Native American Health Bill Passes Senate

Improved access to health care. Preventative screening. Mental health services. Thanks to legislation passed in the U.S. Senate last Tuesday, these things may be more accessible to the Native American Community soon.

Mary Clare Jalonick of the Associated Press tells us that the bill, approved 83-10, would have several effects. In addition to funding existing programs at the Indian Health Service, it would also fuel new construction and modernizing of health care facilities located on reservations, increase tribal access to Medicare and Medicaid, and attempt to recruit more native Americans into health care oriented professions. About $35 billion would be spent on these things over the coming decade.

There is no shortage of commentary on the Senate floor (Via a variety of sources listed at the bottom of this post):

• Senate Indian Affairs Committee Chairman Byron Dorgan, D-N.D., termed this legislation a first step in addressing a crisis in American Indian health care. He is reported as saying that the current system is underfunded and inefficient.


• Senate Majority Leader Harry Reid, D-Nev., said American Indians have access "to some of the least adequate health care in America. [...] Far too many native children are diagnosed with diabetes, suffer from abuse and neglect, or die prematurely because of accidents or illness that could be prevented or cured," Reid said.


• Sen. Tom Coburn, R-OK who is also a doctor, called for a much more comprehensive overhaul of the system and called the legislation "morally bankrupt." "Why are we putting off fixing the system?" he asked. "So we could tell everyone that we did something when in fact we did nothing."


• "Improving the delivery of health care services for American Indians is long overdue," said U.S. Senator Maria Cantwell, D-WA said. "Overall trends in the health of this population are simply unacceptable. American Indians and Alaskan Natives across the country are 400 percent more likely to die from tuberculosis, 291 percent more likely to die from diabetes complications, and 67 percent more likely to die from influenza and pneumonia than other groups. Passage of this bill in the Senate is a critical first step to strengthening health care services for American Indians, and living up to our long-standing trust responsibility to provide for their well-being."


• U.S. Sen Amy Klobuchar [D-MN] stated that this is the first time in 17 years they have been able to pass the Indian Health Care Bill.
  

One of the amendments included in the final version of the bill is an official resolution of apology for the federal governments long history of poor and negative policies regarding native American tribes. Other amendments include the exclusion of abortions at Indian health clinics and a prohibition against spending on programs that discourage gun ownership.

I am sure that there will be a similar variety of available quotes once this hits the U.S. House of Representatives.

SOURCE: "Senate Passes Bill on Indian Health Care " 02/27/08
SOURCE: "Senate approves landmark Indian Health Care legislation " 02/27/08
SOURCE: "Senate Passes Indian Health Care Bill " 02/28/08
photo courtesy of thivierr, used under this Creative Commons license

The Nation's First Statewide eHealth Network

The state of Tennessee has picked AT&T for a major initiative -- the creation of the United States' first statewide health information exchange. The project is called The Tennessee Information Infrastructure eHealth Exchange Zone and will integrate the HIPAA compliant OnDemand Platform developed by Covisint, a company who bills themselves as "the world's largest and most secure on-demand collaboration platform."

The Dallas Business Journal brings us this statement from the Governor of Tennessee:

"Tennessee is proud to be the first to expand its current state network and offer a private, affordable, statewide secure network for exchanging critical health care information among providers," Tennessee Gov. Phil Bredesen says. "Our goal is to accurately and effectively deliver information to health care providers at the point of care, which will improve the quality of health care provided to the citizens of Tennessee. If a patient's medical history and record of care are available to the hospital, laboratory, pharmacy or physician, then they will ultimately receive better and more cost-effective medical care."

AT&T will construct a Virtual Private Network (VPN) that can support a wide variety of online health oriented tasks including sharing images (X-rays, MRIs, etc), telemedicine, remote diagnostics, e-prescriptions, and broad based access to electronic medical records. The combination of AT&T's VPN and Covisint's OnDemand Platform will allow the state's six regional health data organizations, as well as medical providers who are not part of those organizations, to access electronic medical data rapidly and securely.

According to the press release, as found on Fox Business, the secure broadband infrastructure provided by AT&T's VPN is available in all 95 counties of the state. It is the latest investment by the telco, which has put more than $3 billion into wireless and wired networks throughout Tennessee over the past decade.

Covisint's platform is used by more than 30,000 companies in the auto industry for secure data sharing. While the company's roots are in the car business, they are no strangers to health care. According to Information Week health care contributed 30% of the Covisint's $40 million of annual revenue and projections point to an increase to 50% over this year.

Are there any readers in Tennessee who would like to share their thoughts and opinions on this subject? We would love to hear from you!

