The Health Care Blog – Page 835 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Waiting for Dr. Godot

Mar 6, 2010• 49

By MICHAEL TURPIN

“If you think healthcare is expensive now, wait until it is for free.” – PJ O’Rourke

On the eve of sweeping health reform legislation, it is hard not to notice the glowing skyline in Washington as policymakers ignite their torches, grab their pitch forks and race as a mob toward for-profit stakeholders who many feel have created, perpetuated and benefited from our highly uneven, inflationary and inconsistent system of healthcare in America.

Over a quarter century, I have consulted with and led employers, consumers, hospitals, physician groups, attorneys, pharmacuetical manufacturers and insurers. My personal epiphany prompting me to become more vocal about America’s need for systemic change did not spark in the middle of an inflammatory contract negotiation with a major hospital or flash during a heated employee meeting as we announced yet another deductible, co-pay and contribution increase. My burning bush occurred on a gurney in the hallway of British National Health Service (NHS) hospital where I lay for 20 hours deathly ill with pneumococcal pneumonia.

After moving to London with my young family, we decided to opt for public care. After all, I was curious to experience the NHS and with three kids under eight, we were constantly under siege with myriad colds, earaches and symptomless fevers. Best of all, it was free. Our neighborhood NHS family practice clinic was always crowded but convenient. Other than the occasional drug co-pay, we never received a bill. Yet, something was not quite right. My doctor always looked as if wild dogs or the Inland Revenue Service was pursuing him. I broke down during one examination and asked him how much he received from the National Trust for each patient to provide basic care. ” Not nearly enough, Mr. Turpin. Not nearly enough” He said absently while peering into my ear with a pen light.

In the bleak midwinter of our first English February, one of my kids came home with a nasty flu that raged through the house, flattening even my indefatigable wife who I considered indestructible. I was travelling on the Continent and needed to return early to play Florence Nightingale to the family influenza ward. As everyone slowly recovered, rising like Lazarus from the dead, I took ill and within one day, was coughing up blood and bedridden with a raging fever. After a brief visit with my GP, he called an ambulance and I was taken to casualty (Emergency) in a local NHS hospital. I was admitted and deposited on a gurney in a hallway alcove as I waited to be transferred to a hospital room. There was one problem. There were no beds available.

The ER was utter chaos with sick elderly and acute care victims in every conceivable location. The doctors were tireless and clearly dedicated but overwhelmed. Through the haze of illness, I watched the trauma triage go on for hours. My wife briefly appeared with the kids to visit.Continue reading…

The Oxymoron Columnist

Mar 5, 2010• 65

By MERRILL GOOZNER

Charles Krauthammer’s columns in the Washington Post are like the Wall Street Journal editorial page, must-reading for anyone who wants to keep up with the illogical fulminations and small-minded cruelties of what passes for intellectual discourse on the right. The intellectual bankruptcy of today’s offering shows not only why health care reform should pass, but why it will.

After scolding President Obama for continuing to push for reform despite “electoral rebukes” in Massachusetts, New Jersey and Virginia, he complains that the cost-savings in the bill are “ridiculously insignificant.” Dismissing the popular support of the insurance industry reforms that would protect most Americans from the worst predations of the health care insurance marketplace, he goes on to describe the 30 million Americans who would get health coverage as unworthy recipients of taxpayer largesse. The half trillion dollars in Medicare “cuts,” he writes, are “not to keep Medicare solvent but to pay for the ice cream, steak and flowers.”Continue reading…

Why cameras shouldn’t be let into bars

Mar 4, 2010• 5

By Matthew Holt

Captions for a bubble above Jonathan Bush’s or Judy Faulkner’s head? In the comments please

Bush & Palestrant–Live from HIMSS

Mar 4, 2010

By Matthew Holt

After days of technical gremlins holding me back, I’m getting my HIMSS interviews up online. I’ll start with one from two of my favorites. This is Daniel Palestrant of Sermo and Jonathan Bush of athenahealth, who are starting to work together in a potentially interesting way (if you’ve been following my mantra of Health 2.0 Tools and Communities merging). And both of them are pretty riotous to interview, so enjoy!

