Committee Faces Economy and Health Care Issues

The Energy and Commerce Committee's health subcommittee in the U.S. House of Representatives is examining the state of federal health care programs, including Medicaid, which have suffered due to budget shortfalls at the state level. These budget shortfalls are caused by the current downward spiral in the financial sector.

This examination comes on the heels of nationwide cries for assistance from governors across America. As belts tighten everywhere, the impact is felt in our already ailing health care system.

From the Associated Press via Forbes:

While health care is typically seen as the one part of the economy least affected by downturns, recent reports show the financial meltdown already is affecting health care decisions.

Almost one third of patients surveyed by Kaiser Family Foundation last month said they had skipped medical treatment, up from 24 percent in April. Drugmakers like Pfizer Inc. (nyse: PFE - news - people ) also have reported fewer prescriptions are being filled compared with this time last year.

It's a good thing that there are several plans being developed to reboot the system in Congress right now. With a reform-minded President on his way in, one who has already stated that health care is a top priority, the time is right. Besides, as I have commented in the past, fixing some of the cost issues currently burdening the system will have significant impact on the overall economy.

Remember, health care accounts for a lot of US spending....

SOURCE: "Ahead of the Bell: Health care hearing" 11/13/08
photo courtesy of Janie-Jan, used under its Creative Commons license

Health Care in Congress

With almost two and a half months until President-Elect Obama takes the Oath of Office, the U.S. Congress is already ramping up a number of plans to address the health care crisis.

Robert Pear of The New York Timesreports:

Without waiting for President-elect Barack Obama, Senator Max Baucus, the chairman of the Finance Committee, will unveil a detailed blueprint on Wednesday to guarantee health insurance for all Americans by facilitating sales of private insurance, expanding Medicaid and Medicare, and requiring most employers to provide or pay for health benefits.

President-Elect Obama's aides have stated that he welcomes congressional efforts and has encouraged that body to take the lead on this high priority issue. Sen. Baucus, who we have been following here for some time, calls for universal coverage as the final goal. He is not the only one drafting proposals of this nature, however; several others from his own party have ideas in the works as well.

Other Democrats with deep experience in health care are also drafting proposals to expand coverage and slow the growth of health costs. These lawmakers include Senator Edward M. Kennedy of Massachusetts and Representatives John D. Dingell of Michigan and Pete Stark of California.

While each proposal is going to be unique, Mr. Pear says that they will all be "broadly compatible," with the President-Elect's stated positions on the subject. The Baucus plan would go one step further with its universal coverage goal; President Elect Obama's approach would only mandate coverage for children.

It looks like we will be seeing a plethora of options presented soon, a huge step forward as we move towards Health Care Reform Now!

SOURCE: "Senator Takes Initiative on Health Care" 11/11/08
photo courtesy of Kimberlyfaye, used under its Creative Commons license

Warrior Care Month: U.S. Veterans and Mental Health

One of the things that made growing up "interesting" was the fact that my father came home from Vietnam suffering mental health issues. Without going into detail, let's just say that it made me acutely aware of how important the issue of mental health care for our nation's veterans truly is.

So, as we advance towards the advent of a new administration, it is wonderful to see that others are raising awareness of the issue. With the promise of an extensive reboot of health care, the viability of which has yet to be tested, it is important to not let this one aspect get left behind.

According to this press release, the American Psychiatric Association (APA) is working hard to keep this issue on the radar. Their efforts are going into overdrive right now because thanks to the U.S. Department of Defense, November has been named Warrior Care Month this year.

The APA joined other mental health organizations today in recognizing Give an Hour, a national grassroots network that provides free mental health services to military members and their families.

"Not all wounds are physical. There are those hidden injuries that impact the mental health of soldiers, their friends, families and dear ones," said Carolyn Robinowitz, M.D., APA past president at the press event. "All wounds need attention, and a soldier's mental health wounds are no different. The combat experience presents a multitude of challenges to service members -- challenges that persist and affect those with whom they interact."

In addition to Give An Hour, the APA has compiled an array of resources on issues such as post-traumatic stress disorder (PSTD), depression, and other issues facing veterans on www.healthyminds.org. Recent studies by the RAND Corporation indicate that over a third of our troops return from combat with some level of mental health issue.

SOURCE: "Veterans Day Highlights Need for Military Mental Health Care" 11/10/08
photo courtesy of KimberlyFaye, used under its Creative Commons license

Digital Medicine, Intel, and the Common Platform

In 1999, there was a research study called "The Future of Fun" that examined trends in digital entertainment across 100 homes in the United States and Europe. An unexpected surprise was found amongst the results. Users asked for ways to help manage the chronic health problems of elderly relations, especially those geographically separated by great distance. Eric Dishman, who spearheaded the study, shopped these results to Intel, efforts which eventually led to the genesis of the company's Digital Health Group. Now Dishman, a social scientist, is director of product research as a result.

The reason I am pointing all this out is simple. Intel is making a push to be the first on the ground offering integrated home health serves.

Via Rick Merritt at EETimes:

The Intel Health Guide is a PC customized to monitor vital signs and deliver health services to elderly patients managing chronic health conditions. Based on an Intel motherboard, the system is designed to be simple enough for technophobic users but robust enough to have received FDA Type 2 certification in August, a first for the company.

Intel provides the software to run both the new device and computers used by health care professionals to track and communicate with patients using it. The chip maker will even host those services and provide consulting to health care groups who want to set them up.

So here we have a fusion of two of my favorite topics: electronic medical records and care for chronic conditions. Attention to either of these subjects stands to reduce the overbearing cost of health care in this country; the combination of both could be a great boon.

With the Baby Boomers entering retirement at ever increasing rates, the market for this sort of device and interface will expand almost exponentially. In pure business terms, it is massive.

The move is an effort to define a common platform for the emerging field of remote health care expected to reach $5 billion in 2010 and explode to $34 billion by 2015, according to a recent report. It also marks a major expansion for Intel which has been studying the health care market for several years, but to date focused on defining systems and standards.

