The Health Care Blog – Page 896 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Interview with Hal Luft, author of Total Cure

Jun 15, 2009

By Matthew Holt

Hal Luft is a veteran policy analyst who's been looking at all aspects of the health care system. He's Professor Emeritus at UCSF and now is director of the Palo Alto Medical Foundation Research Institute.

His recent book Total Cure had a fabulous review from JD Kleinke in Health Affairs and essentially presents a combination of a universal insurance pool for chronic care and hospital care, and choice between independent physicians for routine primary care. It's a mix of universal care, and market solution. In this (long) interview I ask Hal about the idea, and he also goes on to explain how the central core of the idea–a public body that essentially re-routes payments to care delivery teams might well be part of the emerging legislation. Given that (as Robert Samuelson points out in the WaPo today), we haven't seen much of a mechanism for cost containment from the legislation proposed so far, yet all agree that we need one, Luft's ideas are becoming become influential rather quickly.

Video: Matthew went to Redmond, Part 3: Mike Raymer, Amalga

Jun 15, 2009

Continuing my series of interviews from my trip to Microsoft the week before last (before their conference) I met with Michael Raymer. Mike is a long time health IT veteran who’s been at Microsoft for about six months and is in charge of the Amalga product line. Amalga includes a standard HIT clinical product aimed mostly at the Asian market, and an enterprise integration product aimed at large hospital organizations in the US. What that means exactly, and how Amalga fits into the EMR ecosystem, Mike explains in this interview…

Technical note: If you’re having trouble with this video in IE, you may need to download the latest FlashPlayer version. Unfortunately our video service Vimeo is having some problems that appear to need the latest version of
FlashPlayer. You can do that here. Alternatively Firefox seems to work fin (but don’t let the folks at Microsoft know that I told you that!)

THCB alum going gone places

Jun 15, 2009

By Matthew Holt

Sarah Arnquist left THCB earlier this year to go work at a newspaper with a slightly higher journalistic profile and somewhat longer history. I'm very proud to tell you that below is a link to Sarah's first byline in The New York Times—even if it’s not typical THCB material!

In Some Swimming Pools, a Nasty Intestinal Parasite, by Sarah Arnquist

Quick Sunday roundup or “OMG I agree with Tyler Cowen”

Jun 14, 2009• 2

By Matthew Holt

I can’t say that I often agree with libertarian Tyler Cowen and I think it’s pretty appalling that the New York Times gives someone with such, as Republicans used to say, “out of the mainstream” views a regular place to air them. Like this column saying that our health care system is better than those of other nations because we’ve got more Nobel prizes for example.

But today in his column Cowen basically says the we should pay for the expansion to the uninsured through reallocating current government spending (mostly on Medicare).

The House Tri-Committee Bill—The Playing Field Just Moved Back to the Middle

Jun 14, 2009• 10

By ROBERT LASZEWSKI

Just when people were getting ready to write-off the Baucus bipartisan approach to a health bill the debate has swung back to the middle on a number of critical issues.

David Gratzer is Nice. Dennis Kucinich is not.

Jun 13, 2009• 12

By Matthew Holt

I had David Gratzer on THCB a while back. He was so nice, that it was really hard for me to get mad with him—even though his book was basically a pack of lies. He seriously suggested that the UK under Blair was NHS was going to covert into an American-type system, and he couldn’t answer why he allowed his wife to come here and be uninsured! (Of course my father the gynecologist always told me that all psychiatrists are nuts anyway)

Then last week the single payer crowd finally got to appear before a Congressional committee, and for some bizarre reason Gratzer was there too (I guess he provided balance). And the very nice David Gratzer finds that Dennis Kucinich is not quite so nice. Watch this…

Designing an Effective Insurance Exchange. Or Not.

Jun 13, 2009• 4

By ROGER COLLIER

If health care reform legislation is passed, it will almost certainly include provisions for Insurance exchanges. Theoretically, these could be key to controlling costs and expanding access to coverage. In practice (and in addition to assumptions about guaranteed issuance, community rating, and the elimination of medical underwriting) these goals will be achieved only if exchange design adheres to some basic principles:

The Story of Dr. Sidney R. Garfield

Jun 13, 2009• 4

By JON STEWART

“It’s about time,” declares Jay Crosson, MD, a recently retired physician executive at Kaiser Permanente, in his foreword to The Story of Sidney R. Garfield – The Visionary Who Turned Sick Care into Health Care (Permanente Press, 2009). “For too long,” writes Crosson, “Sidney Garfield has stood in the giant shadow cast by his more celebrated partner and friend, Henry J. Kaiser… (whose) name and fame live on, mainly in association with the only nonprofit organization ever incorporated by the builder of more than 100 for-profit companies – Kaiser Permanente. But the physician whose extraordinary vision and daring innovations in health care delivery gave birth to that same organization remains largely unrecognized beyond the select circle of medical historians and the heritage-minded physicians and staff of Kaiser Permanente.”

Sidney R. Garfield (1905-1984) is indeed one of the great under-appreciated geniuses of 20th century American medicine.

Starting out from the humble beginnings of a 12-bed hospital in the middle of southern California’s Mojave Desert, where he tended to injured industrial workers on the California aqueduct through the early years of the Great Depression, he not only went on to create the nation’s largest private, nonprofit, vertically integrated health care organization (Kaiser Permanente); he virtually reinvented the economics and organizational structure of health care delivery by envisioning and demonstrating the manifold advantages of the prepaid, group practice model – a model that many today view as a necessary element of effective health care reform.Continue reading…

Op-Ed: How I’ve Missed the AMA….

Jun 13, 2009• 17

By MATTHEW HOLT

Over at Dr Val’s Get Better Health site Evan Falchuk from Best Doctors is very grumpy about Steve Pearlstein’s column in the WaPo. Pearlstein rewrites Gawande’s rewrite of Shannon Brownlee’s Overtreated. Not much surprise here—everyone is doing it and despite my cynicism Gawande’s piece in The New Yorker has hit a nerve, not least because Obama told everyone to read it—showing that he’s way more influential than Orszag in the White House despite what we wonks all think. Orszag by the way has been hammering on about the Dartmouth stuff for years and even dragged me into his office at CBO back in 2007 to suggest THCB kept plugging away about practice variation. But obviously no one in the White House was heeding his back reading of THCB, until the boss came and told them all to read Gawande.

Op-Ed: It’s the Waste, Stupid.

Jun 12, 2009• 6

By MICHAEL PAINTER

A recent Wall Street Journal editorial strongly challenged the notion that there is enormous waste in American health care. In the article the editors acknowledge that dramatic variation in health care spending exists across the country–but point out that the precise reason for that variation remains uncertain. They also note that much of the data about regional variation comes from the Dartmouth Atlas–and that work, they point out, is limited in that it only examines Medicare data. And they cite work from Richard Cooper at the Wharton School that directly challenges some of the Dartmouth Atlas conclusions–essentially arguing that the Dartmouth observed regional variation is actually simply an artifact of Medicare. They conclude that “Dr. Cooper’s assault on the Dartmouth Atlas is controversial but compelling. He argues that the less-is-more theory is based on the flawed premise that when a region’s outcomes did not improve as spending increased, the difference is simply classified as ‘waste’ – even if it isn’t.”