Happy Thanksgiving, everyone!
Posts Tagged ‘Healthcare’
The super-nerds in team Obama are turning their attention to the health care system. The leader in this drive, somewhat counterintuitively, is thought to be budget director Peter Orszag.
What makes Orszag’s vision so interesting is that it is utterly data-driven. In a time of negative growth and yawning deficits, Orszag believes it is possible to extend coverage to everyone and lower costs over all. The New Yorker’s Ryan Lizza has a great profile of the man & his ambitions:
Orszag is convinced that rising federal health-care costs are the most important cause of long-term deficits. As a fellow at the Brookings Institution, he became obsessed with the findings of a research team at Dartmouth showing that some regions of the country spend far more money on health care than others but that patients in those high-spending areas don’t have better outcomes than those in regions that spend less money. If spending more on health care has no correlation with making people healthier, then there must be enormous savings that a smart government, by determining precisely which medical procedures are worth financing and which are not, could wring out of the system. “I spent several months in very intense study,” Orszag told me. “The reason that I wanted to go to C.B.O. was I thought that was one of the key bodies that could really delve into what we could do about it.”
Interestingly, when the Times’ David Leonhardt sat down with President Obama recently, Obama struck a similar note:
“if it turns out that doctors in Florida are spending 25 percent more on treating their patients as doctors in Minnesota, and the doctors in Minnesota are getting outcomes that are just as good — then us going down to Florida and pointing out that this is how folks in Minnesota are doing it and they seem to be getting pretty good outcomes, and are there particular reasons why you’re doing what you’re doing? — I think that conversation will ultimately yield some significant savings and some significant benefits.”
But the President goes a step further, bringing up the example of his grandmother, who had hip replacement surgery last summer, and died a few months later. Expensive procedures like these, which frequently occur at the end of life, are some of the biggest drivers of healthcare costs.
NYT: So how do you — how do we deal with it?
THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.
Scary stuff, medical bills. The idea that better information can make health care cheaper is enticing but untested. We do know, however, that much of the cutting edge of medicine is super-expensive, precisely because it’s so advanced.
UPDATE: It seems like the healthcare industry is sufficiently frightened of having cost-cutting imposed on them to make some preemptive announcements that they’ll cut costs themselves. Hmm…
I really couldn’t say it any better.
Why is it so hard for us to get concrete information on healthcare and our options? As David Wessel describes so well in his (2004!) Wall Street Journal piece, he and his wife faced a bewildering array of options and terminology as they tried to choose between the two plans offered by their employers. And as he acknowledges, they were actually lucky in that at least they knew they were going to have health insurance. For those who aren’t being offered any plan by their employer or are unemployed, the lack of information is even starker.
Over four years later, little has changed. There are worksheets like this one for people looking to buy an individual plan, where you can plug in your zip code and some basic information and compare different health plans, though you still need to figure out what the difference is between “co-insurance” and “deductible.” If you click on “co-insurance,” the site helpfully tries to give you a definition, but ultimately needs to provide this disclaimer: “Please note, however, that definitions of certain terms may vary across insurance companies.”
I also found a forum or two where people write in questions, but as the answer very often seems to be, “It depends.” Or if you’re not feeling so polite, “Ask your health insurance carrier. We haven’t read your policy.” And this in a forum called “Health Insurance and HMO Plans”! (Being a lawyer, I know this is often the correct and right answer, but it only goes to show how complicated it’s gotten.)
So much depends on which state you live in, as each state has its own rules and regulations regarding healthcare, so it was particularly depressing to find this. Although many other consumer and advocacy sites had linked to this series of state-by-state guides, run by the Georgetown University Health Policy Institute, the site had lost its funding in September 2008.
Of course, this doesn’t mean there’s no information on healthcare out there. There are a gazillion blogs, focusing on everything from the pharmaceutical industry to nurses. There are numerous research institutes. But the ones below are the sites I found interesting and useful as we began to think through what we wanted for our CDP healthcare pilot project.
- HealthCareCoach.com (a project of the National Health Law Project)
- Healthconsumer.org (for Californians)
- Health Information Tool for Empowerment (for New Yorkers)
- About.com Health Insurance
Online Data on Healthcare Coverage and Issues
- CDC National Center for Health Statistics
- U.S. Census Bureau Data on Health Insurance
- Agency for Healthcare Research and Quality
- Prevention Quality Indicators in NY State
- New York City Community Health Profiles
- Medical Expenditure Survey
Organizing Sites, with Places to Share Personal Stories
Please let me know if there are other sites you have found useful or interesting, as I’d love to add to this list.