Looks like the game is changing. The Perfect Storm for health care reform spoken of by George C. Halvorson seems to be gaining strength!

SOURCE: "Intel rolls health care system and service- Chip maker hopes to set platform for personal care" 11/09/08
photo courtesy of k0a1a.et, used under its Creative Commons license

A Thought on Health Care Spending

As is needed in these troubled times, President-Elect Barack Obama is marshaling his forces for January 20 when he is is sworn into office. As that time approaches, it will be interesting -- as it is with any new resident of the Oval Office -- to see what elements of his health care platform will make it into actuality.

Our President-Elect certainly has an awareness not only of the importance of health care issues, but also an awareness of how important it is to his constituency. This is demonstrated by the amount of ad spending his campaign engaged in that addressed health care issues.

Via Jacob Goldstein on the Wall Street Journal (Oct 25, '08):

Barack Obama is going big on health-care advertising. He’s spent $113 million — 68% of his total TV ad budget — on commercials that include a health-care theme. Only 13% of John McCain’s TV ad spending has gone for health-related commercials.

By spending more than half his ad budget into health care, the Obama has created expectations that he will have to follow through upon. I predict we will be hearing a lot more about electronic health records soon!

SOURCE: "Obama Has Spent $113 Million on Health-Themed Ads" 10/24/08
photo courtesy of iChaz, used under its Creative Commons license

Post Election: Health Care and The Obama Administration

President-Elect Barack Obama will be taking the reigns on January 20, 2009. He takes office amidst a veritable hailstorm of crises: the financial meltdown, the housing meltdown, the wars, and, according to voters, health care.

Rebecca Ruiz over at Forbes brings us a recap of Obama's plans along with an examination of what the next steps will be and what direct effect we will experience. In one of the first of what will no doubt become an endless stream of speculation between now and January 20, she explores the pros, cons, and unknowns of the subject.

One particularly telling quote in her article comes from John Sheils, senior vice president of the Lewin Group, a health care policy research company in Falls Church, VA:

Sheils' analysis found that Obama's plan would decrease the number of uninsured by 26.6 million beginning in 2010. The estimated federal cost of enacting the plan is $1.17 trillion from 2010 through 2019. By 2010, annual spending on health care is expected to reach $2.7 trillion. But Obama's plan is expected to cut spending by $54.1 billion in the next decade. The savings are important, but regardless, the price tag is staggering.

Another thing that Sheils notes is that one crucial flaw remains unaddressed, a crucial flaw that George C. Halvorson has expounded upon in his most recent book: incentives. Currently, incentives in the health care industry are geared towards care services and procedures performed instead of being based on actual health results.

This article is particularly advised reading, especially for its last few paragraphs where Ms. Ruiz looks at the potential interactions on this subject once Obama is sworn in and the discussion moves to the floor of Congress.

On the whole, it seems like there is positive news in the wind.

SOURCE: "What Obama's Health Care Plan Means For You" 11/05/08
photo courtesy of realjameso16, used under its Creative Commons license

The President Elect Faces Hard Work On Health Care

So history has now been made. On January 20, 2009, our 44th President will take his place as Commander-in-Chief. That man will be Barack Obama. With the vast majority of health care organizations backing his plan, and a seeming mandate from the people, he should be in a position to rapidly enact change, correct? Well.....no. Not really.

You see, like everything in life, health care reform is going to cost. With $700 billion recently allocated to the financial bailout, I would be willing to wager that purse strings are going to be a bit tight. Then you add in the $455 billion budget deficit. To be blunt, I think it could be a fight for every penny. Of course, the one thing that is a huge variable, as his winning campaign has shown all along, is President Elect Obama's seeming mandate from the people. How much leverage will that give him with Congress?

Maggie Fox, Health and Science Editor over at Reuters shares some optimism from the Senate floor:

But Senate Majority Leader Harry Reid predicted the momentum for change would be there. "We have no alternative," Reid told National Public Radio on Wednesday morning. "A wave of hope has swept the country."

Reid said Republicans would not dare to block legislation, given Tuesday's voter mandate.

The next few months are going to be very interesting....

SOURCE: "ANALYSIS-Even with mandate, Obama faces health care pain" 11/05/08
photo courtesy of EricaJoy, used under its Creative Commons license

Electronic Medical Records

Shari Roan of the Los Angeles Times thinks that "[i]f ever a case was made for electronic health records, perhaps this is it." The reason? A Canadian study of over 3,000 patients on the subject of continuity of care and patient/doctor communication. The primary finding of that study is that when tracking records, only 22% of them are available between visits to two or more health care providers. That's roughly one fifth; not much continuity in the care there.

Via Ms. Roan's article:

"We believe that poor exchange of information between physicians caring for the same patient may be detrimental to the quality of patient care," said the authors of the study, from the Ottawa Health Research Institute. Sometimes, doctors use hand-written notes that are difficult to transfer, the study noted. Other times, doctors aren't aware of visits to other doctors or they may think the records from previous visits aren't necessary.

If all physicians and other health care providers have to access the same consistent system in order to read a person's medical records, the chance of data slipping through the cracks reduces drastically. Once the immediate rush of post-election craziness dies down, I look forward to seeing what our new Commander-in-Chief plans to do in regards to EMRs. At least we knew going into it that both sides backed the idea from the beginning.

SOURCE: "Canadian doctors don't share their patients' records either" 11/03/08

Photo courtesy of Sirkully used under its Creative Commons license

Health Care Reform Research on Election Day

Okay, folks. As someone who has become addicted to using his iPhone for web surfing when stuck in lines, I'm going to provide an election day resource list for those of you doing just that. Here are some of the pertinent pages available online so that you can do any last minute research while waiting for your opportunity to be part of the process. With record level voter turnout expected, and long lines across the nation during early voting a few days ago, I am willing to say it's a safe bet you may find some time on your hands.

