At the National Journal Online, health policy analyst Uwe Reinhardt explains why the United States is lagging behind other industrialized nations in the adoption of health information technology (like electronic medical records or electronic prescriptions):

One explanation is that our health system has not been spending enough on HIT overall. It often is the stepchild in the budgeting process of hospitals and medical practices….A second reason for our lagging in HIT is that, by the very nature of our pluralistic health system and the equally pluralistic HIT industry, we have produced a veritable HIT Tower of Babel….A third reason for our lagging in HIT is that there have been too many fly-by-night outfits in this industry, often elaving their clients in the lurch over the longer run. HIT applications must be serviced reliably, over the long haul. Many users have been sorely disappointed in that area in the past.

But underlying all the questions about health IT is the question of who should pay for it. That is, while insurance companies could benefit from reduced costs in moving from a paper-based system to electronic health records, the costs of implementation are far higher for providers.

An analysis by the Center for Information Technology Leadership (CITL), for instance, found that “while providers are footing the bill for HIT, they may experience only 11 percent of the potential gain. Other stakeholders, payers principally among them, may reap 89 percent of the gain.”

Also, as Dana Blankenhorn of ZDNet speculates, “there’s another, deeper problem. Fear“:

Many doctors fear automation because documentation invites lawyers. As one correspondent put it: The Democrats love it because it will make it much easier to sue physicians. Auditing care will find mistakes, and mistakes will lead to lawsuits. Mistakes are inevitable, however, so don’t put anything down and maybe no one will be able to find out.

Still, according to a new Commonwealth Fund opinion survey of health care leaders, 78 percent of respondents thought that investment in health information technology was a very important or “absolutely essential element of a stimulus package.” In other words, the benefits of health IT — in terms of eliminating health errors, creating jobs and containing health costs — far outweigh its perceived dangers. The fear that doctors face in terms of increased litigation costs can certainly be addressed by designing a system that dismisses unmeritted or flimsy lawsuits, while at the same time punishing doctors for real medical errors. Smart policy can make that distinction, no?

Over at his new blog, The Treatment, Jonathan Cohn highlights a Wall Street Journal story with “this genuinely newsworthy item:”

The incoming administration plans to move fast on his proposal to overhaul the health-care system, with a major event at the White House, likely in March, two Obama officials said. There, members of Congress and interest groups will hold a working session of sorts to launch the debate. … Mr. Emanuel declined to say whether the new White House wants Congress to deal with health care or climate change first, though another transition official said the assumption is that health care will top the agenda.

The anatomy of the Obama’s administration’s proposal is still somewhat murky and Cohn wonders if the new team will “seek legislation designed to achieve universal coverage (or something very close to it)? Or will it try to achieve universal coverage sequentially? (And if it’s the latter, what will the sequence be?).”

The Obama team and its health-conscious senatorial counterparts (Sens. Max Baucus (D-MT) and Ted Kennedy (D-MA), among others) have promised to do “big serious things” for affordable health care reform and conventional wisdom suggests a single bill, with SCHIP expansion and the stimulus laying the groundwork for universal coverage.

Still, some health care pundits worry that key elements of Obama’s proposal — establishing a health insurance exchange, employer mandate, building a new public plan — will encounter fierce partisan opposition. Bob Laszewski of Health Care Policy and Marketplace Review rang the first alarm bell, warning Democrats that excluding ranking Senate Finance Committee member Chuck Grassley (R-IA) from the SCHIP expansion compromise, “does not bode well for bipartisan health care reform.” “This is the kind of dumb stuff the Clintons did in their failed 1993 unilateral health care reform effort,” Laszewski writes.

Joe Paduda of Managed Care Matters also predicts a drown-out process:

As much as I’d like to believe the battle for health reform will commence soon and while tough and unpleasant, end soon thereafter, experience teaches otherwise. I’d suggest that anyone who thinks this will get done quickly recall DC pundits’ statements about the Civil War (lets watch the fun at Bull Run, win the war, then ride home for dinner), the First World War (trench, what’s a trench?), or for those more current on their history, the Iraqi conflict (they’ll welcome us with open arms).

In some ways, the Civil War has already begun. Since the election, the Wonk Room has chronicled the right-wing’s smear campaign against universal coverage. In fact, just this week, the Wall Street Journal published two new pieces attacking the Federal Health Board and SCHIP expansion.

Progressives should answer these attacks by defending progressive proposals on their merits, rather than resorting to the comfortable/familiar rhetoric of “affordable health care for all” or “shared responsibility.” Such buzz language has doomed past reform efforts. As Haynes Johnson and David Broder argue in their analysis of President Clinton’s failed health care reform effort, by relying on hollow buzz words, rather than policy specifics, the Clintons allowed the opposition to ascribe meaning to reform rhetoric. Let’s hope that Obama doesn’t make that same mistake again.