The HIT Transition Weblog

Best Care, Lowest Price Under Attack

The Wall Street Journal offers a doomy, gloomy perspective on the state of primary care in the US: Primary Health Care Needs Fixing Before Universal Care Can Work

We don't train enough, we don't pay enough, and adding more patients to the load is not going to work, either at the state level or the national level.

I agree with the author, Dr. Benjamin Brewer, but I'm afraid he doesn't know the half of it. High deductible health plans are eating PCPs for lunch, and they don't even realize it yet.

Right about now, the final adjudications for January's billing will be coming in. That means the millions of new HDHP enrollments that shifted over on the calendar year are starting to move from claim-to-payer to patient-responsibility.

And patients, as we know, are deadbeats. At least collectively. And collections is going to become an even bigger component of the non-healthcare business of the PCP's business.

First In, Worst Off
There's a wierd sort of non-standardized "preventive care" benefit that is allowable (but not mandated) under HDHP, but as low-dollar, first-seen physicians, PCPs are going to be eating deductibles way out of proportion to both their number and their revenue.

Think about a broken wrist -- $10,000 according to my wife's recent unfortunate experience. ER gets paid by the payer (mostly), then come the hospital and surgeon's bills, along with the anaesthesiologist. That eats up the $2500-5000 deductible -- and then some.  The last providers in the door finally start to get paid by the health plan. Physical therapists, as the caboose on the train of care, have it made (except if the health plan declares them out of network and disputes the number of visits -- that's another story!).

But most patients don't spend $10K in a year. They get sick, they go to their PCP. They never meet their deductible. PCPs will take a disproportionate share of the hit as HDHP deductibles turn inevitably into bad debt.

UHC, Ingenix and...Hillary????

It's not like UnitedHealthcare needed any more bad news. First they and their Ingenix software division get the business-headline perp walk in New York Attorney General's investigation of the intentional skewing of "usual and customary" fee calculations that govern millions of Americans' out-of-network payments.  Then some uppity blogger points out that Cuomo planted his flag a the top of a very hefty deductible-sinking iceberg.

Then, adding insult to inquiry, they flat out lose a national popularity contest among hospital administrators. And they didn't lose by a little -- they doubled the score of their nearest competitor, Wellpoint.

Orangemen Take Football, Go Home
You'd think today's story would just be a minor piling-on thing, to look at it. Everybody wants to smack the gorilla when he's down, right? So, the lost business represented by University Hospital's decision to leave the UHC provider network over $1.5 billion in unpaid bills (okay, that's per the hospital's account, so I should say "allegedly unpaid bills" -- but why don't we ever read such disclaimers when the payers shout about the billions in fraud and abuse, when "abuse" is being determined unilaterally by the payers themselves? I digress.)

Other than the fact that I was born in or near that hospital (I was quite young at the time and haven't been able to follow the institutional mergers and acquisitions in the years since), this wouldn't have been much of a blip on my radar.

Why Let Readers Comment, Anyway?
But then alert reader Cyndee Weston, Executive Director of the American Medical Billing Association, sent me a note suggesting I read the story. And right under the press account, I found a comment from someone who had found a smoking gun tying presidential candidate Hillary Clinton to UHC.

When campaign finance reports first started coming out,  I wasn't too thrilled to hear that Hillary was accepting campaign donations from the insurance industry in disproportionate measure to the other candidates. Remember, though, that not all health care insurers are against universal care, and we at HITTG think that's the number one priority. So, I thought I'd judge her health care policy on its merits first, then dig for skeletons in her closet before I rendered judgment on the accusations that she was sleeping with the enemy.

I didn't realized she was the enemy.

Mathlete to the Line
According to the report she filed last June 15, and published at opensecrets.org, Ms. Clinton owns some stock in UnitedHealth Group, parent to UHC and Ingenix. I'm no accountant, nor am I a political snooper of much acumen, but the way I read page 38 of that report it looks like she checked the box under "Assets" in the $100,000 - $250,000 column, and the box under "Income" in the $50-100,000 with a "CG." Now, that CG looks like it might be referring to Capital Gains. So if the capital gain was at least $50,000 during the period covered by the report, then somebody with better financial brains than I have might be able to say whether that spread is closer to $100,000 than $250,000.

