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The Savvy Tech Strategy Behind Obamacare

Soulskill posted about 9 months ago | from the i-bet-the-borg-have-low-health-care-costs dept.

Government 146

snydeq writes "The U.S. health care industry is undergoing several massive transformations, not the least of which is the shift to interoperable EHR (electronic health records) systems. The ONC's Doug Fridsma discusses the various issues that many health care IT and medical providers have raised regarding use of these systems, which are mandated for 2014 under the HITECH Act of 2004, and are all the more important in light of the 2010 Patient Protection and Affordable Care Act, aka Obamacare. Key to the transition, says Fridsma, is transforming health IT for EHRs into something more akin to the Internet, and less like traditional ERP and IT systems. 'I think what we're trying to do is the equivalent of what you've got in the Internet, which is horizontal integration rather than vertical integration,' Fridsma says. 'We've done a lot of work looking at what other countries have done, and we've tried to learn from those experiences. Rather than trying to build this top down and create restrictions, we're really trying to ask, "What's the path of least regret in what we need to do?"'"

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146 comments

Handsome man (-1)

Anonymous Coward | about 9 months ago | (#44264457)

The savvy daycare behind Obama's strategy.

HealthBook (-1)

Anonymous Coward | about 9 months ago | (#44264475)

Just add a HealthBook app to Facebook and let everyone post their EHRs. Facebook probably has them already in their 'Shadow Profiles'.

Too bad someone didn't figure this all out (5, Insightful)

hsmith (818216) | about 9 months ago | (#44264493)

Before the govt started handing out $44k for docs to adopt shitty EHR systems and collect free money. We now have a plethora of shitty EHR systems in hospitals that don't solve any issues at all.

So, the government created this incentive (Which made a few companies insanely rich, like Epic, Cerner, and Athena) - and created this massive siloed data mess. Anyone who has worked in HIT knows what a complete failure this EHR rollout has been on every front.

Even better are the CHIIT "certification" standards (aka, a complete pile of shit) which were to ensure that EHR software met a bunch of standards to get that $44k. One of the hallmarks was "Interoperability" - which to CHIIT meant "systems can communicate with themselves" - derp.

The EHR rollout was a complete failure, mainly due to the govt pushing shit out on the marketplace with their stupid incentives. It is going to take over a decade to untangle the mess of complete crap.

Re:Too bad someone didn't figure this all out (-1, Troll)

Anonymous Coward | about 9 months ago | (#44264519)

F*ck Obama and the US government.

Re:Too bad someone didn't figure this all out (0, Troll)

MetalliQaZ (539913) | about 9 months ago | (#44264613)

I think it's safe to assume from your short post consisting of nothing more than impotent rage that you are an American citizen that is considering leaving the country for good. Let me be the first to say "good riddance"

Re:Too bad someone didn't figure this all out (-1)

Anonymous Coward | about 9 months ago | (#44265045)

I see by your short post consisting of nothing more than impotent rage that you are not an American citizen or indeed a citizen of any free country. It is the duty of all members of a society to complain, however they see fit (as long as it does not violate the law (usually)). Those that would stop them must hate their country and that country's freedoms. Or...maybe you're just an asshole that likes being able to say things to people online that would normally get you pasted in the mouth. In that case I feel sorry for you as well.

Re:Too bad someone didn't figure this all out (0)

Anonymous Coward | about 9 months ago | (#44265727)

It is not the duty of citizens to complain, it is the duty of citizens to bring up informed critisism. (and fuck 'whoever' is not a very usefull cristsism even if they deserve it)

Re:Too bad someone didn't figure this all out (4, Insightful)

intermodal (534361) | about 9 months ago | (#44264531)

This is from the same government that brought us the VA hospital system. I work in HIT myself, and I see nothing good coming of these new technology mandates.

Re:Too bad someone didn't figure this all out (3, Insightful)

hsmith (818216) | about 9 months ago | (#44264677)

Good idea, but in reality it should be all revolved around creating true standards and interoperability. Systems communicating together should have been the single desirable element in all of it. Instead, it was an afterthought. Now we get garbage like Commonwell (From the 5 largest EHR vendors) that will create more proprietary garbage.

The people that created the mess we are in want to fix it? Please.

Re:Too bad someone didn't figure this all out (2)

h4rr4r (612664) | about 9 months ago | (#44264693)

The best way to do that would have been to recreate a FOSS reference implementation. Let this be the BIND of these types of systems. Also it would give an inexpensive starting point for all the other systems, so many vendors could compete for integration and management, or even alternate implementations.

Re:Too bad someone didn't figure this all out (0)

Anonymous Coward | about 9 months ago | (#44265117)

The biggest problem is not the concept. the concept is great. The problem is the laws are written by politicians rather than the people who have are forced to use the products. Does anyone really think that these politicians know ANYTHING about actual healthcare? I mean seriously. you need to team up programers and users to come up with the products that are needed.

posting anon to save mods

Re:Too bad someone didn't figure this all out (1)

intermodal (534361) | about 9 months ago | (#44265353)

I quite agree. Even then, I'm reminded of the saying that I'm just not going to take the time to find. It's something along the lines of "you don't get change by forcing it. You get change by bringing something to the table that people see and wonder how they got by without it." This government-mandated system is the exact opposite of that.