SOURCE: "Covisint And AT&T Enter Health Care Exchange Market " 02/25/08
SOURCE: "AT&T to Deliver Country's First Statewide eHealth Exchange Zone" 02/25/08
SOURCE: "Tennessee, AT&T team up on development of statewide health-record network" 02/26/08
photo courtesy of euthman, used under this Creative Commons license

Health Care 2017: One Dollar Out of Every Five

Twenty cents out of every dollar. One dollar out of every five. Twenty dollars out of every hundred. No matter which way you view it, health costs will almost double by the year 2017. (See the Health Affairs Report.) While impressively large, those figures assume even more magnitude when you realize that they represent a rise to 20% of our nation's gross domestic product.

Aliza Marcus at Bloomberg reports that the increase in spending on health care will be primarily fueled by an aging population -- primarily Baby Boomers -- as they seek treatment and care for chronic ailments such as diabetes and high blood pressure. When you combine this with the projected increases in pharmaceuticals and medical technology it paints a fairly grim financial portrait.

As the baby boomers, born between 1946 and 1964, begin turning 65 and qualify for Medicare coverage, the program's share of the national health bill will rise to 21 percent in 2017, or $884 billion, from 19 percent in 2006, according to the study.

The Washington Post reports the forecast of total health care spending to be $4.3 trillion by 2017, almost double the amount spent in 2007. They also note that while overall spending will increase, the amount spent on private health care will actually shrink while public spending accelerates.

The Wall Street Journal's Health Blog points out some of the efforts being made to slow Medicare spending on Capitol Hill. According to their health care blogger, Jacob Goldstein, the Democrats have tabled the idea of reducing payments made to privately operated Medicare plans, which have a higher out of pocket cost for the federal government than traditional ones.

Kevin Freking of the Associated Press takes a look on the other side of the aisle where President Bush proposes slowing the cost of Medicare by freezing reimbursement rates for the next three years to health care providers such as hospitals, home health centers, and nursing homes. In addition, Bush proposes requiring wealthier Medicare beneficiaries to pay higher premiums on prescription medications.

All in all, it looks like the rate of health care spending will continue to outstrip growth in the gross domestic product. It is hardly surprising that this is recognized as a crisis by most experts and, increasingly, by the public at large.

SOURCE: "Health Spending Projections Through 2017: The Baby-Boom Generation Is Coming To Medicare" 02/26/08
SOURCE: "Health Costs Will Rise to 20% of Economy by 2017, U.S. Says " 02/26/08
SOURCE: "WASHINGTON IN BRIEF: Big Jump Forecast In Health Spending" 02/26/08
SOURCE: "Feds’ Health Spending to Double in a Decade" 02/26/08
SOURCE: "Spending on Health to Rise Dramatically" 02/26/08
photo courtesy of tracy_olson, used under this Creative Commons license

Coverage and Care: Two Very Different Things

Monday provided us with a wonderful opinion piece in The Philadelphia Enquirer. It was written by a physician and lawyer who is also a visiting scholar at the Georgetown University Law Center named Caroline Poplin.

Have you noticed that presidential candidates assume that universal health insurance means universal health care? They use the terms interchangeably. They assume that once the law enables or requires everyone to buy health insurance, everyone will have adequate health care.

But anyone who has been seriously ill or cared for a sick relative knows that while health insurance may be the solution, too often it is part of the problem.

In fact, health insurance and health care are two different products for two different markets. Health insurance is for healthy people. Health care is for the sick. What we need to lead full, productive lives is good health care.

Dr. Poplin goes on to address the oft invoked example of auto insurance. While it has come up repeatedly in debate, I am not aware of a more concise comparison than the one presented here.

There was a time when health was like driving. Illness or injury was sudden, unpredictable and brief. You either recovered, or you died. Medical care was not expensive, and (surgery apart) not terribly effective. Insurance did not cover doctor visits for minor problems or for physicals, any more than car insurance covered routine repairs.

Since then, medicine has been transformed. Many people no longer die from heart attacks, pneumonia, cancer, even HIV/AIDS; they may live many years if they are treated promptly, aggressively and often long-term.

These patients are no longer average drivers. They have "pre-existing conditions" and are thus at high risk for predictable, serious, expensive, often chronic complications. A diabetic patient is at high risk for heart attacks and kidney failure. Many cancer patients are at high risk for pneumonia. Even someone with uncomplicated high blood pressure is at increased risk for heart attack and stroke.

Commercial insurance was never designed for situations like this. No one sells flood insurance for a house that regularly floods.

So insurers routinely exclude pre-existing conditions from coverage. Most commercial health insurance, like car insurance, is intended for one-time, unpredictable expenses.

But people with pre-existing conditions, the chronically ill, are exactly the people who need health care the most. They can get it now only if they qualify for public programs like Medicare, or they work for large employers who can spread their expenses over a large, mostly healthy, workforce. The chronically ill are disproportionately uninsured.

Since five chronic diseases account for 75% of all health care expenditures, this should be cause for alarm. As noted in Health Care Reform Now!, management of chronic conditions is cheaper by several orders of magnitude than emergency room visits. Asthma, for instance, requires only a few hundred dollars per year to manage, but one ER visit caused by an asthma attack can skyrocket past the $20,000 mark.