• Scott Whipple of The New Britain Herald takes a look at likely outcomes for health care should either side win. [link]
• Channel 6 Action News, an ABC affiliate, provides video comparing the candidates' plans. [link]
  
• Paul Krugman compares the plans in an Op-Ed for The New York Times. [link]
• The AP Fact Check article by Calvin Woodward covers many issues as well as health care [link]
• The Kaiser Family Foundation's Daily Health Policy Alert [link]

Let us hope that we all have the opportunity and the motivation to participate in this election. No matter which way things go, it will have a drastic impact on health care for every American. In the meantime, I hope that some of today's post is useful for the iPhone, Blackberry, and Google Phone set!

Thank you for being part of the process! Let us hope for a healthy four years!

photo courtesy of SanFranAnnie used under its Creative Commons license

American Hospitals Rated

Grades are in on American hospitals, and while not horrible, they are also far from exceptional.

The American public has been queried about their satisfaction with our nation's hospitals in the first nationwide survey of its kind and their opinion is not stellar. Called the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), the survey was created by a public-private partnership including a wide variety of agencies. (The Centers for Medicare and Medicaid Services and the federal government's Agency for Healthcare Research and Quality are central players in this partnership.)

Conducted in roughly 60% of all United States hospitals during a timespan running between July '06 and June '07, the HCAHPS polled patient perceptions of the health care they received. The survey itself was conceived to assist in crafting hospital policies while also helping provide consumer tools allowing informed heath care decisions.

The eight areas of patient perceptions covered in the survey were:

• Communication with doctors, communication with nurses
• Quality of nursing services
• Communication about medications
• Pain control
• Information received when leaving hospital
• Were hospital rooms were clean and quiet.
  

While the survey respondents were not glowing in their praise for our hospitals, they did reveal some surprising things. Ashish Jha is the assistant professor of health policy at the Harvard School of Public Health and lead author on the NEJM paper that analyzed the survey data. His analysis of the data collected brings some interesting details to light.

Via Laura Blue of TIME Magazine:

Jha's analysis of the data found that patients liked not-for-profit hospitals more, on average, than for-profit hospitals. Institutions with more nurses per patient were also more popular than those with fewer. And, on the whole, the hospitals that scored better according to the survey were also those that performed better on more traditional measures of clinical performance, such as providing the appropriate emergency treatment for heart attack or correctly following procedures designed to reduce risk of medical error.

If you want to find and compare hospitals using the data unearthed in this study, you can do so on the Medicare site here.

SOURCE: "Patients Give U.S. Hospitals So-So Marks" 10/30/08
photo courtesy of Jose Goulao, used under its Creative Commons license

Halloween and Health

In deference to the holiday, today's post will be of a slightly different nature than the usual fare -- a slightly different tone before we return to election mania.

Preventative medicine is vitally important. That is something that I believe few will quibble with. Emergency rooms are expensive; that has also been well established. Chronic conditions such as obesity and type 2 diabetes absorb a huge amount of the funds in the health care system, an amount that proper prior behavior can reduce drastically. And Halloween? Halloween is just fun, right?

Like all good things there is dark side to Halloween, and I am not just talking hordes of kids on a massive sugar buzz. The Center for Disease Control has a page up on their web site that details a wide array of health and safety tips ranging from "be careful with toy swords," to advice on substituting health snacks for candy. It's comparatively short and presented as a bullet list, but a good starting point.

The one I really got the most out of this season was a piece by Samara Felesky-Hunt, for The Calgary Herald. Since massive snowdrifts of candy are about to blow through homes across the country her tips for reducing the impact are well timed.

[...] for now, you're dealing with the candy. Here are a few tricks to have up your sleeve before your kids are out of the door on the Halloween neighbourhood prowl.

Have a healthy dinner first. Having a well-balanced dinner with lots of veggies sets the tone for the whole evening. If you send them out with their tummies full, they're less likely to eat candy along the whole way. A healthy dinner -- or even a quick peanut butter sandwich with carrot sticks -- will help to prevent sugar highs and nasty tummy aches later.

The list goes on and is worth a look. You can strike a blow against diabetes, obesity, and sugar fueled hyperactivity all at once. (Hint: look under Sources below.)

SOURCE: "CDC- Halloween Health and Safety Tips" 10/08
SOURCE: "Halloween doesn't have to be unhealthy" 10/30/08
photo courtesy of C.J. Sorg, used under its Creative Commons license

Will Health Care IT Get a Leg Up Under the New President?

One thing that both of our current contenders for the Oval Office have in common is the fact that they both support the use of information technology to help fix our broken system. Since every poll I have seen for the past year agrees that reform is vital, and this approach is one that is central to George C. Halvorson's views on the subject, I would say this is a very good thing.

For analysis, I would like to avoid the usual round of health care publications and instead take a look at Information Week where Marianne Kolbasuk McGee is at it again -- writing intelligent and insightful commentary about IT and health care, that is.

Regardless of the outcome of the presidential election, there's potential for a lot of change in the health care industry in the next four years. Barack Obama and John McCain have very different visions when it comes to health care reform, but there is one thing they both have in common, and that's an emphasis on using technology to digitize patient records and eliminate paper-based processes that are inefficient, redundant, costly, and potentially deadly.

Now we all know that implementation of these sort of systems is a costly scenario, one that many providers balk at. As we watch the bizarre and disturbing ups and downs that Wall Street and the economy have been undergoing, one could easily assume that costly measures like EMRs would be back-burnered while other more seemingly pressing issues get funded.

At least one Senator disagrees:

"We need to make money available for direct grants" and via other avenues to promote the deployment of IT in health care, said Massachusetts Sen. John Kerry (and Democratic presidential nominee in 2004) during a keynote speech in Boston yesterday at a technology symposium put on by the Center for Connected-Health, a division of Partners HealthCare, which operates several Boston area hospitals, including Mass General and Brigham & Women's.

Health care reform can't be deferred by the weak economy because health care is such a big part of the economy -- or $1 out of every $6 dollars spent in the United States, says Kerry. Addressing the health care system's big cost issues will "help the economy move," he says.

