Health Man Blog

While it feels like 1994 (the year of the final demise of HillaryCare), I have it on good authority we will have a substantive health bill passed in this session. Careful readers may notice I am no longer referring to it as health reform. I’m not convinced the fundamental elements of the Senate bill constitutes health reform. I am convinced, however, that it contains a number of very important provisions that are needed to begin the process of more fundamental reform.

On Sunday 2/7, I attended a forum at Temple Beth Am (Seattle’s  Ravenna neighborhood) organized by the Healthy Washington Coalition. The forum featured Rep. Jim McDermott (D), who represents my district in congress. He was there to provide an update on the state of the national legislation and answer broader questions on health reform. Also at the forum was David Hanig who is a Senior Health Care Policy Analyst for the WA
State Senate Democratic Caucus.

The crux of the message Rep. McDermott brought with him was that he’s convinced there will be a bill this session just because there are the votes to get something done and to come away completely empty-handed would be too big a mistake to make. He also recounted the story of the ‘winner’ of the healthcare battle in the ‘90’s, Newt Gingrich. He paraphrased Newt in saying that the Republicans had to oppose the health care bill because to fail to do so would be to hand over the legislative branch to the Dems for another 40 years (like what happened after social security was passed in the 30’s). While no one wants to slap the ‘obstructionist’ label on every Republican. It is notable that they have put forth no comprehensive plans (yes, they have ideas around the margins, but no plan that strikes at the fundamental issues of universal coverage, perverse incentives and control of costs). So it looks like it’s the same tack all over again: make sure nothing gets done so the Dems can’t take credit for taking on any big challenges.

You don’t really ‘win’ in politics by just making sure the other guy can’t do the right thing for the country, can you? Of course you can, who am I kidding?

Waiting with great anticipation to see if any Republicans will show up at the televised healthcare debate.

Feels like old news by now, but the recent dust-up in relation to new breast cancer screening recommendations put forth by the U.S. Preventative Services Task Force deserves a post. Oh so much uninformed outrage – some of it genuine – some of it expressly for political gain: mostly all of it disregarding some very simple facts. Instead of really authoring a post, I’ll include below a response to a local talk show host (whom I admire a great deal, by the way) who weighed in on this topic:

Let’s dig a little deeper, shall we

First off, I’m not convinced that this new set of recommendations in any way could be considered a substantive ‘cost saving’ measure. These primary prevention tests are an infinitesimal portion of the overall healthcare dollar. I don’t think there’s enough crack on the planet which, if smoked, would lead one to conclude this recommendation would bend anybody’s ‘cost curve.’

To the issue of some ‘impersonal commission’ who, pray tell, *should* make these guidelines? The patients themselves? Each individual physician? Surprisingly (at least to me) your reaction to this is very anti-science. Who better to make recommendations than professionals who have actually looked at the data and have made a professional determination based on that data. What’s your alternative?

You seem to forget how women came to expect the annual mammogram at 40 and routine self-exams as the way to go. It was likely this same body (or one very similar). So you’re put in a position now of essentially saying "don’t bother me with any new facts – just keep telling me the same thing you told me 20 years ago."

What this recommendation highlights (and, very coincidentally, the recommendation from the ACOG {American Congress of Obstetricians and Gynecologists} regarding cervical cancer screening) is that we *do* need to be continually evaluating care guidelines and adjust them based on the actual clinical outcomes. The reaction to this update (and the accompanying political whiplash) is another reminder of how out of whack our sensibilities are about the delivery of health care. We seem to operate under the assumption that more care is always better. The facts are that the data show that this is not universally the case (see the Dartmouth Atlas of Health Care for clues). Uninformed (bordering on petulant) reactions don’t help us here. Let’s at least try to think things through whenever possible.

As I re-read the thing, I don’t see a whole lot more I’d add to the post (without making it completely unwieldy by diving into the changes in recommendations point-by-point).

And … yes, I know I do not have a cervix. If you think that disqualifies me from opining on this topic, you are free to make that judgment. Know that it’s not likely to keep me quiet.

While I endeavor to keep this blog all about one’s personal health choices and outcomes, There are times where other related interests worm their way into this forum. The recently-released Declaration of Health Data Rights is one of those occasions. Here are the core principles of the declaration:

A Declaration of Health Data Rights

In an era when technology allows personal health information to be more easily stored, updated, accessed and exchanged, the following rights should be self-evident and inalienable. We the people:

1. Have the right to our own health data
2. Have the right to know the source of each health data element
3. Have the right to take possession of a complete copy of our individual health data, without delay, at minimal or no cost; if data exist in computable form, they must be made available in that form
4. Have the right to share our health data with others as we see fit

These principles express basic human rights as well as essential elements of health care that is participatory, appropriate and in the interests of each patient. No law or policy should abridge these rights.

As you know by peeking at my ‘About’ page, you know that in my day job, I work with the big, bad Microsoft on the HealthVault product (nothing on this blog, by the way, represents my employer in any way shape or form). In the course of this work over the last couple of years, I have been on the vanguard of making personal health records available to consumers. During that time, there has been an enormous sea change in the way this area has been viewed by all involved. I can remember numerous conversations in the summer and fall of 2007 where the idea that patients (consumers) might have any value or inclination to have a copy of their health information.

In short two years, the notion that patients deserve a copy of their own health information has made its way into the national consideration of health care reform as a core assumption (see p.3 of the Meaningful Use Matrix put forth by ONCHIT).

The aforementioned declaration is notable as so many of the supposed adversaries in this brave new world of health information technology. The index case is that both Microsoft and Google have signed on and are co-existing quite nicely here. This is a big deal. It sounds like ‘mom and apple pie’ today, but I can remember a day – not so long ago – when this very idea was considered a little nutty.

First they ignore you, then they ridicule you, then they fight you, then you win.       Mahatma Ghandi