SOURCE: "Health insurance and health care are not the same" 02/25/08
photo courtesy of takomabibelot, used under this Creative Commons license

Google Your Health Records!

Looks like Google is moving forward on its health records project. Thomas Claburn and Marianne Kolbasuk McGee of Information Week take a look at their new pilot program and some of the privacy concerns being voiced about it:

"We believe patients should be able to easily access and manage their own health information," said Marissa Mayer, VP of search products and user experience at Google, in a statement. "We chose Cleveland Clinic as one of the first partners to pilot our new health offering because as a provider, they already empower their patients by giving them online tools that help them manage their medical records online and coordinate care with their doctors."

The pilot program represents a tentative first step for Google into the thorny area of health care data issues. It also gives Google a greater opportunity to cash in on the lucrative business of health care advertising. The company on Wednesday announced the availability of its Healthcare Industry Knowledge Center to AdWords advertisers offering health care-related products and services.

Google's timing could be better. The World Privacy Forum on Wednesday issued a report warning that personal health records (PHR) are not protected by federal HIPAA privacy and security rules and that entrusting such records to a PHR service -- the very thing Google is offering -- raises a number of possible risks.

The issue with any sort of electronic medical records always boils down to the question of how secure and private are they? The article cites the recent controversy surrounding Blue Cross of California's letter to doctors asking them to identify patients with pre-existing health issues. Critics speculate that Blue Cross was collecting this information preparatory to limiting or denying coverage to those people. The fact that Blue Cross Wellpoint was fined $1 million last year for canceling and withdrawing coverage in violation of California state law does not help the company's credibility. Many worry the same could happen if insurance providers got access to Google's records.

Another major sticking point raised is the data harvesting that comes hand in hand with an advertising supported service, which all of Google's applications are:

[...] the World Privacy Forum report is skeptical that any ad-supported PHR [Public Health Records] service will really protect health information. "Advertising-supported PHRs are not necessarily likely to support or allow strict control over consumer information or to fully and readily tell consumers how personal information may be shared," the report states. "Many PHRs will only succeed if they can sell advertising, and advertisers will seek as much detailed information about PHR clients as they can obtain. Wheedling consent from consumers for the profitable sharing of records is something that some PHRs are likely to try."

Todd Chambers, chief marketing officer at Courion, an identity and access management company that works with health care industry clients, believes security and privacy worries are justified. "Obviously, it's concerning, to say the least," he said. "When you look at all the issues that hospitals and health care providers have to deal with to be compliant [with health industry regulations]... to think that there would be a business process put into place that would allow that all to be circumvented, and all that data could be put out there in the public domain, is certainly a huge concern."

Regardless of the risks, Google (NSDQ: GOOG)'s vision, or something like it, may be unavoidable. Over 100,000 of the Cleveland Clinic patients already participate in a PHR system called eCleveland Clinic MyChart. Between 1,500 and 10,000 of these will be invited to enroll in the organization's pilot program with Google, which will last between six and eight weeks. Cleveland Clinic received no funding from Google to participate in this pilot, said Dr. C. Martin Harris, Cleveland Clinic's CIO. "Google was a natural" fit to help Cleveland Clinic in this health data exchange for patients, said Harris.

It is quite probable that this sort of debate will be increasingly frequent more online and application based solutions are brought to the fore and tested. As with all things computer oriented, Google, Microsoft, and possibly Apple should be observed carefully over the next year or so. This pilot program is only the tip of the iceberg.

If you want to get an idea of what the tech community thinks on the subject, check out the short piece about this on Slashdot. The discussion in the comments is quite diverse and contains much food for thought.

SOURCE: "Google, Cleveland Clinic Partner On Personal Health Record Service" 02/21/08
SOURCE: " Google to Begin Storing Patients' Health Records" 02/21/08
photo courtesy of Yodel Anecdotal, used under this Creative Commons license

Putting a Face on Health Care Reform

As the debate about health care reform continues to evolve, we see many facets of the issue examined. Political platforms are dissected, technology based solutions debated, costs analyzed, and statistics quoted in every variety of media the U.S. consumes. Amidst the maelstrom of numbers, it seems to sometimes get lost that the reason we need reform is people. People such as the ones Kristen Gerencher writes about in MarketWatch:

At age 49, small-business owner Jacqueline Church Simonds doesn't want to gamble by going without health insurance but she considers the price she pays for that peace of mind exorbitant.

She transitioned from COBRA seven years ago when her husband left his job and employer-sponsored coverage behind so they could start a business together. They now pay $1,300 a month -- $15,600 a year -- for a small-group PPO policy that covers the two of them, she said. With costs soaring and consumers asked to make more decisions, you need up-to-date health advice.

She looked into health savings accounts but found that having to pay full price for services would leave them with no savings, and the couple hasn't found a more affordable comprehensive option because of their health histories, she said.

