We have big but not insoluble problems. They can’t be solved in a top down fashion. Will the public cooperate in sacrifice and life style change if they don’t trust the government and the secretary of H & HS?
I value Glenn Greenwald; I think that he’s mostly correct about Daschlehttp://www.salon.com/.... Daschle has a good side, mostly related to his experience and coziness with the old pols and the insurance industry. He’s not dumb. Daschle was paid $20,000 to speak to America’s Health Insurance Plans, an insurance lobby group, in September. He was cozy with Obama then but saw no reason to curtail his well-paid insurance industry role. He made over $2 million from insurance “consulting” last year. It’s no surprise that AHIP endorsed his nomination. AHIP and Newt Gingrich love Daschle’s emphasis on electronic Health records (EHR).
They smell big money coming to subsidize the software. That software will make it easier for the big insurance companies to keep track of their clients, but it won’t work across systems- when you go to an ER not owned by your HMO (financially savvy businesses don’t own ERs) there is no link to the primary physician or to the insurance company, no cross platform integration. How can there be if each insurance company independently picks their computer system?
Look at the pie chart showing the massive HHS spending on Medicare. The average Medicare patient visits seven different physicians every year. They work for different entities 80% of the time - some are ERs. Consider my situation, working for a public hospital. Every day some Kaiser subscribers are brought to our ER. When you call 911 you are taken to the nearest hospital able to handle your problem- heart attack, stroke, car accident, pediatric trauma etc. When I see a Kaiser patient in our ER (a few times a month) I sit down that day, write a 2 paragraph note and FAX it to the patient’s Kaiser doctor. I can’t get into the Kaiser EHR; I can’t add material to it. I ask the ER doctors why they don’t FAX the summary sheet for every ER visitor to Kaiser, they say various things- “it’s handwritten, maybe illegible, won’t copy well, Kaiser docs will send for the records if they need them, etc.” When I ask our medical records department how often Kaiser requests records from us, they say, “It happens”. When I ask how often they say, “If you want to pay us to track those requests we can do it, otherwise not- we’re overwhelmed”.
The IT gurus that Daschle relies on expect a new health care plan to include money to partly subsidize buying software for EHRs and a law requiring all docs and clinics to use EHRs within 5 years. There would be no requirement for integration with other systems and they don’t envision the government providing the open source VistA that the VA uses (it has some problems). They say that the market will sort out which systems are best. I shout BS- hospital administrators buy the systems (sometimes getting kickbacks), doctors and nurses who have to use them get limited input – I’m speaking from personal experience at other hospitals.
If every doctor, clinic and HMO has their own EHR, this would be some help and would definitely help the insurance companies, but it wouldn’t control the big cross platform problem . About 75% of healthcare dollars are spent on people with chronic illnesses such as diabetes, kidney trouble, heart trouble, etc. They see a lot of different doctors & ERs. Our psychiatrists prescribe all kinds of medicines, some of which are actually helpful, but there is no outpatient psychiatric info in the non-electronic medical record- HIPPA, privacy etc makes it easy for them to dodge this bullet. if psychiatric drugs never affected body health, this wouldn’t matter but they do- sometimes aggravate diabetes, heart trouble. etc.
Whatever is done in the first wave of healthcare reform, there will have to be many subsequent waves. We’ll need trust and cooperation from the general public. We don’t have that trust today- Daschle and many others demonize doctors and hospitals and the general public feels that we are all out for money (some of us are, the cost of medical education is a factor). Sixty five is too late to start an exercise program, going to a gym is not the best solution for most people, etc. Avoiding conflicts of interest AND the appearance of impropriety is critical. Will the public cooperate with painful changes if they see guys like Daschle and Geithner at the top of the pile? They will remain cynical and overweight. Geithner is a done deal, the general public will never trust him. They don’t and shouldn’t trust Bernanke. Health care and finance are interlocked- controlling healthcare will help US businesses, but how can we make real reforms without trust? Trust, which is currently lacking would increase with making Daschle secretary? Come on.
Dean is not the answer. He is a bright and wonderful man, but he can’t get difficult legislation through Congress; I’m not sure that he can run a bureaucracy as big as HHS. Even if he could, Rahm Emmanuel will make sure that he stays on the periphery of the Obama administration. That’s a done deal. I say, cut Obama some slack about time. Let him plan carefully, but put the heat on him about these improprieties. Flood whitehouse.gov with complaints. I give the Obama vetting system a D plus for its shoddy work with the big names- Daschle, Geithner and Richardson. I won’t get into HR Clinton who is a more complex case and possibly OK. (time will tell). I think Daschle's appointment would be a serious mistake. I understand why Clinton, kerry & Dole like him, but they assume that stuff can pushed down on "the working world". I’m Faxing my stuff to the white house at 202-456-2461.