What Medicare For All Really Means (And Why It Ain’t Happening)

By MARGALIT GUR-ARIE

I am going to make a prediction here. No matter who we elect in 2020, Bernie or Trump or anything in between, Medicare For All is not going to happen in America. One can run an electrifying campaign on the promise of Medicare For All, or indignantly against it, but this is pure theater on both sides. I don’t know if God can make a rock so big and heavy that even He can’t lift it, but I do know that government can make corporations so big and powerful that even government itself can’t break them.

For decades our government encouraged the health care industry to consolidate vertically, horizontally and obliquely so it can achieve economies of scale and therefore lower consumer prices. In the last couple of decades, the government also compelled the industry to computerize its operations, because technology makes everything better and cheaper. Once the resulting monopolistic behemoths were summoned into existence, it was time to nationalize the whole lot, into one super monopoly, with super technology and super economies of scale. The only other example of such government monopoly in America is the Military.

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Health Apps, Data Sharing and the Trust Deficit

By SUSANNAH FOX (16)

There has been a steady drip-drip-drip of articles documenting how health apps are sharing data with third parties:

Data sharing practices of medicines related apps and the mobile ecosystem: traffic, content, and network analysis, by Grundy et al. (British Medical Journal, Feb. 25, 2019)

Is your pregnancy app sharing your intimate data with your boss?As apps to help moms monitor their health proliferate, employers and insurers pay to keep tabs on the vast and valuable data, by Drew Harwell (Washington Post, April 10, 2019)

You Give Apps Sensitive Personal Information. Then They Tell Facebook. Wall Street Journal testing reveals how the social-media giant collects a wide range of private data from developers; ‘This is a big mess’, by Sam Schechner and Mark Secada (Wall Street Journal, Feb. 22, 2019)

Assessment of the Data Sharing and Privacy Practices of Smartphone Apps for Depression and Smoking Cessation, by Huckvale, Torous, and Larsen (JAMA Network Open, 2019)

This post is my chance to share some relevant data, add my perspective, and ask for your input.

First, the data from a 2018 Hopelab/Well Being Trust study I helped write:

  • 71% of female teens and young adults say they have tried mobile apps related to health, compared to 57% of males. Three in ten (30%) females say they currently use a health app, compared to two in ten (20%) males.
  • Fully 48% of females ages 18- to 22-years-old and 25% of teen girls say they have used a period tracking app, compared with 2% of males.
  • Sixteen percent of females use a meditation app, compared with 5% of males.

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N of 1

By CHRIS DWAN (7)

We are living through an uncomfortable period in the practice of medicine.

The dialogue between patient and physician is critically underserved, both in terms of tools for patients and physicians, and also in terms of the data context where that conversation takes place. This is unfortunate, because those are the moments of human to human care. Whether it’s a clinic visit, a lab test, a counseling or physical therapy session, the patient / provider meeting is when the full breadth of the caregiver’s experience and training can be brought to bear. At these moments, the subtle observations and pattern recognition that constitute diagnostic expertise come into play. These are are also the times when the nuance and detail of the patient’s lived experience can be shared to influence the course of diagnosis and treatment.

Population health turns into personal medicine at the bedside.

That conversation between patient and physician ought to be a first class citizen in terms of tool development, but it is not. It is within our reach to build a clinical care environment that retains high standards of data integrity and privacy while also focusing on empowering the human beings in the room rather the interests outside the door.

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Rep Jayapal and Sen Sanders Have Introduced Medicare For All Bills: One Is a Lot Better Than the Other

By KIP SULLIVAN (25)

Two bills that are called “Medicare for all” bills by their supporters have just been introduced in Congress. On February 27, Representative Pramila Jayapal introduced the Medicare For All Act of 2019, HR 1384 , in the House of Representatives. On April 10, Senator Bernie Sanders introduced a bill bearing the same name in the Senate, S 1129. The cost-containment section in Representative Jayapal’s bill will cut health care costs substantially without slashing the incomes of doctors and hospitals. Senator Sanders’ bill cannot do that. 

In this article, I explain the differences in the cost containment sections of the two bills and call upon Senator Sanders to correct two defects in his bill that minimize its ability to reduce costs. Defect number one: S 1129 authorizes a new form of insurance company called the “accountable care organization” (ACO). Defect number two: S 1129 fails to authorize budgets for hospitals. Representative Jayapal’s bill, on the other hand, explicitly repeals the federal law authorizing ACOs, and it authorizes budgets for individual hospitals. 

I write this essay as both a long-time organizer, writer and speaker for a single-payer (the older name for “Medicare for all” system) and a strong supporter of Senator Sanders. Bernie’s enthusiastic support for a “single payer” solution to the American health care crisis has added millions of new supporters to the single-payer movement. But precisely because he is now the most recognizable face of the single-payer movement, it is extremely important that all of us, whether we’re already in the single-payer movement or we just long for a sane and humane health care system, encourage Bernie to fix the defects in his bill. 

To explain the two defects in S 1129, I must first explain why a single-payer bill like Representative Jayapal’s will be effective at cutting the high cost of American health care. I begin by explaining the origin and meaning of the “single payer” label. I will then describe the two defects in S 1129 in more detail.

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Life After Twitter

By DAVID SHAYWITZ, MD (8)

Quitting carbs last year was hard. Quitting Twitter this year has proved delightfully easy.  You might even want to try it for yourself.

