Saturday, November 21, 2009

Harvard Study Debunks Health IT Claims

Projections of Savings from Health IT are Baseless, Harvard Researchers Say

National survey of U.S. hospitals shows information technology has yielded neither administrative efficiencies nor cost savings

WASHINGTON - November 20 - The increased computerization in U.S. hospitals hasn't made them cheaper or more efficient, Harvard researchers say, although it may have modestly improved the quality of care for heart attacks.
The findings, published in today's [Friday's] online edition of The American Journal of Medicine, contradict claims by President Obama and many lawmakers that health information technology (health IT), including electronic medical records, will save billions and help make reform affordable.
"Our study finds that hospital computerization hasn't saved a dime, nor has it improved administrative efficiency," said lead author Dr. David Himmelstein, associate professor at Harvard Medical School and former director of clinical computing at Cambridge Hospital in Massachusetts. "Claims that health IT will slash costs and help pay for the reforms being debated in Congress are wishful thinking."
The study uses data from the most extensive survey ever undertaken of hospital computerization. Data from approximately 4,000 hospitals for the years 2003 to 2007, including those on a list of the "100 Most Wired," were analyzed for evidence of increased quality, cost savings or improvements in administrative efficiency.
The data came from the authoritative Healthcare Information and Management Systems Society (HIMSS) Analytics annual survey of hospital computerization; Medicare Cost Reports that virtually all hospitals submit annually to the Centers for Medicare and Medicaid Services (CMS); and the 2008 Dartmouth Health Atlas, which compiles CMS data on costs and quality of care.
Although the researchers found that U.S. hospitals increased their computerization between 2003 and 2007, they found no indication that health IT lowered costs or streamlined administration, even in the "most wired" institutions. While U.S. hospital administrative costs increased slightly, from 24.4 percent in 2003 to 24.9 percent in 2007, hospitals that computerized most rapidly actually had the largest increases in administrative costs. (By way of comparison, older studies have estimated administrative costs in Canadian hospitals at 12.9 percent).
The study found no evidence of lagged effects, e.g. lower costs in 2007 resulting from information technology introduced in 2003.
Modest quality gains were noted in the treatment of heart attacks (acute myocardial infarction) in more-computerized hospitals, but even these small improvements may merely represent better documentation rather than actual gains to patients.
Himmelstein said a report from the Congressional Budget Office in 2008 signed by Peter Orszag, now Obama's budget director, expressed skepticism about claims by the RAND Corp. and others that health IT could generate $80 billion annually in savings.
"Part of the CBO's skepticism was based on the limited information available to the RAND study and similar studies," Himmelstein said. "But this new, detailed, national survey of diverse hospitals shows such doubts are well-founded. Information technology can't rescue us from our national health care crisis."
Dr. Steffie Woolhandler, professor of medicine at Harvard and study co-author, said several factors may explain why health IT has failed to reduce administrative costs.
"Any savings may have been offset by the costs of purchasing and running new computer systems," she said. "In addition, most software is designed around the accounting and billing needs of hospitals, not the clinical side."
She noted that a computer success story in recent years has been at the Veterans Administration, where global budgets eliminate most billing and internal cost accounting, allowing physicians to focus instead on delivering care.
"The VA system now has our nation's highest quality and patient approval ratings," Woolhandler said. "Congress should take note: to get the most benefit from our health care dollars and from health IT, we should adopt a single-payer, Medicare-for-all program. Nothing short of that will allow us to reap the full potential of computerization or to provide comprehensive, quality and affordable care to all."
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"Hospital computing and the costs and quality of care: a national study," David U. Himmelstein, M.D., Adam Wright, Ph.D., and Steffie Woolhandler, M.D., M.P.H., The American Journal of Medicine, Nov. 20, 2009 (online).

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Physicians for a National Health Program is a single issue organization advocating a universal, comprehensive single-payer national health program. PNHP has more than 15,000 members and chapters across the United States.

