Not-So-Fine Print

Who knows how many freakin’ pages long the current stimulus bill is, but here’s betting there’s not one elected official in a hundred who knows what’s in it.

If the elderly Ted Kennedy knows, I gotta think the so-called health care portions of the stimulus package might make him raise a bushy eyebrow. After all, he is doing everything possible to fight off one of the most aggressive types of brain tumors known to man, and I imagine his treatments are costing a pretty penny. Maybe he pays for his medical care privately, but even if that’s true, under the new stimulus bill, his private doctor would be considered a renegade and would come under the scrutiny of the feds.

But let’s suppose for a moment that Senator Kennedy has health coverage provided to him by the taxpayer, as part of his compensation. He’s no young whippersnapper, you know. And when the European-style health rationing INCLUDED IN THE CURRENT STIMULUS PACKAGE becomes law, the HealthCare Czar will begin to dictate which remedies, tests, surgeries, and medications are deemed appropriate for someone with such a measly number of years left on this earth.

Senator Tom Daschle, before his pesky tax-evasion problems goosed his backside out the Crummy Healthcare Clinic door, contributed his last efforts toward a collection of wrong-headed ideas found buried in this behemoth of a stimulus:

“Daschle says health-care reform ‘will not be pain free.’ Seniors should be more accepting of the conditions that come with age instead of treating them. That means the elderly will bear the brunt. Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost- effectiveness standard set by the Federal Council (page 464).”

Now, don’t get me wrong. I really don’t mind rationing my own health care. In a very real sense, I do that already. Doug and I, as the only two employees of our corporation, have high-deductible health insurance, with high premiums, and a health savings account on the side. We each have an individual policy, and in a bad year when we both require medical care, we are each out-of-pocket $3000 before the insurance kicks in. And that’s with spending $800 per month in premiums for the privilege.

We think once, twice, and then a bunch more times before going to the doctor. But you know what? That’s OUR decision, based on our own unique set of circumstances and how we’ve chosen to allocate our limited resources. Our doctors, of course, are consulted in matters in which we know we need their professional opinions about how to proceed. But it’s never crossed our minds ONCE to seek the advice of the GOVERNMENT when attempting to determine whether or not we “deserve” to be treated.

Read this article, O fallible ones, and tell me what YOU think. Do you want your healthcare determined by a board of government officials, who intend to go so far as to impose penalties on doctors who fail to withhold care according to federally-regulated “cost-effective” standards?

I’m getting a strong sense that a bunch of old folks are about to get offed, courtesy of the Unread Stimulus Bill of 2009.

Hang on to your hat, Senator Kennedy.

Posted by Katy on 02/10/09 at 04:21 PM

Fallible Comments...

Hi Katy,

Ooh, this is such a hot button topic, I almost hesitate to comment, but here goes:

Although misguided, there could be some wisdom in the proposal. There is so much misappropriation of pharmaceuticals in general esp. in the elder-care sector, it could actually be beneficial to elders IF, and this is a big IF, the attention was on a holistic view and less on matching symptom to medication. It's amazing to me how many meds are dispensed as a matter of course to elders! An irresponsible approach to say the least.

I'm not agreeing that pulling the rug out is the answer, by any means, and I hope reason will prevail and there is a viable compromise!
Posted by Natalie Tucker Miller on 02/10/09 at 05:23 PM
Natalie--Thanks for the salient comment! I don't disagree at all about the often inappropriate healthcare/medications that seniors receive. I have spent the past seven years NON-STOP monitoring my mother's medications, etc, she she started having seizures at age 72, presumably related to overmedicating with prescription pain pills, etc. It has been so hard to find doctors who will STOP prescribing more meds each time she stubs another toe. But with vigilance, I believe these problems can be ameliorated with cooperation among the patient, doctors, insurance companies, and medical powers-of-attorney. Adding the layer of government control to the mix sounds like the worst possible idea to me, since it effectively circumvents what should be/can be a symbiotic relationship among the parties who actually CARE.

