Unbiased Analysis of Today's Healthcare Issues

Government IT

Written By: Jason Shafrin - Feb• 16•15

Information technology without a doubt is helping to restructure the very fabric of society, business and government.  However, these changes do not come without challenges.  For instance electronic health records (EHR) may harm the patient-physician interaction and are susceptible to hacker attacks.

A recent Fiscal Times article demonstrates how government programs often do not invest in IT infrastructure efficiently.

Meanwhile, the government has seriously struggled with its IT projects—most notably the launch of HealthCare.gov, the federal portal built to facilitate the sale of health insurance set up under Obamacare. The website, was so plagued with tech problems at the start of its rollout that only six people were able to sign up on the first day.

Eventually, HealthCare.gov received a massive revamp and repair effort that ballooned the project’s price tag to more than $2.1 billion, Bloomberg reported. Watchdogs still worry that it could be vulnerable to hackers.

Though HealthCare.gov is the most publicized federal tech flop, there are plenty of other examples where the government bungled an IT project. The Pentagon and the Veterans Affairs Department, for instance, abandoned a $1.1 billion program to build an integrated electronic health record system after failing to get the systems to communicate. In fact, almost none of the systems built are compatible agency to agency.

Why are government IT projects so expensive? There is no one answer, but for Healthcare.gov, the answer is partly due to poor organization. Bloomberg reports:

The construction of healthcare.gov involved 60 companies, supervised by employees of the Centers for Medicare and Medicaid Services instead of a lead contractor, according to the inspector general at the Health and Human Services Department. The project was marked by infighting among the contractors, CMS officials and top officials at HHS, the Cabinet-level department that oversees CMS, according to e-mails released Sept. 17 by the House Oversight and Government Reform Committee.

The GAOs 2015 High Risk List now includes “Improving the Management of IT Acquisitions and Operations” as one of its top risk to the federal budget.

Friday Links

Written By: Jason Shafrin - Feb• 13•15

Valentine’s Day HWR

Written By: Jason Shafrin - Feb• 12•15

Then Valentine’s Edition of Health Wonk Review: For Health Policy Lovers Everywhere has been posted by Peggy Salvatore at Health System Ed.

Why isn’t there more mental health drug innovation?

Written By: Jason Shafrin - Feb• 11•15

There have been a number of efforts emphasize the importance of mental health and put mental health treatments at the same level of respect as physical health.  For instance, there was the Mental Health Parity Act of 1996 and also The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) , which:

…requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.

Despite, these efforts, drug development for serious mental illness has lagged behind physical health treatment developments. One reason is restrictive reimbursement policies. For instance, the head of R&D&D at mental health drug specialist Lundbeck stated that government pricing restrictions made the development of drugs to treat mental illness less enticing for Pharma.

“Over the past five or six years, many of the major companies have actually pulled deliberately out of the area because they foresaw the systems that governments have to curtail their costs,” he pointed out to us. “They basically apply metrics that are not appropriate for mental health treatment.

“There has been no willingness to pay for the medication when it comes out. And if that’s the case then companies would obviously much rather research and invest in other therapeutic areas where there is an apparently higher appreciation of what we bring. That’s how simple it is.”

Although there is much rhetoric about the importance of treating mental health, society’s priorities will only change when key stakeholders put their money where there mouth is.

Autism vs. Measles

Written By: Jason Shafrin - Feb• 10•15

A powerful article from Medium about an autistic person’s view of the measles debate:

No matter what other lofty ideas of toxins and vaccine-related injury anti-vaxxers try to float around in their defense, that’s really what all of this is about: we’re facing a massive public health crisis because a disturbing number of people believe that autism is worse than illness or death. My neurology is the boogeyman behind a completely preventable plague in the making.

The title of the article is: “I’m Autistic, And Believe Me, It’s A Lot Better Than Measles”


Written By: Jason Shafrin - Feb• 09•15

Kids with 3 parents

Written By: Jason Shafrin - Feb• 08•15

No, this is not science fiction. The British Parliament approved a procedure that would permit a new procedure that would allow children to use DNA from 3 parents rather than 2. Here’s why:

That insight is why MPs were right to agree, on February 3rd, that Britain should become the first country to allow the creation of children with genetic material from three people instead of the usual two (see article).

By doing so, they hope to relieve terrible suffering. Faults with mitochondria—the tiny power sources inside cells—afflict about one child in 6,500, or 100 a year in Britain. The many conditions that result, a lot of them agonising and fatal, have no cure. So scientists hope to prevent them at conception, by transferring the healthy nucleus of an egg cell with damaged mitochondria into the body of an egg with functioning ones.

After the House of Commons voted to allow UK clinicians to perform “mitochondrial donation”– a form of in-vitro fertilisation (IVF) designed to ensure that…children [with seriously damaged mitochondria] can be born free of the condition.–the UK is the first to allow kids to have DNA from 3 parents. This may should like an episode of Orphan Black, but dispite the “strangeness” of the procedure, helping sick kids is what matters most.

The downside of EHRs

Written By: Jason Shafrin - Feb• 05•15

Electronic Health Records can help doctors access the information they need regardless of whether they have treated you before. Setting up integrated health care systems or systems where EHR networks are interoperable can improve this facility across healthcare organizations. However, this approach is not without risks, as shown by this recent hacking episode at Anthem.

Health insurance giant Anthem Inc. said late Wednesday that hackers had breached its computer system and the personal information of tens of millions of customers and employees was possibly at risk.

The attack on the nation’s second-largest health insurer could be one of the largest data breaches in the healthcare industry.

“Cyber attackers executed a very sophisticated attack to gain unauthorized access” to one of the company’s computer systems and “have obtained personal information relating to consumers and Anthem Blue Cross employees who are currently covered, or who have received coverage in the past,” Indianapolis-based Anthem said in a statement.

While EHR interoperability has gotten most of the focus of policy wonks, the importance of data security should not be ignored.

The Future of Medicine

Written By: Jason Shafrin - Feb• 04•15

The next decades of medicine and health care will be about using technologies and keeping the human touch in practicing medicine. Everyone’s genomes will be sequenced to access personalized treatments. We’ll measure almost any health parameters at home with diagnostic devices and smartphones. The 3-D printing revolution will produce affordable exoskeletons and prosthetic devices.

Is 2% US GDP the new normal?

Written By: Jason Shafrin - Feb• 03•15

In the past, many economists targeted 4% GDP growth as the long-run average.  However, in recent years long-run GDP growth has fallen to about 2% per year.  Is the US economic engine slowing down?  Maybe, not.

Growth in a country’s GDP comes from 2 components: growth in GDP per work and growth in the number of workers.  As the US population has aged and the fertility rates have dropped, labor force growth has flattened to around 0%; previously, labor force growth averaged close to 2%.  Now the economy is growing by about 2% whereas before this number was about 4%.  The Calculated Risk blog shows this trend graphically.


Using simple algebra, one can see that growth in GDP per worker has remained constant at around 2% per year.  Because labor force growth has fallen from 2% to 0%, however, overall GDP growth has slowed from around 4% to around 2%.

As Arthur Kemp once said, “Demographics is destiny.”