The Machinery Behind Health-Care Reform

Blackford Middleton
Blackford Middleton (Courtesy Of Healthcare Information And Management Systems Society (Himss) - Courtesy Of Healthcare Information And Management Systems Society (Himss))
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By Robert O'Harrow Jr.
Washington Post Staff Writer
Saturday, May 16, 2009

When President Obama won approval for his $787 billion stimulus package in February, large sections of the 407-page bill focused on a push for new technology that would not stimulate the economy for years.

The inclusion of as much as $36.5 billion in spending to create a nationwide network of electronic health records fulfilled one of Obama's key campaign promises -- to launch the reform of America's costly health-care system.

But it was more than a political victory for the new administration. It also represented a triumph for an influential trade group whose members now stand to gain billions in taxpayer dollars.

A Washington Post review found that the trade group, the Healthcare Information and Management Systems Society, had worked closely with technology vendors, researchers and other allies in a sophisticated, decade-long campaign to shape public opinion and win over Washington's political machinery.

With financial backing from the industry, they started advocacy groups, generated research to show the potential for massive savings and met routinely with lawmakers and other government officials. Their proposals made little headway in Congress, in part because of the complexity of the issues and questions about whether the technology and federal subsidies would work as billed.

As the downturn worsened last year, advocates helped persuade Obama's advisers to dust off electronic records legislation that had stalled in Congress -- legislation that the advocates had a hand in writing, the Post review found.

Their sudden success shows how the economic crisis created a remarkable opening for a political and financial windfall: the enactment of a sweeping new policy with no bureaucratic delays and virtually no public debate about an initiative aimed at transforming a sector that accounts for more than a sixth of the American economy.

"It was perhaps a once-in-a-generation opportunity to make something happen," said H. Stephen Lieber, the trade group's president. Obama "identified the vehicle that he could use to move his policy agenda forward without the crippling policy debate."

Obama and some of his advisers had been thinking about health-care reform for years before they made it a top campaign issue. Some advocates have talked about improving use of health information technology for decades.

Government and private studies have found that much of the $2.5 trillion spent on health care each year is wasted on the duplication of tests and unneeded procedures.

Many technology advocates, including health policy specialists, say that networked electronic patient records that can be transmitted instantly would make health care more efficient and provide valuable insights about costs and care. Only a small minority of doctors use such technology to track the care they give people. Some health policy analysts have recommended the use of government subsidies and incentives to spur the adoption -- as the stimulus spending is intended to do.

Some advocates also say the savings could amount to tens of billions of dollars each year from reduced paperwork, faster communication and the prevention of harmful drug interactions. An equally important benefit, they say, could be to enable researchers to determine the most effective procedures for an ailment.

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