The Health Care Blog

Is John Goodman joking or just mean?

By Matthew Holt

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

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

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

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Balloon Mania: Happy Birthday Health 2.0

By Scott Shreve

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

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

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

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THCB UPDATE

If you haven't had a chance to sign up for THCB UPDATE yet, you really should. You'll get a helpful reminder email from us a few times a week when important posts go up on the site. In the two and a half six months since the service launched more than 700 1,000 1,200 1,300, 2,000  people have signed up, thoroughly surprising me. I've pledged not to divulge any details about the people who sign up, but I can tell you that list reads a bit like a health care who's who. Go on: It's free. It's useful. And people seem to like it. Go visit the sign up page.

Stanford Med School rejects industry funding for continuing education

By Sarah Arnquist

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

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

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

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

Cost-containment missing piece of Mass. health reform

By Niko Karvounis

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

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

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

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Health Reform Prospects Fade as Presidential Campaign Enters Homestretch

By Jeff Goldsmith

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

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

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

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Health 2.0 User-Generated Healthcare

How are Web 2.0 technologies like social networks, wikis and online communities changing the face of the health care industry? How are hospital systems and physician practices evolving as a result of rapid technological change?  How can health plans evolve in the face of emerging challenges with the help of new technologies and new thinking? What will come of the recent controversies over genetic testing and the privacy of patient data? Where does the hype over social networks and user-generated content end and the reality begin?

Come learn more about these questions and many more at Health 2.0 on October 22nd - 23rd at the San Francisco Marriott. You'll meet industry insiders and new players entering the field. You'll see rapid-fire demos of new technologies and hear both expert reaction from established players in the field and fresh perspectives from newcomers. You'll also get critical insight from industry observers as well as practical, common-sense advice on employing these new technologies in your own business or organization.

Confirmed speakers include: Google Health, Microsoft, Yahoo Health, Healthline, Cisco, Eliza, Silverlink, DestinationRX, AthenaHealth CEO Jonathan Bush, Sermo CEO Daniel Palestrant, HealthGrades CEO Kerry Hicks,  WebMD CEO Wayne Gatinella, Clay Shirky, author of "Here Comes Everybody: Organizing Without Organizations." Dr. David Kibbe, Jay Parkinson, M.D., Jane Sarasohn-Kahn, THCB's Matthew Holt, Health 2.0's Indu Subaiya,  CrossoverHealth founder Scott Shreeve, 23andMe and many, many more.

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Two Blues, two different Health 2.0 approaches

By Matthew Holt

Two of the better behaved and more innovative health plans (both non-profit regional Blues) have been taking different approaches to Health 2.0, user-generated content, communities and all that. BCBS Minnesota created a separate company called Consumer Aware which created HealthCare Facts, and the Healthcare Scoop. Now the Healthcare Scoop is going national. (You can hear more about that in the podcast I did with CEO MaryAnn Stump last year).

Meanwhile, in the Pacific Northwest Regence has been beavering away creating its own communities within its core web site -- and has been making a pretty job of it, too. They're theoretically for members only, but you can get a guest pass. And there's a good deal of activity there. Which kind of answers the question, should health plans get involved in Health 2.0?  These early adopters say, yes.

And, of course, I'd be remiss in my crass marketing duty if I didn't tell you that Mary Ann Stump and Regence's Joe Gifford will both be at the Health 2.0 Conference in October.

Cisco's Frances Dare talks about Congressional action on health IT

By Matthew Holt

Frances Dare is someone I've know for a long time in the health care IT world (sorry, Frances!). That means that she's seen the painfully slow developments in many aspects of health IT since the 1990s, and has an experienced view of what's coming along at what pace. These days Frances is a Director at Cisco focusing on health care, and more recently she's taken an active role in Cisco's health care lobbying efforts on Capitol Hill.

Given that we don't spend much time on THCB talking about the impact of the Federal sausage-making process on health care IT, telemedicine, et al, I thought that getting the view of a major IT vendor about what they expect to come out of the current Congress would be pretty interesting. And it was. Here's the Interview.