One-sixth of the economy. A perversely incented system, to use Mr. Halvorson's words, that is rife with redundancies and top heavy with bureaucracy is one sixth of the American economy. This fact alone should help put things into perspective. For an excellent summation of the situation and the options before us, go take a quick moment and read Ms. McGee's latest. As always, it is a highly informative gem of a column!

SOURCE: "Could Health Care IT Get A Boost Next Year?" 10/28/08
photo courtesy of Violator3, used under its Creative Commons license

The Obama Plan: Economists Speak Out on Forbes

Forbes brings us an interesting piece by a pair of research associates at the National Bureau of Economic Research. The topic, unsurprisingly, is health care and the approach taken on the subject by the Democratic nominee for U.S. president.

The first of the pair, David M. Cutler, is the Otto Eckstein professor of applied economics at Harvard's Department of Economics and Kennedy School of Government, and is also an adviser on health care to Barack Obama. I think we can guess what side of the issues he comes down on. The second one, J. Bradford DeLong, is a professor of economics at U.C. Berkeley.

Between the two, they have crafted a exploration of why their chosen candidate is the one who can save the current health care system. I'm just going to point out two ways in which Sen. Obama's plans agree with our own George C. Halvorson's analysis of the current health care crisis.

First, let's take a glance at one of my favorite topics, Electronic Medical Records. Via the Forbes article:

One element of reform is information: Doctors, patients and administrators simply do not know enough about which treatments work and which are ineffective or harmful. An estimated one-third of medical costs go toward care with no value. Obama proposes to jump-start the long-overdue information revolution in health care with $50 billion to computerize the medical system and spread the word about best practice.

If you have any questions on why this is important, I suggest using this blog's internal search function and looking for "electronic medical records." I have written extensively over the past year on the subject from a variety of angles. Let it suffice to say that administrative costs -- the dreaded paperwork that elicits groans from almost everyone -- is one of the areas where spending can most easily be curtailed. To make it a true win-win scenario, doing so will increase efficiency of treatment across the board.

A second element is to fix perverse incentives in medical care. Doctors and hospitals today are paid for performing procedures, not for helping patients. Insurers make money by dumping sick patients, not by keeping people healthy. Obama proposes to base Medicare and Medicaid reimbursements on patient outcomes in a coordinated effort to drive the entire payment system toward paying for improved health rather than just more care.

Perverse incentives is exactly the way Mr. Halvorson puts in in his book, Health Care Reform Now!. There is a vital need to switch from the pay by treatment attitude to results-oriented incentives. With over 9,000 billing codes, there is not one for a cure. That speaks volumes.

The article goes on to cover other health care issues that we return to consistently here: the massive importance of prevention, accessibility of care, affordability of coverage, and more. A very nicely presented piece, and since it is penned by economists, it is of additional interest as we watch the DOW bounce up and down like a rubber ball.

Good reading!

SOURCE: "Obama Can Cure Health Care's Ills" 10/28/08
photo courtesy of bobster1985, used under its Creative Commons license

Oval Office: One Week Away

It is one week until Americans everywhere cast their vote for the future of our nation and the future of its health care system. This is an historic year and one in which the choices we make are of incredible importance.

With that in mind, I'd like to point you towards a piece from USA Today that is great for an overview of the candidates' plans. Composed by the publication's editors, it endorses a strongly bipartisan approach similar to the one that Sen. Ron Wyden has proposed.

Nonetheless, it does help dispel some of the fog of rhetoric that has surrounded the claims on both sides since the election cycle began. Citing highly pertinent, impartial sources like The Annenberg FactCheck and the Kaiser Family Foundation, and deconstructing the media/advertising spin, it does a pretty concise job of laying everything out for the thoughtful voter.

Ultimately, the best health care plan might combine elements of both McCain's market-based reforms with mandates to make sure that everyone has access to coverage. Given how contentious the campaign has been, that might seem far-fetched. But Sen. Ron Wyden, D-Ore., has a plan to do just that.

Even if Democrats pad their congressional majorities on Nov. 4, many of the tough issues that this nation faces won't be solved without bipartisanship. Health care reform is no exception.

Certainly well worth examining. Follow the Fact Check link when you read it.

SOURCE: "Health care Rx: Mix up McCain's and Obama's plans" 10/27/08
photo courtesy of Jeff Milner, used under its Creative Commons license

Reaching Across The Aisle on Health Care

There has been a stealth campaign running in the background during the sturm und drang of the U.S. presidential race. It has been a campaign for health care orchestrated by the terminally ill Sen. Edward M. Kennedy involving a tremendous bipartisan effort to craft a universal health care bill for presentation to the new President in the beginning of 2009.

Jeffrey H. Birnbaum of The Washington Times reports of the stupendous selection of people involved in what Kennedy is calling the "cause of his life":

The discussions, which started in June, included 14 roundtable meetings in the Dirksen Senate Office Building. These were attended not only by Kennedy aides but also by staffers, both Republicans and Democrats, from the Senate committees with jurisdiction over health care. Those include the Budget Committee, the Finance Committee and the committee that Mr. Kennedy leads, the Committee on Health, Education, Labor and Pensions.

Also attending was the entire panoply of interest groups with stakes in the cost and availability of health coverage. These included the AFL-CIO, the Business Roundtable, the U.S. Chamber of Commerce, the National Federation of Independent Business, the National Retail Federation, the Federation of American Hospitals, the American Medical Association, America's Health Insurance Plans, Families USA, AARP and the Consumers Union.

Mr. Kennedy's staff has started to meet regularly with a small group of people representing each facet of industry as well as consumers. Kennedy aides said they have not drafted legislation but probably will do so soon.

Kennedy has remained in touch with the closed door proceedings via regular telephone updates from his staff. In addition, he is spending several hours a day on the phone with other Senators as he pushes to bring this bipartisan effort to fruition. Much like the efforts of Sen. Max Baucus which I have written about in earlier postings, this is an effort to bring all sides together. It would seem from the reports that I am starting to get that Sen. Kennedy's efforts are involving a much broader group of participants than any thus far.

