A wonderful article from Jane Sarasohn-Kahn (at Health Populi) on how making strides in healthcare is all about data liquidity. So many folks who are interested in healthcare reform have “talked” about this very thing, but it’s only now that it is actually becoming a realistic goal.

As we head off for Health 2.0 in SF next week, I begin to have visions of history repeating itself. Too many of us remember those business plans of the dot-com era that were brilliant yet the market for them had not reached critical mass.  They became the casualties of the dot-com bust. Now, a decade later, many of those business plans are being dusted off and successfully rolled out.

I remember the dot-com days when we talked about live radio broadcasts and streaming video. Today we have YouTube and Mevio. It happened, just not when we envisioned it. At Health 2.0, I will look around for some old friends, and they will not be there any longer. Why? Bad economy. Bad business model. Bad management. Bad timing. Or simply bad luck.

Casualties.

It’s ugly, this war to achieve healthcare data liquidity. And, like any war, it’s so senseless.

Just got finished trying out the White House twitter site that allows tweeple to pop off a pre-formatted mantra in favor of healthcare reform. It’s a neat bit of technology – cool in many ways. But it’s an agenda pusher.

It’s all talk and NO action.

Now compare that with the recently-launched Twitter app from change:healthcare. It allows tweeple to receive information on health conditions and medication costs as well as prescription medication costs, generic alternatives and more using secure private messages via Twitter.

Government talks. Industry acts.

If you want to find the cost of prescription medication and medical term definitions via Twitter – Just Ask! Follow @askch on twitter and send a question in the proper format to see how you can change healthcare too.

“Have you heard of tiny Melinda Mae,
Who ate a monstrous whale?
She thought she could,
She said she would,
So she started in right at the tail…”

- Excerpt from Melinda Mae by Shel Silverstein

Healthcare reform is a “monstrous whale.” The federal government could learn a little something from the childrens’ tale about Melinda Mae. Instead of trying to cram ALL of healthcare reform into one big bill and get everyone to swallow it all at once, smaller bites would be more manageable.

Smaller bites might actually pass.

What Do Small Bites Look Like?

Let’s start with some easy small bites that most Americans are eager to agree on. How about a bill with just these points in it to garner support and get something/anything passed.

1. No more pre-existing conditions
2. No more pulling of policies for large claims
3. Same premium rates for all with premium adjustments only on the basis of tobacco use, age, family size and geographic location
4. Banish all attorneys to…erm…I mean…malpractice suit limitations

Those are things most all of us can get behind. Once we get that, let’s go for the next bite. Eventually we will finish the whole whale, or at least we’ll eat what we’re able to stomach.

That’s how Melinda Mae would do it.

Let us know your thoughts on healthcare reform in the comments! Your voice matters.

Photo by Kevin Dietsch for Time

Details on the health care reform plan being pushed by the gang of six and headed up by Senator Baucus are coming out.

The BIG Question: Will it Add to the Deficit?

The stock answer is NO, it will not add to the federal deficit. Note the qualifier – the FEDERAL deficit…FEDERAL. Now your personal deficit and that of your employer, well, that’s a different story. The government won’t speak for business. Government only addresses the federal cost issue.  Hmmmm.

The Next Question: How will it impact Your Pocketbook?

Funny you should ask. The plan calls for 50% reduction in Medicare Part D prescriptions at a cost of $8B to the pharmaceutical industry. If you are naive enough to think pharma is simply going to cut $8B in profit to cover this expense out of the goodness of their heart – think again. The price of prescriptions to the private insurance portion of the population will rise to compensate. It’s called cost-shifting. It happens every time the government lowers Medicare rates on what it pays for medical services and products – the lost revenue has to be made up somewhere, and it is made up in increased rates to the private health insurance industry. This is also known as the healthcare policy your employer pays for and that has been eating your cost of living increase for the past few decades.

In addition, there is a law that prevents exclusion on pre-existing conditions. That HAS TO COST MORE for the insurance company to cover. Rates HAVE TO GO UP to cover services that, well, they were not covering before. And plans now HAVE TO OFFER WELLNESS PROGRAMS. Those incur costs that have to be covered as well, so that will increase insurance plan costs.

But the good news is all rates HAVE TO BE THE SAME for all groups. Insurers can only discriminate based on tobacco usage, age, family size and geographic location – all fairly legitimate adjustments to cost. More good news is that the rates for the oldest people can only be as much as 5x (five times) what they are for the youngest members on a plan. That’s a good way to keep costs within an artificially controlled range. But what does that mean will happen to costs? The cost for the youngest in the population (the very folks who put Obama in office) are going to go up – just so the insurance companies can get the 5x rate to cover the exponentially higher utilization of the older population. In other words, the most expensive portion of the population to cover will increase the cost of the lowest portion as they “drag the bracket upward.”

Sounds expensive for those of us on private insurance.

