Questions and Answers

Thank you for your insightful question. Overall, the Senate Finance Committee bill affirms the necessity of the wider use of EHRs as part of any health system restructuring. However, there are no major provisions on health IT included in the published version of the bill since the requirements for the use of EMRs was set as part of the American Recovery and Reinvestment Act (ARRA) passed in February 2009. The Office of the National Coordinator for Health Information Technology (Dr. Blumenthal’s office) is responsible for establishing “ meaningful use” criteria that will create a structure for paying physicians for using these systems. As it currently stands, there are some minor provisions that relate to health IT:

• Using quality provisions to promote the development of EHRs that facilitate the collection of performance measurement data
• Utilizing technology through the , such as EHRs and patient-based remote monitoring systems, to coordinate care over time
• Using data collected from EHRs (as well as other sources) to assist the Patient-Centered Outcomes Research Institute
• Integrating the physician quality reporting initiative (PQRI) with the standards for EHR “meaningful use” and ensuring the EHR reporting requirements for PQRI are incorporated into the requirements for Accountable Care Organizations
• Developing a national workforce strategy, encouraging training in provider use of HIT to support delivery system reform goals
• Conducting a study on methods that entities offering insurance plans through the exchange can use to encourage increased “meaningful use” of EHRs
• Adding free clinics to the list of providers eligible for Medicare and Medicaid health IT incentives.

Kevin thanks for your insightful summaries on this society-changing legislation. One thing strikes me as somewhat painfully absent is the consumer’s role in the machinations of the reform “solutions.” While you (and others) mention that various segments of the population may, more or less, be taxed to address the budget issues, I have not heard there will be incentives or penalties for consumers to get and stay healthy as part of the equation. Just as I do not believe Certificate of Need or managed care has necessarily reduced healthcare costs, nor generally improved the health of our citizens over the last 30 years, I do not believe true reform can be realized without the consumer being engaged in managing their health more actively. What is your take on that perspective?

Thanks for the question. You touched on a point where I have a lot of thoughts. First, I absolutely concur that we need to engage consumers as part of their contribution and responsibility for health. Second, while there was not anything I have seen in the Chairman’s mark-up that discussed personal responsibility, support for wellness activities, or any additional funding for such programs, we have seen more and more companies implement their own private wellness programs. I think that is a very positive step in helping create a healthier population. For example, here at Perot Systems, we have an internal wellness program where we can create credits for healthy behavior and activity, thereby reducing our overall personal healthcare costs. Incentive programs like this have shown to have a positive impact.

I have long been a strong advocate of citizens taking personal responsibility for their own actions. Last week in the Oct. 19 Washington Report, I spoke to my own personal issues on this topic as a former smoker and former obese person. It’s clear that as part of healthcare reform, we – as a society – must collectively create initiatives to reduce unhealthy behaviors (e.g. smoking), encourage exercise, and generally maintain a healthier lifestyle. I remember very distinctly during the Kennedy Administration how, through the efforts of the President, we developed physical fitness programs in our schools throughout the nation. While those programs continue, healthy lifestyles are not solved by fitness programs alone. In the final analysis, I would offer that the government is not going to solve the problem for us, and we shouldn’t sit around and expect them to. I think we can create incentives and support individuals to take responsibility for their health. Being a healthy individual means taking control over your own life and making smart decisions. From my perspective, this issue begins to touch on true healthcare reform, and I predict it will be the essence of our discussions in the next round of debates, which will begin next year.

Thank you Doctor for these informative reports. They are very helpful in following and understanding this complex topic. Would you consider addressing any of these issues in future reports?

• Is the objective of this “healthcare reform” debate improving healthcare or turning more control of healthcare over to the federal government?
• What control does the Constitution allow the federal government to have over healthcare?
• What does it reveal about the majority’s objectives that they have repeatedly defeated in committee amendments that would:
  • Explicitly prohibit federal funding of abortions
  • Include an explicit “conscience clause”
  • Explicitly prohibit illegal aliens from receiving government funded healthcare, except in truly life-threatening situations
  • Require members of Congress to have only the same health insurance options the government would allow for the public?

I’m sure your observations on those topics would be valuable.

Thanks for the question. Clearly, these are important issues, but they touch on areas I feel – in many cases –relates to one’s personal perspective. I have really strived to maintain my role in providing information through the Washington Report to stay focused on keeping the facts straight related to healthcare reform, without interjecting particular ideologies. The purpose of my weekly report is to educate the public on what has happened and how it might be impacting the overall healthcare system and debate being waged in . While it’s probably clear that I’m “in the middle” regarding politics, I’m also an advocate for healthcare reform. For me, it comes down to several key issues.

First, as one of the leading societies of the world, I have felt for many, many years that all members of our society deserve access to a basic set of healthcare services. At the same time, I also recognize that in our society some will want more and be willing to pay more for additional services. My philosophy has been embodied in the notion that every house needs a floor and every floor needs a roof. In other words, there should be a baseline of services for all American citizens and a roof so that once catastrophic expenses take hold, they are also covered.

Second, healthcare reform – from my perspective – is a long term economic issue for the nation. We are spending nearly 17 percent of GDP on healthcare at the present time. If it continues at the current rate of inflation, it is projected to consume 100 percent of GDP by 2055. 100 percent of GDP means that the only thing we do in our society will be healthcare – no highway investments, no schools, no daycare, no aviation development, and no anything else! That will not happen. So, to deal with the dilemma, we need to reform our approach.

Third, healthcare reform requires we “transform” our approach to healthcare delivery. I don’t think we are dealing with that issue in the current debate but, it will come. We can’t add 20 million uninsured to the system without transforming our approach. So, I anticipate this discussion will occur over the next three to five years.

Finally, while I appreciate your inquisitiveness on these subjects, I am aiming to keep the Washington Report free from both liberal and conservative leanings. Hope you understand…

What are you looking at in ? They had one of the lowest rates of uninsured to start with, and costs have increased while quality and access have decreased?

One thing we need to keep in mind is that , and other state-run healthcare systems for that matter, is not perfect. While you are right that already had a fairly well run healthcare system prior to the reforms by most accounts, it is also one of the most expensive in the nation. As a result, the uninsured were largely cut out of the system prior to the changes in . The measures passed by the state legislature several years ago have clearly and dramatically reduced the number of people without health insurance. The state is now at a level of 98 percent% insured – the highest in the nation. Also, support by the general public, employers , hospitals, and physicians remains remarkably high. As a result, the program has begun to improve the healthcare for thousands of ’s citizens and allowed them to seek the care they need. Though the ’s system is far from perfect, decreasing the amount of uninsured to the lowest level in the country is a huge accomplishment. I think we need to look at as one of those “laboratories of democracy” – take the lessons learned and apply them at the national level.

Finally, while there are lots of blogs and opinions out there on the Web, I encourage everyone to review the sites that have editorial oversight and evaluation such as The Hastings Center or The Commonwealth Fund who provide balanced perspectives and evaluations on all of the various health reform initiatives.

The views and opinions expressed herein are my own and do not necessarily represent the views and opinions of Dell Services or its affiliates.