Sunday, April 25, 2010

I've Moved

This blog is no longer being updated. I've begun a new blog, Wellness & Technology.

Tuesday, February 24, 2009

CDHPs No Longer a Euphemism for Cost-Sharing?

Three fiscal quarters into my new role at work I am pleasantly surprised to discover that CDHPs have quietly evolved from a disingenuous cost-sharing scheme foisted on workers by employers (see the Pollyannaish video, below) to a proactive, multifaceted approach intended to achieve “a pluralistic system that empowers patients and demands accountability from individuals and the health system, while adequately supporting the needs of the disadvantaged.”

Moreover, the criteria for determining whether or not these lofty goals are met are both simple and progressive:

  1. Consumer-driven programs must encourage and attract enrollment from the sickest members as well as the healthy.
  2. Consumer-driven programs must work for those members who don’t want to get involved in decision-making as well as for those who do.

Granted, the above is only Wye River Group’s take on the matter, but given that it comes directly from their An Employers’ Guide to Healthcare Consumerism which was published in 2006 I am inclined to take them at their word and note this as a sea change in suppliers’ attitudes towards the healthcare crisis in this country.

What Wye River Group refers to as healthcare consumerism is a synthesis of old and new ideas as well as delivery and payment models in the healthcare market. It encompasses consumer-driven health plans, value-based benefit design techniques, and good old-fashioned managed care (as opposed to managed access and/or managed costs).

Despite its name, healthcare consumerism isn’t mutually exclusive of government involvement. Indeed, the techniques it espouses could go a long way towards making the already superior healthcare model in place for US military veterans that much more cost-effective and efficient – not to mention portable to state and local governments and private industry.

There are few people as skeptical of for-profit payers as I am, but in light of this evolution of thought in the consumer-driven healthcare space I am open to – and hopeful at the prospect of being – proven wrong.

Wednesday, November 05, 2008

Election Results and Their Healthcare Implications


Last night's historic election of Barak Hussein Obama as the 44th President of these United States isn't just a watershed moment in American history, the U.S. civil rights movement, and world affairs; it also signals the turning of a new page in the realm of U.S. healthcare policy.

How many pages will be turned remains to be seen at the federal level, but here in Michigan two ballot proposals passed that will have immediate implications for those of us with an interest in health and wellness.
  • Proposal 1, legalizing medical marijuana use at the state level passed with more than 60% of the vote.

  • Proposal 2, which would allow the donation of unused embroyos from fertility clinics, passed by a more narrow margin, but passed nevertheless.
Both proposals were met with stiff and frequently hysterical and baseless opposition. Proposal 2 opponents wanted to see Michigan's ridiculous existing laws that punish researchers who utilize discarded human embroyos with a $5 million dollar fine and prison time remain on the books.

Proposal 1 opponents thought they knew better than Michigan's healthcare professionals and the patients themselves about the benefits and risks of medical marijuana use. They were wrong, the prohibition against medical marijuana use was wrong, and last night Michigan voters showed them just how wrong they were.

The era of politically sanctioned stupidity appears to be over - for now, at least. The triumph of reason and rationality over fear and ignorance in Michigan appears to have been replicated around the country. Also worth noting last night:

Still, for the first time in a long time, we have something we haven't had to support us along the way: hope!

Monday, June 16, 2008

Gay Men, Straight Women Have Similar Brains; Pat Robertson to Advocate Forced, Publicly Funded Lobotomies

Actually, I made that last half of the title up, but it wouldn't surprise me if he did.

National Geographic News reported today that heterosexual men and homosexual women, and their respective opposites, share significant physiological and neurological similarities in their brains.
Differences both in the brain activity and anatomy were observed in a study involving 90 men and women, including homosexuals and heterosexuals of both genders.

The researchers monitored neural activity in the brain by charting blood flow.


The scans were carried out when the volunteers were resting and exposed to no external stimuli.


Researchers focused in particular on the amygdala, an almond-shaped structure inside each brain hemisphere associated with processing and storing emotions.


