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Above the Fold

A Second City Warning to Obama

Jul 8, 2009• 8

By MICHAEL MILLENSON

Millenson For all those Obama-ites confident that they won’t make the same
mistakes pushing health care reform that the Clinton administration
did, might I suggest a trip back home?

Just a few minutes into the Second City comedy troupe’s latest show, America: All Better!,
the usual japes about the Jesus-like hopes projected onto our 44th
president gave way to a quick bit about health care reform. A doctor
was telling a woman that her diagnosis gave her only three months to
live. When she pleaded for help, he told her that the good news was
that Obama’s health reform plan meant she was scheduled for her next
visit just six months from now.

Bad news for Obama — the audience laughed.

Conventional wisdom says that the shopworn distortions and
deceptions that killed health care reform in the past have lost their
sting due to combination of middle-class economic worries and soothing
on-message reassurances. Perhaps. But comedy works only when it
connects with real anxieties. The fact that Second City comics in the
heart of Chicago are successfully playing to GOP-fueled fears of
rationing should raise a bright red warning flag at the White House.

Meaningful Use vs. Meaningless Adoption of Electronic Health Records

Jul 7, 2009• 9

By RICK WEINHAUS MD

Dr. David Blumenthal, the new National Coordinator for Health Information Technology, has stressed that the goal of the ARRA/HITECH initiative is to improve patient care, not to mindlessly adopt health information technology. In this regard, he wrote that many CCHIT-certified EHRs “are neither user-friendly no designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system.”

It is therefore disconcerting that the Association of Medical Directors of Information Technology (AMDIS) just weighed in on the issue of meaningful use with their letter to Dr. Blumenthal, recommending that the new national HIT Policy Committee use the 2008 CCHIT certification criteria to determine which hospitals and physicians get HITECH incentive dollars.Continue reading…

The Tri-Committee Health Reform Bill: Implications for Children

Jul 6, 2009• 7

By JOCELYN GUYER

A little more than two weeks ago the three major committees in the
House with jurisdiction over health reform put out a draft legislative
proposal, known as "The Tri-Committee bill." We've now read the 852-page document
a few times, and think it would make giant strides in providing access
to coverage to millions more people and transforming the country's
health care delivery system. Of particular note for kids, it includes:

Major expansions in access to affordable coverage for their parents and other adults. (Click here for just a few of the articles showing a clear link between how children fare and the health and stability of their parents.);

Continued coverage of children through Medicaid with its strong, child-specific benefit package;

Increases in Medicaid reimbursement rates; and

A
guarantee that no child born in a U.S. hospital leaves without
insurance. (For more details on these and other provisions, see our Fact Sheet on the Tri-Committee bill.)

HELP! IS THE CBO GETTING SUCKERED?

Jul 6, 2009• 8

By ROGER COLLIER

In a comment on my previous post on
the Senate Health, Education, Labor, and Pensions reform bill, tcoyote
explained some of the political thinking behind what seem like totally
spurious cost projections. While I can readily accept tcoyote’s explanation
of the pols’ efforts to ignore reality, I’m still politically innocent
enough to want to know what the HELP bill might really cost. So I spent
some time looking at the Congressional Budget Office report on the bill.

Here are a few things I noticed:

The “ten-year projection”
starts in 2010, although the bill does not require insurance exchanges
to be implemented until 2014. The result is that the projection includes
only six years of reform (plus a lengthy transition period), NOT ten
years.

The CBO projections
include a $58 billion “credit” for the impact of the HELP bill’s
proposed new long-term care program (the so-called CLASS Act). However,
the “credit” accounts for the difference between premiums and benefits
over the 2010-2019 period on a cash basis only. If conventional accrual
accounting were used, CLASS would show a net cost for the period.

No Country for Old Men

Jul 6, 2009• 58

By JEFF GOLDSMITH

As we enter summer, the health reform process is moving into its Newtonian phase: irresistible forces meeting immovable objects. In both health cost and access, the trend is not our friend. There is ample evidence not only of intolerable inequities, but also intolerable waste and inappropriate use of expensive clinical tools. President Obama embodies the need for change. He has assembled a very talented and politically savvy crew of helpers. He confronts the sternest test of any Presidency, fixing a poorly tuned and fragmented health system that is, by itself, larger than either the French or British economy.

Washington Post’s “Salon” Disaster and Health Care Reform

Jul 6, 2009• 5

By CRAIG STOLTZ

As a former citizen of the Washington Post newsroom, the recent disaster about the newspaper’s “salon” project is heartbreaking and embarrassing.

I won’t belabor the issues many others have so thoroughly covered, including today’s “apology” by publisher Katharine Weymouth, which feels a bit short of fulsome.

Instead I want to point out something that’s gotten lost in the media frenzy: That
the topic of the first “salon” [sorry, I find I have to use quotes when
referring to that] was to have been health care reform.

As an independent journalist [among other things] and participant in
the “health 2.0″ movement, I find this particularly distressing.

The fact that Weymouth and her team identified health care reform as
the first ripe target for a scheme to bring together “the powerful
few”: CEOs/lobbyists, “Congressional and Administration officials” and
Washington Post health care reporting and editorial staff” demonstrates
the peril faced by the group with the biggest stake in health care
reform.

I refer, of course, to patients.

A Declaration of Health Independence

Jul 6, 2009• 8

By DONALD W. KEMPER

Donkemper When in the course of human events, it becomes necessary for individuals to dissolve their professional bands of medical dependency and to assume among their obligations the primary responsibility for their own health to which the Laws of Nature and of Nature’s God entitle them, a decent respect to the opinions of humankind require that they should declare the causes which impel them to seek Health Independence.