Physicians For National Health Program (PNHP) Links:

Thursday, November 19, 2009

Pierre Tristam column

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Published on Thursday, November 19, 2009 by Pierre Tristam.com

Nuclear Power’s Megafraud

by Pierre Tristam

Energy independence is the new creationism; nuclear power its deity. As the head glow for nuclear's new dawn, you can't do better than Aris Candris. He's president and CEO of Westinghouse Electric, the company aiming to build 14 of 25 new nuclear reactors planned in the United States. Candris also sums up everything that's wrong with the nuclear power industry's orchestrated revival-the deceptions, the manipulated numbers, the false promises and the sheer swindle of taxpayer dollars for a technology with a lethal past and an unproven future. Candris' Nov. 9 tribute to nuclear in The Wall Street Journal tells the tall tale.
Candris claims that, because electricity demand will grow 21 percent by 2030 from current levels, and "renewable energy sources produce only a small percentage" of total electricity output, it's "doubtful that they can be scaled up to a degree that would make a significant impact on rising electricity demand over the short or intermediate term." Actually, that's more true of nuclear, far less so of renewable. Not a single nuclear power plant has been approved and built in the United States since the 1970s. The newest one, Watts Bar in Tennessee, began construction in 1973 and went online in 1996 -- a 23-year span that multiplied its initial costs, to $7 billion. Candris gives the impression that a slew of plants are about to be built. Not so. A slew of plants applied for licenses, but only because the federal government is offering up to $1 billion in tax credits per new nuclear plant (once electricity production begins), as long as the application was in by the end of 2008.
"We expect the first of these new plants to come online about 2016," Candris writes of Westinghouse's planned construction, which includes reactors for Progress Energy and Florida Power & Light's Turkey Point plant south of Miami. But the Nuclear Regulatory Commission three weeks ago declared Westinghouse's designs flawed and possibly in need of redesign. Westinghouse's Web site still claims its reactors will churn by 2016. Look for pigs flying around Turkey Point, too, because Westinghouse's claims are identical to those of Areva, a French company building what was supposed to be a next-generation nuclear plant in Finland-quick, safe, cheap. The plant, Europe's first in 30 years, was supposed to open last summer. Finns will be lucky if it's open by 2012. It was to cost $3.5 billion. The cost is now creeping close to $7 billion and counting.
Candris presumes that growing electricity demand is "too great to satisfy with energy efficiency and conservation alone." And he points to France, which produces 80 percent of its electricity through nuclear energy, as the model of "the world's most nuclear-dependent and energy-independent country." But French electricity consumption is 7,200 kilowatts per person per year, 44 percent less than the American consumption of 12,900 kilowatts per person. France is a model-of conservation. (Candris is wrong about France's independence: it imports all of its oil and natural gas.)
In the United States between 1995 and 2008, electricity consumption increased by 22 percent, more than the projected increase over the next 21 years. The country coped without gobs of nuclear power-and can cope again as renewables like wind and solar increase their share of electricity generation, from 5 percent today (compared with nuclear's 20 percent) faster and safer. Imagine if renewables had the kind of obscene tax subsidies the nuclear industry is receiving.
Candris' final fallacy: Renewables are "comparatively more expensive energy sources." In fact, nuclear energy is more expensive than solar or wind energy. Take Florida Power & Light's plan to build two new nuclear reactors sometime over the next 12 years (it's not clear when, though the company is already socking it to customers by making them pay for construction today. No other state but Georgia allows that con). The projected cost of the two reactors is $18 billion. It'll certainly go up well beyond that by the time they're done, but go with the $18 billion figure. The two reactors will produce 2,234 megawatts of electricity. That comes out to $8 million per megawatt at the opening bell. FPL just started operating a 25-megawatt solar-power plant in DeSoto County. Cost: $152 million, or $6 million per megawatt -- $2 million cheaper than the projected cost of the nuclear reactors. With wind, it's even cheaper. A Chinese-American consortium on Oct. 29 announced plans for a 600-megawatt wind farm in West Texas. Cost: $1.5 billion, or $2.5 million per megawatt. Cheap nuclear power? Demonstrably not.
Keep in mind that wind and solar farms require zero raw materials to operate, and minimal security. Terrorists aren't about to crash planes into wind turbines or solar panels. Operating a nuclear plant is said to be cheaper than operating gas- or coal-fired plants-but not when security, liability and potential catastrophes are figured into the equation. And for all the safety advances of the past 30 years, the current fleet of about 100 reactors has a projected Chernobyl- or Three Mile Island-like severe accident rate of one every 100 years. Would you like to live near those odds?
The nuclear power industry can't even persuade its own investors to bet on it, so it's going after tax dollars and captive customers to pay for its dreamed-up expansion. Simple solution: If nuclear power can make it on its own, fine. But it's far too dangerous, too uncertain, too costly and too tempting to terrorists to be subsidized by taxpayers and unwilling customers. So far, the nuclear power industry is betting equally and exclusively on public dollars and gullibility. Don't let it get away with it.

