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Above the Fold

Can Social Media Save Healthcare Reform?

Oct 1, 2009• 2

By DANIEL PALESTRANT, MD

Daniel Palestrant is the Founder & CEO of Sermo, the largest online physician community, and a friend of THCB’s from the Health 2.0 world. Lately Dan has been seen on cable TV representing the 110K+ Sermo members in the health reform debate—including a very public break-up with Sermo’s former partners at the AMA, which has endorsed the House 3200 bill. I’ve been asking Dan, if his members’ don’t want the House bill, what do they want? This is the piece he sent me in reply—Matthew Holt

Speaking at Fortune’s Brainstorm Technology Conference last month, longtime healthcare reform advocate, Howard Dean pointed out that the “dirty secret” of social media is that it can put a whole lot of politicians out of business because it allows the truth to bubble up. For the sake of healthcare reform, let’s hope he is right.

True healthcare reform has no chance of occurring with the current political topography. As the general public tries to make sense of the 1,000+ page version of the bill and President Obama distances himself from Howard Dean’s raison d’etre, the public option, two things are becoming increasingly clear:

1. There is very little actual healthcare reform going on.

2 The insurance companies look like they will win, no matter what, especially if you believe the cover of the most recent Business Week “The Health Insurers Have Already Won”.

At Sermo.com we seem to be seeing Governor Dean’s prediction come true.

The Health 2.0 Accelerator is really gunning it…

Oct 1, 2009• 2

By MATTHEW HOLT

The Health 2.0 Accelerator was a glimmer in the eye of Commerce.net’s Marty Tenenbaum late in 2007. But under the dedicated leadership of Julie Murchinson and Aaron Apodaca, something quite remarkable is happening. The Accelerator is an industry consortium, mostly made up of very small Health 2.0 companies who are just getting started in their own young lives. But working together they’re integrating data and services in a way that’s going to make consumers’ use of online health tools very different from the patchwork we see today.

And the effort is getting attention. Today Kaiser Permanente announced that it was joining the Accelerator, moving alongside Sage and Catholic Healthcare West as corporate members. And in the wings is a major health care data player, who’s going to be adding their seal of approval next week.

What’s happening here is the evolution of an ecosystem—an ecosystem where innovation on the web and in mobile Health 2.0 is now finding ways to present itself to consumers and healthcare organizations in new ways.

I don’t want to let the cat out of the bag completely, but I think that anyone who’s interested in seeing the evolution of Health 2.0 and the evolution of health care consumer technology will be fascinated by what around a dozen Health 2.0 Accelerator members are going to show—together—at the tools panel at the Health 2.0 Conference next week.

In the meanwhile kudos to Julie and Aaron, to Erick & Linda von Schweber from PHARMASurveyor who’ve been founding board members and have driven the technical process, to the folks from Sage who were great early supporters and to the more than 100 people and companies who’ve been supporting the Accelerator.

They’ve all made a real difference. And it’s just beginning.

I was largely in favor of Swiss-style health care…

Oct 1, 2009• 2

By Matthew Holt

until I found out that the people who the NY Times says are really in favor of it are Bill O’Reilly and Regina Herzlinger…

Actually I’m kidding. I knew Regi says she likes it, and Maggie Mahar ripped her position—(Herzlinger’s position being that she espouses a version of the Swiss system for the US)—to shreds a while back. But would Herzlinger really want to live in a world where there was no easy money to be made trading in the stock of health insurers who are defrauding state governments? But I’ve got to say that Herzlinger and O’Reilly make a interesting couple.…pass the falafel.

Health Reform and Medicare: Part I

Sep 30, 2009• 12

By THOMAS L. GREANEY

Here’s a pop quiz on health reform: Which prominent Republican said the following:

And if you don’t [oppose this health care legislation] and if I don’t do it, one of these days you and I are going to spend our sunset years telling our children, and our children’s children, what it once was like in America when men were free.

