“Just as breathing exercises help integrate body and mind, writing is a kind of psycho-neural muscular activity which helps bridge and integrate the conscious and subconscious minds. Writing distills, crystallizes, and clarifies thought and helps break the whole into parts." Stephen Covey

Tremble, Health Care, Tremble

Wed, 6 Dec 2006 17:49:51 -0500

If you have caught my transparency/P4P rant, you’ll recall I said, “Employers and states are going to drive it…Now there’s talk of forcing change.” Well, last Wednesday, the WSJ announced that Wal-Mart, Intel, British Petroleum and others large firms are planning to provide their employees with “po

Why Consumers' Checkbook v CMS is a Sideshow

Tue, 30 Oct 2007 18:35:57 -0400

There are people who call for market solutions as the answer to every societal problem, but who then work to restrict the information that markets (and societies) must have to function effectively. Often, the truth is that these supposed market advocates need secrecy and opacity to protect their cur

Those Crazy Californians: This Time Its Childhood Diabetes

Fri, 13 Jul 2007 09:29:02 -0400

California always seems to be ahead on things that matter. A CNN story this week highlights that state's terrific anti-obesity TV campaign. The ads have cute kids sweetly asking "Dad, could you buy me some diabetes?" and "Can I drink another cup of sugar?" The goal is to shock adults into appreciati

To Fix Health Care, Fix America First

Sun, 15 Jul 2007 09:25:11 -0400

Been to see Sicko yet? If you haven't, I'd urge you to go right out and catch it. The audience in my conservative Southern community was riveted and clapped at the end, and everyone I've traded notes with has told me their audience applauded too. While it has its flaws, its central argument – that A

To An Engaged Life

Wed, 18 Jul 2007 09:22:50 -0400

OK, I'll admit it. I love reading the obituaries. They recount the marvelous achievements as well as, occasionally, the equally glaring flaws, of people we knew or, more often, didn't know. I can't help being astonished, shocked, delighted, repulsed. Who knew all that was lurking under there? paff

Should We Have Health Care Performance Transparency? By Whom? And How?

Thu, 19 Jul 2007 09:17:01 -0400

Last week the New York Times reported that New York's Attorney General (AG) office threatened UnitedHealthcare (UHC) with a lawsuit if it proceeded with the September release of a physician profiling report. The details were fuzzy, but apparently the AG was responding to charges by different physici

Crabby Doctors and the Explosion of Big Practices

Sat, 21 Jul 2007 09:12:05 -0400

Doctors are a cranky bunch these days, and justifiably so. Their world is changing. Its undoubtedly less fun to be the object of a paradigm shift than its driver or observer. A new Modern Healthcare Physician Compensation Survey showing that doctors across the board have gotten recent income boost

Mr. Bush's Health Care Reform Proposal

Tue, 24 Jul 2007 09:03:25 -0400

The Wall Street Journal (subscription required) ran an op-ed yesterday by Allen Hubbard, Director of the National Economic Council and the President’s Assistant for economic policy. The piece supported President Bush’s health care reform proposal that would offer tax deductions for individual purcha

Don't Invite Anyone From Health Care

Fri, 27 Jul 2007 08:54:50 -0400

Last year the Nevada Health Care Coalition in Reno asked me to work with them on a mid-October health care conference. They wanted to grow their coalition, and encourage their members to fund a data-mining project that would allow them to develop performance ratings on the region’s doctors (by speci

Mega Life and Health: We Must Be Stupid, Stupid, Stupid

Wed, 1 Aug 2007 08:50:15 -0400

I’ve filled a lot of airtime and column inches over the last couple years talking about the financial conflicts that characterize so much of health care. I’ve focused on topics like oncology drug rebates, Medicare D drug plan scams and unnecessary care by doctors and hospitals, but the truth is that

Transparency and Health Care Power Shifts

Thu, 9 Aug 2007 08:45:56 -0400

Mention a health plan to doctors or hospital administrators, and they’ll likely bend your ear about how the performance feedback data they get from the plans are wrong, how their reimbursements are based on inaccurate data, and how they think the inaccuracies are intentional. Because they aggregate

The Father of Physical Culture

Thu, 16 Aug 2007 08:42:25 -0400

One of my early morning pleasures is reading the day's edition of Garrison Keillor's Writer's Almanac - click on the link to sign up for the daily email newsletter - which contains a poem and then usually several short summaries of writers' lives. They always manage to focus on the particularly huma

In McDonalds vs. Kids, Guess Who's Ahead

Thu, 16 Aug 2007 08:38:54 -0400

Here's news to warm the heart of every fast food executive, but that, if the world were a sensible place, should jolt parents, school administrators and non-food industry business leaders out of their nutritional malaise. The New York Times reported this morning on a small sample taste test with 63

Taking Obesity Seriously

Wed, 12 Sep 2007 08:30:37 -0400

Over at Health Care Policy and Marketplace Review, the always insightful Bob Laszewski drew my attention to the release of a new report from The Trust for America's Health , F as in Fat: How Obesity Policies Are Failing in America. This 120 page document, funded by the Robert Wood Johnson Foundation

