Effect Measure

If the 1960s film, The Graduate, were to be made today (Graduate, II: The Stimulus), the iconic scene at the party where a friend of the family takes Dustin Hoffman aside and whispers in his ear, “I have only one word for you, Plastics“) would be transmogrified into, “I have only three words for you, Health Information Technology.” HIT, and its love child with the recently passed stimulus package, the Electronic Medical Record, have all the characteristics of a good idea destined to go bad. One of my vivid memories from my early career was being shown a new kind of quiet printer, called an ink-jet, in the Mass General laboratories of Dr. Octo Barnett, one of the early pioneers of electronic medical information systems. Octo was an evangelist and visionary for the new digital technology at a time when most doctors had never seen a computer, much less used one. He was himself a physician working in a hospital and he had a keen appreciation for the problems in adapting the technology to medical practice. He had no option for making medical practice adapt to the technology, so his knowledge and experience was especially pertinent to making the technology work for medicine and not the other way around. Unfortunately Octo’s experience seems to have been lost somewhere along the way. This is a theme ably and persistently presented by the bloggers over at Health Care Renewal, in particular Dr. S. Silverstein who blogs under the name MedinformaticsMD:

As many have now observed, electronic medical records products on the market are clunky, fail to support the cognitive and workflow needs of clinicians, contribute to clinician cognitive overload and increased clerical work burden, and may be harming patients at a rate far higher than, say, VIOXX, which was summarily withdrawn from the market to be followed by billions of dollars of lawsuits.

Health IT can indeed improve healthcare quality, reduce costs and achieve other benefits claimed of it, but only if it’s done well. There is tremendous underlying social and technical complexity underlying those two words “done well”, and unfortunately in 2009 most health IT is simply not done well. Yet the technology is actually worshipped in what I see as a Bernard Madoff syndrome, an irrational exuberance in IT for reasons not entirely clear to me considering the existing objective evidence. (MedinformaticsMD, Health Care Renewal)

The example of Vioxx seems especially pertinent given recent work purporting to show that the adverse cardiovascular effects of that arthritis drug might have been picked up if there had been a medical information system available to mine. As an Editorial in Nature notes, Obama’s enthusiasm if not infatuation with HIT as a saviour for runaway medical costs is just the next step in a program initiated by his predecessor, George W. Bush in 2004. Bush established the office of a national coordinator for a program to have access to an Electronic Medical Record (EMR) for every American by 2014. The stimulus bill spends 53 or its 407 pages on this and pumps $19 billion into pushing Bush’s plan forward. Ironies abound. Most of the discussion about EMRs has been about their use in improving the quality of clinical practice, although probably it is cost control that will be the lever that makes it happen. Nature calls attention to another feature of HIT that is especially seductive to those of us in research, especially epidemiologists like me: the use of EMRs for population studies, including but not limited to post-market surveillance of drugs and medical devices (the Vioxx case).

MedinformaticsMD and others (see links at the end of his piece here) have called attention to a number of possible undesirable effects of a badly done HIT effort (and in the view of many of us the speed with which it is being urged on us is likely to lead to a bad outcome), but there are also many deatils to be ironed out on the research end, too:

Imagine, for example, that Mrs Smith checks into the hospital for hip-replacement surgery. Her doctors will be able to call up the electronic records of her personal physician, her physical therapist, her pharmacist and everyone else who provides her with health care. But this scenario poses some knotty questions. Even leaving aside the technical challenge of securing all those far-flung databases against attacks by hackers, who has the right to access any given database? And how much are they allowed to see there ? everything, or just those portions of the data they need for their jobs, keeping the rest private? And who decides? Patients? Doctors? Hospitals? Anonymization and pseudonymization, in which identities are masked but all data can still be ascribed to respective individuals, protect individuals while enabling research, but how should such measures best be implemented?

These questions have been contentious even in the United Kingdom, which has deployed an electronic records system through its unified National Health Service. They will be even more contentious in the United States, where the health system is anything but unified, and where privacy concerns run deep.

The scientific questions are just as knotty. For example, will each patient have to give permission each time a researcher wants to access his or her records? That sounds reasonable ? and indeed, this is the spirit of the strict data privacy and security provisions of the federal Health Insurance Portability and Accountability Act. But that would make using the records for, say, routine epidemiology prohibitively cumbersome. There needs to be a clear policy allowing for such uses, as long as the researchers have no access to any aspect of the data that reveal a person’s identity. But at the same time, the health-records system should provide individuals with an audit trail that shows them who has been looking at their records, and what they have seen there.

