I have been pondering what is behind President Bush's messianic campaign to hard wire the U.S. healthcare system. It's not that I disapprove in principle; achieving a national health data network is in line with everything this page has been promoting in the past few years. However, when this president spends so much political capital on a healthcare project, I want to know which special interests stand to gain from it. Is this cynicism or realism? You pick. I just know that every time I have found myself in agreement with something this administration has done, I wake up sooner or later to find a Trojan horse.
That drug benefit for seniors? Yes, there's some benefit, but it's equally white-collar welfare for HMOs, drug companies and employers, not to mention a multimillion-dollar payday for ethically challenged Bush cronies like Tom Scully, Billy Tauzin and John Breaux. Medicaid flexibility? Nope, more like a block grant, a backdoor method to sabotage the program. How about a common-sense policy on medical records privacy? Perhaps, but then you have to remember John Ashcroft's sleazy effort to subpoena private patient records in response to a physician lawsuit over late-term abortions.
With that in mind, I was skeptical when Bush said in late January that he was re-appropriating the $50 million he had sought for the office of David Brailer, the would-be health IT czar. Next year, the president promises to seek $125 million to fund regional health information groups, continue a program to certify electronic health records and study how to lure physicians, particularly those in small practices, to go paperless (Health IT Strategist, February, p. 6). All of this comes a year after Bush announced an overly optimistic effort to achieve a fully wired healthcare system by 2014.
Meanwhile, a gigabyte of reports, announcements and studies contributes to a sense that health IT has the Big Mo.
A group of 13 health and information technology organizations gave the administration recommendations for achieving a national health information network. They seek open, nonproprietary technical standards for communication across the network. Surprisingly, a powerhouse coalition of the largest IT companies, calling itself the Interoperability Consortium, embraces this approach, eschewing their normal cutthroat competition.
A study published on Health Affairs' Web site in January estimated annual savings from an interoperable IT system of $78 billion per year (though the system would cost a whopping $276 billion over 10 years).
So most of the health IT news is positive, worthy of a round of congratulatory mouse clicks. And yet the question lingers. Why is the president so fixated on this?
We don't know the full answer yet, but here's one strong suspicion: The president and his allies in Congress believe they have a golden opportunity to fulfill a long-sought goal of turning our shared-risk, employer-sponsored health insurance system into one in which individuals are left to buy catastrophic coverage policies and pay far more of their health costs through sky-high deductibles and copayments.
The philosophy behind this scheme is that consumers, spending their own hard-earned dollars, would be "empowered" to buy care only from the best and most cost-efficient providers, thus reducing runaway health inflation and rewarding quality of care. That power would come only from a plethora of data, for which of course you need powerful information technology.
Call it a mixed blessing. We may have a jump start to a robust healthcare IT system, but the empowered consumer won't have the wherewithal to take advantage of it.
This editorial originally appeared in the Feb. 7, 2005 issue of Modern Healthcare.