Trust me, I do NOT want to keep sick old people alive forever. I only want to keep these decisions private and personal, and not dictated by Uncle Sam. After all, when times are good, he's always begging for my money, and then when my mama gets sick, instead of sending flowers he wants to off her? :)

Please do comment again!!! I feel a series of rants coming on, and I appreciate your input.....
Posted by Katy on 02/10/09 at 05:45 PM
government should stay OUT of the health care business, the financial business, the education business, etc. and only do what it is supposed to do according to the Constitution.
Posted by suzan on 02/10/09 at 05:50 PM
Amen to that! Private and personal....dare I dream?? lol

Thanks again for this post. Such an important topic, and the way change and improvement is through getting the word out and people involved.
Posted by Natalie Tucker Miller on 02/10/09 at 05:59 PM
Katy,

I read the bloomberg article and followed the rabbit trail to the Library of Congress website. I then went through, line by line, and tried to verify the information from the bloomberg article. I couldn't. In fact, I was rather impressed with the clarity in which the EHR system was explained. I will follow up with some comments about how misleading the bloomberg article is...
Posted by Daniel on 02/10/09 at 09:50 PM
Nevermind...I guess I wasn't the only one who noticed (thank goodness because I am tired of thinking):

http://tinyurl.com/bqoefq
Posted by Daniel on 02/10/09 at 09:52 PM
Daniel, let's assume that you are correct, and that the entire Bloomberg article is a scare tactic, as you suggest. Why, then, was this provision, clearly a health care provision -- included in a must-pass bill -- a so-called "stimulus bill," no less? Why no debate? What constitutional or other justification is there for having the federal government involved in the health care of individuals, at all, regardless of how benign? These are questions that concern me, because frankly, I know what the plans are for nationalized health care -- and I do not trust these people to play fair. Tom Daschle has advised the new president, as much, and made it quite clear in his book -- that previous attempts to impose nationalized health care failed because too much time was permitted for the details of the plan to be made known -- and if necessary, that the plan should be attached to a must-pass bill, etc.
Posted by Barbara on 02/11/09 at 05:31 PM
Barbara, wish I had more time to respond. Here is a link to what the goals of HIT are.

http://www.hhs.gov/healthit/
Posted by Daniel on 02/11/09 at 05:58 PM
I imagine these lines from the hhs.gov link will prove objectionable to many:

"Interoperable health IT will improve individual patient care, but it will also bring many public health benefits including:

Early detection of infectious disease outbreaks around the country;

Improved tracking of chronic disease management;

and
Evaluation of health care based on value enabled by the collection of de-identified price and quality information that can be compared."

The words "health care based on value...." etc, are rife with meanings still to be determined by those of us who may have our health outcomes predicted by this legislation.

And WHY is this part of a stimulus package? Many doctors offices and hospitals are already accomplishing this electronic medical records keeping through private sector means. Every hospital I've dealt with in the past two years does everything electronically. So does my primary care doctor. Why has the private sector been deemed to be incapable of handling this problem, so that it now MUST be handled at the federal level? That's one of my objections, but not the only one.....
Posted by Katy on 02/11/09 at 06:33 PM
Here's a Wall Street Journal piece (http://online.wsj.com/article/SB123327719403931465.html) in which the author describes the HUGE increases in Medicaid spending also included in this bill. Coverage for the newly unemployed, the long-term unemployed, and the might-soon-be unemployed---huh? Plus HUGELY expanded ability to stay on Cobra should you become unemployed. Not just for 18 months, and at your own expense. But (if you are already age 55 when you become unemployed) until you reach age 65 and become eligible for Medicare! AND 65% of the tab for your Cobra coverage will be picked up by the taxpayer!!!! What a deal. So it's not just that the government might run the comps and decide my mama ain't worth two nickels. It's all the enormous entitlements that are built into this thing, which may automatically increase Medicaid recipients by millions of people. WHERE IS THE MONEY COMING FROM? I thought we were broke? Evidently NOT.
Posted by Katy on 02/11/09 at 06:44 PM
RE: #9:

My wife is a RN.* ... ...

(I was going somewhere with this but got distracted (see below)).

*I had such trouble stringing this sentence together and would love some input.