Or consider another scenario: a research group that wants to do a study aggregating EHR data over a large area. Will they have to get approval from every Institutional Review Board (IRB) ? which oversee all research on human subjects in the United States ? in every hospital and university involved? Common sense suggests that one IRB process is enough ? and then only if the research uses personally identifiable data. But mechanisms to coordinate the oversight will have to be created. (Editorial, Nature)

Don’t get me wrong. As a researcher I look enviously at my colleagues in countries where a national health system provides them with research resources (for an epidemiologist this means data) almost unheard of in the US. But I see a rocky road ahead and I am not especially optimistic. I fear HIT will neither live up to its promise of saving money nor of providing a gold mine of research data. It will fulfill its potential for changing medical practice in unforeseen ways (some of them perhaps even good). This is not a function of government intervention in health care. It is being forced upon us by a way of financing and practicing medicine that has broken the bank and needs to be reined in. If left up to the private sector, as it has been until now, HIT will almost certainly turn out even worse, with incompatible systems allowing no way to exchange data and giving us data mainly geared to what private insurance companies want (and don’t want), not what the patient needs.

The US will likely remain backward among modern industrialized nations when it comes to its medical care system, and that will include its medical information systems. As I said, ironies abound.

Comments

  1. #1 M. Randolph Kruger
    March 20, 2009

    I agree with most of your post Revere, this system here would be used against us for a number of reasons.

    I have read the portions of the Presidents plan for a nationwide database and its not a question of who has access to your information, its how many. Primary Tier 1’s (hospitals-Primary Care docs)—-240,000 entities with how many employees could access it. Why hack it? Everyone will have access to it anyway. Then there is the use for insurance purposes and studies, and the lawsuits that will follow. There simply isnt anyway for it to remain private and the worst part…Government will run it. The FBI, police, DHS/TSA everyone will be able to get ALL of your information then. Its bad enough now when you check in, how about if you were a recovered mental patient? Or our old favorite – TB. Or just about anything else they want to tag you on.

    Lets see they tell you to protect your address, your phone number, your date of birth, your social security number… And you want to give that AND your medical history and records to the government?

    How about that DNA thing….Used against you in a court of law without being able to face your accuser. This is yet another whittling away at our civil liberties and all in the name of what…Healthcare? Forget it.

    This is a bad idea of the most immense proportions and there are security breaches from one end of the Brit and other systems to other.

    http://www.ihealthbeat.org/Articles/2007/7/25/Indianapolis-Hospital-Data-Breach-Affects-51000-
    Patients.aspx

    http://news.bbc.co.uk/nol/ukfs_news/hi/newsid_7760000/newsid_7764000/7764069.stm

    How about PM Browns records being breached?
    http://www.theregister.co.uk/2009/03/02/nhs_database_breach/comments/

    http://www.canhealth.com/News871.html

    http://www.aapsonline.org/nod/newsofday482.php

    And Revere, if we ever get into a bug fur ball the OpFor could get access to the DNA and tailor make bugs that are specific to say…Britons, or Americans.

    UHC is bad enough, giving them total control over your bodies and your information is the worst affront to civil liberties in the name of health in the history of the world.

    World government folks, thats the push. They’ll call it something else, but thats what it is plain and simple. Control the media, make it sound like it will save money. Hell they have all your records now at the insurance companies, now we are going to give it to the government too? They’ll be notifying you when to show up for work and noticing when you are not there and say its all in the better public interest…. And then the wrist bands will be replaced by biometric chips implanted and they’ll say you cant do this or that unless you have one implanted, thus making you a criminal by condition.

    More socialist control.

    Sorry, I’ll be opting out or hitting the courts with this one.

  2. #2 Tasha
    March 20, 2009

    Revere, I understand your concerns. However (whether this was the intent or not) your post has an overarching tone of surrender – “HIT will never work, why bother.”

    I respectfully disagree. The obstacles may be difficult, but are not insurmountable. And if we don’t invest time and effort on working on the issues now, things are only going to get worse are individual hospitals entrench themselves in their own incompatible IT systems and become less willing to convert to a national standard.

    Historically there are plenty of models for this type of project. It all starts back to the famed Chicago fire – all of the fire departments had their own hoses, none of which matched the fire hydrants, and buildings needlessly burned down. Hence the birth of ANSI standards. The basic idea is that if we all get together and agree on one standard, we can work together compatibly. The wrench you buy at Home Depot will always match the bolt you buy at Lowe’s, because it’s all based on a standard.

    In IT, these compatible standards mean that we can communicate together easily. The standards aren’t always perfect, and they don’t always meet everyone’s needs, but they create the basic building blocks for a unified information system.

