Here are the facts on Obama's healthcare plan. 

godzgirl21 Oct. 6, 2008 at 6:32 AM

Thank you for the facts, GG!

peacelily3 Oct. 6, 2008 at 7:08 AM

http://www.factcheck.org/elections-2008/obamas_inflated_health_savings.html

godzgirl21 Oct. 6, 2008 at 7:55 AM

If health information technology can save so much money, why don't more people use it? There are a number of reasons, one of which is the financial disincentive that Hillestad mentions. In 2006, only 12 percent of physicians and 11 percent of hospitals had electronic records systems, according to the Congressional Budget Office. Estimates vary, however, and RAND used a higher level of adoption as of 2004 – 15 percent to 20 percent for doctors and 20 percent to 25 percent for hospitals. Both organizations laid out similar benefits and barriers to the use of paperless records.

Electronic health records can lead to fewer medical errors or bad drug interactions or duplicate tests. The systems could also allow doctors and hospitals to transfer or share patient records, shorten hospital stays, increase prevention efforts that lead to better health, and make getting a prescription filled as easy as hitting the send key. But all of that mostly reduces costs for the insurance companies paying the bills and, to some degree, uninsured patients who are footing the cost of their health care.

Individual physicians' offices and hospitals are the ones that have to pay to implement the systems. But, particularly at small practices, the only financial benefits they'll see are lower costs for maintaining records and transcribing data. And even health insurance companies, which stand to benefit the most, don't have incentive to push for faster adoption, because the savings benefit would go to competing insurance providers as well.

"It's really expensive to buy these systems, particularly for small, one and two doc practices," which are half of all physician practices, says Desroches. And the various records systems – CBO says there are 40 different vendors – can't communicate with each other. Desroches says doctors tell her that they're not implementing electronic records because of the cost, the limited value in terms of interoperability and the slow down in efficiency they'll face as they change the way their practices operate.

Hillestad says the government could speed up adoption by offering incentive money to physicians, requiring doctors to report measures of quality of care (which is easier to do with electronic records) or providing subsidies, particularly to physicians with a high proportion of disadvantaged patients – physicians who are less likely to buy electronic records systems. Desroches, too, says the government could "offer significant financial incentives combined with sticks," such as requiring electronic records for those getting Medicare payments.

Obama has proposed spending $10 billion a year over five years and phasing in requirements for adoption. Hillestad didn't want to comment on how that might affect the percentage of health care providers with electronic records. Both the RAND study and CBO agree, however, that adoption would be a lot faster if the government played a larger role.

There have been some efforts on the federal level: Bush set up a National Coordinator for Health Information Technology to set standards for such systems; Congress modified laws to prevent kickbacks so hospitals could give a system to outpatient providers at a heavy discount; Medicare gives additional money to physicians who submit performance data electronically. The Centers for Medicare and Medicaid Services gave out $98 million in state grants, much of it for electronic records or e-prescribing systems, and in the future the agency will give bonuses to small practices that have electronic records.

Obama's health plan says he'll "commit the necessary federal resources" to make health IT happen. But Kaushal, who is also the director of a group of independent evaluators who are assessing health IT improvement efforts in New York state, thinks that sticks and carrots alone will not be enough, and that the entire system will need to be overhauled to make information technology an integral part of daily operations. "It's not sufficient to take existing physician workflow and make it electronic, not sufficient to just go from paper to a computer," Kaushal told FactCheck.org. "What we want is to really wire the system; we want doctors and office practices and nursing homes and pharmacies to all be communicating. Adoption of health information technology becomes a byproduct of the requirement to wire the system." This will require guidance and vision, Kaushal says, not just incentives and disincentives. Realizing the kinds of savings that Obama cites will take much more than federal resources. It also requires a big-picture approach, and a lot of time.

Obama says his plan will "lower premiums by up to $2,500 for a typical family per year," partly through the use of electronic records. But experts say large savings from health IT are unlikely to flow to consumers.

