The Health Care Blog

Senate Deal on Health Care Bill Done

By Matthew Holt

As it's a work day for the Senate worth reporting here that Ben Nelson’s vote has been bought for more Medicaid spending for Nebraska and a complex formula for States to opt out of exchanges being able to fund abortions. So presuming there’s no problems in reconciliation we can expect the reform bill to be done relatively soon. Full details on what’s in the new bill on Think Progress’ The Wonk Room.

The netroots left has been complaining loudly over the last couple of days since Lieberman was bought off by dropping the public option and the Medicare buy-in. Howard Dean and Markos of Daily Kos both called for massive changes to the bill, or killing it and the debate between the “sensible left” and the “this is a sellout to insurers” has got a little silly. However, (unless Bernie Sanders pulls  fast one) none of the more left wing Senators (Sherrod Brown et al) are going to vote against the bill, so what we see now is what we get.

The real issue will be when the voting public finds out that nothing happens for 3 years.

Kate's Counterpane

A wonderful sad and happy story about someone who never thought disease could happen to them. (It's relatively long and plays in sections or you can go to the original site)

From a system/policy perspective, the role of complementary and allopathic medicine is pretty interesting. But this is a story about a fighter.

Interview with Paul Taylor, renegade hospital CEO

By Matthew Holt

Paul Taylor is CEO of Ozarks Community Hospital, a teeny 2 hospital system catering to the poor and senior populations in rural Missouri and Arkansas. He thinks that he's figured out a way to deliver health care at government rates and is incensed that every other hospital claims it can't make it on what Medicare pays. (That's they I call him a renegade--I don't mean that his hospital is called "Renegade"!) He also gets much less from the local Blues than he does from Medicare for the same services.

I wrote about Paul a while back and he sounded like a guy with interesting ideas on how to fix health care. So I called him up to see if he would be a good interview--and he didn't disappoint!

Paul Taylor

Health 2.0 Does Webinars

By Matthew Holt

I'm excited to announce the latest program coming from Health 2.0 - The Health 2.0 Show with Indu & Matthew!  This monthly webinar series will focus on news from the Health 2.0 community, a look at some cool new technologies, and interviews with industry leaders.

January 19, 2010
11 am PT / 2 pm ET
We’ll start the series off with a look at what lies in store for Health 2.0 in 2010 – including updates from the Advisors, the Accelerator and exciting new partnerships.

We’ll also chat with Thomas Goetz of Wired Magazine about his upcoming book,The Decision Tree: Taking Control of Your Health in the New Age of Personalized Medicine and his thoughts on technology, personalized medicine, and how it all relates to Health 2.0.

For more information and to register, check out:  http://www.health2con.com/webinars.

Health Reform as Theater: Let Me Down Easy

By MICHAEL L. MILLENSON

For a Broadway stage, the set is simple and spare – a long, white leather couch, a handful of wooden tables and chairs. No ornamentation is needed; the stories being told on the stage are what command the audience’s attention. Let Me Down Easy is health reform as poignant, funny and gripping theater.

A supermodel compares the high-powered physicians a cosmetics company gets her after she signs a lucrative contract to the doctors she had access to during her working-class childhood. A middle-aged woman emotionally refuses dialysis because of the terrible injuries her daughter sustained while undergoing dialysis when a hospital’s mistake left her covered in blood. And a cancer patient hospitalized with a post-chemotherapy fever describes being told not to take it personally that her chart has been lost: “that happens here quite a bit.”

Every word is true, every story describes a personal struggle with illness, dying and the medical care that sometimes happens in between. Twenty people speak, each in a separately titled vignette, but only one person appears on stage. That’s Anna Deavere Smith, who carefully selects verbatim excerpts from interviews she conducted and then meticulously mimics those interviewees’ body language and speech patterns in a manner so convincing that, in the miracle that is theater, she disappears into her characters. Some are well-known – Lance Armstrong, former Texas Gov. Ann Richards – others are not – a musicologist, a Buddhist monk, a rodeo bullrider.

Continue reading "Health Reform as Theater: Let Me Down Easy"

Improving the Harvest: Farming and Health Care

By Bill Kramer

I love Atul Gawande’s writings on health care. 

He has a rare talent for describing technical details of health care, insurance and finances in terms that most people can understand. His recent article in the New Yorker discussed the current health reform bills’ approach to curbing costs, using the agricultural industry as a potential model.

One of his basic points is similar to one I have made before. He describes two kinds of problems: “those which are amenable to a technical solution and those which are not. Universal health care coverage belongs to the first category . . . Problems of the second kind [referring to rising health care costs], by contrast, are never solved, exactly; they are managed.”