Can We Make Those Numbers Look A Little Better?
But for the sake of fairness, let's suggest it's right at the bottom and say, as far as we know, she owns merely $100,000 in UHG stock.  Heck, that's just 20 years worth of deductibles for a family on a HDHP plan.  Or, if you use a customized database to adjust the patient's payments, you can boost that $5K deductible to as much as $12,987 and whittle that down to a mere 7.7 years of deductibles (that's $100,000 divided by the $12,987 a family would actually have to pay to satisfy their annual deductible, using our proprietary U&HC deductible-skewing engine. Change the deductible amount from $2000 to $5000 when that spreadsheet loads and watch the magic happen!).

There's Nothing to See Here, Mister
So, when you do the math just right, she really only owns about 8 families-worth of unpaid claims, in the what hospitals say is the worst healthcare payer in the country. (Hey, don't shoot the messenger! I love UHC!).  And that's only if someone in the family gets really, really sick. What kind of story is that?

No story, really. But where she got the stock? That might be a story.

Luckily, this is a healthcare IT blog, and we don't do politics. The one time we tried, it really came out badly.

What's that? I seem to have some overdue editorial on curing the systemic economic failure that drives up healthcare costs. That's more up my alley than tracing individual money trails.

Okienomics and the Answer to the Question of Healthcare

It started when this blog and our HITSync email newsletter stuck our necks out on Super Tuesday.  Endorsing a political candidate was the kind of thing we never do, and endorsing a political candidate at the moment he closes up shop is the kind of thing no one should do.

One long-time reader even questioned our mental stability, suggesting it might be evidence of bipolar disorder. 

"Are you saying I need to see a therapist?" I asked. 

"Worse. I think you need to see a philosopher."

So I did what I always do in such circumstances.  I headed down to the Chili Bowl for a cheese coney.

As soon as I swung the door open, I saw him there at the lunch counter, hunched over a hot sausage burger smothered in jalapeños. I hung my coat on the wall and sat down on the stool next to him.

"How's it hangin' podner?" Yeah, people around here really talk like that.  At least a few of them do, and Fizzy Sweetwater is one of them.

"Not so good, Fizzy," I admitted. "I told all my readers I was going to fix healthcare, I endorsed John Edwards at the precise moment he dropped out of the campaign, and I challenged the Wall Street Journal to a battle of wits."

"Sounds like a pretty good day's work," said Fizzy.

"It took a couple of days, actually." It's easy to talk straight to somebody who listens straight, so I continued. "The way I see it, Fizzy, it's all about starting off with the wrong answer.  We've got one side saying the answer is the free market, and anything else is socialism.  We've got the other side saying the answer is to expand insurance coverage, like insurance is the solution rather than actual healthcare being the solution."

"Have I told you about my neighbor Clayton?" Fizzy asked.  It didn't sound like he had heard what I said, but after twenty years at Fizzy's elbow, I knew better than to head off one of his stories.

HITSync to the Journal: "Prove It!"

No sooner had we made our vow to prove that covering everyone would cost less than the idiotic, immoral system of chinks and imbalances we have now, than the Wall Street Journal came out with a gleeful obituary of California's unsuccessful attempt to achieve a bipartisan consensus on Gov. Schwartzenegger's universal healthcare bill.

Sayeth the Journal:

You can't make coverage "universal" while at the same time keeping costs in check -- at least without prohibitive tax increases. Lowering cost and increasing access, in other words, are separate and irreconcilable issues.

Of course you can't!  Everybody knows that. Why it says so right here in...well, right here in the Journal. And who knows more about The Market -- oops, I mean the market -- than the Wall Street Journal?

In fact, I bet they have scads of researchers working on it right now, compiling a list of all those examples that prove their case.  You know, all those places where they cover everybody and spend so much more on healthcare than we do in the US.

I'll just wait for them to get back to me on that one.

Bury the Hillary Campaign at Yasgur's Farm

Well, I came upon a Child of God
He was walking along the road
And I asked him, where are you going
And this he told me
I'm going on down to Yasgur's farm

I was in a fine snit this morning.  Michael and Allie noticed right away.  "What's the matter, honey?" Allie asked.

"I was listing to my Pandora station.  You know, 'It's a Beautiful Day?'" I had tuned my personal music channel to play the old psychedelic stuff that was always on my siblings' turntables during that boisterous era. Years after any incipient fog had long since lifted, I continue to find the melodies and optimism uplifting.

"I was doing fine until it played 'Woodstock,' then I got really mad."

"But you love that song!" she protested.

