Vol. 116 December 15, 2014 Obamacare Update

December 16, 2014

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“After a year in place, the Affordable Care Act has largely succeeded
in delivering on President Obama’s main promises.”
– NY Times

“Americans would rather see it improved than repealed.”
– Boston  Globe

Today, December 15, is the deadline for new enrollees to sign up for health care insurance under Obamacare ( December 23 in Massachusetts). It seems an appropriate time to take a look at how it is going. The deadline for renewals is February 15.

The recent Jonathan Gruber “revelation” about Obamacare’s “non-transparency” alleged that “ they did not tell the public that young, healthy people must subsidize sick people to make the numbers work.” Well, hello, what about insurance don’t you understand?! Those of us whose house has not burned down are subsidizing (aka “insuring the loss of”) those whose house has burned down!

Since the ACA was passed in 2010 the number of uninsured has fallen by 25%-33% depending on the study. At least 8 million and perhaps 11 million previously uninsured are now covered. Critics of the ACA charge that number is overstated by about 700,000 who merely got dental insurance coverage. More about that later in this blog. The law “is helping the health care industry by providing new paying patients and insurance customers.” It certainly is!  Health insurance companies are looking at a “nearly $2 trillion ( yes, TRILLION) of subsidized coverage through insurance exchanges and Medicaid over the next 10 years,.” Share prices of four of the major health insurance companies – Aetna, Cigna, Humana, and United Health – have more than doubled since March 2010. (1)

ACA subsidies are helping many who could not get health care coverage previously, but deductibles and variable out-of-pocket costs can remain a burden on low- and middle-income Americans. Please note the key word “Americans” here because the law does NOT extend coverage to un-documented immigrants. Undocumented immigrants and adults in 23 states that have not extended their Medicaid coverage as subsidized by the ACA comprise the major portion of uninsured persons. Texas, Florida, and California have the highest proportions of those people.

ACA health care insurance premiums were predicted to skyrocket, but in fact they will rise an average of 5% for 2015. “One reason may be that insurers who came in high in 2014 found themselves beaten out for enrollments. 77 new insurance plans will be competing for customers in 2015.” (2)  The online application for new customers is down to 16 screens from the original 76 screens that scuttled the first website application.

A physician from Kentucky in an essay in the NEJM pointed out that the two Kentucky senators remain vehemently opposed to Obamacare despite the fact that 413,000 Kentuckians have gained health insurance coverage under the ACA law. Senate Minority Leader Mitch McConnell (R-Ky) has suggested that Kentucky could keep its health care exchange established by the ACA, Kynect, “even if the ACA is repealed”. (Does “have your cake and eat it too” come to mind here?) “It is unfathomable that they can continue to oppose the law and that geography can determine the adequacy of American’s care.” (3)

Government reports reveal that 1.4 million new enrollees have made selections of plans through December 5 through federal exchanges in 37 states. Reaching the CMS announced target of 9.1 million enrollees by 2015 appears to be imminent. The law’s “penalty” for individuals remaining underinsured started out at $95 (or 1% of income) annually in 2014 will go to $325 (or 2% of income) in 2015.

It is too early in its implementation to evaluate the ACA’s promised improvement of quality. A recent study of Massachusetts mortality rates after ACA implementation suggested that its effect has been positive, but many criticized the study’s conclusions as speculative and premature. Obamacare did create the Medicare Hospital Readmission Reduction Program aimed at reducing readmission within 30 days of hospital discharge; an expensive event supposedly associated with inadequate treatment during the first hospitalization or inadequate follow-up as an outpatient. The national readmission rate for Medicare dropped from 19% in 2007-2011 to 17.5% in 2014, “in part as a result of the ACA”.

An early sign of the success of Obamacare might be the very recent demand to expand its dental insurance benefits for children to adults via a proposed Comprehensive Dental Reform Act of 2013. (4) Look to this concept and the coverage of non-documented immigrants to become issues in the 2016 election. For those of you with a really long-term outlook, expect Hilary’s Affordable Veterinary Office Care (HAVOC) to be a hot issue in 2020.

Even during this very polarized midterm election some perceived a subtle shift on the Republican side from “Obamacare opponents” to “Obamacare critics”. They may be getting the message that a large portion of the citizenry is liking the health insurance coverage that reduces their stress and concern about the potential impact of uninsured illness on their life and pocketbook. Maybe more member of both parties will switch from Obamacare “opponents” to Obamacare “critics”, since we all agree that Obamacare, or whatever Hilary chooses to call it during her first term, can be improved.

