Archive for healthcare
The Sad Story About Joint Replacement (in the US, at least)
Posted by: | CommentsA hip or knee replacement can offer people with chronic joint pain the chance to return to an active life. The potential promise of being pain-free, in some cases after decades of restricted movement, is a powerful incentive to arthritis sufferers around the world.
I know from direct observation that not all joint replacements result in the patient returning to the dance floor, or the jogging track, or even the walking path. My dad had a hip replacement in 1996 that inserted the wrong appliance, leading to 18 dislocations in the ensuing three years. The issue was finally resolved with yet another surgery, paid for by Medicare and my father’s supplemental insurance. This was a doctor error, not an appliance failure.
Imagine my surprise this past Saturday (April 3, 2010) at this piece in the New York Times, revealing that almost all manufacturers of artificial joints offer no warranty whatsoever to US consumers who wind up with defective products surgically strapped on to their skeletal structure. The dodge is facilitated by the way device manufacturers sell the implants: to the hospital, not to the patient.
The skids on that dodge are further greased by the consulting fees paid to many surgeons by implant makers, giving those surgeons little impetus to bite the hand that feeds them.
Here’s a chart for the visual learners:
US device manufacturers who sell artificial joints overseas offer warranties in the countries outside the US where their implants are used. Why not here? One reason could be our tort-crazy system. Got a consumer complaint? Don’t try to work it out directly – hire a lawyer and sue the bastards.
That does not, however, excuse the failure of medical device makers to offer any kind of warranty on their products. And it’s not excuse for their expectation that we – taxpayers (Medicare and Medicaid), insurers, and patients – foot the bill for their lousy manufacturing processes.
This is another example of why we need what I call “real health care reform” in the US: fully-informed consumers (patients) communicating fully and frankly with health care providers (doctors, hospitals, device manufacturers). Price and outcome disclosures at the outset of every interaction. Both sides held to account on compliance with best practices.
Wow – what a revolution that would be.
That’s my story, and I’m stickin’ to it.
Got comments? Brickbats? Kudos? I welcome all. Bring it on.
A Modest Proposal (on U.S. Health Insurance)
Posted by: | CommentsThis is a guest post by Hank Keiser, an accounting and hay-farming expert (don’t laugh, you need both in the farming biz today), who has a great idea on how to resolve two thorny issues with one bold stroke.
If you will give me 5 minutes of your life, I will give you a health care plan that will work.
When U.S. taxpayers bailed out AIG, we got 80% of the stock in return. We own the corporation. Why not make it work in the best interests of the shareholders?
AIG is licensed to sell insurance, through its subsidiaries, in all 50 states. Why not sell health insurance that covers pre-existing conditions, is not employer dependent, and does not drop you (or jack your rates) if you need to use it?
Isn’t that what just about everybody wants? Wasn’t that the original intent of Mr. Obama’s plan, before it got turned into a Christmas tree by the Senate?
Doesn’t this cut the legs out from the opposition’s arguments? After all, this is not a tax-driven, big-government piece of legislation.
It has zero negative impact on the deficit, is provided by a corporation, not a government agency, and requires absolutely no legislation to enact.
In fact, it’s pure (if there is such a thing) capitalism at work – without the greed factor.
AIG doesn’t have to pay dividends, so it can plow any operating profits back into the business. It doesn’t have to pay bloated salaries, bonuses, or country club fees. It will operate with a lower overhead, hence it can charge less. Much less.
You start off by moving the management of Medicare to AIG, then all Federal government employee health insurace, then state and local government employee insurance, and finally private group and individual health insurance, all under the umbrella of a corporation. A corporation owned by the taxpayers, providing a competitive product in the marketplace. A corporation that would manage the insurance of maybe 200+ million people. That’s a pretty big pool to spread the risk.
There is a huge political upside to this – it doesn’t have to be legislated. It doesn’t care if you are a citizen or not. If you want a plan that restricts coverage for abortions, there will be other providers out there who will compete for your business.
And it is bullet proof – no bank, no financier, no corporation, no tea-bagger can scream socialism, because it is not socialism. Nobody on Wall Street turned down TARP money when it was offered, none of AIG’s creditors lost a penny in the settlements they received.
Oh, we promised not to interfere with AIG’s management when we bailed it out? Too bad, promises are broken every day on Wall Street. If you can dish it out, then you can learn to take it.
Who loses? WellPoint, Cynergy, et al. And Joe Lieberman – he loses big. Real big.
No one is saying WellPoint and the rest can’t offer health insurance that is better than this plan. After all, they aren’t being legislated out of business.
They are just going to confront honest, open competition for the first time from a publicly chartered corporation that we had stuffed down our throats because it failed to price risk correctly.
Health Care Storytelling
Posted by: | CommentsIn all the sturm und drang over the US health care system in the last couple of years – and the last many decades – one voice seems to be largely missing in the discussion.
We’ve heard from health care providers – hospitals, doctors, et al.
We’ve heard from insurance companies.
We’ve certainly heard from politicians.
We have not, however, really been hearing from patients, unless some disease sufferer with a story to tell to support the POV of a health care provider, an insurer, or a political position gets trotted to the microphone to tell his or her story.
