Checking Up On Health: November 18, 2014

Health Care News and Views
Compiled by Benita M. Dodd



I had this visual of net “neutrality” today.

It’s such a nice word, isn’t it? It smacks of “fairness” and digital “justice;” of no favorites on the Internet.

All things being equal and Internet capacity being infinite, that’s a great idea. But the capacity is limited and providers sometimes need to make choices. It’s complicated, but think of it as the difference between routing an e-mail and flawlessly streaming your Netflix video. Would you be willing to pay a little more for your online streaming? Or be willing to see a tiny delay in the relay of your e-mail to keep your price low?

The visual of net neutrality for me, however, came in recalling a recent TV commercial for Edward Jones. In it, the surgeon is on the hospital phone and his patient is in his kitchen holding a knife:

“Hey, Bob. Have you disinfected the area? Good.

“Now make a 3-inch incision between the fourth and fifth abdominal muscles.”

Bob: “Shouldn’t you be doing this?”

Imagine if this was a telemedicine or mobile health surgical emergency, and the camera connecting the specialist and the layman/nurse practitioner/EMT in a rural area hiccups because of an unstable Internet connection. (It’s not an unlikely scenario under the best of circumstances. Just today at a meeting, a video presentation had to be cancelled because the Internet connection was slow, “buffering, buffering …”)

An unstable connection happens for many reasons, but one is that consumers are using more and more Internet each year, straining the spectrum. What if consistent service is crucial to your profession or business? What if you need faster speeds for some services, including telemedicine consultations and surgeries?

What if lives depended upon it? I don’t know about you, but it seems to me the Internet is working out its kinks nicely on its own. It’s enough that we have to credit Nobel winner Al Gore with inventing it; we certainly don’t need to credit Nobel winner President Obama with turning it into a utility in all 57 states.

“It is irksome when politicians take credit for the creations of others, and set ‘rules’ for the future that assure political involvement in what should be liberalized, non-politicized industries,” writes Clyde Wayne Crews of the Competititive Enterprise Institute in Forbes magazine.

If there’s ever a case of why the Internet shouldn’t move at the speed of government, the Edward Jones commercial is my reminder. Let the markets and competition decide on what’s fair. The marketplace is regulating itself just fine, IMHO. Allowing government to establish neutrality is a recipe for technological disaster. The Affordable Care Act stands as a reminder of how tough it is to turn an unpopular tanker when government is at the wheel.

(In my desperate search to find this commercial, I reached out to my Facebook friends, and Lisa Roberts of Universidad Francisco Marroquin finally came up with the answer. I thought I’d share what I came across in googling: a list of layperson surgeries performed in movies.)

Jonathan Gruber’$ per$i$tent role in health care

If you haven’t heard of Jonathan Gruber by now, you must be one of the stupid American voters he was referring to when I first reported on him last week. Since then, more video clips have surfaced while the Obama administration and Democratic leadership scramble to distance themselves from the arrogant bigmouth economist who was an architect of the legislation. Gruber raked in dollars, according to “By all accounts, Gruber is among a handful of economists with top-tier expertise in developing the kind of models that HHS and other agencies depend upon in the formulation of massive initiatives like ObamaCare, and one expert in government contracting told Fox News the MIT professor has carved out a ‘lucrative’ niche.” A Fox found the MIT economist and his firm have secured millions in federal and state contracts stretching back over the last 15 years.

How can health care be like Uber?

Uber recently made headlines when it launched UberHEALTH by delivering free flu shots on demand in three cities. It is no health care company and has neither clinicians nor health care facilities. Uber is also not a taxi company, nor is Airbnb a hotel company, “Yet Uber and Airbnb are currently the most influential companies in these industries,” writes Kenneth Kaufman for Becker’s Hospital Review. “For these companies, influence comes from leveraging technology to establish powerful connections with consumers that create an experience light years ahead of any associated with a legacy company.” Kaufman says that as Americans become accustomed to this level of quality and convenience, “they will expect it in all of their customer experiences. Companies that deliver a superior experience will be the industry leaders, and the foundation of that experience is connectivity. Health care will not be exempt. Very soon, leading health care companies may not have the best clinical outcomes; they may not even own hospitals or employ physicians. Rather, they may be companies that leverage connectivity to drive services to customers in a highly convenient and engaging way.” He cites examples of disruptive technology, changing the way health care and consumers interact:

  • Wal-Mart has opened several primary care clinics and a service to compare health insurance plans.
  • Walgreens’ goals include delivering “comprehensive care for its customers by leveraging its community presence in all 50 states
  • And now we can add UberHEALTH to this list.

 I’m looking forward to seeing the consequences of this disruptive approach!


A kinder, gentler federal exchange

Open enrollment for 2015 health insurance began Saturday. On Sunday, the Obama administration said 100,000 people had submitted applications for health insurance on the first day of open enrollment. Sylvia Mathews Burwell, the secretary of health and human services, cited this as evidence that the refurbished web site for the insurance marketplace was working for most users. In contrast, only six people were able to sign up for insurance the first day the exchange was live in 2013, with 248 enrolled in 48 hours, according The New York Times. (Insert Jonathan Gruber quote of your choice here.)

Time to pay the piper

People who didn’t have health insurance during 2014 may soon have to pay a penalty starting at $95 and increasing based on earnings. Some Americans know about the penalty imposed under the Affordable Care Act and have budgeted for it, or at least accepted its inevitability. But millions more are in for a rude surprise when the Taxman assesses a fee they didn’t even know was coming. Exemptions exist for low-income workers and others who would have to pay more than 8 percent of their income for a policy. About 60 percent of the uninsured are poor and likely to qualify for an exemption. About 30 percent of the uninsured don’t know they’re required to have it or pay a penalty; about 65 percent of the uninsured say they’re not familiar with the health care exchanges set up to offer policies.

Pfizer’ steps forward, steps back?

U.S. drugmaker Pfizer will pay Germany-based Merck $850 million upfront for sharing the rights to develop Merck’s experimental cancer immunotherapy. Merck is also eligible for up to $2 billion more based on the drug’s success. Merck’s MSB0010718C is part of a class of drugs known as anti-PD-L1 therapies, which work by blocking a tumor’s ability to evade the immune system’s defense. Analysts say the move is likely to rule out any further Pfizer action on AstraZenica; Pfizer was unsuccessful with a $118 billion bid for the British group in May. (It has a chance to renew its approach under British takeover rules from Nov. 26.) Source: Reuters

Safety in numbers?

Georgia and South Carolina have connected their statewide health information exchanges, becoming one of the first state-to-state information exchanges in the country. The Georgia Health Information Network and South Carolina’s Health Information Exchange could connect the health records of approximately 14.8 million people, if all constituents in both states join the system. Let’s hope it doesn’t offer a one-stop shop for hackers, too. 

Quote of note

As health care executives and physicians look on with chagrin, retailers are moving aggressively to fill unmet needs in the delivery of primary care for millions of Americans. … The competition is no longer just the primary care practice down the street and the urgent care center around the corner. Today, there are some 1,600 Retail Based Clinics (RBCs) in 39 states that are serving more than 20 million patients.” – Robin L. Rose

Benita Dodd is vice president of the Georgia Public Policy Foundation..