Health Plan in the Obama Stimulus Plan
 

I found this an interesting read.
http://www.bloomberg.com/apps/news?p...d=aLzfDxfbwhzs

Interesting article and ironic in a way that you post this. I received a call from Pennsylvania today from a friend who reminded me to make sure I read up on this very provision. I am afraid there is much more...this thing will pass and we will need to live with anything that was forced in and we are being rushed to do it even on items that do not influence our current financial situation, although those supporting claim there is some economic gains to be held. Off to read !!!

Thanks for the link

The Article Concentrates Only On The Downside Of The Proposal
 

I am certainly no expert in the medical sciences--other than having more cuts and stitches than most. Yes, I think that something needs to be done to control healthcare costs and provide some sort of healthcare to the 20% or so of Americans who have none. But I surely don't have a comprehensive proposal to accomplish those objectives.

But the Bloomberg op-ed piece does remind me of an article I read that was published by the AMA recommending exactly the type of medical records system described in the article and presumably the current stimulus legislation. As I recall, the AMA ascribes considerable savings to the healthcare system, and substantial improvements in the quality of healthcare as the result of having a national diagnostic data base.

The problem that the AMA said needed to be overcome was the cost of the system for the individual doctor. As I remember the article, they estimated that it would cost each doctor a little less than $100,000 to set the system up in his/her office, and then about $12,000 a year to maintain it. The AMA survey showed that an overwhelming percentage of doctors--almost 90% as I recall--said they couldn't afford those costs, regardless of the benefit, and would not plan on participating. If I understand the description of the proposed legislation, the government is proposing to pick up the tab for this system.

If the program described in the article and in the legislation provides for this type of diagnostic data base, there may be a positive flip side to the story. In my wildest dreams I can't imagine that the primary purpose of such a program is for the government to "...monitor treatments to make sure your doctor is doing what the federal government deems appropriate", as asserted by the Bloomberg op-ed writer.

On the other hand, with healthcare costs escalating at a rate that is a multiple of inflation, something needs to be done to reign in those costs. To me a better approach would be medical tort reform, thereby reducing medical insurance premiums and almost certainly all the CYA tests and procedures prescribed by doctors and hospitals. But we all know the chances of getting a bunch of lawyers elected to Congress to limit the income of the legal profession, don't we?

I don't know for sure, but maybe this newly proposed system is the best "second choice" to control healthcare costs.

The author of the Bloomberg op-ed piece doesn't mention any of the advantages of the system. This article reminds me of all those who claim to know what will happen if we build more nuclear reactors. They claim to know exactly what will happen if new reactors are built and do everything they can to slow or stop the process concentrating only on the negatives, however remote they may be. As they beat the tambourines about "more Chernobyls," as mainstream environmental groups hem and haw about how they support nuclear in principle but not in this particular instance, as the public remains confused about whether a reactor really can blow up or become the target of a terrorist attack, completion of a single reactor is unlikely, however valuable they might be in accomplishing energy independence. The Bloomberg article seems to beat the same drums regarding a proposal to reduce healthcare cost and improve quality.

Why are there always so many more naysayers than those with ideas on how to solve problems? Those thoughts are probably easier to derive, I suppose.

Actually, the electronic tracking was brought up a few years ago in the last administration but they did a lousy job of selling and implementing. BUT, I am not sure that it had a provision that specifically allows what this article implies, and that is the montoring of treatment by the government to insure they agree on the treatment.

I can see many merits except that "monitoring" is bothersome. But this bill is on the fast track and trying to wade through all the implications is next to impossible thus I suppose we need to live with it. There is much in this stimulus bill that is not DIRECTLY tied to economic recovery !!!

Just for the record, the link below is from April 2004 !!! If only Bush was able to communicate and actually reach across the aisle !!

http://www.thebostonchannel.com/heal...06/detail.html

Bucco...even if Bush was the best communicator.....
 

there was/is no way to overcome the partisan credo espoused by the likes of Pelosi:

"...if it is from the opposition, I am against it..."

Just as Obama is touted as the better communicator....reaching across the aisle....and getting frustrated...lawmakers go by what THEY like....nothing to do with what is right!!! Both parties....that is why we have the mess we have....the condition is exclusive of who sits in the WH or how good or bad they communicate.

BTK

BTK

Our Only Hope...
 

As I've said many times before...the ship of state turns slowly, but it does turn.