Re:Too bad someone didn't figure this all out (1)

anagama (611277) | about 9 months ago | (#44266417)

Concerning your sig, I think you have the wrong Superpower.

But whatever, soon Nixon's healthcare plan (AKA obamacare) will be in full swing and with everything digitized and flying around the net, the NSA will have it too. I imagine Nixon hard on just bursting through his coffin by now. Thanks Obama.

Re:Too bad someone didn't figure this all out (5, Interesting)

cs668 (89484) | about 9 months ago | (#44264533)

Actually makes things worse. Because when the EHR's are in place they usually make sure to maximize the billable services provided in the back office so that you make sure to submit every claim possible. This helps to raise healthcare costs instead of lowering them by reducing paperwork......

Re:Too bad someone didn't figure this all out (1)

modmans2ndcoming (929661) | about 9 months ago | (#44266397)

The only billable services from Epic (the EMR that my employer uses) are the software support contract (maintenance patches/upgrades/technical support), any custom build you request (but the system is so flexible it is rarely needed) and training. Those seem pretty standard for any niche system. Epic is a lot more like IBM or Microsoft from a vendor standpoint than they are like GE.

Re:Too bad someone didn't figure this all out (5, Insightful)

PatHMV (701344) | about 9 months ago | (#44264805)

Right on. Moreover, who benefits from all this, anyway? The idea is that the patient benefits, because an ER doc at one facility can see all of that patient's health records when treating him. But what if the patient doesn't want that? The reality is that all this centralized electronic data will benefit insurance companies, not patients. Once certain things (epilepsy, say) are flagged in your electronic, accessible to any person authorized by law to see them (and that will be insurance companies, governments, and probably your own employer at some point), then it's there, and you're tagged for life. Good luck getting a driver's license. Or overcoming the stigma of some unpopular disease.

I don't WANT all of my medical records out there. I don't think it will benefit me or my health. But these days I have little choice.

Re:Too bad someone didn't figure this all out (1)

Bill, Shooter of Bul (629286) | about 9 months ago | (#44265365)

Why wouldn't you want your doctor to have your complete medical history at hand?

I understand why you'd want to limit the access to your health records, but not if that includes doctors. Especially if it includes ER doctors.

Re:Too bad someone didn't figure this all out (1)

0123456 (636235) | about 9 months ago | (#44265507)

Why wouldn't you want your doctor to have your complete medical history at hand?

Because if they have it, so does the NSA.

Re:Too bad someone didn't figure this all out (1)

ColdWetDog (752185) | about 9 months ago | (#44265523)

Because if doctors have it then everyone has it -- in the above scenario, a patient has epilepsy but essentially doesn't want the government (DMV in this instance) to see that.

- First of all, he is committing a crime. And anyone knowingly abetting that is in some legal jeapordy (may not be big).
- Secondly, as soon as the doctor puts it on the chart, it gets stuck in the database. Then the insurer and anyone else who gets to see the database (? DMV) gets to see the diagnosis. It's like the Internet - once it's out there, the data''s not coming back. Access to the Big Database in the Sky isn't going to be hard to get, no matter what anyone says.

So, if you have any medical secrets, be sure not to tell anyone. But don't get mad when some doctor prescribes another medication that interacts with your epilepsy drug and puts you in a coma (and those drugs tend to interact with lots of other drugs).

Re:Too bad someone didn't figure this all out (0)

Anonymous Coward | about 9 months ago | (#44265829)

Why wouldn't you want your doctor to have your complete medical history at hand?

Doctors can be HIGHLY judgemental.

Re:Too bad someone didn't figure this all out (2)

brentrad (1013501) | about 9 months ago | (#44265897)

So what you're saying is, if you have epilepsy, you want the ability to hide that from the DMV, so that you can still drive your car while having a potentially very dangerous condition to have while driving? You want the "freedom" to continue to endanger the lives of others so that you're not inconvenienced by having to take public transportation. Gee, thanks for your concern for your fellow man.

Not really that convincing an argument for keeping your medical diagnoses secret.

Re:Too bad someone didn't figure this all out (5, Interesting)

AK Marc (707885) | about 9 months ago | (#44264853)

As opposed to the EHR before Obama, where I literally had to pay $200 for a hard copy of my X-ray to walk it two doors down the hall to give it to the doctor, who had to go walk down the hall the original place to see the electronic stored copy because the resolution wasn't sufficient on the hard copy, but it was stored electronically. I never had a patient system that talked to any others.

I moved out of the US, now any doctor I go to in the country, can look me up by name and DOB and see my entire medical history (or health care number, which nobody ever has on them).

The problem the US commits every time is that they ask the people who profit from the systems, how to make them. Every solution I've seen could have been done better by a bunch of high school students. The pros have a vested interest in making it fail. The worse it works, the longer they have jobs. And never are there financial penalties in government contracts.