Sidelined for weeks due the diagnosis of brain cancer and the subsequent treatment, Kennedy is nowhere near out of the running. As best as can be determined by the Washington Times article above, his audacity in having universal health care as a goal has drawn together lobbyists and consumers, providers and insurance companies, conservatives and liberals. I have a feeling that the next president will be presented with something truly unique and American when this bill is finalized and hits his desk.

SOURCE: "Kennedy secretly crafts health care plan- Turns 'cause of his life' into '09 bipartisan bill" 10/24/08
photo courtesy of diggersf, used under its Creative Commons license

Report: Community Based Prevention = Health Cost Savings

Prevention is generally acknowledged as a key factor in fighting chronic health issues. I don't think there is anyone who would dispute the fact that quitting smoking, while incredibly hard to do, vastly reduces your chances of lung cancer among other nasty illnesses. (I pick smoking as my example here because I am on day 22 without nicotine right now.)

Since these chronic issues consume so much of the expenditures made on health care, it is only natural that prevention should come to the fore as we attempt to craft a new system. As obesity and diabetes statistics skyrocket this becomes more and more obvious. What is interesting is a new report that has just been released which addresses a species of prevention not often spoken of in debates: Community-Based Disease Prevention.

Via MarketWatch:

In its report - commissioned by The California Endowment -- entitled Prevention for a Healthier California: Investments in Disease Prevention Yield Significant Savings, Stronger Communities, the Trust for America's Health (TFAH) and Prevention Institute and the Urban Institute find that an investment of just $10 per person per year in proven community-based disease prevention programs to increase physical activity, improve nutrition, and prevent smoking and other tobacco use could save California's health care system more than $1.7 billion within five years. This represents a return of $4.80 for every dollar spent.

Furthermore, in 10-20 years the savings could grow to more than $1.9 billion annually, which would be a return of $5.40 for every $1 invested.

Wow. Encouraging numbers. Granted, like most things, implementation is a whole different ball game, but it still provides a goal to shoot for. One thing is confusing though. What exactly is "Community-Based" disease prevention?

Community-based disease prevention programs are things that impact health outside of the doctor's office, such as planning communities to have sidewalks to encourage walking; keeping school athletic facilities open after normal school hours so that youth have a safe haven to engage in physical activity; making fresh fruits and vegetables easily available in communities where there are few or no supermarkets; and implementing local ordinances that prohibit smokers from lighting up in public areas, among many others.

I have no trouble seeing the positive effect such measures could have on both individual health care and on the collective financial bottom line. Of course, much like herding cats, it will be an adventure getting the majority of people to actually utilize or participate in these programs, options and efforts once they are in place.

As always the variable is human behavior, although with so much to gain if may well be possible. I guess we will have to wait and see.

SOURCE: "Report Finds Community-Based Disease Prevention Saves California Money and Improves Californians' Health" 10/23/08
photo courtesy of kcjc009, used under its Creative Commons license

An Injection of Interaction

Health 2.0 is not just a concept, it is also an LLC. A quick glance at the links I've just provided should illustrate the difference handily.

The LLC is currently hosting their Second Annual Health 2.0 Conference , examining the plans offered by our candidates as well as the effects of the chaotic economy on health care and how social technology fits into the overall picture. Evidently, there is quite a bit of interest since as of last Friday night they have had to add another room to the conference where the proceedings may be watched on a large screen due to attendee demand. It is a sign of how vital this conversation is when we see people shelling out money to sit in an adjoining room watching a video feed.

One of the biggest themes at the event is the way in which the methodology is shifting. Social media-driven approaches need to engage with the patient base in ways entirely unprecedented within the medical industry.

Lidija Davis of The New York Times reports:

The rules of engagement however, as Clay Shirky pointed out in his keynote on Wednesday, are changing.

According to a study released today by Edelman [PDF], trust and confidence are inversely proportionate to demand for health care. With an aging population, behavior-related chronic conditions, and expensive innovations, companies must help people address their specific personal health concerns with thorough, transparent and specific information.

Additionally, the financial meltdown is aggravating an already weak health system as people forgo or postpone essential health care due to loss of insurance or inability to pay.

The answer, according to the survey, is engagement: "Effective health engagement can build trust, and conversely, trust is the key to deeper engagement," said Nancy Turett (Edelman).

Interactivity in the name of the game is the modern day. Online access is becoming less and less optional as time goes by, and companies are starting to realize this. The consumer of 2008 has high expectations learned from their use of services like online banking and websites such as eBay and Amazon. As belts tighten during the economic downturn, more and more people will be taking a closer look at their health expenditures trying to find ways to reduce their capital outlay.

A good example on the corporate end is Aetna. The company is working on a system to allow their customers to transfer their existing health records to Microsoft's Health Vault, an online EMR option. Other big players in this aspect of the industry are WebMD, Google, Yahoo and Microsoft all of whom have programs worth watching. (Ms. Davis' article linked below has more detail and quotes from each them.)

Transparency note: The Health 2.0 Conference has Kaiser Permanente as its Flagship Sponsor. This blog's affiliation with Kaiser Permanente can be viewed on our About page.

SOURCE: "Health 2.0: Rules of Engagement " 10/23/08
photo courtesy of zaldylmg, used under its Creative Commons license

Is More Comprehensive Health Care Reform Actually Cheaper?

Ezekiel Emanuel thinks it is, and he says he has got a plan. Starting from the premise that incremental changes involve more fees which mount up to an overall higher cost, sweeping changes and fundamental reforms can be made for substantially less.

In his piece on The Huffington Post last Tuesday, Emanuel goes into detail, reviewing the proposals and expected costs of each presidential candidate's health care platform in detail. That alone makes it a good read; however, that is not where it ends. He then goes on to make the case for the affordability of universal coverage.

