Senate stimulus bill strips provisions giving the unemployed health care
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Combing through his section of the bill, law professor and health care author Timothy Jost noticed that the Senate had removed the House provision that would allow people 55 and over who are laid off to continue COBRA coverage at a subsidized rate until they're 65 and eligible for Medicare. The House version also made folks who were laid off temporarily eligible for Medicaid; the Senate version strips that out, Jost found. Every one percent increase in unemployment throws more than a million people into the ranks of the uninsured.
And read the comments, too. People are ready to get rid of the insurance companies; it's just the Village that isn't.
And even more amazing:
Real journalism from HuffPo. Read the whole article for how they got hundreds involved in reading the bill. More like this please.
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too cool
i'll consider signing up.
the medical devices industry seems to be about as crooked as the drug industry, so i hate to be seen approving of anything they say, but i too think we need clinical effectiveness research, not cost effectiveness research. can't say i agree with them about the "national coverage determinations" though, but that's mostly because i can't figure out for sure on that one, and if i can't figure out what they're saying then i'm against it.
keep an eye on the device peddlers
They want to assess efficacy (change in outcome measured by survival, quality of life, patient satisfaction, etc) and not track cost effectiveness (cost of Device A versus Device B, cost of device and procedure in dollars per added year of survival, etc) because that is the most advantageous method for the device manufacturers.
Let's say that a new device shows an increase in efficacy, but at a cost that is twice that of the old device. It might be a fair trade, but at some point as this pattern continues the escalating cost outstrips the ability of the system to pay for it regardless of benefit.
Both measures are needed. We should support development of new devices (and drugs) that provide better outcomes, but we also need to accept that we do not have unlimited resources. The device manufacturers would prefer that we not track the second part of the equation, and just pay more and more for each new generation of marginally incremental improvement in efficacy.
The next generation of healthcare devices and drugs must provide increased efficacy at lower consumer cost, in order to make them widely available.
cost effectiveness... bwah hahahahahahaha!
your faith in the market is touching.
if you have a single payer system, where an item is available to everyone for the same cost, then you have some justification, maybe.
but in our present system, with its thousands of buyers, payers, and resellers, the 'cost' is going to depend on some unholy and unpredictable combination mad negotiating skillz, number of layers, and how much each layer can skim off for itself, not to mention all the price fixing, price gouging, price wars, and gaming of the patent system.
yep, i realize what the device manufacturers' motives are here [and yes all my examples are from the drug industry] but cost control and cost effectiveness are both going to remain mythical creatures until you knock out all those other problems. none of the obaukennewydencare* plans tackles any of it that i can see.
one payer, negotiating a single price for each item [or service], can cut a lot of fat out of the system. then we can decide whether or not to spend the leftovers on avastin or liver transplants or what-have-you.
* must give credit where credit is due, even if they're the enemy. best healthcare mashup evah.
clinical effectiveness and electronic records
Electronic records could* provide a treasure trove of data on clinical effectiveness for so many different aspects of medical treatments. When you have companies controlling the clinical trial data and have doctors scattered across the country monitoring the outcomes it is rare when you get solid collections of unbiased data.
* I'm assuming privacy issues are taken care of. Of course it could be done incompetently as well.
yes, they could
the problem, as i see it from reading health wonk blogs, is that most health it geeks seem to be expecting to use billing data, rather than actual treatment data, for comparing effectiveness. two things i see wrong with this, if we keep the private insurers, is 1. that there's a lot of outright fraud in the system [stuff billed for, but never actually done] and 2. the various delays and denials that insurers inject will affect outcomes.
if you first establish a publicly-funded, publicly-run, fully transparent system, with aggressive auditing to look for fraud [and routine data maintenance to go make sure fraudulent charges don't end up being counted as actual treatment], as well as treatments not being interrupted by bureaucratic delays, then look at billing vs outcomes, then maybe it could work.
well-designed, rigorously-conducted clinical trials, with all results reported, favorable or not, would be terrific, and you don't really need an it infrastructure for that. the two are generally being touted as one package: wah! we can't do effectiveness research without electronic health records!
maybe its environment
Having been within the confines of an academic hospital for the last 8 years, I have a different view of what researchers want to do. No legitimate scientist I've encountered would want to use billing data instead of real data. I'm thinking along the lines of VA reporting such that your records are within the system such that no matter where you are, your records can be retrieved. To be sure, a single payer system *wink wink* would make the implementation easier.
