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Above the Fold

Ditching the Public Option

Aug 18, 2009• 53

By ROBERT LASZEWSKI

It looks to me like the popular objections to a health care bill being expressed by voters this month are concentrated in two primary areas:

A concern about “government control of the health care system”—mostly around the public plan option.
The trillion-dollar cost of a health care bill at a time deficits are swelling and worries about who will really end up paying for it.

As a result of the first concern, we are getting the first indications that some Democratic leaders are ready to ditch the robust Medicare-like public option and are beginning the process of talking the party out of demanding it be included in a health care bill.

This from Politico today:

After the toughest week yet for health reform, leading Democrats are warning that the party likely will have to accept major compromises to get a bill passed this year – perhaps even dropping a proposal to create a government-run plan that is almost an article of faith among some liberals…"Trying to hold the president's feet to the fire is fine, but first we have to win the big argument," former President Bill Clinton said Thursday at the Netroots Nation convention, a gathering of liberal activists and bloggers who will prove most difficult to convince. "I am pleading with you. It is OK with me if you want to keep everybody honest. . . .But try to keep this thing in the lane of getting something done. We need to pass a bill and move this thing forward."

It has been clear to me for months, and I have been saying so on this blog, that the public option has not had the votes even among Democrats to make the finals. With all the heat “a government takeover” of health care has attracted from those at the town hall meetings either the Democrats ditch it or get used to the idea they have no chance of passing health care reform.

EHRs and Multi-Provider Use: Lessons from the VA

Aug 17, 2009

By AUSTIN FRAKT

With billions of dollars of stimulus funds available and the President and state governors promoting them, electronic health records (EHRs) are likely to become commonplace in the U.S. health care system. To be sure the transition will be complex and costly, but incentives provided by insurers and the federal government for quality improvement tied to EHR use will encourage providers to enter the brave new electronic world and bring their patients with them. While EHRs are praised for their promise to increase efficiency and safety, it is still an open question how much of those benefits will be realized or when.

There is one clear threat to the fruition of EHRs’ potential for quality improvement: the inability of various EHR systems to share information with one another. This potential limitation is highlighted prominently in a new Congressional Budget Office (CBO) report Quality Initiatives Undertaken by the Veterans Health Administration (August 2009), principally authored by Allison Percy of CBO’s National Security Division.

Medical Data in the Internet “cloud” (part 2) – Data security

Aug 17, 2009

By ROBERT ROWLEY, MD

This is the second of a 3-part series, where we dig a little deeper into the questions of medical data in the Internet “cloud.” In the first part, we reviewed issues of data safety – how to guard against loss of data. In this second part, we will review data security – how to guard against data theft. The third part will focus on privacy and ensuring that only the right people can access the right data.  

DATA SECURITY

A review of issues around medical records ownership and protection shows that medical records are the property of those who prepare them (medical professionals), and not the property of those about whom they are concerned (patients), although patients generally have a right to review them, demand copies of them and demand their confidentiality. With limited and specific exceptions, consent is required in order to disclose such information to others. So, how does one create a framework of security that protects the confidentiality of such records against unauthorized breach?

Continue reading "Medical Date in the Internet "cloud" (part 2) – Data Security"

Why Standards Matter (1): The True Meaning of Interoperability

Aug 17, 2009

By DAVID C. KIBBE and BRIAN KLEPPER

Americans are generally skeptical of words that otherwise intelligent and articulate people can’t pronounce. “Interoperability,” like nu-cu-lar, is one of these. After a while, these words can take on a mystique all their own.

But interoperability is a hugely important word in the context of today’s ongoing debate about the use of EHR technology by physicians, hospitals, and patients too. The federal government is going to provide billions of dollars to encourage today’s fragmented health care providers to convert from mostly paper to mostly computerized information systems. It is critically important for these systems to talk with one another. We want health data to flow between and among these systems and to be, well, interoperable. And it isn’t now.

So how can this word be so difficult to put into action? Here’s a clue: a lot of people are confused about its meaning.

Continue reading “Why Standards Matter (1): The True Meaning of Interoperability”

I am shocked, shocked that Rick Scott would twist the truth

Aug 16, 2009• 12

By Matthew Holt

Surprise, surprise, the British women who appear in the so-called Conservatives for Patients’ (so-called) Rights” propaganda are complaining that their words were twisted completely out of context. ‘We were duped’: Two British women tricked into become stars of campaign to sabotage Obama’s healthcare reforms. Further the British oncologist featured was told that he was appearing in a documentary, not in a right wing advertising campaign.

And most disingenuously of all—whether you agree with it or not—at no point have the Congressional leaders running the process or Obama introduced legislation calling for either serious single-payer (Canadian-style) or nationalized government provided care (UK-style).

So Rick Scott is conning people to twist their stories to run adverts to oppose something that no one is proposing.