"We decided we didn't want to be self-employed and have no insurance," said Simonds, vice president of Beagle Bay Inc., a book publisher and distribution company in Reno, Nev. "Because of that we probably had our nose rubbed in the inequalities and inefficiencies of the system more than most people."

The article gives us a personal view into the lives of three different Americans who have run up against the brick wall of our "non-system" of health care. As awareness of the weaknesses in health care delivery enter the mainstream consciousness, people are getting nervous.

A survey of 1,200 adults in the March issue of Consumer Reports found that six guaranteed principles for health reform garnered more than 80% approval. They were: coverage for all uninsured children; protection against financial ruin due to a major illness or accident; the ability to obtain coverage regardless of a preexisting condition; coverage that continues even when people are laid off, change jobs or start their own business; premiums, deductibles and out-of-pocket expenses that are affordable relative to family income; and the ability to keep current health coverage if desired.

"People are becoming more and more aware of how vulnerable they are to a hugely expensive medical episode," said Nancy Metcalf, senior project editor at Consumer Reports in Yonkers, N.Y. "They're starting to see insurance isn't helping them out as much as they thought it would."

Gerencher helps us to put a face on health care reform. The unfortunate thing is that the face is one creased with worry as it stares at a medical bill.

SOURCE: "Confronting health care's inequities: Three middle-class workers struggle with high costs, limited coverage" 02/20/08
Photo Courtesy of atul666 used under this Creative Commons license

Boozing For Health Care in Colorado

Chris Barge of the Rocky Mountain News shines a spotlight on a member of the Colorado government who has a radical plan for addressing the cost portion of our national health care crisis:

While the governor and lawmakers said what they would and wouldn't do for health care this year, nobody mentioned Rep. Jerry Frangas.

But the Denver Democrat very quietly drafted a bill [HB 1341] introduced this week that would raise alcohol taxes 2 percent to cover all of Colorado's 180,000 uninsured children.

The tax of 11 cents, for example, on a $5.49 six-pack of Budweiser, would raise about $57 million for the state children's health care program.

When paired with federal matching funds, Frangas said it would provide up to $150 million.

According to Barge's article, Colorado Governor Bill Ritter has been engaged in public debate with various lawmakers and special interest groups about the possibility of asking voters to raise taxes. These talks have recently veered away from health care and towards other issues such as education, transportation, and the environment.

Gov. Ritter's spokesperson, Evan Dreyer, said he had not heard about the bill, but did point out the governor's position as being "not inclined to see a health care measure go to the ballot in November." In the meantime, Frangas has spoken with both Colorado Senate President Peter Groff and Colorado House Speaker Andrew Romanoff about his bill, although no public commitment has been made by either at this time.

The real battle, if the bill makes it that far, will occur once the billion dollar liquor industry sees fit to get involved. On one hand, it could well be an instance of using a "luxury tax" to fund health care. On the other hand, it could end up just another case study of government under the influence -- of lobbying groups, that is.

SOURCE: "Booze tax for health care? 2% increase could raise $57 million to cover children " 02/20/08
photo courtesy of yanivba, used under this Creative Commons license

The Medicare K-O: A Cost and Budget One-Two Punch

Eileen Alt Powell of the Associated Press brings us info on the study released Tuesday by the Center for Retirement Research at Boston College. The study that holds ominous news for future retirees as well as others who reply on Medicare:

The government currently estimates an individual's costs for Medicare premiums, co-payments and other cost-sharing at about $3,800 a year for a single person and $7,600 for a couple. Add to that $500 per person for dental care, eye glasses, hearing aids and other items not covered by Medicare.

To cover such costs in the decades most baby boomers and Generation Xers will live after quitting their jobs, an individual needs to go into retirement with some $102,000 earmarked just for health care coverage, the center estimated. A couple needs about $206,000.

Baby boomers come from the generation born between 1946 and 1964; Gen Xers were born between 1965 and 1974.

$102,000 just for health care coverage? For many people, that is a truly daunting number. The study goes on to graph these expenses against the average savings balance of approximately $60,000 in most households approaching retirement. That is the first punch to the gut.

To complicate matters even more, let us turn our eyes towards Medical News Today, where Robert M. Hayes, President of the Medicare Rights Center, issues a warning about the effect of President Bush's budget cuts on Medicare. Those budget cuts deliver the second part of "the old one-two:"

The proposals to tie Medicare payments to hospitals, doctors and other health care providers to measures of quality and efficiency are worthy of consideration but are completely unworkable in the context of the drastic, across-the-board payment cuts included in the President's budget. Paradoxically, the President's budget allows insurance companies to continue to bilk Medicare, even though the Medicare Payment Advisory Commission has concluded that these private Medicare health plans are overpaid.

Measurements and standards are extremely important if we are to get a grip on the out of control state of health care costs, but Hayes' point is worth considering. How do we implement new standards of practice with no money to implement them? How do we manage to afford standards if we continue to overpay for the services we have?