Twitter has tremendous upside. Most notably, it provides the chance to connect and engage with more, and more varied, people than you otherwise might, and in the process, learn things you didn’t know, and hear about interesting articles you might have missed. A real highlight of the medium was getting to know so many extraordinary people in the healthcare and biotech communities.

My Tech Tonics podcast co-host Lisa Suennen (@VentureValkyrie) and I originally met on Twitter, for example.  I’m impressed by the ability of colleagues like Bruce Booth (@lifescivc) to use Twitter strategically and effectively, sharing thoughts on science and investing while steering clear of politics.  Many top scientists also enjoy the engagement of Twitter, as rock star Stanford chemist and Twitter newbie Carolyn Bertozzi (@CarolynBertozzi) recently highlighted on her captivating Long Run podcast with Luke (@ldtimmerman).

And yet.

As my economist friends (who, I acknowledge, I mostly met through Twitter) incessantly emphasize, everything is about trade-offs. The relevant question about Twitter isn’t whether there are benefits, but rather, whether the benefits are worth the costs. This analysis presumably will differ for each person.  For me, the calculus was pretty easy, and I’m hardly alone (indeed, “How I Improved My Life By Quitting Twitter” feels like a blogging subgenre at this point).

The costs of Twitter are consequent to the attention it demands and extracts, and the amount of mindshare you give over to it. Insidiously, it seemed to claim more and more of my time and emotional energy in the years since I first joined in 2011. You could say I became a very avid user. I tweeted around 45,000 times over an eight-year period, and had around 13,000 followers. Even though I carefully curated a group of just 40 accounts to follow, in effort to minimize distraction, it wasn’t working. By late February, I decided it was time to quit.

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Q: How Do You Build a “Great Party of Healthcare?”
A: Build a Party of Doctors

By NIRAN AL AGBA, MD

The narrative goes like this:

The Democrats are the party of healthcare. The Republicans are the party that wants to take healthcare away from people. Dismantle the Affordable Care Act and we’ll have a disaster on our hands, millions will lose their healthcare coverage, middle class Americans will go bankrupt, the World will end

All this political propaganda ignores a fact that physicians have understood for some time now:   For doctors and millions of Americans, Obamacare already is a *total and unmitigated disaster*. From opening day when the administration’s Healthcare.gov web site symbolically blew up, it was clear that things weren’t going to be going according to plan.

Giving millions of people access to healthcare was a great thing and long overdue. But kowtowing to health insurers and pharmaceutical companies, obsessing about centralization, and endless digital paperwork all but guaranteed an epic fail.

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The AMA Is Using Its Government-Granted Healthcare Data Monopoly to Power a Sketchy New Commercial Venture

By LEAH HOUSTON, MD (11)

Source: Health2047.com

Like many academic institutions and non-profits these days, the American Medical Association (AMA) decided not long ago to get into the innovation business, launching Health 2047, a new for-profit Silicon Valley-style venture innovation incubator.

One of the AMA’s first new ventures is Akiri, a blockchain-enabled data transmitting and sharing network built to efficiently transmit the data the AMA owns among patients, physicians, and health systems. According to a news brief filed at the time, Akiri’s data transmission network includes health information exchanges, and will allow the personal health records of patients to be transmitted. [1]

What most people don’t know is that Congress effectively granted the AMA a monopoly on healthcare data back in the sixties.

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The Electronic Medical Mess

By CHRIS DWAN (47)

I posted a quick tweet about this a few months ago:

Over the years, I’ve worked with at least half a dozen projects where earnest, intelligent, diligent folks have tried to unlock the potential stored in mid to large scale batches of electronic medical records. In every case, without exception, we have wound up tearing our hair and rending our garments over the abysmal state of the data and the challenges in getting access to it at all. It is discordant, incomplete, and frequently just plain-old incorrect.

I claim that this is the result of structural incentives in the business of medicine.

What is a Medical Record?

Years ago the medical record was how physicians communicated amongst themselves. The “clinical narrative” was a series of notes written by a primary care physician, punctuated by requests for information and answers from specialists. Physicians operated with an assumption of privacy in these notes, since patients didn’t generally ask to see them. Of course they were still careful with what they wrote. If things went sideways, those notes might wind up being read aloud in front of a judge and jury.

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In Defense of Pediatricians … (And a Few Words of Advice For Doctors and Other Public Health Types)

By NIRAN AL AGBA, MD (19)

Allow me to share a few select comments from Twitter with you.

“You people are awful.”

“This is just sick,” wrote another.

“All this to enrich yourselves. DISGUSTING!!”

“You endanger KIDS LIVES for a $400,000 a year salary and a Lexus???”

“This is just terrible, horrible behavior!!!”

Wow. What’s going on? What are these people talking about?

They’re taking me and my fellow pediatricians to task because of the perceived role pediatricians play in perpetuating the conspiracy that pediatricians, public health officials and greedy pharmaceutical companies encourage vaccinations in order to make money and are therefore willing to endanger the lives of children everywhere.

The anger toward pediatricians is real. How did things end up this way?

How did a medical specialty most people associate with sniffles and sore throats, reach the point where labels are thrown at us that are more commonly used to describe axe murderers and third world dictators?

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