Obama's $80 Billion Exaggeration

[Skull Pilot]

Obama's $80 Billion Exaggeration - WSJ.com

Last week, President Barack Obama convened a health-care summit in Washington to identify programs that would improve quality and restrain burgeoning costs. He stated that all his policies would be based on rigorous scientific evidence of benefit. The flagship proposal presented by the president at this gathering was the national adoption of electronic medical records -- a computer-based system that would contain every patient's clinical history, laboratory results, and treatments. This, he said, would save some $80 billion a year, safeguard against medical errors, reduce malpractice lawsuits, and greatly facilitate both preventive care and ongoing therapy of the chronically ill.

Following his announcement, we spoke with fellow physicians at the Harvard teaching hospitals, where electronic medical records have been in use for years. All of us were dumbfounded, wondering how such dramatic claims of cost-saving and quality improvement could be true.

The basis for the president's proposal is a theoretical study published in 2005 by the RAND Corporation, funded by companies including Hewlett-Packard and Xerox that stand to financially benefit from such an electronic system. And, as the RAND policy analysts readily admit in their report, there was no compelling evidence at the time to support their theoretical claims. Moreover, in the four years since the report, considerable data have been obtained that undermine their claims. The RAND study and the Obama proposal it spawned appear to be an elegant exercise in wishful thinking.

To be sure, there are real benefits from electronic medical records. Physicians and nurses can readily access all the information on their patients from a single site. Particularly helpful are alerts in the system that warn of potential dangers in the prescribing of a certain drug for a patient on other therapies that could result in toxicity. But do these benefits translate into $80 billion annually in cost-savings? The cost-savings from avoiding medication errors are relatively small, amounting at most to a few billion dollars yearly, as the RAND consultants admit.

Other potential cost-savings are far from certain. The impact of medication errors on malpractice costs is likely to be minimal, since the vast majority of lawsuits arise not from technical mistakes like incorrect prescriptions but from diagnostic errors, where the physician makes a misdiagnosis and the correct therapy is delayed or never delivered. There is no evidence that electronic medical records lower the chances of diagnostic error.

So what do you think is Obama's "evidence of benefit"?

There really is none. the only "benefit" the government will get out of this is to have complete access to your confidential medical records.

All of us are conditioned to respect the printed word, particularly when it appears repeatedly on a hospital computer screen, and once a misdiagnosis enters into the electronic record, it is rapidly and virally propagated. A study of orthopedic surgeons, comparing handheld PDA electronic records to paper records, showed an increase in wrong and redundant diagnoses using the computer -- 48 compared to seven in the paper-based cohort.

But the propagation of mistakes is not restricted to misdiagnoses. Once data are keyed in, they are rarely rechecked with respect to accuracy. For example, entering a patient's weight incorrectly will result in a drug dose that is too low or too high, and the computer has no way to respond to such human error.

If you've ever had an error on your credit report, you know how virally propagated electronic errors work and how difficult they are to correct.

Throughout their report, the RAND researchers essentially ignore downsides to electronic medical records. Rather, they base their cost calculations on 100% compliance with the computer programs "adopted widely and used effectively." The real-world use of electronic medical records is quite different from such an idealized vision.

Where do the RAND policy analysts posit major cost-savings? They imagine that the computer will guide doctors to deliver higher quality care, and that patients will better adhere to quality recommendations embedded in the computer programs. This would apply to both preventive interventions like vaccines and weight reduction, and to therapy of costly chronic maladies like diabetes and congestive heart failure. Over 15 years, the RAND analysts assert, more than $350 billion would be saved on inpatient care and nearly $150 billion on outpatient care. Unfortunately, data to support such an appealing scenario are lacking.

And the computer guidance will be programmed by whom?

You guessed it, the government.

A 2008 study published in Circulation, a premier cardiology journal, assessed the influence of electronic medical records on the quality of care of more than 15,000 patients with heart failure. It concluded that "current use of electronic health records results in little improvement in the quality of heart failure care compared with paper-based systems." Similarly, researchers from the Brigham and Women's Hospital and Harvard Medical School, with colleagues from Stanford University, published an analysis in 2007 of some 1.8 billion ambulatory care visits. These experts concluded, "As implemented, electronic health records were not associated with better quality ambulatory care." And just this past January, a group of Canadian researchers reviewed more than 3,700 published papers on the use of electronic medical records in primary care delivered in seven countries. They found no solid evidence of either benefits or drawbacks accruing to patients. This gap in knowledge, they concluded, "should be of concern to adopters, payers, and jurisdictions."

