In an article posted by the Wall Street Journal on January 5th – IBM Chief: IT Investment Will Create Jobs -  IBM CEO Samuel Palmisano presented a report to the Obama transition team stating that a $30 billion  investment in computerizing health-care records, expanding broadband access, and improving the electrical grid could create more than 900,000 U.S. jobs. Considering we spent $2.2 trillion on healthcare in 2007, $30 billion almost seems like small change.

So what are the issues here??

Well first and foremost, IT investments are usually intended to reduce the number of employees and increase internal efficiency.  Will those jobs be short-lived once the IT practices become routine?

Second, the article states that there are very little metrics available (basically none) that site how IT  investments affect job creation. So the report is potentially more speculative than factual?

The good news: the breakdown of the government investment highlights that $10 billion invested specifically in electronic health records could create 212,000 jobs. Not bad.

Dr. Stanley Feld, “Top Health Blogger” by Wellsphere, claims that the healthcare reform agenda has already been set by Obama and Daschle.  You can read his post here.  He has some good points regarding reform and the need to involve physicians in the process.  However, his post struck a chord with me when he wrote about everyone believing that doctors are at fault, and that the government is out to change the way that doctors practice medicine.

I feel that most people agree that the quality of care in our system needs to improve.  Some might agree that reimbursement patterns must shift to reward high quality healthcare and wellness.  Few might agree that doctors are going to have to change the way they practice medicine, whether its integrating information technology and electronic medical records, or estabilishing stronger doctor patient relationships.  I would like to hear your opinions…

In the meantime, I wrote a response to Dr. Felds opinion piece.  It is available below:

“Dr. Feld,

I respect your opinion on the involvement of patients AND physicians in healthcare reform and policy. But without reading the by-line, about half way through your piece, I could tell you were an MD incapable of writing an unbiased piece on healthcare reform.

Problem: Unfortunately, not all doctors are out to service the best interests of their patients and some are most concerned with the thickness of their wallets. When I go to the doctor, why can’t he tell me about how much the services will cost?

Problem: We pay doctors only when patients are sick. You don’t make money if you keep me healthy, now do you?

Problem: The average patient does not understand medicine or the CONFUSING healthcare system.

The worst part of it all – is that I would argue that most MDs do not understand the system either. While I agree with you that “Socializing” healthcare is not the appropriate answer to our problem, I whole-heartedly disagree that the government is trying to “FORCE DOCTORS TO CHANGE THE WAY THEY PRACTICE MEDICINE.”

Let’s not equate “changing the way doctors practice medicine” with “changing incentives and reimbursement.” This is about keeping more people healthy and increasing the quality of care delivered. This is about rewarding physicians for delivering high quality care and keeping their patients healthy. This is about asking doctors to do their job efficiently and accurately. If to do this doctors have to change the way they “practice medicine,” then I might argue that they entered medicine for the wrong reason to begin with.
Transparency. Accountability. Competition. – Its time to make some changes in healthcare!”

I can only imagine how many differing opinions there are about how to solve our healthcare crisis.  But how many opinions are out there about what is wrong with our healthcare system?  Dare I start a list…

Anyhow, in doing some recreational reading and email sorting this morning, I came across a link to an article (sent from a colleague) “Government Contemplates Financial Bailout While Taxpayers File Bankruptcy for Medical Bills – When Will Congress Intervene in Skyrocketing Healthcare Costs?”  Great title, right? As I read through the article I couldn’t help but wonder how many people think that our healthcare problem should be “solved” by our government. Yes, yes, please let the government solve our healthcare crisis (read: tax payers pay for it).

I do not have beef with the article, or with the government “solving” problems for that matter.  The piece is very well written and highlights the problems and costs Americans are facing in relation to their health expenses.

I guess my question lies in this last paragraph, “The unacceptable result of all this is that an increasing number of Americans are foregoing expensive but much-needed drugs and treatments, including those for serious conditions such as diabetes and high blood pressure, which if left untreated can result in worsening conditions, hospitalizations, or even death. The problems in our health care system need to be addressed by Congress now.”

Hmmmm, so what does Congress do… implement a mandatory exercise hour across America?

Our solution has to be a JOINT EFFORT.  This is not solely the government’s problem!!

