Monday, February 16, 2009

H.I.L. Forum -- Blogging Health Care

As the health care conversation finally crowds its way into the news cycle I'm tracking a couple more blogs keeping a finger on that pulse. So far the patient's vital signs are stable but the pulse is still very weak. Symptoms indicate a sickness that has made the patient life-threateningly sick but a final diagnosis has not yet been announced.

The H.I.L. Forum focuses on the emerging convergences of healthcare, information technology, and life science by bringing together stakeholders in a variety of forums to discuss issues at the intersection of these sectors and by providing a home for the projects that flow from these forums.

An impressive group of four professionals with sterling credentials started H.I.L. Forum. Read about them at your leisure. As you look closely at health care you will find nothing but sterling CV' s. They all look like that. So if you plan to separate the good guys from the bad ones by looking at their creds, think again. Thus far I have a good feeling about this group, but I'm waiting to see what cards they hold.

Not wanting to be shy, I felt the need to get their entry into the blog world off to a good start, so I left the following comment at the second post I found. So far they still don't have a "preview" feature, so my comment is all messy with italics because I messed up an HTML tag. But that's not important. Content is what is important. The following is what I left.

These are exciting times and this is an exciting discovery: a near virgin blog! I don’t know if my comment will be read by many people, but I want to get my two cents in early.

After a forty-year career in the private sector (food service) trying to squeeze an after-tax nickle or dime out of every dollar of revenue, I worked five years in a “not-for-profit” health care environment. Here are my observations.

1. Accounting methods of non-profits come nowhere close to those of the private sector. Words like cost, revenue, budget, cash flow and profit are used but the meanings are not the same. During five years I never heard a dollar amount of anything mentioned for food, labor or other expenses. Everything was relative to a “budget.” When I asked where the money came from and how much it was I got deer-in-the-headlights looks.

2. Hospitals have two main revenue streams: government and insurance. Co-pays and tax-deductible contributions are important but the least important source of revenue is from those being served. In the private sector we called them “customers.” In health care they are called “patients.” Customers know about costs. Patients have no clue. Take it from there as you have your meetings.

3. Using the magic of a Google highlighter I was able to look for the word “insurance” in every post from the start of this blog. Most of the contributions were from providers and other professionals, although I noticed one by someone from the insurance industry. With private for-profit insurance companies having such a large part in the costs of the delivery of health care, there is something wrong with that picture. Providers are experts at providing quality health care but generally have a poor understanding of business. (Unfortunately, politicians suffer from the same handicap. I think it would be helpful if business operators accustomed to analyzing costs would be a good resource. This does not include the insurance industry.)

4. The mission of insurance companies is not to deliver health care. Providers deliver health care and insurance companies ration health care. The mission of providers is to earn a living by delivering health care in all its forms. The mission of the insurance industry is to make profits for their shareholders and collect enough to remain competitive with others in the business by offering performance bonuses to (non-medical) employees from brokers to executives.

5. We have at least five different delivery systems for health care in America, not counting private pension plans. The VA is as close to socialism as we have. Government employees and their families have a special plan. Military people and their families have Tri-care. Medicare and now SCHIP furnish another form. And finally there is a variety of snatch-and-grab ways to take care of the rest of us (unemployed, untouchables with pre-existing conditions, Medicaid recipients) that don’t fall into any of the other four categories.

6. My wife and I will qualify for Medicare in April and are facing a bewildering array of options. I understand the principles behind Parts A and B, the deductible for Part B and the need to have supplemental (medigap) insurance. But in addition we are confronted with an array of so-called “Advantage” plans which are some kind of hybrid created when the insurance industry invited Medicare to give them money to become Uncle Sam’s TPA. (That’s an abbreviation I learned last week which stands for “third party administrator.” That’s what self-insured companies employ to administer health care plans. It’s a way of keeping a cap on corporate expenses without risking any profits on the part of the administrator. Nice work if you can find it.) I find that for several Medicare Advantage plans in my county the premium is ZERO! What the hell is that all about?

7 There is a toxic, incestuous, symbiotic relationship between the insurance industry and health care (now including Medicare itself) which is the business equivalent of HIV-AIDS. There may not be a cure, but until a cure is found your mission is to find a cocktail that will keep this disease in check until we can come up with something that will eliminate it altogether.

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Here endeth the lesson.

Before I leave the subject, I want to point to a deliberately negative, misleading attempt to kill affordable universal health care while still in the cradle. The Wall Street Journal last month reported that "The drug and medical-device industries are mobilizing to gut a provision in the stimulus bill that would spend $1.1 billion on research comparing medical treatments, portraying it as the first step to government rationing." Indeed, Betsy McCaughey, former lieutenant governor of New York, adjunct senior fellow at the Hudson Institute and long-time opponent of universal health care, last week published a damaging hit piece conflating clinical clinical effectiveness research with cost effectiveness in a misleading effort to frighten people with the notion that government is attempting to ration their health care. I'm no big fan of AARP but even there someone saw through it. Ms. McCaughey has a fifteen-year history of fighting universal health care, going back to Hillary Cllinton's ill-fated attempts.

As this debate unfolds I expect a serious and quite ugly fight to develop as Big Pharma and Big Insurance break out their big guns. Those two powerful interest groups together with Republican politicians who now have little to gain and everything to lose in the midterm elections by being a "loyal opposition" create a perfect storm that can kill off meaningful health care reform for years to come.

Copied from Wikipedia...

In 1994, McCaughey (as she was then known) vigorously criticized the health care reform package proposed by Bill Clinton in a widely read article in The New Republic. The piece, "No Exit", won the National Magazine Award for excellence in the public interest. Supporters of the Clinton plan (including some of the editors of the New Republic) were vociferous in their criticism of McCaughey's criticism. (Andrew Sullivan, The New Republic's then-editor later acknowledged "I was aware of the piece's flaws but nonetheless was comfortable running it as a provocation to debate.") While the article was seized by conservative commentators seeking to discredit the Clinton plan, much of McCaughey's article later proved inaccurate; particularly, her claims that "the law will prevent you from going outside the system to buy basic health coverage you think is better," and that "doctor[s] can be paid only by the plan, not by you" were flatly contradicted by the text of the legislation. (Section 1003 of the Health Security Act provided that "[n]othing in this Act shall be construed as prohibiting the following: (1) An individual from purchasing any health care services.")

The New Republic ultimately recanted the story and apologized for it.
On February 9, 2009, McCaughey wrote an opinion piece for in which she posited that the 2009 stimulus bill was "dangerous to []our health". She claimed that the stimulus bill would cause a newly created office to "monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective" which was, in essence, "enforcing uniformity." The portions of the text to which she cites, however, do nothing of the sort. Sec. 3001(b) of the bill, which sets forth the "purposes" of the substantive provisions, does not in and of itself do anything but set forth the reason for the substantive provisions. The bill gives the Office of the National Coordinator for Health Information Technology no duties to review actual treatments but only to establish standards for a technology infrastructure that would allow doctors to better guide their patients' treatments and to ensure that doctors are given the appropriate tools to establish a proper course of treatment.

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