In homosexuals, brain activity most closely matched that of heterosexuals of the other sex.

Source: Gay Men, Straight Women Have Similar Brains
While the full implications of the study aren't yet clear, interesting observations were made that would seem to explain the origins of stereotypes about gay men being inherently more creative and "artistic" than their straight counterparts, and gay women so often being "butch:"
[T]he study found that straight men and gay women are both wired for a greater "fight or flight" response than gay men or straight women, the team reports this week in the journal Proceedings of the National Academy of Sciences.

Also, homosexual men and straight women showed significantly more neural connections across the two brain hemispheres than heterosexual men did.


ibid.
Of course, these are stereotypes. There are boorish, slovenly, aggressive and abusive gay men (I know, I've dated a couple of them) and there are "lipstick lesbians" who are indistinguishable from heterosexual "babes" except for their taste in men (which is to say, it's completely absent). Still, stereotypes, like myths, often have their basis in fact, however distorted or misunderstood those facts may be.

The study also doesn't do much to shed light on the (again, stereotypes) similarities between homosexual men and women and their heterosexual counterparts. For example, many biological determinists have posited that heterosexual males are driven by biology to copulate with as many partners as possible to propagate their genes. Assuming there's any validity to this argument at all, if gay men are "wired" like heterosexual women, where do the incidents that underlie the stereotype of the unfaithful, promiscuous gay man come from? Why "behave like a man," if you're "programmed" like a woman?

Conversely, if gay women are "wired" like heterosexual men, why aren't lesbians disproportionately more prone to violence and criminal behavior when compared to gay men the way that heterosexual men are when compared to heterosexual women?

While incidents of heterosexual women abusing their heterosexual male partners are almost certainly higher than reported numbers would indicate, males are more violent than females. Yet same-sex couples of both genders show the same levels of domestic violence as their heterosexual counterparts; how can this be if homosexual males are supposedly genetically predisposed towards flight and homosexual females are predisposed towards fight?

While I think the science of sexuality is interesting, I also think it's rather pointless because ultimately what it comes down to is what two (or more if that's your thing) consenting adults are comfortable with. Whatever that might be, if you've got a problem with it, it's your problem.

Sunday, June 15, 2008

"Diabetes Reloaded," a Health 2.0 Montage that Joseph Conn Would Love

Props to Richard MacManus at ReadWriteWeb for highlighting this YouTube video in a post entitled How the Web is Enabling Consumer-Driven Healthcare.




While I don't think Diabetes...RELOADED actually explains how the Web is enabling consumer-driven healthcare, I do think that it presents a great thumbnail sketch of the Health2.0 paradigm that Joseph Conn so eloquently explains in his December, 2007 post Health 2.0: The next generation of Web enterprises at Modern Healthcare Online.

In his piece, Conn restates the seven elements of "Web 2.0" as they apply to healthcare, with an emphasis on the first three:
  1. Web 2.0 products improve as more and more people make use of them.
  2. Web 2.0 products must "harness collective intelligence," i.e.: leverage "the wisdom of the crowd."
  3. Web 2.0 products take the outcomes of harnessed collective intelligence and enhance them with specialized knowledge, then return these enhanced outcomes back to the crowd - and the cycle repeats.
They say a picture is worth a thousand words; Diabetes...RELOADED summarizes the very abstract concepts that make up Health2.0 in 3 minutes, 12 seconds; it's more than worth your time and attention.

Friday, June 13, 2008

I've Been Shmapped!!

Please excuse me while I pat myself on the back over this...
Hi Jeff,

I am delighted to let you know that your submitted photo
has been selected for inclusion in the newly released
second edition of our Schmap Northwest Guide:

Whidbey Island
http://www.schmap.com/northwest/water/p=302080/i=302080_8.jpg

If you like the guide and have a website, blog or personal
page, then please also check out the customizable
widgetized versions of our Schmap Northwest Guide, complete
with your published photo:

http://www.schmap.com/guidewidgets/p=79461431N00/c=SG33032501

Thanks so much for letting us include your photo - please
enjoy the guide!