Hopefully, in time, the thoughtless partisans from both sides are replaced with more responsible and statesmanlike representatives of the people. They all don't have to meet that test...just a reasonable majority.

What a slam against seniors! What Former Senator Daschle doesn't say is that, as a multi-millionaire so rich he "forgets" what he makes and thus doesn't pay tax on the forgotten income, he himself is above any such medical decision-making by virtue of past position and present wealth.

Shades of "Logan's Run!" This only demonstrates the ultra-liberal mindset that if you can kill off the most defenseless of humankind with impunity because of their being at the very front-end of the age-line and an inconvenience to the stronger, it's not long before you can start knocking them off from the furthest end of the age-line as well. This is to be a Land of No Responsibility for those in far-youth and middle-age, and everyone else is an incumbrance which can be discarded "by choice."

"Change you can count on...."

I keep vowing not to even look at political. But a reference to health care grabs me every time. When I opened ejp52's link, the part that jumped out at me was "elderly hardest hit."

While we Boomers will never, ever, ever think of ourselves as "elderly," I shudder to think how we are being viewed by those in power. "Unfunded Liability" comes to mind.

The Baby Boomers........

They had to build more public schools to hold all of us. We crowded the colleges. We have been marketed to since birth. Florida has been expecting us for years.

And now, here we are, the front end has reached early SS and all of us are slouching toward Medicare, at this perilous time in economic history.

The book "Boomsday" is not so funny. I just hope Chris Buckley has not sold the movie rights to his book, intended as a satire, actually as a satire of a satire. If "Boomsday" hits the big screen, discussions could get really interesting.

Let's not be too eager to roll over and play dead. No matter what some of those in power might like to see happen.

Boomer

Hey Steve,

I hit send, looked back, and there you were in the post ahead of me. Thinking just about the same thing it looks like.

I have said for years, "They will issue the Baby Boomers' Medicare cards with a cyanide pill and they will call it Pro-Choice." (and that really is a quote from Boomer. I used to be able to make people laugh with it.) I did not want to be right.

So.....do we get organized or what?

And yes, my name is Boomer.

If we can agree to oust the Congressional incumbents (at least 75% of them) on 2010, then that agreement is "organization."

Hmmm.... I wonder if the stimulus package can include money for "community organizers" to oust anyone who has had more than 8 years in Congress! It seems to be willing to fund "community organizers" for other things......

Working in hospitals for the past two years was a real eye-opener for me as far as medical records are concerned. It seems to be impossible to share records between units never mind between the patient's doctor and the hospital. We've had to redo costly procedures (MRI's, CT's, bone scans etc.) because we didn't have immediate access to the MRI they did last week and we couldn't wait for hand delivery due to the sickness of the patient. Some things can be faxed but the quality isn't always perfect and e-mail isn't acceptable for privacy reasons.

I know it will be costly and there will be privacy issues to address but it needs to get done someday. Is the stimulus plan the place for it? Perhaps not. I think it should be addressed on its own merit.

I am soooooo tired of filling out the new patient forms at every doctor I go to. They always ask the same questions and I answer the same things. At my first visit to the doctor in TV I had to bring all of my prescriptions..that was a load. They wanted to repeat the tests I just had I refused and told them to contact my doctor. No information was ever exchanged

The electronic medical record has been talked about for many, many years and the Medical IT industry has been working on standard interfaces, terms and codes to be used. (I have sat in on some of those discussions)

It not about monitoring its about access to vital information.

I certainly hope you understand the reason to bring in all of your prescriptions.

Actually I could have told her without bringing them in ....but if she had access to my electronic medical record there would be no need.

It would also cut down on the number of patients "shopping for drugs" by going from doctor to doctor.

AND it would certainly help patients who can not speak for themselves....say someone in a car or golf cart accident....and no family in the area....

I have a friend that can not have an MRI due to past issues with a brain aneurysm. He must have a CT scan. If he is not able to speak for himself...his family is not there with him...if he had to go to the ER for a head emergency they would automatically want an MRI...if they do it...he could die or become a vegetable.

His wife wants to put a Tatoo on his head that states "NO MRI". I think the national health care system would helo this issue as well!!