SOURCE: "Health Costs Loom Large for Retirees" 02/18/08
SOURCE: "President Bush Puts Health Of Americans With Medicare In Jeopardy While Overpaying Medicare Private Insurers" 02/18/08
photo courtesy of Andre Malerba: AMPhoto, used under this Creative Commons license

Prevention and Coverage: A Malignancy Revealed

This morning, Forbes brings us confirmation that preventative care is a key issue in the ongoing debate about health care reform. The article examines the ominous topic of cancer in this context:

"Having financial barriers to health care, based on insurance status, is having a significant impact on our efforts to reduce the toll of cancer," said Elizabeth Ward, director of surveillance research in the department of epidemiology and surveillance research at the American Cancer Society.

"We could make considerable progress in reducing cancer mortality if we could ensure that financial barriers, such as lack of health insurance, did not prevent people from getting recommended cancer screening and access to health care when they have symptoms," Ward added.

Like any health issue, the sooner you are diagnosed, the better your chances. Being without coverage and having minimal financial resources makes the idea of spending money on screenings quite simply out of the question for many Americans. As with other chronic conditions, by the time a malignancy is causing enough physical discomfort for a trip to the emergency room, it is not only vastly more expensive but the chances for recovery are also drastically reduced.

"We know that the uninsured are 25 percent more likely to die than other Americans," said Dr. Steffie Woolhandler, an associate professor of medicine at Harvard Medical School, and co-founder of Physicians for a National Health Program. "This study tells us one reason why. Many uninsured cancer victims don't get the screening and primary care that would find their disease early, when a cure is still possible," she said.

While important, these findings are not exactly new news. Go back to the top of this post and take a look at the poster image again. That poster was printed in 1938 according to the Library of Congress. It would seem that the lack of preventative care in the United States is, in and of itself, a chronic problem.

SOURCE: "Timely Cancer Diagnosis Linked to Insurance Status" 02/18/08
Public domain photo courtesy of Library of Congress via pingnews.

Asian Americans and Health Care Reform

Marguerite Ro, deputy director of the Asian & Pacific Islander American Health Forum and a former professor of Columbia University Medical Center, shares the concerns of the Asian American and Pacific Islanders (AAPI) community on the subject of health care reform in Asian Week:

New data from the Centers for Disease Control reveals that nearly one out of every five AAPIs is uninsured. Almost one out of every six AAPIs does not have a usual place for health care.

[...]Unfortunately, the presidential candidates have yet to assure Asian American and Pacific Islander communities that they understand or even acknowledge the challenges that our communities face in accessing health care.

She goes on to cite numerous community-specific statistics and concerns including the following:

• Language barrier as a bar to receiving quality health care
• A stress on improving prevention that notes a 10% incidence of hepatitis B in Asian Americans as opposed to a 0.01% incidence in whites as an example.
• A need to tailor the delivery of health information to the numerous disparate communities that exist in order to assure that the information gets across.
• A call for Asian American voters to make their voices heard at the polls.

Once again, we see that the desire for true reform is one that crosses all strata of society, all communities, all ethnicities, and all political boundaries. As we attain the "perfect storm" of reform that George C. Halvorson speaks of in his book, Health Care Reform Now!, we see that, as he puts it, "buyers are ready for a change."

SOURCE: "Health Care Refom: Why It Matters To Us " 02/16/08
photo courtesy of Joka2000

Microsoft EMRs: What's in a Name?

Amalga. It's a name you will be hearing quite a bit about if you follow the news about electronic medical records. Amalga is Microsoft's new name for their portfolio of health care oriented applications. Marianne Kolbasuk McGee reports for Information Week:

The new "Amalga" brand is now the umbrella name for all Microsoft enterprise health care industry software, including products formerly known as Azyxxi and Hospital 2000, which were products Microsoft acquired. Microsoft's Amalga brand offering spans clinical, operational and financial functions in health care.

In addition to its Amalga product line for hospitals and other health care providers, Microsoft last October entered the consumer health care market with HealthVault, a platform that provides free Web-based health-related search and personal health record tools.

Touting new technology "on the architecture side" that provides better security and reliability, Microsoft seems to be continuing the consolidation of its efforts into a more vertical approach. These new enhancements are slated for general availability in fiscal 2009. Products under the Amalga name cover a wide array of information management needs throughout all aspects of the health care industry.

With its Microsoft Amalga product, formerly known as Azyxxi, Microsoft offers health care providers with a "unified intelligence system" that enables doctors and other clinicians to "get data anywhere data is stored to help them make more intelligent clinical decisions," said [Microsoft health solutions group's general manager of enterprise marketing Davide] Vigano. In most hospital environments, there are multiple disparate systems and applications in many departments, making it very difficult for say, an ER doctor, to access a patient's radiology or drug information in other systems, said Vigano.

