Deem These Data From Intrade --Obamacare Takes a Tumble

I wrote yesterday for Politico that the "Slaughter Solution" was too clever by half--exactly the sort of trickery that the voters hate. (See "Cornhusker Kickback," etc.) And so, I wrote, the Obamacare bill, which had been gaining momentum in recent weeks, might have taken "a fatal turn."

And now, on Intrade, the wisdom-of-crowds betting outfit, I see that the "value" of Obamacare has fallen from 70 to 55. That's a 15-point drop in a single day, or 21 percent.

That's a big drop. Yes, getting Dennis Kucinich's vote was a big deal, but when I read that there are 36 "no" or "likely no" votes among Democrats, and 50 or so undecideds, I start to wonder if maybe the price for Obamacare is still not too high. (The "magic number for the Democrats is 37--that is, the number of votes that they can afford to lose.)

How A Changing Internet Could Change Healthcare

Big things are happening to the Internet, and that means big potential changes to healthcare. This is, after all, the Information Age, so anything that happens to information happens to our health. The challenge will be to simultaneously improve our health while protecting our privacy and dignity.

The official plan from the Federal Communications Commission is to be released on Tuesday, although FCC Chairman Julius Genachowski teases it in Sunday's Washington Post.

In the meantime, Grant Gross, writing for PC World, reports that some hints are already available. In a speech last month, Genachowski said that the FCC's goal is "to bring 100M bps (bits per second) broadband service to 100 million U.S. homes by about 2020."

Nationwide, that's would spell a huge increase, more than a hundred times faster than current DSL plans, for example. Such ubiquitously accelerated speed will change everything about the Internet, of course, but here at SMS, we were struck by a little throwaway in The New York Times report on the broadband plan that wasn't so little:

The plan envisions a fully Web-connected world with split-second access to health care information and online classrooms, delivered through wireless devices yet to be dreamed up in Silicon Valley.

Note the inclusion of "health care information." Indeed, that could be the future of healthcare, to see everything integrated into one vast interactive tool, one vast record keeping mechanism. Imagine: Being able to get a diagnosis online, via fullmotion interactive video, anywhere in the world. And perhaps it will be automated some day--a computer could provide at least the first "consultation." And who knows what might be possible after that. Imagine all your health records following you around, in the cloud. Imagine the whole of humanity uploading data into that same cloud, so that doctors and scientists can better identify public-health patterns and take constructive action. An Internet-as-Mednet could save, and extend, a lot of lives.

So that's a goal worth working for, if. If, that is, the problems can be worked out. As PCW's Gross puts it, the FCC's plan is no slam dunk:

The broadband plan could meet resistance from incumbent providers as soon as it sees the light of day, said Craig Settles, a community broadband consultant and president of Successful.com.

"I believe the plan is too ambitious for many inside Washington to fully embrace in terms of executing legislation and making funds available," he said. "The average lawmaker, particularly with elections coming up this year, could not care less about broadband. These are the ones most susceptible to lobbyists' attempts to neuter the plan. The telecom and cable industry will mine the lofty rhetoric while trying to kill anything they feel threatens profits."

And the pipeline companies have a point: They paid for this infrastructure, and so they should have a say in how it is used. A say, which is not the same as veto.

And there will be other problems ahead. As one of the commenters in the PCW story, "ebystrom," put it:

This will result in government takeover of the industry. It won't happen overnight, but incrementally. They already have the name for it: National Broadband, like National Health Care.

Not everyone worries about national health insurance--some are all for it. But as the polls show, most people are a little bit nervous at the thought of too much power being centralized in Washington--whether it's broadband or healthcare.

The great challenge, of course, is that abundant medical information, online, is a double-edged sword. Medical digitalization is great if you control the data, not so great if others can snoop or hack into it. Digitalization is great if doctors and hospitals have online files that can be moved around, wherever they are needed, at the push of a button, but it's not so great if the trial lawyers, too, can push a button and get the same information. Digitalization is great if it helps your doctor treat you, not so great if a cost-conscious government puts a bureaucrat between you and your doctor. So controversies over security and privacy and transparency are going to be profound questions in the years to come.

And a past FCC Chairman, Reed Hundt, provided a fascinating peek into the FCC's past policies in a recent speech at Columbia University, as reported by Harry Jessell of TVNewscheck:

Hundt said that his decision to favor broadband over broadcast was made in 1994, when his first days as FCC chairman coincided with the introduction of the Mosaic browser and the emergence of the Internet as a commercial medium.