This can't be the "evidence" Obama was talking about could it?

It seems the president has changed the definition of the word to suit his political ends. Gee what a surprise.

What is clear is that electronic medical records facilitate documentation of services rendered by physicians and hospitals, which is used to justify billing. Doctors in particular are burdened with checking off scores of boxes on the computer screen to satisfy insurance requirements, so called "pay for performance." But again, there are no compelling data to demonstrate that such voluminous documentation translates into better outcomes for their sick patients.

And all the government cares about is cost. When the government provides health care, it will be the cheapest course of treatment that will be recommended, not necessarily the best.

Even before these new data, there were studies casting doubt on the benefits of electronic medical records. In response, the RAND researchers boldly stated, "We choose to interpret reported evidence of negative or no effect of health information technology as likely being attributable to ineffective or not-yet-effective implementation." This flies in the face of the scientific method, where an initial hypothesis needs to be modified or abandoned in the face of contradictory results. Rather than wrestle with contrary information, the report invokes the successes of computer-based systems in saving money in industries like banking, securities trading, and merchandizing, using ATM machines, online brokerage and bar-coded checkouts. Medical care of human beings -- treatment of acute and chronic illnesses and the even more complex process of effecting lifestyle changes like smoking cessation and weight loss to prevent disease -- is not analogous to buying bar-coded groceries and checking-account balances online.

That interpretation is what Obama is calling "evidence"

Some have speculated that the patient data collected by the Obama administration in national electronic health records will be mined for research purposes to assess the cost effectiveness of different treatments. This analysis will then be used to dictate which drugs and devices doctors can provide to their patients in federally funded programs like Medicare. Private insurers often follow the lead of the government in such payments. If this is part of the administration's agenda, then it needs to be frankly stated as such. And Americans should decide whether they want to participate in such a national experiment only after learning about the nature of the analysis of their records and who will apply the results to their health care.

Of course that is the agenda here and of course Obama will never state that agenda clearly.

All agree skyrocketing health-care costs are a dangerous weight on the economic welfare of the nation. Much of the growing expense is due to the proliferation of new technology and costly treatments. Significant monies are spent for administrative overhead related to insurance billing and payments. The burden of the uninsured who use emergency rooms as their primary care providers, and extensive utilization of intensive care units at the end of life, further escalate costs.

The president and his health-care team have yet to address these difficult and pressing issues. Our culture adores technology, so it is not surprising that the electronic medical record has been touted as the first important step in curing the ills of our health-care system. But it is an overly simplistic and unsubstantiated part of the solution.

We both voted for President Obama, in part because of his pragmatic approach to problems, belief in empirical data, and openness to changing his mind when those data contradict his initial approach to a problem. We need the president to apply real scientific rigor to fix our health-care system rather than rely on elegant exercises in wishful thinking.

I don't think Obama will change his mind if it means the government can't control your medical treatment, do you?

 

[pete]

Here is the transparency he was talking about ... he doesnt know what hes talking about.

 

[editec]

I share you concerns about this issue, Skull.

 

[007]

Obama = "If you can't dazzle 'em with brilliance, baffle 'em with bull shit."

One way or the other, this guy is a freakin' con artist.

 

[PoliticalChic]

Obama's $80 Billion Exaggeration - WSJ.com

Last week, President Barack Obama convened a health-care summit in Washington to identify programs that would improve quality and restrain burgeoning costs. He stated that all his policies would be based on rigorous scientific evidence of benefit. The flagship proposal presented by the president at this gathering was the national adoption of electronic medical records -- a computer-based system that would contain every patient's clinical history, laboratory results, and treatments. This, he said, would save some $80 billion a year, safeguard against medical errors, reduce malpractice lawsuits, and greatly facilitate both preventive care and ongoing therapy of the chronically ill.