I would frame it somewhat differently. The two basic kinds of problems are those, which are amenable to a government solution, and those which are best addressed using decentralized market forces.

Continue reading "Improving the Harvest: Farming and Health Care"

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MedEncentive's Five Year Report

By Matthew Holt

As many involved in the worlds of Health 2.0 and Information Therapy know, some of the most interesting experiments in the world of patient-physician engagement have been happening in the somewhat unlikely environs of small town Oklahoma. There the City of Duncan has put its employees (and their providers) into a system that incents (but doesn’t mandate) physicians to practice according to accepted guidelines, and incents (but doesn’t mandate) patients to read information prescribed by their physicians about their treatments (and tests them about it). The system then asks each party to rate the other.

It sounds simple and frankly, compared to much in health care, it is. The system is supplied by MedEncentive, an Oklahoma City firm led by the charming and engaging Jeff Greene. While I remain fascinated by MedEncentive’s program (and FD MedEncentive has sponsored the Health 2.0 Conference in the past), it’s perhaps grown a little more slowly than Jeff and other fans might have liked—given the scope of the problem.

But the results have been impressive in reducing costs (mostly by reducing hospitalizations) and increasing patient involvement. Yesterday MedEncentive released a five year retrospective. The key finding?:

City of Duncan costs for the most recent year was 8.6% less than five years ago prior to implementing the Program, which is 34.9% less than the projected costs. The resultant four year savings equates to an 8:1 return on investment. (emphasis added)

Jeff abandoned a lucrative business in physician practice management to have a go at this intractable problem. Five years on he deserves plaudits for what he and his team have achieved, and hopefully we’ll see much more innovation like this mushrooming in the future.

Given the relatively lightweight nature of the intervention, I’m amazed that many much larger payers/employers haven’t given it a try. After all, whatever else they’re doing doesn’t seem to be exactly working too well!

Joe is kicking them when they're down

By Matthew Holt

From a deeply depressing survey of the unemployed in today’s NY Times:

Nearly half of respondents said they did not have health insurance, with the vast majority citing job loss as a reason, a notable finding given the tug of war in Congress over a health care overhaul. The poll offered a glimpse of the potential ripple effect of having no coverage. More than half characterized the cost of basic medical care as a hardship.

Meanwhile what is Joe Lieberman concerned about? Playing politics against liberals who, correctly, think he erred terribly in his support for Bush’s war and McCain’s candidacy.

And even if we pass legislation, when does the help arrive for these unemployed? 2013.

States Should Have Flexibility to Develop Own Health Reform Plans

By MAX BARTLETT and JOSE AGUILAR

One issue has generated little discussion during the heated health care reform debate: whether states should have the right to develop their own approaches to universal coverage.

The Health Security for New Mexicans Campaign wants to see language included in the national proposal that gives states flexibility to develop their own approaches to solving rising health care costs and growing numbers of uninsured.

The focus of current health care reform proposals is to create “insurance market exchanges.” These one-stop-shopping insurance exchanges must offer consumers -- primarily the uninsured -- choices of different insurance products, including some type of public option. A less than robust public option is in the proposal passed by the House of Representatives. The Senate is in the process of negotiating an alternative to the House version.

Continue reading "States Should Have Flexibility to Develop Own Health Reform Plans"

Is it Unconstitutional to Mandate Health Insurance?

By MARK HALL

Is it unconstitutional to mandate health insurance? It seems unprecedented to require citizens to purchase insurance simply because they live in the U.S. (rather than as a condition of driving a car or owning a business, for instance). Therefore, several credentialed, conservative lawyers think that compulsory health insurance is unconstitutional. See here and here and here. Their reasoning is unconvincing and deeply flawed. Since I’m writing in part for a non-legal audience, I’ll start with some basics and provide a lay explanation. (Go here for a fuller account).

Constitutional attacks fall into two basic categories: (1) lack of federal power (Congress simply lacks any power to do this under the main body of the Constitution); and (2) violation of individual rights protected by the “Bill of Rights.” Considering (1), Congress has ample power and precedent through the Constitution’s “Commerce Clause” to regulate just about any aspect of the national economy. Health insurance is quintessentially an economic good. The only possible objection is that mandating its purchase is not the same as “regulating” its purchase, but a mandate is just a stronger form of regulation. When Congressional power exists, nothing in law says that stronger actions are less supported than weaker ones.

Continue reading "Is it Unconstitutional to Mandate Health Insurance?"

