Today, the Center for American Progress Action Fund hosted a forum to discuss how the Medicare program can inform this year’s health care reform debate. After the event, ThinkProgress sat down with Thomas Scully, the Administrator of the Centers for Medicare and Medicaid Services (CMS) from 2001-2003, and asked him to respond to conservatives (like Sen. Jon Kyl (R-AZ)) who argue that health information technology and comparative effectiveness research would ration health care:

I had a lot of those fights because the reality is the government should be able to look at what’s the appropriate level for PET scans or MRIs?…You know, Medicare makes decisions on coverage all the time. I made decisions on coverage all the time based on what I thought was not – on comparative effectiveness research. You got to do it the right way. But I think – I’ve always been a big fan of comparative effectiveness research if done correctly.

Watch it:

Scully dismissed the likes of Sally Pipes and Betsy McCaughey as “just noise” and argued that since Republicans are in the minority, “their job is to hurl attacks,” just as some Democrats did during the debate surrounding Medicare Part D.

Asked if the odds of health reform are better this year, Scully predicted that “the odds are lower” of passing health reform now “because the economy is in such bad shape, I think it’s going to be very difficult to finance this thing.” “I don’t think that the core people that are really in the weeds of health care in the Senate is as big as it was…I don’t think there is a group of 20 guys that really are health care wonks like there was 15 years ago,” Scully explained.

During the panel discussion, however, Scully admitted that the world would have been a better place had Congress passed President Clinton’s health reform plan. “They made a lot of strategic errors back then…but the core issue was trying to fix the commercial insurance option…which is the right thing to do, they probably went too far… but had the plan passed back then, the fundamental concept behind it was regional purchasing cooperatives with a better structured insurance market, which is exactly what we’re talking about right now.”

Transcript: Read more

Betsy McCaughey is back. This time, she has stuffed the entire stimulus bill into a large white binder– a sort of fundamentalist bible McCaughey uses to misinterpret the intentions of the legislation. McCaughey is still preaching that the stimulus bill contains provisions that “provide less care” and tie doctors hands in prescribing procedures — but this time, she’s added to her sermon.

In her new comeback tour of Fox News Channel programming, McCaughey regurgitates insurance-industry arguments against the public plan option and argues that the government will import Canadian-style rationing into the American health system. Short: We will all end up like Natasha Richardson:

- On public option: “The public plan will pay doctors and hospitals below market rates, as Medicaid and Medicare currently do, and doctors and hospitals will have to shift those costs to the private health plans, including the one you get at work, and therefore those premiums in the private sector will go up to unaffordable levels.”

- Cost benefit killed Richardson: HOST: So she’s lying there, they have a CT scanner – and it’s my understanding that we don’t know ether or not they used it. But there’s no doubt that what you’re talking about, this cost-benefit analysis, went into that decision. McCAUGHEY: Exactly.

- Critical choice for Americans: The really critical issues here for all Americans is to think twice about whether they want to lower their healthcare costs if it will mean that they don’t get the care they need to live.

Watch a video compilation:

McCaughey’s connection between Canadian single payer health care and Richarson’s death is unclear. McCaughey quotes Dr. Saba, an emergency room doctor at Lachine Hospital, as saying that the hospital had to conduct a cost-benefit analysis before performing a CT scan. It’s unknown if a scan was performed, but McCaughey certainly misquotes the doctor. He discusses cost benefit in the context of deploying a medical rapid response unit — “You have to do a cost-benefit analysis,” Saba said. “It takes time to get the helicopter’s medical team assembled, get the helicopter to the location of the patient, pack in the patient and fly the helicopter to Montreal” — not a life-saving test. In fact, while the United States is generally better equipped to handle medical emergencies, we consider similar factors before dispatching a medical unit.

In fact, any health care system operates on criteria that are based on general characteristics, not individual patients. A fever of 101 degrees triggers a different medical response than a fever of 98 degrees. Similarly, a hospital won’t dispatch a helicopter for someone who broke his leg, but would send a rapid response unit if paramedics believed that the patient sustained internal injuries. In 2005, a study concluded that “60 people have have died in 84 air ambulance crashes since 2000 — “more than double the number of crashes during the previous five years.” The report cited “a 2002 study in The Journal of Trauma that found helicopters were used “excessively” for patients who weren’t severely injured.”

In Canada, publicly financed health insurance plans provide universal coverage to the entire population “while constraining spending and largely protecting the clinical autonomy of physicians.” Canada has lower overall costs, administrative efficiency, and higher satisfaction rates, but it is not without it’s problems. McCoughey’s modus operandi is to distort certain inefficiencies — like longer waiting lines for specialty procedures — and suggest that American reformers would simply copy-and-paste the system.