Following his announcement, we spoke with fellow physicians at the Harvard teaching hospitals, where electronic medical records have been in use for years. All of us were dumbfounded, wondering how such dramatic claims of cost-saving and quality improvement could be true.

The basis for the president's proposal is a theoretical study published in 2005 by the RAND Corporation, funded by companies including Hewlett-Packard and Xerox that stand to financially benefit from such an electronic system. And, as the RAND policy analysts readily admit in their report, there was no compelling evidence at the time to support their theoretical claims. Moreover, in the four years since the report, considerable data have been obtained that undermine their claims. The RAND study and the Obama proposal it spawned appear to be an elegant exercise in wishful thinking.

To be sure, there are real benefits from electronic medical records. Physicians and nurses can readily access all the information on their patients from a single site. Particularly helpful are alerts in the system that warn of potential dangers in the prescribing of a certain drug for a patient on other therapies that could result in toxicity. But do these benefits translate into $80 billion annually in cost-savings? The cost-savings from avoiding medication errors are relatively small, amounting at most to a few billion dollars yearly, as the RAND consultants admit.

Other potential cost-savings are far from certain. The impact of medication errors on malpractice costs is likely to be minimal, since the vast majority of lawsuits arise not from technical mistakes like incorrect prescriptions but from diagnostic errors, where the physician makes a misdiagnosis and the correct therapy is delayed or never delivered. There is no evidence that electronic medical records lower the chances of diagnostic error.

So what do you think is Obama's "evidence of benefit"?

There really is none. the only "benefit" the government will get out of this is to have complete access to your confidential medical records.

All of us are conditioned to respect the printed word, particularly when it appears repeatedly on a hospital computer screen, and once a misdiagnosis enters into the electronic record, it is rapidly and virally propagated. A study of orthopedic surgeons, comparing handheld PDA electronic records to paper records, showed an increase in wrong and redundant diagnoses using the computer -- 48 compared to seven in the paper-based cohort.

But the propagation of mistakes is not restricted to misdiagnoses. Once data are keyed in, they are rarely rechecked with respect to accuracy. For example, entering a patient's weight incorrectly will result in a drug dose that is too low or too high, and the computer has no way to respond to such human error.

If you've ever had an error on your credit report, you know how virally propagated electronic errors work and how difficult they are to correct.



And the computer guidance will be programmed by whom?

You guessed it, the government.


This can't be the "evidence" Obama was talking about could it?

It seems the president has changed the definition of the word to suit his political ends. Gee what a surprise.


And all the government cares about is cost. When the government provides health care, it will be the cheapest course of treatment that will be recommended, not necessarily the best.



That interpretation is what Obama is calling "evidence"

Some have speculated that the patient data collected by the Obama administration in national electronic health records will be mined for research purposes to assess the cost effectiveness of different treatments. This analysis will then be used to dictate which drugs and devices doctors can provide to their patients in federally funded programs like Medicare. Private insurers often follow the lead of the government in such payments. If this is part of the administration's agenda, then it needs to be frankly stated as such. And Americans should decide whether they want to participate in such a national experiment only after learning about the nature of the analysis of their records and who will apply the results to their health care.

Of course that is the agenda here and of course Obama will never state that agenda clearly.

All agree skyrocketing health-care costs are a dangerous weight on the economic welfare of the nation. Much of the growing expense is due to the proliferation of new technology and costly treatments. Significant monies are spent for administrative overhead related to insurance billing and payments. The burden of the uninsured who use emergency rooms as their primary care providers, and extensive utilization of intensive care units at the end of life, further escalate costs.

The president and his health-care team have yet to address these difficult and pressing issues. Our culture adores technology, so it is not surprising that the electronic medical record has been touted as the first important step in curing the ills of our health-care system. But it is an overly simplistic and unsubstantiated part of the solution.

We both voted for President Obama, in part because of his pragmatic approach to problems, belief in empirical data, and openness to changing his mind when those data contradict his initial approach to a problem. We need the president to apply real scientific rigor to fix our health-care system rather than rely on elegant exercises in wishful thinking.

I don't think Obama will change his mind if it means the government can't control your medical treatment, do you?