The biggest surprise is that even more comprehensive reform, not only achieves universal -- true 100% -- coverage of all Americans but does so while controlling costs. Prof. Victor R. Fuchs and I have proposed Guaranteed Healthcare Access Plan. It phases out employer-based insurance, Medicaid, and Medicare. Instead each American would receive a voucher to buy a standard benefits package modeled on the federal employee health benefits plan through regional insurance exchanges in which private health plans would compete. Workers would receive a pay increase from their employers who no longer pay for health care; state taxes decline because states no longer have to devote 32% of their budgets to health care. The plan is financed by a value-assed tax.

Emanuel continues in this vein for quite some time, elaborating on their approach and reasoning. All-in-all, a fascinating perspective and one that is well worth looking at as we enter the last two weeks of the election. It bears many similarities to the Wyden-Bennett plan I have written about in earlier posts in that it assures Americans portability, guaranteed enrollment, and precludes exclusions for any pre-existing conditions. Follow the source link below to read his entire article.

SOURCE: "More Reform is Cheaper: The Paradox of Health Care Reform" 10/21/08
photo courtesy of a.drien, used under its Creative Commons license

Max Baucus Steps Up for Health Care Reform

Max Baucus, the Democrat who chairs the U.S. Senate Finance Committee, is coming out in a big way for health care reform. He has assembled a council of over 30 medical professionals with the intent of developing five ways in which to improve the health care system, not just in his home state of Montana but across the nation as a whole.

Via Diane Cochran at The Billings Gazette:

"I think in life we only have two choices on most things - try, or do nothing, and clearly we've got to try to crack this nut," Baucus said at St. Vincent Healthcare during one of 10 health care listening sessions across the state. "Doing nothing is not an option."

Reforming the country's health care "hodge-podge" - it's too fragmented to be called a system, Baucus said - will probably be the biggest problem he tackles in his congressional career, the senator said.

One aspect of the problems faced by Americans is especially prevalent in Montana. That would be the plight of small businesses and those employed by them. According to an interview with St. Vincent Health Care CEO Jim Paquette on Montana'sNewStation.com, out of 160,000 uninsured Montanans, roughly 53% of them work for small businesses that do not employ enough people to to create the large pool needed to drive employer provided health care costs down. This among other factors is giving Baucus' efforts a high profile.

SOURCE: "Baucus hears concerns over health care system" 10/21/08
photo courtesy of KimberlyFaye, used under its Creative Commons license

Economics and Health Care in Utah

In the first of what I feel sure will be many articles examining this topic, The Salt Lake Tribune looks at some of the ramifications the current economic crisis is already having on American health care. This particular piece looks at the increasingly dire situations faced by the residents of Utah.

From the obvious implications such as people skipping routine care to conserve finances to the not so blatant ones like the fact that low income residents who rely on Medicare or Medicaid are also skipping these procedures because they are unable to afford the costs of transportation. If you add in the increase in health problems caused by stress and bouts of economy-induced depression amongst the populace, the picture gets more and more grim.

Heather May and Lisa Rosetta report:

Scrimping Utahns are skipping preventive checkups and forgoing needed dentures and crowns. More are seeking treatment for depression and anxiety. They're lining up for nearly free health care or heading to emergency rooms.

Or they simply suffer until they can afford to care for their out-of-control diabetes or festering wounds.

"It takes a lot on one's body and soul even," said Shawna Zink, of Magna. "I'll be 45 this month and I feel like sometimes I'm 60."

The article in question provides a disturbing view of the trends that seem to be beginning to take hold, showing why the need for immediate reform of American health care is essential. It is an unsettling read, but one that I advise. Let us hope that the incoming administration is able to implement substantive reform in time to avert more stories like this one.

SOURCE: "Cash woes bruise health" 10/13/08
photo courtesy of Kugelfish, used under its Creative Commons license

Candidates Claims Under The Magnifying Glass

Yesterday, we looked at what the American people seem to think of the candidates and their approaches to health care reform. Today, we will be looking at both the things that have been distorted by each side and what the experts have to say about the effectiveness of both proposals.

Unlike prior generations, we are inundated with media at every turn: radio, TV, Internet and, with increasing frequency, mobile devices. This not only allows extensive opportunity to be exposed to each side's position but also allows access to numerous non-partisan groups that exist solely in order to get to the substance beneath the glitz. One of my own personal favorites is the Annenberg Political Fact Check.

On the October 14, the Anenberg crew produced their own analysis of the candidates' plans, the mis-statements used to sell them, and the input of a variety of health care experts concerning the contents of said plans. I highly advise checking out the detailed analysis, but for the general edification I will include their summary statement here:

McCain and Obama have sharply different health care plans, and each has made sharply worded attacks that are either false or misleading. McCain proposes a market-based system that relies on tax incentives, which one Obama ad falsely characterizes as the "largest middle-class tax increase in history." Obama proposes new subsidies to expand private insurance coverage and some expansion of government insurance, which McCain falsely claims "will rob 50 million employees of their health coverage."

Neither candidate has offered enough specifics about his plan to allow experts to assess the cost or impact without making various assumptions. Studies agree generally, however, that Obama’s plan would cover more of the uninsured than McCain’s would.

The original piece includes archives of pertinent campaign advertisements, point by point breakdowns of what the candidates have said on the subject, and the results of numerous fact finding polls and studies. As always there is a full bibliography of sources and all claims are hyper-linked to the supporting documentation.

Happy Reading!

SOURCE: "Health Care Spin - McCain and Obama each make false claims about the other's health care plan. We sort through the misinformation." 10/14/08
photo courtesy of Okko Pyykko, used under its Creative Commons license

Who Do the Voters Prefer on Health Care Reform?

The big question -- when not discussing the economy -- is who will win the U.S. presidential race this year. It is an historic ticket of each side of the aisle combined with a colorful, and at times shocking, stage show before the media. Discussion of which way things will go is far beyond propriety for this blog to address.