References:
1. Bos Globe Nov. 18, 2014; pg A8
2. Cape Cod Times Nov. 1, 2014
3. The Affordable Care Act, 1 Year Later, NEJM 371;21, pg. 1960, Nov. 20 2014
4. Integrating Oral and General Health Care, NEJM 371:24, pg. 2247, Dec. 11, 2014


Vol. 108 August 15, 2014 “Big” Marijuana?

August 15, 2014

hubWhat will be the future impact of marijuana use?

A recent article in the New England Journal of Medicine suggests very plausibly
that the history of tobacco use tells us how the marijuana industry might develop.

 


“The tobacco industry has provided a detailed road map for marijuana:

  • deny addiction potential,
  • downplay known adverse health effects,
  • create as large a market as possible as quickly as possible,
  • and protect the market through lobbying, campaign contributions, and other advocacy efforts.”

Marijuana (MJ) IS LESS addictive than tobacco. Presently about 9% of MJ users meet the criteria for dependence as compared to 32% for tobacco users. But, recent studies show that heavy MJ use by an adolescent can lead to structural brain changes and subsequent dependency as an adult. All researchers agree that MJ use in those under 21 years can be harmful and should not be permitted. Most agree that MJ is NO more a gateway drug than alcohol and tobacco are.

MJ’s effect on cognitive functioning IS LESS than alcohol, but it can slow reaction time. Effects of MJ are independent of blood or urine levels. There is no breathalyzer test for MJ. DUI standards for MJ do not exist. (see Buzzfeed video, “Drunk vs. Stoned”)

We now accept that smoking tobacco is a major cause of death. To our knowledge no one has ever died of marijuana. Since it is inhaled it can cause lung damage, but it doesn’t cause cancer. Sensitive to the concern about damage caused by inhaled MJ, sellers are already pushing vaporizers and edible products. A rumored joint venture between a medical MJ vendor and an e-cigarette manufacturer apparently sent stock prices soaring.

MJ is cited often for its useful effects for cancer and AIDS patients, and those benefits are real. There is very little evidence that MJ “reduces anxiety”. Such claims imply that “a little reduction of anxiety” will, of course, make your work and life easier and users will be more successful. Can’t you just envision the ad campaigns for “cool”, “mellow”, and “helpful MJ”?

Cigarettes started out as a “roll your own” process used by a small portion of the population in the 1880’s. By 1950 half of our population used tobacco, mostly cigarette smoking. As the process of making cigarettes was industrialized, 120,000 cigarettes a day were rolled and packaged by machines. Advertising and marketing soon expanded the use of cigarettes to the general population with special targets of women and the young. Cigarettes were made “more mellow” and had additives to speed absorption and “enhance taste”. Increasing the potency of MJ is already well under way and literally has free rein, since there is no standardization of MJ products. Competitive sellers boast of their product’s enhanced potency and use it as a marketing tool.

As the tobacco industry grew, so did the smoking lobbies and corporations that resisted regulation of tobacco products or distribution of the scientific studies of tobacco effects. The National Cannabis Industry Association with 450 business members and offices in Washington, D.C. and Denver already exists.  The strength and power of the tobacco lobby prevented us for 50 years from accepting cigarette smoking as a public health problem. Unlike cigarettes, MJ also has the internet that provides direct, and directed, advertising to the public; a fantastically effective and profitable way to sell a product as proven by our pharmaceutical companies.

Anyone that does not believe that MJ will become a major business need only look at the competitive scramble for permits in states newly allowing medical marijuana dispensing ; a fierce competition despite ambiguity of Federal vs. state law compatibility, as well as hefty application and annual permit fees.

“The free-market approach to tobacco clearly failed to protect the public’s welfare and the common good: in spite of recent federal regulation, tobacco use remains the leading cause of death in the U.S.” The author calls for “collaboration among the FDA, NIH, SAMHSA (Substance Abuse and Mental Health Services Administration) , the National Highway Traffic Safety Administration, and other agencies” to “understand the harms and forecast the effects of industrialization” of MJ. In light of the ineffectiveness of multiple governmental agencies in “collaborating” to ensure proper, transparent food labeling and enhance the public health, one can’t be too optimistic about government’s effectiveness in influencing the manufacture, selling, and use of MJ in the future.

References:
1. NEJM 371:5 July 31, 2014 “Big Marijuana – Lessons From Big Tobacco”, Richter and Levy
2. Institute of Medicine, Marijuana and Health, 1982
3. Institute of Medicine, Marijuana and Medicine – Assessing the Science 1997


Vol. 106 July 1, 2014 Whas’up with Obamacare?