It has always been our conceit that for most people, if they are unwilling to provide sensitive personal information, it’s just because you haven’t asked in the right way.
Tell me that you need my social security number to access my money and I’ll recite it faithfully to an automated voice system.
Ask me for my email address as I’m checking out of a store and I won’t even give you my never-check-it-spam-hotmail address.
(There’s also the issue of trust and security, but I’ll gloss over that for now.)
Personal information, like it or not, has become a commodity in the modern era. And like any commodity, individuals make pragmatic decisions about when and to what extent they exchange personal information for another commodity or service.
Like other market transactions, valuations are subjective and fickle. I have a friend who is a sweepstakes junkie and will give out every last detail about herself for a one in a million shot at winning a shopping spree or a sports car she can’t drive.
Others balk at sending anything over the wire, unprotected, and end up encrypting even mundane reminders to “Please remember to pick up milk on the way home.”
Our challenge for this pilot is to figure out how to make it compelling for people to contribute information about themselves vis-a-vis their healthcare.
The New York Times recently published a succinct but meaty article on New York City’s new electronic health record system. Planned and promoted by the Bloomberg administration, the system includes about 1000 primary care physicians, focused primarily on three of the poorest neighborhoods, and the data they generate about their patients. As I read it, I found myself counting all the different functions of the system. I found at least ten:
• Clean up outdated filing systems;
• Enable a doctor to compare how one patient is doing compared with his or her other patients;
• Enable a doctor to compare how one patient is doing compared to patients all over the city;
• Enable the city’s public health department to monitor disease frequency and outbreaks, like the flu;
• Enable the city to promote preventative measures, like cancer screening in new ways;
• Create new financial incentives for doctors to improve their patients’ health, on measures like controlling blood pressure or cholesterol;
• Provide reports cards to doctors comparing their results with other doctors’;
• Improve care by less-experienced doctors with advice and information based on a patient’s age, sex, ethnic background, and medical history, including prompts to provide routine tests and vaccinations and warnings on how drugs can potentially interact;
• Allow doctors to follow up more closely with patients, like reminding them of appointments through new calling and text-messaging systems and being notified if their patients do not fill prescriptions; and
• Allow patients to access their own records, make appointments electronically, and monitor their own progress on health targets (should the doctor decide to do so);
Pretty amazing, isn’t it?
Data is like that. Once you collect it, the possibilities are endless. Reading about this one system for health records made me realize why it’s so hard for me to describe CDP’s goals in one sentence. We’re not trying to do something singular, like “enable a doctor to compare patients’ data.” We’re trying to create a place where this function, and innumerable other possibilities can exist, while also being mindful that “endless possibilities” include some scary ones that we need to guard against.
Let’s be honest—it’s not easy to explain what we at the Common Data Project are trying to do.
It’s been a year since we incorporated as a nonprofit organization, and over the past year, we’ve had conversations with a lot of people, from media professors to actuaries, about why we decided to found this organization. Different people have been excited about possibilities in different areas. A friend who works in housing advocacy saw possibilities in addressing the subprime mortgage crisis; a law professor saw possibilities in analyzing federal tax policy. It’s what makes our work exciting—that it can be applicable to so many contexts—but it’s also what makes it difficult to explain in simple terms.
So we’ve decided to follow our grade school English teacher’s advice: “SHOW, don’t tell.” Instead of trying to describe what we want to do, we hope to demonstrate our information and privacy values through the launch of a new web-based application.
The site will be focused on the issue of healthcare reform, and we will be giving people a new way to voice their support for comprehensive, effective healthcare reform in this country. It’s an issue that we’re passionate about, and we know other people are passionate about. Even before the Obama transition team began holding community discussions on healthcare, we’ve been amazed how much people were already talking about healthcare in deeply personal ways. There is already so much organized energy around this issue, groups and communities working together to accomplish their goals, that we could see a real value to providing a new outlet for that energy. Although the issue touches upon health, one of the most sensitive and private areas of people’s lives, it’s also an area in which the value of sharing information is so obvious, people have been trying new, imaginative things to make that sharing happen.
So what does all this have to do with “real privacy, more data”? Stay tuned for more.