We hold these truths to be self-evident, that all people are created equal, that they are endowed by their Creator with certain inalienable Rights, that among these are the freedom to direct ones own Life, to provide for ones own Health and to die with dignity—that to assist in providing such rights when otherwise unattainable, health professions are instituted among people, deriving their roles solely from the consent of the people they serve—

The other Michael Jackson mega-mix

Jul 6, 2009• 1

By MATTHEW HOLT

Never ones to be shy with an interesting view into celebrity pharmacology (and truth be told responding to a little tickle from me) the inventive folks at PharmaSurveyor have added Michael Jackson to their celebrity drug cocktail page.

It’s an interesting way to show the dangers of multiple drug regimens, and a great way to show off PharmaSurveyor’s computational capabilities of analyzing multiple drug regimens at once. (PharmaSurveyor calls those assessments surveys). You can find it on www.michaeljacksondrugs.net which has a static picture of Michael Jackson’s survey and links to the interactive one on PharmaSURVEYOR.com. (FD I’m an advisor to PharmaSurveyor with a few stock options)

Is Wal-Mart Leading the Charge on Health Reform?

Jul 6, 2009• 28

By RAHUL PARIKH

Last Wednesday’s headline in the Wall Street Journal may have surprised you. It read: “Wal-Mart Backs Drive to Make Companies Pay for Health Coverage.” The article discussed Wal-Mart’s open support for an employer mandate requiring all but small businesses to provide care for its workers, a stance that other retailers have opposed for obvious reasons.

I’ve been following the story of Wal-Mart and health care reform for the past several years. While some see this move as the company’s way of trying to level the playing field between it and other retailers, it nevertheless has taken several actions over the past decade to make health care more accessible and affordable.

Wal-Mart’s transformation began in 2006, when then CEO Lee Scott shook hands with Andy Stern, the head of the Service Employees International Union. In the past, such a handshake would have been unimaginable. Wal-Mart had earned a reputation for failing to provide its workers with health care, and the SEIU was one its strongest critics.

That changed with rising health care costs. Wal-Mart, like labor, recognized the need to provide affordable health care. The Scott/Stern handshake was a call for affordable care for all Americans by 2012.

This handshake can be seen as a bookend to another handshake decades ago, described by Malcolm Gladwell in a 2006 New Yorker piece. This first handshake was, like this one, between two powerful men representing labor and industry:

“The president of General Motors at the time was Charles E. Wilson, known as Engine Charlie. Wilson was one of the highest-paid corporate executives in America, earning $586,100 (and paying, incidentally, $430,350 in taxes). He was in contract talks with Walter Reuther, the national president of the U.A.W. The two men had already agreed on a cost-of-living allowance. Now Wilson went one step further, and, for the first time, offered every G.M. employee health-care benefits”

Thus, American health care: –employer based, brokered by private insurers, and provided by doctors on a fee-for-service basis. The kind of care that has created the fragmented market that most of are a part of today. The kind that has left 48 million Americans uninsured and millions more underinsured and just one illness away from bankruptcy. The kind of health care that led Wal-Mart the SEIU and the Center for American Progress to write a letter to the White House today in support of change.

As reported in the Journal, Wal-Mart has taken sincere steps to provide health care to its employees. Today, as a result of cutting the time of eligibility in half and increasing choices of plans, 52% of Wal-Mart U.S. employees are covered by the company. That’s compared to 45% of the rest of the retail industry.

Wal-Mart hasn’t just stepped up to increase coverage for its employees–in 2005, it became the first company to offer $5 generic prescriptions–a breakthrough price for people who previously needed to decide between taking their meds or eating dinner.

Wal-Mart has also been in the lead in opening walk-in clinics in its stores. Although the recession seems to have slowed the initial enthusiasm for retail medicine, the idea, in principle, has the potential to offer convenience at a very affordable price for people who have minor ailments like sore throats.

Finally, Wal-Mart has also recently started offering an electronic medical record to doctors. While it remains to be seen whether it will sell, you have to give credit to the big box retailer for taking the initiative.

Whether you like or loath Wal-Mart (and all of us seem to fall into one or the other category), its efforts to shape up American health care shouldn’t go unnoticed. In fact, I would dare “real” health care groups, like the American Medical Association, to show that they can match Wal-Mart’s initiative and drive to improve health care. So far, all we’ve seen from the AMA in the past few weeks has been a lot of lip service trying to assure us that they’re on the side of reform while behind closed doors, the Association’s members are still fighting about its future. And remember, the AMA represents at best 20-30% of doctors in this country, which is one reason why the New York Times’ Nicholas Kristof urged “President Obama, don’t listen to the A.M.A. on this issue. Instead, for starters, call your doctor!”

Sunday reading-Jon Cohn on French & Dutch health care

Jul 5, 2009• 21

By Matthew Holt

Jon Cohn has a long article in the Boston Globe about how the French and Dutch get health care about right at half the American cost with none of that unpleasant Canadian or Britishness that FoxNews loves to complain about. Given that (if we get reform even vaguely right) we’ll look more like Holland or Germany that Canada, it's your essential Sunday reading.

Of course Jon is slightly too nice as ever. One minor point about access to specialty care—it may take longer there than here, slightly. But in the same Commonwealth study Cohn quotes, waiting times for elective surgery were shorter in Germany than they are in the US. And of course no one there gets bankrupted by the cost of medical care.