OK, it’s a trick question: the answer is Ronald Reagan, paid spokesman for the American Medical Association’s Women’s Auxiliary, speaking in 1961 against the bill that ultimately emerged as Medicare. (A recording of his “coffee klatch” talk, “Ronald Reagan Speaks Out Against Socialized Medicine,” is here.

Although what political scientist Jonathan Oberlander has termed “a politics of consensus” lasted for some thirty years after Medicare’s enactment, bipartisanship broke down in 1995 when Newt Gingrich targeted Medicare for cuts of 30% and urged privatization using managed care. By the lights of conservative Republicans, severe cuts in traditional Medicare would encourage flight to managed care alternatives, so that, in the famous phrase of Newt Gingrich, Medicare would “wither on the vine.” (1 St. Louis U.J. Health L. & Pol’y 5-43 (2007), Abstract). Although President Clinton used the Republicans’ Medicare reform to his own benefit (polls showed that his defense of Medicare helped him secure re-election), ultimately much of the Republicans’ agenda for reform was adopted in 2003. Since then Republicans have not relented in their criticism of the program– with some in leadership positions even questioning the government’s role in health care for seniors. (See Rachel Maddow’s cable television show featuring a parade of video clips of Republicans bashing Medicare, including former Speaker DeLay –echoed by Representative Roy Blunt–asserting that “Medicare shouldn’t be a government program”).

Swine flu, uninsurance and not-so fondly remembering the teenage years

Sep 30, 2009• 5

By Matthew Holt

We get sent lots of rants to our tips line, most of which we ignore in an amused jaundiced way. But this one I found very amusing. I’m not sure it’s 100% accurate, but it is very funny and essentially details something that we know happens every day. So to have some fun with how to buy individual insurance in California, head over to this post on a blog usually concerned with selling you credit cards.

By the way, a close colleague of mine trying to buy a short-term stop-gap policy while her husband changed jobs got a very similar “we’re not selling you insurance and we’re not telling you why” just last week.

Don’t forget that virtually any form of the bills in Congress outlaws these shenanigans.

Medicare Policy Might Discourage Proper Care for Hospital-Acquired Infections

Sep 29, 2009• 7

By MAYA SEQUEIRA

Medicare’s recent policy of refusing to pay hospitals’ additional costs to treat hospital-acquired infections fails to adequately incentivize prevention and proper treatment of these complications, associated with 99,000 deaths annually. A recent analysis by Peter McNair and colleagues in the journal Health Affairs suggests that, in the entire state of California, only 11 hospitalizations complicated by infection would have received lower reimbursement as a result of the policy if it had been in place in 2006.The Medicare policy focuses on infections that have low mortality, such as catheter-associated urinary tract infections, and infections that affect few people, such as mediastinitis after CABG surgery. This means that the vast majority of severe hospital-acquired infections remain completely unregulated.

To Change Health Care, Change Diabetes.

Sep 29, 2009• 14

By DANA HAZA

As we work to change health care in America, we must recognize the need to dramatically change diabetes. Twenty-four million Americans have diabetes at a cost to our nation of an estimated $218 billion for diabetes and pre-diabetes, according to a series of studies recently published in Population Health Management. Imagine the effects diabetes will have on our health and economy in the future if we don’t take action now. The prevalence and economic burden of undiagnosed and pre-diabetes make the case for the importance of policies that promote early diagnosis and prevention. About 25 percent of Americans with diabetes aren’t even aware they have the disease. And, those with undiagnosed diabetes result in $18 billion in health expenses, or $2,864 per person each year, according to one of the studies mentioned above.

Morons like us

Sep 29, 2009• 27

By Matthew Holt

I still read the articles every day that Google and the rest of my searches spit into my inbox. But as the sausage gets made I despair for the country. Not so long ago the NY Times met the Rush Limbaugh fan who decries the government takeover of health care, even though his wife ran up $68,000 in care while she had breast cancer and no insurance. Somehow because his local hospital let him off the charges, he thinks that the system was OK, and drove for an hour to shout at a Democrat who wanted to change it! (Of course the taxpayer absorbed the costs).