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While Rush Limbaugh has taken credit for spreading the health IT falsehood, the real mastermind behind the story may be Betsy McCaughey, Gov. George Pataki’s (R-NY) Lieutenant Governor during his first term and an Adjunct Fellow at the conservative Hudson Institute.

McCaughey wrote the Bloomberg editorial that sparked the Fox News coverage and as the Atlantic’s James Fallows notes in his article about why President Clinton’s health reform efforts failed, she’s quite the trouble maker:

Much of the problem for the plan seemed, at least in Washington, to come not even from mandatory alliances but from an article by Elizabeth McCaughey, then of the Manhattan Institute, published in The New Republic last February. The article’s working premise was that McCaughey, with no ax to grind and no preconceptions about health care, sat down for a careful reading of the whole Clinton bill. Appalled at the hidden provisions she found, she felt it her duty to warn people about what the bill might mean. The title of her article was “No Exit,” and the message was that Bill and Hillary Clinton had proposed a system that would lock people in to government-run care. “The law will prevent you from going outside the system to buy basic health coverage you think is better,” McCaughey wrote in the first paragraph. “The doctor can be paid only by the plan, not by you.”

Fallows goes on to explain that “these claims…were simply false”:

Her shocked claim that coverage would be available only for “necessary” and “appropriate” treatment suggested that she had not looked at any of today’s insurance policies. In claiming that the bill would make it impossible to go outside the health plan or pay doctors on one’s own, she had apparently skipped past practically the first provision of the bill (Sec. 1003), which said, “Nothing in this Act shall be construed as prohibiting the following: (1) An individual from purchasing any health care services.”

You get the picture. By cherry picking certain words in the bill that neatly conform to a conservative narrative about comprehensive health reform, McCaughey sparks outrage and instantly becoming the darling of the right. In a throw back to her earlier work, Fox News packaged her editorial — which they described as an article — as an archeological discovery for the ages.

Then and now, facts don’t matter. And this time around, McCaughey has Fox News to broadcast her findings far and wide.

Yesterday, the House Energy and Commerce Committee marked-up the health care portion of the economic stimulus. Here are the guts of the proposal:

- Subsidizing COBRA: The bill provides a 65% subsidy for Cobra premiums to workers involuntarily terminated between Sept. 1, 2008, and Dec. 31, 2009. The assistance, expected to cost upward of $30 billion, would cover premiums for up to 12 months and would end sooner for those who get hired and are offered employer-sponsored health-care coverage.

- COBRA as stop-gap: The bill would permit Cobra-eligible individuals who are 55 years or older and who have worked for an employer for at least a decade to retain Cobra coverage at their own expense until they become eligible for Medicare at age 65, or secure a new job with health-care coverage.

- Increasing Medicaid funding: Medicaid would receive upward of $87 billion under the bill, with additional federal matching funds to help states maintain their Medicare programs through 2010.

- Investing in Health IT: Information technology would get $20 billion of federal funding under the bill, which calls for the Department of Health and Human Services to develop standards by 2010 for a nationwide system to exchange health data electronically.

Health care wonks interpret the stimulus as a down-payment on broader health care reform. Cover more Americans now and the road towards universal coverage will be a little bit easier and less expensive, they argue. The more Americans have health insurance and access to regular care, the less health care costs they incur once they’re brought into the system.

As Dean Waldman suggests over at the Huffington Post, “Health is infrastructure. Health care is the maintenance and repair service for this key element of our productive capacity. As a nation we need to treat the health of our people just like repaving a road – as an investment in our future.”

And Obama does this two fold: he gets more people into the system and lays down the infrastructure for the expansion. The lessons of the Massachusetts Health Care Reform Plan of 2006 “make it clear that an expansion of insurance coverage quickly uncovers the debilitating problem of the crumbling infrastructure of primary care. In Massachusetts, inadequate primary care capacity resulted in many newly insured residents not being able to find a medical home and gain access to medical care.”

Nationally, “the trajectory of the supply of primary care physicians for adult patients is now falling behind the growth of the adult population” and HHS estimates that “by 2020 there will be a shortage of 66,000 primary care doctors nationwide.”

The slowing growth in primary care physicians is traditionally attributed to the pay gap between generalists and specialists but Kevin Grumbach at Health Affairs blog argues that even “more consequential is the lack of investment in the core infrastructure of primary care“:

Specialists, who spend many of their work hours in operating rooms, hospital wards, come-and-go surgery and endoscopy centers, and imaging facilities, have much of their practice infrastructure… Primary care physicians spend most of their work hours in ambulatory care in their own offices and clinics, paying all practice overhead from their own billings. Purchasing and maintaining an office-based electronic medical record and hiring an extra staff person to work with diabetic patients on self-management skills are daunting expenses for a small primary care office operating on the slender margin of “evaluation and management” billing codes. Equally problematic is obtaining the technical assistance to effectively deploy these types of modernization and practice improvement resources.

