The Health Care Blog – Page 882 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The opposite of that bridge to nowhere

Aug 21, 2009• 26

By MICHAEL PAINTER MPainter

An elderly family member recently received a devastating cancer diagnosis. She gets her care in California from a team of health professionals in a large integrated delivery system. We’re supposed to be reassured that her care team is working together in seamless accountability–dedicated solely to the best possible outcomes for her, right? Unfortunately, that’s not entirely the case. She, of course, has a primary physician and a surgeon. She had a hospitalist who managed her inpatient post-operative complications. She has a number of oncologists. Guess what? None of these five or six physicians were communicating with each other about her care until family members prompted them to do so. She didn’t really have much, if any, choice in selecting her specialists. She had minimal, if any, information about the performance of the various professionals she suddenly needed.

JSK & Joe DeLuca on KQED

Aug 21, 2009• 1

By MATTHEW HOLT

One of the best local talk shows anywhere is Michael Krasny’s Forum on 88.5 KQED, San Francisco’s establishment NPR station (SF of course has a rebel NPR station KALW which has had me on a couple of times but I’m too scruffy for KQED!).

At 10 am PST Forum has a show about health IT which has Robbie Pearle from the Permanente group and 2/3 of my old HIO project team at IFTF, Joe DeLuca and Jane Sarasohn-Kahn.

You can listen in here

Science Is Leading Us to More Answers, but It’s Also Misleading Us

Aug 20, 2009• 6

By DAVID SHAYWITZ

Be careful what you wish for. That is the unexpected lesson of the past decade of biomedical research, which has been characterized by an overwhelming abundance of interesting things to study and powerful ways to study them. A pioneer of this era, MIT geneticist Eric Lander, speaks eloquently of the “global view of biology,” meaning that scientists now have extraordinary tools to study not only individual genes, but also multiple genes at the same time. Rather than immediately investing all their resources in a few favorite genes (the traditional approach), modern researchers first can survey thousands of initial candidates, then identify and ultimately direct their attention to the most important players and pivotal networks.But we are increasingly discovering that this global perspective comes at an unexpectedly steep price: We’re making a lot more mistakes. Or, at least, we seem to be having a lot of trouble picking out the rare, meaningful signal from the deafening noise in the background.

Health Care Reform: What do People Really Want?

Aug 20, 2009• 101

By HUMPHREY TAYLOR

Humphrey Taylor is Chairman of The Harris Poll. Prior to joining Harris, Taylor worked in Britain where he conducted all of the private political polling for the Conservative Party and was a close adviser to Prime Minister Edward Heath in the 1970 campaign and subsequently to Margaret Thatcher.

What do people really think about health care reform? When political issues are difficult and complicated, published polls sometimes confuse rather than enlighten the debate. And health care reform is fiendishly complicated, with many different issues and many different proposals for addressing them. No wonder that the debate is generating more heat than light. This is surely one of the times when political leaders should lead rather than follow public opinion. As Winston Churchill once said, “The problem with politicians who keep their ear too close to the ground is that it is difficult to look up to them in that ungainly posture.”

While policy makers have to address the details of the proposed policies, most people do not. They know what they want, or don’t want, but have only a very limited understanding of which policies will actually achieve their aims. They are often strongly influenced by political rhetoric that varies from the accurate to the simplistic to the completely false. Many different words and phrases are used to describe different policies. It is unreasonable to expect the public to understand the details of the proposed reforms or how they work in practice.

However, if you study all the polls, as opposed to cherry picking them as many politicians do, a clear picture of public opinion emerges:Continue reading…

Are Cooperatives a Reasonable Alternative to a Public Plan?

Aug 20, 2009• 10

By TIMOTHY S. JOST

Jostt First, a word about history. We have tried cooperatives before.
During the 1930s and 1940s, the heyday of the cooperative movement in
the United States, the Farm Security Administration encouraged the
development of health cooperatives. At one point, 600,000 mainly
low-income rural Americans belonged to health cooperatives. The
movement failed. The cooperatives were small and undercapitalized.
Physicians opposed the cooperative movement and boycotted cooperatives.
When the FSA removed support in 1947, the movement collapsed. Only the
Group Health Cooperative of Puget Sound survived. Over time, moreover,
even Group Health, though nominally a cooperative, has become
indistinguishable from commercial insurers-it underwrites based on
health status, pays high executive salaries, and accumulates large
surpluses rather than lower its rates.