"My wife is an RN" (I just like the way it rolls off the tongue)

but

"My wife is an registered nurse" (just hideous and cruel)

so

"My wife is a registered nurse" (has way too many letters)

alas

"My wife is a RN" (The aesthetics of this are difficult because they depend on how the reader reads RN (like, are they sounding out 'are^en' or are they unpacking the acronym and saying 'registered nurse'?)).
Posted by Daniel on 02/11/09 at 09:04 PM
Daniel---I say let's unpack the whole darn thing from the get-go. Why use language on a government website or in a stimulus bill or, for that matter, on a blog post (ha!) that is so open-ended as to leave everyone---friend and foe alike---in the dark? If the crafters of the bill have something to say, they should go ahead and SAY IT.

For example, in the excerpt from the government site, what ON EARTH is the word "de-identified" supposed to mean? Is this speaking about a patient whose records the government is surveying in order to provide comps on another patient's potential care, and the first patient (for privacy's sake, of course!) is having their name blacked out on the record, albeit temporarily? If that is NOT what the word "de-identified" means, I can't imagine what it means. If you understand it, I need you to help me here.....Because words mean things, clearer is always better. Until, I guess, now.

BTW, I really appreciate you commenting here. And thanks to your wife for being an RN. :)
Posted by Katy on 02/11/09 at 09:51 PM
De-identified information, or as I understand the term, information that withholds all personal and business identities, would be used to evaluate quality and cost of care (macro). This data would be used in public and private research to advance healthcare practices (micro).

Physicians are offered incentives to adhere to EHR, or put more blatantly, they are given money to follow the procedural steps necessary to keep our data private while also keeping data open and flowing between networked institutions of government, education, research, etc. (i.e. they will have to adopt a numbered code system when inputting data).

Senate Committee on Finance released a statement claiming that the IT director would "absolutely not" have influence about the decisions doctors and patients make about tests and treatment.

... more later.
Posted by Daniel on 02/11/09 at 10:24 PM
ultimately, methinks, it would influence doctors and patients for reasons other than the government mandating change (which they claim will not happen). the data would be incredibly useful for research and the insights gained would ultimately have effect on practices... more later.

ps Lindsay is working on her master's degree to become a nurse practitioner. She has enlisted me as her research and analysis study buddy (which basically means I am taking the class minus the credit) so I have been immersed in this more than I would have wished. :)
Posted by Daniel on 02/11/09 at 10:41 PM
Okay, Daniel, I understand that you are all for an electronic health care records database, and I am sure that that there are many benefits to it. But again, I ask my question -- why is this a function of government (with its unique ability to use the force of law to compel/coerce compliance)? And secondly, why is this tucked into a so-called "stimulus" bill? Why not leave the development of the database to private enterprise and give patients and doctors a choice to subscribe to the service or not? It all sounds good on paper, but centralized bureaucracies are not only notoriously obtuse, but more importantly, they are notoriously inefficient (since they have no incentive to be otherwise).
Posted by Barbara on 02/11/09 at 10:43 PM
I think this is/should be a function of government AND it should be included in the stimulus package. As boomers age our current healthcare system is going to have to make adjustments. Prices for healthcare will continue to increase. This much is certain.

What is also certain is that most all paradigm shifts and innovations precede a technology that allows for greater accuracy in measuring something (be it telescope, microscope, x-ray, etc). By developing the technology to track data (that also conforms to HIPAA policies) we have an incredible measurement device for researchers. What is not certain but is highly probable, is that the data measured will lead to innovations that will cut medical costs.

The costs associated with healthcare for aging boomers is tremendous. Healthcare costs are already expensive and will certainly go up as the demand on the system increases. Not only will this hurt those who currently have health insurance but it will also create greater disparities. This is when the conversation turns from money to morality...

The government is not asking to nationalize healthcare. They are providing a means by which willing participants can share information that will in-turn, improve practices and reduce cost.

more later... :)
Posted by Daniel on 02/11/09 at 11:29 PM
Okay, let's back up. The purpose of the so-called "stimulus" package is to stimulate our faltering economy, correct? This is not supposed to be a spending bill. It is supposed to -- or President Obama is billing it as -- a jumpstart to the economy. So how is this new health agency going to boost the economy? My point is that if this is such a worthwhile goal and project of government, then why not debate it openly? Why enfold it into a massive, 600-page "stimulus" package, with very little opportunity to debate, clarify, etc.?