"We decided ... that the Internet ought to be the common medium in the United States and that broadcast should not be," he says. The "we" includes Blair Levin — who is the principal author of the National Broadband Plan and who was Hundt's chief of staff — as well as Genachowski, who was a top aide and thinker.

Hundt said the decision was made even though TV broadcasting had ably served the country as the common medium since the year he was born, 1948.

And then he gave several reasons why.

The Internet was "going to be the pathway for the global promulgation of American values and American technology, he said. "A nation that doesn't believe ... that its values are values that ought to be shared and sold, if you will, to other countries, that's not the United States.

"Second, [the Internet] was fundamentally a richer medium — text and pictures — and that therefore it was going to be an easier and better way for people to have access to information. ..."

He also believed the Internet was "certain to be diverse in every conceivable respect and not by dint of regulation — diverse, meaning it would be in every language and every race would be welcome and the content would be ... generated by people who ... would choose any points of view; and any kind of ownership of the content would be admissible and any form of the content would be possible."

The whole article is extremely interesting, because Hundt is staking his claim to the historical record as a major mover and shaker on the Net. Indeed, as Hundt says, the FCC "stole the value of the telephone network and gave it to . . . society." Legally, of course--any more questions? And Hundt says, at the same time:

The FCC tried to suppress broadcasting. "This is a little naughty: We delayed the transition to HDTV and fought a big battle against the whole idea."

In other words, according to Hundt, he and his colleagues deserve credit for hurting the phone companies, and the broadcasters, and helping the Internet suppliers. This is Hamiltonianism of a high order, or, if one prefers, industrial policy.

Historians will kick these claims and counterclaims* around for a long time to come, but in the meantime, myriad issues of the present Net are unresolved--and perhaps becoming more unresolvable.

It seems, for example, that the Net is becoming ever more like "The Truman Show"--everybody is watching everybody. How happy are we to read, for example, "Twitter is watching you... New technology tells the world where you're tweeting from"? Might that be just a tad disconcerting? Tweeters have the power to opt in or opt out, of course, but do people really trust such promises? And it's probably the same with other services, such as Foursquare and Loopt and all the rest. Let's face it: If these companies are giving customers their services for free, they must expect something in return.

Indeed, the same sort of data-trend is apparent in other areas of our lives. How will we feel about knowing that every new car has a "black box" that tracks our vehicle activity? As Reuters puts it:

National Highway Traffic Safety Administration chief David Strickland told a congressional hearing on Thursday that the regulator is considering whether to make "black boxes" mandatory for all new vehicles. The devices can capture data on speed, braking effort and other details which can be vital in reconstructing accidents.

Scientists are even starting to figure out how to read our minds:

In a recent study, published in the March 11 online edition of Current Biology, British scientists from University College London found that they could identify human thought patterns in the brain by using functional magnetic resonance imaging (fMRI).

It's possible, of course to read too many articles and get too worked up over privacy. And in fact, a contrarian view comes from well-known tech journalist Declan McCullagh, who wrote a piece on Friday entitled, "Why no one cares about privacy anymore."

But plenty of people do care about privacy. And so the FCC plan is going to face a rocky road, even as most people agree that it would be pretty cool if we all had greater access to a faster and ever more useful Net.

So some of the grand battles of the 21st century are being outlined now: Between the old and the new, between tradition and innovation, between privacy and transparency. And that's just in the US. The rest of the world will have its own fights.

*The historical battle for Net credit is by no means as open-and-shut as Hundt claims. Back in 2000, Hundt published a book, You Say You Want a Revolution: A Story of Information Age Politics, in which he argued, “Al Gore did not invent the Internet, but he did invent the political economy of the Internet.” There was a claim perfectly timed for the 2000 presidential election. But in a Newsday column dated June 13, 2000, I took exception to the pro-Gore claim:

In a brief aside on page 133 of his book, Hundt notes a “far-sighted, or accidentally smart” ruling by the Reagan-era FCC that prohibited phone companies from levying “access charges” on data (as distinct from voice) transmissions. “In the absence of the FCC’s decision,” Hundt writes, “the Internet would have been so expensive that [founder Marc] Andreesen’s Netscape would not have been a hiccup, much less one of the first bubble stocks of the Internet.”

Whoa. After all this pro-Gore buildup, Hundt concedes that the biggest pro-Internet policy dates back to the early 80s - - when then-Congressman Gore was denouncing the evils of Reaganism. Could it be that Hundt’s intellectual honesty has, in this instance at least, gotten the best of his partisan fealty?