    As for security of the electronic records – perhaps I am naive, but this always feels like a straw man argument to me. There is no guarantee that anyone’s records are secure now. In fact, medical records actually have a higher value on the black market than credit records. Why? Because it takes everyone so darn long to realize that they’ve been stolen, so they are more viable for longer. Perhaps if medical records could be monitored on a national scale (similar to credit records) this would actually increase security.

    Finally, the issue of privacy. This is perhaps contentious, but how are we handling this now? When a patient is referred, does the primary doc only send a small portion of the medical file? Is any of the medical file passed on? In larger medical systems and HMOs, who already have their own electronic medical records, how is this done?

  3. #3 MedInformaticsMD
    March 20, 2009

    The obstacles may be difficult, but are not insurmountable. And if we don’t invest time and effort on working on the issues now, things are only going to get worse

    I tend to agree.

    The outstanding problem is, most in health IT are amateurs who don’t understand what the most crucial issues are.

    (I use that in the same sense that I am a radio amateur, extra class, with significant knowledge and experience, but not a radio telecommunications professional who would consider himself appropriate to manage a complex telecommunications project).

    As to what those crucial health IT issues are, they are not technical. They are not about standards or lack thereof.

    They are much more complex than those simple issues.

    It is difficult to communicate this, however, in an era of unquestioning computer worship.

    From someone who has been involved with computers for 40 years, my observation is that the Syndrome of Inappropriate and Unjustified Overconfidence in Computing is the cornerstone of a new religion, I’m sorry to say.

    — SS

  4. #4 anon
    March 20, 2009

    I am a physician in one of the nations largest HMO’s and we are using EPIC software for our EMR. It has pro’s and cons depending on how you look at it.

    Having legible records all in one place for the whole organization is a plus. You can see what happened in the Emergency Room etc. when the patient returns to their primary doctor. Specialists can forward their impressions back to PCP both as continuity and form of education. Some good Data Mining is being done for monitering quality and research etc. but is not linked to any other organization.

    From the providers’ standpoint, there is definate cognitive overload and burdensome clerical work. I now supposedly am a computer geek, stenographer and proofreader. We have been forced to spend tremendous amounts of time in computer training to understand how the software works. It does not help me communicate with or diagnose patients. Dictation services have been terminated to save costs and physicians are responsible for typing everything or using voice recognition software which is a whole other debacle.

    I think the ECR takes a lot of the art out of medicine; even the art of a good history and physical. Most providers now use “TEMPLATES” to save time. These are skeleton frames of generic documentation in which a provider can tab through and fill in the blanks. Every note looks the same and has piles of extraneous Bull@#$% information which is automatically pulled into the note in many of these prefabricated systems. Providers do not describe or paint a picture of the patient in words because they don’t have the time.

    I also do not see how HIT/EMR is going to be a cost saving panacea in this country. The people that have never tried actually using a system like this need to wake up.

  5. #5 revere
    March 20, 2009

    tasha: I am not nihilist on the subject. I am, dare I say, a med informatics enthusiast, primarily because of what it can do for me as a researcher, although I also appreciate the potential for improving quality and decreasing costs. I also am not of the view that we should give up, but it wouldn’t matter if I were: it is inevitable. The question is exactly what this inevitability will produce.

    So far I see mainly uncritical cheerleading for HIT without the recognition that there are many ways to do this that will be very bad, not reduce cost, not increase quality and be useless for other beneficial purposes. MedinformaticsMD at healthcarerenewal.com has been in the forefront of reminding us of this, and I encourage everyone to visit the post I linked to for the reading list (with links) therein and see the link he gives in his comment (#2 in this thread just after Tasha).

  6. #6 revere
    March 20, 2009

    Randy: Time to buy some Reynolds Wrap. Last time I looked being “American” wasn’t a genetic trait. Do I want insurance companies to have my medical information? No. But I’d rather someone had my records and for me, the people accountable to me are my choice.

  7. #7 Phila
    March 20, 2009

    Randy: Time to buy some Reynolds Wrap.