BTW, in the interview I get the name of Frances' division at Cisco wrong, Frances is a Director in the ISBG which stands for Internet Business Solutions Group. (FD, I have done consulting work for Cisco in the past, even if I didn't know the name of the group I was working for!).

Comparing Biden's health reform plan to Obama's

By Craig Stoltz

It's the time in the political season to make way too much of the impact a vice president can have on the presidential contest.

So I hope you don't mind if I extend that amusing parlor sport into the arena of health care reform and consider how how Joe Biden's original proposal for health care reform compares to Barack Obama's.

If nothing else, it's a good way to parse a few of the issues likely to be magnified when Obama and McCain yammer back and forth about their health care plans in the coming weeks.

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In Online Health Content We Trust?

By Fard Johnmar

Late last week, Susannah Fox of the Pew Internet & American Life project announced that the nonprofit had updated its statistics on the number of adult Americans using the Internet. Currently, 73 percent are Web users.  Of this group, three-quarters have looked for health or medical information online. Fox notes that regardless of whether the number of online health searchers increases or decreases from year to year, “Internet users are doing something [and] the horse is out of the barn.” 

The growing power of the Internet has generated enthusiasm in some and dismay in others. It has also exacerbated long-standing tensions between patients and medical professionals –- especially physicians. For example, in a famous Time magazine essay, Dr. Scott Haig admonished some medical “Googlers” for possessing a wealth of information, but lacking the expertise to interpret it correctly.   

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A few socialist musings for Monday

By Matthew Holt

I just watched the closing ceremony of the Olympics, and the word is that state sponsorship of little known or cared about sports like swimming, gymnastics and cycling gets more medals and so should be encouraged. Bob Costas told me that China spent $40 billion on the games, even if London is going to spend less than half that. So it got me thinking about socialism.

Kevin Pho, blogger of KevinMD fame, and usually reliably anti-government in his views, asks for more socialism, at least directed in the direction of him and his fellow MDs. In this USA Today op-ed he suggests rightly that cutting doctors fees in itself saves little in health costs..

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Medical debt is increasing even for the insured

By Jane Sarasohn-Kahn

Four in 10 Americans had trouble paying for medical care in 2007, according to the Commonwealth Fund's latest study on medical debt.

The study, "Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families," looks at 2007 data on consumers' and health costs.

The Fund's researchers examine 4 areas of cost-related access problems when it comes to health care for Americans age 19-64:

• Those who did not fill a prescription (31%)
• People not seeing a specialist when needed (20%)
• Those skipping a medical test, treatment or follow up (25%)
• Adults with a medical problem, but not seeing a doctor or clinic (31%).

Overall, 45 percent of American adults age 19-64 had at least one of these cost-access problems. This includes 29 percent of people who were insured all year.

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The first one's always free....but will you buy a kid a bike?

By Matthew Holt

Many times because I'm an independent consultant, blogger or general self-appointed health care know-it-all people want to talk to me. And I’m always happy to talk. Sometimes these conversations turn into business for me or THCB or Health 2.0, but sometimes they don’t. What I tell anyone who wants my time is that the "first one is always free."

Meanwhile, as part of her return from a back injury my wife Amanda has bought a bike and is training for a triathlon later this Fall. It’s also renewal time for our favorite cause the Saigon Childrens Charity. Much of its resources are spent buying rice for poor families so that they don’t need to send kids out to work, and so the kid can go to school instead. With the price of rice doubling this year, things are getting tougher for the charity and the kids.

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Who'd be a pollster, eh

By Matthew Holt

HSC says that the number of Americans going online for healthcare goes way up:

In 2007, 56 percent of American adults—more than 122 million people—sought information about a personal health concern from a source other than their doctor, up from 38 percent, or 72 million people, in 2001, according to a national study released today by the Center for Studying Health System Change (HSC).

Harris Interactive says it’s gone down ;

Ten years ago, in 1998, the Harris Poll began measuring the number of people going online for health care information. At that time we reported that 54 million people had done so at least once. Since then the number of those people, whom we labeled "cyberchondriacs," have increased almost every year, reaching 110 million in 2002, and 160 million in 2007.

