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Above the Fold

Those Goody Goody Canadians Not So Good

Mar 19, 2009• 12

By MICHAEL MILLENSON

C’mon admit it: you’re sick of hearing how those goody-goody Canadians provide comprehensive health care to all, while we let an estimated 22,000 Americans die each year (http://www.urban.org/publications/411588.html ) because they don’t have coverage. Or the way their cost of prescription medications is so much lower than ours that Congress finally threw up its hands and legalized the equivalent of small-scale (prescription) drug smuggling. Heck, Canadian provinces even do comparative effectiveness research without anyone calling them Nazis.

Now comes word from the Fraser Institute in Toronto that Canadians are not so goody-goody after all. The institute puts out a peer-reviewed and risk-adjusted report card comparing hospitals in Ontario, the nation’s largest province. Last year, the first for the report, just 43 of 136 acute-care hospitals agreed to participate. This year, though, the number of participants plunged 60 percent, to just 17 hospitals, according to a story in Healthcare IT News.

Tom Epstein, Blue Shield of California, on the hot seat

Mar 19, 2009• 8

By Matthew Holt

A couple of weeks ago the PR company for Blue Shield of California contacted me asking if I wanted their take on health reform. I somehow suspect that the PR flack concerned wasn’t as familiar with the California rescission issue as I am, or hadn’t checked on THCB’s extensive coverage of it

But Blue Shield of California is an odd case. CEO Bruce Bodaken has been a leader among health plans in looking towards a regulated utility model, and supporting both Arnie-Care and now Obama/Baucus-care. On the other hand, as we’ve discussed numerous times on THCB, Blue Shield has not only been as bad as the rest in terms of bad behavior in the individual market–but has also been the most aggressive of all insurers in defending its right to that behavior in the courts.

Tom Epstein, is an old Clinton White House hand who’s now running Public Affairs at Blue Shield of California. Tom was brave enough to come on THCB, discuss the good, the bad and the ugly, be frank about what they want to happen and to forecast what he thinks might happen in terms of reform, and the potential role of health plans in it. Here’s the interview and I think you’ll find it very interesting.

Pharma vs. Devices – FDA, Supreme Court and Liability Whiplash

Mar 18, 2009• 16

By TOBIAS GILK

Whiplash. I don’t know what else to call it when the US Supreme Court does a near 180° reversal on a decision from just a year ago on medical product liability. Consider the following…

On February 20th, 2008, the US Supreme Court ruled in favor of Medtronic in the case Riegel v. Medtronic. The case involved a cardiac catheter, which ruptured during surgery. Medtronic asserted (and the Court agreed) that, because the company had received premarket FDA approval for the device, the company was immune from suit in state courts. The prevailing argument was, in essence, that the rigor of the federal review and approval process trumped the individual’s right to seek judgment using the state courts.

Many supported the notion of keeping federally-regulated medical devices above the reach of state courts, but at the same time questioned whether the FDA was really capable of the safety rigor that the Court attributed to it.

Jonathan Cohn on the internal politics of Obama’s health care plan

Mar 18, 2009• 7

By Matthew Holt

Jonathan Cohn has started blogging almost daily on the politics of health care at The Treatment. And it's a treat to read. Jon is a member of the recently exposed vast left wing conspiracy (so am I, but that’s because Ezra’s soft), but the difference is that instead of being a San Francisco based ranter with an unfocused cynicism, Jon actually knows the inside Obama players and cares what they do. And he’s an optimist.

His latest piece at TNR, Stayin' Alive describes the inner story of why the Administration decided to come up with the $65bn a year number in the budget for health reform, rather than just brushing it under the rug. And the somewhat surprising (to me) answer is that the member of the Obama team who would not let health care die was Obama.

Now I know I’m very cynical about both the chances of any reform passing and the value of said reform, but there is the (ever so slight) chance that I might be wrong. So paying attention to Jonathan is a smart idea.

CODA: BTW, why are health care reform costs always quoted as “$1.5 trillion” or whatever. Why are they not quoted like everything else, in annual terms?. After all $1.5 trillion over 10 years is a pretty small fraction of the $30+ trillion we’re going to spend on health care in the next 10 years.

For whom the HITECH Bill Tolls?

Mar 17, 2009• 18

By MARGALIT GUR-ARIE

As part of a sweeping effort to address the woes of the current US economy, the government has placed $19 billion on the table for HIT, aimed at containing healthcare costs and creating new jobs. The ultimate instruments for implementing this HITECH bill are America’s physicians and there is much confusion and apprehension in the physician community regarding the net effects of this bill on doctors in particular and healthcare in general. The HIT stimulus effort will not reach its stated objectives without voluntary adoption by our doctors. The government and the HIT community must find a way to draw physicians all over this country into the process of defining and implementing the stimulus package.