:faint: I can't believe I made my way back into the political forum!!:ohdear:

I agree, all records and all should be electronic. When I was in Japan back in 1983 to 86, a friend of mine got married to a Japanese Lady. Her dad owned a hospital and we were discussing medical records and all due to us being in the military, if we had an accident while outside of the base. How would the hospital know anything about us. They were talking then that all Medical info could be stored electronically and transmitted to any hospital. ALso that You could be issued a storage device like we now call Jump Drives to keep with all your info. I know there will be someone say cant do that. But in the 80's i had already heard this deal in Japan. Man are we behind times.
All info could be stored in a Medical National Directory. That would work...

Nothing Like a venture back into the Politcal Battleground.

This is what some patients tell me: " a blue one for my pain, a red capsule for my reflux, a cholesterol pill, etc.... once a pt told me they were given a new "pain pill"... when they brought it in it turned out to be carbamazepine, a drug which seriously interacted with a med our office was prescribing. One she got "90 days of thru the mail" one she got "for 4 dollars at Sprawlmart".

Always drag your bottles to your appts. Consider it a painful inconvenience like going thru security checks at the airport....

Electronic record-keeping makes great sense.

Government setting medical policy as to what health care can be given to an individual based on patient chronology is dangerous.

The European Socialized Health Care Model
 

Some countries solve the problem of caring for expensive, sickly elderly patients through euthanasia. Denial of treatment or medications to the elderly is a form of the same. Here is an article from The Heritage Foundation, followed by an excerpt from the same article:

http://www.heritage.org/Research/HealthCare/HL711.cfm

<Material removed for copyright infringement. Tony, admin>



I hope we are not headed down the same path...

John

JOHNFARR makes a sobering post for sure, and I ask those who are discussing the merits of the computerized medical records, which from a purely administrative point of view makes so much sense....but...

Is nobody concerned about the language in this bill that it seems would allow government intervention in your actual care ??????

Unlike the Insurance Company clerks intervention?

I am speaking specifically about language that seems to imply the US Government has some say in the type of care you receive, not in a simple adminstrative manner as you allude to !

And I am wondering why you have a problem with the Government setting medical policy as to what health care can be given to an individual, but you don't have a problem with the Insurance Companies setting their profit motivated medical policy as to what health care you receive, by denying claims and procedures.

what do you mean by "the government"? If you mean Congress.... well, let's see... mostly a bunch of crooked lawyers who base their votes on the highest paying lobbyist. Guess who wrote the Medicare part D program? Lobbyists for the pharmaceutical industry.

most offices, like ours already has electronic medical records. Not a big deal at all. The real issue is NETWORKING all offices together. That is a real challenge.

Fair question. I have been blessed in that I have never had a situation as you describe nor do I know anyone who has ever had it happen (Insurance companies dictating what tests are ok and what are not).

I suppose I am being naive but it sort of gives me a strange feeling to have the Government "approve" and/or "monitor" my medical treatment.....the Government ! The Insurance company has a vested, monetary interest but the Government being involved just bothers me !!!

Perhaps I am overreacting...just how I feel !!!

Doesn't the Health Insurance Portability and Accountability Act (HIPAA) and the various privacy laws make networking these data systems exceptionally diffficult?

I wonder if we will be permitted to pick our poison.

Boomer

I read the link and the replies with interest. While I am sure to get flamed there are some tough but valid questions raised by this article.

Having medical records at your fingertips is extraordinarily helpful and really a necessity in today's practice of medicine. I could not take care of my hospitalized patients adaquately without even the basic systems we have in place.

The "tracking" is an issue that warrants some exploration and discussion. Physicians and hospital's treatments are tracked now, make no mistake about it. Penalties(financial) are being used now when the goverment doesn't think providers/hospitals are towing the line as prescribed by the incredible, undecipherable morass of beauracratic regulations that the majority of us can't even fully comprehend. This is not new, perhaps the screws are being tightened a bit but this is certainly not groundbreaking.

The "guidance" concerning doctor's decisions has been in place in both private and government payers rules for a long time. This is in the form of refused reimbursement, denied procedures, etc. Obviously with the private companies it is profit driven. Physician's autonomy has been slowly and steadily stripped away for the last two decades.

The goal is to reduce costs and guide physicans decisions? The question is who is doing the guiding. It was and is beaurcrats..in every political environment that has preceeded the present one, so all may share the shame equally. The inherent problem is overpayed, undereducated people that have little or no working knowledge of or medical system. You would be beyond amazed if you were exposed to an inkling of the ridiculous hoops that have to be jumped through every day with every patient and for every problem. I sat in a meeting last night that spent nearly an hour discussing one tiny piece of admissions criteria for hospitals to get reimbursed, containing two pages of information and left with no better appreciation for the situation that I started with, a sentiment echoed by my colleagues. So these people have been are are to continue to be our guides?