This year, the Harris Poll finds only 150 million who claim to have gone online to obtain health care information. Of course, 150 million is still a huge number and includes 66 percent of all adults and 81 percent of those who are online.

Extra points if you can spot the flaw in my reasoning. (Yes, it’s easy but I’ve been up late watching the Olympics….even though I said I wouldn’t)

Merck's marketing for HPV vaccine trumps science

By Maggie Mahar

A frequent contributor to THCB, Maggie Mahar's work has appeared in the New York Times, Barron's and Institutional Investor. A fellow at the Century Foundation, Maggie is also the author of the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.

I first wrote about Gardasil on The American Prospect online in the summer of 2006, just weeks before the Merck vaccine designed to protect against cervical cancer went to market.

There, I noted that “the hullabaloo began in June when the FDA approved Gardasil, a vaccine widely described as ‘100 percent effective’ in preventing cervical cancer, a disease that kills some 233,000 women worldwide each year. The drumbeat grew louder last month when a federal panel recommended that all American girls and women ages 11 to 26 should be inoculated. And now there is talk that states may mandate the vaccine for all school-age children.

“But before prescribing for the entire population,” I suggested, “it's worth asking a few questions: Why does the vaccine cost $360 for a three-shot regimen? How much do we know about the new product? And is this a cost-effective use of health-care dollars?”

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On Rural Doctoring: The Generalist's Mind

By Theresa Chan

This is the second part of a series that first appeared on the blog Rural Doctoring, where Theresa Chan writes about her experience working as a family physician and hospitalist in a rural community in Northern California. Chan moved from San Francisco to try out rural life.

When I think of rural doctors, I think of family practice. Part of this is training bias, because I am a family doctor, but this bias is supported by surveys which demonstrate that a significant number of rural communities would be medically underserved if it were not for the presence of family physicians.

In this post series, I will emphasize the family practice model of medical training as an approach to preparation for rural practice. I do not mean to imply that other primary care specialties--such as internal medicine, pediatrics or OB/GYN--have no place in rural communities. Quite the opposite, in fact. My job in rural California would be much more difficult if I did not have the support of the other primary care specialties. I hope this post series will be useful to medical students and residents who are training in those specialties as well, even if the content tends to veer towards family practice. I will argue that it is the generalist's mind, rather than the specialty, which will suit a doctor for rural practice.

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Reports on Gardasil study offer varying interprations

By Sarah Arnquist

Merck's HPV vaccine, Gardasil, has received significant press in recent days, following a cost-effectiveness study published in the current issue of the New England Journal of Medicine.

Depending on where Americans get their news, they received different summaries and interpretations of the study. No wonder consumers are confused. Here are four examples:

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Chastened and More Sober, Harry and Louise Return

By Brian Klepper

On Tuesday, Ron Pollack of Families USA led a call with bloggers -- unfortunately, I couldn't be on it -- to discuss  Harry and Louise Return -- the new health reform campaign sponsored by five prominent organizations: the American Cancer Society's Cancer Action Network (ASC CAN), the American Hospital Association (AHA), the Catholic Health Association (ACHA), Families USA and the National Federation of Independent Business (NFIB).

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Health Wonk Review

The biweekly compendium of the best of the health blogs is up over at Worker's Comp Insider.

Health 2.0 on icyou

Check out videos from past conferences and learn all about Health 2.0 at our very own channel on icyou, an online source filled with loads of useful health videos!

Personal genetic companies back in service

By Sarah Arnquist

Two direct-to-consumer genetic testing firms, 23andMe and Navigenics gained approval from California regulators this week to continue providing clients access to and interpretations of their personal DNA.

The NY Times reports this morning that, "The licenses, granted to Navigenics and 23andMe, should help defuse a controversy that began in June when the California Department of Public Health sent “cease and desist” letters to the two companies and 11 others that offer genetic testing directly to consumers."

The news sparked a heated summer debate over whether consumers should have unbridled access to their DNA or whether a doctor should lead the process.

