Zero Interest

Patients Turn to No-Interest Loans for Health Care | NYT | 8.30.07

Zero-interest financing, a familiar sales incentive at car dealerships and furniture stores, has found its way to another big-ticket consumer market: doctors’ and dentists’ offices.

The zero-interest plans are not for everyone. In fact, they are available only to the creditworthy—meaning they offer no help to those among the nation’s 47 million uninsured who are in difficult financial situations.

Zero-interest consumer debt and zero interest in the growing ranks of the uninsured?

Uninsured Rising

Household Income Rises, Poverty Rate Declines, Number of Uninsured Up | US Census Bureau | 8.29.07

Meanwhile, the nation’s official poverty rate declined for the first time this decade, from 12.6 percent in 2005 to 12.3 percent in 2006. There were 36.5 million people in poverty in 2006, not statistically different from 2005. The number of people without health insurance coverage rose from 44.8 million (15.3 percent) in 2005 to 47 million (15.8 percent) in 2006.

The uninsured not related to poverty.

A Sobering Census Report: Bleak Findings on Health Insurance | NYT | 8.29.07

The number of uninsured Americans has been rising inexorably over the past six years as soaring health care costs have driven up premiums, employers have scaled back or eliminated health benefits and hard-pressed families have found themselves unable to purchase insurance at a reasonable price. Last year, the number of uninsured Americans increased by a daunting 2.2 million, from 44.8 million in 2005 to 47.0 million in 2006. That scotched any hope that the faltering economic recovery would help alleviate the problem.

The main reason for the upsurge in uninsured Americans is that employment-based coverage continued to deteriorate. Indeed, the number of full-time workers without health insurance rose from 20.8 million in 2005 to 22.0 million in 2006, presumably because either the employers or the workers or both found it too costly.

Census Income Report Feeds Health-Care Debate | WSJ | 8.29.07

The percentage of Americans living below the poverty line fell to 12.3% last year from 12.6% in 2005, the first significant drop in a decade, according to the Census Bureau’s annual snapshot of American living standards. The inflation-adjusted income of the typical, or median, household rose, but median household income remained below a 1999 peak, and earnings of full-time workers fell despite a low unemployment rate.

Sufficient to be a major election 2008 issue?

Humor Abhors a Vacuum

Dwarf gets penis glued to vacuum cleaner | Wikinews | 8.22.07

Daniel Blackner, known as “Captain Dan the Demon Dwarf” was ready to perform at the ‘Circus of Horrors’, which is known for its oddball, offbeat performances. As part of the show, the dwarf pulls a Henry vacuum cleaner using a special attachment, across the show attached to his penis. But the attachment broke before the performance and when Blackner attempted a repair, he neglected to let the extra-strong glue dry for the recommended 20 minutes, instead utilizing it for the performance just 20 seconds after. The glue not being completely dry meant his penis began to stick to the solidfying bond.

Dan pulls Henry…

Full Justification

Insurers’ Lists on Doctors Under Fire’ | WSJ | 8.21.07

Physicians, Critics Claim Rankings Focus More on Costs

Doctors and regulators are pushing back against rating systems that some health insurers have developed to guide consumers in choosing physicians.

New York Attorney General Andrew Cuomo demanded last week a “full justification” of the rankings…[h]e warned…the ratings are confusing and potentially deceptive, in part because insurers don’t disclose how prone to error their rankings are. The move follows rankings lawsuits by doctors accusing insurers of libel, unfair business practices and breach of contract in other states.

Wow, could you see this train coming? Now the big question, are the methodologies used in physician rankings any more reliable then the methodologies used by Press Ganey?

Reentering the Public Domain

A Quest to Get More Court Rulings Online, and Free | NYT | 8.20.07

The domination of two legal research services over the publication of federal and state court decisions is being challenged by an Internet gadfly who has embarked on an ambitious project to make more than 10 million pages of case law available free online.

The project is the latest effort of Carl Malamud, an activist who founded public.resource.org in March, with the broad intent of building “public works” accessible via the network, and with the specific plan to force the federal government to make information more publicly accessible.