Best regards,

Emma Williams,
Managing Editor, Schmap Guides
Here's the photograph in question:

Picture 057 by Jeff O'Connor

I am not a professional photographer, or even an amateur photographer except in the most literal sense of the word, so I feel very good about being included in the Shmap!! Guide. Although my photographs are not uploaded to Flickr under a Creative Commons license, I do make use of Creative Commons-licensed images in my freelance Web work; I feel like I've given something back.

Related posts:

Tuesday, June 10, 2008

Liars, Damned Liars, and the Heartland Institute, Part I of III

Just as The Heartland Institute purports to be a non-partisan think-tank, so, too, does the monthly rag it puts out every month purport to be news, specifically, Health Care News.

It ain't so.

Every first-year high school debate student learns about fallacious arguments. It's a requirement and something you had better learn well unless you want your argument to fail, your proposal to lose, and what little social standing there is to be had from membership on the debate team to be negated by having your ass publicly handed to you by an even bigger geek at a public (albeit most likely unattended) public event.

I speak from experience here.

As the saying goes, things change.

In our modern era of corporate media, where a powerful and wealthy few dictate what constitutes both entertainment and news, as well as their bastard offspring - infotainment, the validity and coherence of one's argument doesn't matter; volume does.

Volume can be measured in decibels (talk radio), eyeballs (Drudge Report), Nielsen Ratings (Fox News, Desperate Housewives), circulation (The National Enquirer), or some combination thereof. Health Care News apparently knows how to pump-up the volume: according to their masthead they reach 53% of all healthcare professionals.

I know that healthcare is a business, and that even the most selfless non-profit organization has to figure the bottom line into the equation somewhere, but it is my sincere hope that when most healthcare professionals and the organizations they work for need to get a feel for the pulse of the nation on important questions of the day, they'll keep in mind that Charmin is a better quality paper than The Heartland Institute's propaganda organ is.

Why am I being so hard on Health Care News? For starters, they have a widget on their site that is a consistent part of their navigational structure that declares Crichton is Right! This is a reference to science fiction author and 2006 American Association of Petroleum Geologists Journalism Award-winner Michael Crichton, whose novel State of Fear denies the science of the greenhouse effect and slanders The New Republic Senior Editor Michael Crowley.

With both John McCain and Barack Obama in favor of joining some version of the Kyoto Protocols and enacting some sort of carbon cap-and-trade system, this ranks The Heartland Institute right up there with holocaust deniers and The Flat Earth Society in my book.

Is this unfair of me? Am I painting with an overly broad brush? Am I resorting to unjustified Ad Hominem attacks and throwing the baby out with the bathwater just because I think Michael Crichton is a despicable human being and corporate drama whore who is trading on name recognition in lieu of long-since-gone talent?

I don't think so.

Here's a critique of their three-article, red-letter Single-Payer expose'.

Read it.

Better yet, read the original articles independently of my critiques, and decide for yourself.

Meanwhile, I will be tackling all three of Health Care News' extremely fallacious and biased articles one-at-a-time over three posts. First up:

Russia's Failed Universal Health Care Program Exposes the Perils of Single-Payer Systems

This article attempts to paint a picture of what universal healthcare in the United States will look like by describing in lurid detail what's going on at the bottom of the barrel in Russia's healthcare system.

For this article alone, the fallacies include:

If you look at the subheadings in this article, two of the three read like they're straight out of the tabloids:
  • Awful Facilities
  • Rampant Corruption
  • Proposed Solutions
Now sing along withe me:

One of these things is not like the others,
One of these things just doesn't belong,
Can you tell which thing is not like the others
By the time I finish my song?

Did you guess which thing was not like the others?
Did you guess which thing just doesn't belong?
If you guessed this one is not like the others,
Then you're absolutely...right!