July 1, 2014

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My nomination to the
“Understatement Hall of Fame”

“I think that probably no one fully anticipated when you have a law
that phases in over time how much confusion that creates for a lot of people.”

- Health and Human Services Secretary Kathleen Sebelius, April 8, 2013

The news media (and a lot of republicans) have not been ranting or raving about Obamacare lately. They seem to be preoccupied with Immigration laws, Tea Party challengers in Congressional primaries, and Hilary’s uptick in her campaign (aka “book tour”). I thought it might be helpful to look at “where Obamacare is at”.

82 out of 87 provisions are in effect
Of the 87 provisions in the Affordable Care Act signed March 3, 2010 (over 4 years ago!) 82 are in effect in today. Granted there have been some postponements in deadlines for enforcement and some delays in implementation of certain sections, but overall Obamacare is apparently plugging along very well. Only 3 additional provisions are slated to go into effect for 2015 to 2018. Kaiser Foundation has an interactive website to track each provision and its implementation status if you really want to know all the details.

27 states have decided to expand their Medicaid coverage
The ACA offers federal reimbursement for 100% of the initial years cost to states expanding coverage by raising the income level of eligibility for Medicaid. The federal subsidy to the states who expand coverage will gradually decrease each year, but the maximum cost to the state will be 10% by 2020.Medicaid ACA status by state
Three more states are openly discussing the move and 29 are not moving at all.

Enrollment targets continue to be met.
As of April 2014  13.5 million individuals have been determined to be eligible to enroll (“buy health insurance”) in a “marketplace plan” (either state-created or federally run) 8.5 million individuals or two-thirds of these could be eligible for financial assistance in the form of an advanced tax credit for their health insurance purchase. 8.1 million individuals of the 13.5 million total eligible have actually selected a plan. However, no premiums have actually been billed or paid just yet.

ACOs are blossoming nationwide, particularly in the northeast corridor.
Creation of Accountable Care Organizations (ACOs) which incentivize health care providers (physicians, hospitals, and other members of the health care team) to band together to provide patient care more efficiently (“less costly”) and with improved quality. It is a lynch pin of Obamacare. According to the Levitt Partners (yes, creation of the ACOs legal entities has become another guarantor of lawyers’ retirement funds), a total 626 ACOs covering 20 million patients, or 17% of the U.S. population, now exist. Most of these individuals have purchased commercial health insurance policies (another reminder of the boon of ACA to health insurance companies)  AND most patients don’t even know that they are now in an ACO. About 2/3 of the U.S. population lives in localities with ACOs mostly concentrated in the Northeast, 40% of the general population have access to at least two ACOs, and 10% of Medicare patients are patients of an ACO.

MSSP participating ACOs
As of May 2014 about one-half of the ACOs (338) are participating in the Medicare Shared Savings Program (MSSP) covering 5 million patients in 47 states, DC, and PR. In the MSSP the ACO that “saves money” by reducing costs without compromising defined quality standards gets to keep some of that money for its providers. This is usually called “risk sharing”, and though dismissed initially as “managed care in different clothes”  reluctant providers have clearly jumped on the bandwagon. In May of 2012 the first report  period identified 27 MSSP ACOs. There are different levels of risk to ACO providers so “when you see one ACO you have seen just one ACO”. About 50% of ACOs include hospitals as members. Preliminary data about ACO performance is currently mixed, and credible  data about which models will work the best is still unavailable.

What about the cost of ACA?
Of course, increased access of individuals to effective health insurance is going to cost money. In April of this year the non-partisan Congressional Budget Office (CBO) working with the Joint Committee on Taxation REDUCED their estimate of the cost of ACA in 2014 by $5 billion (from the $36 billion originally estimated). The estimated cost over 2015-2024 wa REDUCED by $104 billion (of $1,400 billion total originally estimated).CBO est. cost of Obamacare

 

Billions of Dollars, by Fiscal Year graph

 Wrap Up Of  Whas’up with Obamacare
“First, all major parts of the ACA except the individual mandate are popular — including the insurance-market reforms, the subsidies to make insurance affordable, closure of the drug-benefit “doughnut hole,” and the incentives for most employers to provide affordable insurance as a fringe benefit. Second, lawmakers who support repeal will not want to snatch insurance coverage from an estimated 37 million people who will be insured thanks to the ACA in 2017. Third, repeal would cut into the sales and profits of health care providers and suppliers of all stripes.”  (1)

The Supreme Court ruled that the individual mandate penalizing people (via their annual tax return) who don’t purchase some form of health insurance was constitutional because the court considered it  “a tax, not a fine”. Justice Robert’s unexpected vote in favor of the ruling prompted Jay Leno to quip,”The Obamacare ruling makes Roberts the first Republican to favor an insurance law with an individual mandate since, well, Mitt Romney.”