    Not enough tinfoil in the world to protect your noggin from HAARP, thats the big push now as we speak….big government inside your head as well as outside. Pretty much a done deal according to my sources:

    http://www.rense.com/general28/deathray.htm
    http://www.timecube.com/
    http://www.lhj.com/style/beauty/makeup/the-10-best-undereye-concealers/

    You cant argue with facts revere. Maybe Pete Seeger isnt singing about it but that doesnt mean it aint happening….more the opposite if anything. Looks like the hippies were right about “US imperialism,” just going in the wrong direction towards our privacy/liberty….and they blamed the wrong people as usual instead of taking a closer look at Obambi whose not even a legal citizen last time I checked. Sure trust us everything will be fine….where have we heard that one before? can you say stalinism/IPCC/Hillarycare?? Make no mistake its coming and a lot of us will die, never mind CO2 cause the real question is what to do with the bodies after its all over…. your talkin about a hell of a bonfire right there but maybe “carbon emissions” wont matter so much once planned depopulation is well underway per the UN. Maybe algore can find a way to make oil out of them to heat his giant house…should keep any surviving libs happy, at least.

  8. #8 Tasha
    March 20, 2009

    I’ve been working for a state agency in Oregon for a couple of years now, and let me just say, you would be surprised with the amount of information the government does not know. Different government agencies don’t work as well together as they should – even though this could in some cases save a lot of money and effort – and usually obtaining information from another agency requires at the very least a lengthy contract between the agencies (which may or may not be difficult to obtain depending on the request). We don’t have a master file on every citizen, we can’t keep all of our different databases straight… And it’s not just people, it’s companies too… We can’t even agree of the definition of a “business” so that we can have an effective central business registry.

    Seriously, you’d think all the recent food illness outbreaks and inability to track the food supply would have taught you something… The G-Men couldn’t find you if they were standing in your own living room.

    Anywho, I’m not saying that my experience is representative of all other governmental agencies (it may not be), and I’m not saying that there isn’t potential for abuse in certain areas, and I’m certainly not saying that there isn’t room for improvement on all levels (is there ever…). I’m just saying that the age old adage about your permanent record is more fiction than fact. But if you want to invest in Reynolds, be my guest.

  9. #9 Lea
    March 20, 2009

    You said it right off the bat revere, “a good idea destined to go bad”.
    Then you said near the end, “If left up to the private sector, as it has been until now, HIT will almost certainly turn out even worse”.

    It appears I have more faith than you when it comes to the “private sector”. Although, there are exceptions because it took over four (4) hours today to find out if the blood tests my Gastroenterologist ordered were covered by our health insurance.
    The right hand doesn’t know what the left hand is doing.

    It’s going to happen regardless and as my dearest friend said many a years ago, “technology will bury mankind”.

  10. #10 Phila
    March 21, 2009

    If left up to the private sector, as it has been until now, HIT will almost certainly turn out even worse, with incompatible systems allowing no way to exchange data and giving us data mainly geared to what private insurance companies want (and don’t want), not what the patient needs.

    I know a few people who are really excited about this as something that’s going to “empower” the consumer — which tells you right away where their sympathies lie — but I’ve never been able to get a clear idea of how they think that’s going to happen. Maybe it’ll be a case of spontaneous order a la Hayek.

    Your scenario sounds a lot more plausible to me.

  11. #11 M. Randolph Kruger
    March 21, 2009

    Revere, when people have access to records its a bad thing. Its also a much documented fact that when they do, they use them illegally. Joe the Plumbers records were hacked apparently by the local DNC Chairman who was a government official and she has been removed, but damage done. They had absolutely NO right to do so and you apparently want to try to defend this? There is no difference in your healthcare records to your tax records….. Its yours and yours alone. That is unless you piss someone off or the money is right to buy the information.

    No, its not like living on the prairie in the 1800’s and healthcare was something that was 80 miles away. This is something thats dead in the middle of everyones faces. Celebs who check into hospitals have their records hacked by nurses and admins and then sold to the Paps regularly.

    Like you said though, at least SOMEONE will have access to your records…. You just might not like who it is. I want you to understand that the FBI uses hackerware themselves under RAPTOR. They look for keywords and there is ONLY one government supposedly in the US right? They find you use either coded or uncoded words too many times and then you tip their scale and they start a file…Thats documented fact.

    But its that one government right? You give one branch access then you turn around and find that its being used by another. AGAIN, DAMAGE DONE….It puts the burden of suing, bringing charges, indictments, trials, your time, other peoples time onto your back, plus any other side damages. Previously or currently existing problems can be used to deny employment… Or they get your whole fucking dossier. They know your taxes, they know your health, they know your political affiliations. Tis the one world govenment Revere and its being hung with a new wallpaper and called healthcare this time. Control of weapons, ammunition, media, how much money you can make even though there are contracts, where and how you live. Its a takeover….This is communism pure and simple. People are just too stupid to understand whats happening. The revolt will be coming either in the courts or on the streets. How about that 100,000 man police force he wants? What do you call 100,000 police that are under the control of one or two people?

    The SS…..