The first section, Awful Facilities, is clearly an Appeal to Fear as it describes Russia's hospitals in the following manner:
Many state-run hospitals, particularly in remote areas, do not have hot water, and some do not have running water at all. Even the most basic medicines are often in limited supply.
This is an attempt to form a Post Hoc fallacious argument. It fails in this regard, however. Awful Facilities actually Confuses Causes and Effect - the Russian Federation is the successor to the collapsed Soviet Union and the product of more than a decade of economic decline before its recent economic stabilization. Consequently, it's healthcare infrastructure isn't a shambles because the country's national, single-payer healthcare model is a failure; the country's national, single-payer healthcare model is a failure because the country's healthcare infrastructure is a shambles!

The article then tries to draw a direct linkage between these sorts of conditions and not just healthcare reform in general in the United States, but healthcare reform originating with one particular political party:
Healthcare is far too important to leave to politicians - be the autocrats or Democrats [sic]," said John R. Graham, director of health care studies at the Pacific Research Institute.
Did you spot the Ad Hominem fallacy? It's tricky because it's also an example of Guilt by Association. In the above statement, the poor state of the Russian healthcare system is the fault of the autocrats, who are synonymous with Democrats! Since all Democrats are autocrats, and autocrats can't be trusted to administer healthcare, then obviously neither can the Democrats.

Finally, with the Democratic Party poised to increase its congressional majority in November and favored to win the White House as well, a Slippery Slope is hinted at: if Democrats are autocrats, and autocrats believe in large, ineffective healthcare bureaucracies, then putting Democrats into power will increase the likelihood and speed at which the U.S. healthcare system will come to resemble the failed healthcare systems in states run by autocrats (i.e.: the U.S. will be just like Russia if the Democrats get their way).

Though I can't imagine why, the author goes on to further develop the linkage between Russia's incredibly corrupt and byzantine bureaucracy and government healthcare by painting the faithfully terrifying picture of government bureaucrats picking the pocket of ordinary tax payers and giving them absolutely nothing in return - a Hasty Generalization if ever there was one:
"The Russian 'free healthcare for all' system is nothing of the sort," said Jeff Emanuel, research fellow for healthcare policy at The Heartland Institute and managing editor of health Care News. "Instead, it is simply another program built on governmental taking of taxpayer fund and mismanagement of the services it promises to provide."
You see, in the neoconservative fantasy land that Jeff Emanuel lives in, any single failed government program from any government anywhere is proof that all government programs from all governments everywhere will fail! And be sure to take a good look at just who Jeff Emanuel is: the editor of the very publication the article appears in! While this isn't a logical fallacy, it certainly makes him a less than objective - and therefore credible - subject matter expert for this particular piece.

The article fails the Biased Sample test because it holds up Russia's national, single-payer healthcare systems up as the only example of a national, single-payer healthcare system. Moreover, by sensationalizing this small sample, the article is guilty of Misleading Vividness, as the statistical evidence doesn't bear out the original premise.

Despite the fact that there is currently no legislation before Congress to institute a national, single-payer healthcare system, nor a presidential candidate from either party intending to introduce one (a Factual Error), even if universal coverage and a national, single-payer system were the same thing (which they are not), citing only Russia as a representative example of such a system is not only a Biased Sample fallacy, it also grossly distorts the success of the many other national, single-payer healthcare plans of every other industrialized country, all of whose citizens enjoy a comparable or superior degree of health and wellness than the average American does from healthcare systems that universally consume fewer resources and produce comparable or superior outcomes to our own.

(It is also insulting to the intelligence of anyone who has been paying attention since 1991 and knows that for all of our problems, the United States and the keystone republic of the former U.S.S.R. have about as much in common as William McGuire and Mother Theresa when it comes to infrastructure and other assets to bring to bear on their respective national healthcare concerns!)

In fact, according to the CIA World Factbook, as of 2007, per capita GDP in the Russian Federation was $14,600 - less than .33% (one-third) of per capital GDP in the United States of American ($46,000) during the same period!