"I know.  But it made me mad. Mad at Hillary." I said.  I wasn't finished. Not nearly.

Worst in the World. Again.

It hurts me deeply every time the American healthcare profession is knocked around by researchers. And here it comes again: Among 19 developed countries, the U.S. ranks worst in deaths that could have been prevented by healthcare says new research published in the Jan/Feb issue of Health Affairs.

How bad is it? If we had performed as well as France, Japan and Australia, 101,000 fewer Americans would have died unnecessarily in 2003.

Researchers Ellen Nolte and Martin McKee state in their report "Measuring the Health of Nations: Updating an Earlier Analysis" that while other nations made strides and saw these types of deaths decline by an average of 16% between 1997 and 2003, the U.S. experienced only a 4% decline. All other countries had improved substantially except the U.S. They add that

It is difficult to disregard the observation that the slow decline in U.S. amenable mortality has coincided with an increase in the [U.S.] uninsured population.

The study did not ferret out causes (Was it access to care? Quality? Mistakes? Timeliness?). Rather than placing blame, the study simply reports the horrible news: In 1997–98 we ranked 15th out of 19 countries on the "mortality amenable to health care" measure; by 2002–03 we had fallen to last place. Based on our poor performance improvement (4% compared with 16% global declines in mortality), the U.S. is falling woefully behind.

Karen Davis of The Commonwealth Fund, supporter of the research, makes the message clear:

Our failure to cover all Americans results in financial barriers that are much more likely to prevent many U.S. adults from getting the care they need, compared with adults in other countries.

110 American deaths per 110,000 population. Lives lost because we can't get healthcare right in the wealthiest (at least for the time being) country in the world.

http://hittransition.com/flashpoint/ad.htm

Marty's HIT List 2008

Here's my official list of prognostications for 2008.  In 2006 and 2007, I didn't call them predictions, so I probably don't deserve any credit if anything I said came true.  If you agree -- or not -- you can give me your own scorecard by clicking here.  Give your feedback by January 23 and I'll post the results (and any interesting comments) in a blog at the end of the month. As far as we know, we're the only industry analysts that give you, our valued reader, this critical "You're Full of..." HIT response tool.

How Much Would Universal Coverage Save?

Earlier this morning I made a point that has been clear to me for a long time: Universal coverage will cost less.  This opinion has evolved over a long period of time, starting with my college studies in economics, which were focused on another domain impacted by the interactions of individual, societal and natural forces: the environment.  My career in healthcare, particularly in its focus on business operations and financial interactions, made it clear that the cost-shifting shell game we play in America is what is causing the system to spiral out of control both in terms of economics and quality: Letting people get sick costs more than helping them stay well.

Sometimes the urge to put this all into a single analysis is paralyzing, distracting me from my "real job" of merely trying to help the industry do health IT right.

Thank goodness someone appears to have done it for me.  They even put a price tag on the profligate ways of our dysfunctional "free market" (NOT) system: $1.5 trillion.

That's what the Commonwealth Fund's Commission on a High Performance Health System report, Bending the Curve: Options for Achieving Savings and Improving Value in Health Spending, says we can save over 10 years by covering everybody and making wise, systemic changes to the way the elements of the healthcare system interact.  I'm just popping it open now, but it seems they are not "anti-market," but rather seek to employ market forces within the context of correcting known dysfunctions, for instance, by setting prices based on outcomes rather than on procedures, using collective purchasing power to drive down drug prices, etc.  Pharma's just going to love this one.

It's not a piecemeal effort by any means, though.  They actually attack the problem at the national level, and identify ways that different policies can work together to control costs.

Nice present to put under your tree.

(Michael says I need to remember, though, that our company is not a non-profit enterprise, so this time I'm going to put in our little ad for the Health IT Grant Resource directories he worked so hard to assemble.)

http://hittransition.com/flashpoint/ad_rhio2.htm

Uninsurance Is a Deadly Sin

In what should be a no-brainer for anyone who has thought deeply about US healthcare, Matthew Holt over at The Healthcare Blog cites some fresh statistics that prove that not having insurance can kill you.  Quoting this new study by the American Cancer Society, he offers a dark truth: "For all cancer sites combined, patients who were uninsured were 1.6 times as likely to die in five years as those with private insurance."

Is it that they can't afford those expensive surgeries and heroic interventions?  Perhaps.  But most of it seems to happen earlier -- they don't get the screenings they need for early detection.