    So you get arrested for sedition or un-american activities or eco-laws which are pure bullshit ….. Tail gunner joe sounds very familiar.

    By salting the courts with appointees it will be just like Nazi Germany. That was the final straw that broke the system. Activist judges will find this to be legal as will implation of chips and biometrics and THEY will call it “necessary to receive benefits” and that its a cost cutting measure and its an attack pure and simple under the guise of health care. Bullshit.

    Mandatory vaccinations are for what? Anyone really know whats in that shit? Give you a vax that makes you weaker? Susceptible ? Hey, Obamanation controls the HHS and FDA now.

    You keep talking about UHC like its some divine right, a gift from God …Well maybe not God, but Obama for sure. There are too many problems with this and it gives government yet another well to draw water from….Cash Flow. The vaunted UK UHC system is falling apart like a two dollar watch-Its bankrupt and they know it.

    They dont have enough people to perform the services, it costs too much and when I read about a NOT isolated incident where people are having to drink out of flower vases, I couple it up with WHY? Why in the world should we believe anything about UHC and this national data system? You tout it like its the cats meow of what we should do. Those filithy rich insurance companies are screwing us… I am sorry but the USGovt has a much better record of that and all money will go resident with it. They will just steal from it any time they want… Just like another two programs that are abysmal failures-Social Security and Medicare.

    They will force physicians to install huge computer systems so that the feds can track your every move. They also want to put pinging devices onto your car to auto detect you on the roads when you are doing a couple over. Computers controlled by whom making all the decisions of the world.

    Hey Revere, remember I found out who you were in under a couple of days when I put my mind to it and just using ping addresses and two other programs, one of which that I wrote. I was doing it because some craphead was trying to hack my system by doing a build a bug program into your posts. This system is supposed to be secure right? Who has access to this? Get the feeling that you are und

    Better than that, how would you like for a computer to go after everything you do, every day of the week to ensure your compliance?

    About 37000 primary agencies and contractors have access to your information by law right now Revere. The cons to this far outweigh the pro’s. It will hasten the demise of a country already in decline and could end up in a full blown revolt.

    .

  12. #12 revere
    March 21, 2009

    Randy: I’ve been working in hospitals for most of my life. Lots of people have access to your medical record there. Insurance companies have access to them and they use it to screw you. What do you want? NO medical records? HIT won’t require docs to have huge computer systems. What’s your evidence for that? Once there is a data format it can be done with the computing power of a PDA. Yes, I’m for mandatory vaccinations. I grew up in the polio years and I know about diphtheria and tetanus — from books. You have a one track mind: UHC. HIT isn’t about UHC. We already have lousy HIT that only hurts us, doesn’t help us. It’s in the hands of AIG and their incompetent cronies. Do we have to be afraid of government? Some governments, yes. Nixon, Bush, Wilson are three examples. But you have lights and mail delivery because of government, too, not to mention safer food, cleaner air and water, police protection, fire protection, etc., etc.

    Yes, the US has passed its peak of power. Did you expect to last forever? Big deal. Who cares? We’re already being passed by countries with UHC. You are one of the reasons we are behind. Being behind doesn’t bother me but being behind for (among other reasons) we can’t provide medical care for our people does. If you knew more history (instead of making up history) you’d figure out that your paranoid delusions are paranoid delusions. Get some Reynolds Wrap. You’ll feel better.

  13. #13 M. Randolph Kruger
    March 21, 2009

    I would counter that with FDR, Johnson, Carter, Clinton and Obama Revere. You dont think that HIT isnt about UHC, its the facilitator Revere. You think its JUST about healthcare and thats not it at all. You do that class warfare thing on the insurance companies. Perfect? Far from it…. But you actually think that a big bodacious gubbermint is going to fix all? The guy is a communist and we are now slipping from socialism into it.

    OH and by the way Revere, Obama in the NYT tomorrow will unveil plans to limit ALL top executive pay in the US.. Now if you dont think thats communism then you need to hit different books and get out of the medical ones.

    If you paid more attention to real history rather than selective, you might notice that Hussein Obama is taking over just as Stalin did. Problem is that when you finally figure it out it along with others it will be too late. They’ll tout this one as being necessary for the good of the economy and to restore confidence in Wall Street. I again remind you that it was the Democrats who set the stage for this and then when warned time and again, they did nothing… Now you know why….Its a takeover. It will be government by Washington and not the state and local governments. This is going to be ILL received across the world. Paul Krugman is the new policymaker and unfortunately, no one is going to buy it at all.