Despite the enormous differences between the two counties, the average life expectancy at birth for all Russians is 84.5% that of their American counterparts, a difference of only 15.5%. Based on these numbers, if the United States were to adopt the horrific Russian healthcare system in its current form in its entirety tomorrow, but maintain current U.S. healthcare spending levels, median life expectancy at birth for all Americans would exceed 129 years!

Life Expectancy at Birth Russian Federation United States of America
Total population 65.94 78.14
Males 59.19 75.29
Females 73.1 81.13
Life expectancy: Russian Federation and United States of America as of 2007
Source: CIA World Factbook

Now, I know that this is a Misleadingly Vivid example, but then again so is Health Care News' representation of the Russian healthcare system as a legitimate cautionary tale for healthcare reformers in the United States looking to implement some form of universal coverage or otherwise assure care is made available to nearly 50 million of their fellow uninsured citizens.

As I pointed-out above, Rina Shah bases her entire article on a Factual Error when she presents the situation in Russia as an example of a failed universal healthcare system. However , Russia's implementation of universal healthcare is a national, single-payer universal healthcare system; there are no proposals for implementing such a system in the United States from either political party or presidential candidate.

I would argue that the entire article is nothing but a Strawman, but the second section, Rampant Corruption, is particularly egregious. In two paragraphs, the article's author serves up all of the quantified data in the entire piece, but they have nothing to do with single-payer or universal healthcare plans; on the contrary they have everything to the country's overall poor standard of living and lack of effective regulation and oversight of the Russian healthcare market. According to the article:
Research conducted by Moscow's INDEM think tank in 2004 showed Russians spent some $600 million each year on under-the-counter payments to health care providers. The Russian Academy of Sciences' Open Health Institute more recently estimated rampant corruption siphons off as much as 35 percent of the money spent on health care nationwide annually.

Low wages are another problem. Yearly salaries of physicians average $5,160 to $6,120, while nurses average $2,760 to $3,780. This often results in underpaid physicians accepting bribes for higher-quality care.
Do you see the Strawman here? The figures presented above only proves that Russia's healthcare market is inadequately policed; it doesn't prove that universal or single-payer healthcare systems are inherently corrupt or result in substandard wages for healthcare professionals. The average pay of Russian healthcare professionals is also something a Red Herring: compensation of individual healthcare practitioners is not an indicator of the likelihood of an overall healthcare market's ability to function efficiently, as the performance of healthcare markets from Canada to Cuba clearly show.

The article's concluding section, Proposed Reforms, is nothing of the sort. Instead, it merely serves to Poison the Well:
Reforms drafted this spring by the Russian Federal Assembly include placing higher emphasis on primary care, shutting down numerous substandard hospitals, scaling down the scope of free medical assistance guaranteed by the state, and increasing physician salaries by reimbursing doctors according to the number of individual treatments given instead of by the number of hours worked.

"Instead of forcing people to pay into this failed program, Russia's government should allow the market to influence the health care system, which it can begin to do by allowing its citizens to choose how their own health care money is spent," Emanuel said.

So-called "universal" health care does not actually exist, says Graham.
Do you see what's going on here? The reforms proposed by the Russian government are never addressed. Instead, they are summarily dismissed.

That's the the set-up; here's the pitch:
"At best, in a functioning democracy like Canada or Britain, it results in unequal access to health care by government rationing, lack of investment in innovation, and shortage of medical professionals," Graham pointed out. "At worst, in a country with little democratic bona fides, it results in the situation we are seeing in Russia."
The author has taken great pains to paint an unfavorable, ugly, and frankly prurient (from a healthcare policy perspective) picture of Russia's national, single-payer healthcare system. Having savaged the concept generally (i.e.: Poisoned the Well), Rina Shah sees no reason to bother backing up the claims made in the concluding paragraph about the failings of universal healthcare systems in functional democracies, which are better and more realistic models for potential universal healthcare solutions in the United States. Which was clearly her intention all along.

Next up: My adverse reaction to Universal Health Care is the Wrong Prescription