Tristam is a News-Journal editorial writer. Reach him at ptristam@att.net or through his personal Web site at www.pierretristam.com .

Wednesday, November 18, 2009

Columnist Opeyemi Parham

American actor John Cusack at a Dow Jones' D C...

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My Cultural Creative Visit to the World of Moderns

The movie that should have been the blockbuster for the month of
November didn’t even come close. Michael Moore’s “Capitalism—a Love
Story” was in competition with the totally distracting movie “2012.”
Let’s keep The Masses asleep to their own pain and suffering. Let’s
actually play on their deeper psychological desires and wishes.

I am outside that Modern culture of malls and materialism. Here is
what I saw, in that horrible film. Moderns watching that film might
not notice the intense manipulation of their emotions. It is no
accident that the hero—John Cusack’s character-- represents everything
to which Moderns SHOULD be waking up. He is a writer, who writes
well, yet whose books don’t sell. He neglected his family in a vain
attempt to live up to the dominator culture’s role of husband and Dad,
then was divorced by his frustrated wife. As the movie begins, he is
sinking, and sinking fast. He is employed as a chauffeur for a big
nasty Fat Cat.This is exactly the type of viewer that should be over
at “Capitalism—a Love Story”, getting an education on plutocracy,
dead peasant’s insurance and gotcha capitalism. The promise of stuff,
and the reality of debt, exposed. But we aren’t at the Michael Moore
film. We are at the big Blockbuster Fantasy.

Enter the end of the world, as we know it. Mr. Failure has an
opportunity to re-invent himself, shining through adverse situations
one after another, ordeal after ordeal after ordeal, winning the love
of each member of his family back along the way, and guiding them to
safely take their place in the New World Order. That is the narcotic,
designed for unhappy middle class American men. Ignore your
creativity, continue to just stuff it down. A better day will come
for you, lottery style.

Then we move onwards, to the manipulative message for middle class
women. John Cusack’s wife is described as having dropped out of med
school to support her family, when her husband was trying to write.
Her character arc, as the world falls apart, is clearly written by a
man. Ms. Former Pre Med is portrayed as a woman who doesn’t even get
up off of her ass to SEE what is going on as they are escaping, but
simply cowers in the corner, guarding her children. The plot
development and character arc on this one feeds on Modern women’s
CONFUSION about their roles in their families. Many are finding
that—without a sufficient connection to a consciousness raising men’s
movement (similar to what happened for women in the 1970’s)—their men
are behaving like adolescent boys. Here, the adolescent boy grows up;
he morphs into the man of her dreams (despite a pretty decent step-dad
to her children who has entered the picture, but is too “geeky” to
merit a place in the New World Order), The couple, reunited, come out
of the ark into the sunlight together, Mr. Adam and Ms. Eve.

No Lillith, anywhere in the picture.

There is a homogenized version of the above scenario for us African
Americans, too. We are represented, magic negro style, in the
characters who earn their place in the New World order. Yes, we take
meritocracy values forward, with us. In this case, the man is smart.
And the woman is the daughter of the president.   No, I don’t consider
her title of “Doctor” (a PH.D in art history) a suggestion that she
has actually EARNED her spot; it is her status as the daughter of the
president and her drop dead gorgeousness that gets her a “yes” vote.

Dare I continue on to the manipulative psychological messages for
middle class Modern children? In a culture of broken families,
children viewing this movie are presented with the option every child
of divorce longs for; their biologic parents are reunited.

And, having been so blatant in seeding this “my family is gonna win
the lottery as the world ends” this movie grinds it in, laughing in
our faces with a few other disturbing messages:

   The brilliant brown scientist from India, the one who discovered
the disaster that will take us all out, isn’t even picked up to take a
place on the ark with his family. Oh well.

A mysterious figure whose wealth is evident, but whose political
position is never fully explained (Oliver Platt’s character), is
always at the right hand of the president. When the political ship of
our democracy begins to go down, he places himself in charge AND STAYS
IN CHARGE.