Secondly, maybe you have a more optimistic view of government than I have, but I don't see any evidence of centralized bureaucracies working in any kind of efficient manner to accomplish the goals that you envision. You seem to think that I have a quarrel with data collection or the technology that will permit it. I do not. Nor do I doubt your contention that data collection may lead to innovations that will cut costs. What I have a quarrel with is your view that this is a legitimate function of government, and that government can do it well. I don't see any government program that has succeeded in efficiently delivering services to individuals who need them -- let alone in a cost-effective way. Do you? All you have to do is look at Medicaid and Medicare and the billions of dollars of admitted fraud and waste, not to mention the layers of bureacracy required to administer the programs. Governmental agencies cannot even meet the same auditing standards that ordinary businesses are required to meet: they don't have a clue where all their money is going. Furthermore, I do not see much evidence that government is responsible for much innovation. Almost all of our major innovations have come from individuals working in the private sector (Bill Gates, for example). It's not the business of government to pick winners or losers in the health care field or in any other field.

Another major problem that I have with government taking over this function is the politics involved. When government is the source of your grant money, it pulls the strings. All you have to look at is the way in which the RU46 abortion pill was handled by the FDA versus it's slow progress on other types of drugs to understand that politics is a factor when government is involved.

Finally, you're just plain mistaken when you say that the government is not looking to nationalize healthcare. It absolutely is one of President Obama's and the Democrats' long-stated goals. This is a first step, particularly when accompanied by the billions of dollars alloted for increases in Medicaid and the large numbers who will become eligible. And you are mistaken if you think that there is a real element of choice in the bill for "willing participants." It is pretty clear in this bill that both doctors and patients will be obliged to participate.

The problem of health care costs for aging boomers will not be solved by the federal government, but by innovations made possible by the private sector -- provided government gets out of the way. This problem is more likely to be solved by permitting greater market influence into the health care field, instilling incentives for people to be more responsible for paying for their own routine health care, encouraging competition and removing the total dependence of the health care system on third-party payers, etc.
Posted by Barbara on 02/12/09 at 01:05 AM
What reason(s) would any of us have that would lead us to believe the government is not capable of managing our health care issues? President Obama has surrounded himself with the very best the country has to offer. I have total confidence in the President, Nancy, and Harry to lead the charge for significant changes in our nation's health care. And I doubt if our new Treasury Secretary, Tomothy Geithner, has any serious concerns about how he is going to pay for any future health care issues he may face. After all, when you are a tax evasion artist and now sitting as the head of the U.S. Treasury, you should have a great surplus of money to use for any future health care issues.
Posted by John on 02/12/09 at 01:51 AM
John, are you being cutesy & sarcastic?

Barbara, hope you received my email.
Posted by Daniel on 02/12/09 at 05:00 AM
Yeah, they've done such a good job with education, now we should let them decide about our health care?? NO THANKS!!
Posted by Sandi Thompson on 02/14/09 at 02:26 AM
I hear the argument over and over agian how the American Model of healthcare reform is on its way here. Are Canadians indeed taxed more then their American counterparts and is our helath care system in its present state still a better overall product.
Posted by Supplement on 10/19/09 at 06:08 AM
Hi,
How does the Senate Finance Committee work?Where can I find a website that explains how the SFC works? How do they vote, who get elected and how? This information is not easy to find.Can anyone please tell me?
Posted by comparativa hipoteca on 09/23/10 at 04:01 AM