    Wall Street will be down about 800 points or to the limit come Monday afternoon. Forget health care Revere, he cant pay for it with a 13 trillion dollar deficit…. Neither can we. He cant pay for it by taxing executive pay either, its an income tax and he is going to loot everyone. All money goes resident with the government, not the people…WTF do you think is going to happen to the economy? Certainly not going up and so far Wall Street isnt showing one sign of faith in the anointed ones policies. Its WALL STREET Revere. It didnt work under Carter, it didnt work for the Communists.

    Get some bleach Revere and start pouring, that bullshit smell is really getting bad. This is a takeover by government and its coming on more and more.

    But neither of us is going to feel better. Me, because I can see it now. You because you think that all is going to be well. Its not.

  14. #14 revere
    March 21, 2009

    Randy; Since Obama’s middle name has nothing to do with this, I conclude it is a racist slur. Please stop. Regarding the rest of it, I consider it delusional nonsense. Saying it over and over again is tiresome. Go read a book about Stalin so you can learn to tell the difference.

  15. #15 M. Randolph Kruger
    March 21, 2009

    Its not a racist slur and its a statement of fact…. Hussein may not be on our side. It wouldnt seem so. Thats a dodge… If he is a rook then I like others are calling hin on it. Communista is very much he is heading for and it needs to be said as many times as necessary to move this bozo back to the center.

    It just keeps coming out of him and he is going to deepen this into a Depression. Long, loud and deep. You will be happy to know I cut another three people yesterday. Not only do they not hold a job, they dont have insurance either. Told them before the election this was going to happen. So who is the prophet here Revere? Didnt I say that he would deepen it? The markets have spoken and now the EU is weighing in on the pay cap issue AND health care. The HIT stuff is an automatic no brainer. He is a poser and thats all it is. He hasnt been vetted in the courts as to his legality in the Presidency and well, when it goes south his own party is going to take him out. He isnt a leader and this computerized bullshit isnt paranoia because its ALREADY HAPPENING! I wonder what you could possibly pull from this other than its a bad idea. It saves nothing and only makes it easier for some medical guy to pull your records up on a screen… In fact, people lose their jobs because of it.

    When they can hack the records of a Brit PM, the home of socialized medicine I think I would think mighty quick before jumping into it. Better to not do it. ONE violation would result in massive lawsuits by many. I wouldnt do it at all. Government records open to whom? Certainly everyone but medical types.

    As for his name…. I didnt name him. So we called him Barry you take issue, we call him Hussein you take issue.. I’ll just call him Mr. Stupid because Presidents deserve respect, this guy doesnt. He lost that when he announced that the vets are going to be on their own.

  16. #16 revere
    March 21, 2009

    Randy: Don’t sleaze out of the name calling. We all know what you are doing. As for your speculations, you only care when it’s not a Republican asshole doing it. I care when ANY asshole does it. I will call Obama out on the economy, probably tomorrow, but only an ignorant idiot would call him a Communist: he’s clearly just what Bush was, an out and out corporatist and Geithner, Summers and company (his boys) aren’t selling us out to the politburo but to the banks. Until you get with the program and see that we are on the same side (against the banks and big corporations) you may as well put your head between your legs and kiss your ass good-bye. You’ve constructed the whole world on the model of liberals and conservatives or Democrats and Republicans and you are so out to lunch it isn’t funny. Not funny at all. Our only hope now is to wheel back the bank sellout and get the stimulus going with public works. Spending, lots of it, on worthwhile things we need and that will put people back to work. That can be done. We can force Obama to do it. But not your way.

    As for the bogus vets issue, you don’t even bother to follow it. Or maybe Fox News forgot to send you the info that this was withdrawn by Obama days ago, acknowledging that the vets groups were right. And it didn’t leave vets on their own, either, as you falsely allege. It never did that. That was what Bush did for 8 years, so maybe you think everyone does that.

  17. #17 pft
    March 22, 2009

    Randy seemed comfortable during the days Republicans were in power, not so today, even though the Dems will be using many of the powers the Republicans gave government.

    Anyways, the main reason for the IT push is to give access to Homeland Security and provide for public health. At some point, you will be denied travel rights due to you were diagnosed with an illness, or there is some glitch in the data base. In and of itself this is not a terrible thing, but Big Brother has shown us they abuse their powers, doesn’t matter who is in power, Dems or Republicans.

    The push for mandatory insurance will make this a useful tool for the insurance companies who will be given universal access to set premiums.