As far as praising Europeans for being more accepting of hopless diagnosis..probably true and worth some exploration. Approximately 30% of all Medicare dollars on spent "in the last year of life". That's 30% of about 454 BILLION dollars for 2008. More than you can imagine is spent keeping terminally ill people in their 80s and beyond on life support for weeks or even months on end, knowing beyond a shadow of a doubt that the outcome will not not be changed. Are you aware that if you are over 70 and arrest in the hospital and receive immediate resuscitation to "bring you back" that your chances of ever leaving the hospital are alive are 1%(if unwitnessed arrest) or about 10% (if the arrest was witnessed)? This would be in spite of full blown "life support" for days or weeks on end. The numbers for functional survival at one year out are equally as dismal. These numbers worsen with age. Are you aware how many tens of thousands of patients with severe advanced dementia coupled severe heart and lung disease, diabetes and other progressive illnesses there are that exist on feeding tubes and around the clock care, with multiple hospitalizations per year? Are you aware of the amount of critical carethat is provided to drug abusers and noncompliant patients that have 10 or even 15 hospitalizations per year directly because of their own choices and behaviors? The tough questions, which are more societal in nature than political is where and when is it appropriate to limit some of this, when is it appropriate to limit interventions and diagnostic labs and procedures when we know we are not positively affecting the outcome, who makes those choices, and who pays for it?

Is a "new" beauracracy the answer? I seriously doubt it. Look at what a couple of decades of much the same have gotten us. I think any oversight without practical input from people that actually work and function in the system is doomed to the same failure we see now. I also suspect that unless we are ready to examine some of the futile ways that we use our resources things will continue to decline. Is some oversight necessary? I think most physicians in the trenches would say yes, but not in the old standard way of doing things. Is the thought of care being rationed out and decided by some formula comparing costs and benefits scary..certainly is in some ways, for the above stated reasons.

The real kicker here will be that as long as the legal system is essentially a personal injury lottery, doctors will continue to order and do things that are really not reasonable in an attempt to protect themselves no matter what the government or private payers say. When the penalties of not following guidelines exceed the malpractice suit risks, a lot of us will leave as our colleagues are now doing.

In summary, very little of what is proposed is new, and has been happening to a great degree, in ever growing frequency with EVERY administration in recent memory. The basic problems and questions inherent to our system (only a few of which are above) are not being addressed, nor have they been in the past. This is not a Clinton, Bush or Obama problem and presenting it as so is simply more rhetoric and waste. We have some hard decisions to make about what we can do, what are the right things to do, and how we can implement those things. What we have been doing is a dismal failure, and without a major paradigm shift in both patients and providers (and the legal/lottery system) we will continue to watch our system race to catastrophic failure.

The prime reason there will be little or at best...
 

unacceptable progress is not truly defining the benefactor. What? Of course we would all like to think we the people are the benefactor of any improvements to the health care system. However, history has proven that not to be the case. It will be more of the same. How to provide or protect the lobbyists, pharmaceuticals and political interests while offering a miniscule bone to the masses.
Take Medicare Part D as an example.

Real change would be to define what is to be accomplished for we the people.....FIRST. Then task the political lawmakers to accomplish the objective.

Not a chance. First off it is an organized approach. One totally not condoned or understood by the self serving, lawyerly, non business savvy legislature.

The plan(s) are doomed to failure from the start.

Change? Not in our life time!!!! An already demonstrated more of the same approach to legislation.

BTK

bingo!

Being a medical type myself I am a little better than that....

There appears to be a lot of posters "in the know" on this subject so want to take advantage of our inhouse experts....

What I am asking is this.....if this is so important that is must be part of an ECONOMIC STIUMULUS plan to save our economy, why has congress not acted on it in the past ???? It is not new (the concept) !!!

Certainly is not a new concept. I suspect that like many other things it was either not timely to pic it up and run with it to gain votes, because some other media or politician driven cause was the flavor of the moment. Just as likely is the fact that it is a difficult expensive proposition and some didn't have the cajones to address for fear of negative fallout from the inevitable attacks that would come from those screaming about "socialized medicine" , a tired old worn out phrase used to strike fear in people.