Women without health insurance are about half as likely as those with private health insurance to have received a mammogram in the past two years (38.1 percent of uninsured women versus 74.5 percent of insured women age 40-64), a pattern seen for all race/ethnicities studied (white, African American and Hispanic) at all levels of education.

As a result...

Twenty to 30 percent of uninsured women were diagnosed with late stage (stage III/IV) breast cancer, compared with ten to 15 percent of privately insured patients.

What the study doesn't seem to address is the financial impact, either to the individual or to the nation.  I'll fill you in on something I learned back in my days at the hospital: Sicker patients cost more to treat.

We don't spend more on healthcare despite not covering all our citizens.  We spend more on healthcare because we don't cover all our citizens.  The moral case and the economic case come up with the same answer.

Integrated Disease Management for Diabetics Not Worth It?

The following is the text of an email I just sent to the esteemed Dr. Blackford Middleton, in response to a presentation he gave to the Agency for Healthcare Research and Quality: "Evaluating the Value of Healthcare Information Technology: New Studies on Return on Investment from HIT Adoption from the CITL."  As we've come to expect from Dr. Middleton, the research was brilliant, innovative, and persuasive.  But the conclusions were devastating: According to the analysis, the most comprehensive kind of diabetic disease management programs don't save any money.  I invite you to download the presentation and read my response below.

Fair Share of Charity Care

In the form of proposed legislation, Sen. Charles Grassley is expressing his concern about how much nonprofit hospitals spend on charitable care. The ranking Republican on the Senate Finance Committee suggests that more is due in exchange for the billions of dollars in tax breaks received by hospitals.

Finance Committee staff has developed a controversial wish list of reforms, including one that would require nonprofit hospitals to dedicate a minimum of 5% of revenues to free care. The alternative would be to forfeit their tax-exempt status.

As we have noted in our publications, hospitals are the rare bird in the huge nonprofit sector. There are about 3,100 nonprofit hospitals, out of a universe of a million and a half U.S. nonprofit organizations. Looking at it more conservatively, there are 299,000 "reporting public charities" -- organizations large enough to be required to file tax returns with the IRS. Of those, nonprofit hospitals represent only about 3% of the entities, but consume 42% of the total charitable revenues of these reporting public charities.

PBGH Releases Consumer Tools Ratings

If we want consumers to "drive" healthcare, then we ought to let them see where they're going, right?  A few stalwarts have developed decision support tools to help them do just that, and a new report from the Pacific Business Group on Health gives a detailed comparison on their efforts.  Read about it here and download the free report here.

There are detailed specs on several national services (and a California Blue plan) on three decision support tools:

• Treatment Option support
• Hospital Choice support
• Personal Cost support

Health Care is Cheap; Sick Care is Expensive
We're still dubious about the underlying merits of "consumer directedness" as either a primary tool to improve an individual's outcomes or an approach to overall cost reduction.  We agree that informed personal responsibility is critical, but most of the efforts seem to be about penalizing people for "consuming" healthcare, which is entirely NOT the problem. 

We need to do whatever it takes to keep people from becoming sick or getting sicker -- and when they do get sick, it's unconscionable if our "solution" drives them into bankruptcy.  It's also damned expensive: Employer-based coverage turns productive employees into wards of the state.  Then we all complain about the taxes we have to pay to keep them living hand-to-mouth.

CDHC, like most of the "innovations" that preceded it, is primarily a game of cost-avoidance hot potato which drives up overall costs and reduces outcomes.  The reason we spend more on healthcare than any other nation is because of our failure to provide comprehensive universal coverage, not in spite of it.

Giving consumers (we sometimes like to call them patients) better information to take care of themselves is great, though, and this report is an exemplary and timely study.

Kaiser Family Foundation Tracks Healthcare Campaigning

Republicans and Independents rank healthcare right behind Iraq as the most significant issue in the 2008 presidential election; Democrats rank the two equally.  You can track the issue between now and next November on a site the Henry J. Kaiser Family Foundation has set up: health08.org

Very Hot Off the Press

Two days after the WSJ covered the "New Arms Race" of denial management, the NY Times went even further: tracing the logical path from the struggle over denial to the absurdity of US financing healthcare overall.

I found the column re-printed in the Dallas Morning News. 