  18. #18 MoM
    March 22, 2009

    Couple of thoughts (back on topic, I hope)
    First, I’ve been a fan of single payer universal coverage for a couple of decades, thinking in part that when docs had to report to get paid, I’d get better reporting.
    Second, as it happens, I’ve recently been seeing a physician who is part of a hospital-oriented medical group that is “paperless”. All of their records are electronic. While he likes the fact that he can call up my history easily, and he can read it rather than fighting his colleagues’ handwriting, he hates having to put his own observations and information into it. I know because I asked him. What he told me is that he has to pick everything off a list, and the choices on the list don’t always (don’t usually) fit the exact thing he wants to say. Also, he is a 2 finger typist.
    Likewise, his nurse hates it because what it used to take her 2 minutes to chart now takes 15 (and she’s pretty fast.)
    It gets back to software done well, and was there ever such a thing? The probability of that will increase when there are a significant number of practicing physicians and nurses with advanced degrees and experience in computer programming and database management. (i.e. no time soon)

  19. #19 M. Randolph Kruger
    March 22, 2009

    Slease out? What would you have me call one Barack HUSSEIN Obama? I didnt name him. I will use Mr. Stupid and Company from now if you like on since it seems to fit in my mind. The cats are in charge of the canaries and you seem to continue to support this spendathon. Krugman, Geithner… O vey! His policies are pure Communist and continue to ratchet up the tax bill which will ensure a collapse in two years. There is nothing that is sustainable here except with printed money to pay for bullshit programs. We now have a debt load higher than the 1940’s. Sorry Revere, you are going to come out on the other side of this one in tatters. He might be the first President who is impeached by his own party to get him outta there.

    If UHC is put in, then its game over. The cost of operations are too high now and now you want us to put a bandaid on everything. Healthcare at all costs. You seem to think that we should provide healthcare to everyone Revere. You show me where in the Constitution of these United States that is the law? It will turn this place into a shambles and triple the cost of living for most. Toss in hyperinflation too…500 a barrel oil looms. As long as the economy is down everything will be fine….If you have a job. If not, dont wory the Politburo will pay for your house, determine how much you will make and of course someone else will pay for YOUR healthcare.

    Husseins latest is to give out “stimulus” money to the states, as long as you toe the line and put his new programs in. Then after that, you turn around and find that the states have to fund it afterwards. The states have put programs in that they cant afford themselves, the feds put in programs that they cant afford and we are their credit card. But, we are tapped out too.

    But okay so now you get HIT to be like a farm animal now. Records kept on weight, health, shots, address, telephone number, and its all in the name of saving money. Hey, I want one of them yellow tags on my ear that they give to cows. Well I for one dont want Hussein and his boys to have any control over me thats not in the Constitution. This wasnt in there on the last check. Nor is HIT or anything like it. This is control, pure and simple and it wont save one red dime. It might at best save a couple of lives but opposed to losing freedom I would cut them down to the last man or woman and I wouldnt think twice about doing it.

    But its all about the economy and the idea of saving money. In fact its those same bozo’s who created the financial mess that are in charge of it now. So you want me to give all my personal information to Hussein and his minions, all of it? All of it in the name of what? Healthcare…. Sorry. I’ll pass and you just might see the secession of the South again. Hey saving money? What about transcription errors, what about the costs of implementing such as system? How about who has access to it? All of this is obscuring the one really big issue and that is that the government will have TOTAL control over our day to day lives. This is going to give them control of all the money, our health decisions and its just one big commie/socialist love fest.

    EVERY poll taken says that there shouldnt be bailouts, there shouldnt be government control of healthcare and mandating mandatory healthcare at the cost to others is against our Constitution and that Revere is going to be held, or there will be revolt. Lets hope that its a peaceful one and within the system. But, hey lets cross match that health registry with the gun control registry….

    Back door gun control too. Registering weapons every two years, thumbprinting for ammunition? Dont you see where this is heading? Its a takeover by Hussein Stalin and you are going to disagree. But your bent is far left and feel that healthcare is a right. Sorry pal but that is a position that isnt held by most people. You are responsible for yourself and only yourself. There are things that are in the Constitution that are spelled out and this control is Orwellian and its going to possibly push the US off the cliff. Bottom line is that if HUSSEIN (Mr. Stupid and Company) is wrong the US will implode and probably as a result the EU with it.

    They too are expressing their views on it so dont come back with any stuff about that I am an outlier, racist or anything like that. Thats pure crap. If they are calling him on it then that puts you at a 700 plus million to one disadvantage and that Revere is not counting the people who are against it here.

    By what authority or right does this bozo have to even come close to asserting that he can control pay? By what right does he have to make statements that he will make private insurance companies pay for veterans care? He has nothing to offer us, the working class and those that provide jobs under UHC except massive bills. More massive than the 55 trillion that Medicare and Social Security that are unpaid now.

