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Above the Fold

Voila! Uninsured problem solved by not counting them

Aug 29, 2008• 1

John McCain’s health adviser John Goodman in the Dallas Morning News on solving the problem of the uninsured:

"So I have a
solution. And it will cost not one thin dime," Mr. Goodman said.
"The
next president of the United States should sign an executive order
requiring the Census Bureau to cease and desist from describing any
American – even illegal aliens – as uninsured. Instead, the bureau
should categorize people according to the likely source of payment
should they need care.

"So, there you have it. Voila! Problem solved."

Read Matthew’s comments and a great discussion on Goodman’s quote here.

Obama and Krugman — almost mirror each other

Aug 29, 2008• 9

By Matthew Holt Obama

I thought Obama was fabulous last night at the convention. He’s a great speaker, but
also able to gently laugh with his audience. His introduction showed what a tough road he had. If the Republicans manage to convince the American people that a black kid with a single white parent living in middle America is an elitist son of privilege then Karl Rove is better than I thought.

He was happy to rip McCain not on personality but on the issues. I’d like to have seen a lot more from the Democrats at this convention ripping Bush and Cheney on personality, personal corruption and the issues, and I wish Kerry had done even more in 2004, but that’s water under the bridge.

But the key point is that for most Americans things aren’t going well. Paul Krugman, who’s had his differences with Obama says it well today showing just how much key Republicans are out of touch — especially on the economy and health care.

Of course all he has to do is quote Phil Gramm, who appeared in Obama’s speech, and John Goodman who didn’t but does make it into Krugman’s column today. Goodman, of course, was pilloried in THCB yesterday. But I still think it’s a triple bluff on his part.

Two Boston Health 2.0 companies show a little more

Aug 29, 2008

By Matthew Holt

Two MD-run Health 2.0 companies in Boston had decent interviews recently in which they told a little more about themselves.

American Well’s Roy Schoenberg was interviewed by Health Business Blog’s David
Williams. It’s a long and thorough interview although Roy doesn’t tell anything particularly new, it’s as good a summary of what he thinks their business will be as I’ve seen anywhere. And they get all those fun trips to Hawaii too!

Meanwhile, across the Charles River in Cambridge Sermo’s Daniel Palestrant is making a
little more public. It’s no longer just Pfizer, now most of the big pharma companies are dipping their toe in the Sermo pond, as he tells Xconomy. What he won’t tell anyone yet is how deep their feet are in, but Sermo which reached more than 70,000 signed up docs recently — Sermo from less than 10,000 only 18 months ago — is clearly basing most of its business plan on getting big pharma to move from experimenting with it to using Sermo as a mainstream educational and marketing channel. As I’ve said before, this makes lots of sense for Sermo and its users. Whether it helps big pharma remains to be seen!

But the good news is that Daniel is not shy with his advice to other Health 2.0 Companies. “You Will Not Pay Your Bills with ads by Google,” he says.

Why not, Daniel? It works pretty well for Google!

(Both Roy of American Well and Daniel of Sermo will be at Health 2.0 next month, of course!)

The mirage of a “nonprofit” health system

Aug 29, 2008• 3

By Don Johnson

Not-for-profit hospital monopolies are helping make health insurance unaffordable for millions of Americans.

In its Thursday edition, The Wall Street Journal profiles the near monopoly that Carilion Health System has in Roanoke, Virg., and how it uses its monopoly power to inflate prices and enrich its executives.

The impact graph:

Carilion’s market clout is manifest in other ways. With eight hospitals, 11,000 employees and $1 billion in assets, the tax-exempt hospital system has become one of the dominant players in the Roanoke Valley’s economy. Its dozens of subsidiaries include businesses ranging from athletic clubs to a venture-capital fund.

The power of nonprofit hospital systems like Carilion over their regional communities has increased in recent years as their incomes have surged. Critics charge this is creating untaxed local health-care monopolies that drive the costs of care higher for patients and businesses.

The Journal also published a story in its Jan. 17, 2005, edition. about how the Federal Trade Commission was trying to stop monopolistic hospital mergers. I commented on it here.

On Jan. 24, 2007, I said health care reform should include breaking up not only health systems, but also medical groups and large regional insurers.

The Journal continues to call not-for-profit, tax-exempt health care providers “nonprofit.” Its stories show that tax-exempt health care providers are not “nonprofit.”

Checklists save money but adopted at glacial pace

Aug 29, 2008

By Charlie Baker

For the past year or so, I’ve been listening to and participating in a conversation in New England and nationally about the rising cost of health care. It’s a sticky wicket, to be sure, with no obvious, simple solutions. But I must say, I’ve been surprised that at least one pretty good idea hasn’t generated more traction. Intensive Care Unit checklists — which I’ve written about before — have already demonstrated that they can save lives, money and time, reduce variation, and improve quality, but they remain the exception instead of the rule in ICU care.