There are many researchers who are trying to improve the clinical trials process without having access to a national electronic tracking record. In a sense, the original clinical trial tracking is orthogonal to more nationalized electronic records. The longer term and subpopulation data, however, will benefit most from e-records.
agree with you about the scientists
but it's not clear whether we'll end up with an actual science-based system or not, at least to start with. if the policy wonks and it geeks and managers listen to the end users and give them what they need, cool.
but i've been doing it implementation [non-medical] for pretty much the same time you've been been doing the academia thing [which is way cool, and a long time ago you said you were going to give us some science posts]. i've been fortunate to work on projects that have been primarily user-driven, but not all of them are.
the va's vista system is by all accounts pretty darn good, but there are a lot of health it geeks out there calling for its demise. some of their critiques seem legitimate, but there's no doubt that inventing a whole new system [or tying together lots of existing systems] will create jobs for them.
one of the reasons i fear for the billing vs real data issue is that the obama-approved wonks, advisers, and admirers all seem to be enamored of the dartmouth atlas, which appears to be based entirely on billing records.
Ride the EHR pony, let the spinning wheel turn.
Effectiveness/outcomes/safety will be aggressively tracked and managed as long as there is a private-profit concern somewhere. Surgeons, hospitals and doctors WANT less invasive tests, simpler interventions, and shorter stays. It directly impacts the bottom line. It makes their lives infinitely easier. (They also want credit, so the whole "public good" thing can be a tough sell.)
I'm not so worried about research. Anything that is guaranteed anonymity, a physician or site will be happy to share outcomes data. Guaranteeing anonymity/privacy/whatever you want to to call it - and nothing less - is what is necessary. Bring that to the table (along with some professional licensing requirements) and you'll wipe away a lot of resistance.
I think the ball to keep your eye on in the establishment of ObamaNet is a camel's nose of tort reform, and perqs for insurers in giving them an excuse to not pay for "unnecessary" tests.
No facility or physician is going to sign on to a deal where they rely on others' recordkeeping and reports and histories to make treatment decisions about a patient on hand, and forego an "unnecessary" test. They don't do it now. They know that medical records are like sausage and laws. Part of all that "unnecessary" testing is lawsuit prevention.
The private-insurer twist is that with a national health database, with access granted to private insurers, a private insurer (and not a physician) can decide whether a test is unnecessary (and ineligible for reimbursement) based solely on the availability of a recent enough test result, and making none of the value judgments which physicians sometimes must.
Spend less time on the phone getting pre-certs!
We'll shoot you down in email in _seconds_!!!
spinning the ehr ponies
yep, that's what it looks like to me. i'm not at all sure they're serious about the clinical effectiveness part.
ha hah hah ha! "privacy is assured!"
sorry, just had to be snarky there. i'm sure no one could predict the sale and blackmail of amurkin public health data to russian IT gangs, republicans, or greedy gov't workers. that just couldn't happen. evah.
/slinks off to bed/
As long as USB drives, laptops, copiers and MS Excel exist,
Any one of our medical records for any aspect of our health will be for sale by the highest bidder.
Viz this:
http://tinyurl.com/d8ee7s
One clerk checking people in for surgery was never caught by her hospital. Only when the conspirators were stupid enough to let their storage unit get behind in payments did some Average Joe buy it, find hundreds of ids there, and call a news station because the police? Did not give a damn.
The weakest link for any electronic security practice is the employee.
With all the money TARP's giving anyone with a Swiss bank account, PLUS, ahem, FISA, you think security matters to anyone who wants to harm someone else? Really?
Computers can be built
With no external access, like USB drives.
They could be allowed to interface only with each other, with only one central server allowed to transmit data outside, to the database. The weak point there are the administrators of that server, which is a lot smaller group than every Joe and Jane with a logon function.
Closed information systems are possible.
True. But computers without printers?
employees without phone-cameras to screenprint records? Workarounds will happen.
Also, and addendum:
Hospital worker says she stole 20 identities a week