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Should Progressive Reformers Talk About Reining in the Cost of Care?

• 14

By MAGGIE MAHAR

“It seems that John McCain may have stolen some of the fire that Democrats traditionally wield on health issues by making cost control his top priority, rather than universal coverage.” -Rob Cunningham, “Health Affairs” May/June 2008

Last week, the bold proposal for health care reform that Dr. Ezekiel Emanuel outlines in Healthcare, Guaranteed drew high praise from the American Prospect’s Ezra Klein. As Klein described it:

Emanuel’s Guaranteed Health Care Access Plan maps out “a total transformation of the system.  It does not build on the inefficiencies of the current structure, preserving them in amber for the next generation.”

Rather than expanding on the dysfunctional system that we have today, Emanuel, who is the director of bioethics at NIH (and brother to politician Rahm Emanuel), is calling for structural reform. This is what makes his proposal both brave and fresh.

But Emanuel’s plan isn’t just exciting; it’s practical. As usual, Klein cuts to the heart of the matter: “The big deal, he explains is cost control. In health care, cost control is everything.”

Continue reading…

The mutli-factorial equation of individual insurance

• 3

By Matthew Holt

I’m up at Spot-on talking about the perils of being in the individual insurance market and wondering whether I should get out. As ever, come back here to comment if you please.

I want to ask your help. I have to make a financial decision
regarding my health insurance and given the confusion of the system –
one I’m supposedly expert in – I need advice.

Now realistically you’re not likely to be much good to me. Why do I say this? Well, the data says you’re dummies.

Last week Trizetto, a private tech company, put out a survey that said as much. While 80% of consumers surveyed were concerned about health care costs, less than a third knew how much their family spent.

It gets worse. Around 60% of Americans, including the vast majority
of those under 65, get their insurance from their employer. How much
are employers paying each year? Well according to Joe Public, not that
much. Most don’t know, or they think it’s less than $5,000 per family. In
reality it’s around $9,000.

But I’m not one of the blissfully ignorant who gets his
insurance at the company trough. Well, not quite. And hence my cry for
help. Read the rest

Markle promotes a privacy standard

• 1

By Matthew Holt

The Markle Foundation put together a group creating a road map over the last few years and today they announced their new policy framework for privacy in PHRs and personal health information. In general this is a great framework, and hopefully will help gain more consumer confidence in PHRs and other uses of personal health information online by consumers and doctors. (The AMA was on the call and was a “supporter” if not an “endorser”).

Overall I’m not sure that privacy is that big a deal (as I’ve written elsewhere). Given the choice between being private and being useful, most people pick useful. (You’ll give out your Social Security Number to just about anyone to make a credit check). So I think that PHR and consumer online services need to be useful first. It was a little telling that when someone asked if this would change any of the PHR vendors actual activity, they all said that they’d been adhering to these processes all along! But there is something to being publicly and loudly transparent about it.

Continue reading…

Universal access to high speed Internet

• 6

By Sarah Arnquist

Achieving universal Internet access may happen well before we see universal access to health care — at least if the advocacy group Internet for Everyone has its way.

The Mercury News reports that a "broad coalition of Internet business leaders, online gurus, community organizers and advocates across the political spectrum launched a campaign Tuesday with the lofty goal of universal high-speed Internet service."

The group is driven by the ideals that "Everyone must be connected to a fast, affordable and open Internet connection to prosper in today’s economy and participate in our democracy. The Internet is no longer a luxury. It’s a lifeline."

Increasing access to broadband Internet is obviously important to
expand the use of personal health records and other health 2.0
technologies, but on a more basic level it’s key to eliminating health
disparities.

Communicating and informing people about their health and major health care issues are integral parts of eliminating
health disparities. And that communication increasingly occurs
electronically on the Web. So expanding access to affordable Internet
and improving public health go hand in hand.The coalition will
hold forums around the nation and try to build support for plans that
improve access, choice and innovation. To learn more about the movement
or participate in upcoming hearings, you can email the organizers at co*****@*****************ne.org.

Internet expert fields questions on participatory medicine

• 1

By Susannah Fox

I always suspect that audience members have as much to share as I have to say. So when Mary Madden and I received an invitation to speak at the National Institutes of Health we created a participatory talk about participatory medicine: 35 minutes of our findings; 45 minutes of discussion.

It was a blisteringly hot day, so we ended up having 50 people in the room and about 50 more watching the videocast from the cool of their offices on the NIH campus. The video is a little blurry, so I recommend treating it like a podcast and downloading the slides separately, but you might enjoy hearing how we wove together our research on digital footprints, Web 2.0, and health.

Here is a sample of the excellent questions we were asked and our attempts to answer them:

Continue reading…

Check the WSJ opinion section for more BS on Medicare Advantage

• 2

By Matthew Holt

Scott Gottlieb, who passes for what the right call a health economist these days, has an opinion piece in the WSJ singing the praises of Medicare Advantage plans.

Anyone reading the article would think that Medicare Advantage plans provide better and cheaper care than the FFS program, showing the triumph of private enterprise over government welfare. And that’s why evil Democrats hate them so much.

