The Cato Institute’s Michael Cannon has replied to Part 1 of my response to Cato’s report on the Patient Protection and Affordable Care Act (ACA) .You’ll find his reply here. Unfortunately, the Cato Institute website doesn’t have a space for comments, so I decided to respond here, on HealthBeat.

First, let say that Cannon’s reply is both civil and gracious. Thank you, Michael Cannon. I’m hoping that this debate will move forward as I continue to write about the rest of the Institute’s recent white paper, “Bad Medicine: A Guide to the Real Costs and Consequences of the New Health Care Law.” This seems to me a good opportunity to have an intelligent, rational dialogue about reform, comparing facts, while laying out two very different points of view, calmly and clearly.

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This week, the Cato Institute released a 52-page report on health care reform titled: Bad Medicine: A Guide to the Real Costs and Consequences of the New Health Care Law.

The tract was written by Michael Tanner, a senior fellow at the Institute, and it rests on the thesis that the Patient Protection and Affordable Care Act (ACA) is both Unaffordable and Unfair. Inevitably, Tanner’s claims about affordability are shaky; in truth no one can project how much reform will cost over ten years—and how much it will save. There are too many variables involved. Nevertheless, Tanner seems sure: the legislation will add to the deficit, he asserts, and force insurance premiums higher. Moreover, he stamps the legislation “unjust”: it would turn private insurance companies into regulated “public utilities,” forcing them to insure sick people, while “redistributing income” from families earning “over $348,000” to families earning “$18,000 to $55,000.”  Ultimately, he argues, reform represents yet another step toward transforming the U.S. into a “Nanny State.”

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This week the White House unveiled its new national plan to cut HIV infections and curb the AIDS epidemic. The plan, the first ever since AIDS emerged on the scene some 30 years ago, has the goal of  "intensifying HIV prevention efforts in communities where HIV is most concentrated;” specifically in the gay and African-American communities who are disproportionately affected by the disease. It also aims to increase access to treatment and mount "a more coordinated national response to the HIV epidemic."

Some specific goals from the National AIDS Plan include:

• Reduce new infection rates by 25 percent by 2015.
• Devote $30 million from the health care reform law to reducing infection rates.
• Link 85 percent of those who are HIV-positive to care within three months of being diagnosed.
• Provide $25 million in funding to help states pay for drugs to treat HIV

This plan, which took 15 months to draw up and included input from 14 community forums around the country, is a good start and helps put the fight against AIDS back on the national radar. Some 1.1 million Americans are currently infected with HIV and infection rates haven’t budged since the mid-1990s. After hitting a peak of 130,000 new infections a year in the 1980’s, the rate dropped to 49,000 a year in the early 1990’s, according to the Centers for Disease Control. But in the past decade this number has increased and remains at 56,000 new infections each year. Meanwhile, in 1995, 44% of Americans indicated that HIV/AIDS was the most urgent health problem facing the country; in March 2009 that number had plummeted to only 6%.

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Today the Department of Health and Human Services announced what criteria doctors and hospitals will be required to meet if they want to receive payments to help buy the Health IT needed to computerize patients’ medical records.  Under the HiTech Act’s incentive program, Medicare and Medicaid will be giving out some $27 billion over the next ten years. The program begins next year.  A doctor can receive up to $44,000 under Medicare and $63,750 under Medicaid, while a hospital can receive millions of dollars, depending on its size. (Starting in 2015, hospitals and doctors will be subject to financial penalties under Medicare if they are not using electronic health records.)

The rules boil down to this: providers who want to be eligible for incentive payments will have to show that they are making “meaningful use” of electronic health records (EHRs)—i.e., that they’re not just using them to  expedite billing , but that they’re using EHRs to improve patient care.

For example, under the final rules doctors will be expected to transmit more than 40% of their prescriptions electronically, hospitals must be able provide more than 50% of patients who are discharged with an electronic copy of discharge instructions if they request it, and providers must produce an electronic copy of a patient’s medical  record within three business days to more than 50% of patients who request it. Click here for a summary of all of the rules.

Regina Holliday appeared at today’s announcement to stress just how important patient access to a medical record can be. Below, she tells the tale of what happened to her husband, Fred, after he was diagnosed with Renal Cell Carcinoma and hospitalized.

What is striking about her story is that Holliday is not complaining that the hospital didn’t “save” her husband. She is objecting to how little information she and her husband received: “the terror of not being told what was going on.” In other words, this is less about what treatment he did or didn’t receive than it is about how he was treated. Holliday is calling for “patient-centered care” that includes the patient in the decision-making loop, giving him the information he needs to make an informed choice.

This piece originally appeared on Regina Holliday’s Medical Advocacy Blog in October of 2009 where it was titled "Thoughts on Medicine and Social Media."   Many thanks to THCB’s Matthew Holt who cross-posted Regina’s story in October, and wrote about her appearance at today’s "meaingful use" announcement. Holt describes her as “the poster child for why access to health data matters to ordinary people," adding: “we need to get her from the world of webinars, Health 2.0 Conferences and HHS announcements onto Oprah and the 6 O’Clock News right now.”