Re:Too bad someone didn't figure this all out (1)

modmans2ndcoming (929661) | about 9 months ago | (#44266353)

Epic and Cerner are the best in the market from an over all EMR standpoint (there are specialty functions they will not due such as Hemodynamics etc). These systems give the IT staff a lot of control and power to implement functions that the staff ask for rather than simply asking the vendor for a feature and waiting for them to build it.

-1 Redundant Technology (1)

some old guy (674482) | about 9 months ago | (#44264497)

Why not just parse the existing NSA database?

No point in reinventing the wheel. Like a good neighbor, Big Brother is there!

Re:-1 Redundant Technology (1)

gl4ss (559668) | about 9 months ago | (#44264699)

well..

you know why most of these are top down? so that there's some control on who gets to the data. obviously if you drop that requirement then doing the data sharing between hospitals etc is pretty easy.

Re:-1 Redundant Technology (1)

Mitreya (579078) | about 9 months ago | (#44264849)

Why not just parse the existing NSA database?

Snowden hasn't yet confirmed that NSA trawls medical history. Maybe they don't (yet).

Bingo (5, Insightful)

Anonymous Coward | about 9 months ago | (#44264501)

I just filled out my BS bingo card when they called both "horizontal integration" and "vertical integration".

On topic: The path of least regret would have been single payer system, but we somehow ended up with a Republican profit-utopia called "Obamacare".

Re:Bingo (3)

h4rr4r (612664) | about 9 months ago | (#44264631)

Infinity Imaginary mod points to you sir.

Re:Bingo (1)

cold fjord (826450) | about 9 months ago | (#44266101)

On topic: The path of least regret would have been single payer system, but we somehow ended up with a Republican profit-utopia called "Obamacare".

Infinity Imaginary mod points to you sir.

Infinity irony points to you, fellow poster.

It is often claimed that Obamacare is a Republican creation by way of the Heritage Foundation. In fact the Heritage plan was substantially different, and they figured out quite some time ago that plan was not a good idea, and they disowned it. [wsj.com]

In fact, Obamacare was written by Democrats in Congress with help from a progressive think tank.

Center For American Progress President Shares Part In Obamacare: "I Helped Write The Bill" [realclearpolitics.com]

Obamacare was passed in Congress on a straight party line vote.

House passes health-care reform bill without Republican votes [washingtonpost.com]

Obamacare was signed into law by President Obama.

So how is a law written by Democrats assisted by progressive think tanks, passed solely by Democrats, and signed into law by a Democrat President a "Republican" plan?

PRUDEN: Obamacare called ‘The fiasco for the ages’ [washingtontimes.com]
Democrats' New Argument: It's A Good Thing That Obamacare Doubles Individual Health Insurance Premiums [forbes.com]
Analysis: Obamacare to cost $2.6 trillion over first full decade [dailycaller.com]

President Barack Obama promised his health-care law would cost approximately $900 billion over ten years when he first proposed it. Since then, the price tag has continued to climb. Total spending under the Affordable Care Act will reach $2.6 trillion over its first full decade, according to a Senate Budget Committee analysis, which was based on Congressional Budget Office estimates and growth rates.

It is said that success has many fathers but failure is an orphan. Trying to leave the Obamacare baby in a basket on the Republican's doorstep won't work. The bastard stepchild of Obamacare belongs to the Democrats.

 

Mod up parent!!! (2)

Presto Vivace (882157) | about 9 months ago | (#44264957)

it's not too late, we could still pass HR 676, Medicare for All [healthcare-now.org].

Re:Mod up parent!!! (2)

CanHasDIY (1672858) | about 9 months ago | (#44265039)

it's not too late, we could still pass HR 676, Medicare for All [healthcare-now.org].

Doesn't matter if it's the best idea humanity ever came up with, it won't go anywhere in its current form.

Now, were it to be renamed the Anti-Terrorism Immigration Marriage For the Children to Protect America Act, we might actually be able to move the ball forward...

Re:Mod up parent!!! (1)

Culture20 (968837) | about 9 months ago | (#44265823)

Now, were it to be renamed the Anti-Terrorism Immigration Marriage For the Children to Protect America Act, we might actually be able to move the ball forward...

ATIMFCPAA is a terrible acronym. Ahtimpfkapahah?

Re:Bingo (1)

CanHasDIY (1672858) | about 9 months ago | (#44265011)

On topic: The path of least regret would have been single payer system, but we somehow ended up with a Republican profit-utopia called "Obamacare".

Yea, almost as if Republicans weren't the only ones who wanted it...

Partisanship: because independent thought is hard!

Re:Bingo (2)

Geste (527302) | about 9 months ago | (#44265175)

In the Clinton era (think HRC and Ira Magaziner) the arrogant, doomed approach was to use the Democratic "Big Tent" and invite all players -- pharma and insurers included -- to invent some fanciful "Health Care Reform (TM)" that would make all parties happy. Instead, insurers and pharma burned down the tent, scattered the ashes, then stabbed Health Care Reform to death.

Fast forward to the Obama admiserablestration, and there's not even a pretense of making anybody happy beyond the guys with the knives. You might call Clinton's failure a blunder born of hubris, but Obama's "success" is a tawdry monument to special interests and avarice.