Yes, a lot of this is their fault. However, I would argue that there are five major players in this mess, one of which is the government. (See my previous posts for the four contributors – since then I have added one). The other four: doctors, pharma (newly added), individuals, and insurance companies. Unfortunately, I have yet to appoint percentages of blame.

The majority of Americans know our system is failing, but are unwilling to make any sacrifices or changes. We have had a third party paying for our care for far to long, with ever increasing bottom lines and stricter rules for coverage. On top of that, the government cannot bail us out of our obesity (or sub other unhealthy behaviors) and sense of entitlement. Insurance companies sure aren’t going to help either.

There are three things that are going to help fix this system, and individual accountability is one of them.  We have to stop running to the doctor every time we have the sniffles. We must make health and wellness a priority – and start exercising.  Second, is transparency.  No one really knows what the true cost of healthcare is.  Guess what folks; an office visit does not cost $20.  To be accountable, cost and quality information must be available to consumers.  Last, is competition.  By being accountable for our decisions, and knowing the true cost and quality of healthcare, providers can begin to compete for our care. Until doctors/hospitals have to be accountable for the quality of care they provide and the amount they charge, nothing is going to change.  Every other market has competition, why should healthcare be any different.

Great article from a freelance writer in The Morning Call. Richard has some of the ledgers from NY and Pennsylvania banks the 1950s to 1960s showing how household expenses were distributed. Of particular note is that the family paid all of their medical bills in cash. When someone came down with a more serious illness, there were more and more payments finally totally a whopping $1084 for a fairly serious medical condition. It offers a great idea of household life during those times prior to privatized medicine and reminds us as we see the shift to consumerism in healthcare that history always repeats itself.

The proof of our book is in and people have already started to latch onto the free downloadable PDF version at My Healthcare Is Killing Me.

Seems like we might have struck a bit of a nerve.

Thanks so much to Bob Coffield for the shout out on the book. Can’t wait to catch up with him at Health 2.0 in just a few weeks. Bob is a master of Twitter. If you don’t know him, he’s @bobcoffield.

We’ll probably catch a lot of hell from Steven Krein at OrganizedWisdom for not calling it change:healthcare, but we’re working on that as another title and hope to have it out before November .

And many thanks to the others like Frank Hone and “Why Healthcare Matters” and Zane Safrit who have started to pick up on the book.

“The doctors said he’s comin’, but you’ gotta pay in cash”

-The Eagles

We’ve enjoyed a bit of a free ride for the past several decades when it comes to healthcare. Employers and the government have picked up much of the tab. But now we are starting to pay the price literally. Increasingly we are asked to pay for medical services. Locally, The Tennessean just featured a piece on a doc who is going to charge his patients $1,500 annually to maintain access to him. We had best get used to it.

I have nightmares of other businesses becoming like our current healthcare system. In these night terrors, I go to buy groceries, pay a $20 co-pay and then get the bill 30-45 days later, can’t understand what it is I got, have already consumed the product and am expected to pay far more than I would ever have dreamed it might cost.

Predictable costs in healthcare will have to become more the norm. Concierge healthcare is becoming more popular. Just ask Jay Parkinson, M.D. who has had a concierge practice in NYC and is starting Hello Health. He uses REAL docs, not nurse practitioners like the retail based clinics (RBCs), but like the RBCs, Hello Health has [gasp] transparent pricing. You will actually know what you are paying at the time of service. Novel concept.

It’s a different way of thinking and doing business on the healthcare front, but it has tremendous merit.

Our unfettered access to the healthcare system has taken much of the responsibility for our health off of our hands.  As partial proof of that, we can point to our obesity epidemic, overprescribing of drugs for any small ailment and overuse of the system (even I have kids who go to the doc at every sign of a sniffle, and then feel silly for being asked what I’ve done to treat it – I noticed it and brought them to the doc). Not only have we stopped being responsible for the cost, but we’ve also stoped being responsible as a society for understanding and managing our health. I’m guilty.

Now we are paying the price.

Tomorrow marks the one year anniversary of the Mass State Health Plan deadline requiring most individuals to carry health insurance. Though the insurance law has been praised by some and criticized by others, Drew Altman president of the Kaiser Family Foundation believes the law falls somewhere in the middle.

So what’s the main problem, and everyone’s number one concern? COST… go figure.

