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Re: Be afraid, be very afraid Health Info
From: David Farber <dave () farber net>
Date: Mon, 6 Apr 2009 18:00:24 -0400
Begin forwarded message: From: Thomas Lord <lord () emf net> Date: April 6, 2009 12:08:24 PM EDT To: dave () farber net, gumby () henkel-wallace org Cc: ip <ip () v2 listbox com> Subject: Re: [IP] Re: Be afraid, be very afraid Health Info On Mon, 2009-04-06 at 05:14 -0400, David Farber wrote:
From: DV Henkel-Wallace <gumby () henkel-wallace org>
More generally I don't understand the rush to electronic health records, of all things. There are some serious technical and institutional problems to be addressed (I'm not talking about privacy or other t social issues) and until they have been I don't see the point and in fact consider the shift quite risky.
Some history to answer your question appears below. I had to study this area fairly extensively as part of a diligence process a few years back and then informally continued to pay some attention to it. In 2000, the World Health Organization published a famous report comparing US health care and its costs to the res of the world. Here is a link to a copy: http://dll.umaine.edu/ble/U.S.%20HCweb.pdf Meanwhile, it was becoming widely apparent to many financial industries types that the boomer retirement bubble was going to cause many problems. The state of the "big three" car companies today, for example, was fully anticipated back then. And, meanwhile something the financial types were pretty upset about: the looming threat of a "single payer" system. Health care was recognized (because of the aging demographics) as a big growth industry for the next decade or two yet a successful political move to nationalize the system would suck a lot of profit out of that sector. The WHO report and several others noticed something interesting about the cost vs. outcome stats in the US. The US ranked low in the world in many categories but the VA hospital system, regarded separately, ranked very highly. While people like Esther Dyson were attending symposia for the financial world to study the situation, medical experts close to that society announced the official explanation for the VA system's success. Two main elements: First, VA doctors, including specialists, are paid salary rather than paid by procedure. Second, the VA's system-wide electronic medical records improved outcomes and saved money by reducing mistakes and streamlining assessments of patients. That was the story and they're sticking to it. After 2001, DHS and CDO became very interested in real-time monitoring of population health for the purpose of early detection of deadly outbreaks either from natural events or bio-terrorism. They began suggesting ways for the government to reward medical providers for adopting electronic records system with real-time reporting features. H&HS gathered these various stakeholders in a series of meetings - public hearing panel sessions - around the country. Representatives of health care providers and the insurance industry were represented. They generally speaking formed consensus around the idea of: 1. Not socializing health care. 2. Somehow getting everyone to switch to VA-like electronic records in order to produce cost savings and more secure public health. By perhaps 2004 or so all of the "movers and shakers" had agreed on that general plan. We'd just get private investment in new technologies, changes in labor contracts with providers, and health care would become less expensive and better even as the industry continued to grow. The entrepreneurial side of the financial industry took off. One big symbolic act was Google's hiring of Larry Brilliant in part on the strength of his interest in using Google search queries to detect epidemics in their early stages. Google and MSFT started planning on and building hosting services for electronic medical records. The personal genomics firms took off and it is interesting to note that several of those firms directly took on (by ignoring them) regulatory barriers to their handling of patient medical information. On the smaller end, there were *lots* of new ventures to make practice management software, to build little tablet computers for use in medical offices, and so forth. I haven't tracked those - I presume there's been a decent amount of churning and contraction in that area with a few key players emerging who look fairly strong. Oh, and: political pressure was brought to bear and the VA "open sourced" their medical records system. As the 2008 elections approached, Clinton (H.) had a difficulty in seeking the full support of "high tech" rich folks: she was politically identified as a single-payer (health care nationalization) advocate (rightly or wrongly). The Obama campaign exploited that and several other "our issues" issues of the tech elite. He came out fairly early with that consensus position - drive down costs by adopting VA system management practices - as a centerpiece of his health care platform. The insurance companies, around this same period, had a masterstroke of brilliance: "We must not nationalize the medical system but rather, we must nationalize the patients!" Nothing could please the finance industry folks better than a captive customer: a customer required by law to buy your products. Thus was born the notion of a "mandate" system in which citizens are required to buy insurance. Limited (and likely to be inadequate) aid would be available to those who can't afford it. This famously became law in Massachusetts and has gradually become more and more of a feature of the Obama plan. Even with all of that political greasing of the skids there is still a big, big problem: Hospitals and clinics aren't rolling in dough (most of them). Physicians and other providers are not quick to agree to big changes. Insurance companies - especially the managed care variety - are bloated behemoths about as easy to change in course as a full super-tanker. And, of course, in recent years: private capital is variously sitting on the side nervously or simply gone. How *convenient*, then, that there is a perceived inevitability of the new administration spending trillions for "stimulus". So to answer your question: the reason that there is a big push for electronic medical records Right Now is simply because of the plausible promise that new federal debt can be taken to offset some of the public risk of investing in deploying such systems. Yet another form of socializing risk and privatizing gains. You mention the risk and I assume you mean to the public health, to citizen privacy, and so forth. Indeed. Yet look at the attitude and approach to risk taken by the financial side and you'll see how unlikely you'll get far raising such concerns. The rhetoric around 23andme, a business model that recapitulates some of the risks in miniature. Look at the handling of dissent in that area. Basically, they don't substantially care about the risks (only their own liabilities) and reflexively dismiss the concerns of others as those of Luddites. The new system is going to be *better* for you and if you don't believe that you're just in the way. -t ------------------------------------------- Archives: https://www.listbox.com/member/archive/247/=now RSS Feed: https://www.listbox.com/member/archive/rss/247/ Powered by Listbox: http://www.listbox.com
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- Be afraid, be very afraid Health Info David Farber (Apr 04)
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- Re: Be afraid, be very afraid Health Info David Farber (Apr 07)
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- Re: Be afraid, be very afraid Health Info David Farber (Apr 07)