The one rational chance for "reform" would have been a hard-fought, progressive fight for single-payer. That chance sank to the ocean floor in 1993.

Remind us how many Republicans voted for it (2, Informative)

Anonymous Coward | about 9 months ago | (#44265215)

It's kind of hard to blame any of it on the Republicans since they were not at all involved in the meetings and didn't vote for it.

Re:Remind us how many Republicans voted for it (0)

Anonymous Coward | about 9 months ago | (#44265663)

Sorry, no facts allowed in the supremely partisan Obamacare creation.
All behind closed doors. The dems got EXACTLY what they drafted.
If you think otherwise please get back on Reddit where you belong.

Re:Bingo (1)

Curunir_wolf (588405) | about 9 months ago | (#44266017)

I just filled out my BS bingo card when they called both "horizontal integration" and "vertical integration".

On topic: The path of least regret would have been single payer system, but we somehow ended up with a Republican profit-utopia called "Obamacare".

Maybe he should have had all the meetings in the open, and broadcast on CSPAN, like he promised to do during the campaign [youtube.com], instead of negotiating the entire thing behind closed doors with the corporate executives and buying votes with pork and bribes.

This article is built on a bad premise. (3, Informative)

intermodal (534361) | about 9 months ago | (#44264521)

There is nothing necessary about what they're mandating.

Thanks to the way Washington, D.C., works, the end result will be smug bureaucrats patting each other on the back, and doctors wondering if they should just find a different field to work in.

Re:This article is built on a bad premise. (1)

i kan reed (749298) | about 9 months ago | (#44264735)

There is nothing necessary about what they're mandating.

Yeah, these computer things are so transient and unnecessary.

Re:This article is built on a bad premise. (0)

Anonymous Coward | about 9 months ago | (#44264787)

wow. That was obtuse to the point of irrelevant.

Re:This article is built on a bad premise. (1)

i kan reed (749298) | about 9 months ago | (#44264833)

wow. That was obtuse to the point of irrelevant.

See that's a fine criticism, it's just you usually follow it with a clarifying statement explaining what the relevant point ignored was, rather than just stewing in your own smug superiority.

Re:This article is built on a bad premise. (0)

Anonymous Coward | about 9 months ago | (#44265303)

I'll leave the smug superiority to you. I wouldn't want to devalue your trademark.

Gotta make it electronic (0)

Anonymous Coward | about 9 months ago | (#44264525)

Because the NSA can't hack paper.

Just another method of tracking you. (1)

Anonymous Coward | about 9 months ago | (#44264529)

This all sounds good... It sounds good like using Skype to make phone calls until you find out everything has been freely handed to the NSA... Now, everything in your medical records is available to the NSA and Obama... I'm not at all happy about the prospect!

It uses the standard government tech strategy (4, Insightful)

Richy_T (111409) | about 9 months ago | (#44264569)

Costs three times as much as the originally budgeted cost, is delivered five times past the deadline and doesn't do a tenth of what was promised.

Re:It uses the standard government tech strategy (1)

Capt.DrumkenBum (1173011) | about 9 months ago | (#44264603)

Costs three times as much as the originally budgeted cost, is delivered five times past the deadline and doesn't do a tenth of what was promised.

You sir, are an optimist.

Re:It uses the standard government tech strategy (1)

schwit1 (797399) | about 9 months ago | (#44264971)

Wait until you find out it only works with Internet Explorer.

Re:It uses the standard government tech strategy (1)

CanHasDIY (1672858) | about 9 months ago | (#44265053)

Wait until you find out it only works with Internet Explorer.

IE6. With NoScript disabled, and some proprietary ActiveX component that NEVER FUCKING DOWNLOADS RIGHT.

Learning from what other countries have done? (5, Insightful)

Hatta (162192) | about 9 months ago | (#44264611)

Other countries have single payer health care, which delivers better outcomes at a lower cost. Try learning from that.

Re:Learning from what other countries have done? (4, Insightful)

h4rr4r (612664) | about 9 months ago | (#44264639)

That does not maximize insurance industry profit. Which is in fact the entire point of the ACA.

Re:Learning from what other countries have done? (1)

JWW (79176) | about 9 months ago | (#44264847)

Yep. It really amazes me that Obama set up the law so that he had to fight with states to set up health care exchanges.

All he had to do was have the law make health insurance markets work across state lines (easily justified by the commerce clause) and then he would have had to only set up ONE exchange for the whole country.

But, of course, the insurance companies would not have made as much money that way.

Re:Learning from what other countries have done? (3, Insightful)

CanHasDIY (1672858) | about 9 months ago | (#44265059)

Yep. It really amazes me that Obama set up the law so that he had to fight with states to set up health care exchanges.

Ah, well, simple answer there - he didn't [house.gov]

Re:Learning from what other countries have done? (3, Interesting)

Anonymous Coward | about 9 months ago | (#44265015)

That does not maximize insurance industry profit. Which is in fact the entire point of the ACA.

Nope. The entire point of the ACA is to destroy the insurance industry, causing an emergency for which the only solution will be single-payer.

