Diet and Nutrition. Natural Health, and Healthy Living

Yesterday we tried to put EHRs into perspective. They're important, and we can't effectively move health care forward without them. But they're only one of many important health IT functions. EHRs and health IT alone won't fix health care. So developing a comprehensive but effective national health IT plan is a huge undertaking that requires broad, non-ideological thinking.

As we've learned so painfully elsewhere in the economy, the danger we face now in developing health care solutions is throwing good money after bad. We don't merely need a readjustment of how health IT dollars are spent. We need to reboot the entire conversation about how health IT relates to health, health care, and health care reform. To get there, we need to take a deep breath and start from well-established and agreed-upon principles.

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Kibbe & Klepper are back with an update to their pre-Christmas piece on EHRs and the forthcoming Obama Administration's investment policy towards them. Lest you think that this is just a small group here on THCB and fellow traveler blogs shouting to each other, I'd point you towards the Boston Globe article about their previous "Open Letter," which shows that this discussion (and a similar piece on THCB from Rick Peters) appears to be being taken very seriously. As it should--Matthew Holt

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In last week’s NEJM, physician-author Abraham Verghese paints a disturbing picture of a medical world in which technology has morphed from tool to object, the patient relegated to a supporting role. To me, Abraham has nailed the diagnosis but not the treatment.

I had the distinct pleasure of getting to know Abraham when we both served on the board of the ABIM (actually I came to know his work 15 years earlier, when I reviewed his bestselling book, My Own Country, for the NEJM). Abraham is a romantic and a traditionalist, and in last week’s New England Journal piece he poignantly lays out a problem he has fretted about for years: namely, that information technology is dehumanizing the practice of medicine. Describing rounds with his ward team at Stanford, his new academic home (he was recently recruited there from the UT-San Antonio), he recalls:

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Those of you outside of Washington, DC likely missed the Washington Post's three-part investigation of the events leading to the downfall of AIG.

It makes for good holiday reading. I highly recommend the series to you.

Knowing the culture at AIG from many years of activity with the company and its leadership, I can tell you the story certainly has the culture right.

While this is not a health care story per se, it is a story about risk taking and understanding, and never getting cocky about, risk. AIG execs argued for years they really had no risk in their credit default swap business. My experience is that when someone is willing to pay you lots of money to lay a risk off on you--in this case a whopping $80 billion of exposure--there is risk.

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Like legions of other wonks when I discovered that Tom Daschle was going to be Obama’s point guy on health care, I sent off for a copy of his book Critical. It’s a fast and easy read, but in its examination of the problem it doesn’t add much to superior books on what’s wrong with health care (much of the first section reads like an undergrad’s attempt to summarize Jonathan Cohn’s Sick) and there are some pretty weak logic flows and basic editing throughout (he refers to the book Uninsured in America on p155 as though it’s already been introduced before it actually gets introduced on p161). But ignoring all that, what does Daschle suggest we actually do?

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I get asked this question a lot these days, which shouldn’t be that surprising. Harvard Pilgrim is headquartered in Massachusetts, and the Massachusetts health care reform plan is already a couple of years old. More importantly, it has added about 440,000 people to the insured ranks (185,000 through unsubsidized private plans and another 255,000 through subsidized, Medicaid-like coverage), has maintained high employer participation (over 70%) and doesn’t appear to be crowding out private coverage as public coverage expands.

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As we inevitably do this time of year, we prognosticate about the new year. This time around, it's a toughie: there are too many uncertainties that preclude us from doing a straight-line forecast for 2009, especially in health and health care.

Here are some trends and wild cards to keep in mind for 2009: the year of managing risks.

How will the macroeconomy play out against health care in the new year? Keep in mind the Kaiser Family Foundation's metric on unemployment: an increase of 1% unemployment leads to 1.1 million uninsured, and 1 million more people added to Medicaid. This was the math that worked in 2007-8. The metric will probably change in 2009 as Governors struggle to balance budgets while providing medical services, education, and safe streets to citizens. The National Governors Association, and the individual state heads, have all warned that Governors will inevitably cut services in 2009 and into 2010 if tax receipts continue to decline.

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The Obama-Biden Transition Team has encouraged individuals across the country to gather in small groups with friends and neighbors to discuss their ideas for health care reform. The team provided a background paper, discussion guide and a specific list of questions as a framework within which citizens could provide feedback to health reform czar-designate Tom Daschle. More than a thousand would-be hosts have officially registered on the change.gov website, and my wife and I were recently invited to one such gathering in a small village (yes, that’s the official designation) north of Chicago. My report below is not the official one.

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Here’s a greeting card conundrum. What exactly do you say to an 82-year old man who, emailing you about a joint project you were working on, notes that he has just survived “a 12-foot backward fall into a jagged confined space. Result at least 6 smashed cervical and thoracic vertebrae. [But] no paralysis! In a halo and off full duty for a while, but eager to rejoin the hunt.”

“Get well soon” seems so pallid a reply.

Paul Ellwood, who survived this most recent harrowing accident, is best known as the man who originated the term health maintenance organization and then got the federal government to support the concept. He was also one of the first policy thinkers to push vigorously for patient-centered measures of care quality, through his Jackson Hole Group and, since the mid-1990s, on his own.

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Thanks for reading THCB this year. Thanks to to all the authors who we’ve featured and thanks to John and Sarah for keeping the train on the tracks. And thanks to all who commented and made THCB a great place for educated debate about health care issues.

We’ll be posting a little over the next week with some forecasts for 2009–-which is shaping up to be an interesting year in health policy at least. And there’ll bea new look for THCB early in 2009 too.

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