The Health Care Blog – Page 969 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Health care expansion? Forget about it

Sep 23, 2008• 2

By Jeff Goldsmith

Thoughbubble

"Jane has missed the most obvious implication of the implosion: the
bailout will use up the fiscal margin for any subsidized solution to
health reform. There will simply be no extra dollars in the federal
budget for the uninsured for many years. Obama’s health reform plan,
which relied on new taxes, is dead as a doornail unless he is willing
to push the budget deficit into Argentinian territory, or finance it
from savings inside existing health spending or health related tax
subsidies. Even the existing base of health spending will probably have
to be re-examined. Stay tuned for a more detailed analysis."

Addressable Health 2.0 market opportunities

Sep 23, 2008

By Vijay Goel

Last week was an interesting one in Health 2.0, most notably for the disagreement on the direction of Health 2.0 that turned personal between Matthew Holt and Dmitriy Kruglyak.

Also, Fard Johnmar summed up nicely the potential steps going forward where the empowering/ democratizing models of health 2.0 meet real profit-sustaining enterprise.

–Medical Decisions: This includes decisions about what medications physicians should prescribe and how to manage end of life care cost effectively.

–Information Sharing: Providing valuable health data and education to consumers, providers, payers and others.

–Medical Technology: Tools that help prolong lives, reduce administrative costs and meet emerging health needs.

–Funding: Ensuring scarce health resources are allocated effectively and finding ways to stop breaking the health care budget.

Around the Web in 60 Seconds (Or Less)

Sep 23, 2008

New surgery technique uses the somebody’s existing openings to allow for scarless surgery, the Washington Post reports. The new experimental procedure takes "minimally invasive to a new level."

Microsoft plans to buy back another $40 billion of its own stock — the single largest buyback in U.S. history, the Associated Press reports. Analysts say the move is an attempt to use spare cash to boost its share price.

What were they thinking? The Wall Street Journal Health Blog reports that employees at the University of New Mexico Hospital were fired after posting pictures of patients on MySpace.

Expanding health coverage isn’t enough if there are no doctors to see you. The Boston Globe reports that patients are waiting longer than ever to see a primary care doctor. What’s that you say about the awful Canadian wait times?

CHARITY: Are you an American Express cardholder? Do you want to help save children’s sight in India? ORBIS and “Kids for Sight” are asking for you and your readers help. Nyan and Lehka Pendyla, ages 9 and 7, launched a “Kids for Sight” initiative one year ago to help ORBIS establish a specialized pediatric eye care unit and training center in India. “Kids for Sight” has made it into the Top 25 of the American Express Members Project and now needs your help. For more information on “Kids for Sight” visit www.orbis.org/KidsForSight. If enough AMEX cardholders vote for the “Kids for Sight” project by September 29, it will advance into the Top 5 and be eligible to win $1.5 million in funding.

Health Affairs makes an apPaul(y)ing choice

Sep 22, 2008• 10

By Matthew Holt

Health Affairs ran a couple of partisan analyses last week. Joseph Antos, of AEI, Gail Wilensky, former Bush 41 HCFA administrator, and Hans Kuttner labeled the Obama plan as excessive tax and spend socialized gulag regulation.

In the other analysis, four liberal academic wonks — Thomas Buchmueller, Sherry A. Glied, Anne Royalty, and Katherine Swartz — derided the McCain plan as the counter-productive ravings of a right wing nutjob. OK so they didn’t exactly say that, but you get the message. No surprises here.

The McCain plan is so far out of the mainstream that, when Bush proposed something very similar in 2006, he could not even get it introduced into a Republican-controlled Congress. Obama’s plan is a wishwashy centrist Democrat plan that doesn’t even pretend to get to real universal coverage and ignores the fact that the vast majority of Democrats prefer a straight single-payer plan (and so does he when scratched hard!).

So who does Health Affairs chooses to create a middling compromise between these two?