HIMSS impressions

Mar 4, 2010• 6

By MATTHEW HOLT

HIMSS is like a 4 day party with interesting conversations, meetings that I always miss (sorry RelayHealth & Ingenix—I owe ya both!), and usually a travel complication. This time I got there smoothly but missed my plane out while chatting with Mitch Work at the next door gate. I was going to be spending the night in Dallas but I got lucky and the next plane to DFW arrived early enough that I could rush to the SFO flight and make it home. Great to see my wife for the first time in two weeks!

I have about 10 longish interviews that will go up when the video gremlins give up, but here are a few impressions.

Busiest booth?: I think Cisco wins. Maybe it was HealthPresence, maybe the magician—but it was always packed. What I think it means is that mainstream Internet tools are now coming into health care (with some little tweeks). But as MrHISTalk says, putting all the big guys in the A hall was a mite unfair on the C side—although I got to both a little.Continue reading…

Dispatch from HIMSS

Mar 4, 2010• 6

By JOHN HALAMKA

I’ve just finished my day in Atlanta and am beginning a commute to Tokyo.

Every year, I describe my top 10 impressions from HIMSS. Here’s my summary of the event for 2010

I’ve just finished my day in Atlanta and am beginning a commute to Tokyo.

Every year, I describe my top 10 impressions from HIMSS. Here’s my summary of the event for 2010Continue reading…

Antitrust Warfare

Mar 2, 2010• 32

By Daniel Palestrant, MD

Not since the days of monopoly busting and Standard Oil has anti-trust been such a contentious topic in American politics. Today, Teddy Roosevelt has been replaced by Nancy Pelosi and the oil barons have been replaced by……doctors? The healthcare debate is quickly turning into a dog fight about monopolies and price controls, and in doing so, unveiling some of the dark truths about how the money really flows in this country’s largest industry.

Turns out antitrust law has become so contorted and subverted that it now serves the interests of those it was meant to regulate far more than those it was meant to protect. This past week, the FTC announced a consent decree with Roaring Fork IPA, a physician network in Colorado ( click here). Of course, this is less than a week after the Speaker of the House announced that she will pin her party’s hopes of resurrecting healthcare reform on repeal of the 1945 McCarran-Ferguson Act, a little known antitrust exemption that benefits the insurance industry ( click here).

So why has antitrust become all-the-rage-all-of-a-sudden? The Sherman Antitrust laws were originally intended to prevent monopoly behaviors, however, it has become a key tool in keeping physicians as indentured servants in our healthcare system. As Medicare continues to reduce payment rates, more and more providers are choosing to opt-out rather than contract to deliver services at a loss. Most notably, the Mayo Clinic chose to do this a few weeks back ( click here). What is fascinating, however, is that the FTC is claiming that the Roaring Fork’s decision (unlike Mayo’s) constitutes an anti-trust violation so egregious that it is worthy of an investigation and the consent decree. With 65 physicians, Roaring Fork represents well less than 1% of the physicians in Colorado, so why the anti-trust concern?

The answer lies in the cozy relationship between the insurance industry and the FTC. Insurers are determined to make sure that physicians are kept from having any leverage nor allowing market forces to create a balanced supply-demand between physicians and patients. The net goal of both is keeping physician payment artificially low, while maximizing insurance company profits. For physicians, Roaring Fork should be a wake up call to accelerate their efforts to decrease their dependence on third party payers and their adoption of technologies and services that can even the playing field.

Today we are witnessing a Kafka-esque sequence of events. Teddy Roosevelt, the original trust buster, would literally bust out laughing if he could see the incumbent political party pinning their hopes for their highest profile political effort on repeal of an anti-trust exemption, while the government chases after……..doctors, for ostensibly violating this same law. Only in America.

Daniel Palestrant is the CEO of Sermo, the social networking site for physicians. He is a regular contributor to THCB.

The Enthusiasm Gap

Mar 2, 2010• 29

By ROBERT REICH

I had dinner the other night with a Democratic pollster who told me Dems are heading toward next fall’s mid-term elections with a serious enthusiasm gap: The Republican base is fired up. The Dem base is packing up.

The Dem base is lethargic because congressional Democrats continue to compromise on everything the Dem base cares about. For a year now it’s been nothing but compromises, watered-down ideas, weakened provisions, wider loopholes, softened regulations.

Health care went from what the Dem base wanted — single payer — to a public option, to no public option, to a bunch of ideas that the President tried to explain last week, and it now hangs by a string as Nancy Pelosi and Harry Reid try to round up conservative Dems and a 51-vote reconciliation package in the Senate.