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Personal blog of christian writer & fallible mom Katy McKenna Raymond in Kansas City, Missouri Katy is represented by Greg Johnson at WordServe Literary Read more Katy at LateBoomer.net Follow Katy on Twitter Follow Katy on Facebook 123 Recent Posts Try Becoming Brenda Starr Off Beat Scattered That’s It So I’ve Finally Signed With An Agent. Now What? The Spoon Sciatica Sweetheart A Woman’s Train of Thought Has No Caboose However much we own, we are all still living on borrowed time After all, when restaurants shrink portions, they don’t shrink prices. As with everything in life, balance is key. Slow down, you move too fast… Yeah, I know. I have issues. Search Advanced Search Syndicate Login E me at katy @ ngenius.com	Not-So-Fine Print Who knows how many freakin’ pages long the current stimulus bill is, but here’s betting there’s not one elected official in a hundred who knows what’s in it. If the elderly Ted Kennedy knows, I gotta think the so-called health care portions of the stimulus package might make him raise a bushy eyebrow. After all, he is doing everything possible to fight off one of the most aggressive types of brain tumors known to man, and I imagine his treatments are costing a pretty penny. Maybe he pays for his medical care privately, but even if that’s true, under the new stimulus bill, his private doctor would be considered a renegade and would come under the scrutiny of the feds. But let’s suppose for a moment that Senator Kennedy has health coverage provided to him by the taxpayer, as part of his compensation. He’s no young whippersnapper, you know. And when the European-style health rationing INCLUDED IN THE CURRENT STIMULUS PACKAGE becomes law, the HealthCare Czar will begin to dictate which remedies, tests, surgeries, and medications are deemed appropriate for someone with such a measly number of years left on this earth. Senator Tom Daschle, before his pesky tax-evasion problems goosed his backside out the Crummy Healthcare Clinic door, contributed his last efforts toward a collection of wrong-headed ideas found buried in this behemoth of a stimulus: “Daschle says health-care reform ‘will not be pain free.’ Seniors should be more accepting of the conditions that come with age instead of treating them. That means the elderly will bear the brunt. Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost- effectiveness standard set by the Federal Council (page 464).” Now, don’t get me wrong. I really don’t mind rationing my own health care. In a very real sense, I do that already. Doug and I, as the only two employees of our corporation, have high-deductible health insurance, with high premiums, and a health savings account on the side. We each have an individual policy, and in a bad year when we both require medical care, we are each out-of-pocket $3000 before the insurance kicks in. And that’s with spending $800 per month in premiums for the privilege. We think once, twice, and then a bunch more times before going to the doctor. But you know what? That’s OUR decision, based on our own unique set of circumstances and how we’ve chosen to allocate our limited resources. Our doctors, of course, are consulted in matters in which we know we need their professional opinions about how to proceed. But it’s never crossed our minds ONCE to seek the advice of the GOVERNMENT when attempting to determine whether or not we “deserve” to be treated. Read this article, O fallible ones, and tell me what YOU think. Do you want your healthcare determined by a board of government officials, who intend to go so far as to impose penalties on doctors who fail to withhold care according to federally-regulated “cost-effective” standards? I’m getting a strong sense that a bunch of old folks are about to get offed, courtesy of the Unread Stimulus Bill of 2009. Hang on to your hat, Senator Kennedy. Posted by Katy on 02/10/09 at 04:21 PM Fallible Comments... Hi Katy, Ooh, this is such a hot button topic, I almost hesitate to comment, but here goes: Although misguided, there could be some wisdom in the proposal. There is so much misappropriation of pharmaceuticals in general esp. in the elder-care sector, it could actually be beneficial to elders IF, and this is a big IF, the attention was on a holistic view and less on matching symptom to medication. It's amazing to me how many meds are dispensed as a matter of course to elders! An irresponsible approach to say the least. I'm not agreeing that pulling the rug out is the answer, by any means, and I hope reason will prevail and there is a viable compromise! Posted by Natalie Tucker Miller on 02/10/09 at 05:23 PM Natalie--Thanks for the salient comment! I don't disagree at all about the often inappropriate healthcare/medications that seniors receive. I have spent the past seven years NON-STOP monitoring my mother's medications, etc, she she started having seizures at age 72, presumably related to overmedicating with prescription pain pills, etc. It has been so hard to find doctors who will STOP prescribing more meds each time she stubs another toe. But with vigilance, I believe these problems can be