The unifying vision of all of the challengers to the current system is a Wikipedia-like effort to make the nation’s laws freely searchable by Internet search engines. They believe this will lead to a public system of annotation of the laws by legal scholars as well as bloggers, giving the American public much richer access to the nation’s laws.

Public.Resource.Org’s letter (PDF) to West | 8.14.07

One of the joys of the Internet is to see information previously considered the domain of a few specialists reenter the public domain and become once again relevant to all people.

Excellent!

GIM and MIM

Google and Microsoft Look to Change Health Care | NYT | 8.14.07

By combining better Internet search tools, the vast resources of the Web and online personal health records, both companies are betting they can enable people to make smarter choices about their health habits and medical care.

The Google and Microsoft initiatives would give much more control to individuals, a trend many health experts see as inevitable. “Patients will ultimately be the stewards of their own information,” said John D. Halamka, a doctor and the chief information officer of the Harvard Medical School.

A prototype of Google Health, which the company has shown to health professionals and advisers, makes the consumer focus clear. The welcome page reads, “At Google, we feel patients should be in charge of their health information, and they should be able to grant their health care providers, family members, or whomever they choose, access to this information. Google Health was developed to meet this need.”

I suspect GIM and MIM will do what HIM hasn’t. If only they can solve the BOM left at home problem—containing the “white one,” the “red one,”… Webcams? RFIDs?

King Errors and Failures

King-Harbor inspection report released | LAT | 8.14.07

At a specially convened board meeting, supervisors also released a 124-page report by federal inspectors that detailed dozens of errors and failures by the hospital during a make-or-break review last month.

King Dies

King-Harbor fails final check, will close soon | LAT | 8.11.07

Martin Luther King Jr.-Harbor Hospital shut down its emergency room Friday night and will close entirely within two weeks, a startlingly swift reaction to a federal decision to revoke $200 million in annual funding because of ongoing lapses in care.

The extraordinary developments mark an end to nearly four years of failed attempts to reform the historic institution, treasured by many African Americans as a symbol of hope and progress after the 1965 Watts riots.

“People fought to have this place built, and it’s been employment for some people. It’s been a symbol that our community is somewhat whole, that the resources are there that you need when you want them,” she said.

For the families who lost loved ones after medical lapses at the hospital, however, King-Harbor had come to symbolize betrayal, and Friday’s news brought bitter satisfaction

Another significant break, not replaceable, in the Los Angeles County safety net.

EDD, a Bigger Noose?

Hit ‘Delete’ to Prevent EDD Disaster | Law.com | 8.7.07

[Plaintiff:] Gary Michelson, M.D., a spine surgeon and prolific inventor, with hundreds of patents and patent applications worldwide, primarily in the field of spinal fixation and surgical implants, instruments and methods.

[Defendant:] Medtronic Sofamor Danek Inc., a subsidiary of Medtronic Inc., manufactures and markets medical devices used to treat spinal conditions.

Discovery was extensive…44 million pages of e-data…thousands of requests for admission…nearly 70 depositions taken in the case. Medtronic produced more than 2 million pages of paper documents and over 500 gigabytes of electronic data…

Medtronic estimated at one point during the litigation that the EDD processing and review would cost approximately $16 million to $22 million dollars — all to find, retrieve and review evidence that was helpful to [the plaintiff].

EDD is a growing strain on companies, law firms and solo attorneys. Better electronic record management is critical to keeping costs under control — and all companies should remember to “take out the trash.” If a company does not need the ESI for business, regulatory or litigation reasons, it should be discarded.

The verdict in this case was for $570 million. On the high side the defendant’s burden for discovery production was almost 4% (of the verdict award). As physicians and healthcare move towards the “holy grail” of an EHR—so does the problem of ESI loom larger. Moving paper to ESI may be the easy part—and a trade up in the size of the noose.

No Time to Rest

In a Hospital Stay, No Time to Rest | NYT | 8.7.07

Grand Central Terminal may be synonymous with noise and haste. But as I recently discovered, it can be a lot quieter than a hospital bed.

Described well. Not mentioned was the very tacky and rude practice of playing Brahms Lullaby throughout the hospital, day or night, loudly every time a baby is born. We are healers with no sense of a healing or compassionate environment.

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