They told the insurance industry "sure we're bending you over a barrel here, but at least you are going to get a lot more people buying policies." The insurance industry never wanted this, but tried to get the best deal they could to try to weather the storm.

But insurance companies are screwed. If you don't buy insurance, you pay a penalty, which goes to the US federal government and not the insurance companies. The penalty is cheaper than insurance, and because of "no preexisting conditions" the insurance companies have to accept you even if you took the penalty for years. So, when you are young and healthy, you pay the penalty; then when you get cancer, or get hit by a car, or incur any other major health problem, you immediately sign up for insurance, they have to take you. So the insurance company gets one month of premiums and then pays big for care. The ACA makes it so that the rational thing to do is only to sign up for insurance when you know you have bills that will cost more than the insurance payment.

Also, the ACA defines what kind of insurance you must buy: did you want high deductible with low premiums? Sorry, you can't have that, the ACA doesn't allow high deductibles. So premiums are guaranteed to be high, thus encouraging people to just pay the penalty.

Is this by design, or is the ACA incompetently written? I'm pretty sure it's the former.

I remember seeing a YouTube video of a Democrat in Washington D.C. talking to a group. "People say the Affordable Care Act has a 'Trojan Horse' hidden inside it that will lead to single payer. What's hidden about it? It's right there!" The audience laughed and cheered.

I couldn't find that one but I did find this. At about 4:40 a Democrat says "some guy from the insurance industry said the public option would put insurance companies out of business. He was right!"

http://www.youtube.com/watch?v=926bPZiQhgY [youtube.com]

Re:Learning from what other countries have done? (0)

Anonymous Coward | about 9 months ago | (#44265793)

You have no idea what you're talking about.

Re:Learning from what other countries have done? (1)

Anonymous Coward | about 9 months ago | (#44265955)

Politifact: Is the penalty less than the cost of insurance? TRUE
http://www.politifact.com/truth-o-meter/statements/2013/jan/24/ron-desantis/desantis-says-obamacare-tax-cheaper-insurance/ [politifact.com]

CBO estimates that 6 million people will pay penalty rather than buy insurance in 2014; also, IRS says the cheapest insurance for a family under the ACA will be $20,000. (I think the CBO estimates will prove to be very low. $20K is more than the pre-ACA average cost of insurance for a family.)
http://townhall.com/tipsheet/katiepavlich/2013/03/05/six-million-to-pay-obamacare-penatly-n1526185 [townhall.com]

Columnist spells out the details on why the penalty is cheaper than insurance and says he already cancelled his insurance. (He thinks this implies that the ACA will "crash" and that the architects of the ACA are worried. I think this is an intended feature, paving the road for single payer.)
http://www.breitbart.com/Big-Journalism/2013/01/25/Politifact-Ignores-Primary-Reason-Obama-Might-Crash [breitbart.com]

Investors Business Daily asks "will only suckers buy insurance under the ACA?" and suggests insurance companies are headed for a "death spiral" (words in original).
http://news.investors.com/021913-644948-will-only-suckers-buy-obamacare-coverage.htm?p=full [investors.com]

Re:Learning from what other countries have done? (2)

brentrad (1013501) | about 9 months ago | (#44265989)

The entire point of the ACA is to destroy the insurance industry, causing an emergency for which the only solution will be single-payer.

We can only hope. That would be the best possible outcome. Tell me again what the point of insurance companies is?

Re:Learning from what other countries have done? (0)

Anonymous Coward | about 9 months ago | (#44266491)

We can only hope. That would be the best possible outcome. Tell me again what the point of insurance companies is?

Are you opposed to auto insurance, fire insurance, theft insurance on expensive paintings, etc? If not, then I think you already understand the point of insurance.

Insurance allows risk to be spread across a large pool. When done correctly, it works. For health care, the more the government jacks with the system, the more messed up the system gets.

If we want to make sure that poor people have access to care, let's extend the benefits of Medicare, not scrap everything and force everyone into a new system.

The problem with single-payer is that one size doesn't fit all. In countries with single-payer, if something common place happens (e.g. you break your arm) you get free care, it all works, and you are pretty happy. But when you get cancer, or something else very out of the ordinary, single payer gives a much worse result (ie more people die) than the US.

http://www.cato.org/publications/commentary/cancer-societys-deadly-medicine [cato.org]

I assume that you want the greatest good for the greatest number of people. I want that too! But I believe that single payer isn't as good as a free market. The expense of medicine in the US is better fixed with reforms than by junking everything and going single-payer. You may not agree, but I hope you don't think everyone who disagrees with you is an inhuman monster who just wants poor people to suffer and die.

Re:Learning from what other countries have done? (1)

Anonymous Coward | about 9 months ago | (#44266043)

The disconnect here is rather striking. I watched that entire video and it took me a while to realise that it was anti-ACA, especially since no arguments were made that single-payer was a Bad Thing. If what you say is true, then Obama is a savvy politician who has pwned the Rs and done something that about 70% of the US population wants and most of the rest of the civilised world already enjoys!

It kind of made my day.

