I can see clearly now the rain is gone …
How often does a cabinet secretary endorse an op-ed column?
— 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.
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