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Vic Fuchs Speaks!

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By Matthew HoltPicture 7

I was absolutely delighted that after several polite “maybe later” responses I was able to  recently interview Victor Fuchs, the Henry J. Kaiser Professor Emeritus at Stanford University. Vic is best known as the “Father of Health Economics” and perhaps less well known (but more importantly to me!) the professor who taught the first health economics class that I ever took.

Matthew Holt: Victor, thanks so much for agreeing to come on THCB. I must admit Vic when I joined your class I had no idea about your background and reputation in health economics. So, I was just delighted to figure out that I blundered in right at the top. It’s a real pleasure to have you on the line

Victor Fuchs: I think you’re doing a great job and therefore I’m glad to spend some time with you.

Matthew Holt: Fantastic! You’ve, obviously, been observing and commenting on– and more recently sort of promoting ideas around –health reform for quite a while now, so let’s jump into a couple of things that you’ve published very recently, in fact just these past few weeks.

The first is a paper in The New England Journal of Medicine about a conceptual future for new biomedical innovation and I’d be grateful if you could just explain just a little bit what your general concepts are here. You’ve been working on this for quite a while. In fact, back when I was in your class, you were publishing some stuff with Alan Garber about technology assessment and this is sort of a continuation to that in some ways. So, I’d love to hear your thoughts.

Victor Fuchs: Well, I think there were two key elements here, one of them better understood by a larger audience and one of them I think rather new. Let me do the new one first. The new one is that we are going through what I call the second demographic transition.

The first transition was when every country had high mortality and high fertility and then the mortality especially of young people started to drop, but fertility did not drop right away, so you had a divergence there and in some cases it lasted for a couple of decades and during that time the population soared because there was this discrepancy between mortality and fertility.

You see the high fertility made sense when mortality was high because you wanted to have at least a couple of children survive to adulthood, but when mortality dropped it didn’t sink into people’s consciousness right away, so it took quite a bit of period which the historians and the demographers referred to as the demographic transition, okay. I don’t know if you’re familiar with it or not, but —

Matthew Holt: Yeah, I get the concept and there’s been some stuff written about that in terms of the impact on social security and healthcare.

Victor Fuchs: And some of the third world countries are going through it now, but now the second demographic transition is the one that I talk about in the NEJM piece a little bit. It has the following elements.

First is that a very large and increasingly large percentage of the population cohort lives until age 65, whereas at the beginning of the 20th century only a small percentage lived until 65. Now we’re going to 80% and we’ll eventually approach close to a 100% living till 65.

The second element is that life expectancy at 65 is increasing and it’s increasing at a quite brisk pace in recent decades. You put those two things together and you find out a very large and growing percentage of all the additional years that are lived if you have increasing life expectancy will be lived after 65.

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Health 2.0 Europe: Alensa Demonstration

By Bianca Grogan

Alex Savic from Alensa AGA presented a demonstration on the main stage of the at the Health 2.0 Europe Conference, April 6-7, 2010, in Paris, France. He introduced a new product called NextWidgets which is a tool which health publishers can use to create a store inside a widget.

Cliquez pour la vidéo en français French

Five Big Ideas that Shaped Health Reform

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By BILL KRAMER

During the Great Health Reform Debate of 2009-10, much of the public discussion and media analysis focused on the political battles, the legislative process and specific elements of the health reform bill.  We talked a lot about daily public opinion polls, the futile search for bipartisanship, the political implications of the Massachusetts special election and the impact on the upcoming mid-term elections.  We also learned more than we probably wanted to about filibuster rules, reconciliation bills and CBO scores.  And we were inundated by detailed descriptions and analyses of the public option, abortion, payment reductions to Medicare Advantage plans, excise taxes on “Cadillac” health plans, and many other specific policy issues.

Future historians, however, will want to look more deeply for the policy frameworks and political forces that shaped the health reform bill.  From a high level vantage point, there are Five Big Ideas that established the fundamental framework for the bill.  With some exceptions, these ideas were not the subject of much public discussion or formal debate in Congress, but each of them shaped the reform bill in fundamental ways. As Ezra Klein and others have observed, much of the form of the health reform bill was established long ago.

1. Managed competition

Why didn’t we go down the path of a single-payer health system?

