Thomas Friedman on Obamacare: It’s gonna be a bright bright bright bright sun shiny day
I can see clearly now the rain is gone …
How often does a cabinet secretary endorse an op-ed column?
NYT’s Friedman sees a revolution in innovation and care under the Affordable Care Act: http://t.co/vNwDTumGqs #HealthInnovation #ACA
— Kathleen Sebelius (@SecSebelius) May 25, 2013
Thomas Friedman must feel really good right now, Secretary Sebelius endorsed his latest, ObamaCare’s other surprise.
Obamacare is based on the notion that a main reason we pay so much more than any other industrial nation for health care, without better results, is because the incentive structure in our system is wrong. Doctors and hospitals are paid primarily for procedures and tests, not health outcomes. The goal of the health care law is to flip this fee-for-services system (which some insurance companies are emulating) to one where the government pays doctors and hospitals to keep Medicare patients healthy and the services they do render are reimbursed more for their value than volume.
To do this, though, doctors and hospitals need instant access to data about patients — diagnoses, medications, test results, procedures and potential gaps in care that need to be addressed. As long as this information was stuffed into manila folders in doctors’ offices and hospitals, and not turned into electronic records, it was difficult to execute these kinds of analyses. That is changing. According to the Obama administration, thanks to incentives in the recovery act there has been nearly a tripling since 2008 of electronic records installed by office-based physicians, and a quadrupling by hospitals.
The Health and Human Services Department connected me with some start-ups and doctors who’ve benefited from all this, including Dr. Jen Brull, a family medicine specialist in Plainville, Kan., who said that she was certain she had been alerting her relevant patients to have colorectal cancer screening — until she looked at the data in her new electronic health care system and discovered that only 43 percent of those who should be getting the screening had done so. She improved it to 90 percent by installing alerts in her electronic health records, and this led to the early detection of cancer in three patients — and early surgery that saved these patients’ lives and also substantial health care expense.
Friedman suggests that the experiences of one doctor provide an example of how Obamacare will work universally. That’s a huge leap of logic. But the next part really bothers me:
Todd Park, the White House’s chief technology officer, said many new apps being developed have been further fueled by the decision by Health and Human Services to make available massive amounts data that it had gathered over the years but had largely not been accessible in computer readable forms that could be used to improve health care.
It started in March 2010 when Health and Human Services met with “45 rather skeptical entrepreneurs,” said Park, “and rather meekly put an initial pile of H.H.S. data in front of them — aggregate data on hospital quality, nursing home patient satisfaction and regional health care system performance. We asked the entrepreneurs what, if anything, they might be able to do with this data, if we made it supereasy to find, download and use.” They were told that in 90 days the department would hold a “Health Datapalooza,” — a public event to showcase innovators who harnessed the power of this data to improve health and care.
Ninety days later, entrepreneurs showed up and demonstrated more than 20 new or upgraded apps they had built that leveraged open data to do everything from helping patients find the best health care providers to enabling health care leaders to better understand patterns of health care system performance across communities, said Park. In 2012, another “Health Datapalooza” was held, and this time, he added, “1,600 entrepreneurs and innovators packed into rooms at the Washington Convention Center, hearing presentations from about 100 companies who were selected from a field of over 230 companies who had applied to present.” Most had been started in the last 24 months.
Friedman wants to credit Obamacare for this innovation. The innovation comes from American spirit not Obamacare. If government concocts an impossibly complex tax code, businesses like H & R Block and Jackson Hewitt form to help regular people deal with the complexity. If Sarbanes-Oxley imposes burdensome new regulations on commerce, a new industry of Sarbox compliance emerges. The innovation of these health care entrepreneurs is a sign that America’s innovative spirit is alive and well; it says nothing about the merits of Obamacare. At best it is a silver lining on a cloud or, to use a presidential metaphor, lipstick on a pig.
I can see all obstacles in my way …
To present electronic records as a savior of Obamacare is to oversell their benefits.
Steve Denning recently wrote Why is your doctor typing? in Forbes:
In the last year or two, there’s been a shift. Much of my time with doctors has been spent watching them type. In one case, the doctor tapped away on his laptop, occasionally looking up to ask questions before returning to the main focus of his attention: his computer. In another case, the doctor intermittently tapped on an iPad while we spoke. In a third instance, the doctor had a conversation with me and then apologized that he would be spending the next half of our session typing up the results of our conversation. All this typing was required, he said, if he was ever going to be reimbursed for his services. It was getting in the way of being a doctor.