The USA TODAY article Mass. Pioneering Health Plan turns 1 highlights some of the plans successes and failures. The success story highlights a woman who had lost coverage when she lost her job and was able to get coverage discounted through the state. Lucky – she was even able to get coverage after being diagnosed with cancer. She is now in remission!

Failures? Well the article doesn’t do a very good job of examining this side. They touch on a woman who is self-employed. Her monthly premium last year was $422. In August that will increase to $615. $615 x 12 = $7380. Now I am not exactly sure how that works with tax write-offs (being self-employed) but that number is ridiculous.

Now I applaud Mass for getting their uninsured down to 7%, however the program/law needs to take into account the cost of insurance to everyone… not just those with low income. In a scenario where someone is paying $615 a month for health care , or even half of that, is difficult for me to digest considering the amount of money I make (thank you change:healthcare for covering my health insurance). No wonder people don’t purchase health insurance. At that price… I would be tempted to keep my fingers crossed that I don’t get sick.

With the changes in our economy, especially on the verge of electing a new president, finding a health insurance solution for the whole country is going to be anything but easy. And the Mass approach will not work for every state, or the whole nation for that matter.

Keeping costs down needs to be one of our main concerns. The fact that health care is 20% of our GDP, compared with similar countries hovering around 10%, is proof that something has to change. (I would not harp on the 20% if we ranked near the top of the list for infant mortality and life expectancy… but we don’t, we are actually in the bottom third.)

Our second focus needs to be quality and subsequently preventative care. As one of our partners pointed out, we do not have a HEALTH CARE system, we have a SICKNESS TREATMENT system. The shift to health care must take place.

Renovating a system that is so set in its ways is not going to be easy. As you can see with Mass, its a work in progress, and very few people embrace change with open arms. However, focusing on changing the ways in which we approach insurance coverage and enrollment, as well as the ways in which we approach our health are good places to start. Add in the end goal of reducing cost, improving quality, and extending access… and we can begin to change:healthcare as a country. Since Mass has tried to change first, lets take this as an opportunity to learn from their successes and failures.

So the Mass. attempt at “socialized” healthcare turned one year old today. CONGRATS!

Our resident Bostonians on staff @ change:healthcare, George and Vic, must be so proud. Oh wait, they’ve already fled the state to be here.

Nevertheless the plan seems to be working well according to Julie Appleby of USAToday – residents are getting better coverage…and premium rate increases of 5.1 to 9.4% unless you take the person profiled in the article who got a 45.7% increase in premium over the first year’s premium. Wow! Even the private insurance industry is hard pressed to pull that one off!

An excerpt from the article: “I almost fell on the floor,” says Pelletier, 55, of Newbury. “Costs are getting out of control.”

No kidding.

People will eventually make the connection. The decisions you make regarding their healthcare – when to go, whom to see, and what to pay – are what ultimately determines the premium. The premium is an effect, not a cause.

Happy Birthday!

The best thing about this job is that we get to meet some really great people. Today we met some outstanding folks who are going to make a difference.

Cover America made a stop right here in Nashville today and a few of the change:healthcare team had a chance to catch up with them. The cross country trek to capture stories of consumers’ difficulties with the healthcare system is part of a Consumer Reports effort on the healthcare front.

We really enjoyed meeting Meg, Blake, Pauline and Liz. Even got our photo with the RV in Centennial Park, in the shadow of Hospital Corporation of America (oh, how we love the irony of that one). Many thanks to these folks for what they are doing – fighting for the healthcare consumer.

Meg is getting a much deserved break after three weeks on the road, and we wish her a happy mini-vacation.

The rest of the crew is headed on to eastern Kentucky before hitting Virginia. We are going to try and hook them up with our favorite West Virginian, Bob Coffield of the Health Care Law Blog when they hit Charleston.

Let’s be emphatic. Government will not help the country’s healthcare crisis in the least by nationalizing healthcare. However, there are some things they CAN do that will probably ease our pain.

1. Repeal HIPAA

Let’s start with a big one right off of the bat. HIPAA regulations guarantee privacy of medical information. That’s a good thing. Personal privacy is the highest priority we have. But the legislation allows self-serving insurance companies and providers to act in their own best interests and block access to data the very data that is most valuable to healthcare consumers.