ameliorated with cooperation among the patient, doctors, insurance companies, and medical powers-of-attorney. Adding the layer of government control to the mix sounds like the worst possible idea to me, since it effectively circumvents what should be/can be a symbiotic relationship among the parties who actually CARE. Trust me, I do NOT want to keep sick old people alive forever. I only want to keep these decisions private and personal, and not dictated by Uncle Sam. After all, when times are good, he's always begging for my money, and then when my mama gets sick, instead of sending flowers he wants to off her? :) Please do comment again!!! I feel a series of rants coming on, and I appreciate your input..... Posted by Katy on 02/10/09 at 05:45 PM government should stay OUT of the health care business, the financial business, the education business, etc. and only do what it is supposed to do according to the Constitution. Posted by suzan on 02/10/09 at 05:50 PM Amen to that! Private and personal....dare I dream?? lol Thanks again for this post. Such an important topic, and the way change and improvement is through getting the word out and people involved. Posted by Natalie Tucker Miller on 02/10/09 at 05:59 PM Katy, I read the bloomberg article and followed the rabbit trail to the Library of Congress website. I then went through, line by line, and tried to verify the information from the bloomberg article. I couldn't. In fact, I was rather impressed with the clarity in which the EHR system was explained. I will follow up with some comments about how misleading the bloomberg article is... Posted by Daniel on 02/10/09 at 09:50 PM Nevermind...I guess I wasn't the only one who noticed (thank goodness because I am tired of thinking): http://tinyurl.com/bqoefq Posted by Daniel on 02/10/09 at 09:52 PM Daniel, let's assume that you are correct, and that the entire Bloomberg article is a scare tactic, as you suggest. Why, then, was this provision, clearly a health care provision -- included in a must-pass bill -- a so-called "stimulus bill," no less? Why no debate? What constitutional or other justification is there for having the federal government involved in the health care of individuals, at all, regardless of how benign? These are questions that concern me, because frankly, I know what the plans are for nationalized health care -- and I do not trust these people to play fair. Tom Daschle has advised the new president, as much, and made it quite clear in his book -- that previous attempts to impose nationalized health care failed because too much time was permitted for the details of the plan to be made known -- and if necessary, that the plan should be attached to a must-pass bill, etc. Posted by Barbara on 02/11/09 at 05:31 PM Barbara, wish I had more time to respond. Here is a link to what the goals of HIT are. http://www.hhs.gov/healthit/ Posted by Daniel on 02/11/09 at 05:58 PM I imagine these lines from the hhs.gov link will prove objectionable to many: "Interoperable health IT will improve individual patient care, but it will also bring many public health benefits including: Early detection of infectious disease outbreaks around the country; Improved tracking of chronic disease management; and Evaluation of health care based on value enabled by the collection of de-identified price and quality information that can be compared." The words "health care based on value...." etc, are rife with meanings still to be determined by those of us who may have our health outcomes predicted by this legislation. And WHY is this part of a stimulus package? Many doctors offices and hospitals are already accomplishing this electronic medical records keeping through private sector means. Every hospital I've dealt with in the past two years does everything electronically. So does my primary care doctor. Why has the private sector been deemed to be incapable of handling this problem, so that it now MUST be handled at the federal level? That's one of my objections, but not the only one..... Posted by Katy on 02/11/09 at 06:33 PM Here's a Wall Street Journal piece (http://online.wsj.com/article/SB123327719403931465.html) in which the author describes the HUGE increases in Medicaid spending also included in this bill. Coverage for the newly unemployed, the long-term unemployed, and the might-soon-be unemployed---huh? Plus HUGELY expanded ability to stay on Cobra should you become unemployed. Not just for 18 months, and at your own expense. But (if you are already age 55 when you become unemployed) until you reach age 65 and become eligible for Medicare! AND 65% of the tab for your Cobra coverage will be picked up by the taxpayer!!!! What a deal. So it's not just that the government might run the comps and decide my mama ain't worth two nickels. It's all the enormous entitlements that are built into this thing, which may automatically increase Medicaid recipients by millions of people. WHERE IS THE MONEY COMING FROM? I thought we were broke? Evidently NOT. Posted by Katy on 02/11/09 at 06:44 PM RE: #9: My wife is a RN.