Is this the plan perfect? No way. Is it a step in the right direction? In some ways. Many ways. Is it going to cost more? No. Well, at least it won’t cost the government any more.

If your company is trying to find out how they could save their employees and themselves money now, and after the reform, check out some of the change:healthcare tools for employers. We have some interesting programs that help everyone save money on healthcare.

Image from Mike Moreu

As long as we’re herding cats on healthcare reform, let’s ask a critical question…What is the timing for the changes being made for healthcare reform? Not “when will it get passed” but rather “when will the changes, whatever they end up being, go into effect”?

Logistically, it’s a nightmare.

Healthcare Reform Will NOT be here by January 2010

Employee populations have already been underwritten for 2010. Rates have already been set. Policies are already in place. Open enrollment has already begun. Surely no one would jump in front of that rolling momentum even though the government has the authority to do so. It takes a full year to do all that needs to be done for a health plan when it is business as usual.

[cats like big balls of yarn, and this is a BIG one]

Imagine the implications of just two details…

1. Insurers Have to Cover Pre-existing Conditions
2. Insurers Cannot Drop Clients with Extreme Expenses.

In short, the very business practices on which insurers, doctors, hospitals and every company that provides health insurance have built their business are undermined. Wow!

[think two wild feral cats left to their own devices in the barnyard]

Insurance companies would be SCRAMBLING…

• to change rates.
• to underwrite to new standards.
• to negotiate new provider agreements
• to develop new policies.
• to train people on the changes.
• to print new materials.
• to engage countless attorneys to understand and interpret changes.

[think of the crazy old cat lady with 72 cats in her one-bedroom 650 square foot apartment]

At the same time, employers would be scrambling to understand and reevaluate their business model as their health plan costs changed. They would be looking to alter their plan in an effort to control their rates and protect their business. They would be struggling to educate their employees. And struggling to meet a bottom line with new rules on one of their single largest line item expenses – health insurance.

[think of the animal shelter stuck with the crazy cat lady's 72 cats - what the hell do we do with these?]

Docs and hospitals and other care providers are little better off. They would have new rules on what is or is not covered. They would be left to figure out how much they could expect in income on those “Good Samaritan” services they had been providing for “free”. They would have new systems and rules to evaluate. Their very business model would shift.

[think of the vet trying to provide services out of the goodness of their heart, but faced with the financial implications of having to spay ALL 72 cats]

Cats would be living with dogs. And January 2010 would be here.

A Similar but Not Related Video that Conveys my Thoughts on This…

Image Courtesy aflcio2008 on flickr

Senator Jim Cooper (D) of Tennessee has been one of the most prominent politicians traversing the country on the idea of healthcare reform. In his early presentations on the subject, the approach was a hard line push to get universal coverage (covering the uninsured) with NO FOCUS ON CUTTING wasted expense that could have paid for the program. Cooper is clearly the most articulate and knowledgeable politician I have run across with an in-depth perspective of healthcare AND business. I am convinced that he has a hand in the movement of the healthcare reform to something that will be more beneficial to Americans that earlier plans.

The modifications that have been made in the past few weeks are significant. Socialized healthcare (a wholly government run program) is giving way to government incentives for consumerism coupled with universal healthcare (getting the uninsured covered), and more ethical treatment of members by health plans (no pre-existing conditions and protection from being kicked off of a plan for large claims).

It is encouraging to see that questioning of Senator Cooper and other prominent members of congress have started to take root in D.C., either as a result of that meeting or others. I hope the plan is not finished evolving. Private business needs to get behind the idea of making healthcare more efficient and some are fighting for the opportunity to do that through organizations like SIIA.

For far too long, companies have been passive about healthcare as an outsourced expense and did not get involved preferring to push the burden of understanding this to the insurance companies. The insurance companies obliged and took the power that came with that responsibility.

The government is pushing employers to get involved. Getting employers MORE involved and not less involved is what we help us drive the cost down while improving quality. If employers continue to wholly outsource their healthcare without actively addressing it, look for us to wind up back at the sort of option that Senator Cooper had originally presented.

Just saw the CNN report on 13 million uninsured 20-somethings in this country. New to the job force and turning down their health insurance.

What are they thinking?!?! Do they believe that they can just go out and buy what they need in terms of medical goods and services on the free market? Good grief! This is America for goodness sakes.

So what are they doing in lieu of buying insurance?

Radical things like minding their health– watching what they eat, working out, bundling up before they go out in the cold, washing their hands (oh, these kids – they’re like modern day hippies shunning the norms of society).

They go to the doctor only when absolutely necessary instead of for every little ache and pain. They go to retail clinics (like Minute Clinic and The Little Clinic) where they know the costs BEFORE they buy (oh my, what are these kids coming to wanting to know the price before they blindly incur the expense). They look things up on the internet (It may be MY chronic disease but shouldn’t the doctor know more about it than me? He treats it, and I only live with it…every single day of my life).

But why should these 13 million have insurance? In case something happens.

