By John Ballard
Did you ever try to clean out a desk or closet and come across a pile of stuff you need to toss but somehow it's too good to put in the trash? When that happens to me I box it all up and donate it to Goodwill. Maybe someone will find a use for it.
Anyway, here's a pile of links that caught my attention. None of them strikes me as good individual post material but they all have something about them I don't want to toss. I particularly like the Avishai piece. The more I think about it the more it stands out. (I owe Bedouina for introducing me to this man's writing.)
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Imagine my shock and surprise when I checked The Health Care Blog and found a post by Sara Palin! That may be the bump in my reading that gave me whiplash for the rest of the day. Check it out and read the reactions -- all over the place -- in the comments thread. Between Nate's comments and Palins post this is the blogging analogue to dog fighting.
I don't think she actually follows THCB; seems like the blogmaster picked up her Facebook post. My Tweet was Fools rush in where angels fear to tread.
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The Wall Street Journal put up a map tracking the progress of H1Ni in the states.When you click the dates advance monthly for the last year. It takes less than a minute for most of the country to get infected to the max.
Impressive.
I read at Crawford Killian's blog that H1N1 is expected to infect about 65% of the population reaching a peak somewhere toward the end of this month.
Speaking of the Wall Street Journal, another piece [subscription wall, but you get the idea] suggested that employer sponsored health insurance may be following the same path as defined benefits pension plans, drive-in movies and watch pockets on men's trousers.
Two-thirds of big companies that cut health-care benefits don't plan to restore them to pre-recession levels, they recently told consulting firm Watson Wyatt. When the firm asked companies that have trimmed retirement benefits when they expect to restore them, fewer than half said they would do so within a year, and 8% said they didn't expect to ever.
Employers that offer health insurance spend an average of $6,700 per employee on it this year, nearly twice as much as in 2001, according to consulting firm Hewitt Associates. ... The percentage of employers offering health-care benefits is 60% this year, down from 63% in 2008 and 69% in 2000, according to the Kaiser Family Foundation. In a survey by Hewitt last winter, 19% of large employers said they planned to move away from directly sponsoring health-care benefits over the next five years.
Maybe they have been reading an AEI report I tripped over back during the Bush era the argued for uncoupling employment from insurance altogether. Together with his failed attempt at immigration reform, this was one of the policy items on the poor guy's agenda that I liked but never got out of the file.
After explaining the decisive influence of tax policy in shaping the current system, with its preference for employer-based health insurance, this essay discusses the main options for altering the tax treatment of medical expenses and identifies three measures that could lead the way toward more comprehensive health-care reform.
This is a very impressive piece of work. And it has the blessing of one of the country's most respectible conservative think tanks. Too bad the Republican Party has allowed the crazies to squeeze them by the balls so hard they no longer can be rational.
I'm certain that some bright young clerk in a Republican staff knows this study chapter and verse, but the odds of it's ever getting to the right ears or eyes are slim to none. Too bad. Or maybe not.
Heard on the news tonight a couple of sideways mentions of the big insurance exemption from anti-trust laws. No explanation, just a passing reference. Managed Care Matters put up a post about this.
Anti-trust and the Health Insurance Industry - what's this all about?
Last week the Senate Judiciary Committee held an initial hearing aimed at removing some of the health insurance industry's anti-trust exemptions. The hearing, entitled "Prohibiting Price Fixing and Other Anticompetitive Conduct in the Health Insurance Industry", may be a reaction - at least in part - to the health insurance industry's public (and private) assault on health reform legislation.
And over the weekend, President Obama added his considerable weight to the call for a review of the industry's anti-trust exemptions.
On the subject of monopolies and anti-trust matters (How do you spell "banksters" ?) Frank Rich's column wanders around the financial clouds getting nowhere.
As Wall Street was celebrating last week, Congress was having a big week of its own, arousing itself to belatedly battle some of the corporate suspects that have helped drive America into its fiscal ditch. The big action was at the Senate Finance Committee, which finally produced a health care bill that, however gingerly, bids to reform industries that have feasted on the nation�s Rube Goldberg medical system. At least health care, like oil, is palpable, so we will be able to keep score of how reform fares � win, lose or draw. But the business of Wall Street, while also at center stage in a Congressional committee last week, is so esoteric that the public is understandably clueless as to what, if anything, the lawmakers were up to, if anyone even noticed at all......The idea of investing in the real economy � the one that might create jobs for Americans � remains outr�n this culture. Credit to small businesses remains tight. The holy capitalist grail is still the speculative buying and selling of companies and the concoction of ever more esoteric financial �instruments.� The tragic tale of Simmons Bedding recently told in The Times is a role model. This successful 133-year-old manufacturing enterprise was flipped seven times in two decades by private equity firms. Investors made more than $750 million in profits even as the pile-up of debt pushed Simmons into bankruptcy, costing a quarter of its loyal workers their jobs so far.
Real economy my backside. Bedding? Gimme a break.
Am I the only person alive who can see that health care is among the few sectors screaming for more people to hire in a drought of jobs?
Hello! Anyone out there?
Here are two or three dots that need connecting: Health care>>>Jobs>>>Education reform>>>Training>>>Reasonable rates for student loans>>>Grants...
Those are investments that promise good future dividends.
But Rich gets extra points for the phrase "...Rube Goldberg medical system." Excellent description.
