Does It Work? Applying the Obama Test to Healthcare

Does it work?

That is the test President Barack Obama set out in his inaugural address for evaluating government programs.  When programs work, Obama said, we will “move forward.”  But when they don’t, he promised these programs “will end.”

Last week I asked readers to put aside their natural skepticism that any government program, no matter how dysfunctional, will “end” under the Obama Administration.  

And this week I’m taking a dose of my own medicine.  At the National Press Club yesterday, I joined with a group of physicians and healthcare experts to take the Obama challenge and apply it to healthcare.  We looked at Medicare, Medicaid, healthcare information technology and the range of healthcare programs and asked “do they work?”

You can watch the video here.

Fraud Accounts for As Much as 10% of All Healthcare Spending

The bad news we found won’t shock anybody.  In so much of our healthcare system, programs don’t work.

•    Outright fraud — criminal activity — accounts for as much as 10% of all healthcare spending, more than $200 billion every year.
•    Just 4% of doctors use advanced electronic medical records, despite irrefutable evidence that electronic prescribing, record keeping and communication saves lives and saves money.
•    The federal government treats science and healthcare investments as costs only, refusing to factor in the savings that result from investments like the $10 billion invested in basic research on HIV/AIDS between 1985 and 1995 that saved the United States $1.4 trillion in healthcare expenditures.

The Good News:  Health Entrepreneurs Are Creating Systems That Work

The good news is that there are healthcare entrepreneurs in America who are developing ways to provide more choices of better care at a lower cost.  The “best practices” they have developed aren’t theoretical.  They exist.  The key to transforming our health system is to see that they are adopted by all the players in the system, public and private.

•    A workplace-based healthcare plan in Omaha, Nebraska called Simplywell gives employees at the Greater Omaha Packing Company the tools they need to take charge of their own healthcare, including an electronic personal health record, tailored patient education, and annual screening. Repeat participants had a 27% improvement in normal blood pressure readings; a 16.7% improvement in normal cholesterol levels, and 41.3% fewer participants had elevated glucose levels — all at a cost per employee that was less than half the industry average.
•    The Massachusetts eRx Collaborative uses e-prescribing tools to allow physicians to access patient-specific prescription drug and medical histories, be alerted to drug-to-drug and drug-allergy interactions, and electronically transmit prescriptions directly to a pharmacy, minimizing possible errors from illegible handwriting.  In 2007, approximately 104,000 electronic prescriptions were changed or cancelled because of drug-safety alerts to the physician.  And data from the previous year show that e-prescribers saved 5% on their drug costs compared to prescribers that did not use the technology.
•    Memorial Hermann Health Centers for Schools, a group of five school-based clinics in Houston, Texas uses private funding to serve mostly uninsured students.  The centers diligently collect data and adjust their services to meet strategic objectives.  In 2006-2007, student asthma exacerbations, ER visits, and hospitalizations decreased by 67%; cholesterol levels among targeted students declined by 73%; and students who received mental health counseling had improved grade point averages and fewer suspensions, detentions, and days absent.

The Center for Health Transformation (CHT) has collected examples like these best practices that 1) Improve individual health and wellness through prevention and personal responsibility; 2) Improve the quality, administration and delivery of care; 3) Lower costs; and/or 4) Expand access to care.  All are available at CHT’s website,  

Four Steps to Saving Lives and Saving Money
Using these best practices as a base, the Center for Health Transformation has developed four initiatives to improve healthcare, lower costs, and insure every American:

The first is creating a healthcare system that works by insisting that the government and other healthcare players constantly adopt these best practices.  Best practices should drive policy — not the other way around.

Second is dramatically reducing healthcare fraud so the savings can help pay for health information technology and covering the uninsured.  Medicare fraud alone could account for as much as $40 billion in healthcare spending a year.  This level of theft and crime can be detected, eliminated, and then prevented with the right kind of technology.

Third is implementing science and investment-based budgeting with generation-long scoring.  This is an issue that I personally spoke to at length yesterday.  The federal government treats investments simply as costs and doesn’t take into account future savings that result from investments in science and healthcare. This must change if we are to have the kind of real change we need.

My Advice for Creating Electronic Health Records?  Be Like Ike

The fourth CHT initiative for transforming our healthcare system is one that President Obama has also made a priority: electronic medical records.  I couldn’t agree more with his goal of seeing that all our medical records are computerized within five years.

But as I pointed out in the New York Post recently, the hard part is making this goal a reality.  My advice?  Be like Ike.  President Dwight Eisenhower’s investment in creating the interstate highway system created a wave of productivity and prosperity that we continue to ride today.

The same can be true of electronic medical records.  Creating an infrastructure of an interconnected electronic health records system, that incorporates both the public and private sectors and the federal and state governments, is the first step in transforming our entire healthcare system and creating more choice of better care at lower cost.

To learn more about what some extraordinary Americans are doing to save lives and save money in their communities, go to  For a direct link to the video of yesterday’s event, click here.

Your friend,

P.S.  I’m not sure what to make of this inauguration video montage — or how the filmmakers managed to get so many people to participate — but it was fun to be a part of it.  Watch it here.

P.P.S. Some may find this video even more out of place than the former, but it is evidence that the right issues can unite people of all political stripes.  On Martin Luther King, Jr. Day I had the honor of speaking at an education reform rally hosted by the Reverend Al Sharpton and New York City Schools Chancellor Joel Klein. There was a long list of bipartisan speakers, including Sen. John McCain, former Education Secretary Margaret Spellings, current Education Secretary Arnie Duncan, New York Mayor Michael Bloomberg, D.C. Mayor Adrian Fenty, and others. Click here to watch the video of my speech.

P.P.P.S. I was proud to record a video on behalf of Kids First Awareness Learning Center, a non-profit after school learning center for at-risk children run by American Solutions activist Cindy Hawkins.  Click here to watch the video, which includes my introduction and interviews with parents and teachers, and click here to learn more about the program.


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