Healthcare Informatics Technology

As we look for more and more ways to save money on health care, the California Health Care Foundation released a report in 2006 that explores the world of open source software for health care.[1] This report looks at the advantages and disadvantages of the open source software for healthcare and looks at such public domain turned open source software as VistA (the Department of Veterans Affairs “Veterans Information System and Technology Architecture”) and OpenVistA.

If we are going to truly reduce costs in healthcare, then we are going to have to turn from our “tried and true” models of doing business. However, we must be careful that we do not “throw out the baby with the bath water” in our effort to change models. Requiring everyone to have healthcare can very easily lead to no one having good healthcare. Should everyone have access to quality healthcare? They should and they can, but not by denying their freedom of choice in choosing their providers. We have, for the most part, already done that for the majority who get their healthcare through their employer. Employers can not afford (nor should they be required to) carry a writer to every plan that exists in the industry. So we are restricted to those one or two plans our employer carries, which generally will mean choosing between a “high” option and a “low” option. The difference is the amount of coverage and the cost of the deductable. If the low option is too low, and the high option is too high, then you just have to suffer with it.

True freedom of choice would mean we could choose our provider and our provider would not have to jump through multiple hoops to be “acceptable” to any insurer. Additionally, we could choose our own “plan” by selecting the best of every insurance company. Perhaps we like the out-patient features offered by Blue Cross and the pharmacy features of Aetna. The preventative care features of State Farm might look good along with the alternative care features (such as chiropractic and massage therapy) of Kaiser. The problem is no one provides insurance by the “feature”. All insurance is sold by the “plan”. Maybe someday we will have freedom of choice, but not yet; not yet.

We have gone a long way to get people to stop smoking by taxing it to the point where no one can afford to smoke. We made the argument that these taxes would be used to pay for “smoke related illnesses” that the American taxpayer was currently paying. That seemed like a good argument, except that the real reason was the campaign to convince people how unhealthy smoking really was just was not working. If I can not convince you that smoking is bad for you, then I will make cigarettes $10 a pack instead of $10 a carton so you can not afford to smoke. According to the statistics, a large number of people have finally “seen the light” and quit.

The problem we are having now is that the healthy people, the “non-smokers” of healthcare are saying, “I’m a healthy person, why should I pay high premiums for health insurance I never use?” This type of logic would seem to make good sense from a personal perspective. I know people who live in large metropolitan areas who don’t own cars. They live and shop in their own neighborhoods and commute to work using mass transit. When they want to leave town, they rent a car and that is cheaper than the monthly upkeep and insurance on a car.

The President is quoted as saying, "People have made some pretty compelling arguments to me that if we want to have a system that drives down costs for everybody, then we've got to have healthier people not opt out of the system," Okay, so if we want to make sure the American automobile industry stays sound, then every American should be compelled to own at least one American made car. Buy as many of any other car as you like, but you must buy at least one American made car at least once each decade. Truthfully, if everyone is compelled to have health insurance, as President Obama desires, then the cost for all to have health insurance will surely go down; won’t it? I mean, if we equally share in the bounty of our economy then we can eliminate poverty, right? At least great thinkers like Karl Marx have thought so.

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1. "ABC News Exclusive: President Obama Shares His Health Care Vision - ABC News." ABCNews.com - Breaking news, politics, online news, world news, feature stories, celebrity interviews and more - ABC News. 24 June 2009. 24 June 2009

# posted by R. Kay @ 4:24 PM 0 comments

The government has set up a new site at http://www.healthreform.gov in which they are carrying on the campaign to reform health care. The site is well put together and very informative, citing not only stories of families who have suffered through the loss of health care benefits, but also success stories of companies (like Safeway) who have flattened increases to their health plans by instituting incentives for a healthier lifestyle for their employees. Way to go, Safeway!

Secretary Sibelius has released a new report about the rise in “out of pocket” expenses, and we believe her numbers are sound. However, out of pocket expenses rise when health care costs rise, and everyone (including members of Congress) are quick to blame the courts and huge awards for injury and suffering as the reason for the rise in the cost of malpractice insurance. Meanwhile, a scientist at Harvard Medical has found that the cost of awards for malpractice have risen very little during the last 20 years.[1] This 2005 study makes note that the sharpest rise in malpractice insurance premiums occurs during the years of the greatest revenue loss from investment income. While the connection was not pursued, it was noted as a significant possibility for the rise in malpractice insurance.