Hellooooo – they’re 20-somethings and invincible.

But seriously, why should they? Because it underwrites the rates of the older portion of the population. If they don’t get healthcare, they don’t offset the risk pool – they don’t underwrite the older segment of the population. And we know what that means – our rates will go up because they aren’t contributing monetarily (and taking less out than they put in) as we expect them to do.

But we can still get them. In New Jersey, children can stay on their parents insurance to age 30! Thirty!!!! In many other states it’s only 24 or so.

So now I’ll set aside the sarcasm.

What we are seeing is the revolution. The new generation is taking a stand. We have a product – health insurance – AND THEY ARE NOT BUYING! The business world should get the message here. These folks are going to opt for surgery overseas, retail clinics and internet consults. They are going to cost shop prescriptions and doctors. They are going to demand affordable access to care and they are going to want to know the price AHEAD of time. And they are going to return health insurance to truly being insurance – a safety net for catastrophic situations instead of the all you can eat buffet for $20 we have bad for soooo long – too long.

Do NOT think that it is the sage old regime of healthcare executives and politicos in D.C. who are going to change healthcare. It is the 20-somethings. They alone are able to break out of the old ways of thinking. It has been that way generation after generation. THEY have the new ideas. THEY are taking a more rational approach. They are getting organized and THEY are not content to go along with the system as it has been.

Yes, they are 13 million without health insurance…and growing. THEY will change healthcare.

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!”

Monday (10/6) at SHOUTAmerica’s first leadership conference I had the pleasure of hearing Senator Corker brief the audience on his recent accomplishments in bi-partisan healthcare activities.

Here are his four opening points:
1.    Congress does little communicating across party lines – this needs to change
2.    30% of healthcare delivered is wasted, i.e. it does not actually help people get well/healthy
a.)  That directly translates to 5% of our GDP wasted
3.    800,000 Tennesseans and more than 45 million across the country do not have health insurance coverage
4.    Healthcare is not a right, rather a moral obligation
a.)  Everyone deserves access to affordable private healthcare

He was cautious to make the distinction between what Republicans are striving for (preservation of choice) and what Democrats are striving for (universal coverage).  Corker wants the best of both worlds.  He wants  to preserve choice while finding a way to cover everyone.

Throughout the hour and a half speech/discussion I had several points of contention/questions.

1. Is choice our number one priority when we have 45 million uninsured Americans, 9 million of which are children?
2. Should we be providing tax credits as an incentive to purchase health insurance coverage?
3. Should the federal government mandate health insurance coverage?
4. Should all health insurance be community rated?
5. Should we separate health insurance benefits from the employer?

Choice should never be our number one priority (should I never say never?).  We need to focus on increasing access, coverage, and quality, while simultaneously reducing costs.  Choice isn’t even in my top 3 priorities for healthcare reform.

The American government has used the tax-credit concept for years with respect to financial saving.  Despite the tax incentives, Americans still fail to reasonably save the money they earn.  Why would the concept be any different applied to healthcare?  Just because a $5000 per family tax-credit is issued does not mean people will purchase a policy costing $14,000.  That’s still $9000 left for a family to cover.

I still haven’t figured out all the reasons why health insurance coverage has not been mandated by the government. Obviously cost is one (look at the difference between auto insurance and health insurance, we are talking thousands of dollars).  But what are some other reasons, and possibly coverage should be mandated and subsidized by the government up to a certain % of the poverty level.

Community rating all health insurance would mean that risk would be spread equally over large groups of people.  If you have high blood pressure and high cholesterol you would pay the same as the same price as a healthy individual your age.  This could be a good thing if the price groups change/account for age, smoking, family size and location.  It certainly provides a way to increase coverage and reduce costs for high-risk groups.

Health insurance benefits have been linked to our employers for years.  Is this practice too entrenched in our culture to separate it?  No.  However, I think the idea has its pros and cons.

Pros:

1. Makes healthcare portable.  Individuals will no longer feel tied to their dreaded job due to health benefits.  Their coverage and chosen plan could be taken with them to any place of employment.
2. Leads to more individual responsibility.  An individual will have to better understand what they are purchasing.

Cons:

1. Less guidance on aggregating large numbers of people to spread insurance risk.
2. Decoupled benefits will reduce competitive advantages between employers. Not that this directly is a bad thing – but will we see employers giving employees the money in their pockets that they used to see by way of health benefits?

All and all I still haven’t figured out the details of my proposal for healthcare reform.  Fortunately Senator Corker seemed to have a solid “moderate” stance on the issue!

The SHOUTAmerica Conference was a huge success!  About 100 student n leader, presenting almost a million students across the country, attended the conference to hear CEOs, Senators, House Reps and health care educators speak about the current healthcare crisis.  By the end of the conference once puzzled students emerged engaged and ready to make a difference!

The new LiveBlog on the SHOUTAmerica documents the conference, student sentiments, and speakers.

Check out Christoper in Part 3.