Surely, I said, computerized medical records generate benefits. They are easily retrievable. They can be transferred from one practice to another and accessible to the many different service providers—hospitals, laboratories, specialists, radiology and so on—that might be involved in any one patient.
“In theory, perhaps,” he replied. “But in practice, it’s a horrible and costly bureaucracy that is being imposed on doctors. I spend less time with patients, and more time filling out multiple boxes on forms that don’t fit the way I work. Often I am filling out the same information over and over again. A lot of it is checking boxes, rather than understanding what this patient really needs.”
In addition to the question of the utility of electronic medical records, there’s the additional problem of the increased bureaucracy mandated by Obamacare. While not addressing Obamacare specifically, Jonathan Turley (!) warned about the The rise of the Fourth Branch of Government. (via memeoarandum)
The rise of the fourth branch has been at the expense of Congress’s lawmaking authority. In fact, the vast majority of “laws” governing the United States are not passed by Congress but are issued as regulations, crafted largely by thousands of unnamed, unreachable bureaucrats. One study found that in 2007, Congress enacted 138 public laws, while federal agencies finalized 2,926 rules, including 61 major regulations.
This rulemaking comes with little accountability. It’s often impossible to know, absent a major scandal, whom to blame for rules that are abusive or nonsensical.
Maybe Turley’s recognition is a bit late, but it is significant. Pity the doctor or consumer who defies the mandates of Obamacare.
Obamacare is an impossible construct that can’t possibly work. Some innovative people will make a living from it. But that doesn’t make it any more palatable – or possible.
Thomas Friedman pretends otherwise. The good news is that Friedman probably doesn’t have to worry about being audited or investigated by the DOJ. He’s a good lapdog.
If the Friedman column makes you sick, maybe some Johnny Nash will make you feel better.
Donations tax deductible
to the full extent allowed by law.
Sebelius, every time I view that name, I immediately think of antibiotics.
When I see the name Sibelius I think of the composer Jean Sibelius [“Finlandia”] and, of course, Finland — a very cold, dark place.
Which brings me back to the other Sibelius…
“Sebelius” misspelled throughout. Sigh….
sebelvicious spelled any way is still brain dead,criminal, commie scrunt.
Saunas & a roll around in the snowy birch forests are very invigorating. Then there is the smoked food , the licorice & long lazy swims in the manly lakes in summer. A train trip to St Petersburg , Vilnius , Riga & Talinn. . A ferry to Norway & Denmark . A pretty well organised country & one which tops all the international school tests every year.
Plus 70% of the population are blonde.
What is not to like?
I am not positive, but i think the only area where Friedman is an expert at all is grammar. I recently read about giant contracts being given to a obama giant donor that runs a company that is working on the electronic health records system that a recent study proved did not reduce costs or improve health care. The company has a poor reputation in the data management business in that the various systems fail to interact. There is a way for all our records to be available to every treating doctor, all our records can be stored on a thumb drive or an equivalent that “we” could carry and would not be subject to hackers. Hospital and insurance records could be stored under a number rather than a name for medical studies, epidemic detection, and adverse reactions or the like.
That’s funny because I think of an STD!
So instead of spending money on doctors, nurses and hospitals we are spending money to hire data gatherers. Theses folks in turn will sell our medical information to whomever pays for it. Don’t say it will be illegal because it won’t matter, especially when the government wants to get their hands on it.
Wasn’t Friedman among the super duper A-list presstitutes invited to one of the super secret WH briefings held so the POS and his lapdogs could get their stories straight?
Also, notice the fall off of POS scandal coverage this weekend and the freshly emerging meme that the Rosen snooping scandal is all Fox news fault because (so CNN reports) the DOJ notified News Corporation about and they did not notify FOX management?
Yes, my doctors have indeed been spending a lot more time fighting their computers instead of treating me and my family. The only ones who don’t are ones who have an assistant with them who deals with the computer while they continue to be doctors.
And I got to fill out the same forms multiple times as part of the the pre-op for surgery last month. Everyone involved either uses the exact same EHR system at the hospital or has a system which supposedly talks to the hospital EHR. I got to the point where I would just write “This info is already in the system” on the forms rather then go through my long list of prn meds for the gazillionth time. And it must have been because no one ever got back to me and said they needed me to be more specific.
As for the saving all that money by catching three patients cancers early, not to sound crass, but how much money was spent on the tests for the other 45% of her patients who didn’t have cancer? I’ve read a lot of papers whose general thrust is that preventive care may save money for a given patient but in the long run costs everyone more.