In June, the World Health Organization shared preliminary data on a demonstration it’s running using a “Safe Surgery Checklist” that showed reductions in deaths, complications and infections, along with significant improvements across many care standards for a wide range of surgeries that were done using the tool. And yet the take-up rate on this tool — which is so simple it fits on one single sheet of paper — is very slow to occur.

Is John Goodman joking or just mean?

Aug 28, 2008• 34

By Matthew Holt

The uninsured numbers went down a touch because in 2007 Medicaid expanded. In 2008 they’ll go up as unemployment increases and S-CHIP coverage is cut. Really this doesn’t change too much.

Right-wing nut jobs all over the Internet are saying that uninsurance doesn’t matter. It’s surprising that one of the more sensible right-wingers has joined in and now says that the uninsured don’t exist.

But the numbers are misleading, said John Goodman, president of the National Center for Policy Analysis, a right-leaning Dallas-based think tank. Mr. Goodman, who helped craft Sen. John McCain’s health care policy, said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort. (Hospital emergency rooms by law cannot turn away a patient in need of immediate care).

Balloon Mania: Happy Birthday Health 2.0

Aug 28, 2008• 2

By Scott Shreve

Having been around for the beginning of the Health 2.0 movement, it is good to see the conference continuing into its sophomore year. A lot has and continues to happen regarding the ongoing health care innovations that collectively make up Health 2.0.

An ongoing criticism and source of frustration for me has been the banter of those who continue to regard the entire space as a “farce.” People who demand the “proof”, demand unwarranted standards of outcome/impact prior to experimental implementation, and dismiss the space because current business models have yet to produce multiple exits (although there have been a few notables, including AthenaHealth, Medstory, HealthCentral, etc).

So at the infancy of this movement, all I can share with those doubters is an anecdote from the life of one the most famous tinkerers of all time — Benjamin Franklin (just finishing up his biography). In describing the distinctively French invention and subsequent “hype” associated with hot air balloons:

Stanford Med School rejects industry funding for continuing education

Aug 28, 2008• 4

By Sarah Arnquist

Stanford University’s medical school announced this week new restrictions on educational contributions by drug and medical device companies, which turn out to be among the strictest in the nation.

The rules are an effort to limit industry influence on physician practice. Currently, the continuing education programs tend to follow the market’s needs and not necessarily the best advancements for optimal patient care.

"The school will no longer accept funds from pharmaceutical or device companies that are targeted to specific programs, as industry-directed
funding may compromise the integrity of these education programs for
practicing physicians," a press release states.

SiliconValley.com reported that "Drug and medical-device company
contributions for continuing medical education have surged nationwide
from $302 million in 1998 to $1.2 billion in 2006, according to the
Accreditation Council for Continuing Medical Education. Stanford
officials said about $1.87 million — or 38 percent — of the medical
school’s budget for continuing education came from industry sources in
fiscal 2006-07."

Cost-containment missing piece of Mass. health reform

Aug 28, 2008• 5

By Niko Karvounis

Niko Karvounis tracks the health care system for the Century Foundation. This post first appeared on the HealthBeat blog, one of our favorite health care reads.

The Massachusetts experiment in health care reform is all about expanding access. But it doesn’t try to control costs. This, in a nutshell, is why it’s running into trouble.

The plan didn’t reform health care delivery, just coverage. Granted, in terms of bringing more people in under the tent, it’s been a success: Since the plan went into effect in 2006, 439,000 people have signed up for insurance — a number that represents more than two-thirds of the estimated 600,000 people uninsured in the state two years ago. This surge in coverage has reduced use of emergency rooms for routine care by 37 percent, which has saved the state about $68 million. (Going to the ER for routine care drives up health care costs by creating longer wait times and tying up resources that can be used to help patients who are critically ill).

Health Reform Prospects Fade as Presidential Campaign Enters Homestretch

Aug 27, 2008• 13

By Jeff Goldsmith Ijeff

Jeff Goldsmith is President of Health Futures, Inc, and a professor of public health sciences at the University of Virginia.

As presidential aspirants geared up their issue analyses last fall, health reform ranked as the number one domestic policy item the next President should address in many national public opinion polls. As the campaign season draws to a close, however, health reform has virtually disappeared from the headlines, supplanted by concern about gas prices, home mortgage foreclosures, soaring food costs and, most recently, the "Soviet" invasion of Georgia. Though you will hear campaign rhetoric from both parties at their upcoming conventions, health reform has been demoted to the second tier of campaign issues. Their platforms and campaign pledges on health reform seem increasingly unlikely to decide who is the next president of the United States.

As previously argued in this space, "health reform" really meant doing something about "health costs for my family" to most voters, not reducing inequity in access to coverage. Ninety-three percent of the voting public has health insurance of some kind. It is clear now that voter concern last fall about health reform was really a leading indicator of anxiety about the deteriorating economy and their own household economic insecurity. As Brian Klepper pointed out a few months ago in THCB, the purchasing power in real dollars of the American paycheck moved into negative territory last September, thanks to the rising price of energy, food and the resetting of home mortgages to higher rates. All these problems have worsened materially in the ensuing year