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  • The Crushing Costs of Addressing the Crushing Cost of Health Care

    President Obama vows to “address the crushing cost of health care” by, among other things, “invest[ing] in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives.” Sounds great. Let’s take a quick trip across the Atlantic to see how that’s worked out for the British.

    In two words, not well. In 2002, Tony Blair ordered Britain’s National Health Service to participate in the National Programme for IT, and thus launched an ambitious attempt to computerize the entire Service. The initial projected cost: 2.3 billion pounds. It was widely described as the largest IT project in the history of the world.

    Fast forward to late 2008. Costs had risen to a minimum of 12.7 billion pounds, and since the system was 4 years late – and counting – its final cost, actual full in-service date, and even whether it would ever work at all remained up in the air. The Financial Times described it as exhibiting an unhealthy level of ‘Great Leap Forward Syndrome.’

    So what went wrong? Where to start. There was the crass malignancy of the government’s attitude to its suppliers. The official responsible for delivering the system compared the project to a sled team and failing suppliers to dogs who would be shot and fed to the survivors to motivate them. A year later, he abruptly quit the project after one key firm was accused of accounting irregularities and another major contractor dropped out and threatened to sue the government to escape from the affair.

    Then there was the incompetence of the Department of Health. The 2007 ‘competence review’ of the Department by the Cabinet Office is richly amusing. Of the 12 assessed areas, the Department got a green light in zero of them. The “Base Choices on Evidence” area was described, for instance, as an “Urgent Development Area.”

    In other words, the Department was pathetically bad at the elementary job of making decisions based on facts, and equally bad at learning from past errors. The House of Commons’ Public Accounts Committee produced a 180 page report on the system in April 2007 listing a similar avalanche of misjudgments: no delivery timetable, no cost controls, and no cost-benefit analysis.

    Above all, there was the faith in the top down model, and the resulting failure to realize that creating a system linking all doctors, hospitals, and administrators was going to be immensely expensive and complicated, and that building the system had no necessary connection to solving substantive problems. The Public Accounts Committee’s report summed it up by noting that the entire project was afflicted with a worshipful attitude to IT, which led to the delusion that it would be easy to fix complex social problems and simultaneously save money by applying large amounts of centralized technology.

    All of this led a senior executive at Fujitsu, which at the time had an 896 million pound contract for the system, to publicly compare it to a camel, a tightrope walker, and a sinking ship, and to sum up by saying:

    It isn’t working, and it isn’t going to work. There is a belief that the national programme is somehow going to propel transformation in the NHS simply by delivering an IT system. Nothing could be further from the truth. A vacuum, a chasm, is opening up.

    When Gordon Brown appeared before the Commons Liaison Committee two weeks ago, he was still defending the indefensible. Meanwhile, the chief executive of London’s Royal Free Hospital described the system’s trial deployment as “incredibly disappointing” and said it would cost the hospital an addition 10 million pounds a year to cope with it. In 2007, 91 percent of all doctors opposed it. A later survey found that most NHS hospitals were simply refusing to implement parts of the system. The Department of Health’s response was to impose massive fines on any hospital that refused to cooperate in full.

    And then there’s the question of privacy, which Obama raised. Many individual doctors are refusing to use the system: as one put it, “Any lock that can be opened by 50,000 keys is not secure.” That’s a wise attitude: in late January, the government came forward with a proposal, hidden in an obscure corner of the Coroners and Justice Bill, to allow ministers to “draw up new information-sharing orders that would allow them to release private data – such as tax returns, personal details or medical records – to any public or private body.

    Naturally, there will be safeguards. Naturally. But the only defense the government could make of the proposal was that it would “reduce the number of people who need to be notified of a death, thereby helping to relieve distress.” That’s right: a vast, comprehensive medical database is being compiled in Britain, with widespread information sharing by ministerial order, just so Britons will be spared the pain of notifying the gas company that their aunt has died. If you believe that, you probably believe Obama’s proposal will work too.

    Posted in Obamacare [slideshow_deploy]

    7 Responses to The Crushing Costs of Addressing the Crushing Cost of Health Care

    1. Ron, Derry NH says:

      Inexperience coupled with arrogance is the doom of all well intentioned ventures.

      The other dilemma is thinking history isn't documentation of well intentions gone bad BECAUSE of bureaucrats and not despite of the same.

      It is a shame our nation is now being lead by a level of arrogance and inexperience that is coupled with people who not only won't read history but can't even see it appearing in real time right before their eyes.

      The only way to benefit from the success of the past is to follow their examples and resist the usurpers approach of change for the sake of change, and get back to basics.

      We are not going to be so lucky. Presently we are not on a path of proved wisdom but one of exuberant arrogant abandonment of past principles for the sake of supreme ideology over sense.

    2. Vicky Lomax Oklahom says:

      Great article. Sounds like an expensive way to promote incompetance to me. Please Obama, don't do this to us!!!!!!!

    3. Scott B, Portland, O says:

      When I first heard about this I was really surprised. We completed this project in 2005. It was called HIPAA, Title II. You know those privacy forms you had to sign at your doctor's office? Those are the HIPAA Title II privacy forms. The software part of HIPAA included things like record format standardization, data communication standardization, medical procedure code standardization, and more.

      This proposal is really weird because the Obama administration is saying that they want to redo the work that was just completed. I don't get it.

    4. Pingback: Health Care Links « Brian Simpson

    5. Cindy, San Diego says:

      The only good news I can find these days is that every step this administration takes, it becomes more likely they will fail. I say fail quickly for the hope that America can somehow turn this around and kill this socialist anti-american movement.

    6. Jamey, Central Calif says:

      I do not except the lefts' premis at all. I work for a huge company that gives benifits. It is the same old song and dance, "we can't afford health care." B.S. They NET'D over 12 BILLION last year. That means that even paying the current premiums, they made billions. It is just cool to jump on the "healthcare" band wagon as a CEO to take the heat off of slowing stock shares.

      I believe there is an underlying problem that is of more concern. WHEN in america, is it profits at ALL cost. There was a time when right triumphed over wrong. When men of stature didn't need regulation to do the right thing. There was an unspoken law of the gentleman. A man's man. The kind of gentleman that stood for America. God and country. Now it is the bottom line first. The share holders need preformance. We are where we are now because big business has lost its' humanity. Making as much money as possible is the American dream, but not at the expense of what is right. If by paying health care to your workers SLOWS the stock dividends, it is the cost of doing business. I do not EVER want America to be in the place where business is forced to do so either. If you do though, it says a lot about you, and the state of the American people. Big business is going to hand health care over to Obama lock, stock, and barrel crying wolf the whole way.

    7. Barb -mn says:

      Get rid of health care insurance all together. Go back to the 1800's when the doctor treated the patient's health without insurance. And treated the patients health with the will to heal the patient. The patient would work it off or pay it monetarily or both. Everybody pays somehow. Nothing should be FREE to anyone. Permitting stringent exception.

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