Please recommend this post.

By allowing the healthcare discussion to be shelved, which seems a tactic of the Obama administration, we are not dealing with important information. Out of sight, out of mind. One would hope that your post will be recommended here. We must keep healthcare in the news !

Looks as though they may now debbiedoesnothing!

I think Ms. McCaughey’s article is well thought out, but a bit alarmist and missing the gigantic point, which is that electronic health records will save lives. This is a technology that will give public health officials the single strongest tool imaginable to bring life-saving epidemiological information to the attention of the public in near real-time. If this had been in place, we would’ve known about the peanut butter salmonella outbreak weeks sooner by seeing an anomalous spike in clinical data from the various pockets around the country. If we would’ve had this with HIV, or with cryptosporidium outbreaks, or even with potential bioterrorism, well, the benefits are vast.

And it is going to happen. The electronic format has already been designed by the national standard setting organization HL7 and there are already tools in development by Microsoft (Amalga), IBM/Google and Epic using this format (and the codification of these standards already popped up in the federal register on 1/21/09: http://edocket.access.gpo.gov/2009/pdf/E9-1068.pdf). The only question is deployment and penetrance. And by ‘penetrance’, I mean, will it be just for Medicare, Medicaid, VA, and SCHIP? Or will it be all of us, in a nationwide effort like the standardization of electronic transactions under the HIPAA legislation? The language referenced in the proposed HR 1 EH seems to suggest the latter. Indeed, the infrastructure is already being put into place with regional workgroups (Workgroup for Electronic Date Interchange and Ehealth Initiative) working on the gap analysis and figuring out the transition.

There are two distinct things at play here; the consolidating of health care information electronically, and the specter of someone ‘managing care’ via electronic information (which already happens, by the way). Personally, I think there’s a strong argument that the benefits of the former outweigh the concerns of the latter, but I don’t even think that’s an argument that needs to be made. Managing care electronically is really about managing cost. This is a good thing. For example, a CT scan is a frequently used diagnostic tool but it is a test that is unnecessarily repeated as patients go from ER to ER. A CT scan costs around $1500-$3000. Say one hospital does one less CT scan every other day, even at $2000 a test, that’s a savings to that one hospital of $365,000 per year. So yes, someone might tell your doctor not to do a CT scan, but if your doctor sees that one was done 2 days ago and he/she has access to electronic records with the image report, your doctor will not be ordering one anyway. This is something doctors want. They want baseline lab values. They want to reduce redundant tests and wasted time so they can focus more on patient care.

I do agree with Ms. McCaughey’s criticism of Daschle’s “board.” Though, in his book, note that he compares his board both to the UK model, and the Federal Reserve. These are very different entities and I think his idea works better if it is closer to the Federal Reserve model, and not a clinical decision-support group (or what is called a Utilization Management or Utilization Review Committee in the HMO world) as it is in the UK. The Federal Reserve model speaks more to the need for a board that can cut through bureaucracy in the interest of public health. The UK model is more a clinical decision support group. The Federal Reserve model also is a rough parallel to the Connector Board in Massachusetts, which would most likely be the eventual model for universal health care (with many tweaks). Daschle’s book gets ahead of itself and basically thinks it is a foregone conclusion that the national model will be just like the Massachusetts model, and that, you know, it would be passed by Congress. Quite an assumption.

Perhaps you haven't seen the story about the VA hospitals electronic records being screwed up recently resulting in the wrong medications being given out, and the wrong tests done on the wrong patients?

While I agree, electronics is the way to go -- I do not agree that Government should be in the business of deciding (nor insurance companies) whether a procedure is covered or not -- especially if AGE is is used in the criteria formula.

It should be up to the doctor (which Obama claims is what HE wants) and the patient and/or family.

Ezra Klein has a blog posting up about this article:
http://www.prospect.org/csnc/blogs/ezraklein_archive?month=02&year=2009&base_name=lies_damn_lies_and_betsy_mccau

As for McCaughey's broader claim, nothing in the bill, nor in the structure of the federal government, gives the Secretary of Health and Human Services the capacity, funding, authority, or mandate to monitor the medical profession's treatment decisions and decide if they're appropriate. There may come a day when that data is used to make coverage decisions, but that day is not today, and nothing in the stimulus brings it any closer. Indeed, doing so would be a question not of data collection but of payment reform (you'd have to change payment rates to reflect the research). There is nothing on that in the bill. McCaughey is simply lying, much as she did in 1990s. And, like in the 1990s, her lies are convenient, and they're being amplified by opportunistic rightwing outlets. But this isn't the 90s. And the thing about nostalgia tours is they never last very long, and they're never as effective as the original.

Horrible! I'm hoping that when people find out what's in there, it'll lead to a tsunami of support for universal healthcare, instead. We should be looking at reducing administrative costs before applying draconian measures such as this.

But I'm really torn, because in general, I support the stimulus effort...

I've been telling you fools for months this is what Marxists have in mind for us.

If you'll notice, politburo members and family members of the politburo are exempt from these draconian rules. They will continue to have access to any health care their hearts desire.

And of course politburo members will be able to pull strings for those donors and connected ones whom the politburo members wish to keep alive. This is the 'go home and die' healthcare Spric described a few months ago.

This is what I like about TPMer's. They are utterly generous in sharing their knowledge. I read this blog earlier today and since I was unsure and didn't feel up to speed on the details, I waited to comment until I could do a little research. Lo and behold, the research was here when I came back!

Good post. Rec'd.