"Suffer the Children" Say Oklahoma Southern Baptists

At first I was simply outraged that the Oklahoma Southern Baptist Convention had declared that children in so-called "non-traditional" families did not deserve health insurance.  My immediate reaction was that my Southern Baptist Brethren had simply not read the same bible I did.

Okay, I felt that and a little bit of rage, followed by a snarky suspicion that, by these fruits some may finally get to know them and opt for a more Christ-like version of Christianity.  Then, of course, came the pleasant sensation of moral superiority that tends to spread through me when I see someone I consider a modern day Pharisee (praying loudly in the street, changing money in the temple, adhering blindly to poorly understood Old Testament scripture, etc.) show their hypocritical hindquarters in the public square.

Visiting the "sins" of the father, mother, fathers or mothers on the heads of the children -- indeed!  Who could condone such a thing?

That's when my indignation left me.  I had a veritable revelation: As an American, I condone exactly such a thing -- and so do you.  Read on.

Uninsured Pay First Class for Coach?

In the current issue of Hospitals and Health Networks, editorialist Ian Morrison points out that wealthy Americans pay proportionately less for healthcare than poor and near-poor citizens while obtaining far better relative outcomes.  You can read the full text here.

He goes on to explain that even this relative national advantage pales in comparison to outcomes in countries with more civilized systems that cover all citizens and pay less for better care.  Rich people in those countries are better off than rich people here.  Kind of makes you question the merits of market-based oppression, doesn't it?

Morrison makes the case based on the concept of "regressive" vs. "progressive" comparisons -- "rich people pay a smaller share of income to health care than poor people."  He doesn't make the more express quantitative arguments that further support his position: Uninsured patients (which Morrison points out are hugely disproportionately represented by the poor and lower-middle class) are charged the absolute highest rates for any given service.  Further, those who pay any taxes whatsoever (almost all of them) are subsidizing the rest of us for benefits they do not receive.

Bush to Push HIT with Pen

HIT bills bottled up in congress?  Blue Ribbon commissions having a hard time producing consensus?  What's a president to do?  Well, there's always the Executive Order -- a sweep of the pen an you can make whole industries snap to. 

And, according to the Washington Post, that's just what President Bush has in mind.  Today's issue covers HHS Secretary Mike Leavitt's announcement to the National Governors Association that the order will "require that all providers of federally financed health care adopt quality-measurement tools and uniform standards for their information technology."  Not only that, he's working with 100 major employers to insist on the same set of rules.  And he urged the governors to follow suit.

Blue Health Data Reaps Payoff of Standards

The St. Paul Pioneer Press covers Blue Cross Blue Shield of Minnesota's participation with 19 other Blues plans in an initiative to leverage the intelligence in patient data to lower costs and increase the effectiveness of care.  The new system, dubbed "Blue Health Intelligence" goes into testing this year, with a rollout next year. According to the article, patient identification will be concealed, but suggests provider information may be included: "Although patient names and other personal identifiers are stripped out, specific doctors with their treatment patterns typically are identified when insurers mine their databases for information." (Note to the folks in Chicago: You'll want all the NPI granularity you can get in that data.)

The article points out that the data can be used for research purposes as well as patient care and cost control. "What sets Blue Cross's effort apart is its size — it's twice the size of the Medicare database."  From a healthcare IT perspective, what makes the data valuable is that standards have enabled the normalization of data on tens of millions of people.  Just as significant is that this data is in the hands of a private company that plans to use it for competitive advantage.  Great news for the free-market-will-control-healthcare-costs crowd, but of some concern to those who see market forces driving high-cost patients out of the insurance pool. 

Doctors + Lawyers = Better Healthcare?

From the "Whoda Thunkit" drawer comes this news item, courtesy of Matthew Holt's FierceHealthcare newsletter:

Boston Medical Center is launching a major expansion of a program that uses lawyers to tackle legal issues that eventually lead to health problems for many low-income Americans. The Medical-Legal Partnership for Children expects to do business in all fifty states, linking doctors who suspect patients may be experiencing problems with attorneys willing to take action.

Hello?  I know the farmer and the cowman should be friends, but the sawbones and the shyster?  Yes, indeed, and Boston.com has the full story.

So why do I categorize this one under "Covering the Uninsured?"  I guess because while an insurance policy can cover your kids, a good lawywer will cover your a__.

US Healthcare: Why The "Best of the Best" Isn't Any Better

I read a lot of articles about healthcare policy.  This is the most important article on the subject I've read this year.