   Fat Cats buy space in the arc at a billion euros a ticket. We are
manipulated into actually rooting for these scandalous plutocrats to
be successfully saved.

Why is all this of any importance? Because I pay attention when I am
feeling manipulated, emotionally. I remember the comments after 9/11
that some folks made: “I felt like I was watching a movie”

PAY ATTENTION: forces out there want to shape Moderns’ reaction to a
real life catastrophe. Post “2012: The Movie” don’t be surprised if
Modern Americans react to the next volley of severe weather as we
ratchet it up on global warming with something like: “What an
opportunity to get back together with my ex!”

--
Opeyemi 413-336-1291
“Be who you are, and say what you feel, because the people who mind
don't matter, and the people who matter don't mind"
Dr. Suess

Saturday, November 14, 2009

Glen Greenwald Column

Cover of "A Tragic Legacy: How a Good vs....

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Published on Saturday, November 14, 2009 by Salon.com

The Right's Textbook 'Surrender to Terrorists'

"We're too scared to have real trials in our country" is a level of cowardice unmatched in the world.

by Glenn Greenwald

Understanding and Combatting Terrorism, USMC Major S.M. Grass, 1989:

Terrorism is a psychological weapon and is directed to create a general climate of fear. As one definition cogently notes, "terror is a natural phenomenon, terrorism is the conscious exploitation of it." Terrorism utilizes violence to coerce governments and their people by inducing fear.

William Josiger, Fear Factor: The Impact of Terrorism on Public Opinion in the United States and Great Britain, 2006:

At its heart terrorism is about fear. While terrorist attacks destroy, maim and kill, the intended audience for these attacks is almost always the whole body politic and the terrorist's goal is to strike fear into their hearts.

GOP House Leader John Boehner, condemning Obama's decision to bring Khalid Sheikh Mohammed to New York for trial, yesterday:

The Obama Administration’s irresponsible decision to prosecute the mastermind of the 9/11 attacks in New York City puts the interests of liberal special interest groups before the safety and security of the American people.

This is literally true: the Right's reaction to yesterday's announcement -- we're too afraid to allow trials and due process in our country -- is the textbook definition of "surrendering to terrorists." It's the same fear they've been spewing for years. As always, the Right's tough-guy leaders wallow in a combination of pitiful fear and cynical manipulation of the fear of their followers. Indeed, it's hard to find any group of people on the globe who exude this sort of weakness and fear more than the American Right.
People in capitals all over the world have hosted trials of high-level terrorist suspects using their normal justice system. They didn't allow fear to drive them to build island-prisons or create special commissions to depart from their rules of justice. Spain held an open trial in Madrid for the individuals accused of that country's 2004 train bombings. The British put those accused of perpetrating the London subway bombings on trial right in their normal courthouse in London. Indonesia gave public trials using standard court procedures to the individuals who bombed a nightclub in Bali. India used a Mumbai courtroom to try the sole surviving terrorist who participated in the 2008 massacre of hundreds of residents. In Argentina, the Israelis captured Adolf Eichmann, one of the most notorious Nazi war criminals, and brought him to Jerusalem to stand trial for his crimes.
It's only America's Right that is too scared of the Terrorists -- or which exploits the fears of their followers -- to insist that no regular trials can be held and that "the safety and security of the American people" mean that we cannot even have them in our country to give them trials. As usual, it's the weakest and most frightened among us who rely on the most flamboyant, theatrical displays of "strength" and "courage" to hide what they really are. Then again, this is the same political movement whose "leaders" -- people like John Cornyn and Pat Roberts -- cowardly insisted that we must ignore the Constitution in order to stay alive: the exact antithesis of the core value on which the nation was founded. Given that, it's hardly surprising that they exude a level of fear of Terrorists that is unmatched virtually anywhere in the world. It is, however, noteworthy that the position they advocate -- it's too scary to have normal trials in our country of Terrorists -- is as pure a surrender to the Terrorists as it gets.

Glenn Greenwald was previously a constitutional law and civil rights litigator in New York. He is the author of the New York Times Bestselling book "How Would a Patriot Act?," a critique of the Bush administration's use of executive power, released in May 2006. His second book, "A Tragic Legacy", examines the Bush legacy.

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