    By what right?

    ZERO!

    I also want him to explain where all of that foreign campaign money came from. Chinese with the Clintons. How about it HUSSEIN? DIDJA SELL US DOWN THE RIVER AND CEDE POWER TO THE CHICOMS? If those guys ever show up and sell treasuries rather than buy them you are going destroy the economy of the US and it likely will never return in our lifetimes. Come on HUSSEIN, are you even an American citizen? A computerized birth certificate that wasnt even around in the 60’s isnt going to be acceptable and nor should it be. Lets go HUSSEIN, its not a biggie. You have to show it when you get your drivers license, so how about removing that nagging question that everyone wants to know the answer to.

    He wont of course and all of the leftists of the world will continue to support him. Right up until the time his new SS shows up for not supporting him.

    Heil HUSSEIN!

    The leader of the free world is a communist.

  20. #20 M. Randolph Kruger
    March 23, 2009

    Well here it comes….. If the Chinese and Ruskies are able to push and get a new currency then the value of the dollars will fall to near zero. Why? No one will want them as Obamanation continues the spend. The devaluation of the dollar will FORCE the Chicoms to sell our treasuries which are backed up…. by paper. Then the value of the dollar goes to zero. Thats it the leftists win and it becomes a Communist society.

    Our homes, cars and everything will then technically be worthless because its based upon dollars that are worthless. One world currency, one world government and Obama and the Dems will be responsible. Our Constitution will be worthless, and it will result in wars and civil war very likely as the country pulls itself apart.

    Crafted skilfully I might add and lets just call it a stimulus… Lets really call it what it is and that is that the UN will be in charge of your destiny. We will no longer have a standard of living in this country because it will be broken down. It will be blamed on just about everything except the spending.

    All wealth will be gone, all property will be gone. We will all start from scratch again

    http://www.drudgereport.com/

    http://www.themoscowtimes.com/article/600/42/375364.htm

    We have spent ourselves into a total disaster.

  21. #21 revere
    March 23, 2009

    Randy: But what about The Rapture? Surely you won’t be Left Behind?

  22. #22 M. Randolph Kruger
    March 23, 2009

    Probably will not get to participate in that particular party Revere… Too much to atone for in one lifetime and maybe three? I will have to deal with that and this fine mess to boot. But, its not my decision Revere.

    The one key thing that has been noted by every financial person out there about China….. WTF does the US do if they become sellers of our bonds and treasury notes? We wont be able to unload ours at just about any price.

    The single unanimous answer is that it would bankrupt the US and the currency would not be worth what it was printed on.

    I think thats a big problem myself Revere. But that might be because I am not blinded by the light of Hussein (Mr. Stupid and Company) Obama, Geithner, Krugman and you said spend more. The markets were set to tank this morning and then bingo, they came back with news that they are going to finally do what they should have done and that is buy up the bad paper of the banks. Instant rally. Bear trap though. The banks likely will not lend a bit more money than they have been already.

    As to China and Russia, you are about to get your wish. Spend more and the Chinese said that they will with the IMF create a new currency of trade. They do, then we are screwed and its game over. You might not get that, most people do though.

    Again, what do we do if the Arabs refuse to take our paper one day? Its paper that you can buy stuff nearly everywhere right now with. What do you do if suddenly you could only buy US stuff with? Well dont worry about that… We dont make anything anymore its all offshore and Dems and Republicans are both responsible for making us non-competitive. Unions especially. The spendaholic is talking another trillion for healthcare and the like and the ChiComs are not happy with him. Those notes are numbers on paper with no value at all if we keep spending. So they get a new currency and they dump the old which is dollar bills and we cant sell new debt. Then no one takes the paper….? What happens?

    Get back to me about how long the economy would last on that single day, week or even a month.

    All debts would be wiped because the banks would be gone. No need to run on them, the paper is and would be worthless. We could present to the Fed Reserve for payment in gold and siliver, they would tell us to get bent. Then, you wont be able to buy anything because no one will want anything but tangibles. The entire world economy tanks and the two countries holding something of worth? China and Russia… The EU might be able to trade them for Euro’s, but maybe not.

    Its an interesting discussion right now…But what if? Krugman is a Nobel prize winner. Bet he hasnt thought this one out yet.

    Or …..he has.

  23. #23 M. Randolph Kruger
    March 31, 2009

    http://www.foxnews.com/story/0,2933,511721,00.html

    The last people I want to have my medical records is the government… they are superceded by the next to the last… Medical providers.

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