Hot Air and Red Ink

Gary Baldwin, for HealthLeaders News , November 6, 2007

One year from today will be the 2008 presidential election. Healthcare is going to be a big issue, given the rising number of uninsured people, the ever growing costs that are pushing that number higher, and the increasing doubts over Medicare's long-term solvency. However, whenever I hear the candidates start talking about healthcare, I usually cringe. Many of them peddle clich├ęs. For conservatives, the mantra is that the Democrats--especially Hillary--want a government-run system that will tell us who our doctor is going to be. For liberals, the argument is that the Republicans want to deny healthcare to little children and are wedded to big business interests that mercilessly exploit the system. In other words, the parties rely on faded--and highly exaggerated--scripts that are preaching to their own imagined choirs.

I'd love to hear candidates who favor a bigger government role in healthcare address not only the source of the funds, but the paperwork and regulatory burden that invariably follows the government dollar. Likewise, it would be great to hear the conservatives offer some insight as to where personal responsibility for health really begins. But what politician is going to give us the bad medicine and tell us that we can't afford the programs they want or that our own lifestyles are a big part of healthcare's woes?

One thing's for sure. The presidential platform can be immensely powerful when it comes to motivating the industry. I remember President Bush's call for electronic medical records in his 2004 state of the union address. With but a brief mention, he lifted the spirits of countless IT advocates. His later appointment of David Brailer to a newly created federal post to champion clinical IT resonated as well. Brailer embodied the notion that the feds were somehow going to "do something" about the lack of EMR adoption. Back then, nobody wanted to think of the job of national coordinator for health IT as just another bureaucratic slot.

Now, the Bush Administration is attempting to give EMR adoption another shot in the arm, so to speak. Last week, the feds announced a program to recruit some 1,200 physicians into a "demonstration" project. In short, Medicare will pay physicians bonuses for completing various tasks electronically, such as writing prescriptions or retrieving lab results. As we reported in September, physician adoption continues to lag. One reason, MGMA President William Jessee told my colleague, Rick Johnson, is the ever-declining reimbursement levels from Medicare. That's causing physicians to cut back on technology investments. "HHS is trying to spur more technology investment, meanwhile the base rate gets cut," says Jessee.

Healthcare economics aside, the EMR announcement sure didn't generate the same bounce as the Brailer appointment. When that happened, I got a flood of press releases touting the appointment and congratulating the president. In contrast, the latest EMR program--ostensibly a much bigger deal--generated hardly a peep.

Why? Optimism around any federal role--or figurehead--in promoting clinical IT has been dampened down considerably since Bush's foray into EMR territory. And for good reason. The fiscal shadow of Iraq looms large--just like the one cast by us baby boomers awaiting enrollment into Medicare. A financial crunch seems inevitable. So federally promoted clinical IT--the rare example of a non-partisan cause--is just one of a long list of programs now called into question by the war, if not the hordes of boomers about to stampede the Medicare trough.

Candidates, your game plans please. No bumper stickers needed.

Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at




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