Meanwhile, the President says the new public health plan is, “an important tool to discipline insurance companies.”[2] Since when is it the responsibility of the Federal Government to “discipline” American business? Perhaps we should change the title from “Mr. President” to “Big Daddy”. With the quality of speech writers available to the President, you would think a better choice of words could be found.

Later…

Depending on who you are reading, a government plan for healthcare is either in real jeopardy or is going to be pushed through no matter who is against it. One ray of hope is the comment, “Over the break, comments from constituents could determine whether Congress sticks to its goal of passing legislation this summer.”[1] This means, as it should, that the constituents have a chance to weigh in on the President’s plan.

It was also announced on Monday that the President had reached a deal with the pharmaceutical association to reduce the cost of name brand prescription drugs for seniors. This would be great news, except that Ken Johnson, spokesman for the pharmaceutical association is quoted as saying, “"There are a lot of discussions going on right now, there are a lot of moving pieces, there are a lot of elements to it that have not been finalized.”[2] This begs the question if an agreement has been reached, or could some of these “moving pieces” kill the deal?

What can be seen emerging as some sort of “bottom line” is that the American people are going to have a chance to weigh in on all of these issues during the July 4th Congressional Break. Representatives and Senators will be back on their home turf, and this will be the time to connect and inform. Understand that if the majority of people want socialized medicine, as the polls would indicate, then that is what we will happen. We can always figure out how to pay for it later, maybe. This much is certain, the President is wasting no time spending all the political capital he managed to accumulate through the election. Come 2012, he will either be seen as the answer to our prayers, or the biggest villain since Saddam Hussein. There doesn’t seem to be a lot of middle-ground here.


[1] Alonzso-Zaldivar, Ricardo, and Philip Elliot. "Democrats may go it alone on gov't insurance plan - Yahoo! News." The top news headlines on current events from Yahoo! News - Yahoo! News. 22 June 2009 .
[2] Loven, Jennifer. "Obama announces agreement with drug companies - Yahoo! News." The top news headlines on current events from Yahoo! News - Yahoo! News. 22 June 2009 .

# posted by R. Kay @ 8:56 AM 0 comments

We have gone over a lot of ideas, but we need to gauge the reaction of the American people. The best folks I know for doing that are the people at Employee Benefits Research Institute (http://www.ebri.org) who do this on an annual basis. According to their latest press release on the subject:

“Survey respondents were asked their reaction to a number of options to expand coverage “in order to make sure all Americans have access to health insurance.” Here are the results:
• 88 percent support (strongly or somewhat) allowing major health insurance companies to offer national plans that anyone can purchase.
• 83 percent support a new public plan option that anyone could purchase.
• 80 percent support requiring insurers to cover anyone who applies—so-called “guaranteed issue.”
• 75 percent support expanding Medicare and Medicaid.
• 75 percent support some form of an employer mandate to subsidize coverage.
• 68 percent support a mandate requiring individuals to obtain coverage, but only 22 percent support fines for those who do not comply.”[1]

Since 88 percent support allowing major health insurance companies to offer national plans to the general public, I wonder how many would support purchasing at the “feature” level?

But let’s look at some numbers, shall we? According to the Bureau of Economic Analysis[2] the Gross Domestic Product for 2008 will be $14,246,600,000.000.00 which is a 3.3% increase over 2007. Now let us look at the President’s Budget[3] the Proposed Budget by Category racks up $3,591,000,000,000.00. When we add $1,245,000,000,000.00 for Funding Levels for Appropriated (“Discretionary”) Programs and $8,249,000,000,000.00 for Federal Government Financing and Debt, we see the budget at $13,085,000,000,000.00. This would be great if our tax system was one of “What did you make?”; “Send it in”. Then we could actually pay for the budget. And now we want to add another $1,400,000,000,000.00 for nationalized healthcare.

Makes you wonder if the majorities listed above had any idea about the cost.

Later…








[1] Employee Benefits Research Institute. 12th Annual Health Confidence Survey:. News from EBRI. Paul Fronstin, John MacDonald, 11 June 2009. Web. 19 June 2009. .

[2] "BEA National Economic Accounts." U.S. Bureau of Economic Analysis (BEA) - bea.gov Home Page. N.p., n.d. Web. 19 June 2009. .

[3] "The President's Budget." Welcome to the White House. Office of Management and Budget, n.d. Web. 19 June 2009. .

# posted by R. Kay @ 7:54 AM 0 comments