* ... ... (I was going somewhere with this but got distracted (see below)). *I had such trouble stringing this sentence together and would love some input. "My wife is an RN" (I just like the way it rolls off the tongue) but "My wife is an registered nurse" (just hideous and cruel) so "My wife is a registered nurse" (has way too many letters) alas "My wife is a RN" (The aesthetics of this are difficult because they depend on how the reader reads RN (like, are they sounding out 'are^en' or are they unpacking the acronym and saying 'registered nurse'?)). Posted by Daniel on 02/11/09 at 09:04 PM Daniel---I say let's unpack the whole darn thing from the get-go. Why use language on a government website or in a stimulus bill or, for that matter, on a blog post (ha!) that is so open-ended as to leave everyone---friend and foe alike---in the dark? If the crafters of the bill have something to say, they should go ahead and SAY IT. For example, in the excerpt from the government site, what ON EARTH is the word "de-identified" supposed to mean? Is this speaking about a patient whose records the government is surveying in order to provide comps on another patient's potential care, and the first patient (for privacy's sake, of course!) is having their name blacked out on the record, albeit temporarily? If that is NOT what the word "de-identified" means, I can't imagine what it means. If you understand it, I need you to help me here.....Because words mean things, clearer is always better. Until, I guess, now. BTW, I really appreciate you commenting here. And thanks to your wife for being an RN. :) Posted by Katy on 02/11/09 at 09:51 PM De-identified information, or as I understand the term, information that withholds all personal and business identities, would be used to evaluate quality and cost of care (macro). This data would be used in public and private research to advance healthcare practices (micro). Physicians are offered incentives to adhere to EHR, or put more blatantly, they are given money to follow the procedural steps necessary to keep our data private while also keeping data open and flowing between networked institutions of government, education, research, etc. (i.e. they will have to adopt a numbered code system when inputting data). Senate Committee on Finance released a statement claiming that the IT director would "absolutely not" have influence about the decisions doctors and patients make about tests and treatment. ... more later. Posted by Daniel on 02/11/09 at 10:24 PM ultimately, methinks, it would influence doctors and patients for reasons other than the government mandating change (which they claim will not happen). the data would be incredibly useful for research and the insights gained would ultimately have effect on practices... more later. ps Lindsay is working on her master's degree to become a nurse practitioner. She has enlisted me as her research and analysis study buddy (which basically means I am taking the class minus the credit) so I have been immersed in this more than I would have wished. :) Posted by Daniel on 02/11/09 at 10:41 PM Okay, Daniel, I understand that you are all for an electronic health care records database, and I am sure that that there are many benefits to it. But again, I ask my question -- why is this a function of government (with its unique ability to use the force of law to compel/coerce compliance)? And secondly, why is this tucked into a so-called "stimulus" bill? Why not leave the development of the database to private enterprise and give patients and doctors a choice to subscribe to the service or not? It all sounds good on paper, but centralized bureaucracies are not only notoriously obtuse, but more importantly, they are notoriously inefficient (since they have no incentive to be otherwise). Posted by Barbara on 02/11/09 at 10:43 PM I think this is/should be a function of government AND it should be included in the stimulus package. As boomers age our current healthcare system is going to have to make adjustments. Prices for healthcare will continue to increase. This much is certain. What is also certain is that most all paradigm shifts and innovations precede a technology that allows for greater accuracy in measuring something (be it telescope, microscope, x-ray, etc). By developing the technology to track data (that also conforms to HIPAA policies) we have an incredible measurement device for researchers. What is not certain but is highly probable, is that the data measured will lead to innovations that will cut medical costs. The costs associated with healthcare for aging boomers is tremendous. Healthcare costs are already expensive and will certainly go up as the demand on the system increases. Not only will this hurt those who currently have health insurance but it will also create greater disparities. This is when the conversation turns from money to morality... The government is not asking to nationalize healthcare. They are providing a means by which willing participants can share information that will in-turn, improve practices and reduce cost. more later... :) Posted by Daniel on 02/11/09 at 11:29 PM Okay, let's back up. The purpose of the so-called "stimulus" package is to stimulate our faltering economy, correct? This is not supposed