As social media rises as the brave new communication platform for any and all global-village ideas and events, health care is starting, sloooooowly, to dip its toe into social networking as a tool to get their message out. What we have not seen, though, is a lot of listening, other than the usual suspects listening to (and yammering at) each other.
There are a number of community sites that have grown up around specific conditions and issues – Fran Drescher’s Cancer Schmancer community and Lance Armstrong’s LIVESTRONG efforts around cancer spring to mind.
Microsoft has launched MyHealthInfo.com, and Google’s got Google Health.
Patients are out there: on Facebook, on Ning, on Twitter, and other online community sites like SparkPeople.com. However, less than 20% of doctors are currently using technology to manage their patients’ medical records – given that resistance to technology, combined with the strictures of HIPAA (which I swear must mean Health Insurance Paying All Attorneys), it’s easy to see why the health care industry seems to be MIA in the Web 2.0 world.
One of the reasons cited by health care providers for not using web tools to communicate with their patients is privacy concerns. That is a legitimate concern, but I think it’s being used as a smokescreen – there are plenty of security apps and protocols available that would allow a dialogue between doctors and patients without having the conversation become Twitter status updates.
How refreshing, even revolutionary, would it be to have a way to communicate with your doctor and his/her staff online? To log in, schedule an appointment, enter your blood sugar numbers or blood pressure, request a prescription refill, ask a question, get a referral, download your medical records.
The health care sector has been losing the trust of its customer base for a long time – gone are the days when doctors were looked at as elevated beings who knew way more than the average dude (dude, in this usage, is gender neutral).
Doctors can take some of the blame there, since they’re not batting 1.000 on calling out the bad apples in their bunch, and have, as a group, been acting as the supply-chain for the pharmaceutical industry more than is, um, healthy.
The pharma industry takes some heat on the trust gap, too, since they seem to be all about “ask your doctor” and not so much about “you’ll be able to afford this stuff”. And don’t even mention Celebrex or Vioxx…
These revolutionary web-enabled conversations would allow doctors and other health care professionals to start to build those one-on-one and one-on-many trust relationships that could actually bridge that trust gap. Even help us understand, manage, and maintain our health.
Patients need to take the lead here, I believe, because left to their own devices doctors, hospitals, insurers, and politicians will continue to talk at each other, and not listen to the ultimate consumer of health care: the patient.
That’s my story, and I’m stickin’ to it.
My 15 Minutes…on BusinessWeek.com
Posted by: | CommentsI had my 15 minutes of internet fame recently, with a "My Take" essay on BusinessWeek.com. To say that made my month would be an understatement!
Social media played a part in bringing me this opportunity. If you're not a believer in the power of the Holy Trinity of SM (Twitter, LinkedIn, and Facebook)…you need to be.
That's my story, and I'm stickin' to it…
A Great Story On Healthcare IT
Posted by: | CommentsIn today's Health Care Blog, David Kibbe MD and Brian Klepper PhD continue a discussion that they kicked off with an open letter to the incoming Obama administration in December about health care IT and electronic medical records (EMR/EHRs).
Patients think that EMR/EHRs are the answer to their prayers – no more forms to fill out, no referral slips to carry around, hey-presto, it's all on this flash drive. What Kibbe and Klepper point out is that's just the tip of the iceberg:
In other words, let's not create a tower of Babel just because IT tools exist that will let us. There's enough failure-to-launch across the medical-care sector now: forests of paper records that are a bear to manage, much less share; HIPAA standing like Colossus over every single one of those sheets of paper; and the rising tide of 'perfect EMR solutions' that have been developed in the last few years.
There is no 'perfect solution' – what's required is that healthcare realize that it's an IT business, just as every other commercial sector has come to realize over the last decade.
As someone who has recent experience as a patient managing cancer treatment, the idea of having my records securely available to any medical practitioner in the U.S. via the internet sounds like Utopia. An achievable Utopia, if the incoming administration listens to the rising chorus of voices asking for exactly that.
Add yours to the chorus.
That's my story, and I'm stickin' to it…
Cancer for Christmas – One Year Later
Posted by: | CommentsI had my annual mammogram this last Tuesday – remembering how last year’s formerly routine event wound up, to say I was a little nervous is a vast understatement.
Here’s the news: I’m now officially a survivor.
Looking back at the last 372 days, I have to say it’s been quite a ride. So many people have helped me, have lifted me up, have kept me from feeling that terrible aloneness that’s part of fighting a life-threatening disease.
‘Thank you’ sounds inadequate, but it comes from the deepest and most tender part of my heart.
I will finish the first draft of "Cancer for Christmas" by New Year’s Day. Then it’s on to finding an agent, a publisher, or – best of all possible worlds – both. I’ll be reaching out to Save the Tatas and the Susan G. Komen Foundation, offering them a piece of the cover price in exchange for helping promote the book once it’s published.
My goal is to help anyone in the fight – against cancer, or any other life-changing disease – navigate the medical car-wash and manage their medical care for their benefit.
Because if you don’t, no one else will.
2008 has been quite a journey. I’m in an incredibly wonderful place, which I don’t know that I would recognize had I not had my dance with the Cancer Troll.
2009 is already a mortal lock for my best year yet – I wish you the same!