Cost of insurance mandates

Sep 22, 2008• 12

By Charlie Baker

A few months ago, the MA Division of Health Care Finance and Policy (DHCFP) released a study that showed that mandated health insurance benefits cost insurance purchasers about $1.3 billion – or 12% of their premiums – each year. Thanks to DHCFP for publishing the study. This issue is always the source of heated debate, and it’s nice to have a piece included on it that tries to inform the discussion.

Business people read the study and said, “Ah ha! Mandates cost a lot of money!” That would be correct. Health care advocates read the study and said, “Ah ha! Mandates don’t cost that much money!” That’s correct too – sort of. As usual, where you stand depends on where you sit, how much twelve percent is worth to you for what you’re getting, and who pays the bill.

It’s also hard to tell if this kind of reporting influences the policy debate in MA or not. People here are screaming about the rising cost of health care, and the legislature responded by focusing on and enacting a cost containment bill. But at the same time, the legislature considered many new mandates during its last legislative session, including significantly expanding the mental health benefit mandate for kids and adults. Many in the legislature would argue – correctly – that the final bills that passed didn’t expand the benefit as broadly as many advocates would have liked, thereby significantly limiting the increase in costs associated with the new coverage requirements. Again, I think this is mostly a philosophical argument about how much is enough – and one that on the margin is hard to calculate.

Free Lunch: David Cay Johnston off the leash

Sep 20, 2008• 5

By Matthew Holt Freelunch

A version of this review appeared at Spot-on last week, but as you know over there I get heavily edited by Chris Nolan who’s a real journalist and all that. The beauty of the zero cost of publishing online is that you can show lots of versions. This is what it looked before it got to her. Enjoy.

Despite being buried in Health 2.0 work, somehow I’ve been managing to read a few books lately. But none of them have been quite as staggering as Free Lunch, the latest from former NY Times investigative reporter David Cay Johnston.

Johnston’s best known for his exhaustive investigation into how corporations and very very rich individuals subvert the tax code so that they pay less, while the rest of us pay more. But in this book (probably because he’s no longer a NY Times Reporter and is off the leash of restraint that the Grey Lady seems to put on its reporters) he gets almost biblical in calling out the cheats, crooks and murderers.

And when I say murderers, Johnston is talking about John Snow, Bush’s former treasury secretary — yup the one who did such a great job regulating the sub-prime mortgage market that the potential for a credit and housing collapse in the latter part of this decade was avoided…oh, wait….

23andme gets unwanted publicity

Sep 19, 2008• 11

By Matthew Holt

Sergey Brin, Google co-founder and husband of 23andme co-founder Anne Wojcicki, has announced that he has the gene for Parkinson’s disease and that his mother carries it to. She already has the disease, as did her aunt. Sergey has written about this on his new blog Too and it was picked up by the NY Times. Unlike the issues around Steve Jobs and his cancer, there’ll be no impact on Google’s business. If—and it’s only an “if”—Brin develops Parkinson’s it’ll be many many years from now. However, Parkinson’s is a very serious condition which people are right to dread—the father of one of my best friends has it, and his life is extremely grim.

Coincidentally I was doing my “spit” for 23andme just a few minutes ago when this story went on the NY Times site. So I can’t tell you about my results from them yet. I have though had my genome sequenced by Navigenics. Thus far none of the results have been compelling enough to make me actually do anything.

That of course is also Brin’s problem. At the moment there’s nothing he can actually do. In Genomics diagnosis is now running far far ahead of capacity for treatment.

But the hope of services like 23andme, Navigenics, DeCodeMe, and others aimed at promoting cures and treatments like CollabRx and Cure Together, is that the body of knowledge from both genomics and overall patient experiences will advance fast enough that the current situation of “more diagnosis with less ability to change the outcome” will slowly change to one where knowing your likely health future will help you avert some of the worse consequences.