It starts with a startling statistic that, despite having arguably the best healthcare infrastructure in the country, New England's health is not measurably better than anywhere else.  It then runs down a litany of dysfunctional aspects of the nation's healthcare system that explain why things are the way they are, and why we shouldn't expect them to get better unless we change them.

The Evils of a Socialized HS

This week I travelled about 800 miles through the plains of Oklahoma, the Ozark foothills, the forests and fields of Missouri and back.  About half the trip was on a federally-funded interstate expressway, another large piece on state two- and four-lane highways and the most interesting and lively few miles on county roads.  Interestingly, the only fees assessed were the $3.50 co-pays (locally referred to as "tolls") assessed by my own state for traversing the worst-maintained roads on the journey.

I realize this news will probably set up a public outcry from some of my colleagues.  After all, what I've described is no less than a "Socialized Highway System" (SHS).  This is surely un-American, definitely anti-competitive and more than likely a liberal conspiracy.

Nixon to China; Kentucky to Single Payer?

Neil Versel's Healthcare IT Blog tips us to this remarkable story in the Loiusville, KY Courier-Journal: Support swells for universal health care: Ky. panel endorses plan for U.S. system.  The state Kentucky House Health and Welfare Committee has endorsed Michigan Congressman John Conyers' proposal to extend medicare coverage to all americans via a publicly financed, privately delivered healthcare system.

The bill would create a "single-payer" health-care system, publicly financed and privately delivered. All Americans would have access regardless of employment, income or health. Each year, the program would set reimbursement rates for health-care providers and negotiate the cost of prescription drugs.

Wasn't Kentucky supposed to be a red state?  Maybe that doesn't mean what people think anymore....

Will Business Push for Universal Care?

An interesting article in the NY Times suggests that increasing the government's role in healthcare delivery may have an unexpected and powerful ally: US Business.

"The big irony in the health care area is that actually American business would be better off if there were a national health insurance system like Canada's," said Theda Skocpol, a Harvard dean who was an informal adviser on social policy to the Clinton administration. "Costs would be easier to keep down and there would be more flexibility. Workers wouldn't be keeping their jobs to keep their health benefits."

The article talks about the interesting transformation in health policy advocacy of the business community in recent years.  It doesn't go into such details as the high cost that job impermanence has on cost-shifting behaviors by insurers and employers alike, nor the impact that health coverage uncertainty has on individual behavior (some of which incents patients to seek unnecessary care while causing others to delay early diagnostic screening which could substantially reduce overall costs).

Who Says the VA is Taking Care of Veterans?

Well, veterans, for one.  In fact, the Veterans Health Administration scores substantially higher than private sector providers, according to a recent study publicized today in the Washington Post.

We pointed out the inconsistencies in the political grandstanding exhibited by self-proclaimed veteran's advocate and VA critic Rep. Steve Buyer (R-Ind).  Now it seems like veterans agree with us that the VA is doing a better job since ramping up their HIT effort a few years ago.

It also gives some ammunition against the spurious position that providing universal healthcare would somehow erode quality of care in the US -- at least for those who aren't among the 40-some million who don't have coverage.

NY Diabetics: Big Apple Is Watching You

The Washington Post reports that the City of New York will soon start gathering lab results on diabetic patients without asking permission.  This is seen as a significant change in focus of public health authority from the realm of infectious disease control to chronic disease management.

Under the program, independent clinical labs will be required to submit the results of Hemoglobin A1c tests to the health department within 24 hours.  A1c provides an estimate of the patients average glucose control over the preceding few months.  The New York City Department of Health and Mental Hygiene will use the aggregate data to track the impact of the disease and assess management efforts, but is also intending to contact patients directly if their numbers show a lack of control.  Curiously, they've decided to pilot the door-knocking campaign in the South Bronx, long regarded as one of the city’s roughest neighborhoods.  (I wonder what the recruitment ad for that home health position might look like?)

Privacy advocates are, of course, outraged and public health wonks are, understandably, hopeful.

As both a HIT worker and a diabetic, I have my own thoughts on the subject.

US Healthcare: Fix the System and Call Me In the Morning

I spent most of Thanksgiving weekend wishing off my tryptophan buzz (which endless news stories this year seemed bound and determined to debunk) so I could write a killer editorial on the need for universal healthcare.  But after my third slice of cranberry-sauce-shaped-like-a-can, my laptop blipped off and I began to snore.

Luckily, others were working on the story.