I guess Friedman didn’t talk to any of the many, many physicians who looked at the Obamacare incentive structure and said, “I’m outta here.”
Personally thinking, my doctor’s partner is retiring, says she can’t practice medicine this way. My doctor said now there are 30,000 codes. And there will be 170,000 codes, and your prescription info now is all on line. Out there.
As a physician I have to agree with Denning, and expand on it to note that electronic medical records that ‘qualify’ for insurance company and Medicare reimbursement are among the worst creatures ever to walk the earth.
Designed to emulate government databases where input is done by a 7th grade dropout, your personal record is an endless series of drop-down boxes and multiple choice questions. Free text (what you actually said) is discouraged because the computers can’t make sense of it.
Although the EMR may use Mr. Gore’s internet to pull in your CT scan from 2006, you can be sure that the computer’s decision tree will recommend repeating the test, simply because it’s from 2006.
A record-keeping system approved by CMS and sold by revenue-maximization practice consultants or an insurance company has one real goal- enable the absolute highest code to be billed. It’ll help office billers choose among the 16,000 codes (that’ll double with ICD-10) so the doctor can get the claim paid at something more than $26.15.
Obamacare simply put this (not value-added) process on steroids, guaranteeing your 5 minute office visit takes the doctor 20 minutes to record. Outcomes data, disease managemt or primary care incentive demonstration projects are either a footnote or on a wish list. The only thing that got better here is the employment picture for data entry, storage and IT guys, doctors and nurses got another rope around their necks.
I wonder what Freidman might say if he asked to see his electronic medical record– tell me it helps anything!
Of course, the AMA gets their royalty on the “codes.”
Sorry for my fat fingers. Meant to hit LIKE. New iPad user.
What’s scary is like any other business is the person inputting your information is bored or under the gun to input a minimum amount of records to make money for the company. As a result they forget to incude your allergy to penicillin and when you’re admitted to the emergency room the doctor does not get to see that little bit of information. Oops.
Your ‘another rope around their necks’ says it all. I’ve been a patient of the same physician for many years and even when I had to see him for more than just a standard check-up I always enjoyed the personal connection between us that gave us a few minutes to discuss non-medical things that we were both interested in involving mutual friends or local news. I remember when a couple of years ago I went to an appointment wearing a shirt advertising a local band that showed potential…his eyes lit up and he said “sit right there Joy while I run to my office to get my camera.” He was back in seconds and we both had a good laugh when I told him that I could hear him running down the hallway loudly proclaiming that he had a patient wearing his nephews’ band shirt.
Sadly, our visits are not that way anymore. Now it’s like you said, he sits there clicking those boxes on his computer that he never fails to say are a required waste of time. He’s still a wonderful physician…..but he doesn’t smile much anymore.
All you need to know about Thomas Friedman’s prophetic powers: Arab Spring.
Friedman wants to credit Obamacare for this innovation.
Same old “broken windows” concept.
The bulk of the excess health care costs in the US relative to Europe occur in the over 65 population, who are covered by medicare. The only way to bring the costs in line, is to reduce medicare coverage, or put another way, let the Death panels decide who gets treated and who is left to die. This is what they do in the UK and, I believe, most of Europe. If the plan is to gut medicare to pay for Obamacare, then Friedman is correct.
“It’s gonna be a bright bright bright bright sun shiny day.”
Yeah … well, that’s the problem.
Because in the Age of Obamacare, in the time it takes your doctor to check all the digital checkboxes and fumble with the drop-down menus and sub-menus, and after he’s filled out the screen where he’s registered you to vote, allowing him to proceed to the next screen …
… in the time it takes him to do all that, your melanoma will have gone from stage 2 to stage 3 …
… and he’ll have to start all over again. And this time, as he checks a few different checkboxes, treatments available the first go-around, won’t be available now that a few different checkboxes have been checked.
But as he fills out the screen that shows he’s informed you of mortuaries and cemeteries in the area and their range of services and prices … allowing him finally to proceed to the next screen after dealing with that infuriating error message a few times …
… before he lets you go he’ll be prompted on the final screen to look up and make eye contact with you as he says good-bye (it was nice knowing you), before he hits “submit,” only to be warned by another error message and accompanying clanging sound …
… that he must check the checkbox that reads,
“Gave patient free condoms” before hitting the submit button.
