The New Health Dialogue

Lots of health reform activity recently in states. Here's some help in catching up:

Connecticut. The state legislature has approved a Democratic bill permitting municipalities, nonprofits, and small businesses to join the state employee health insurance pool. Unclear whether Gov. Jodi Rell will support it. Some leading Republicans object to a "government-run" health system, while Democrats and labor backers say the greater buying power of the pool will save municipalities money. Not a comprehensive solution but we'll be interested in watching how this plays out.

Alabama. We posted a few weeks ago about Birmingham's plan to cover children—which we confess was a pleasant surprise to us given the state's history, poverty, and health status. Now we see the state has a new $3 million, five-year grant for the University of Alabama's initiative to reduce health disparities among older blacks.

Earlier this week we posted our interview about the future of health IT with Carol Diamond of the Markle Foundation. (Part one, and part two). Today we'd like to point you to The Hill 's interview with Health and Human Services Secretary Mike Leavitt on the same topic.

Two points struck us. First, neither the article nor the full Leavitt transcript mentions the word "privacy"—a big issue both for policymakers and for the public who keep reading about nosy hospital staff, researchers who do sloppy things like leave laptops with patient records in the car, and thieves who steal credit card numbers and other financial identity information from medical records. Not insurmountable but essential if we're going to get the country on board with health IT. Second, Leavitt really depicted the health IT challenge primarily as a technology question involving interoperability (letting different computer systems talk to each other) while Markle's Connecting for Health program and conversations with some other experts have made us think about a far broader range of policy challenges that won't be solved only by the computer geeks.

The Senate Finance committee kicked off a series of hearings on health reform this week, beginning with testimony from two former Health and Human Services Secretaries, Donna Shalala and Tommy Thompson. We were thrilled to see that one of the most powerful committees in the Senate—that will surely play a key role in any major health reform initiative—take on the issue of health reform in an open, bipartisan, and productive manner.

Reuter's Donna Smith has a good summary of the hearing, but having sat just a row behind Shalala and Thompson we'd like to add a few of our own highlights from the hearing.

Senator Max Baucus (D-MT) is a man who not only knows how to quote Goethe (as he did to open the hearing) but clearly knows how to talk about health reform. Stressing the need to move beyond incremental efforts and find a comprehensive way to cover all Americans, he said: "The moral and economic case for reform has never been stronger." We couldn't agree more.

Like most bloggers, we have a thing for celebrities from all walks of life (for years we carried around an autographed napkin from Ben and Jerry in our wallet). So when another famous purveyor of choice, Harvard Business School's Regina Herzlinger, came to town for a CATO Institute briefing on international health care systems the other day, we had to go hear the so-called godmother of the consumer driven health care movement.

Here's our best "Harvard Business Review" of Herzlinger's talk:

• As a country, we're headed toward covering everyone. Herzlinger made this assertion so casually we were a little taken aback. But to hear the author of a popular eulogy for American health care state she believes we're headed toward a future where all Americans are covered is encouraging. Even if we're not in total agreement on how to get there.
• Health care is killing the economy. Herzlinger estimated that GM spends about $900 more per car on health care than its foreign competitors, and cited a recent McKinsey Global Institute study claiming nearly half a trillion dollars of U.S. health care spending provides no added value. In fact, the New America Foundation released a paper today on health care and the global economy, and we're hosting an expert panel discussion this Friday.
  

Yesterday we posted the first part of our conversation with Carol Diamond, M.D., M.P.H., the Managing Director of the Health Program at the Markle Foundation in New York. She spoke about the potential of health information technology to improve the quality and restrain the costs of our care, as well as the research benefits. Today, in the second and final installment, she discusses some of the barriers to bringing 21st century tools to a paper-based health system, and the path to overcome them.

Q: What are the challenges to a national health information technology system?

A: There can't be one information technology "system." We start with a vast, highly fragmented and very diverse health care delivery model that is not centrally controlled or run. The only practical way forward is to acknowledge existing networks, and let them grow incrementally under a basic, common sense set of policies and standards. That's how the Internet grew.

The health care sector has a set of unique challenges that need to be overcome—and some have nothing to do with technology.

The first critical challenge is trust. Without it, patients and physicians will not be willing to use new technologies due to fear of privacy breach or the misuse of personal health information.

Throughout the primary season we have heard two things consistently from voters: they are worried about the economy and concerned about affording health care. Today, New America's own Len Nichols and Sarah Axeen analyzed one linkage between these two domestic priorities: the impact of rising health care costs on global competitiveness and U.S. jobs.

We're suckers for medical mysteries like the one in today's Washington Post health section headlined "Five Doctors, Stumped." Today's medical whodunit (or more accurately who-didn't-do-it) was about the misdiagnosis of a woman named Bettie Munro, thought to have Parkinson's disease. Munro did not have Parkinson's. Instead, an upset stomach among other things had changed how her aging body was absorbing lithium, creating a toxic condition. One sentence near the end of the story particularly struck us, "One physician said he thought another had checked her (lithium) level, so he didn't bother." It made us think about the interview we just posted with Dr. Carol Diamond, an expert on health information technology at the Markle Foundation. We don't believe (and Diamond doesn't assert) that health IT will stop every medical mistake, avoid every misdiagnosis, create a perfect world of health and harmony.

Many Washington, D.C. policymakers (including the presidential candidates) talk about the need for more health information technology.  Everyone seems to agree that health IT will improve quality and can help control costs.  For instance, RAND has estimated that greater use of health IT will yield an annual efficiency savings of $77 billion over 15 years. A study in JAMA showed that when doctors use computers to order medications, preventable errors drop by as much as 55 percent.  Another study in the Annals of Internal Medicine showed 12 to 20 percent improvements in compliance with physician guidelines and other benefits.  Despite all this agreement, we haven't quite figured out how to get from here to there. So we asked Carol Diamond, M.D., M.P.H., the Managing Director of the Health Program at the Markle Foundation in New York, to share her insight into how we can overcome the policy and technical challenges and bring 21st century tools to our paper-based health system.

Q: Health IT can be confusing. If you were at a cocktail party, how would you describe what you do?

The Wall Street Journal Health Blog had a witty interpretation of Sunday's New York Times business section piece on robotic surgery; specifically, the three laws of robotics in I, Robot and how they mesh with the current state of surgical robots. Although not an expert in science fiction written before my parents were born, I looked up the handy Wikipedia page on the subject and thought of one additional maxim: the Zeroth Law.

We keep hearing about the role of a "public plan" as an option under health reform, so we paid attention when the Kaiser Family Foundation asked three health policy experts on a webcast exactly what such an option would look like. We watched as Jacob Hacker, Yale professor, New America fellow and author of the “Health Care for America” plan, Linda Blumberg of the Urban Institute, and Stuart Butler of the Heritage Foundation grappled with this question. The hour-long discussion touched on many aspects of the public plan option—how they would compete with private plans, enrollment levels, payment policy, risk selection. You can see the webcast here (and a transcript will be available soon). But here's our impression of the major takeaways from each expert:

Hacker, whose health reform plan has a public option, was the strongest supporter of the idea. He argued that a public option would guarantee good, fixed benefits at a low cost, especially for the most vulnerable Americans. In his perfect world the option would be administered by the federal government, but he was careful to emphasize that it would not be “Medicare for all.” He sees a public option as another competitor with private plans under a shared public/private health system.