Perhaps there should be $1.8 billion dollar fines for misrepresentation…

Enthoven’s ABCDs and why that socialist Gingrich is wrong on standardized benefits

Aug 16, 2009• 4

By Matthew Holt

Here's Alain Enthoven's four part plan for fixing healthcare. As THCB regulars might guess, it's familiar and very sensible stuff. (Here’s the PDF)

A. Create an exchange with standardized plans, make individuals buy through the exchange and limit outside subsidies to the value of the lowest cost plan.

B. Tax health benefits (starting with those over the value of the cheapest plan)

C. Phase in the same system for Medicare

D. Phase out employer based insurance, giving everyone a voucher for the lowest cost plan based on a dedicated tax like a VAT.

Meanwhile in the LA Times, Newt Gingrich, who continues to smell blood in the Palin-infested waters, spouts BS that would destroy any sensible Enthoven-style reform. Apparently in Newt-world a regulated insurance package of standardized benefits is government bureaucracy run amok.

Will Hospital Stocks’ Rally Continue?

Aug 15, 2009• 5

By DON JOHNSON

Since early July, most hospital companies’ stocks have been rallying in anticipation of relief from uncompensated care costs under proposed health insurance reform bills. On Wednesday, however, profit taking hit the stocks in a small way.

The rally got an added boost in the last week from positive earnings reports and guidance by Community Health Systems (CYH) and Universal Health Services (UHS).

Tenet Health Care (THC) Tuesday reported a small loss on increased revenues. Lifepoint Hospitals (LPNT) reported Friday. (After this post was originally published.)

In its conference call with securities analysts, Tenet said the health care reform bills before Congress would relieve it of the cost of uncompensated care of the uninsured and of the cost of charity care. Tenet didn’t say any more about the health insurance reform debate and how the legislation would affect the company.

Voices from the deserving mob

Aug 15, 2009• 15

By Matthew Holt

From the (UK) Independent. Real quotes from real people attending the free care in LA this week:

“I had a gastric bypass in 2002, but it went wrong, and stomach acid began rotting my teeth. I’ve had several jobs since, but none with medical insurance, so I’ve not been able to see a dentist to get it fixed,” she told The Independent. “I’ve not been able to chew food for as long as I can remember. I’ve been living on soup, and noodles, and blending meals in a food mixer. I’m in constant pain. Normally, it would cost $5,000 to fix it. So if I have to wait a week to get treated for free, I’ll do it. This will change my life.”

***

She works for a major supermarket chain but can’t afford the $200 a month that would be deducted from her salary for insurance. “It’s a simple choice: pay my rent, or pay my healthcare. What am I supposed to do?” she asked. “I’m one of the working poor: people who do work but can’t afford healthcare and are ineligible for any free healthcare or assistance. I can’t remember the last time I saw a doctor.”

***

“You’d think, with the money in this country, that we’d be able to look after people’s health properly,” she said. “But the truth is that the rich, and the insurance firms, just don’t realise what we are going through, or simply don’t care. Look around this room and tell me that America’s healthcare don’t need fixing.”

And that last one is the money quote.

Shocking Google Health Back to Life

Aug 14, 2009• 15

By SCOTT SHREEVE, MD

I hope to use this post to motivate my good friends at Google Health into taking a much more public, visible, and proactive role in the health conversation. More importantly, it is a call to Google HQ to wake up to the opportunity within health care to leverage their current tools and technology to create a platform that others can use to enable the creation of a next generation health system.

The scene was familiar, but it didn’t take away the tragedy. A young motor vehicle accident victim was involved in a head on collision with a drunk driver. The blunt trauma to the chest had created a literal mish-mash of complex internal injuries. The ambulance crew had attempted multiple times enroute to obtain a pulse and the monitors were all flatlined from the field. They intubated the patient in the field, performed CPR enroute, and initiated a ATLS protocol which included shocking the patient en route. In the face of asystole (lack of heart movement) after blunt trauma to the chest, the indication is to literally crack the chest open (called a anterolateral thoracotomy), a serious medieval last ditch rescue effort to save a life.

Tale of Two Health Crises

Aug 14, 2009• 25

By MARIA FOSCARINIS

Maria IJT CURRENT Twenty two years ago I received shocking news: I had Hodgkin’s disease, a cancer of the lymphatic system that affects primarily young people. At the age of 30 I began a long and to date successful effort to fight the disease and regain my health. I was lucky: I had good health insurance, access to top doctors, friends and family with the wherewithal to help. I also had a good education that helped me navigate the health and insurance systems and also remain employed. I also had a home to go to after each round of chemo and, three years later, after hospital treatment for a recurrence. “Scott” is not so fortunate. Twenty-seven years ago, at the age of 21, he lost his left leg after a car hit him. A month earlier, he had lost his job as a forklift operator, and with that, his health insurance. Unable to afford his own home, he was living with his mother. The money he recovered from the driver of the car that hit him barely covered hospital expenses and the lawyer’s fees.