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On Rural Doctoring: The Landscape

By Theresa Chan

This is the first part of a series that first appeared on the blog Rural Doctoring, where Theresa Chan writes about her experience working as a family physician and hospitalist in a rural Northern California community.

I've been reading the blogs of medical students and residents with some interest lately. Their stories about the trials and tribulations of learning to stay awake night and day and how to deal with cranky attendings and even crankier patients take me back to the bad old days of my own residency.

I've also had a few glimpses of the osteopathic medical students (OMS) who are rotating in rural California as they assume their new roles as clinical learners. Hearing about and witnessing these experiences makes me reflect on my own training and the steps I took to become a doctor in a rural community. This post series will examine these steps in more detail, and I hope it will be helpful to trainees who are considering a career in rural health care.

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A.D.A.M. Marketing Manager

Job Posting: Marketing Manager – Healthcare and Technology

A.D.A.M., Inc. is a pioneer in the use of innovative technology to help consumers better manage their health. Clients such as Google, Walgreens, The New York Times and The Cleveland Clinic have chosen to partner with A.D.A.M. due the quality, depth and breadth of our products. And, while we have won countless awards for our products and content, we’re not resting on our laurels. We are continually creating new ways for consumers to engage with our products through the use of latest cutting edge technologies. We are currently seeking a progressive and creative Marketing Manager to help us take our marketing activities to the next level.

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Back-to-school specials at the retail clinic

By Jane Sarasohn-Kahn

People have begun to ration themselves off of medical visits and prescription drugs, according to the National Association of Insurance Commissioners (NAIC).

One in 5 Americans said they reduced visits to the doctor due to the slowing economy. One in 10 have reduced their prescription drug intake.

The NAIC found that 85 percent of Americans have made a change to their health insurance policy.

In related news, Take Care Clinics, part of Walgreens, is offering school and sports physicals for $25 to patients 18 months of age and older. The clinics will also certify that kids' immunizations are up-to-date. The launch of this targeted service is well-timed for back-to-school physicals when pediatricians' offices can be very busy in the weeks leading up to school starts. Take Care's press release has been quick to point out that, "School and sports physicals at a Take Care Clinic do not take the place of a child’s yearly routine health exam and complete developmental assessment." Take Care has about 200 clinics in 14 states.

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A.D.A.M. Product Manager $100-$110K

Job Posting: Product Manager – Healthcare and Content Solutions

A.D.A.M., Inc. is a pioneer in the use of innovative technology to help consumers better manage their health. Clients such as Google, Walgreens, The New York Times and The Cleveland Clinic have chosen to partner with A.D.A.M. due the quality, depth and breadth of our products. And, while we have won countless awards for our products and content, we’re not resting on our laurels. We are continually creating new ways for consumers to engage with our products through the use of latest cutting edge technologies. We are currently seeking an experienced Product Manager to help us take our products to the next level.

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Health IT policy: the fur is flying

By Matthew Holt

Some fur is flying in the rarefied world of health IT policy geeks this morning. Health Affairs has three articles. The first from Markle’s Carol Diamond, writing with Here Comes Everybody author and Internet guru Clay Shirky, more or less says that obsessive attention to rigid standards is not helping and actually may be hindering the IT adoption process. And yes, in case you were wondering they do mean CCHIT and ONCHIT's current policies and agenda which has been going for four years and which they’re accusing of “magical thinking.” Instead, we need new policies which target desired outcomes measured in improved patient care, instead of assuming that creating new technology standards will get us there. And by policies I think they mean money, and its redirection by current payers. After all, if putting in a RHIO costs hospitals operating revenue in reducing admissions and tests, why would they do it?

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Pay doctors for the value they offer patients

By Maggie Mahar

A frequent contributor to THCB, Maggie Mahar's work has appeared in the New York Times, Barron's and Institutional Investor. A fellow at the Century Foundation, Maggie is also the author of the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.

When Medicare first created a fee schedule, critics suggested that it was a Marxist invention. Nevertheless, the schedule, which lists what Medicare is willing to pay for some 7,000 procedures, has become the master list for physician reimbursement in our health care system: Most private insurers peg their payments to the Medicare schedule.