Investing in Health IT not only saves money, creates jobs and reduces medical errors, but it also helps primary care physicians — who often bear the burnt of tech implementation without seeing immediate benefits — afford the infrastructure for expansion. Done correctly, Health IT can truly serve as the “infrastructure” of broader reforms.

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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?

On Saturday, in his weekly radio address to the nation, President-elect Barack Obama proposed modernizing the health care system by investing in “cutting edge technology and electronic medical records“:

In addition to connecting our libraries and schools to the internet, we must also ensure that our hospitals are connected to each other through the internet. That is why the economic recovery plan I’m proposing will help modernize our health care system – and that won’t just save jobs, it will save lives. We will make sure that every doctor’s office and hospital in this country is using cutting edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes, and help save billions of dollars each year.

Less than 25 percent of hospitals, and less than 20 percent of doctor’s offices, employ health information technology systems (HIT). Estimates vary, and real-life experience is limited, but one group of researchers found that implementing health IT would result in mean annual savings of $40 billion over a 15-year period.

A fragmented health care system, “difficult-to-demonstrate HIT return on investment, and first-mover disadvantage” help explain why the market has failed to deliver HIT and underscore the importance of Obama’s leadership on the issue. For instance, while insurance companies, to a greater extent than providers, “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) 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.”

Until gains are distributed a little more equally, medical providers will resist adopting HIT. Fortunately, the federal government, along with several state governments, have begun investing heavily in HIT systems. The Veterans Affairs Administration’s successful VISTA system “has had a profound influence on the quality and efficiency of clinical care and data management in the nation’s veterans hospitals.”

Meanwhile, in Pennsylvania, Gov. Ed Rendell (D-PA) has established the Pennsylvania Health Information Exchange Governance Structure to develop and manage a statewide electronic health record system. Gov. David Paterson (D-NY) announced in 2008 that his state awarded $105 million in grants for the development of health information technology and Gov. Janet Napolitano (D-AZ) signed an executive order in May 2008 directing state agencies to work with the Arizona E-Health Connection to promote the expansion of e-prescribing.

Still, the greatest HIT innovations may belong to the Taiwanese. As T.R. Reid reported in his ‘Sick Around The Word‘ documentary, “Taiwan designed its new health system using state-of-the-art information technology”:

Everybody here has to have a smart card like this to go to the doctor. The doc puts it in a reader, and the patient’s history, medications, et cetera, all show up on the screen. And then the bill goes directly to the government insurance office and is paid automatically.

As a result, Taiwan has the lowest administrative costs in world, less than 2 percent. In the United States, administrative costs eat up 22 percent of health care spending.

This morning, the McCain campaign finally released Sen. John McCain’s (R-AZ) health records. The delayed disclosure comes on the heels of three broken pledges to release the senator’s health documents and contrasts sharply with the way McCain released his records during the 2000 campaign. In fact, while McCain proudly disclosed “1,500 pages of medical and psychiatric records” in 1999 and gave journalists “direct access” to his personal physician, he has circulated “precious little medical information” after being diagnosed and undergoing surgery for melanoma in August 2000:

At least three times since March 2007, campaign officials have told The New York Times that they would provide the detailed information about his current state of health, but they have not done so. The campaign now says it expects to release the information in April.

McCain’s secrecy and reluctance to discuss his health has raised several eyebrows among medical doctors. While repeatedly claiming to be in “excellent” health, McCain has delayed the release of his records. During an interview with CBS’s 60 Minutes in March, McCain promised to release his medical records in April:

PELLEY: At 71 years old, McCain’s health has been an issue. After his presidential race in 2000, he was diagnosed with the most lethal form of skin cancer. How’s your health?

MCCAIN: It’s excellent. It’s excellent, excellent. Thank you. And we’ll be doing the medical records thing with the media sometime in the next month or two.

PELLEY: There has been some criticism that you have not released your medical records.

MCCAIN: Mm-hmm.

PELLEY: You’re saying in this interview that you’re about to do that.

MCCAIN: Oh, I will do it in the next month or so, yeah.

Two months later, the records are out. But today’s release comes with certain caveats that were missing from his previous disclosure. Rather than allowing full and open access to all interested media organizations, McCain is releasing some of his records to a select group of reporters who “can neither photocopy nor keep the documents”; they will only “be allowed to take notes from the records.”

McCain’s handpicked reporters will have to scribble fast, but the senator may change his mind before they finish. Just eight days ago, during a campaign event in Columbus, Ohio, McCain promised that his “administration will set a new standard for transparency and accountability.” Today’s holiday weekend document dump suggests that McCain may continue Bush’s secretive ways.

UPDATE: The Huffington Post notes: “Notably absent from the list is the New York Times. Could this have anything to do with [who] wrote the paper’s controversial article about McCain’s ties to lobbyist Vicki Iseman?”