to be a spending bill. It is supposed to -- or President Obama is billing it as -- a jumpstart to the economy. So how is this new health agency going to boost the economy? My point is that if this is such a worthwhile goal and project of government, then why not debate it openly? Why enfold it into a massive, 600-page "stimulus" package, with very little opportunity to debate, clarify, etc.? Secondly, maybe you have a more optimistic view of government than I have, but I don't see any evidence of centralized bureaucracies working in any kind of efficient manner to accomplish the goals that you envision. You seem to think that I have a quarrel with data collection or the technology that will permit it. I do not. Nor do I doubt your contention that data collection may lead to innovations that will cut costs. What I have a quarrel with is your view that this is a legitimate function of government, and that government can do it well. I don't see any government program that has succeeded in efficiently delivering services to individuals who need them -- let alone in a cost-effective way. Do you? All you have to do is look at Medicaid and Medicare and the billions of dollars of admitted fraud and waste, not to mention the layers of bureacracy required to administer the programs. Governmental agencies cannot even meet the same auditing standards that ordinary businesses are required to meet: they don't have a clue where all their money is going. Furthermore, I do not see much evidence that government is responsible for much innovation. Almost all of our major innovations have come from individuals working in the private sector (Bill Gates, for example). It's not the business of government to pick winners or losers in the health care field or in any other field. Another major problem that I have with government taking over this function is the politics involved. When government is the source of your grant money, it pulls the strings. All you have to look at is the way in which the RU46 abortion pill was handled by the FDA versus it's slow progress on other types of drugs to understand that politics is a factor when government is involved. Finally, you're just plain mistaken when you say that the government is not looking to nationalize healthcare. It absolutely is one of President Obama's and the Democrats' long-stated goals. This is a first step, particularly when accompanied by the billions of dollars alloted for increases in Medicaid and the large numbers who will become eligible. And you are mistaken if you think that there is a real element of choice in the bill for "willing participants." It is pretty clear in this bill that both doctors and patients will be obliged to participate. The problem of health care costs for aging boomers will not be solved by the federal government, but by innovations made possible by the private sector -- provided government gets out of the way. This problem is more likely to be solved by permitting greater market influence into the health care field, instilling incentives for people to be more responsible for paying for their own routine health care, encouraging competition and removing the total dependence of the health care system on third-party payers, etc. Posted by Barbara on 02/12/09 at 01:05 AM What reason(s) would any of us have that would lead us to believe the government is not capable of managing our health care issues? President Obama has surrounded himself with the very best the country has to offer. I have total confidence in the President, Nancy, and Harry to lead the charge for significant changes in our nation's health care. And I doubt if our new Treasury Secretary, Tomothy Geithner, has any serious concerns about how he is going to pay for any future health care issues he may face. After all, when you are a tax evasion artist and now sitting as the head of the U.S. Treasury, you should have a great surplus of money to use for any future health care issues. Posted by John on 02/12/09 at 01:51 AM John, are you being cutesy & sarcastic? Barbara, hope you received my email. Posted by Daniel on 02/12/09 at 05:00 AM Yeah, they've done such a good job with education, now we should let them decide about our health care?? NO THANKS!! Posted by Sandi Thompson on 02/14/09 at 02:26 AM I hear the argument over and over agian how the American Model of healthcare reform is on its way here. Are Canadians indeed taxed more then their American counterparts and is our helath care system in its present state still a better overall product. Posted by Supplement on 10/19/09 at 06:08 AM Hi, How does the Senate Finance Committee work?Where can I find a website that explains how the SFC works? How do they vote, who get elected and how? This information is not easy to find.Can anyone please tell me? Posted by comparativa hipoteca on 09/23/10 at 04:01 AM Page 1 of 1 pages Commenting is not available in this weblog entry. Next entry: Our Fallible Wedding Previous entry: Funny Ha-Ha, Or That Other Kind Of Funny? << Back to main


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Personal blog of christian
writer & fallible mom
Katy McKenna Raymond
in Kansas City, Missouri