David Colton, counsel for the Information Technology Association of America, has the old case at his fingertips: MTS and WATS Market Structure, Order, 97 FCC 2d 682 (1983). That order wasn’t an accident, Colton said in an interview: “It was a principled free-market decision...that in the years that followed gave birth to AOL, to Compuserve, to every ISP [Internet Service Provider] that’s ever come into existence.” And to that honor roll of wealth- and job-creation, one must add such Internet-oriented manufacturers as Cisco Systems - - founded in 1986, seven years before Clinton and Gore took office.

Colton freely credits Hundt with continuing the pro-competitive momentum at the FCC, but of course, that’s not the same as starting it. Hundt’s entertaining book reveals much about how Washington works, but it reveals more about how history can be sculpted to serve a present-day partisan agenda.

Bob Herbert in the NYT--He's Right About Obama, But When Will He See Healthcare as the Next New Deal?

The New York Times' Bob Herbert is an earnest liberal. Eschewing sarcasm and irony--the most prized attributes of most columnists these days, at least within the hermetic circles of professional chatterers--he simply makes his case for domestic liberalism. And while he was on board with Obama for a long time, he has gotten off the train, lately. Take a look at his column this morning:

The talk inside the Beltway, that super-incestuous, egomaniacal, reality-free zone, is that President Obama and the Democrats have a messaging or public relations problem. We’re being told — and even worse, Mr. Obama and the Democrats are being told — that their narrative is not getting through. In other words, the wonderfulness of all that they’ve done is somehow not being recognized by the slow-to-catch-on masses.

But the real problem, Herbert says, is not "message," it's jobs:

The economy shed 36,000 jobs last month, and that was trumpeted in the press as good news. Well, after your house has burned down I suppose it’s good news that the flames may finally be flickering out. But once you realize that it will take 11 million or more new jobs to get us back to where we were when the recession began, you begin to understand that we’re not really making any headway at all.

Continuing, Herbert adds:

Instead of focusing with unwavering intensity on this increasingly tragic situation, making it their top domestic priority, President Obama and the Democrats on Capitol Hill have spent astonishing amounts of time and energy, and most of their political capital, on an obsessive quest to pass a health care bill.

Health care reform is important. But what the public has wanted and still badly needs above all else from Mr. Obama and the Democrats are bold efforts to put people back to work. A major employment rebound is the only real way to alleviate the deep economic anxiety that has gripped so many Americans. Unaddressed, that anxiety inevitably evolves into dread and then anger.

Herbert then wraps it up in a soundbite:"But while the nation is desperate for jobs, jobs, jobs, the Democrats have spent most of the Obama era chanting health care, health care, health care."

So we can see that Herbert is mindful of both "lobes" of contemporary liberalism--past and present. The past lobe is the New Deal lobe: If people need jobs, get 'em jobs. The present lobe is the Great Society: If people need services, provided by middle class professionals, get 'em services--even if they don't want the services. We can quickly grasp that the politics of the New Deal are a lot better than the politics of the Great Society; that's one reason why, for example, the New Deal Democrats won the White House in seven of nine presidential elections from 1932 to 1964, while beginning in 1968, they have lost seven of eleven presidential elections.

OK, so suppose Obama wanted to get off the "services" train, and on the "jobs" train? What would he do? Paradoxically, one place he could start would be healthcare. Healthcare is actually a great source of jobs--but not, of course, if you're trying to ration healthcare.

Meanwhile, the Obamans have take a different turn, they are now trashing the insurance companies. An interesting strategy, albeit not likely to help them get their bill through. However, insurance company bashing will give them some good attack lines as they increasingly resign themselves to "governing from below." That is, having lost the majority in Congress-at least anything like a working majority--the Democrats can now revert to being critics of the status quo. It worked in 2007, it might work in 2011. Of course, Obama will still be president, but if he is willing to go on the attack, against insurance companies, Wall Street, etc., it might work for him. It will surely work better than this.

Jim Pinkerton Debates Healthcare With Robert Wright

A spirited discussion of Serious Medicine with Robert Wright on Serious Medicine for Bloggingheads.tv.

Bob is a well-known author, a techno-visionary--Bloggingheads.tv was his co-creation--and a brilliant fellow overall, but he seems to be a bit behind the curve on healthcare thinking, but alas, he is still mired down with the Obamanik rationers. I don't think he has yet figured out that I agree with much of what he wrote in one of his books, Nonzero.

You can start watching only the healthcare portions of our wide-ranging discussion here.

