Diet and Nutrition. Natural Health, and Healthy Living

I’m viewing the latest rumblings in the US health care debate from the confines of a clear but cold Britain, where the big news is that the country is joining the PIGS in entering economic meltdown—or at least being a lot more broke than it thought it was. (PIGS are Portugal, Greece, Ireland & Spain, not farm animals). And yet it appears that health reform is making if not a comeback then at least vigorous palpitations. The reason for this seems to be the strength that the Anthem Blue Cross/Wellpoint premium rises have imbued into the Administration.

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According to the headlines, 10 percent of Americans are unemployed. The truth is that closer to 17 percent of the population cannot find full-time work; this number includes workers who have become discouraged and have given up looking for work as well as those who have settled for part-time jobs because they cannot find the full-time employment that they need.

The situation is not going to change anytime soon. As Princeton economist Paul Krugman recently warned: “We are facing mass unemployment — unemployment that will blight the lives of millions of Americans for years to come.”

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Right now, American health care information technology is undergoing two enormous leaps. First, it is moving onto Web-based and mobile platforms - which are less expensive and facilitate information exchange - and away from client-server enterprise-centric technologies, which are more expensive and have limited interoperability. In addition, more EHR development activity is headed into the cloud, driven by large consumer-based firms with the technological depth to take it there. Both these trends will facilitate greater openness, lower user cost, improved ease of use, and faster adoption of EHRs.

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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.”

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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.

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"Oft expectation fails, and most oft there

Where most it promises; and oft it hits

Where hope is coldest, and despair most fits."


All's Well That Ends Well (II, i, 145-147)

 
 



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 changeddramaticallyalong the way.

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Until now, non-health care business has been noticeably absent from the health care reform proceedings, and quiet about the bills' impacts on their management of employee benefits, on cost, and on the larger issues of global competitiveness. Where have the voices been of the powerful business leaders who will pick up much of the tab?

They've finally surfaced, and now we'll see whether they have the will to bring reform back on track. They certainly have the strength. The question is whether this salvo by the business mainstream could force Democrats to reconsider and revise the content and structure of their proposals.

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It’s always fun to see my friends beating each other up in public....and if you read down in the comments onthe post published yesterday you’ll see a significant dispute between Maggie Mahar and the Klepper/Kibbe/Lazsweski/Enthoven team (who I'm calling the Four Horsemen from now on). But I think that right now we need to change what we're talking about.

I'm with Maggie in that there is potentially more in terms of changing the payment system in the current bills than nothing, but it's not that much more than nothing. However, pressure from the the Four Horsemen and their fellow travelers on payment reform may increase that section of the bill as it gets worked outon the floor and in the Congressconference committee. Their pressure willalso serve notice that aware, sensible people are looking at the issues of payment and delivery reform.

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Not so long ago, July this yearin fact, PhRMA boss and former Dem Blue Dog & RepublicanBilly Tauzin toldthe Aspen Health Forum that a straw poll of Democrats at dinner with him in DC all said that they didn’t think there’d be a public option in the final bill arriving on Obama’s desk. By the way Tauzin, Dashle, and the rest all said that there would be a health care bill passed in 2009 even though the summer of “death panels’ was just getting under way.

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At last weeks Health 2.0 Conference Maggie Mahar, author of HealthBeatBlog got more than a little feisty about Al Waxman's suggestion that we make people with bad health behaviors pay more. She said that 95% of smokers had some form of mental illness, and therefore we were punishing the mentally ill. Really? Read on for Maggie's explanation (lifted at her request from a comment elsewhere).--Matthew Holt

According to the New England Journal of Medicine,

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