For many years, a single-payer system was the holy grail of the liberals, and it was the driving force behind the campaigns of many of the current reform advocates.  To the disappointment and frustration of those advocates, however, the battle had already been fought and lost long before the 2009-10 debate.  In 1978, Alain Enthoven published a two-part article in the New England Journal of Medicine entitled “Consumer Choice Health Plan: A National Health Insurance Proposal Based on Regulated Competition in the Private Sector.” The title said it all.  It was a proposal for national health insurance (i.e., providing coverage to everyone) through a structured marketplace of private insurers and providers.  As Enthoven described it in a 1993 Health Affairs article, “The History and Principles of Managed Competition,” his concept built on earlier work by Paul Ellwood, Walter McClure and Scott Fleming, as well as the experience of the Federal Employees Health Benefits Plan (FEHBP). In the 1992 Presidential campaign, both of the candidates endorsed this approach to health reform, and it was one of the foundation elements of Bill Clinton’s reform proposal in 1993.  In the work of many policy experts since then, it became the de facto consensus approach.

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Google Hits Reset Button on Google Health

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By JOHN MOORE
John Moore

Google Health has seemingly been stuck in neutral almost from the start. Despite the fanfare of Google’s Eric Schmidt speaking at the big industry confab, HIMSS a couple of years back, an initial beta release
with healthcare partner Cleveland Clinic and a host of partners
announced once the service was opened to the public in May 2008, Google
Health just has not seemed to live up to its promise.
Chilmark has looked on with dismay as follow-on announcements and
updates from Google Health were modest at best and not nearly as
compelling as Google’s chief competitor in this market, Microsoft and
its corresponding HealthVault.  Most recently we began to hear rumors
that Google had all but given up on Google Health,
something that did not come as a surprise, but was not a welcomed rumor
here at Chilmark for markets need competitors to drive innovation.  If
Google pulled out, what was to become of HealthVault or any other such
service?

Thus, when Google contacted Chilmark last week to schedule a briefing
in advance of a major announcement, we were somewhat surprised and
welcomed the opportunity.  Yesterday, we had that thorough briefing and
Chilmark is delighted to report that Google Health is still in the game
having made a number of significant changes to its platform.

Continue reading…

Sickening People

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ROB LAMBERTS, MDLamberts

I found the discussion around my recent post about treating colds very interesting.  Sick people come to the office to find out how sick they are.  Most people don’t want to be sick, and when they are sick they want doctors to make them better.

Most people.

Some people want to be sick, and some doctors want to make people sick.  I am not talking about hypochondriacs – people who worry that they may have disease and become fixated on being sick.  I am not talking about malingerers – people who pretend to be sick so they can get medications.  I am talking about the slippery slope of defining disease.

“I lost my job and have felt depressed ever since.”

“My son won’t obey me.”

“I’m just tired and have no motivation.”

“My daughter’s having trouble in school.”

The definition of disease versus normal has become a big issue recently.  A recent study found that over 50% of Americans are taking regular medications.  In the eye of the hurricane of this controversy is the DSM-5, the new manual for the definition of mental illness.  John Gever, of MedPage Today explained in a recent article on KevinMD that the criteria seem, in the eyes of many, to shrink the definition of a “normal” person.  The motivation to put a label on normal people, he explains, has various motivating forces:

It’s true that drug companies often do little to discourage off-label use of psychiatric drugs and sometimes encourage it. It’s also true that many doctors throw medications at patients who might do better with other treatments or no treatments. (That’s true for many somatic conditions too, let’s not forget.)Continue reading…

Human Resources and Surviving Health Reform

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By MIKE TURPIN
Michael Turpin

As the first snowflakes of change fall on the eve of health reform, HR professionals may soon wake up to an entirely transformed healthcare delivery landscape.  The Patient Protection and Affordable Care Act (PPACA) clearly will impact every stakeholder that currently delivers or supplies healthcare in the United States.

While the structural, financial, behavioral and market-based consequences of this sweeping storm of legislation will occur unevenly and are not fully predictable, this first round of healthcare legislation is designed to aggressively regulate and rein in insurance market practices that have been depicted as a major factor in our “crisis of affordability” and to expand coverage to an estimated 30 million uninsured.  However, fewer than 30 percent of employers polled in a recent National Business Group on Health survey believe reform will reduce administrative or claims costs.

Yet, it is unlikely that reform will be repealed.  For all its imperfections, PPACA is the first in a series of storm systems that will move across the vast steppe of healthcare  over the next decade resulting in a radically different system.  Whether reform concludes with a single payer system or emerges as a more efficient public-private partnership characterized by clinical quality and accountability remains obscured by the low clouds and shifting winds of political will.  One thing is certain during these first phases – inaction and lack of planning will cost employers dearly.Continue reading…

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