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Is Distraction Getting in the Way of HealthCare Reform?

Posted Sep 13 2009 10:22pm

From what I have been seeing lately, it certainly has that appearance to me.  Yes, the president is driving this matter home and sticking to his guns, image as we HAVE TO AFFORD healthcare reform, but how we get there is the big heated debate.  Yesterday I watched some of the videos on the internet with demonstrations and angry made people and after listening to some, I’m not totally convinced they really know exactly what they are mad about.  I see the President as being a target for the anger when in fact he’s not alone and we have a Congress that is fueling this fire with the very public shows we all now see on the internet.  Years ago we didn’t have this, but today we do, so it’s not a matter of someone talking to another person and telling them about what was said or done, we get it in real time, all over the place, so this constitutes for some anger too for those not used to having so much media available and what to do with it all. 

Maggie Mahar, author of “Money Driven Medicine” wrote her opinion piece below and I have included a couple paragraphs and the one point she does make very well is that we had 8 years of President Bush and he didn’t live through transparent times as we are doing now, thus he was not “called out” like President Obama, and during his 8 years he did nothing for healthcare when you think about it.  By the way, the movie, Money Driven Medicine, is very good and is a good wake up call without a huge amount of politics, just talking with doctors about the way it is today and their frustrations.  I watched the Bill Moyer show where a big portion of the documentary was shown. 

Money Driven Medicine – Taking Back Healthcare ...

At any rate, the real matter is getting down to digital laws, digital bills in Congress that are algorithmic centric, in other words the formulas that spell it out, otherwise we end up with verbiage running over and attorneys getting a lot of money to come in later an try to figure out exactly how this all applies. It’s the computers and algorithms I think is what everyone is mad about, as they are 99% of the decision making processes today with insurance companies and for those who think their health insurance business plan is going to stay as it is today, well think twice.  Business Intelligence software allows them to create a new business model quickly, again with computers and software with proprietary algorithms that tell them when to cut off employers from the rolls who are out of range and show too high of a liability, based on what they pay out in benefits for their employees. 

Ingenix Data Base Has Some Long Reaching Legal Tentacles with ...

The same thing is done for individuals, you are scored, and scored again, based on how much money you are costing with your illnesses.  One thing I will give the insurance carriers credit for though is for some of the drugs we have out there and trying to keep those under control.  I realized this when I posted the price of Viagra the other day, 100 pills = $1500.00!  The day ED pills go generic there will be a lot of celebrating for sure, and then I saw another drug, Cialis advertising about a new pill they say you can take every day, ok with prices similar to Viagra, look at that cost, one a day could be up in the neighborhood of 5k a year!  If you are covered by insurance that picks up this tab, you may not be aware of this, and gee, appreciate those samples you get at the office for that matter.

Back on track here though with the payment side of things and how those issues are handled, we do want transparency and honest information.  On the electronic record side of things we go to great lengths to certify vendors who sell electronic medical records to ensure the software calculates and presents accurate data as well as integrating with other software. 

Question here, why do we not certify the insurance carriers and their algorithms?  

I think this is a good question to ponder as we are all over one side of the fence with algorithms and electronic medical records, but we seem to forget this side, and this side is now affecting the other side big time.

I seem to be reading about a lot of lawsuits that come back to the exact item with balance dues created for patients and doctors short paid, and again it’s those proprietary algorithms.  Should the insurance companies not be expected to demonstrate and file algorithms on how they calculate all of this so as consumers we have some knowledge instead of being in the dark?   If a government plan is indeed put in place, those algorithms would be public record and available more than likely as open source, so perhaps this is the real fear of moving in this direction.  image

It’s maybe not the fear of a public plan itself, but rather the exposure of business intelligence methods and algorithms that make all those decisions that could become transparent and then we will have have another angry crowd to deal with.  We are seeing this all over today with transparency issues with more information being uncovered with ghostwriters in journals as an example, so who knows what is buried beneath the surface elsewhere.   Education needs to enter here too, so at least angry individuals have the full understanding of what they are mad about.

Do We Need a Department of US Algorithms?  

If a patient is going to be told their rates are going up, I think in today’s age, a full explanation should be given.  Again, a government plan would have to incorporate this as levels of payments will be based on income, so there’s no hiding this issue.  Members of Congress do not need to be IT experts, but could be able, along with staff members with expertise in IT be able to view demonstrations and have a committee such as we have for EMRS review the software as well, and again a committee like CCHIT to review, so we don’t end up with lawsuits where software creates profits by running human created algorithms that are sided only for profit and leave healthcare on the backside.  Wendell Potter in his years with health insurance knows all about algorithms and took time to explain how one gets caught up in the numbers. 

Are We Ever Going to Get Some Algorithm Centric Law In Place for Healthcare

I know I get kidded a bit about the word “algorithm” and this is the first thing you see smack in the middle of this page as that is one of my goals to help educate and bring an awareness to all to what is doing the work, algorithms that run 24/7 and are created with software by humans to create the desired out put. 

Next time when you attend a rally, tea party or whatever the occasion is, remember it’s the proprietary algorithms you are mad at, created for profit and not open source and available computer code, and certainly not certified, and who knows maybe certification could lead to a few less lawsuits?  That’s a bit of speculation here, but you never know.  Our Executive branch is dealing with all of this getting caught up and bringing the government into the 21st century, so there was a ton of dead wood sitting there when they walked in the door.

We have a very smart Executive branch and they DO know all about those algorithms too, and realize it is an education as well as a technology battle.  

Promising new startup of 2009 - Executive branch of the US federal Government

People that want to keep “status quo” are being the most disruptive, those who resist change. BD

Last night, President Obama gave an excellent speech. He was clear; he was passionate. I did not expect him to draw a line in the sand regarding the public insurance option. That would only have given his opponents a clear target. The decision about the public option will be made at the very end of this process when the House and Senate bills are reconciled. There were no real surprises in the president’s speech. What stood out was the reaction to what he said:

Why are so many people so quick to insist that our president is not telling the truth? For eight years, President Bush misled us —about weapons of mass destruction, about the war, about the economy—yet in all of those years I don’t think he was “called out” as often as this president has been in the last few months.

Each day, it becomes clearer. Those who oppose healthcare reform have but one goal: to destroy this administration. The hate that you have heard throughout the healthcare debate is fueled, not so much by fear of reform, but by conservative rage that Barack Obama is president of the United States.

Health Beat: Maggie Mahar

Related Reading:

Mad As Hell – Doctor’s Group Pushing for Single Pay System

The CodePlex Foundation - New Open-source Non Profit Foundation Funded by Microsoft

The CRIMSON Initiative - Physician Performance Data Management Platform Developed By Physicians

Electronic Medical Records – Many Choices and Integration/Aggregation Need to Be at the Top of the List

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