Great post. The point is that with some 82% satisfied with their own healthcare, and less than 8% of Americans uninsured, he has got to find some basis to push his nationalized healthcare program.

I wonder if we have any chance of stopping the onslaught.

 

[toomuchtime_]

Obama's $80 Billion Exaggeration - WSJ.com

Last week, President Barack Obama convened a health-care summit in Washington to identify programs that would improve quality and restrain burgeoning costs. He stated that all his policies would be based on rigorous scientific evidence of benefit. The flagship proposal presented by the president at this gathering was the national adoption of electronic medical records -- a computer-based system that would contain every patient's clinical history, laboratory results, and treatments. This, he said, would save some $80 billion a year, safeguard against medical errors, reduce malpractice lawsuits, and greatly facilitate both preventive care and ongoing therapy of the chronically ill.

Following his announcement, we spoke with fellow physicians at the Harvard teaching hospitals, where electronic medical records have been in use for years. All of us were dumbfounded, wondering how such dramatic claims of cost-saving and quality improvement could be true.

The basis for the president's proposal is a theoretical study published in 2005 by the RAND Corporation, funded by companies including Hewlett-Packard and Xerox that stand to financially benefit from such an electronic system. And, as the RAND policy analysts readily admit in their report, there was no compelling evidence at the time to support their theoretical claims. Moreover, in the four years since the report, considerable data have been obtained that undermine their claims. The RAND study and the Obama proposal it spawned appear to be an elegant exercise in wishful thinking.

To be sure, there are real benefits from electronic medical records. Physicians and nurses can readily access all the information on their patients from a single site. Particularly helpful are alerts in the system that warn of potential dangers in the prescribing of a certain drug for a patient on other therapies that could result in toxicity. But do these benefits translate into $80 billion annually in cost-savings? The cost-savings from avoiding medication errors are relatively small, amounting at most to a few billion dollars yearly, as the RAND consultants admit.

Other potential cost-savings are far from certain. The impact of medication errors on malpractice costs is likely to be minimal, since the vast majority of lawsuits arise not from technical mistakes like incorrect prescriptions but from diagnostic errors, where the physician makes a misdiagnosis and the correct therapy is delayed or never delivered. There is no evidence that electronic medical records lower the chances of diagnostic error.

So what do you think is Obama's "evidence of benefit"?

There really is none. the only "benefit" the government will get out of this is to have complete access to your confidential medical records.

All of us are conditioned to respect the printed word, particularly when it appears repeatedly on a hospital computer screen, and once a misdiagnosis enters into the electronic record, it is rapidly and virally propagated. A study of orthopedic surgeons, comparing handheld PDA electronic records to paper records, showed an increase in wrong and redundant diagnoses using the computer -- 48 compared to seven in the paper-based cohort.

But the propagation of mistakes is not restricted to misdiagnoses. Once data are keyed in, they are rarely rechecked with respect to accuracy. For example, entering a patient's weight incorrectly will result in a drug dose that is too low or too high, and the computer has no way to respond to such human error.

If you've ever had an error on your credit report, you know how virally propagated electronic errors work and how difficult they are to correct.



And the computer guidance will be programmed by whom?

You guessed it, the government.


This can't be the "evidence" Obama was talking about could it?

It seems the president has changed the definition of the word to suit his political ends. Gee what a surprise.


And all the government cares about is cost. When the government provides health care, it will be the cheapest course of treatment that will be recommended, not necessarily the best.



That interpretation is what Obama is calling "evidence"

Some have speculated that the patient data collected by the Obama administration in national electronic health records will be mined for research purposes to assess the cost effectiveness of different treatments. This analysis will then be used to dictate which drugs and devices doctors can provide to their patients in federally funded programs like Medicare. Private insurers often follow the lead of the government in such payments. If this is part of the administration's agenda, then it needs to be frankly stated as such. And Americans should decide whether they want to participate in such a national experiment only after learning about the nature of the analysis of their records and who will apply the results to their health care.

Of course that is the agenda here and of course Obama will never state that agenda clearly.