Re:Learning from what other countries have done? (1)

Q-Hack! (37846) | about 9 months ago | (#44266677)

Just because 70% of the population wants something, doesn't mean it is a good idea. We may well end up with a single payer system. Good luck finding a doctor when we do.

There are many things we could have done to bring down the cost of medical care. eg. Force doctors to post their prices. Not force insurance agencies into "must provide" plans. Allow insurance to be purchased across state lines, etc... Hell, just bring back the free market's risk/reward concept to the medical world. Sadly, none of these options will ever see the light of day. But don't let my ranting get in the way of your utopian view of how a single payer system will solve everything.

Meanwhile, I will sit here and wait quietly in the VA hospital for my chance to be seen... I am told it might be next Thursday.

Apples and Oranges (2, Funny)

Anonymous Coward | about 9 months ago | (#44264687)

Other countries have single payer health care, which delivers better outcomes at a lower cost. Try learning from that.

Those are free, democratic and egalitarian societies with a socialist bent.

We in the US, OTOH, are a feudal republic with an ignorant population that is under the delusion that all they have to do is work hard and they'll be rich.

Re:Learning from what other countries have done? (1, Insightful)

dfenstrate (202098) | about 9 months ago | (#44264819)

Other countries have single payer health care, which delivers better outcomes at a lower cost. Try learning from that.

And those countries do that by either gaming the statistics, or having a homogenized society where social pressure to conserve public resources can be successfully applied.

Re:Learning from what other countries have done? (2, Insightful)

Hatta (162192) | about 9 months ago | (#44265043)

Single payer just makes sense. A centralized, not for profit system is going to be more efficient than a thousand different companies with their finger in the pie.

And what's wrong with a little pressure to conserve resources? Waste is rampant in the medical industry. As it is now, hospitals get paid for an x-ray whether it's needed or not. More needless tests means more profit, exactly the wrong incentive. We need to tie funding to outcomes, not procedures, and a centralized system is the right way to do that.

Re:Learning from what other countries have done? (0)

phantomfive (622387) | about 9 months ago | (#44265693)

Centralized control is not known for its efficiency and lack of waste.

I don't really care if we have single payer or not, but I think it's foolish to think that making huge changes in the system at once will automatically make things better. France and Germany don't have nearly the difficulties we would have in a single payer system, based on size alone.

Re:Learning from what other countries have done? (0)

Anonymous Coward | about 9 months ago | (#44266103)

Centralized control is not known for its efficiency and lack of waste.

I don't really care if we have single payer or not, but I think it's foolish to think that making huge changes in the system at once will automatically make things better. France and Germany don't have nearly the difficulties we would have in a single payer system, based on size alone.

Why? Germany is not as small as you think it is. The US is only 4x larger.

Re:Learning from what other countries have done? (0)

Anonymous Coward | about 9 months ago | (#44265933)

When that resource is grandpa living too long and not willingly getting Liverpooled it is wrong. When a central bureaucracy decides that the best outcome is to start measuring the value of life conserve its resources it is wrong.

Re:Learning from what other countries have done? (0)

Anonymous Coward | about 9 months ago | (#44265135)

Riiiight. Did you "learn" that from Glenn Beck or Rush Limbaugh?

(Because thinking for yourself is clearly the greatest sin. Right above actually checking things.)

I'm German btw.

Re:Learning from what other countries have done? (1)

Anonymous Coward | about 9 months ago | (#44265219)

Lower infant mortality, longer life spans, etc. are *clearly* made up statistics. There is *no* way such numbers could ever be come up with that could be trusted-- impossible. /sarcasm

Facts oppose your opinion. If spreading unsubstantiated FUD is your only counter then you have no rational basis for your opinion.

If you feel otherwise, provide citations please.

Re:Learning from what other countries have done? (0)

Curunir_wolf (588405) | about 9 months ago | (#44266167)

Lower infant mortality, longer life spans, etc. are *clearly* made up statistics. There is *no* way such numbers could ever be come up with that could be trusted-- impossible. /sarcasm

Facts oppose your opinion. If spreading unsubstantiated FUD is your only counter then you have no rational basis for your opinion.

If you feel otherwise, provide citations please.

What do those statistics have to do with health care? Infant mortality is calculated so much differently in each country, it's difficult to make any comparison at all, and life span is about life style, not quality of health care systems. Try checking, for instance, cancer survival rates, medical treatment for heart attack victims and survivability, trauma survival after emergency care, and mobility restoration after stroke. That's how you measure the quality of health care, not by when people die, by how the treatment they get works after they require it.

There are certainly cost and access problems with health care in the United States, but Obamacare really doesn't do anything to fix those problems, and it exacerbates many of them. This is just one example of that.

Re:Learning from what other countries have done? (2)

Kjella (173770) | about 9 months ago | (#44265467)

And those countries do that by either gaming the statistics, or having a homogenized society where social pressure to conserve public resources can be successfully applied.

And several moderators from the USA! USA! USA! crowd have swallowed it hook, line and sinker already. If any country is doing anything better than the US, they must be lying or the situation is not comparable. Here's how it really works, most of our doctors are public employees working for a public doctor's office or hospital which means they don't have any direct incentive to pad the bills. Private institutions mostly do things by public requisition like this patient needs a back surgery, here's $X to do it and there are no kickbacks to the referring doctor. Our patients wants the best treatment money can buy (without paying the money) just like yours and we too have limited funds. The difference is that we mainly leave it to the doctors to decide what is a medical necessity rather than the insurance companies what is a legal necessity.