The notion of deciding the precise worth of some 7,000 diagnostic and therapeutic procedures is mind-boggling. How exactly does Medicare do it?

The process began in the late 1980s when officials at the Department of Health and Human Services decided that the way Medicare paid doctors should be overhauled. At the time, Medicare was reimbursing physicians  based on what was considered “customary, prevailing and reasonable” in a particular market — in other words the “market value” of the service in that region.

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Health care in the YouTube era

By Bob Wachter

August 11th was the 2nd anniversary of the epic implosion of George Allen's presidential campaign, the first defeat at the hands of YouTube. Two recent videos of unattended patients dying in ER waiting rooms leave me wondering whether health care has also entered the YouTube era.

Remember the George Allen fiasco? A 20-year-old Indian-American named S.R. Sidarth, working for Allen’s opponent Jim Webb, was filming an Allen campaign stop in Breaks, Virginia. Twice, Allen pointed to him and called him “Macaca,” a racial slur meaning “monkey.” Once the video hit YouTube, it went completely viral (this clip, one of many, has been viewed 350,000 times) and Allen’s promising political career was toast.

What does this have to do with health care? In the past 18 months, two powerful, highly troubling videos have surfaced of patients being left to die in ER waiting rooms. The first, in May 2007, involved a woman named Edith Rodriguez. Rodriguez began vomiting blood while waiting outside the King-Drew ER, and soon collapsed. Rodriguez’s husband called Los Angeles's 911 system, but got nowhere. Then someone else in the waiting room called:

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Health care in the YouTube era

Video of the woman dying in the emergency room waiting room at Kings Hospital.

Adam Bosworth speaks about Google Health, Keas and everything

By Matthew Holt

After a long period of time I’ve finally wrestled Adam Bosworth to the floor and forced the microphone to his mouth. Adam of course is the software guru (he’s one of the originators of XML) who went to Google to start Google Health, and spent much of 2007 talking about how he hoped Google Health would change health care. He then left Google Health (several months before it launched in March 2008) and at the very end of 2007 founded Keas. Adam will be at the Health 2.0 Conference and while Keas is in stealth mode at the moment, he may just be ready to show us all a bit of Keas’ technology by then.

But he also has very strong views on health technology, data, PHRs. HealthVault & Google Health, and much much more. Listen to the interview.

Connecting the dots between gas and health costs

By Jane Sarasohn-Kahn

Rite Aid, a top retail pharmacy chain, awarded its first Fill Up & Fuel Up gasoline gift cards this week.

I've been writing about gas 'n health care since the inception of the Health Populi blog; see this inaugural post.

Now comes a pharmacy connecting the dots between consumer spending categories: the interdependency of fuel and prescription drugs.

As the differences between price tiers of prescription drugs have increased over the past ten years, I've often asked pharma clients the question: what is the consumer's marginal value of that $20 (or $30 or $50) co-payment compared to something else on their shopping list -- say, a new electric razor for their husband, or that $95 jar of anti-aging skin cream?

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Health reform for ordinary folks

By Sarah Arnquist

When it comes time to vote in November, will Americans know what they're voting for in terms of their health care futures? Will they understand what Barack Obama or John McCain's health proposals mean for them?

Over at Columbia Journalism Review, Trudy Lieberman says they won't given the current media coverage of health reform. The journalism professor critiques the mainstream media's coverage for basically transcribing the candidates' pitches, and says the blogosphere is overly wonky.

"Exactly how will all these economic and political calculations and pronouncements affect those who struggle daily to fill their prescriptions, find a competent doctor, or pay their medical bills?" she asks. "These are the people whose stories the media have yet to tell."

In a series called "Health Care on the Mississippi," Lieberman examines how the presidential candidates' health proposals will affect ordinary folks.

In Part 1, she goes to Helena, Arkansas, a town of 6,300 along the Mississippi River to talk with the working-class residents about health care. Currently, most knew "nothing of the coming health care battle being waged in their name," she wrote.