Microsoft Amalga helps health care provider access that information to make better clinical decisions, he said. Azyxxi, now renamed Microsoft Amalga, was originally created by doctors and developers at from MedStar Health's Washington Hospital. Microsoft acquired the software in July 2006 and since then has been enhancing it for use by other organizations.

Right now Microsoft's seven early adopters of the software include a variety of different types of hospitals and health care providers. They include MedStar, New York-Presbyterian Hospital, Johns Hopkins Health System, Novant Health (in North and South Carolina), H. Lee Moffitt Cancer Center & Research Institute in Tampa, Florida., St. Joseph Health System (including its entire operations in California, west Texas, and eastern New Mexico); and the Wisconsin Health Information Exchange, a regional health information organization, or RHIO.

The software suite known formerly known as Hospital 2000, targeted at a global market, has experienced a name change as well. It is now the Microsoft Amalga Hospital Information System. As pointed out in the Information Week article, both Azyxxi and Hospital 2000 were originally developed by smaller independent companies and then acquired by the software giant.


SOURCE: "Microsoft Re-Names Its Enterprise Health Care Software" 02/13/08
photo: screencapture of the Microsoft's Amalga page

Health Care: A Picture is Worth A Thousand Words

Craig Stoltz, a former editor of Health, has designed an interactive Web tool for Health Central. This tool, which Stoltz featured in an article in this week's Washington Post, allows readers to see exactly where the various Presidential hopefuls stand on different aspects of the health care issue. It also allows users to graph their own position in relation to said candidates.

The caveats: We report candidates' stated positions, not what they'll do if elected. Underlying the health-care debate is the matter of cost. Democrats' plans involve regulating insurers and offering all Americans a menu of insurance choices similar to those available to federal workers. Republicans would deregulate insurers, arguing that a free market will reduce costs and boost quality. All say savings will come from technology such as digital medical records and from disease prevention and chronic care.

And a note: Some say the focus on health care is not enough. A former assistant surgeon general, Douglas Kamerow, writing last week in the journal BMJ, says candidates' proposals don't address the "crisis" in U.S. primary care, the need for better pay for primary care doctors or ways to reward continuity of care.

Click here for an interactive tool that looks at the candidates positions.

They say a picture is worth a thousand words. It is our hope that this visual aid will help you to develop a picture of where the various candidates stand in relation to your own views on this urgent issue.

Where do you find yourself on this graph?

SOURCE: "Poligraph Web Tool" 01/12/08
SOURCE: "The Candidates on Health Care: Where Do They Stand?" 02/13/08
Screencapture IMage taken from Poligraph Web Tool

Health Care Market Takes to the Web

In America, the market rules — except when it comes to health care choices. A Minnesota company named Carol is trying to change that with a new "care marketplace" website which allows free comparison shopping for health care services. "We want to let consumers define value," said Tony Miller, Carol's founder and chief executive officer. "We don't have care competition in the marketplace today."

While the ability to compare services, credentials and costs — with or without insurance — is a groundbreaking move, it must be noted that these comparisons can only be made amongst providers who are members of the network.

In an Associated Press article entitled "Minn. Web Site Creates Health Market," Elizabeth Dunbar explains the site's features:

Instead of going through a list of doctors or clinics, users tell the site what they're looking for by clicking on parts of the body.

For instance, if a consumer clicked on "entire body," then "annual exam," and chose a routine physical for women age 40-64, the results page would show six different options ranging from $207 to $335. After selecting a number of options, consumers can click "compare" and see exactly what each exam would entail. They can also read a description of the doctor or clinic's philosophy and link to ratings by MN Community Measurement, a nonprofit that measures health care performance in Minnesota.

The combination of provider ratings and the ability to calculate out of pocket expenses brings health care more in line with traditional markets. While this is cause for enthusiasm for many, the endeavor does have its critics, according to Dunbar:

The free site, which went live in January, generates revenue from health care providers who become "tenants" on the site. When a consumer sets up an appointment with a clinic or doctor on Carol.com, the provider pays the site a fee.

[...] Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, said the site is nothing more than advertising, and he hoped it wouldn't catch on.

"Among physicians, there's a belief that health care is too critical ... to be left to the usual marketplace," he said.

[...] Elizabeth Boehm, an analyst with Forrester Research who studies the health care customer's experience [...] was skeptical of the site's prospects because many people's choices are limited by their HMO.

"(Price is) just not what drives people to make their health care choices," Boehm said. "The challenge for a site like this is that while conceptually it's good ... the reality is there are only a small group of customers looking for that."

While Boehm may have a point, there are many people in the United States for whom cost is what drives their health care decisions. There are 47 million Americans lacking health insurance, according to a National Coalition on Health Care report, many of them at or near the poverty line. It would seem that tools of this nature could make a significant difference for a large segment of our population.

Carol.com currently only serves the Twin Cities, but there are plans to expand into other markets during 2008.

