Vol. 40 March 1, 2011 Health Care Reform: Politics, Computers, and the Individual

There are always three solutions to any issue;
the perfect solution,
no solution,
and the one we get.

-Deval Patrick, Gov. of Massachusetts, referring to the Health Care Reform program in Massachusetts

For those of you who, like me, are having a hard time keeping track of the latest Senate and House bills and head counts, periodic promises of vetoes, contradictory federal court decisions, and a veritable blizzard of acronyms, here are some brief reflections to help maintain focus on the important issues.

Of course it is. Gov. Deval (Dem) just complimented past-Gov. Romney (Rep) on the excellent job he did crafting and getting passed the Massachusetts Health Care Reform Act of 2006.  It “guaranteed heath insurance to everyone and incentivized cost reduction and improved quality” AND included the individual mandate (see below). Romney is quietly aghast because he is trying to woo conservatives Republicans for his 2012 run for the presidency, and they want to scuttle the federal program which is modeled after his Massachusetts program. Romney’s response is to proclaim that not every state has to do the same thing, “What is good for Massachusetts is not necessarily good for Mississippi ( or Alabama, or North Dakota)”. That sounds great to proponents of  “States’ Rights” (wasn’t that one of the battle cries of the Civil War?), but the states have no money either. They want to be able to blame the federal government for the increasing cost of providing health care to everyone.

Meanwhile President Obama reminds us that his program allows states in 2017 “to do their own thing” if they think they can “insure everyone while reducing costs and improving quality”. He just announced his support of Senator Brown’s bill pushing that time period forward to 2014. (This clever “calling their bluff” might help deflate the distracting federal vs. states debate.) The “States Rights” guys are now aghast, because they would prefer  to stop Obama’s federal plan in the courts by attacking the individual mandate as unconstitutional rather than being held accountable to come up with viable state-based reforms.

Depending on your view the Massachusetts program is working or it is bankrupting the state. If you check out these references and look for others, you will see that there seems to be little data on the results of the Massachusetts bill after 2009. As a physician who believes that health care needs reforming, I can only hope that Don Berwick, MD and others who are busily supporting innovations and reform will be able to show us the data on what is working and what is not before politics completely obscure the original goals.

HIT, EHR, EMR, mHEALTH, and HITECH are all computerized medical information terms,
or are part of the sequel song to “Initials” in Hair.
While plans to build expensive proprietary systems proceed with all deliberate speed, physicians are rapidly buying iPhones, iPads, and Blackberrys to both enjoy and benefit from the easy connectivity to the rest of the world. The last time I pulled the Physician’s Desk Reference (PDR) off the shelf to check a prescription was last year, which was a year later than the last time my nurse did. There are over 500,000 apps for “smart” devices, but what do we all really value? CONNECTIVITY. Connectivity allows all sources of medical information and, by the way, maybe the patient, to communicate directly and easily. Neither the U.S. nor the U.K., which has been spending millions on its national program to computerize medial information for years, has developed standards for connectivity.”…[Without connectivity] this potentially transformational technology will simply create one more way for different health care providers to talk past each other”. (1)

The individual mandate requires almost all legal residents of the United States to have at least a minimum level of health care coverage through their employer or purchased by themselves individually. Those lacking such coverage will be subject to a penalty to be paid as part of tax filing. (The wages and benefits for thousands of new IRS agents to enforce this regulation is a significant cost of the bill.) Eligible low-income people will be helped in complying with this mandate by government-run insurance exchanges and government-subsidized policies.

This mandate is supported by the health care insurance industry because it promises that the industry will gain 30 million new customers. In fact, this provision causes some to label the current health care reform act as the “preservation of the private health care insurance industry.” It was meant as a sweetener to offset the mandate to the insurance companies to NOT deny coverage to anybody for pre-existing conditions. The precedents for the individual mandate touted by its proponents go all the way from the Militia Act of 1792 to current state requirements for auto insurance. Ah hah! There is that “state” word again. Maybe that is why conservatives attack this federal provision even though it is supported by big corporations and was originally developed by fellow Republican Mitt Romney .

1. Boston Globe editorial March 1, 2011

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