In Part 2, Lieberman examines how Helena's head jailer and his diabetic adult son would fair under McCain and Obama's health plans.

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A Primary Care Paradigm Shift

By Dr. Richard Reece

Dick Reece is a retired pathologist and a prolific health care commentator with an active following, particularly among physicians. An astute, incisive observer, he is the author of 10 books; the latest is Innovation-Driven Health Care: 34 Key Concepts for Transformation. He is regular columnist on HealthLeaders, and writes his daily posts at MedInnovation Blog. THCB welcomes him. -- Brian Klepper

Something profound is happening in buyers’ and the public’s attitudes towards primary care and the health system. With inexorable rises in costs and corresponding decreases in access to primary care doctors, buyers and the public are mad as hell, and they’re deciding they’re not going to take it anymore. Something is badly and sadly wrong, and corrective measures are being put in place.

Signs of Paradigm Shift

Signs of a paradigm shift – a change in assumptions about the system’s basic structure – are everywhere. No longer do we accept the notion every patient should have a specialist for every disease, every life-improvement procedure, every orifice, and every organ. Care, it’s now assumed, must be coordinated to prevent people from falling through the cracks. We must stop wasting time and resources for patients and the system as a whole.

The U.S. system lacks timely access to primary doctors who oversee care. And specialty services are overused. Yet the U.S. has fewer primary care physicians per capita than any other country in the developed world. On the other hand, we have more specialists per square mile than other countries.

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Flacks peddle false "reality"

By Matthew Holt

Such a pity that the NY Times has been so beaten up by the commies amongst us that it actually now feels that it has to point out where Peter Pitts and Janet Trautwein get their money. Although, as per the last time it let Pitts write an op-ed, it didn’t mention his day job as a PR man for pharmaceutical companies. After all, who could be opposed to “Medicine in the Public Interest” — after all it is in the interest of the public to pay for all and any medicine at any price that PhRMA chooses, right?

And let’s not get started on underwriters (for whom Trautwein is the main flack). After all Grace-Marie Turner thinks that they’re the health care heroes! Perhaps they’re heroes because they drive sick people into the uninsured population so that the under-paid clinical staff working in America’s public and community health system get to show their worth by caring for them —even if they’re less heroic than underwriters.

But that’s OK, Pitts & Trautwein can be printed in the NY Times cherry-picking problems with other countries health care systems. Because as we all know there’s absolutely nothing wrong with ours, eh?

And why should Pitts quote the peer-reviewed 2007 Commonwealth Fund study that showed that waiting times for surgery were longer in the US than in the communist hell-hole of Germany, when instead he was able to cite an 11 year old study about longer waiting lists for one specific type of surgery in the Netherlands, which has completely revamped its health care system since then. Something he and Trautwein have helped stop us doing — preserving a dismal status quo they obviously want to maintain.

Those two wouldn’t last 92 seconds in a debate with Uwe Reinhardt or Hillary Clinton.

On the other hand, there’s no letter from Karen Ignagni to make up the trifecta. Did she negotiate some summer vacation time along with her $1.3m salary?

Inappropriate ER use across the board

By Charlie Baker

Charlie Baker is the president and CEO of Harvard Pilgrim Health Care. This post first appeared on his blog, Lets Talk Health Care.

A few months ago, the New England Healthcare Institute (NEHI) issued a report on non-urgent use of Emergency Departments. It didn’t get that much public attention, which is too bad. It offered some interesting insights.

First of all, inappropriate — or non-urgent — use of the Emergency Room was not limited to uninsured populations. It showed up across the board. People covered by private insurance, Medicaid and Medicare were just as likely to use the ER for non-urgent care as people without health insurance. About 20 percent of all ER visits by privately insured and Medicare patients were for non-urgent purposes. About 24 percent of all ER visits by Medicaid beneficiaries and people without any insurance were for non-urgent purposes.

Second, another 25 percent of all ER visits for each group were for primary care treatable/preventable maladies. In other words, almost half of all ER visits were either for conditions that could have waited at least 24 hours to be addressed, or could have been solved in a doctor’s office.

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