1. “Here to Stay- Beyond the Rough Launch of the ACA”,  HJ Aaron, NEJM, June 12, 2014

 

 

 


Vol. 112 May 1, 2014 Sugar is Bad! Oh no, Not Again.

May 1, 2014

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I say “oh, no, not again” because 30 years ago I spent some time in my practice and in the community
defending “bad” sugar against accusations that it caused hyperactivity and attention deficit syndrome.
Research, then and now, has shown that in only about 25% of hyperactive children
eliminating, not the sugar,but the dyes and other additives in sugary foods can reduce their hyperactivity.

 

The film “FED UP” which I just saw in advance of its general release on May 9 makes a compelling argument that the amount of “unaccompanied” sugar (the American Heart Association calls it “added” sugar) that we eat is causing our obesity epidemic. It is narrated by Katie Couric and produced by the producer of “An Inconvenient Truth”.

The film simplifies complex nutritional and biochemistry processes with an easily understood cartoon diagram showing sugar ingested without accompanying fiber or protein being absorbed quickly, traveling directly to the liver where it ignites a burst of insulin that converts the sugar directly into fat. If fiber or protein is ingested along with the sugar this absorption is slowed, less insulin is released, and less fat tissue results. Hence the campaign against super-size sodas in New York City and efforts to ban soda vending machines from our schools. The film points out how detractors try to reframe the soda discussions into terms of “individual liberty vs. an over-reaching government”, rather than that of a serious health issue.

“FED UP” explicitly demands that we demonize sugar the way we have demonized tobacco. “Both are extreme health hazards”.

The average daily consumption of sugar in the U.S. is 84 grams. The American Heart Association recommends 36 grams a day of added sugar. “Processed food” with its high sugar content gets the black mark here as compared to “real food”, which if it has sugar, also has fiber which delays its immediate conversion into fat. The film’s examples of the success, power, and money of the “sugar lobby” and big food corporations are particularly provocative. The film removes all blame from the fat individual and places it squarely on the persistently clever, seductive advertising (particularly to young children) of food processors and distributors. The film’s revelations of the ability of the food and sugar lobbies to resist truthful, transparent labeling and to continue to outmaneuver an amorphous front of three different federal regulatory agencies is compelling .

Fun facts presented by “FED UP” include:

  • When President Reagan cut the school lunch federal subsidy in the 80’s many schools outsourced lunch preparation to fast food suppliers and closed their school kitchen to lower costs. Today 80% of schools in U.S. have their school lunches provided this way (pizza, french fries, cheeseburgers, and sodas – Pizza Hut, MacDonald’s, etc.) Do you know where your schools get their lunches?
  • Promoting student choice of healthy alternatives is an easy, obvious answer to outsourced vendor lunches, but in a school where a healthy alternative is offered a cafeteria worker reports that “only about 25 out of 350 students actually choose it”.
  • Multiple sugar products are often hidden on ingredient labels by use of unfamiliar names.
  • All the fat taken out of milk and other dairy products during the 1980’s rush toward “fat-free” food has been successfully re-marketed as increased cheese products. Many food manufacturers added even more sugar to restore the taste of “reduced fat” foods.
  • Sugar is the ONLY ingredient on the ingredients list that is NOT accompanied with a “percentage of daily requirement” number. This “% number” has been kept off the labels by the sugar lobby. If it were added, we could quickly see that we often exceed our “daily requirement of sugar” about half way through lunch. The film depicts a bowl of corn flakes as actually a bowl of sugar.

A couple of reservations about the film:
1. The film touches only briefly on the genetic contribution to obesity. It explains the two, clearly thin brothers running around in the background of one of the featured fat families, as TOFI (Thin Outside Fat Inside), a recent concept which depends on specialized total body MRI imaging to identify.

2. Its explanation of why the rest of the world is also getting fat is “that we are so good at exporting our ads and processed food to the rest of the world”. I think that is too weak to explain the rise of obesity in countries like Spain, Switzerland, and Korea.