There Be Dragons: The Fiscal Risk Of Premium Subsidies In Health Reform

By JEFF GOLDSMITH

Last week, the Congressional Budget Office weighed in on the biggest economic imponderable in the health care debate: how private health insurance premiums will behave under health reform. Building on its December 2008 CBO health insurance market analysis, CBO forecast largely benign effects from health reform’s private market reforms and subsidies on the vast majority of the presently insured (e.g. voting public).

According to CBO, only 17% of Americans in the so-called nongroup market–largely individuals–would see premium increases in 2016 (the CBO reference year), because they would be required to purchase fatter benefits with less economic risk. CBO believes that the other 83% of the presently insured will see little or no change.

Analysis of how the health insurance market will behave under health reform has become ferociously politicized. After the infamous PriceWaterhouseCoopers study sponsored by health insurers suggested possible large premium increases, the CBO report might provide cover for members of Congress who are contemplating irreversibly tying the federal budget to a volatile “private” insurance market. I think the fiscal risks of a partially federalized private health benefit are significantly greater than CBO has suggested.

Continue reading "There Be Dragons: The Fiscal Risk Of Premium Subsidies In Health Reform"

Health 2.0 in Europe: Couldn't? Wouldn't? Does!

By Denise Silber

They said it couldn’t happen in Europe, that social media and online tools wouldn’t catch on, because the healthcare context was soooo different from the US. They said that Europeans don’t worry about access and cost, that they aren’t looking for information online because they they trust their doctors utterly and fully, and that European doctors don’t go online, except if they're Scandinavian.

Well, it just isn’t so! True collective intelligence will tell you that participatory medicine is a natural human instinct and that Health 2.0 is kicking up a storm in Europe this winter! Consumers and professionals are generating content everywhere, even though they don't necessarily cross language or country borders. Unfortunately, no one European organization is studying consumer health Internet usage trends on the same basis year after year, as is the Pew Foundation in the U.S. Nonetheless, there is empiric proof; during the current flu epidemic, information from informal sources in Europe is fully surpassing official data. Wikipedia is cited in a recent study by Manhattan Research as one of the most regularly used sites for physicians and consumers across Europe. Private initiative has generated many significant consumer/patient communities, several major physician community portals, online consultation sites, and more.

But, while users are generally "with it", Europe institutions are not. What is at stake is the future of ill-prepared healthcare organizations and institutions and the regulated healthcare industries.

Continue reading "Health 2.0 in Europe: Couldn't? Wouldn't? Does!"

The one hundred-- a Boston Cancer Fundraiser

Earlier this month, the Massachusetts General Hospital Cancer Center opened nominations for its annual gala honoring those who have stood out in the fight against cancer, the one hundred. Each year, one hundred people from all walks of life are honored by the Boston-based hospital for a variety of achievements. Doctors, nurses and researchers have been recognized for ground-breaking research and stellar patient care while those outside of the medical community, like Susan Zuker, were recognized for lobbying the state legislature for a vanity license plate that would raise money for cancer research, or the Boston-based "Cops for Kids with Cancer" program that supports families with children who have cancer. Last year, Elizabeth Edwards was also honored and was the keynote speaker of the gala. To nominate someone you think should be recognized for their outstanding fight against cancer, visit here

Better Care Through Clinical Trials

By DOUGLAS W. BLAYNEY, M.D.

Amid hundreds of amendments offered in the health care reform debate, there is a non-partisan, non-controversial gem that will both help patients and speed the search for new cures to deadly diseases.

Senators Sherrod Brown [D-OH] and Kay Bailey Hutchison [R-TX] have proposed an amendment that would encourage patients with life-threatening diseases or conditions to participate in clinical trials by requiring private insurers to cover patients' routine care. It is essential that the Senate pass this amendment as part of health care reform.

As a cancer physician, I can speak to the benefits of clinical trials in my field of oncology. Virtually every advance in cancer prevention, screening, and treatment over the last 40 years can be traced directly to clinical trials - colonoscopies; curative treatment for testicular cancer; improved survival for most pediatric cancers; chemotherapy after surgery to prevent recurrence; new personalized therapies that target specific characteristics of cancer cells; and symptom management. Thanks primarily to the knowledge gained through clinical trials, today two-thirds of cancer patients survive at least five years after diagnosis, compared with only half in the 1970s.

Continue reading "Better Care Through Clinical Trials"

Your Money or Your Wife

By JD Kleinke

Talk about perfect timing.  Just as the last “death panel” falsettos fade into the droning no-government-  takeover chorus, along come those “faceless government bureaucrats” from the U.S. Preventative Services Task Force to stop the music in the nation’s busy and profitable mammography suites.

No more breast self-exams or mammograms for low-risk women under 50; mammograms only every other year after the age of 50; nothing for any woman over 74.  That was the thunderclap pronouncement from the acrobatically acronymic USPSTF, the dreaded “they” from the gub’mint that has the folks at Fox in full fulmination.

