Medscape published several articles a a slide show and a video regarding healthcare reform and the State of the Union 2012. Or more accurately the lack of healthcare and the State of the Union.

President Obama’s 2012 State of the Union address included many important topics, but as far as physicians were concerned, he missed a key one: healthcare reform. To Sally C. Pipes, a longtime activist for free-market healthcare reform, that was no accidental oversight

via Failure to Discuss Healthcare Reform Was Purposeful Lapse: Introduction.

Video discussion.

Interesting article at Slashdot.

But what would happen if patients were encouraged not just to see their medical records but to take them home, study them and really own them?

via Putting Medical Records Into Patients’ Hands – Slashdot.

This relates to many of the articles I have written about EHR, data safety, and ownership. Strictly speaking this is not just a technology question it is a deeper philosophical question. However digital records make it more significant as digital records are much easier to use to copy to transmit and to search. The philosophical question is, who owns the data?

The immediate answer is the patient owns the data. But do they? Doesn’t the person, in most cases the medical person, who created the data and has responsibility to act on the data have some interest? Do you own your own genome? If so should you have easy access to that data?

Having posed these esoteric philosophy questions the reality is more banal. Even if you do own the data so what? What can you do with it? Interestingly that is what most of the commenters on Slashdot say. Having access to your EHR and taking it home will have no effect because you cannot understand what it says or what the relevance of the information might be.

Hmmm

Roughly 1,200 companies received waivers from part of the healthcare reform law, the Health and Human Services Department said Friday…Republicans say the need for waivers proves that the healthcare law is unworkable. HHS argues that the waivers show the law provides flexibility.

via HHS finalizes over 1,200 waivers under healthcare reform law – The Hill’s Healthwatch.

Unworkable or flexible? What concerns me is that politics, that is who you know, what party you belong to, who you supported or contributed to, will become even more important. The success of your biomedical research company or your diagnostic software development firm may be more dependant on your lobbying efforts than on the quality of your product or service.

From the linked editorial:

…69 percent believe the profession will no longer be the choice for the “best and brightest” of America’s young people.

“Most physicians believe payment reforms…will reduce their incomes and increase their administrative costs for needed infrastructure and quality measurement,” the survey concluded. Paul Keckley, Ph.D, the executive director of the Deloitte Center for Health Solutions, noted that “effective reform (of health care) has to consider the physician’s view as a starting point.”

via Survey: Docs No Fan of ObamaCare – Page 1 – Bob Beauprez – Townhall Finance.

The survey referred to in the article can be found here:

Health Care: The number of prescription drug shortages shot up to a record 267 in 2011, nearly four times the level of just seven years ago, a new report says. It’s a shortage made in Washington.

The number of drug shortages rose by 56 in 2011 from 211 in 2010, according to a study by the University of Utah Drug Information Service. As recently as 2004, just 58 drugs were in short supply.

…What happened? As is often the case, government price and output controls are largely to blame for shortages, which have killed at least 15 people since 2010.

via Surge In U.S. Drug Shortages Shows Dead Hand Of Big Government Regulations – Investors.com.

These regulation induced shortages are the kind of thing I was referring to here:

 Another hidden provision of the new health care law as reported by AP.

Starting in 2012, the government will charge a new fee to your health insurance plan for research to find out which drugs, medical procedures, tests and treatments work best. But what will Americans do with the answers?

via New fee coming for medical effectiveness research | AP | 12/28/2011.

As with most of these things on the surface research to determine which drugs, treatments and procedures work best seems like a good idea.  Never the less there are some serious areas of concern.

“The government does not have patients it has interest groups.”

Will the “best treatments” be manipulated by payers to force patients to accept the cheapest care as the most effective? Payers are now insurance companies but increasingly the payer will be the government. That means that government will have a direct interest in seeking out the most inexpensive treatment.

On the one hand medical treatments are in serious need of cost control. On the other hand centralized command and control systems have a dismal record of controlling costs. What they are good at is creating shortages. More local control and more doctor patient control allowing the market to function will be more likely to control costs.

What will this mean in terms of research and future innovations in medicine? Will a politicized system kill the profit motive and stymie innovation?