Let’s hope so for Sergey’s sake and all of ours.

UPDATE: Just to clarify the headline, I don’t mean that 23andme does not warrant or deserve this publicity, or that they have done anything at all bad here. When I say "unwanted" I mean they are getting publicity for their service because of a situation that no one would want to happen to them (or to Sergey Brin). But of course that’s true for many many great health care services of all stripes.

Tags: Genomics

Cognitive Dissonance in U.S. Health Care

Sep 19, 2008• 40

By MAGGIE MAHAR

Princeton economist Uwe Reinhardt is well known as one of the bluntest—and wittiest—critics of U.S. Healthcare. Last week, we both spoke at a conference organized by Princeton’s Policy Research Institute on “Access to Universal Health Care: New Jersey, the Nation and the Globe. As usual, I learned something from Professor Reinhardt.

Earlier this year, New Jersey Governor Jon Corzine received a somewhat startling letter from Princeton economist Uwe Reinhardt. The missive was appended to a report from the “New Jersey Commission on Rationalizing Health Care Resources,” a Commission that Corzine had asked Reinhardt to chair.In the letter, Reinhardt expresses “some personal observations on the inconsistent expectations Americans have of their health system,” describing “these inconsistencies” as “a form of cognitive dissonance.” Reinhardt goes on to explain that, in his view, these inconsistencies reflect “certain deeply ingrained traits in American culture that stand in the way of a rational health care system.”He concludes: “In short, Governor Corzine, in my professional view, the extraordinarily expensive, often excellent just as often dysfunctional, confused and confusing American health system is a faithful reflection of the minds and souls making up America’s body politic.”After reading the letter, Governor Corzine had one question: “You’re not going to publish this in the report, are you?”

In fact, the letter did appear at the front of the report. And last week, at a conference on “Access to Universal Health Care: New Jersey, the Nation and the Globe” sponsored by Princeton’s Policy Research Institute, Reinhardt circulated said letter. It served as a good companion to Reinhardt’s speech, which compared what we euphemistically call our health care “system” to systems in other parts of the world.

McCain, Obama and Palin show ignorance on economic turmoil

Sep 19, 2008• 4

By Don Johnson

The presidential candidates, Sen. Obama and Sen. McCain, and the
vice presidential candidate, Sarah Palin are showing in their comments
on the financial crisis that none of them understand the crisis, the
economy or what’s behind the financial crisis.

They all need to sit down with their financial advisers and learn
what is going on so they can at least pretend to be smart about markets
and the economy.

What they are saying and the ignorance they’re displaying is simply appalling.

The treadmill-desk mashup goes primetime

Sep 18, 2008• 16

By Sarah Arnquist

Could walking at a tortoise pace all day long in the office keep you thin or help you lose weight?

Many people seem to think so and have built themselves treadmill desks — basically a treadmill with a raised platform for their computer and phone. Moving at less than 1 mile per hour all day long helps them burn between 250 and 350 calories a day. Don’t believe me? See this New York Times article. (Illustration by Eric Lister, from Gelf)

A couple of years ago, when I wrote a story about people using treadmill desks for the online magazine Gelf, the phenomenon was just beginning to surface on personal blogs. It’s clearly taken off. (David, the Gelf editor who assigned me the story, now has is own treadmill desk.)

There’s actually a lot of science behind the idea of work-walking, which comes mostly from the Mayo Clinic. Dr. James Levine and his team published research in Science back in 2005 showing that thin people tend to fidget and move around more often than overweight people, thus burning more calories. They call it NEAT— Non-exercise Activity Thermogenesis.

Two years ago, Levine, an endocrinologist, told me that he wanted this idea to go beyond a few individuals. He wanted corporations to embrace the idea, or at least promote practices that get employees moving more.

We’re a fat nation, and our evolutionary biology combined with our current environments practically guarantee we remain so unless we adopt some creative interventions. This definitely is a step in that direction.