What we can address and investigate is the positions of these two fine men on health care's future course. Today, thanks to a poll recently released, we can take a quick pulse on the American public and see how they feel about the proposals put forth by the White House hopefuls via News-Medical.net:

According to a report released today by the University of Michigan C.S. Mott Children's Hospital National Poll on Children's Health, the majority of likely voters polled selected Obama as their top presidential pick to handle the country's biggest health care issues, including the high cost of health insurance, and the millions of U.S. adults and children without insurance.

One deviation from that was found amongst voters over the age of 65 who felt McCain has a better grasp of the prescription drug cost issue. Other than that, those polled generally show a marked leaning towards Obama's proposed handling of the health care crisis. Here are some of the numbers from the report broken out by health care issue:

• Health insurance is too expensive for families. The vote: McCain (38 percent) / Obama (62 percent)
• Many people can't afford prescription drugs. The vote: McCain (43 percent) / Obama (57 percent)
• Millions of children are uninsured. The vote: McCain (35 percent) / Obama (65 percent)
• Millions of adults are uninsured. The vote: McCain (35 percent) / Obama (65 percent)
• Some people get lower quality of health care than others. The vote: McCain (38 percent) / Obama (62 percent)

On this subject, it would seem that the Democratic Party is much more in line with the will of the (polled) people. Only time will tell how much influence that will have on the final election outcome. I would suspect that a lot of it will ride on the news about the economy. After all, it was the meltdown on Wall Street that bumped health care down the priority list of the American public. Extreme good or bad news on the economy will profoundly affect how much impact this data ends up having.

For the complete report and a podcast about its results, go visit C.S. Mott Children's Hospital National Poll on Children's Health.

SOURCE: "Voters pick Obama to tackle nation's health care problems" 10/13/08
photo courtesy of Torley, used under its Creative Commons license

Equal Treatment? Not Always For the Uninsured

While many would like to pretend that this is not the case, I think we are all aware of the fact that many times work done for free tends to be of lower quality than work that one pays for. It's hardly a shocking revelation. Incentive counts for a lot, and being paid is the incentive on most American's minds when considering the work they have made their career.

This makes for disturbing contemplation when you apply that little truism to the medical field. Manoj Jain at The Washington Post takes a look at the disturbing differences in care received by uninsured patients as opposed to those with coverage:

It's not uncommon for patients with no insurance or poor insurance to receive different treatment. A 2006 study of 25 primary care private practices in the Washington area showed that in nearly one in four encounters, physicians reported adjusting their clinical management based on a patient's insurance status; nearly 90 percent of physicians admitted to making such adjustments. For patients with no insurance, alterations occurred 43 percent of the time; and for the privately insured, just 19 percent.

This brings to light an aspect of the health care equation that is oft overlooked. It is especially troubling when you consider that one out of every five patients seen by primary care physicians in a hospital setting are uninsured. From a physician's perspective, that is one fifth of their workload that goes completely uncompensated.

As physicians sometimes say, "No other professionals -- lawyers, plumbers, accountants -- provide uncompensated service to one-fifth of their clients."

There are many reasons possible for a lack of coverage, especially in times as tumultuous as these have been recently. From the workplace that does not offer insurance to sudden job loss or complications arising from pre-existing conditions the possible reasons run the gamut. It is not always a matter of husbanding one's resources or living within one's means:

My primary care friend told me about a patient who had left a boil untreated until it needed surgical drainage and intravenous antibiotics. When asked why didn't have insurance, the man said he had lost his job and was recently divorced. Stories like that helped my friend realize what injustices the uninsured face.

SOURCE: "Equal Treatment for the Uninsured? Don't Count on It. Lack of Compensation Can Tempt Doctors to Tailor Their Care to a Patient's Coverage" 10/14/08
photo courtesy of tacomabibelot, used under its Creative Commons license

Open Standards in Health Care Computing

There is a pronounced movement in certain strata of the health care computing field towards open standards. Combine that with the billions of dollars thrown into the mix due to the fact that both Presidential candidates are banking heavily on automated and computerized systems for their respective reform efforts and you have a rich medium for collaborative growth.

Via Dana Blankenhorn at the ZDNet Healthcare Blog:

The latest move is that of Dossia, an alliance of health care technologists mainly on the consumer or medical office side of things, to join Continua, a separate consortium which includes many hospital computing vendors.

As IBM noted recently, such moves can be excuses for inaction. There is, potentially, an enormous amount of value destruction involved in a move to open standards. Proprietary systems can demand top dollar.

But customers of all sorts — from hospitals to consumers to government — are now demanding substantive, real change.

It would seem that more and more evidence is mounting to support George C. Halvorson's theory that we are at the point of a "Perfect Storm" as far as health care reform goes. I would say that a trend of this nature is a very pointed piece of support for that position. Is it just me or does this indicate a realization that the need for our system to work supersedes the need to maintain a short term profit? Besides, once standards are set, competition can help the continuing evolution of the system built upon them.

We do, after all, already have the baseline tools for this sort of development already in use.

The devil here is in the details, but we do have the ingredients of an agreement, in the form of Internet standards, XML technologies, and such industry-specific things as HL7.

Publication of and adherence to those standards would naturally encourage more open source projects and consortia. Having a firm standard to write to means such groups need not hit a moving target.

And that really is one of the best aspects of this approach. The need for standards -- objectives that can actually be met -- will do an amazing amount for the speed of development.

SOURCE: "Growing open standards pressure on healthcare" 10/13/08
photo courtesy of cmdrfletcher, used under its Creative Commons license

EMRs on the iPhone: The Canadian Lesson

Let's take a good look at what can be achieved when a practical approach to technology is applied. I keep hammering on the subject of Electronic Medical Records (EMR) because it is an aspect of George C. Halvorson's strategy that really resonates with me on a personal level.

In the wake of Hurricane Gustav, we saw one major advantage that the ongoing discussion rarely touched on: having backups of paper records destroyed in a natural disaster. Now it is time to take a look at portability and accessibility in the age of the iPod and iPhone.