LukeHandCool (who refuses to submit … and who will have to slice off and biopsy his own damn irregular moles the way things are going. Luke has had a half-dozen of ’em whacked off at a time. For Luke grew up a beach-loving sun-worshipper like his parents. And back then, when Luke’s older brother had an acne problem … the medical wisdom from the dermatologist back then was to get lots of sun and salt water to clear up the complexion. Oh well. Luke wouldn’t trade those boyhood beach days for anything. Life has risks and that’s a part of living. Luke can live with that. He just doesn’t like the fact that progressivism increases those risks)
Cheer up Luke. One can get melanoma of the anus .
As for a life in the sun – my observations are that the indoor types have better skin by far. However those who spent time in the sun as a youngster have better stature & better frame to build on .
After 40 everything is maintenance.
Looks like Obama has got the front line shock troops out in force today. Here is a story by that classically trained professional stalwart of journalistic integrity Ezra Klein.
Anyone think maybe there was some coordination taking place at the latest meeting of the journalist people and the white house people?
I am sure that both Friedman and Sebelius have an I. Q. of over 80 and must know what a disaster Obamacare really is both in cost and in projected service. Why, then, are they purposely deceiving the public with their comments.
I wonder how many would still follow them if they both were honest about their real agenda?
[…] to do. That's what I call initiative. One of the happy side-effects of ObamaCare is that it is stimulating all kinds of enterprising parties to create new applications that will help keep doctors tapping away on their computers when they […]
“Obamacare is based on the notion that a main reason we pay so much more than any other industrial nation for health care, without better results, is because the incentive structure in our system is wrong. Doctors and hospitals are paid primarily for procedures and tests, not health outcomes.”
This right here is the issue with his entire outlook. Friedman wants to reward or punish those in healthcare based on outcomes. He is trivializing exactly how we get to those outcomes. In addition he is essentially telling anyone with a terminal or difficult to manage disease to go fend for themselves. Outcomes are obviously important but his version would reward doctors taking the simplest cases while punishing those in more complicated specialties.
Another problem I have with this system’s “universal” records keeping is that it will potentially leave you at the mercy of previous diagnoses. As doctors spend less and less time with patients they will be increasingly forced to rely on those records in the name of efficiency.
So if there is a change in your condition, a previous misdiagnosis etc it is much less likely to be noticed.
Assuming he actually has altruistic motives he clearly doesn’t understand how people will react to the incentives proffered in Obamacare. Then again maybe he does..
Up is down and right is left for Krugman. He IS the Democrat’s Baghdad Bob. (Or one of them, at least.)
“At best it is a silver lining on a cloud or, to use a presidential metaphor, lipstick on a pig.”
LOL. Ha! That’s your best line of 2013, so far. ‘At ‘ere’s funny, ah doan care who you are.
Let’s not ask people to take the responsibility for their health (not health care) into their own hands. Why, that would be so un-American.
This sounds illegal as hell:
“It started in March 2010 when Health and Human Services met with “45 rather skeptical entrepreneurs,” said Park, “and rather meekly put an initial pile of H.H.S. data in front of them — aggregate data on hospital quality, nursing home patient satisfaction and regional health care system performance. We asked the entrepreneurs what, if anything, they might be able to do with this data, if we made it supereasy to find, download and use.”
Why are only 45 entrepreneurs selected for this meeting, and who are they, and why were THEY selected? Why are they being given the opportunity to leap ahead of others by being given free data – data they didn’t even ask for? This stinks to high heavens.
I used to think Friedman was a fool.
Now I think he’s an idiot.
[…] David Gerstman has an interesting piece up at Legal Insurrection about the IT panacea for Obamacare. He notes an op-ed by Thomas Friedman that received an endorsement by Health and Human Service Secretary Kathleen Sebelius that paints a glowing picture IT investments made under the act will have at providing better and cheaper medical care. Gerstman then follows up Friedman’s breathless piece with another that asks a simple question, if the impact of IT on health care is so wonderful Why Is Your Doctor Typing? Forbes’s Steve Denning writes about his experience at his doctor’s office where he watches his doctor typing on a computer during his exam. Surely, I said, computerized medical records generate benefits. They are easily retrievable. They can be transferred from one practice to another and accessible to the many different service providers—hospitals, laboratories, specialists, radiology and so on—that might be involved in any one patient. […]
[…] In·sur·rec·tion/David Gerstman –Thomas Friedman on Obamacare: Its gonna be a bright bright bright bright sun shiny day submitted by The […]
[…] In·sur·rec·tion/David Gerstman –Thomas Friedman on Obamacare: Its gonna be a bright bright bright bright sun shiny daysubmitted by The […]