It takes 1,000 pages to solve our health care problems…

Lest we forget.

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It’s good to see that the House health care reform bill dedicates some space to solving primary care‘s problems.  Here’s a pdf of all 1,000 pages if you have a minute (or a couple thousand).

The growing business presence in health care

Last week’s Wal-Mart health care announcement was another step in its progressive image-altering effort (or just a shrewd business move).  It also happens to be a big deal.  And not just on the employer mandate front.  Or on the partnering with a union issue either.  Or how the move increases the likelihood of reform.

It’s a big deal because it signals the rising influence of business in the day-to-day delivery of health care.  From The Wall Street Journal:

The company says it supports the employer mandate because all businesses should share the burden of fixing the health-care system. Wal-Mart also said the mandate will only work if it is accompanied by a government commitment to rein in health-care costs that is guaranteed.

“…all businesses should share the burden of fixing the health-care system.”  Not the burden of paying for health care, but the burden for fixing the system.  Why not?  Health care, on the whole, has proved year after year its ineptitude for fixing itself, its inability to reduce the cost of care, or at the least, prove its increased value.  The annual dollars business spends on health care gives it the right to muddle.  Business needs health care reform.

The second sentence in the WSJ paragraph above is the how: a guaranteed reining in of health care costs.  Whether that’s possible is irrelevant, it’s going to happen.  Reducing reimbursement is a cost cutting mechanism: CMS leads, private payers follow.

Business has efforts in place to improve quality.  Improving efficiency and distribution of resources is a logical next step.  It’s not necessarily a bad thing.  It just is.  (It may even be welcomed.)  The impact on decision making at the delivery level will be significant.

The internet, again, changes everything; the coming health care battle

Up to now, the debates/ideas/plans for health care reform have been mostly cordial.  There’s been some give and take, even chatter about compromise and bi-partisan support.

But, and this is a big but, if the debate is fortunate enough to move closer to an actual vote, the battle for support (read: Congressional votes) between the traditional “big guys” (pharma, AMA, insurance companies) and the now internet/community empowered little guys (individuals, activists, smaller special interest groups) will be excitingly interesting on the premise that the internet changes everything.  We’ve all learned that financial resources mean very little on the internet.  The virility of a production is most important.

From Boing Boing contributor Adam:

Online petitions are a dime a dozen these days — it takes something special for the citizens to break through and get the attention of politicians. The folks at the Progressive Change Campaign Committee (founded by Reddit co-inventor Aaron Swartz and former folks) may have found it. Today, they unveiled featuring a new TV ad that you can sign — which will then be aired in Washington DC on MSNBC, CNN, and the Daily Show. It contrasts the 76% of Americans who support President Obama’s proposed public health insurance option with the insurance interests who oppose it and have given Democratic senators $80 million. It asks those senators to pick a side. You can sign your name as a member of the 76%, and names will be continually rotated into the actual ad aired on TV. Pretty innovative. Check it out.

Will such efforts be enough to overcome Harry-and-Louise-like campaigns (or the requisite advances thereof)?  Could be an intriguing health care reform side story.

Ahhh, competition?

The Health Care Fed idea was one of the best in the now waste of $10 Daschle book (Amazon tags it a BARGAIN PRICE, go figure; any lawyers want to start a class action filing to get our money back?).

Anyway, aren’t the “Me-too” drugs and devices critical to competition?

What we need is a “health-care Fed”: A panel of independent experts, consumers and ethicists who would make these tough decisions based on scientific evidence about what works, and what doesn’t.

Technologies that are real advances would go on the “A list” and be covered in full. “Me-too” drugs or devices with modest benefit for patients would only get partial coverage. And forget about treatments with unsubstantiated efficacy.

Making them more expensive (to the paying party) than the first movers defeats the purpose of competition.

Required reading, part 2

Abraham Verghese writing in The Wall Street Journal:

“Sacred bond,” alas, is not among the descriptors I hear when patients tell me what they think of us or our health care system. The descriptors fit to publish include “inattentive,” “no-one-in-charge” and “money grubbing.” In fact, a thoughtful lay friend recently said to me in the context of her medical care, “Face it, Abraham, medicine is corrupt.” She stated this casually, as if it were an obvious and well-known fact, not waiting to see if I would agree. At the time I remember that I sputtered. I wanted to protest but the sounds would not come out. That word “corrupt” gnawed at me for days.

The truth (should) hurt.  Lots of good stuff in the article.  Here’s part one.

SimHealthCare (plus some reform links)

Health care reform heated up over the weekend, here’s a rundown of both the Senate and House proposals; Democrats generally seem to be in agreement; Republicans not so much; President Obama’s call for action was met with angry tweets (one, two) from Senator Chuck Grassley’s mercurial Twitter stream.

All of that serious stuff aside, the question is will the new plan work?  And if not, what would?  Using a point from Noah as inspiration, Robin comes up with a really cool idea (especially for those of us who enjoyed the Sim series growing up, or still do…):

Or how about some kind of bifurcated simulation: SimHealthCareSystemAndIndividual. One side’s macro, the other’s micro. You play both, and see how decisions on one side affect the other. I like the sound of that, actually. The trick with any social simulation is that, inevitably, the way you design it says a lot about how you view the world. So the micro/macro sim would play up that tension; the models might even be designed to sort of “fight” each other. SimBourgeoisAndProletariat.

That would be fun.  Also educational: we could find out what iteration of our “health care system” works best *and* improve stakeholders’ orientation of micro decisions on the macro environment.