Via Briony Smith at ITWorld Canada:

The paramedics can now use an iPhone to access the patient’s history, courtesy of Raven, a program from Calgary health-care integration and collaboration software vendor Coalese that was rolled out earlier this year. Next January will see the region’s health-care providers take the application bi-directional, and update information in the patient’s file that could benefit the person’s primary care. “That way, if the paramedic sees that Granny hasn’t been taking her meds or needs to note procedures done in the ambulance, the primary care physician can see that in their record right away,” said Coalese president Andrzej Taramina.

To get everyone on the right footing, paramedics and doctors from local clinics and hospitals gathered together to determine what information they needed to access on the go. “Confidentiality was one issue, but, with the iPhone, nothing is stored there. It’s the (Web-based) program that accesses the records,” she said.

The iPhone is ubiquitous; every day you see more and more people carry them or their near cousin the iPod Touch. Both devices have been gaining ground along with a whole new generation of wireless devices. Using these portable devices to access medical records "on the fly" is a logical extension of EMRs that is not often discussed.

In an increasingly mobile and digitally connected society, this makes perfect sense. Health care pros could access full patient records almost instantly from the scene of an accident. Allergies could be determined before administration of medication. Current treatments added to the record while en route to hospital treatment could allow a doctor to be up to the minute on what has been done to the patient on the way.

As we get more and more people on board for EMRs, we really need to look at the potential for wireless devices. I think the Canadians are dead on the money with this one!

SOURCE: "The iPhones Could Save Your Life" 10/10/08
photo courtesy of William Hook, used under its Creative Commons license

Dateline Nashville: Frist Moderates Panel on Health Care Reform

Nashville has been hopping lately -- as far as health care goes, that is. The Nashville Health Care Council hosted a high powered panel discussion about the state of American health care and the potential reform platforms of the Presidential candidates. Bill Frist, former U.S. Senator and Cressey Co. partner, acted as the moderator for the four-person panel which included the following luminaries:

• Chris Jennings, former senior health care adviser to then President Bill Clinton
• Chip Kahn, President of the Federation of American Hospitals
• Dick Morris, former Clinton adviser and current Fox News contributor
• John Podesta, Chief of Staff for Bill Clinton from 1998 to 2001

Walker Duncan of The Nashville City Paper reports on the proceedings:

Dick Morris got the discussion underway with a particularly sunny outlook, opining that the next president will “have a job much like a trustee in a bankruptcy.” He continued saying that while the political will may be there, that the “money for health care reform went out the door last week,” referring to the recently passed bailout solution.

Others disagreed with that take, saying some change could be effected even in light of the current financial crisis. Jennings made a handful of points addressing the issue, pointing to the strong demand from the business community, to the awareness that despite our huge health care spending we’re not getting an equal amount of value, and to the fact that any sort of economic reform is going to have to include health care as a factor.

Essentially, according to his argument, the need for change is both too great and too apparent for no progress to be made.

Duncan does a great job of providing a synopsis of the entire panel, covering issues such as time frame to reform in the face of the economic crisis, current and revised potential for universal coverage, and predictions for the next two years facing us.

All in all, it is a very interesting insight into the situation from a new group of voices. Experts abound, and I am sure we will be hearing from all of them over the next few short weeks before election day.

SOURCE: " Panelists, Frist attempt to tackle health care reform" 10/08/08
photo courtesy of Exothermic Photography, used under its Creative Commons license

Economy vs. Health Care

Everything that happens lately does so to a back beat of economic fear. As the DOW plummets and venerable banking institutions fall to pieces, there is little that is not infected in some way or other by the watchful unease (and yes, outright fear) of American eyes watching the economy as it seems to spiral down the drain.

The question before us in this blog is how does this fear of coming recession -- or if some are correct depression -- affect health care spending by the citizens of America? Simple application of logic dictates that as belts get tightened, essential routine health care expenditures would fall by the wayside. How closely does this train of logic resemble fact?

Via CIGNA press release on MarketWatch:

According to recent CIGNA surveys, about one-third of Americans say yes, the economy has changed the way they take care of themselves. Of those, 55 percent report taking better care of their health by exercising, eating healthier or getting regular check-ups and screenings, while 41 percent say they are taking worse care.

Among those who are taking worse care of themselves, more than one-third (35 percent) say they're not going to the doctor regularly or at all, while 17 percent say they're taking their medications less often or not at all. Ten percent say they can't afford to eat properly or are eating less healthy foods.

The survey goes on to point out long term cost savers built into many policies, things like regular checkups and preventative screenings. I would consider it advised reading, especially if the new austerity ends up lasting awhile.

SOURCE: "The Shaky Economy: Is it Changing the Way People Take Care of Their Health?" 10/08/08
photo courtesy of Epicharmus, used under its Creative Commons license

The Doctor Shortage in Massachusetts

We keep checking back on Massachusetts to see how their experiment in expanding health care is going. Since the state's Health-Care Reform Act, an additional 440,000 people have become insured. The path being tread has been a balancing act from the start. A myriad of factors assert their influences upon the day-to-day mechanics of trying to bring health care to the state's entire population.

Each time we bring our gaze back to Massachusetts, we find more practical lessons to learn from their path-finding exploration in the realm of health care and coverage. This time, we discover a growing shortage of doctors to provide for the health care needs of the thousands of newly insured.

Via Christine McConville at The Boston Herald:

The data comes from the medical society’s annual work-force survey.

For starters, it shows a shortage of physicians who practice internal medicine, family medicine, oncology, neurology, dermatology, emergency medicine, general surgery, neurosurgery, orthopedics, psychiatry, urology and vascular surgery.

[Medical Society President Bruce] Auerbach said some of the shortages are due to the gap between the cost of living in Massachusetts, and what insurance companies and the government will pay for certain medical procedures.

There are also widespread fears of being sued.

As we explore the web of factors that influence the path to universal health care, it seems we shall need to keep in mind that providers are an important piece of the puzzle. Access is essential if coverage is to mean anything substantive.

SOURCE: "Study Sees Doctor Shortage" 10/06/08
photo courtesy of Subconsci Productions used under its Creative Commons license