Internatl obesity rates
“FED UP” closes with some specific recommendations and challenges:

  • Reduce sugar intake by 50% by cooking “real” food.
  • Any food with more than 12 listed ingredients is a processed food not a “real” food.
  • Eat fresh, buy local
  • GO SUGAR FREE FOR 10 DAYS. A difficult thing to do because of all the hidden sugar in soups, sauces, catsup, yogurt, and canned foods. A family in the film did do it for 10 days, liked it, extended it, and lost dozens of pounds.
  • Ask your legislators to pass laws requiring the inclusion of “% of daily requirement” for sugar on all labels, just like all the other listed ingredients.

Dare I close with the tag line that this thoughtful, polemic film provides us (U.S.) with “much food for thought”?
.                                     Look for “FED UP” after May 9.


Vol. 111 April 15, 2014 Who’s On First?

April 15, 2014

Abbott_and_Costello_9396

Washington – April 10, 2014
“A welcome relief from rising health care cost for U.S. consumers is being less warmly received by the Federal Reserve.”

Mr. Abbott, a Washington economist, is heard explaining it to Dr. Costello, a physician.

A: The cost of health care services rose just 0.8% this year.
C: That’s good news. We all have been working hard to reduce costs,what with meaningful use, and evidence-based medicine, and transparent patient portals. It’s hard work.
A: Its not good news.
C: What?
A: Health care sevice prices are down from its 10 year average of 2.6% increase.
C: That’s really good.
A: No,its not.
C: Why?
A: It’s a sign of persistent deflation.
C: Aren’t we afraid of inflation?
A: Not now.
C: What?
A: Their current goal is 2% inflation.
C: Whose?
A: The Federal Reserve.
C: Who?
A: They measure the economy.
C: How?
A: Using the Personal Consumption Expenditures or PCE.
C: What?
A: LIke the Consumer Price Index, the PCE measures what people spend on things.
C: Why?
A: People spending more money on things means the economy is growing stronger.
C: Who says?
A: Mr. Bush. Remember, he asked us all to go shopping to get out of the recession.
C: Where?
A: In America, of course.
C: What do health care services have to do with the mall?
A: Health care services make up 25% of the prices measured by the PCE.
C: So what.
A: Physician fees went up only 0.2%, down from 1.6% in 2012.
C: THAT’S not good for me!
A: No, its not.
C: What!?
A: Nursing home prices went up only 0.3% rather than the 1.8% rise of two years ago.
C: I know, I know. That sounds good but its not?
A: Right!
C: Why?
A: If health care prices don’t go up, the PCE doesn’t go up, and our economy looks stagnant.
C: Oh, boy! I think I got it. If all the efforts to reduce health care costs succeed, the PCE will not rise, inflation will be less than 2% a year, deflation will persist, and the Federal Reserve will label the economy as stagnant.
A: Now you’ve got it!
C: What about the impact of the Affordable Care Act?
A: Economists agree that the impact of Obamacare is not yet clear.
C: Oh boy!
A: Any questions?
C: Just one.
A: What?
C: Who’s on first? 


Vol. 110 April 1, 2014 PUTINCARE UNVEILED

April 1, 2014

 

Putin on horseback  PUTIИCAЯE UNVEILED

Vladimir Putin, President of the Russian Federation, today unveiled his country’s plan for universal medical care, the Accessible Care Act (ACA) or Putincare. The act was passed by a unanimous vote in both the Upper and Lower Houses, “an easy task of collective wisdom once we eliminated the ‘individual mandate’ clause.” Mr. Putin remarked that he had hoped to make the announcement while on the crest of success of the Sochi Olympics, but that the unexpected expression of states’ rights in the Ukraine distracted him. “I understand”, Mr. Putin went on to say, “that Mr. Obama sometimes has his own problems with state’s rights, but our Georgia is not like his Georgia”.

Putincare will establish medical care Exchanges in all states belonging to the Russian Federation. Every citizen (Yes, EVERY citizen. After all, the number of immigrants into Russia is not an issue.) will be able to bring in pigs, or chickens, or even potatoes and exchange them for medical care. Each Exchange will set its own eligibility criteria and rates. For example, in Georgia one pig could be exchanged for a throat culture and ten days of penicillin while in Moscow the same would cost one pig PLUS the names of two suspicious neighbors. The urban-based social networks, like “2Facebook”, will encourage this.

