Thoughts On Your Comments

I’m sitting at my desk with a  bowl of soup for lunch.  I have 30  minutes and I’m thinking this might be a good time to respond to a few comments  you have sent. 

First, let me say, I do read the  comments. I just have a hard time finding the time to respond and make new  postings too.  So, I tend to concentrate  on new postings.

Comment on Guatemala  Inauguration
On January 18,  Science Teacher wrote:
Can you tell us whether the topic of H5N1 came up  with any of the representatives of Latin American countries? Is there concern?

Response:
I was  in Central America about a year ago working on  Pandemic issues with the health Ministers.   We have helped them build lab capacity and actually trained more than  200 people from Central America on pandemic  related issues.  It is not a top of mind  issue there, and they still have a ways to go on public health infrastructure.  Gratefully, we haven’t seen any H5N1 positive birds in that part of the world.

Comment on Guatemala  Inauguration
On  January 22, David A. Haley wrote:
Instead of talking about "safe" topics such as India or Guatemala, why don't you address  meaningful topics to the American people, such as what efforts you and the  Administration are undertaking to fix our healthcare system? Hello. Is anyone  home in Washington?

Response:
David, you are right in saying my writings have been fairly  heavily oriented to international work lately. I think if you look back in past  postings I have written about many different topics that fit the criteria you  lay out.  The concentration of recent  writings on international work reflects the fact that I traveled fairly heavily  while Congress was out of session.   International work is an important part of my work and it has a direct  reflection on the health of the Americas.  The safety  of imports is an example. Most of my time in India was focused on products  Americans consume. 

I should also confess that I use this blog as a way to keep track  of what I learn on these trips as a journal of sorts. 

I encourage you to keep reading as there will be lots of meaty  issues to discuss.

Comment on Day 5 in India
On January 17m Robins Tomar wrote:
It would be great if you could write one more post about your  overall experience, changes in feelings before and after your visit and some  recommendations from your experience.

This is just a request if you get time from your busy schedule.  Anyway I will be following your blog to know your opinions about what is  happening around us.

Response:
I would say one of the most of the most important changes in my  feelings were the kind of things that come when one actually sees a place  rather than reflecting what you have heard or read.

Here are just a couple of examples:

• It is hard to adequately explain the challenges of population as large as India’s and how it impacts every public policy issue.         
• I’m attracted to the people of India.  I have lots of friends in the U.S. of Indian heritage and seeing India created a new context for our relationship.
  In Utah there  is a community of people with roots in India.  They have become prominent in academic and  financial circles.  As governor, I was  often invited to attend their celebrations and events.  I always admired the way they worked to  preserve their connection to an ancestral home even though many of them have  become major successes in the U.S.  Now that I have seen that home, it is easier for me to understand their view of America and India.   
• I found particularly helpful the understanding I gained of the small farmers in India and their political influence.  I wrote some about this in one of my postings.
• The number and size of the drug and vaccine manufacturing facilities in India requiring FDA attention was an important actualization.
• The intellectual connection between the U.S. and India came as a pleasant surprise.  I knew it       existed but didn’t have a sense of scale.

I could go on and on, but this will give you a small sense of what the trip did for me.

Comment on Electronic Medical  Records and the Medicare Sustainable Growth Rate
On December 3, Chris Farley wrote:
The US  government/we the people already own an excellent EHR - the VA's VistA system. It is fast, simple to use, incredibly  stable and a large portion of the work needed to make it viable in private  practice is already done. Two organizations have taken it,  "de-veteranized" it and gotten it CCHIT certified. With a small  fraction of that cost, the system could be fully upgraded and modified to meet  all of the needs of the commercial market-place and fully implement the quality  measures and disease registries necessary to adopt pay for performance and  improve the quality and lower the cost of healthcare

Response:
I am a big admirer of VISTA and  the Veterans Administration.  In fact, I  borrowed the National Coordinator of HIT from the VA, Dr. Rob Kolodner.  The problem comes in creating compatibility  between other systems and the VA because most patients, even in the VA system, deal  with multiple providers outside their system.   We need to achieve interoperability.   As you point out, there are some providers who are using the VA system  as a foundation to develop smaller systems and we welcome that.  This answer is short but in the press of  time, I’ll leave it at that.

Comment on Electronic Medical  Records and the Medicare Sustainable Growth Rate
On December 3, Chris Farley wrote:
It is very easy for the Sec of HHS to say that Electronic records  are the answer to rising Medicare costs. It is very short-sighted to ignore the  reality that the numbers of the Medicare-eligible are increasing every month.  Besides, with increased litigiousness of society, has the HHS conducted an  objective study of what percentage of procedures physicians carry out are just  to protect themselves against frivolous law suits?

Response:
There are a number of studies that document the practice of defensive  medicine.  I would support reforms that would  minimize the practice or perceived need.   Many believe that the development of best practice quality measures will  provide some protection.