2. Outlaw Balance Billing

The practice of balance billing is a disgraceful tactic employed by disreputable healthcare providers. It occurs when a provider bills a patient for the part of a bill that was negotiated as a discount under contract with the insurer! The balance billing comes enough after the fact that the patient, confused by an already arcane system and intimidated by aggressive collections practices, pays the bill thinking it is their portion of the bill.

3. Cut the Employer Tax Break

Cut out the tax break for companies that pay their employee’s healthcare and give it to the employee by increasing their pay to cover the increase. This would push the real cost of premiums down to employees and have the net affect of letting people see more of the true costs of healthcare. Then employee decisions about how they would handle their own care would truly be more informed. Imagine if we treated healthcare insurance like car insurance. Hmm. I have a little ding in the car. Do I call it in and pay the deductible and have it drive my rates up or just cover it with some of that chip paint? Hmm. I have a splinter. Do I go to the ER for $500 or go to the local clinic in the drugstore for $49? Sweet.

4. Cap Malpractice Suits

The multi-million dollar lawsuits against healthcare providers have to stop. They drive up costs astronomically. I understand that there is pain that comes with loss and poor care, but we have become far too litigious a society with too many of us looking for a lottery payout at the end of a lawsuit. It’s becoming increasingly difficult for physicians to afford malpractice insurance. And they pass on its cost to you and me. Docs are also picking up and moving practices from states where they simply cannot afford the rates.

5. Make Docs and Hospitals Post Rates

To me, this is a no brainer. Require doctors and hospitals to post what they charge for treatments and services, which is easy information to access. Government should mandate that rates be posted. I do not care if providers post their billed rate (that’s the rate they charge you before the insurance company gets hold of them and adjusts it down) or the amount they’re ultimately reimbursed. But I think the providers will sort that out pretty quickly once one of them starts undercutting the others by posting their reimbursable rate. Why do you think prices in most commodities come down when competitors start advertising their prices? Because most consumers like value.

6. Disallow Flat Rate Co-Pays

This puts the government in the insurance company’s business, but flat rate co-pays simply keep consumers from knowing what the true cost is. Again, one of the problems with our current system. Consumers are unable to make an informed decision because they don’t have an accurate idea of what the product really costs. Switch to a percentage of cost co-pay system. Some employers and insurance companies have already done this. It gives a consumer an easier way to move into truly understanding the costs without dumping them in cold-turkey like an HSA does, asking them pay the full amount until the deductible is met.

7. Create Competition among Insurance Companies

Insurance companies are licensed on a state-by-state basis as a result of ERISA. The government should centralize this process to create competition. Going state by state effectively holds down competition by limiting the number of choices. There are a few national insurance companies that have gone through the trouble of getting licensing in each state or built partnerships to use networks in other states, but not nearly enough.

8. Monitor Insurance Companies More Closely

It’s unbelievable that my large not-for-profit insurer can build lavish new offices, pay exorbitant salaries and go out and purchase for-profit wellness and disease management companies and other businesses with their excess cash. The government agency responsible for the oversight of this not-for-profit entity is asleep at the wheel. Some customer-friendly insurers return a portion of that excess to their members through premium rebates or reductions, which is smart business in a competitive marketplace. By at least making the general public aware of how companies use their excess, consumers could be mobilized to exert more pressure on insurance companies to keep their costs – and their ostentatious ness — low.

9. Create Incentives for Careers in Healthcare

Wake up Washington! We’re getting older as a whole and needing more care. So help incentivize more people to enter med school. More docs mean more ability for people to get access to healthcare. Usually at a cheaper price. It decreases the demand on the docs’ time which allows them to concentrate and focus on providing high-quality care versus pushing through yet another patient. Also, create more programs to help with med student loans. Perhaps urge more fellowships. Whatever it takes to keep docs from being $250,000 in debt upon leaving school and being in a spot where they HAVE to charge some outrageous amount to cover their malpractice insurance and student loans.

10. Pay for Performance

And we might as well go there. Establish scores for high quality care – the quality of care Americans should come to expect from this country’s healthcare practitioners – and use pay to incentivize physicians to meet and surpass those standards. Make it easy for patients to report who does quality work.

There are many other ways that government could be helpful in healthcare other than socializing it. We’d love to hear your ideas.