Monday, June 15, 2009

Obama's speech to AMA: It's time to get health care (financing) done! (My own history with CABCO, Lewin, BCBS world)


Although President Barack Obama doesn’t directly use Blogger, his approach, apart from his speech today to the American Medical Association in Chicago, for presenting his plan for Health Care Reform seems almost that informal. Staffer Jesse Lee posted the White House explanation for Obama’s Health Care reform plan today here (with a link to the AMA speech) in a posting called “Why Reform, Why Now?”, on what the president calls simply "The Blog". (No, Mr. President, I think mine are "The Blogs!) The White House's idea is almost like that of Blogger: Put it out, encourage people to find it, and get the debate going and keep it sticking this time, not dying as it did for Bill Clinton. The Internet could make all the difference in the world in getting reform through – that is “Internet culture.”

It’s worthy of note that the President spelled out dire consequences for failure to act promptly:

“But let there be no doubt -- the cost of inaction is greater. If we fail to act -- (applause) -- if we fail to act -- and you know this because you see it in your own individual practices -- if we fail to act, premiums will climb higher, benefits will erode further, the rolls of the uninsured will swell to include millions more Americans -- all of which will affect your practice.

“If we fail to act, one out of every five dollars we earn will be spent on health care within a decade. And in 30 years, it will be about one out of every three -- a trend that will mean lost jobs, lower take-home pay, shuttered businesses, and a lower standard of living for all Americans.

“And if we fail to act, federal spending on Medicaid and Medicare will grow over the coming decades by an amount almost equal to the amount our government currently spends on our nation's defense. It will, in fact, eventually grow larger than what our government spends on anything else today. It's a scenario that will swamp our federal and state budgets, and impose a vicious choice of either unprecedented tax hikes, or overwhelming deficits, or drastic cuts in our federal and state budgets.”

Dr. Tim Johnson, ABC’s Medical Editor and reporter, wrote an analysis of Obama’s speech (“11 Observations on Obama's Health Care Speech: A Closer Look at President Obama's Speech on Health Care Reform”) here.

Obama emphasized the importance of automating medical records (and the clumsy manual system of charts – which a lot of doctors and even specialists cling to really does lead to 30% more tests and costs in my own experience) and prevention. Johnson says “At this point, he ignored the fact that there is no evidence that prevention long term saves money -- e.g., we may get so good at it that everyone lives to 90 and gets Alzheimer's.” That sounds a bit tacky, even offensive. Well, you can live to be 100 or more and not get dementia if you live well enough – look at the “blue zones” presented on Oprah. It does seem that the highly individualistic values that we have don’t work to preserve the brain health of many people, who need socially integrated communities – although maybe “neo-nerds” (like me, or maybe our new president and his wife both) are building up enough brain reserve to protect themselves for decades; we just don’t know yet.

The crowning glory of Obama’s speech was “That is why we need to end the practice of denying coverage on the basis of preexisting conditions. The days of cherry-picking who to cover and who to deny -- those days are over." That led to a huge applause (and not the British polite “clapping”).

We’re left to wonder whether a quasi government non-profit corporation to take care of the uninsured would undermine the health care industry. Well, it wouldn’t in a country like Switzerland. We can set up something like a super Blue Cross Blue Shield plan that takes everybody based on what they can afford, for people who don’t get their own and fall below certain income parameters. No, I don’t like means testing, but among those with means there is no reason why the industry today can’t “compete” for customers. BCBS plans, while technically non-profit, are true commercial businesses with intricate (sometimes labyrinthine) management and alliances -- sometimes they get in bed with for-profit giants like EDS to do their processing, so why not take this a step further and let companies like EDS, Perot Systems (they're separate!) and IBM have at it to automate all the record keeping an processing. (A major health care finance consulting company and player in today’s technical debates on reform, Lewin, has some of its roots in the Blue plans; I worked there in 1988-1989.) Funny thing, too, is that I was on a project in Dallas, a BCBS consortium (called “CABCO”, for Combined A&B Medicare Consortium) , intending to do just this from 1979-1981 and it fell apart in politics. The world wasn’t ready for user-defined processing. This time, we have to get it right. Who knows, I could soon find myself working for “CABCO II”. Perhaps Obama’s speech will turn out to be personally prescient, for me at least.

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