And maybe...just maybe, all of the pharmaceutical companies and personal injury/malpractice attorneys gave enough money to those that would accept it to keep it on the back burner.

The fact is it IS that important, and needs to be part of SOME plan because it is not a new concept and it is way past time it is addressed. Do a little research on the coming storm of not enough primary care docs as our population ages...this is not an "if" scenario..it is here now and will get much worse in the next decade.

And we still have to look at the use of our present resources and the appropriateness of their use.

Anything that is "important" is worth the courtesy of constructive thought, analysis and criticism, In the engineering world, it's called "Research, Development, Testing and Evaluation (RDTE)," before Implementation occurs. Anything less than that is called "Panic" and usually results in very limited positive results or abject failure.

Example: What happened to the first bailout money? Was it 90-100% successful, or was it marginally successful, or was it panic-followed-by-exploitation?

Will we have multiple electronic data bases servicing the medical data industry? Will they be able to interface? Which company will establish the technical standards (Microsoft, XYZ Engineering, Daschle & Associates)? How will data conversion occur? What is the life cycle of the system, and how will system evolution occur and when? Will it be mandatory, and who maintains the network? What will the participation costs be, and how will they impact delivery costs to the consumer/patient? These are just a few questions that must be resolved BEFORE mandating system participation and dedicating any federal funds. Yet, there is a cry to "get it on" as part of the Speedy-Stimulus-Act. Illogical, if not downright dumb.

Trying to figure why you quoted me before writing the above??
All of the questions you pose have been posed in the past and the enmeshed bueracratic hades in place dealt with it then no better than we seem to be prepared now....unless these things have/are being addressed unbeknownst to the public.
Where did the cry "get in on" come from?...I missed that one. Just wondering who was being referrred to as dumb this time.

The "important" caught my attention, and the way Congress and the Administration has acted has been either "panic" or "deceit" - am not sure yet which it is.

We'll see how long it takes before the questions come out as to where did the money go. Less thought went into spending almost $800Billion (before the overruns occur on the pork projects) than most folk make buying a car. That action is illogical and dumb, and the "who" are those who voted for the bill.

The final pricetag will be a lot higher than the $787Billion. I can't remember the last construction project or human service effort "managed" by government that did not have significant cost overruns due to constantly changing specifications. So, the actual pricdetag for this "stimulus" won't be known for a long time.

I used the word "important" because it is is..and that is an understatement of the grandest degree.
If it weren't so tragic I could find it laughable that this is now Obama and the Democrats problem. This same ailing healthcare infrastucture and has been strangled for decades by insurance company profiteers, abuse by patients getting a free ride, and by our very country itself with the ever growing self sustaining beauracracy that makes it so inefficient and difficult to practice. Same as it has been with ALL prior administrations.
Not really sure how "dumb" people are that voted on a bill they felt compelled to support, since I dont know their intelligence level nor do I know them personally. I kind of find it hard to believe that ALL of the democrats and a few modern republicans could be dumb...just seems statistically improbable.

At any rate, I think the o.p. was to a link that had some things to do with EMR, government influencing physicians decisions, and our views on treatments for hopeless situations, etc. Not inerested in hearing a lot of partisan BS on this one. It is time look at it honestly, getting the information out there from people that know, and making WHOEVER our elected offcials are accountable for helping to make some knew decions to manage things.
On nearly every level of the crisis we are in we have no model of success for comparrison...finacial, Healthcare. So to immediately pronounce everything being proposed as immediately wrong seems a bit presumptuous and obtuse...more so when it is so ridiculously divided down party lines. Who is omnipitent enough to see the pathway out in a situation we have never faced before? We simply have to do the best we can with advice from people we trust. If two groups are that far apart chances are pretty good neither one holds the monopoly on "right". The partisan squabbling is just another anchor around our collective necks at this point.
So yeah, as I watch our healthcare system grinding to a halt I think its pretty darn important. Panic? I havent got that impression thus far from lawmakers...perhaps its perception. Tell ya what though, in less than 10 years panic and then some will arrived...we are well on our way in healthcare. I for one am willing to listen to almost any ideas at this point, and will remain open minded enough to realize some ideas that are not necessarily on the same vein as mine probably have some merit too. Like my dad said, the truth is almost always in the middle.