And finally, so what? As the AP article says, “What will Americans do with the answers?” Knowing the best procedures will not mean people will want them. Knowledge does not translate to action. If it did then no one would smoke, we’d all be at our ideal weight and everyone would floss.

This Washington Post article is disturbing for many reasons.

With many states unwilling or unable to get insurance exchanges operational by the health-care law’s deadline of Jan. 1, 2014, pressure is growing on the federal government to do the job for them.

via Concern growing over deadlines for health- care exchanges – The Washington Post.

As was observed at Powerline  it is a clinical study of Hayek’s “knowledge problem”—the impossibility of centralizing fundamentally dispersed knowledge in a timely and accurate way. In my opinion it goes to the fundamental flaw in the system. That is that the best medical decisions will be made locally not from a central command.

Additionally the Post article indicates that if the states fail to create exchanges then the federal government is supposed to step in. The problem is that the feds have no more idea than the states on how to do this.

Then again, the future of the law is in doubt from both the supreme court and next years election. How much time and money should be spent on exchanges that are not only unmanageable but may never be utilized?

As Benjamin Zycher said, The federal government does not have patients; it has interest groups.

More:

Most voters still want to repeal the national health care law, even though they tend to believe the law won’t force them to change their own health insurance coverage.

via Health Care Law – Rasmussen Reports™.

Can you imagine going down to the Chevy dealer and picking out a new car, selecting the color and all the options you wanted including the engine, transmission and fancy wheels and then when you ask the salesman how much he won’t tell you?

“We don’t know the fee.” He says, “We will just send you a bill after you pick up the car.”

That’s nuts, no one would consider buying a car that way and yet that is exactly the way people buy medical care every day.

Recently a good friend has been put through the medical ringer with multiple tests, diagnostic scans, doctor visits and biopsies. In two months he has had an MRI, several ultra sounds, three blood tests, a CAT scan, two needle biopsies, a nuclear medicine scan, an endosocope, two urinalysis and even a breath test to check for infection. All of these tests, scans, office visits and lab procedures were undertaken without the least idea of how much they would cost.

(BTW all of these procedures were undertaken to follow up on various vague symptoms and so far nothing serious has been discovered.)

The only way this behavior, that is agreeing to purchase a service without knowing the price, is conceivable is that as the patient we actually don’t pay. The insurance company pays so we don’t care. If we were spending our own out of pocket money of course we would care. We would demand to know the actual fee ahead of time and we would carefully weigh the value of the service before agreeing to get it done. Third part payers whether they be an insurance company or the government distort the normal buyer seller relationship.

As the person receiving the service we get all the benefit without paying the cost so of course we want all the service we can get. This of course drives up the cost of our medical care. On the other hand as the payer the insurance company or the government needs to limit the services to control the costs. The clash is inevitable.

The payer must limit access to care in some way. They must ration care. However this concept is so odious the payers will go to incredible lengths to deny that they are rationing while doing it constantly by various covert means.

If patients had more skin in the game, if they had to pay more of their own money I believe they would make better more cost effective choices and this would force medical providers to find less expensive options and would put control of most health care decisions back in the hands of the patients and their doctors and out of the hands of clerks and bureaucrats.

However with our current system even if a patient wanted to compare prices there is no way for them to find out the cost of a procedure beforehand. The article linked below talks about an online system to compare medical costs in order to help consumers make better choices.

Its easy to compare prices on cameras, vacations, and homes. But in the United States, patients fly blind when paying for health care. People typically dont find out how much any given medical procedure costs until well after they receive treatment, be it a blood draw or major surgery.This lack of transparency has contributed to huge disparities in the cost of procedures.

via Exposing the Cost of Health Care – Technology Review.

BTW in the various areas of medicine where consumers are choosing elective procedures and using their own money such as Lasik surgery and cosmetic procedures providers do compete on price and the cost of these procedures has come down over the years.

A new poll shows that most voters want the Supreme Court to overturn President Obama’s health care law, …. Overall, voters oppose the law by 48%-40%, according to the Quinnipiac University survey.

via Poll: Voters want court to kill Obama health care law.

It is this kind of thing that makes alternative treatment lcations like American World Clinics attractive.