Yesterday NPR reported about the Sacramento man who loves his current health insurance. He’s had six or seven surgeries in the past five years—in other words he would be completely uninsurable if he lost his job (post-COBRA). He even sort of understands that.

“I mean you hear horror stories about people who have insurance and then all the sudden get denied coverage down the line because they may have had a pre-existing condition,” Koenig says. He, too, worries that he’s one step away from being dropped from his plan or losing his job and not being able to afford coverage…..And that’s why Koenig is on board with parts of the big push to change the health care system.

And like about half of other Americans, he’s actually been uninsured.

In the early nineties he was laid off and went without insurance for several months. He says it was an uncertain time and he sympathizes with the millions of Americans who don’t have coverage — or could be dropped at any time

So what does he think?

he says the focus should be on regulating the insurance industry and not a government take-over, which he believes President Obama is pushing for.

Let’s quickly review here.

Obama/Baucus/HR3200 all basically keep employer-based insurance as is with a bit of expansion, keep Medicaid as is with some expansion to suck up a few of the uninsured poor, and change the regulations in the insurance market to prevent (some of) the problems the Sacramento man understands. Oh, and they sort of put in place a backstop public plan (well HR 3200 does anyway) which people could buy into if there wasn’t a private plan they liked.

So does this sound like “regulating the insurance industry” or is it “a government take-over”.

I hesitate to remind the Sacramento man that a government takeover means the communists collectivizing your farm and stealing your pigs, and shipping you off to Siberia. What Obama/Baucus/HR3200 is proposing is minor reform of the insurance market.

And yet, somehow that message cannot get itself into the thick skulls of people who those reforms would actually help.

Another Look: Incident Reporting Systems

Sep 28, 2009• 4

By BOB WACHTER, MD

When the patient safety field began a decade ago with the publication of the IOM report on medical errors, one of its first thrusts was to import lessons from “safer” industries, particularly aviation. Most of these lessons – a focus on bad systems more than bad people, the importance of teamwork, the use of checklists, the value of simulation training – have served us well.But one lesson from aviation has proved to be wrong, and we are continuing to suffer from this medical error. It was an unquestioning embrace of using incident reporting (IR) systems to learn about mistakes and near misses.

The Aviation Safety Reporting System, by all accounts, has been central to commercial aviation’s remarkable safety record. Near misses and unsafe conditions are reported (unlike healthcare, aviation doesn’t need a reporting system for “hits” – they appear on CNN). The reports go to an independent agency (run by NASA, as it happens), which analyses the cases looking for trends. When it finds them, it disseminates the information through widely read newsletters and websites; when it discovers a showstopper, ASRS personnel inform the FAA, which has the power to ground a whole fleet if necessary. Each year, the ASRS receives about 40,000 reports from the entire U.S. commercial aviation system.

HIV/AIDS: The Future Looks Promising, but What About Now?

Sep 28, 2009• 5

By JONATHAN ROCHKIND

Red_aids_ribbon_hi-res

After years of disappointing trial and error, a vaccine shows success in a clinical trial in preventing the transmission of HIV/AIDS. Granted, the trial shows a less than one-third success rate. Compared to the 85 percent success rate of the new H1N1 swine flu vaccine, that’s quite low. Yet it clearly is the most promising success to date , and we can only hope that it soon leads to a workable vaccine that that immunizes against the HIV/AIDS virus. But what until then? Each year, in the United States alone there are 1.1 million people living with HIV and it is estimated that someone in the U.S. is infected every 9 and a half minutes. Even under the best conditions, the optimistic view is that it will take at least three years before a HIV vaccine is available in the United States. What can be done to help those who have the disease now? Is the American public ready to act?

Actually, a lot–though it seems most Americans remain unaware of this. As a researcher for Public Agenda, a non-profit non-partisan research and public engagement organization in New York City, I have had the opportunity to study both what could be done today to reduce the effects of HIV/AIDS transmission and increase treatment and to see what the public thinks of these ideas. The gap between the solutions that HIV/AIDS experts push for and what the public understands about how to address the AIDS epidemic is wide indeed.