The jobs bill went from what the base wanted — a second stimulus — to $165 billion of extended unemployment benefits and aid to states and locales, then to $15 billion of tax breaks for businesses that make new hires.

Financial regulation went from tough new capital requirements, sharp constraints on derivate trading, a consumer protection agency, and a resurrection of the Glass-Steagall Act – all popular with the Dem base — to some limits on derivatives and a consumer-protection agency inside the Treasury Department and a rearrangement of oversight boxes, and it’s now looking like even less.

The environment went from the base’s desire for a carbon tax to a cap-and-trade carbon auction then to a cap-and-trade with all sorts of exemptions and offsets for the biggest polluters, and now Senate Dems are talking about trying to do it industry-by-industry.

These waffles and wiggle rooms have drained the Democratic base of all passion. “Why should I care?” are words I hear over and over again from stalwart Democrats who worked their hearts out in the last election.

The Republican base, meanwhile, is on a rampage. It’s more and more energized by its mad-as-hell populists. Tea partiers, libertarians, Birchers, birthers, and Dick Armey astro-turfers are channeling the economic anxieties of millions of Americans against “big government.”

Technically, the Dems have the majority in Congress and could still make major reforms. But conservative, “blue-dog” Dems won’t go along. They say the public has grown wary of government. But they must know the public hasn’t grown even more wary of big business and Wall Street, on which effective government is the only constraint.

Anyone with an ounce of sanity understands government is the only effective countervailing force against the forces that got us into this mess: Against Goldman Sachs and the rest of the big banks that plunged the economy into crisis, got our bailout money, and are now back at their old games, dispensing huge bonuses to themselves. Against WellPoint and the rest of the giant health insurers who are at this moment robbing us of the care we need by raising their rates by double digits. Against giant corporations that are showing big profits by continuing to lay off millions of Americans and cutting the wages of millions of more, by shifting jobs abroad and substituting software. Against big oil and big utilities that are raising prices and rates, and continue to ravage the atmosphere.

If there was ever a time to connect the dots and make the case for government as the singular means of protecting the public from these forces it is now. Yet the White House and the congressional Dem’s ongoing refusal to blame big business and Wall Street has created the biggest irony in modern political history. A growing portion of the public, fed by the right, blames our problems on “big government.”

Much of the reason for the Democrats’ astonishing reluctance to place blame where it belongs rests with big business’s and Wall Street’s generous flows of campaign donations to Dems, coupled with their implicit promise of high-paying jobs once Democratic officials retire from government. This is the rot at the center of the system. And unless or until it’s remedied, it will be difficult for the President to achieve any “change you can believe in.”

To his credit, Obama himself has not scaled back his health-care ambitions all that much, and he appears, intermittently, to want to push conservative blue-dog Dems to join him on a bigger jobs bill, tougher financial reform, and a more effective approach to global warming. (His overtures to Republicans seem ever more transparently designed to give blue-dog Dems cover to vote with him.)

But our President is not comfortable wielding blame. He will not give the public the larger narrative of private-sector greed, its nefarious effect on the American public at this dangerous juncture, and the private sector’s corruption of the democratic process. He has so far eschewed any major plan to get corporate and Wall Street money out of politics. He can be indignant– as when he lashed out at the “fat cats” on Wall Street – but his indignation is fleeting, and it is no match for the faux indignation of the right that blames government for all that ails us.

Robert Reich served as the 22nd United States Secretary of Labor under President William Jefferson Clinton from 1992 to 1997. He blogs at RobertReich.com, where this post first appeared.

Some Thoughts On the Word “Filibuster”

Mar 2, 2010• 19

By MAGGIE MAHAR

As I noted in another post, the media seems to be turning “reconciliation” into an ugly word.

But “filibuster” is the word with a more unsavory history. (Thanks to HeathBeat reader Barry Carroll who sent me a link to the history of the word.)

“Filibuster” finds its root in the Spanish word “filibustero,” which means “pirate.” The filibuster was originally seen as an opportunity to “pirate” or “hijack” a debate.

In modern American history the filibuster became infamous as a tool used to block civil rights legislation. This tradition goes all the way back to 1946 when Southern Senators blocked a vote on a bill proposed by Democrat Dennis Chavez of New Mexico that would have created a permanent Fair Employment Practices Committee to prevent discrimination in the work place. The filibuster lasted weeks, and Senator Chavez was forced to remove the bill from consideration.