Unbelievably, Gottlieb ignores the extra payments Medicare Advantage have received over the standard Medicare program since 2004. Even Karen Ignagni doesn’t do that any more. The AHIP crew has long changed its argument from “we do it better and cheaper” to “we help poor black and Hispanic seniors get better benefits, and the fact that we rake a ton off the top and the taxpayer gets screwed is just the cost of doing business, sorry!” But Gottleib is back in the dark ages. Is this really the best the right can do?

Continue reading…

Online bullying care management works

• 2

By Matthew Holt

So says a study out in JAMA today from Group Health of Puget Sound. They randomly divided high blood pressure patients into three groups. Being Group Health members they all had online access to the MyGroupHealth site and services, but the second group got blood pressure cuffs and training on the site. That made no difference. But the third group got all that and online counseling from pharmacists about every two weeks.

After 12 months, about one-third of the patients in the first two groups achieved normal blood pressure. However, with the Internet-based pharmacist care, more than half the patients got their blood pressure down to normal.

Which is both good and bad news. Good news because it’s somewhat scalable to have online counseling from clinicians, in that it’s more convenient for patients and clinicians. Bad news because it’s much, much more scalable to have computers do all the work. But currently computers alone, even when the patients are given more training and services don’t do much better than general medical treatment.

Much of what needs to be done to make care management effective is to figure out how to replace and augment the most precious resource (skilled humans) with a cheaper one (less skilled humans, possibly a long way away, and computers). But at least this combination has been shown to be effective.

Congress votes for higher Medicare costs when voting down competition

• 7

By Sarah Arnquist

Congress is bowing to pressure (read: financial contributions) from medical equipment makers that stand to lose money if Medicare expands its competitive bidding program.

The NY Times reports today that the House approved legislation Tuesday that would delay the launch of the competitive bidding program for 18 months — all to appease a few companies that are scared of staying viable in, gasp, a competitive market.

The results of the pilot bidding program show this is good policy that will save Medicare and individuals money. The Times reports:


"When Medicare awarded competitively bid contracts to some 325
companies to serve the 10 metropolitan areas, it reduced equipment
prices by 26 percent on what it would have paid for the same equipment
under the current fee schedule. That means that if the contracts were
allowed to proceed, beneficiaries would save 26 percent on their
co-payments. Medicare would save $125 million the first year and as
much as $1 billion a year if the program went nationwide."

Yet, good policy may lose this battle.

As NY Times columnist David Leonhardt and an accompanying editorial aptly point out, this small battle is ominously prophetic of the impending battles over health care reform.

"By standing in the way of this competition, Congress is really standing up for higher health care costs," Leonhardt wrote.

It will be interesting to see which Congressmen and women vote against competitive bidding now and then assail the rising costs of health care from the podium this fall.

For the cynical out there, this is a reminder of what you already know.

As industry veteran Brian Klepper told me yesterday, "Only innocents and little children think health care reform is going to happen through policy. It’s not going to happen because half of all the money is unnecessary and because Congress is on the take."

Lots of Health 2.0 articles indicates that it’s heating up

• 2

By Matthew Holt

I don’t know if it’s just me, but there appears to be a quick vogue in round-ups of the Health 2.0 world at the moment.

UCLA doc John Luo wrote about******@**ng.com&utm_campaign=06.17.08+l+MDNG+Anesthesiology/PM+eDigest:+Futuristic+Medicine;+Cultural+Competency&utm_source=Listrak&utm_medium=Email&utm_term=/articles/PC_Taking_the_Wheel?utm_source=Listrak&utm_medium=Email&utm_term=%2Farticles%2FPC%5FTaking%5Fthe%5FWheel&utm_content=sjohnson%40mdng%2Ecom&utm_campaign=06%2E17%2E08+l+MDNG+Anesthesiology%2FPM+eDigest%3A+Futuristic+Medicine&utm_content=je******************@***oo.com&utm_campaign=06.24.08+l+MDNG+Pediatrics+eDigest:+Premature+Births+Up;+Pregnancy+and+Child+Obesity”> The People and Companies Driving Health 2.0 on MNDG. He gives a good overview, and mentions some familiar and not too familiar names

In the slightly more rarefied atmosphere of the  American Academy of Neurology, Barbara Scherokman of Kaiser Permanente, and Michael Segal, from SimulConsult, give a great overview of the components in Health 2.0 for Neurologists. They focus alot of course on BrainTalk and PatientsLikeMe.

Talking of PatientsLikeMe, I missed this due to being in the Jordanian desert at the time, but in March Wired’s Tom Goetz (who was on a panel in the March 2007 Health 2.0 conference) wrote a fantastic and long article about PatientsLikeMe called Practicing Patients for the New York Times in March. I learned alot and I’ve been giving  PLM demos in public for the last year (and no, I’m not a shareholder!)

The people at at nursing online education database bombard me with their posts, but this one about Taking Control of Your Health Records throws in everything including the kitchen sink, but has some interesting links.

At ReadWriteWeb, Richard MacManus has been looking at DiabetesMine and DiabeticConnect. Not surprising as he’s a geek who recently discovered that he had diabetes.

Meanwhile Indu Subaiya and I have been diving into the latest rash of companies wanting to present at Health 2.0. Just 12 months ago we were scratching around to come up with enough candidates to fill four demo panels. Now we have 20 panels and we don’t have enough room to show half of the people who want to present.

It won’t stay like this for ever of course, but it’s interesting to be in the middle of the maelstrom!

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