While the House and Senate grind their way through a few thousand pages of legislation and one more battle in the perennial abortion rights Holy War, this abrupt about-face in cancer screening is all people want to talk about, when we’re talking about health reform, in corporate strategy meetings.  And the mix of incredulousness and anxiety in their voices speak volumes: this startling news from the health care technocracy does not affect their business; rather, it seems profoundly and directly to affect them personally, men and women alike.

Why so sudden and radical a reversal, they all want to know, in the war against cancer we have been winning for decades?  And so I, swallowing hard, explain that the very smart people on HHS’ AHRQ’s USPSTF have discovered that all the effort and money dedicated to breast cancer screening for women under 50 actually saves only one life for every 1,904 women screened - while generating too many false positives, hundreds of unnecessary biopsies, and excessive anxiety.

It’s a big waste of money, “they” now tell us, and that certainly works for me, I say, swallowing hard again.  I’m a male medical economist, after all, a hard-headed advocate of hard numbers, data-driven medicine, solid evidence, and efficiency, and I despise waste almost as much as I despise cancer itself.

Continue reading "Your Money or Your Wife"

Senate Compromise on Health Care Reform: Political Genius?

By JOE FLOWER

Democrat Roland Burris, the sudden senator who replaced Barack Obama in that august body, has now joined those who are pledging to filibuster any bill that does not have a "public option" – joining of course those, like Connecticut's infigurable Joe Lieberman who will filibuster if it does have a "public option." But the compromise that is brewing may turn all such pledges inside out. The compromise would allow 55 to 65-year-olds to buy into Medicare, while letting under-55s without insurance into the Federal Employee Health Benefits Plan, along with mandates to buy in, and subsidies for those who can't afford it. If this does indeed emerge, liberal Democrats in both houses may have some trouble defining what they mean by the "public option" they are so strongly demangin. Is it a "public option" for 55-and-overs if they can buy into Medicare? Sure sounds like it - a government-run plan that people can buy into, in competition with private plans. Is it a "public option" if the federal Office of Personnel Management runs an exchange called the Federal Employee Health Benefits Plan (FEHBP) setting the rules and transparency for private plans, with subsidies and tax credits for those 54 and under who can't afford a health plan?Sounds close, but not quite. Close enough for confusion, at least.

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Convergence and the Death of the Public Option

By Tim Greaney

So maybe the two parties are coming together on health reform after all. Last night we learned that after days of “secret talks” among the “gang of ten” the Democrats have reached agreement to restructure their health care proposal. The changes are significant:

- ditch the already-watered-down public option plan;

- create a new insurance exchange “option” for individuals and small groups consisting of a nonprofit plan as negotiated by the Office of Personnel Management;

- expand Medicare eligibility to cover uninsured individuals aged 55-64.

What does the Democrats’ “public option ultralight” compromise have in common with Republicans’ alternative universe? Well, consider the latter’s proposal to open interstate competition for all health insurers–a move they promise will immediately lower health care costs. Besides being shameless attempts to offer simple solutions to complex problems, the two proposals are guilty of the same fundamental misunderstanding of health insurance. Simply put, they both ignore a critical economic truth of health insurance today: insurers require a provider network of hospitals and doctors or must have market leverage in order to negotiate for lower provider prices and for controls on excessive volume.

Continue reading "Convergence and the Death of the Public Option"

Making (sh)it up as they go along

By Matthew Holt

So today’s news is that the gang of ten have come up with something. (If you haven’t been following along, the gang of ten are the five “liberal” Democrats and the five DINOs asked by Harry Reid to come up with something to break the deadlock and get some type of compromise that will pass the Senate).  More details are here from Brian Beutler at TPM

So it might vanish like a Clinton-era trial balloon, or it might be a stayer, but the core of the new concept is to allow the 55–64 crowd to buy into Medicare, and to ask/allow/mandate a non-profit insurer(s) to provide a substitute public option. Exactly what the second point means is unclear to me. It may turn out to be some collapsing of Kent Conrad’s notion of the cooperative with an extension of the Federal Employees’ Plan (presumably minus the for-profit carriers) and somehow cramming that into the exchange. Of course providing something like the choice among private plans that Federal Employees now get was at the heart of Ron Wyden’s plan. We’ll see if it can last a couple of days scrutiny, or the wrath of the House Democrats.

The Medicare buy-in seems both sensible politics and half-decent policy.