Not Paying For Preventable Errors: A Big Step

Mon, 20 Aug 2007 07:59:07 -0400

Fee-For-Service (FFS) reimbursement has been disastrous for the American health care system because, instead of encouraging the delivery of the RIGHT products and services, it simply encourages MORE, and independent of quality and safety. The system lacks transparency, so we haven't been able to di

Essential Reading: Laszewski on Rove and Medicare D

Fri, 17 Aug 2007 07:44:50 -0400

All of us who have worked in policy during our careers know the old joke that there are two things you never want to see made: sausage and laws. Never was this more true than with Medicare D. Earlier this week, Robert Laszewski at Health Care Policy and Marketplace Review wrote an eloquent and succ

Consultants to Hospitals: Prepare for Transparency

Thu, 16 Aug 2007 07:40:44 -0400

We must view and treat the community as the "owner" to whom we are fully accountable. Aggregate financial performance data, aggregate productivity performance and aggregate quality and patient satisfaction data belong in the public realm. How else can consumers make a decision to...support us?

Brokers: Why They Feel Their Commissions Are Justified

Tue, 14 Aug 2007 07:32:07 -0400

As you might imagine, yesterday's post on the excessive and deceptive nature of broker compensation raised a few hackles. I received several protests from brokers/agents who argued that they are saddled with inordinate responsibilities in exchange for their commissions. In the interests of fairness

Brokers: A Price Above Rubies

Mon, 13 Aug 2007 07:26:52 -0400

Let’s take a break from picking on the doctors, the hospitals, the health plans, the drug companies, and the device companies. Let’s talk about the brokers. Brokers, you’ll recall, connect health plans and employers. They typically represent themselves as unbiased, protecting employers’ interests a

Managed Care Redux

Wed, 15 Aug 2007 13:05:01 -0400

Like democracy, managed care is a great idea. It's just that its rarely been tried. Even so, my guess is that its about to re-emerge in a new, improved form, and possibly with some other name. If the signs around us now have any meaning, it will be different than our experience of a couple decades

Can Consumerism Save Health Care?

Mon, 27 Feb 2006 13:03:13 -0500

In January’s State of the Union Address, President Bush called for expanding Health Savings Accounts (HSAs) as one sensible approach to curb rising healthcare costs. An HSA is a tax-favored healthcare-dedicated savings account that a patient controls. Combined with out-of-pocket requirements and a H

Benign Neglect and the Nursing Shortage

Tue, 21 Aug 2007 12:49:27 -0400

I sit on the Dean's Advisory Councils of the Colleges of Health at two public universities in Florida. Both Colleges are led by extremely capable PhD nurses, and have a variety of programs that train students to be health professionals, including nurses. A few months ago, I was startled when one of

Evaluating The Quality of Quality Improvement Claims: The Population Health Impact Institute

Fri, 24 Aug 2007 17:14:03 -0400

Thomas Wilson PhD is on a mission that's important to health care. Tom, a respected epidemiologist particularly well-known in disease management circles, founded the Population Health Impact Institute (PHII), a not-for-profit devoted to establishing clear, objective rules to evaluate claims of finan

What Are They Thinking: ONCHIT & RTI

Fri, 24 Aug 2007 17:11:39 -0400

I'm sure I don't really get the deeper issues involved here, but sometimes its hard to not have your breath taken away by some people's notion of a good idea. Maybe its because I'm not a true geek, but what I'm about to describe strikes me about the same way I feel as when I see a young adult with m

Another Step Toward Transparency

Mon, 27 Aug 2007 17:06:49 -0400

It was the great economist Adam Smith who said that, for markets to work, they need (among other things) "perfect information." Health care hasn't worked, in large measure, because its markets have had almost no information. So in what could be a huge step forward for the health care transparency m

Crimes and Punishments: Zheng and Crawford

Wed, 11 Jul 2007 17:33:06 -0400

On Tuesday China executed Zheng Xiaoyu, the head of its State Food and Drug Administration, an event that, like it or not, contrasts sharply with our response to similar behaviors by our own FDA head. Zheng was convicted of accepting about $850,000 in bribes from eight companies to approve untested

Why Its Unlikely We'll Curb Obesity and Diabetes

Mon, 9 Jul 2007 13:00:25 -0400

I routinely hear well-intentioned people say that, if Americans, and most particularly kids, would just become more responsible for their own health and start eating right, then our obesity and diabetes epidemics would turn around. I don't think this is going to happen, at least not anytime soon. T

Mr. Orszag's Surprise

Thu, 5 Jul 2007 12:44:24 -0400

Over at the always excellent and entertaining Health Care Blog last week, my pal Matthew Holt pointed out a new report on the nation’s health care spending dynamics by the Director of the non-partisan Congressional Budget Office (CBO), Peter Orszag. Unlike political appointees on the right or left,