Desroches points out that the average voter may never see the savings that the RAND study postulates. "Definitely insurance companies and federal and state payers would see savings," Desroches says. "I’m not sure individuals will see savings, [except] in the unlikely event that payers realize these savings and pass them on in the form of lower premiums."

The Obama campaign is counting on that unlikely event. Obama health adviser Cutler confirmed that the campaign's $2,500 per family projection doesn't represent only out-of-pocket savings for individual Americans. It includes savings to the government, employers and insurers, savings that could, Cutler says, trickle down to families in the form of lower taxes, higher wages or reduced premiums. In fact, Cutler says the $2,500 figure simply comes from dividing an overall savings estimate that's somewhat larger than $120 billion by an approximate number of four-person families in the U.S. "[W]e take the total and divide by the total population, then consider a 4 person family," he explained in an e-mail to FactCheck.org.

That's a bit of misleading math. It assumes individual Americans will share in all of the savings for the health care system, which includes insurance companies, the government and health care providers. Obama claims families will save $2,500 under his plan, but they won't see at least some of those savings directly in the form of lower premiums. And they may not see them indirectly either.

• First, it says, RAND measures the potential impact of health information technology, rather than the likely impact. The RAND study looked at what would happen if 90 percent of doctors and hospitals had adopted health IT and implemented and used it perfectly. CBO points out that there are many factors impeding widespread adoption and limiting efficient use. These have to be figured into any truly realistic calculation of costs and savings.
  
  
• Second, CBO points out that RAND based its conclusions only on studies that found positive effects of health information technology, throwing out data that showed negative effects. The study acknowledges that “we chose to interpret reported evidence of negative or no effect of HIT as likely being attributable to ineffective or not-yet-effective implementation.” Hillestad told FactCheck.org that the researchers assumed electronic records systems that had led to increased errors would be fixed or wouldn't be adopted by other health care providers.
  
  
• Finally, CBO says, the RAND researchers were estimating the savings based on the actual level of adoption in 2004, not the possible level of adoption – even without any changes in policy – in the years covered by the study. That means RAND was using an inaccurate baseline, one that doesn't account for the doctors and hospitals that would have implemented health IT systems from year to year.
  

None of these points are huge “gotchas.” The RAND authors are up front about the fact that they are examining potential impact of HIT, that they are discounting studies that found negligible or negative effects from HIT, and that their calculations are based on 2004 adoption levels. Kaushal told us that in her opinion, the CBO and RAND studies were trying to answer different questions: CBO wanted to look at likely outcomes, and RAND wanted to look at potential savings. But CBO is of the opinion that RAND's projections are overly rosy.

Obama’s advisers disagree, calling the RAND estimate “conservative.” Hillestad also told FactCheck that “we felt our numbers were relatively conservative,” adding that RAND had left out some factors that could have resulted in even higher savings estimates. Kaushal agreed, with a caveat: "I personally don't think that the RAND numbers are going to be found to be completely off. I don't think they'll be off by an order of magnitude. But it depends on the way things are being implemented." Because RAND predicts potential savings in an ideal situation, there's a lot of room for its estimates, and those of the Obama campaign, to be wrong.

– by Jess Henig and Lori Robertson

godzgirl21 Oct. 6, 2008 at 7:55 AM

http://www.factcheck.org/elections-2008/out_of_context_on_health_care.html

godzgirl21 Oct. 6, 2008 at 8:01 AM

thanks

mamadita Oct. 6, 2008 at 8:09 AM

Shine the light on the cockroaches, GG.

realtorshelly Oct. 6, 2008 at 9:24 AM

Shine the light on the cockroaches

Shari82 Oct. 6, 2008 at 9:27 AM

Voted popular, thank you for this FACT filled post.

cbtkw95 Oct. 6, 2008 at 9:28 AM

I'm just trying to get the facts out there so people know the truth, everyone has the right to know the facts!

godzgirl21 Oct. 6, 2008 at 9:30 AM