I agree, which is why I’m posting her story here on HealthBeat. (It's not Oprah, to be sure, but unlike the 6 O'Clock News, at least I can give her more than a soundbite.)

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Thoughts on Medicine and Social Media  

On March 27 my husband, Fred Holliday, was diagnosed with probable  Renal Cell Carcinoma (RCC) . Within one day, I became an e-patient, a caregiver and a medical advocate. I would use the internet for both research and patient/family support. To help my husband receive the best care, I surfed the internet at night; researching his cancer using Google, reading the Wikipedia entry on RCC with all of its links, and finding personal cancer stories. Facebook  became the information source on Fred’s medical status. I would take a few minutes each night to post to the 100 plus people following Fred’s care. Within days of diagnosis, two of my friends had set up a  "Lots of Helping Hands"  account. This online network, which rapidly grew to 150 volunteers, would fundraise and provide meals, babysitting and groceries. This pool of helpers was immensely diverse. Before sites such as Lots of Helping Hands, orchestration of a volunteer effort this complex would not have been possible.

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Over at “The New Health Dialogue,” New America Foundation’s Joanne Kenen offers a reading list for health care aficionados. Let me be clear: she’s not talking about wonky books, but books you might read while “curled up in a giant swinging chair in the back yard.”

First, Melissa Fay Greene’s There is No Me without You. “It’s long,” Kenen writes, “about 450 pages — and worth every minute. (With limited time — I bought and read the print version when I could and listened to a library CD version in the car and the kitchen). It’s the story of one Ethiopian widow's attempt to save the AIDS orphans in her country. All of them. Moving and fascinating. Probably my favorite narrative nonfiction book since I read The Spirit Catches You and You Fall Down.”

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Here’s something that frankly, disturbed me. My daughter, who just finished her freshman year in college, recently told me, “I can’t believe how many kids at school take prescription drugs on a regular basis. They take Adderall to help them study, Ambien to get to sleep and Xanax to calm down.” It surprised me that at 18 she even knew all the names of these drugs. Had she said that her fellow students were using marijuana or even ecstasy I wouldn’t have been as shocked. Those are the kinds of drugs you expect to find–along with copious amounts of alcohol–on college campuses.

But this sounded like prescription pills were freely available—prescribed to students with attention-deficit diagnoses or some other mental health problem, (or swiped from parent’s medicine cabinet or obtained on-line) and then traded around like loose cigarettes at a frat party.

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might want to take a look at Bob Wachter’s post over at Wacther’s World. http://community.the-hospitalist.org/blogs/wachters_world/archive/2010/07/08/why-obama-made-the-right-call-on-berwick.aspx. There, the  Associate Chairman of the Department of Medicine at the University of California, San Francisco, makes the most persuasive and cogent case I’ve seen as to why the recess appointment made sense.

 Wachter writes:  “The very things that make Berwick right for the CMS role also make him a target in today’s political environment, where all serious debate is trivialized and caricatured via talking points and schoolyard name calling.  . . .  Obama did not bypass a substantive airing of Berwick’s qualifications to run the most important healthcare organization in the country. Rather, he avoided a sandbox brawl.”

Berwick could have handled the fight, but I'm glad the American public was spared the spectacle of watching their elected representatives turn themselves into trolls on C-Span. We've already witnessed a year of ugly debate on healthcare reform.

Summary: Don Berwick, who will soon become the head of the Centers for Medicare and Medicaid, has declared himself an “extremist” insofar as he is a passionate advocate of “patient-centered care.” Earlier this week, Ezra Klein used the declaration to make a provocative argument that Don Berwick is, in fact, a conservative.  Congressional right-wingers should be happy, even if they don’t know it yet.

If we accede to patients’ wishes, won’t that mean that they’ll bankrupt the system? No, Berwick observes, experience suggests that informed patients are likely to want less care, not more. 

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A Guest Post By Authors:

Mark E Williams, MD , FACP

Ward K. Ensminger Distinguished Professor of Geriatric Medicine, University of Virginia School of Medicine, Attending Physician University of Virginia Health System 

Nortin M Hadler, MD, MACP FACR FACOEM, Professor of Medicine and Microbiology/Immunology, University of North Carolina School of Medicine And Attending Rheumatologist, UNC Hospitals

Summary:  In the guest post below, Doctors Mark E. Williams and Nortin M. Hadler describe the rise of the for-profit nursing home in the middle of the 20th century, at a time when the “temporal gap” between “retirement” and “death” was much shorter than now.  “Today people spend more time in retirement than in childhood and adolescence combined,” the authors point out, as they question whether the nursing homes of the past make sense in the 21st century.

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Tuesday night the White House Blog explained: “In April, President Obama nominated Dr. Donald Berwick to serve as Administrator of the Centers for Medicare and Medicaid Services (CMS). Many Republicans in Congress have made it clear in recent weeks that they were going to stall the nomination as long as they could, solely to score political points.

“But with the agency facing new responsibilities to protect seniors’ care under the Affordable Care Act, there’s no time to waste with Washington game-playing. That’s why tomorrow the President will use a recess appointment to put Dr. Berwick at the agency’s helm and provide strong leadership for the Medicare program without delay.”

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