Continue reading "Making (sh)it up as they go along"

Pelosi’s Hidden Tort Bomb -- an Alternative View

by Charles Silver & David A. Hyman

We once thought Democrats would accept tort reform to win Republicans’ support for national health care legislation.  Now, however, Democrats have dispensed with bipartisanship.  Perhaps they think they can ram health care legislation through without any Republican backing.  Perhaps the price required to obtain even a few Republican votes was too high.  Perhaps Democrats received too much pressure from the trial bar.  Whatever the reason, neither the bill passed by the House nor the bill pending in the Senate contains any of the tort reform provisions Republicans want. To the contrary, the House health care bill is anti-tort reform.  

 Not only does it reject the entire slate of lawsuit restrictions Representative John Boehner put forward in the Republican alternative to the Democrats’ bill; it contains a provision that will reward states for scrapping damages caps and other tort reforms many already have in place.  This provision flew beneath the radar during the House debate, but the editorial board of the Wall Street Journal condemned it after the vote took place.  Describing the provision as a  “hidden Pelosi tort bomb,” the Journal editors predicted that “[i]f it passes in anything like its current form, we are going to be cleaning up the mess for decades to come.”

Most predictions that the sky will fall are wrong. This one is wrong as well.  

Continue reading "Pelosi’s Hidden Tort Bomb -- an Alternative View"

Abortion Should Not Imperil Health Care Reform

By Melissa Reed



The House vote to establish near-universal health-care coverage came at a steep cost to women. That cost, issued as an amendment by Rep. Bart Stupak (D-Mich.), eliminates abortion coverage by private insurance companies even when women are paying for all or most of the premium.

Stupak's amendment is a cynical attempt to push an anti-choice agenda that imperils badly needed reform. His amendment restricts women's access to abortion coverage in the private health insurance market as well as in a "public option," undermining the ability of women to purchase private health plans that cover abortion. It reaches much further than the Hyde Amendment, which has prohibited public funding of abortion in most instances since 1977.

Before its introduction, health-care reform measures in both House and Senate contained agreed-upon compromise language regarding abortion. Public funding for abortion would remain prohibited and women with private health insurance would continue to receive benefits they already have. Though this language satisfied neither side completely, it enabled health-care reform legislation to move forward without being derailed by abortion politics.

Continue reading "Abortion Should Not Imperil Health Care Reform"

Genetic Testing, Fact or Fiction: You Be the Judge

By MICHAEL MILLENSON

Which of these two events is fact and which is fiction?

• Organizations representing employers and health plans call for a moratorium on implementation of the Genetic Information Nondiscrimination Act, asserting that the new rules could have a “significant and adverse impact...on wellness and prevention efforts” in the workplace.

• One of the largest companies in America begins matchmaking its employees based on their genetic compatability, hoping to save on the health insurance bills associated with imperfectly bred children.

Answer: No. 1 is a Dec. 2 press release from the Disease Management Association of America. No. 2 is a description of the Dec. 8 episode of the ABC-TV comedy, “Better Off Ted.”

Coincidence? You be the judge.

Spotlight on Health 2.0: Clinical Groupware from SF '09

Every week we bring you a video from the world of Health 2.0. This week we're featuring a clip focusing on Clinical Groupware and the Next Generation of Clinician-Patient Interaction tools, as seen on stage at our latest conference in San Francisco 2009.

To see more videos from past Health 2.0 conferences, or to purchase the entire conference DVD sets from '07 & '08 click here. 2009 DVD sets will be available shortly, please check back for updates.

2009: A Year of Surprises and Change for the EHR Technology Market

By DAVID C. KIBBE and BRIAN KLEPPER







2009 began with a bang for legacy Electronic Health Record (EHR) vendors, promising strong sales and windfall profits on the heels of stimulus package incentive bonuses initially worth more than $19 billion to doctors and hospitals. But things changed dramatically along the way.

Here ten surprises and notable events that have impacted the EHR market:

Payment for Meaningful Use of EHR technology, not for the software and hardware itself.

The idea that using EHR technologies ought to produce improvements in quality of care, better communication with patients, enhanced safety, and better public health reporting -- and that these outcomes ought to be monitored and providers held accountable for their achievement -- was itself a surprising innovation in 2009.  It has to be counted among the best 10 health care ideas to come out of government in the past generation.

Continue reading "2009: A Year of Surprises and Change for the EHR Technology Market"

Four grumpy lefties with Laura Flanders

By Matthew Holt

Maggie Mahar, Jon Cohn, Jon Nichols and Olga Pierce hang out with Laura Flanders on the amusingly titled GRITtv and discuss how screwed up the politics of health care are in the Senate. Twenty minutes of amusing chat without a “moderate” or a Rpublican in sight. (Can’t get the video to embed here, so sneak over there).