Just because our coverage is universal, it doesn't mean that we're handing out treatments and medications and aids left and right. You have to go through a whole system with your general practitioner, specialists and an application process who employ their own reviewers to be issued an aid, yes you might eventually get a free hearing air or wheel chair but chances are very good that you have a real medical need for one and you don't want to "lose" it to start the paperwork all over again. Not that there's much of a domestic market anyway since those who need it eventually get it for free so you'd have to smuggle it out of the country. Besides it's not like you're getting pampered there, unless I have a real reason for being there I don't want to be stuck in the doctor's office - or rather the waiting area.

Speaking of waiting, we have queues for many kinds of surgery - even if you've passed the medical requirements and everyone has signed off that yes you should have it you're still going to wait for capacity and they have priorities there as well, it's not the person with the right insurance policy who pays the most it's the person with the most dire medical need. I'm not going to pretend that it's all flowers and sunshine and that every patient is actually treated perfectly equally, but we're at least working towards that goal. To that end we also have guest patients, if your local hospital doesn't have capacity you can have the surgery at any other public hospital in the country that does. It's not like in the US where you're stuck with the hospitals your insurance company has a deal with. But hey, social pressure sure. Let's pretend.

Re:Learning from what other countries have done? (0)

Anonymous Coward | about 9 months ago | (#44265721)

I'm a physician practicing in the US. If it comes to pass where I must become a de facto "public employee" or cannot make the money I feel my services are worth, then I will retire or limit my practice to those patients who can afford a "concierge" type service. Anyway, America is not Europe and ObamaCare will be an unmitigated disaster for its citizens and economy. And we certainly got what we (not I) voted for.

Germans and Swiss (0)

Anonymous Coward | about 9 months ago | (#44265521)

Other countries have single payer health care, which delivers better outcomes at a lower cost. Try learning from that.

And those countries do that by either gaming the statistics, or having a homogenized society where social pressure to conserve public resources can be successfully applied.

Or look to the German or Swiss models which have private insurance companies, but must be run as non-profits.

Re:Learning from what other countries have done? (0)

Anonymous Coward | about 9 months ago | (#44266315)

For someone full of nonsense, you sure do know a lot. But then you already knew that, didn't you?

Re:Learning from what other countries have done? (0)

Anonymous Coward | about 9 months ago | (#44264951)

Other countries have a navy that could drown in a bathtub and are just hoping nobody bothers them, or a population the size of a single state with an economy based on depleting resources, or are spiraling towards insolvency after several decades of government largesse, or some combination of all those things. Try learning from that.

Re:Learning from what other countries have done? (1)

epyT-R (613989) | about 9 months ago | (#44265087)

their citizens also have few rights, are manipulated by punitive taxation, then routinely have their life choices dictated by the state so that it can cut costs. these savings go right into funding more bureaucratic growth. in many of these countries, life has already hit not worth living status imo.

while there is no free lunch, ill take freedom over socialism anyday (that includes political shitpiles like obamacare). it's too bad washington doesnt care any more about freedom than these so called 'enlightened' countries do.

Re:Learning from what other countries have done? (0)

Anonymous Coward | about 9 months ago | (#44265265)

their citizens also have few rights, are manipulated by punitive taxation, then routinely have their life choices dictated by the state so that it can cut costs. these savings go right into funding more bureaucratic growth. in many of these countries, life has already hit not worth living status imo.

Are you aware that you're talking about European Nordic countries like Norway, Sweden, Denmark etc.? In those countries life is very worth living. It's way better than in the US, where born poor means staying poor. Everybody is given a fair chance at succeeding in life, including free higher education.

Re:Learning from what other countries have done? (1)

phayes (202222) | about 9 months ago | (#44265371)

Are we talking about the nordic petro economy (aka norway, that thanks to Oil still has the money to spend maintaining the welfare state) or the other countries that have been tightening their belts over the past 5 years?

Re:Learning from what other countries have done? (0)

Anonymous Coward | about 9 months ago | (#44265379)

http://www.economist.com/news/europe/21578725-scandinavian-idyll-disrupted-arson-and-unrest-blazing-surprise

Re:Learning from what other countries have done? (0)

epyT-R (613989) | about 9 months ago | (#44265869)

In general, if you speak your mind and criticize politically correct positions in these countries, some statesman will find a way to get you into jail. After all, there's no freedom of speech in these countries. Oh, and you pay nearly 50% of your income +25% VAT to the state. I fail to see how that's 'fair.' Keeping what you earn is what's fair. The socialist definition of 'fair' is childlike at best.. like a 6 year old screaming that he only got $5 allowance for setting the table while his 12yo brother got $15, when he did so for accomplishing tasks much more complex and difficult than his younger brother's.