Full implementation of Putincare will depend on increasing the number of doctors and nurses in Russia since many towns have none. Despite the concerns expressed by the BAR Association (Babushka Assistants of Russia) that new doctors and nurses will compete unfairly with their services, Putincare calls for the immediate recruiting of as many Indian and Pakistani providers as possible. “It seems to have worked for Britain and America.” Mr. Putin expressed great confidence in their ability to avoid some of the early problems experienced by Obamacare. “Our computer expert, Mr. Snowden, assures us that we will have no problems. Of course, if he is wrong, he will return to America sooner rather than later.”

Putincare, like Obamacare, will not cost any additional money. The medical care provided through the Exchanges will get sick people better and reduce the work days lost due to death. The plan will increase revenue as a result of more pigs, chickens, and even potatoes… not to mention the increased number of State enemies identified in Moscow alone. As proof of the need for this program State spokesmen confirmed reports that one of the Exchanges had collapsed under the weight of 200 pigs. “We were expecting about 25 an hour the first day and so had a floor that could support 100 an hour, but the sudden traffic just overwhelmed us, and we crashed.”

Implementation of the requirement for small business to participate in the Exchanges has been postponed because of unfamiliarity with the term “small business”, some concerns about “creeping capitalism” which would enrich the Exchanges, and the cessation of operations in Russia by Visa and Master Charge brought on by U.S. sanctions. Most of Putin’s close associates were unavailable for comment, being occupied in trying to recover their own frozen assets.

Mrs. Putin, who rarely makes public appearances, will be launching a Russia-wide children’s education effort to support this plan; SISCAK, “Stay In School, the Chinese Are Coming” (rough translation).

Foreign critics of Putincare dismissed this announcement as an obvious attempt to deflect international attention away from the Ukraine. If you read the plan carefully, and we’re not certain anyone has, you will see that there is no Exchange designated for the Crimea. “Federal Russia will provide.”

Donald Berwick, MD, failed-appointee for Chief of Obamacare in America, commented, “Russia needs to improve its cost/quality ratios a great deal. Putincare is a step in the right direction, but I am not certain that even Mother Russia is ready for a Health Czar.”

Several courageous  Soviet scientists introduced a sense of urgency to the discussion, “Because of the current state of the world we should not delay. The Siberian permafrost is already getting squishy, … and the Chinese are coming.”

Putin officially ended the press conference with, “We are confident that all the States and Provinces in the Russian Federation will embrace and implement this plan, …and also visit Sochi to help us pay for it. If they do not, the army will march.”  Putin’s exit words, whispered aside, were unintentionally recorded, rebroadcast on both The Daily Show and The Colbert Report, and immediately went viral;  “Eat your heart out Barrack!

hubHAPPY APRIL FOOLS DAY.

 

 

 

 


Vol. 106 February 1, 2014 Do You Know Where Your Medical Data Is?

February 1, 2014

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The price of freedom is eternal vigilance.

                                                                                  -Thomas Jefferson…or Thomas Paine, Abraham Lincoln,
Dr. Thomas Sowell,  and John Philpot Curran.

The federal government is giving money to doctors and hospitals to computerize their medical records ( “EMR” = electronic medical records). To get paid the medical providers have to show “meaningful use” of EMR by, among other things, writing and sending a certain percentage of their prescriptions to pharmacies by computer , by creating interactive websites (“Patient Portals”) to improve patient access to their medical information , and by entering much more of their patient’s personal data into their computers. The improved coordination of care, collaboration of medical providers, and reduced costs of care through the meaningful use of EMR by Accountable Care Organizations (ACO) is a cherished hope of Obamacare (ACA) supporters.

Recently, another arm of the federal government (NSA = National Security Agency) has been shown to be collecting, and maybe analyzing, huge reams of personal data from our telephones, social network sites, and credit card companies. Facebook, Google, and Verizon have all been put on the defensive and are scrambling to show that they weren’t helping, at least “knowingly helping”, the government do this. Wired magazine recently reviewed how this conflict between the government’s promises of security and the internet giants’ promises of privacy is eroding the public trust in both.

So at a time that our government is aggressively incentivizing medical providers to put more and more patients’ personal data into cyberspace, the public’s faith and trust that such data will be safe and not be misused is weakening.

What’s the worry? How bad could it get? Since a picture is worth a thousand words, I direct you to this 3 minute video on how to order a pizza in 2015. Whether you find it believable or not,  or whether you think that 2025 is a more realistic date, you may rest assured that the NSA will know that you clicked on and viewed it.

Reference:
1. “How the NSA Almost Killed the Internet”, Wired, January 2014
2. http://www.youtube.com/watch?v=Q2DY6jWT2a4  “How to Order a Pizza in 2015″


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