SOURCE: "Minn. Web Site Creates Health Market" 02/10/08

Wal-Mart's New In Store Clinics To Implement EMRs

Jonathan Birchall of The Financial Times reports:

Wal-Mart is to open several hundred new walk-in medical clinics at its stores that will be co-branded under its own name.

Branded as “The Clinic at Wal-Mart,” the new facilities will be owned and operated by local healthcare groups and hospitals, but will share common systems developed by Wal-Mart, including standardised electronic medical records.

This effort comes on the heels of last month's declaration of bankruptcy by Checkups, which operated in store clinics across three states. Even so, this model is being explored not only by Wal-Mart, but by other companies, as well. The Financial Times articles mentions a few:

Target, Wal-Mart’s rival, has opted to set up walk-in clinics under a similar model in Minnesota and Maryland. CVS and Walgreens, both leading US drug store chains, have respectively bought third-party operators Minute Clinic and TakeCare Health to run clinics in their stores.

One aspect of the plan sounds ripped from the pages of George Halvorson's Health Care Reform Now! - the emphasis on e-prescriptions and EMRs. Bernie Monegain, Editor for HealthCare IT News, interviewed Wal-Mart's CEO regarding the announcement:

"We think we can even do more with prescription costs," Wal-Mart President and CEO Lee Scott said Wednesday in a talk to 7,000 managers. "Our approach will be based on taking out unnecessary costs while providing high quality healthcare products and services. We also believe we can help with how prescriptions are filled. We will partner with doctors and other providers to increase the number of electronic prescriptions in the U.S. And, we will provide electronic health records to United States associates and their family members - including retirees - by the end of 2010."

Scott said in the coming months, Wal-Mart would be taking action to help drive down the cost of healthcare, increase the number of electronic prescriptions and promote the use of electronic medical records.

This looks like a step forward for Wal-Mart, a company besieged frequently by negative press and accusations of avoiding health care benefits for its staff. As the world's largest private employer, the transition of their employee base to EMRs should have a significant impact on the push to adopt them on a national level.

What do you, our readers, think?

SOURCE: "Wal-Mart turns its focus to e-prescribing, electronic health records" 01/24/08
SOURCE: "Wal-Mart to open hundreds of medical clinics" 02/07/08


photo courtesy of oswaldo, used under this Creative Commons license

The New Bush Budget: Cutting Health Care for 9/11 Responders, Medicare, and Veteran's Health Programs

The buzz is everywhere now that U.S. President George W. Bush has unveiled his budget plan for the coming fiscal year. Huge cuts in health care spending are part of the package, and the prevalent attitude across the media seems to one of shock.

Let's begin in New York with The Queens Gazette where John Toscana addresses the massive reduction in health care funds for 9/11 survivors:

New York lawmakers in Washington who have been persistently pressing the White House for increased funding for healthcare programs for ailing 9/11 World Trade Center workers were jolted last week when President George W. Bush's proposed budget slashed those programs by 77 percent. [...]

"This dramatic and unwarranted cut flies in the face of common sense, compassion and just plain fairness," Senator Charles Schumer declared as he promised to "fight these cuts tooth and nail to ensure these heroes receive the health care they need and clearly deserve".

An editorial yesterday in the San Jose Mercury News lists some of the extensive health care cuts:

The single most damaging portion of the Bush budget is his proposal to cut an additional $200 billion from Medicare and Medicaid programs. That will cause irreparable harm to public hospitals that are required by law to provide medical care to uninsured residents. And it will further reduce the number of doctors willing to treat a growing senior population, let alone the poor on Medicaid.

[...] Cutting Medicare and Medicaid isn't the only ill-advised health care proposal. Incredibly, Bush calls for a decrease in veterans' medical programs, despite the toll of war and revelations of inadequate care.

He calls for a freeze in the National Institutes of Health budget, which will result in fewer research grants to find better treatments for cancer and other diseases. His proposed funding for the State Children's Health Insurance program falls far short of the bipartisan agreement that has the approval of Congress, including Republicans such as Sen. Orrin Hatch of Utah. One out of every eight children in the nation now has no health insurance, a national embarrassment.

The proposed cuts in veterans' health care come at a time when the Veteran's Administration is facing litigation for arbitrary denial of care and benefits to wounded veterans, an issue that will be joined in a hearing March 7th.

Next stop on the tour is Oregon's Portland Business Journal, where Republican Sen. Gordon Smith's reception of this news is frosty:

"Good policy should drive the budget, not arbitrary cuts to programs that protect our seniors, our children and the most vulnerable," Smith said in a statement. "Cuts to Medicare and Medicaid start an unwelcomed ripple effect in state budgets and doctors offices.... We should strengthen, not bring down the programs that keep America healthy."