The Cognitive Dissonance of Conflicted Care

Fri, 15 Jun 2007 12:43:24 -0400

A few days ago the New York Times ran yet another article exploring the deep financial conflicts in oncology drug prescribing. This one described two facts. First, even though Medicare has limited the profits of oncologists who prescribe drugs, Medicare’s total cancer care expenditures keep rising

How Might Information Technology Actually Change Health Care

Wed, 19 Sep 2007 08:07:33 -0400

Today I’m in San Francisco for the Health 2.0 conference, billed as “User-Generated Health Care.” Organized by my pal Matthew Holt and his partner, Indu Subaiya, "Health 2.0" references "Web 2.0," social networking, applied to health care. The meeting will feature top executives from high and low

Reform's Tougher Problem

Wed, 29 Aug 2007 08:01:04 -0400

Yesterday, Matthew gracefully pointed to my post over at Bob Laszewski's Health Care Policy and Marketplace Review, which I called "The Tougher Health Care Problem." Bob's readership leans heavily toward the DC-based health care policy types who may not follow the happenings over here. The policy cr

What About Health Plan Transparency

Sun, 16 Sep 2007 07:43:56 -0400

Senator Clinton will roll out her health plan tomorrow, but in the roll-up last week she pointedly singled out the health plans as a big part of the problem. "I intend to dramatically rein in the influence of the insurance companies. They have worked to the detriment of our economy and of our healt

Goldsmith's Wisdom

Mon, 1 Oct 2007 07:41:26 -0400

Last week, Jeff Goldsmith, who enjoys a reputation as one of health care's more thoughtful commentators and advisors, wrote a curious post on this site. He puzzled over Kaiser Family Foundation Chairman Drew Altman's failure to gush that the 2007 health care inflation rate had moderated to 6.1%, dow

A Broad Vision of Health 2.0: Reformulating Data for Transparency, Decision Support and Revitalized Health Care Markets Brian Klepper and Jane Sarasohn-Kahn

Fri, 12 Oct 2007 07:32:36 -0400

Before you start reading, download this document. It's a single PowerPoint slide that's animated to build. Go into presentation mode, then read along with the narrative below. The term Health 2.0 refers to the concept, described by O’Reilly in September of 2005, of Web-based platforms that allow us

Bogle on the Financial Sector's Threat To Democracy

Wed, 3 Oct 2007 07:18:15 -0400

Some years back I was mortified to realize that it would be all-but-impossible to fix health care without first fixing America's patronage system, that puts virtually all policy up for sale to the highest bidder. In 2006, American corporations spent $2.5 billion lobbying Congress, nearly $5 million

Aspen Health Forum - A Rage To Know: A Few Days at the Aspen Health Forum

Sun, 14 Oct 2007 07:09:19 -0400

At one of the opening sessions of the Aspen Health Forum, Peter Agre and Michael Bishop, both physician researchers and Nobel laureates, recounted their childhoods, their families, their likes and dislikes, their school experiences, and the barriers, successes and lucky breaks that led them into liv

Aspen Health Forum - Healing Unbound: The Promise of Advancing Computational Power

Mon, 15 Oct 2007 07:04:30 -0400

Laptop-attached ultrasound units that produce startlingly clear internal images for five dollars in the field. Organs that re-generate inside scaffolds. Drugs tailored to an individual’s biology. Micro-images of cancerous cells lit up by bio-chemical markers. Decision support tools that scan the ph

What Obesity Really Costs

Tue, 16 Oct 2007 06:43:06 -0400

Any lingering doubts that America's cavalier attitude toward lousy food and obesity is draining the nation's health and economic vitality should have been laid to rest a couple weeks ago. Two important studies were released that quantified just how much our inability to resist fast food is costing u

We Are What We Eat: Where Is America's Leadership?

Wed, 17 Oct 2007 06:37:24 -0400

One of the attributes of a great image is its ability to convey vast amounts of information and meaning quickly and simply. Here's a terrific example. In one of his typically astute comments, Barry Carol alerted us to a wonderfully clever graphic by Wellington Gray, displaying the percentage of peo

The Hot Seat: GM and UAW

Wed, 3 Oct 2007 06:31:32 -0400

The GM-UAW deal is a turning point for American health care. In a stroke – OK, it was a 456 page stroke – GM agreed to turn over as much as $35 billion, about 70 cents on the dollar, for a trust that will fund the union’s retiree health care benefits in the future. With the exception of modest addit

Health 2.0 and the Promise of Market-Based Health Care Reform

Mon, 15 Oct 2007 05:18:06 -0400

I have been skeptical about the potential for meaningful policy-based health care reform. The health care industry fields the largest, best-funded and most powerful lobby that has held huge sway over health policy for decades. If the reforms necessary to re-establish stability and sustainability in

Aspen Health Forum - Removing The Blinders: Dr. Kelman’s Wonderful Contribution

Thu, 18 Oct 2007 05:03:51 -0400

One of the most fascinating and moving experiences at the Aspen Health Forum – Given the quality of the content there, this is saying something. The audience was rapt – was a talk by Neen Hunt, Executive Director of the Lasker Foundation. Each year this organization bestows a hugely prestigious priz