The Cost Curve vs. The Innovation Curve: New Breakthroughs In Non-Invasive Diagnosis--Why Aren't You Hearing About This?

Shall we do less diagnosis--or more? The dividing line is clear: The governing elite wants us to have less, everyone else wants more. So who will win? In the long run, the will of the vast majority will prevail, but in the short run, it's a jump-ball between "less" and "more," between the rationers and the consumers. So the only question is how much damage the elites will do in the short run, before the long run trend of technological exuberance asserts itself. So it's important to understand: The real bending of the curve that is going on today is not the flattening out of any cost curve, but rather, the attempted flattening out of the innovation curve. And if the innovation curve is flattened, the cost curve will rise, even as productivity and life-prospects fall.

And because the bulk of the Main Stream Media are in tune with the rationing, restrictionist elite, news about breakthroughs is reported, but MSM reporters choose not to make the connection between the science of healthcare and the politics of healthcare. So science, and scientific entrepreneurship, does its thing, in its sphere, while politicians do their thing, in their sphere--and never the twain shall meet, at least not in Washington DC.

Except, of course, when politicized activists seek to do the bidding of the political class, seeking to flatten out the innovation curve. Recently here at Serious Medicine, we have taken note of the pushback against diagnosis, including CT scans. The SMS view is that various healthcare reformers and gadflies, in their zeal to see Obamacare enacted, and in their larger green zeal to see an overall de-technologification of society, are doing their best to minimize the importance of early diagnosis, because they think it will be cheaper for the government. Ignorance might not be bliss, but it is cheaper--in the short run.

Such willful blindness was the backstory, for example, of the mammogram flap of late last year, as the US Preventive Services Task Force, convened by the federal government, recommended fewer screenings for breast cancer. The recommendations were immediately hooted down, of course, which reminds us how politically toxic such rationing-think is among ordinary people. Indeed, such screening "savings" are the dictionary definition of penny-wise and pound-foolish; yet that's all too often the story of government finance--today's governments, eager to make their own budget numbers look good, will happily push vastly greater quantities of red ink onto tomorrow's budget.

Still, there are legitimate issues of concern surrounding some kinds of diagnosis. Yesterday in The Wall Street Journal, reporter Laura Landro noted some challenges to CT scans--specifically the danger of radiation. But as Landro also notes, there are plenty of alternatives, from different scanning technology to reductions in the radiation dose:

While one CT scan has a minimal risk for any patient, "the damage from radiation is thought to be additive over time," says Steven Birnbaum, a radiologist affiliated with the center and developer of the program. In 2008, 15% of scans were canceled and 15% switched to an MRI or ultrasound as a result of the program.

Health-care providers are also taking steps to lower the radiation dose in tests that are deemed necessary by changing the speed of the scan or the intensity of the radiation. Using scans on cadavers, for example, researchers at Loma Linda University Medical Center reported in December that they were able to reduce radiation exposure by 95% and still detect kidney stones.

So there are ways to overcome these challenges, while continuing to pursue the best possible diagnosis. And now a new report from Israel tells us that diagnosis of coronary artery disease might be done through a simple stress test on a finger--repeat, on a human finger. It doesn't even break the skin. This possible breakthrough was first seen on Breakthrough Digest, and offers plenty of hope:

Researchers at Rabin Medical Center used an innovative respiratory stress test developed by SPIROCOR TM Ltd. The test uses a Pulse Oximeter (PPG) to measure a patient’s blood flow in the finger in response to his or her paced breathing for 70 seconds. PPG data captured in the study are recorded immediately and analyzed using a proprietary algorithm that determines the Respiratory Modulation Response in a percent value. The findings of this study were further validated in research recently published in Cardiovascular Revascularization Medicine.

“Identifying significant coronary artery disease through non-invasive testing is very challenging,” said Dr. Ran Kornowski, Director, Interventional Cardiology, Rabin Medical Center, Tel Aviv. “This study shows that the SPIROCOR test is a simple and non-invasive test that independently predicts significant coronary artery disease in patients referred for a coronary artery evaluation.”

The point here is that if science is allowed to continue, as well as entrepreneurship, we will see all sorts of breakthroughs of this type. We will get closer and closer to the "Tricorder" that we saw on the old TV show "Star Trek"; a completely non-invasive medical device. Indeed, GE's V-scan, released last year, is a major step toward the iPhone-ization of healthcare (there's an app for that!). But there's a lot more Moore's Law-ing to be done before we get to Trekkie technology. And yet to get that nirvana of non-invasiveness, the answer is not to do less R&D, it's to do more.