I'm not gonna jump into the fray about whether or not the president has convictions as well as values, but that seems to be the topic du jour. (My instinct is that poking at Fox is political genius, pouring propellant into an already hot fire. See the reference above about crazies squeezing GOP balls. The hotter it gets the worse the consequences for the loyal opposition.) (Wait... did I just say "loyal"? 'Scuse me.)
Jotman put up a reflective post more or less related to this subject, contrasting the values and responsibilities of royalty with those of an elected leader.
In certain Asian countries, it is believed that kings rule on the basis of rajadharma, or the virtues of kingship -- of which there are said to be ten. Bangkok Pundit, in a recent post concerning the future king of Thailand, asked: "The more pertinent question is, who decides whether the monarch has all the 10 virtues? A referendum? Parliament? Or Sondhi L as the sole arbitrator?" Without beating an eye, many Thais would respond to the question: "The king has the 10 virtues because he is the king."
It's one thing for Thai royalists to believe in the goodness of their king, it's quite another thing when the citizens of a republic make such a claim about a political leader.
Bernard Avishai's short essay is worth a few minutes to read and digest. Of all the links in my collection here, this one may be the most important not to skip. It makes Obama's use of deliberate, disciplined timing come into focus. Reading this essay makes me have a deeper respect for the Nobel committee's insights. They may not have been contemplating this subject, but they recognized Obama's commitment to doing policies right ahead of getting them done quickly.
Readers who can step back a few paces and take another look at history will discover that the role of Israel in US foreign policy has morphed over the years as the playing field changed.
...the key to AIPAC's emergence was a Manichean view from America; the fight against the Evil Empire, or since 9/11, the clash of civilizations. In this drama, Israel became cast as America's biggest regional aircraft carrier. AIPAC has succeeded by staying close to American hardliners, arguing against pressuring Israel (to give up territory, to stop settlements, etc.) for the same reason a basketball coach will not foolishly demoralize his slightly brazen power-forward. At the center of the argument was a way of thinking about American hegemony in a dangerous world.
YOU CAN SAY that AIPAC was misguided, that it�s even become a pernicious force, but you can't deny that it got its strategic premises ordered properly. One cannot just assume that the Congress will care what Jews want. One has to start with America's foreign policy strategy and then apply its logic to the Middle East. Crucially, this means building coalitions with non-Jews as well, as any watcher of FOX News can see.
Indeed, what J Street really represents--what progressives argue for--is not just support for Israel as such, but for a globalist strategy in which Middle East peace is a key pillar; a strategy of collective security agreements, regional alliances, and international peace-keeping; of patient engagement over the unilateral use of force; of recognition that offering access to economic development and cultural freedom over time is hard power (I hate the term "soft power"); indeed, of the power to attract, not only the power to deter. It means diplomatic containment, not foreign invasion and counter-insurgency. It means what, say, Chuck Hagel calls "realism."
It is within this logic that America�s urgent search for regional Middle East peace is "pro-Israel"--but also pro-Palestinian, pro-Jordanian. Which means that J Street will become a focus for a coalition supporting goals that would make President Obama's worthy of his Nobel: deescalation in Afghanistan, containment of (not an attack on) Iran, building cooperation with the EU.
Finally, for the total HIT nerd here is a link to Dr. Halamka's post today with an elegant outline of his approach to one of health care's most intractable can of worms, information technology.
The focus on consumer consent, privacy, and security as the foundation of data exchange will accelerate interoperability. A few thoughts:
1. As the Chairman of NEHEN, a Health Information Exchange in Massachusetts, I know that consent management (policy and technology) is a very important first step to implementing interoperability. To coordinate care, improve quality, and measure population health, we need data and patients need to trust our HIEs so that we can share data for their benefit.
2. Policymaking can constrain technological complexity. If every possible permutation of consent (opt in, opt out, segmentation of the record, approval for sharing at the institution level, approval for sharing at the provider level, approval based on the situation - emergent care or not, etc.) needs to be supported by every stakeholder exchanging data, then the number of standards needed will be significant. Ensuring conformance with a large number of standards at every point of data exchange will be challenging. In my experience, something simple such as opt-in consent for data sharing at the institution level, will result in much more privacy because the security technologies required to support it are simple and easy to understand.
3. Although provider to provider data sharing will always be important, the notion of sharing data with the patient who then shares it with others per their consent preferences is a viable alternative approach. However, we need to maintain the integrity of the data from its source to its use by ensuring the data is not modified or the context of the data changed along the way. Jamie Ferguson from Kaiser Permanente wrote a great blog about this issue.My ideal plan for consumer preferences would be
1. We develop national policy which clearly delineates the types of consents we need to support. Ideally, this will be a short list. I prefer consumer opt-in at the institution level. To be compliant with ARRA and state laws I can imagine this being expanded a bit to include very basic segmentation of the record into mental health, HIV results, and everything else.
2. This consent will be recorded electronically and made available via a health information exchange, the PHR of the patient's choice, or via a mobile storage device such as a USB drive. When a patient presents for care, the consent is queried, and all data exchanges follow this declaration of confidentiality preferences.
3. The standard for recording consent would be XML-based and not require a "wet signature" or an image of a signature. I realize that some state laws still require handwritten consents, so policy work is needed here.
Now I ask you, what could be easier than that?
Maybe tomorrow's reading will be a little more coherent.
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