Re: Be afraid, be very afraid Health Info

[David Farber <dave () farber net>]

Begin forwarded message:

From: Thomas Lord <lord () emf net>
Date: April 6, 2009 12:08:24 PM EDT
To: dave () farber net, gumby () henkel-wallace org
Cc: ip <ip () v2 listbox com>
Subject: Re: [IP] Re:    Be afraid, be very afraid Health Info

On Mon, 2009-04-06 at 05:14 -0400, David Farber wrote:

> From: DV Henkel-Wallace <gumby () henkel-wallace org>

> More generally I don't understand the rush to electronic health
> records, of all things.  There are some serious technical and
> institutional problems to be addressed (I'm not talking about privacy
> or other t social issues) and until they have been I don't see the
> point and in fact consider the shift quite risky.

Some history to answer your question appears
below.   I had to study this area fairly
extensively as part of a diligence process
a few years back and then informally continued
to pay some attention to it.

In 2000, the World Health Organization published
a famous report comparing US health care and its
costs to the res of the world.   Here is a link
to a copy:

http://dll.umaine.edu/ble/U.S.%20HCweb.pdf


Meanwhile, it was becoming widely apparent
to many financial industries types that the
boomer retirement bubble was going to cause
many problems.  The state of the "big three"
car companies today, for example, was fully
anticipated back then.

And, meanwhile something the financial types
were pretty upset about: the looming threat
of a "single payer" system.   Health care
was recognized (because of the aging demographics)
as a big growth industry for the next decade
or two yet a successful political move to nationalize
the system would suck a lot of profit out of
that sector.

The WHO report and several others noticed something
interesting about the cost vs. outcome stats in
the US.   The US ranked low in the world in many
categories but the VA hospital system, regarded
separately, ranked very highly.

While people like Esther Dyson were attending
symposia for the financial world to study the
situation, medical experts close to that society
announced the official explanation for the VA
system's success.  Two main elements:  First,
VA doctors, including specialists, are paid salary
rather than paid by procedure.  Second, the VA's
system-wide electronic medical records improved
outcomes and saved money by reducing mistakes
and streamlining assessments of patients.  That
was the story and they're sticking to it.

After 2001, DHS and CDO became very interested
in real-time monitoring of population health for
the purpose of early detection of deadly outbreaks
either from natural events or bio-terrorism.
They began suggesting ways for the government to
reward medical providers for adopting electronic
records system with real-time reporting features.

H&HS gathered these various stakeholders in a
series of meetings - public hearing panel sessions -
around the country.   Representatives of health
care providers and the insurance industry were
represented.

They generally speaking formed consensus around
the idea of:

1. Not socializing health care.
2. Somehow getting everyone to switch to VA-like
  electronic records in order to produce
  cost savings and more secure public health.

By perhaps 2004 or so all of the "movers and shakers"
had agreed on that general plan.   We'd just
get private investment in new technologies, changes
in labor contracts with providers, and health care
would become less expensive and better even as the
industry continued to grow.

The entrepreneurial side of the financial industry
took off.   One big symbolic act was Google's hiring
of Larry Brilliant in part on the strength of his
interest in using Google search queries to detect
epidemics in their early stages.   Google and MSFT
started planning on and building hosting services for
electronic medical records.  The personal genomics firms
took off and it is interesting to note that several of
those firms directly took on (by ignoring them) regulatory
barriers to their handling of patient medical information.

On the smaller end, there were *lots* of new
ventures to make practice management software,
to build little tablet computers for use in
medical offices, and so forth.  I haven't tracked
those - I presume there's been a decent amount
of churning and contraction in that area with a few
key players emerging who look fairly strong.

Oh, and: political pressure was brought to
bear and the VA "open sourced" their medical
records system.

As the 2008 elections approached, Clinton (H.) had a
difficulty in seeking the full support of "high tech"
rich folks:  she was politically identified as
a single-payer (health care nationalization) advocate
(rightly or wrongly).

The Obama campaign exploited that and several other
"our issues" issues of the tech elite.   He came out
fairly early with that consensus position - drive
down costs by adopting VA system management practices -
as a centerpiece of his health care platform.

The insurance companies, around this same period,
had a masterstroke of brilliance:  "We must not
nationalize the medical system but rather, we
must nationalize the patients!"   Nothing could
please the finance industry folks better than
a captive customer: a customer required by law to buy
your products.   Thus was born the notion of a
"mandate" system in which citizens are required to
buy insurance.  Limited (and likely to be inadequate)
aid would be available to those who can't afford it.
This famously became law in Massachusetts and has
gradually become more and more of a feature of the
Obama plan.

Even with all of that political greasing of
the skids there is still a big, big problem:

Hospitals and clinics aren't rolling in dough
(most of them).   Physicians and other providers
are not quick to agree to big changes.
Insurance companies - especially
the managed care variety - are bloated behemoths
about as easy to change in course as a full super-tanker.
And, of course, in recent years: private capital is
variously sitting on the side nervously or simply
gone.

How *convenient*, then, that there is a perceived
inevitability of the new administration spending
trillions for "stimulus".

So to answer your question: the reason that there
is a big push for electronic medical records
Right Now is simply because of the plausible promise
that new federal debt can be taken to offset some
of the public risk of investing in deploying such systems.
Yet another form of socializing risk and privatizing
gains.

You mention the risk and I assume you mean
to the public health, to citizen privacy, and so
forth.   Indeed.

Yet look at the attitude and approach to risk
taken by the financial side and you'll see how
unlikely you'll get far raising such concerns.
The rhetoric around 23andme, a business model
that recapitulates some of the risks in miniature.
Look at the handling of dissent in that area.
Basically, they don't substantially care about the
risks (only their own liabilities) and reflexively
dismiss the concerns of others as those of Luddites.
The new system is going to be *better* for you and
if you don't believe that you're just in the way.

-t






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