In upstate New York hospitals are looking at a loss of $2.4 billion in funding over the next five years if the proposed budget gets passed. Christian Livermore of the Hudson Valley Times-Herald-Record brings us that perspective along with more commentary by Senator Schumer:

Sen. Chuck Schumer yesterday called the proposed cuts -- the largest, he said, since he has been in the Senate -- "a punch to the gut of upstate New York hospitals."

"Our hospitals are already struggling to get by," Schumer said in a conference call with reporters. "Many are in red ink. You put these cuts in and you're pulling the rug out from under them, not just the hospitals themselves, but the doctors, the nurses, the technicians and the people who sweep the floors at night, who depend on these hospitals for their livelihood."

Bush's cuts to New York hospitals and health systems could total $10 billion statewide, much of it from rate freezes and reductions in reimbursements for indigent care, and would cut Medicare and Medicaid by $200 billion nationwide over the next five years.

It will be interesting to see what happens when this reaches Congress. Senators Smith and Schumer are far from the only critics on Capitol Hill.

SOURCE: "NY Lawmakers Shocked At Bush's 77% Cut In 9/11 Health Funding" 02/06/08
SOURCE: "Editorial: Bush's budget takes money away from health care" 02/06/08
SOURCE: "Veterans not entitled to mental health care, U.S. lawyers argue" 02/05/08
SOURCE: "Smith criticizes proposed health care cuts" 02/04/08
SOURCE: "Proposed cuts could sting: Local hospitals face decisions they'd rather not have to make" 02/07/08

photo courtesy of U.S. State department (Official Portrait, Public Domain)

Happy Super Fat Tuesday!

The Health Care Reform Now! Blog is written by a team of bloggers in New Orleans, Louisiana. As the rest of the United States prepares for an historic Super Tuesday presidential primary, we in New Orleans are preparing for an historic Fat Tuesday.

On Fat Tuesday in New Orleans -- also known as Mardi Gras -- citizens and visitors are required by law to lay down their labors unless they are in the service of Mardi Gras merriment.

For your listening pleasure this Mardi Gras, as you make your way to the polling place or work place of your choice, allow us to recommend the streaming broadcast from WWOZ, the Jazz & Heritage Station from the tropical climes of the Crescent City.

Until Wednesday,
Laissez Les Bon Temps Roule!
STEVE O'KEEFE
Health Care Reform Now! Blog Team

photo courtesy of Mr. Gunn, used under this Creative Commons license

Super Tuesday Resource Guide

On February 5, 2008, ("Super Tuesday") twenty-four states will vote or caucus to determine who will be the official U.S. presidential nominees for the Democratic and Republican parties. With that in mind I would like to present some source material for voters in those states to whom health care is a priority issue.

Health Policy correspondent Julie Rovner and Michele Norris of National Public Radio (NPR) provided an overview of the candidate's positions on yesterday's edition of the popular radio news program, All Things Considered:

Candidates from both parties are proposing fairly far-reaching health plans. But while the Democratic plans would probably cover more of the uninsured, they would change the health care system for most people less than the Republican plans would, and the GOP plans envision a much bigger shift in the way people get their health insurance.

In the end, it's still back to the same old debate of Democrats pushing a bigger role for government and Republicans more of a role for the free market, Rovner says.

For the full breakdown in print as well as a link to listen to the original audio click here.

Next stop is CNN.com, where Dr. Sanjay Gupta gives us his own comparison of the positions taken by the candidates. He embraces transparency wholeheartedly by reminding his readership that he was a White House Fellow in Hillary Clinton's office back in 1997 and 1998. While his piece is rather short it does include a link to video of Republican candidates discussing the Clinton and Obama plans as well as a thought-provoking array of comments left by Gupta's readers. He ends his overview by boiling the differences down to a single basic question:

So, which do you think will work? Using the free market and enterprise or expanding existing programs to cover everyone?

For a terrific side by side comparison of the proposals on the table interested parties should take a look at the Kaiser Family Foundation's Health08 website where they will find a variety of comparisons along with a nifty tool to generate a custom comparison by picking up to four candidates and clicking the friendly blue button labeled "compare." This guide is extremely useful due to its extensive documentation

This side-by-side comparison of the candidates' positions on health care was prepared by the Kaiser Family Foundation with the assistance of Health Policy Alternatives, Inc. and is based on information appearing on the candidates' websites as supplemented by information from candidate speeches, the campaign debates and news reports. The sources of information are identified for each candidate's summary (with links to the Internet). The comparison highlights information on the candidates' positions related to access to health care coverage, cost containment, improving the quality of care and financing. Information will be updated regularly as the campaign unfolds.

Hopefully these tools will provide clarity as the cacophony of "Super Tuesday" campaigning rains down upon us.

SOURCE: "Parsing GOP, Democratic Health Care Proposals" 01/31/08
SOURCE: "Candidate health care plans" 01/31/08
SOURCE: "2008 Presidential Candidate Health Care Proposals: Side By Side Summary"
photo courtesy of ryanjunell, used under this Creative Commons license