And in the long run, it will all be cheaper, just as we have seen with every other category of electronics. That's a the machinery Spirocor uses, pictured above. No doubt there's a lot of capital tied up in Spirocor's R&D--it takes vast brain power to miniaturize machines. And in addition, if the technology proves out, Spirocor deserves a great return on its investment. But as with cell phones and every other kind of electronic device, the price will plummet as soon as this finger-meter--although Spirocor prefers to call it a "pulse oximeter"--is mass produced. So bring it on!

In the pithy formulation of Serious Medicine Strategist Jeremy Shane, "Technological innovation + valuable need x affected population = bending the cost curve."

And a last point: Before your elected representatives, Senators or Members of Congress, vote on the Obamacare healthcare bill, why not ask them if they are familiar with Breakthrough Digest, or any of the news therein? If not, then chances are that they don't know much about bending the curve on healthcare.

Will Healthcare Reform Create Jobs?

The Center for American Progress, searching for inventive ways to spin Obama-style national health insurance, argues that the sort of healthcare legislation it supports would create at least 2.5 million new jobs in the next decade.

Now of course, it is common knowledge that healthcare is one of the fastest-growing sectors in the economy. A 2004 study from the US Department of Labor, for example, found that six of the ten fastest-growing occupations through 2012 will be were health-related. (For the record, those fast-growing categories are, medical assistant, physician assistant, home health aide, medical records assistant, physical therapist assistant, and physical therapist aide.)

So is that what Center for American Progress has in mind? The expansion of those kinds of jobs, or others in the health field? No, not at all. Instead, the CAP asserts that Obamacare will lower healthcare costs and thus make it easier for firms to hire new employees. One might first note that CAP should be careful with such a line of reasoning, because if the left gets in the habit of admitting that lowering burdens on business is a way to increase hiring--well, who knows where that line of thinking could end up.

And of course, one might further note that not everyone agrees that Obamacare will lower healthcare costs. For example, according to a survey published by the Society for Human Resource Management, a full 71 percent of employees think that Obamacare will raise their costs, not reduce them.

But second, we might note that CAP seems completely uninterested in the healthcare sector itself as a source of jobs. Consider the CAP argument:

A more optimistic view of health reform recognizes its potential to improve the efficiency of the U.S. health care system. More efficient health care will lower the burden of health insurance premiums for firms, and in turn allow them to hire more workers. This will also increase the number of jobs and at the same time reduce the financial woes of those struggling with uninsurance and a depressed labor market.

We found in a recent analysis that the reduction in health insurance premiums caused by health care reform would create between 2.5 million to 4 million additional jobs over the next 10 years, at a rate of 250,000 to 400,000 per year. This study extends those results to show how many jobs health care reform would create in each state.

No mention that I could find, anywhere in the CAP post, of the actual existence of the healthcare sector itself, or its employment. Yet as we have learned by now, the left has such an eagerness to enact national health insurance--or, maybe, such an aversion to medicine--that now ignores even the mere thought that anybody would make a living in the healthcare field. Roll over, Hippocrates.

But as noted here at the SMS in the past, if the goal is to get the economy out of a recession, it doesn't make much sense to provoke a recession in one of the biggest sector of that same economy.

Newsweek's Evan Thomas Has Some Good Advice For President Obama: Lead on Malpractice Reform

Evan Thomas, the Newsweek veteran--and author or co-author of many books on US history--makes a great suggestion at the end of his column,

But is there anything more he could do—anything immediate and concrete—to cut through the Gordian knot tying up health care?

Actually, there is. Obama is well in-formed enough to know that sky-high malpractice-insurance rates and defensive medicine drive up health costs. There is debate over how much, but any doctor will attest to the costly fear of a lawsuit. Almost all objective medical experts agree that something should be done to cut back the vast jury verdicts won by clever trial lawyers in medical-malpractice cases. But the Democrats have declined to even try. Why? Because trial lawyers are among the biggest campaign contributors to the Democratic Party.

If Obama were to come out squarely for medical-malpractice reform—in a real way—he would be making an important political statement: that as president he is willing to risk the political fortunes of his own party for the greater good. It would give him the moral standing, and the leverage, to call on the Republicans to match him by sacrificing their own political interests—by, for instance, supporting tax increases to help pay down the debt. At last week's summit, Obama said Republicans were overstating the costs of medical malpractice, but suggested that some remedies might be pursued at the state level. He'll have to do more than that to break through the partisan paralysis. But, as young Marines and soldiers understand, real leadership requires risks.