The Blue Cross/Blue Shield movement, which also began in the 1930s,
shared some of the characteristics of cooperatives. Although the Blue
Cross plans were initiated and long-dominated by the hospitals and the
Blue Shield plans by physicians, they did have a goal of community
service. The plans were established under special state legislation
independent from commercial plans. They were non-profit and, in many
states, exempt from premium taxes. They were exempt from reserve
requirements in some states because they were service-benefit rather
than indemnity plans and because the hospitals and physicians stood
behind the plans. They were exempt from federal income tax until the
1980s. In turn, they initially offered community-rated plans and
offered services to the community, such as health fairs. In some states
their premiums were regulated and they were generally regarded as the
insurer of last resort for the individual market.

Mississippi, Alabama – and the winner is!

Aug 19, 2009• 4

By BRIAN BAUM

A study was released last month by the Trust for America’s Health and the Robert Woods Johnson Foundation titled: “F is for Fat 2009”. The essence of the report once again raised the apparent hopelessness of our national “condition” – we are a “supersized” nation. The report ranked the neck in neck race between four states for the distinction of having the highest rate of obesity in the nation. While the competition was intense, the distinction for the fifth year in a row was awarded to Mississippi, (with honorable mentions to Alabama, West Virginia and Tennessee.) From “sea to shining sea” these states are certainly not alone in this national epidemic. We seem to have lost all rational thought when it comes to the food levels we consume and the eroding levels of activity we collectively engage in.

A Town Hall Meeting 3000 Miles from Washington, DC

Aug 19, 2009• 3

By BILL KRAMER

Seaside, Oregon, is about as far away from Washington, DC, as you can get in the continental U.S. Not quite 3000 miles, but almost (2860 to be exact). And it seemed very far away from the sound and fury of the health care debate in the nation’s capital when I attended a Town Hall meeting last Friday. Sen. Ron Wyden was the speaker at the event, which was attended by over 400 people crowded into the Seaside High School cafeteria.

As we waited, the crowd was calm and polite, but there was a murmur of anticipation and an undercurrent of tension. We had all seen the stories about disruptions and threatened violence at similar Town Hall meetings across the country. Would it happen here? We could see people standing at the back with signs opposing health reform. Would they interrupt the proceedings and cause problems? We all respect freedom of speech, but somehow it wouldn’t seem like “freedom” if someone else was shouting us down and disrupting our attempts to learn about the health reform proposals.

Barney Frank deals with the loonies

Aug 19, 2009• 15

By Matthew Holt

This is just too funny not to show you all.

Interview: Bob Wachter on reform, safety, primary care and everything

Aug 19, 2009• 4

By MATTHEW HOLT

Robert_wachter

One of the best commentators around on the issues of patient safety, health care quality and basically everything to do with health care organizations is UCSF Professor Bob Wachter. Bob has been in the trenches as one of the leaders in the hospitalist movement, a major driver behind improving patient safety, and has also straddled the worlds of medical practice as a PCP, academia at UCSF, and been publicizing this all to a wider audience–particularly with his 2005 book Internal Bleeding and his more recent book Understanding Patient Safety. Then of course there are his occasional blog posts both on Wachter’s World and here on THCB.

This was a really fun conversation and somehow Bob remains an optimist. Here’s the interview.

Announcement: Money-Driven Medicine on DVD

Aug 18, 2009• 3

Academy-award-winning documentary film producer Alex Gibney (Enron: the Smartest Guys in the Room, and Taxi to the Dark Side) has made a 90-minute documentary based on THCB contributor Maggie Mahar’s book Money-Driven Medicine. Bill Moyers will be showing a shorter 55 minute version of the film on his PBS show, Bill Moyer’s Journal, Friday, August 28 (Check local listings for time.)

Institutions can buy the DVD of the 90 minute version here or by calling 877-811-7495. Individuals can rent a digital version of the film for home use anytime after August 28 for $2.99

“Money-Driven Medicine is one of the strongest documentaries I have seen in years and could not be more timely. The more people who see and talk about it, the more likely we are to get serious and true health care reform.”—Bill Moyers

“Few Americans appreciate how the health care system is gamed against physicians’ professional commitment to focus only on their patients’ best interests. This outstanding film helps us all understand why reform is essential.” – Elliott S. Fisher, MD, Director, Dartmouth Center for Health Policy Research