Like I said, there's no utopia. Everything is a cost/benefit analysis. I prefer to live in a society that lets me have more control over my property and wealth, and fewer limitations on how I get it and live my life. I don't want nannies artificially limiting my available choices or my opinions because some group is butthurt or jealous about it. Worse, many times, these nannies are responsible for breeding said group's entitlement attitude in the first place, just to get votes! Real egalitarian societies wouldn't have laws favoring one set of supposedly irrelevant attributes over another under the guise of fighting discrimination over said attributes! All countries with such policies fail this litmus test. They are not egalitarian, period.

Does liberty have drawbacks sometimes? Of course, but you can't tell me those countries are just so much better off. They're not. They made tradeoffs just the same, tradeoffs I wouldn't want to live with.

Re:Learning from what other countries have done? (2)

Hatta (162192) | about 9 months ago | (#44265607)

What good is freedom if you can't exercise it for fear of medical bankruptcy? Social safety nets make us all more free.

Re:Learning from what other countries have done? (1)

epyT-R (613989) | about 9 months ago | (#44265919)

only as free as the government will tolerate the expenditure. If it decides your behavior is too costly (or just uses cost as an excuse to kill behavior it finds 'dangerous' to its powerbase), it will get taxed into oblivion, or made outright illegal...and if you're caught, you lose your healthcare...permanently. I prefer the current system over that because I still retain the choice and the power. healthcare is just one of the current beachheads for socialist governments to chip away at liberty in other areas.

Re:Learning from what other countries have done? (0)

Anonymous Coward | about 9 months ago | (#44266333)

Apparently you also have the freedom from spelling, grammar and capitalization. Well played sir (or madam)!

Standardization is the right approach (2)

msobkow (48369) | about 9 months ago | (#44264647)

Remember the EDI systems of old? Have you worked with XML today?

Those data transfer systems only work because the information formats are standardized amongst the products that claim to support them.

Unfortunately, EDI standards were often a "kitchen sink" approach with a bazillion "optional" message components to cater to the "special features" of vendors who had enough clout to demand that they be supported.

A rational, clean, genuine reworking and reengineering of data streams would lead to interoperability and the ability to share information between all the different components involved, while allowing specialized features to be tailored to the vertical segments of the marketplace (doctor's office, hospital, pharmacy, and so on.)

The unfortunate thing for the IT industry is that there are very few verticals within the horizontal, so if the "big players" provide for those markets, there is little to no market left for anyone who wants to get a foot in the door. I'd be willing to bet that 90% or more of the negative comments in this thread about the initiative are from people who work with or for those smaller players, and who see their jobs disappearing as the megaproviders take over.

Re:Standardization is the right approach (2)

h4rr4r (612664) | about 9 months ago | (#44264675)

Instead of all of this why not have the government provide one piece of software that does this for free to doctors and let that also be the reference implementation?

Re:Standardization is the right approach (0)

Anonymous Coward | about 9 months ago | (#44266441)

The unfortunate thing for the IT industry is that there are very few verticals within the horizontal, so if the "big players" provide for those markets, there is little to no market left for anyone who wants to get a foot in the door.

Isn't this the way most new markets develop, with the barrier to entry rising as the products mature and the minimum viable product becomes more complex?

I'll Bite (2)

Cornwallis (1188489) | about 9 months ago | (#44264667)

As one in the field the only thing "savvy" about the [fill-in-the-blank-government-agency] strategy is the salespeople getting the government to throw boatloads of money at shit that once again WILL FAIL TO DELIVER.

Re:I'll Bite (0)

Anonymous Coward | about 9 months ago | (#44264873)

Oh, I don't know. Nothing screams "savvy" as aptly using terms "horizontal integration" and "vertical integration" in the same sentence.

Tech savy? (1)

Picass0 (147474) | about 9 months ago | (#44264727)

>> 'I think what we're trying to do is the equivalent of what you've got in the Internet, which is horizontal integration rather than vertical integration...'

It's always fun listening to a suit try to describe the interwebs using MBA terminology.

Next we can look forward to listening to health care issues described as "target markets" and "economies of scale".

"Make it more like the Internet...." (0)

Anonymous Coward | about 9 months ago | (#44264869)

So, we are to turn our health IT environment into one of the most easily abused and hostile IT environments ever created. What could POSSIBLY go wrong?

Making it Easier for the NSA to get your records (0)

Anonymous Coward | about 9 months ago | (#44265203)

It sounds like making more of your personal information available to the NSA to me.

SUPER SAVVY! (0)

Anonymous Coward | about 9 months ago | (#44265757)

1. "We need to pass [the Obamacare bill] to find out what's in it!" --Nancy Pelosi

2. We want to give this great healthcare to everybody! (except us - Congress & unions are exempt) -- Barack Obama

3. "2014 elections aren't looking too great for Democrats, so we're delaying Obamacare until after." --White House

SAVVY!

Heh. (0)

Anonymous Coward | about 9 months ago | (#44266517)

"What's the path of least regret in what we need to do?"

Repeal.

What could possibly go wrong? (1)

BobandMax (95054) | about 9 months ago | (#44266527)

The U.S. government's track record on security, efficiency and effectiveness is unmatched. This is sure to succeed!
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