding Medical
Center on our hands? wonder the fine folks at the NYT.
Even Ronald Reagan, a reluctant
supporter of the AIDS cause, managed to make it. Critics are demanding to know why Canadian prime minister Stephen
Harper, a critic of both needle exchange programs and gay rights, refused to show up for last week’s AIDS
Summit in Toronto, citing – of all things – a previous commitment to visit the
arctic circle. Instead of announcing his government’s new AIDS policy to
assembled scientists and activists in Toronto, Harper chose to be off
inspecting igloos. Activists say Harper wants to dodge tough questions on his
decision not to extend
funding for a legal safe injection site in Vancouver that researchers say has
helped cut the incidence of new infections.
Sorry we can’t hire you, your genetic profile says you’re likely to be a heavy Myspace
user
A new Wall Street Journal/Harris
Poll finds strong support for allowing health care providers, law enforcement
and personal use of genetic information gathered from DNA tests. Most of those
surveyed were a little less enthusiastic about allowing insurers or employers
access to the data. Only 14% say they approve of allowing insurers or employers
to have access to information about their genetic profiles. Oh, and ninety
three percent of Americans think the science of genetics is a “good thing.” One
percent find the concept “evil.”
We report you decide. You report we decide. Or something …
On Friday New York Governor George Pataki signed a bill that
extends a $10,000 tax credit to New Yorkers who sign up to beome live organ
donors. Supporters say a similar
national law could help end the shortage of available organs. Is this a silly and ethically repugnant
solution to a pressing problem, like Arizona’s plan to encourage voter participation by making voters eligible for a $ 1 million
dollar prize or a clever market-based way to bribe the masses? We report. You
decide.
And in the all talk and no action department…
Ian Morrison and Bob Leitman used to go around America calling employers’ attitude towards buying health care for their employees“cranky, confused, aimless and spineless”….that was in the early 1990s. It’s all different now, eh? Well not quite. Deloitte survyed 71 big employers to find out how they were cracking the P4P whip on the system.
The joint Center/ERIC study looked at the views and attitudes of 71 major employers on value-based purchasing, also known as “pay for performance.” Some 10 percent of respondents are currently engaged in value-based reimbursement programs with health plans and/or provider networks, indicating a growing receptiveness to developing regional or pilot programs. However, 38 percent of surveyed employers are waiting for more concrete evidence that the concept can deliver a better return on investment.
Hmm.. so only 10% of big employers are doing anything about P4P. Employees working for employers with more than 1,000 employees represent about 13% of the private sector workforce (yup I scouted the Stat Abstract for that number). So less than 2% of employers are doing anything about P4P. In other words not enough for providers to take note of, so nothing will happen until Medicare makes its move.
Anti-Abortion Groups are opposing the FDA Nominee over the compromise on the OTC switch for for adults only for Plan B. Robert Steeves, who’s desperately trying to stay dry on what’s a fast receding sand bank for rational Republicans, writes to me to pick out one phrase from the story:
"Amid the political accusations, the FDA is contacting both the anti-abortion groups and their main opponent, Planned Parenthood, to hear their last-minute arguments over the fate of the drug, called Plan B. "
Robert’s comment: This plebiscite is a first in the annals of NDA consideration and neither medical nor scientific, eh?
Well from this mob of faith-based crooks, what did he expect? But even by my cynical standards this is going some.
But perhaps we’ve been looking at this the wrong way and instead there’s a new theme here. Forget those expensive clinical trials, let’s do all NDAs American Idol style!
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