In very broad terms, interoperability standards will be defined, Electronic Health Records (EHR) technologies will certify compliance with the standards and physicians will be provided financial incentives to acquire, and meaningfully use, those EHR technologies. The assumptions are that use of these standardized EHRs will reduce costs by reducing medical errors, reducing duplication of tests, improving quality of care and encouraging evidence based clinical decisions. Jobs will be created as the EHRs are deployed across the nation. Experts are already at work “on the Hill”, in the White House, in the boardrooms of HITSP, NIST, CCHIT and other acronym organizations. Technology vendors are feverishly doing their part, from creating websites devoted to the HITECH bill, to making products available at Wal-Mart, to sudden revelations that HIT is really their main business. Everybody is actively involved in making this bill a success. Well, maybe not everybody.

Bill Maher explains why government-run health care is a good idea!

Mar 16, 2009• 41

By Matthew Holt

Maher’s being funny (at least he thinks he is!), but he’s tapping into a meme that I think that many in DC including any Democrats are missing. I was watching CNN on Sunday and Sanjay Gupta brought up the question to Bill Clinton and (and Bill Frist, John Podesta & Mehmet Oz) about whether single payer was really off the table. The answer is, it’s not if they get this wrong (and they will). If we have a mealy mouthed reform this time (a la Massachusetts) then single-payer will be back with a vengeance in a few years.

A Sticky Solution to a Sticky Problem

Mar 16, 2009• 23

By ALISTAIR ROCK

“Don’t pull the knot tight,” the philosopher Ludwig Wittgenstein once warned, “before being sure you have got hold of the right end.” Those who hope to sort out the tangle of health care spending would do well to heed his advice.

Clearly, there’s been no lack of solutions put forward since the Clintons first put health care atop the national agenda more than a decade ago. But with health care spending still rising at twice the rate of inflation, few have made any real and lasting impact.

Employers (who still pay the lion’s share of health insurance premiums here in the U.S.) know, of course, that keeping employees from getting sick in the first place—and minimizing the severity and duration of their illness when they do—is the first step in reducing this unwelcome “growth sector” of our economy. They understand, for the most part, that healthier employees equal not only lower healthcare costs but reduced absenteeism and greater productivity for the economy as a whole.

I shake my fist at Clay Shirky!

Mar 15, 2009• 9

By Matthew Holt

Last week (Tuesday to be precise) Chris Rauber, the health care journo at the SF Business Times calls me to talk about health care IT. But he ends with a question that’s not about Health care or IT, but aimed at me as a blogger. He says “what do you think is the future business model for journalism”

I’ve been mulling this a little bit and my response went something like, media is now disaggregated. Craigslist and Google have destroyed the advertising model for most media, and blogs and social networks have democratized the commentary/opinion playing field (to some extent—I’m not as rich as Tom Friedman yet!). The problem is that not many “new” media outlets—such as THCB—can afford to take on the interesting part, which is paying real investigative journalists to investigate. Something I would love to be bale to do—as there’s lots of muck to be raked in health care.

Op-Ed: Pathway for FOBs Should Balance Need for Competition and Need for Innovation

Mar 14, 2009• 5

By JAMES BIANCO MD

President Obama's first budget calls for the creation of a regulatory pathway for the creation of follow-on, or biosmiliar, biologics. This is obviously now the most high-profile call yet to move forward with a system that will provide the benefit of biotech drugs to patients who need them the most.

The biotech industry has done an outstanding effort in the last 10 years producing some of the most high-tech but also the most expensive drugs on the market. Some biotech medicines cost hundreds of thousands of dollars each year. Many of these products face no competition, because there is no legal way for a generic version of the product to get on the market. Individual patients as well as the healthcare system generally simply cannot absorb these continually rising costs.

To date, the debate over follow-on biologics has been mostly political posturing between the trade groups that represent the generic drug industry and the pioneering companies. The generic industry wants biotech companies to have only three to five years of market protection after bringing a new drug to market. The industry counters it needs up to 14 years of exclusivity to recapture its investment costs, which can reach over $1 billion for a single product.

Another Look: The Wal-Mart and E-ClinicalWorks Deal

Mar 13, 2009• 14

By David E. Williams

The New York Times reported this week (Wal-Mart Plans to Market Digital Health Records System) that
the company’s Sam’s Club division will bundle eClinicalWorks
electronic medical record software, Dell computers, installation,
maintenance and training to offer to small physician practices. Pricing
is about $25,000 for the first physician in an office, and $10,000 for
each subsequent physician. Annual maintenance and support costs will be
about $4,000 to $6,500 (though it doesn’t say whether that’s per
physician or per practice).

Wal-Mart says its package deal of hardware, software,
installation, maintenance and training will make the technology more
accessible and affordable, undercutting rival health information
technology suppliers by as much as half…

Dell will be responsible for installation of the computers, while
eClinicalWorks will handle software installation, training and
maintenance. Wal-Mart is using its buying power for discounts on both
the hardware and software.

This program has promise, but it isn’t revolutionary and is by no
means certain to succeed. Interestingly, the Wal-Mart PR people, who
usually send me a heads up about any new Wal-Mart move in health care,
didn’t tell me about this one. It makes me wonder what’s really going
on. There are a couple of very promising aspects of this program: