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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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In an e-mail, Blumenthal wrote:

"It would be flatout wrong to say Blackford Middleton was a key campaign adviser or had an official role on the campaign. He was one of many people the campaign reached out to, and I personally had minimal contact with him."

The Obama campaign used the center's $77.8 billion cost-savings figure.

After the election, as the economy threatened to collapse, Obama pitched emergency spending on health-care technology as one of many solutions to include in a stimulus package.

In a Dec. 6 radio address, the president-elect said that "We will make sure that every doctor's office and hospital in this country is using cutting-edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes and help save billions of dollars each year."

Five days later, Obama and his top advisers listened as Thomas A. Daschle, then the nominee to lead the Department of Health and Human Services, made a PowerPoint presentation in a Chicago conference room spelling out the virtues of using the stimulus package for electronic health records. Daschle, a proponent of health information technology, had cited the center's cost-saving estimate in a 2008 book promoting health-care reform.

Orszag, the OMB director, was among those at the meeting. While the spending on health records will not stimulate the economy immediately, he said, Obama views it as a long-term "investment" against one of the most persistent drags on the U.S. economy.

"It is a key first step toward a high-performing health-care system," Orszag said in an interview.

On Dec. 17, Lieber, the Healthcare Information group's leader, said in a letter to the president-elect that a "minimum of $25 billion" in subsidies was needed to spur doctors to buy the technology.

In an interview, Lieber said his group was interested not in profit for its members but in improving the health-care system. "It's 'What will this do for health care,' not 'What will this do for GE or Siemens or Phillips.' "

'Overly Optimistic'

The stimulus bill suggests that the government will recoup about a third of the spending allocated for electronic health records over the next decade, an assumption that some health-care observers question, in part because of a critical analysis by the Congressional Budget Office last year.

The CBO, then led by Orszag, examined the industry-funded study behind the $77.8 billion assertion, among other things, and concluded that it relied on "overly optimistic" assumptions and said much is unknown about the potential impact of health information technology.

A CBO analysis of the stimulus bill this year projected that spending on electronic health records could yield perhaps $17 billion in savings over a decade.

Under the stimulus package, Medicaid and Medicare providers will receive incentive payments to offset the cost of electronic health record systems they buy. No one knows for sure how widely the technology will be adopted, and no one knows for sure whether those systems will yield the expected savings, specialists said.

Another open question relates to the development of technical standards that define what equipment qualifies for stimulus payments. Some critics contend those standards could choke off innovation and funnel profit to certain vendors, without necessarily improving care.

To qualify for federal funding, the technology must enable "meaningful use" by doctors and others, according to the legislation -- a standard that policymakers, researchers, vendors and others are struggling to define now.

Joseph Antos, a health-care policy specialist who has examined the legislation, said the risks of the technology plan are high because of the haste with which it is being implemented and the special interests seeking to profit from it.

"This is the real way things get done," said Antos, of the American Enterprise Institute, a Washington think tank. "The stimulus bill looked like a bonanza to an awful lot of people."

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