All agree skyrocketing health-care costs are a dangerous weight on the economic welfare of the nation. Much of the growing expense is due to the proliferation of new technology and costly treatments. Significant monies are spent for administrative overhead related to insurance billing and payments. The burden of the uninsured who use emergency rooms as their primary care providers, and extensive utilization of intensive care units at the end of life, further escalate costs.

The president and his health-care team have yet to address these difficult and pressing issues. Our culture adores technology, so it is not surprising that the electronic medical record has been touted as the first important step in curing the ills of our health-care system. But it is an overly simplistic and unsubstantiated part of the solution.

We both voted for President Obama, in part because of his pragmatic approach to problems, belief in empirical data, and openness to changing his mind when those data contradict his initial approach to a problem. We need the president to apply real scientific rigor to fix our health-care system rather than rely on elegant exercises in wishful thinking.

I don't think Obama will change his mind if it means the government can't control your medical treatment, do you?

An $80 billion exaggeration? That's chump change in Obamaland. How about a $1.5 trillion "exaggeration"?

Q: Robert, I'd like to come back to the question we tried yesterday, now that we have numbers in front of us. The President claimed the other night $2 trillion in savings, now we're calling it a deficit reduction over the next 10 years. This chart tells us that $1.5 trillion of that we're getting from lower costs of the wars in Afghanistan and Iraq.

I mean, to get to that number -- you talking about a gimmick -- you get to that number of $1.5 trillion in savings or reductions in war costs, you have to assume that we would have spent $183 billion in 2019, even though all troops are supposed to be out of Iraq by 2011, even under President Bush's agreement.

So how is it that that's not a gimmick, an artificially high number so that we can say we're saving money that wasn't going to be spent in the first place?

MR. GIBBS: Let me have Peter -- I didn't -- I read some of the passionate rhetoric, but I didn't get quite so deeply into the matrixes.

Q: Do you disagree with it?

MR. GIBBS: I'm out of my depth, and I'll get Peter to go through those numbers.

Q: It's one number. It's just one number.

MR. GIBBS: Which is why I'm going to get Peter to do it. It won't take long.

Q: For all of us, or just for -- I mean, can we get a response to all of us?

MR. GIBBS: Sure. My office is pretty big.

White House Press Briefing by Robert Gibbs

 

[Midnight Marauder]

Obama = "If you can't dazzle 'em with brilliance, baffle 'em with bull shit."

One way or the other, this guy is a freakin' con artist.

Actual Obama quote alert!!!

"What you see in FDR that I hope my team can emulate is, not always getting it right, but projecting a sense of confidence."

Which is exactly what ALL con men do. That's why it's called that. Know what Obamaphiles worldwide are called, in the con lexicon?

Marks.

 

[PoliticalChic]

Obama = "If you can't dazzle 'em with brilliance, baffle 'em with bull shit."

One way or the other, this guy is a freakin' con artist.

Actual Obama quote alert!!!

"What you see in FDR that I hope my team can emulate is, not always getting it right, but projecting a sense of confidence."

Which is exactly what ALL con men do. That's why it's called that. Know what Obamaphiles worldwide are called, in the con lexicon?

Marks.

Instead of FDR, I wish our President had studied President Harding:

"America's greatest depression fighter was Warren Gamaliel Harding. An Ohio senator when he was elected president in 1920, he followed the much praised Woodrow Wilson— who had brought America into World War I, built up huge federal bureaucracies, imprisoned dissenters, and incurred $25 billion of debt.

Harding inherited Wilson's mess— in particular, a post–World War I depression that was almost as severe, from peak to trough, as the Great Contraction from 1929 to 1933 that FDR would later inherit. The estimated gross national product plunged 24 percent from $91.5 billion in 1920 to $69.6 billion in 1921. The number of unemployed people jumped from 2.1 million to 4.9 million.

Harding had a much better understanding of how an economy works than FDR. As historian Robert K. Murray wrote in The Harding Era, the man who would become our 29th president "always decried high taxes, government waste, and excessive governmental interference in the private sector of the economy.

Harding's Secretary of Commerce Herbert Hoover wanted government intervention in the economy— which as president he was to pursue when he faced the Great Depression a decade later— but Harding would have none of it. He insisted that relief measures were a local responsibility."

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