Comment on Electronic Medical Records  and the Medicare Sustainable Growth Rate
On December 3, Chris Farley wrote:
While agreeing that the current formula is an utter failure, I  would like to point out that Physicians are now working at 2005 reimbursement  levels (far from keeping pace with inflation). The moral of this horror story  is that if professionals are paid their legitimate dues, they will not abuse  the system. It is useful to remember that neither the gas nor electricity  prices; employee salaries nor office rent; neither liability premiums nor cost  of EMRs have stayed at 2005 levels - unlike Medicare payments under this  convoluted SGR formula. I have yet to see any effort by Medicare or any other payee  to actually interact with practices that have had extensive experience with EMRs  to identify real world solutions to real world problems. Until that happens, it  will be unreasonable for Mr. Leavitt to expect physician practices to  voluntarily adopt Electronic records. So if HHS would like to push this idea,  let there be a level playing field and objectivity in assessment of its impact.

Response:
I stand by my belief that the system doesn’t work well.  You would be amazed at the amount of work  Medicare does to estimate what things cost for doctors and therefore what the  reimbursements should be.  The truth is, command  and control regulator systems rarely get it right.  A well informed marketplace where consumers  have information on quality and price will both make the relationship between  doctor cost and charges far fairer.

In a previous entry, I talked about walking through a grocery  warehouse with 50,000 items and asked the manager what would happen if the  government started setting prices on every item.  His answer was right, in my view: “fewer  products, higher cost, and continual arguments.”  I told him, he had just described Medicare  reimbursement.

Well, the soup is gone and my time is up so I’ll conclude and post.

 

Comments

Great great article thanks…!Very informative content

Posted by: zobibi | January 29, 2008 at 08:10 AM

Wow!!! Thanks for responding! I think it is an incredible statement about how far technology has come that one of the highest ranking goverment officials in our country has direct interaction with "we the people." I'm full of opinions and ideas - some good, some bad, some smart, some stupid. I can't express how great it is that you are so willing to listen and entertain them.

As a side note, I LOVED the posts from India. While you were there, I won a new contract with a client with technology offices in India. They've found a unique way to use the Indian labor pool to supplement technology usage and bridge some of the gap between paper and electronic efforts.

Thanks for all the responses. I'm looking forward to more postings.

Posted by: Chris Farley | January 29, 2008 at 09:44 AM

Glad to know you are reading and thinking about the comments on your blog. This is a superb example of senior leadership using the new technologies of Web 2.0 to interact with stakeholders.

Any chance you can scare your fellow Cabinet members into following suite? I see a couple have, although your's is the most personal and reflective of the small bunch. Great work & thank you.

Posted by: Peter Stinson | January 30, 2008 at 07:52 AM

Governor/Secretary,

I wish that I'd been able to post this prior to your soup/lunch-break! Thanks for your outstanding work around the world to promote and advance health. As one who works in the world of vaccine/public health policy, I was moved by the picture of the Indian infant in your arms receiving the polio vaccine.

As a former resident (while a student at BYU and Weber State) of the state you governed, I've been pleased to observe your wife's (and your) efforts to improve immunization rates of children in Utah - and now, to improve the health of the people of the world.

Keep up the noble and important work, no matter what the detractors might say. Do what James Taylor would do, and continue to "Shower the People..."

Warm regards.

Posted by: Mike Rush | January 30, 2008 at 11:55 AM

Thank you Mr. Secretary for responding to my question.

Your blog has helped to add many different dimensions to our understanding of health care issues at home as well as abroad. You have personalized the issues for us in your humanistic style of interaction with other cultures.

Would you be willing to comment on the recent spread of H5N1 in India necessitating the culling of thousands of poultry and even goats? Families that rely on these animals for sustenance may soon be stretched to find a source of protein for their daily diet.
Are their ways that we can contribute as individuals to help?

Posted by: Science Teacher | February 03, 2008 at 04:30 PM

You Make some good points in your blog posts. Keep up the good work, There remains to be a lot of work in the health care system needed.

Jamie

Posted by: Jamie | February 04, 2008 at 03:25 AM

I would like Secretary Leavitt to visit VitalKey.com to view a medical record company that is already in business. He would find it interesting and should seek them out for more information. We do not need to spend millions of dollars to fund research we already have.

Posted by: rebecca baggesen | February 08, 2008 at 12:29 PM

Thanks for the post! Recently I have visited Costa Rica and I am pretty quite sure that Costa Rica has one of the best health systems in Latin America. Many people take advantage of the country's relatively cheap, but highly professional, medical care to combine a holiday with medical procedures they could not afford at home.

Posted by: Costa Rica Real Estate Jack | March 19, 2008 at 09:52 AM

Well Mike Your universal research is very helpful in two terms first is that it will provide the complete knowledge of entire world secondly it will be easy for you when you focus specially for america.
Please try to post regulary so that we can gain something which you have earned by your efforts.
Thanks
Selena

Posted by: Selena | June 03, 2008 at 07:45 AM

Secretary Levitt:

I am curious how long you plan to try to define contraceptives as abortion. Are you so conservative? or just a tool of the right wing? To what end?

A few days ago, health care blogger Scott Swenson asked if you plan to have the HHS policy be that Americans who use contraception at some point in their lives are terminating rather than preventing pregnancy? You have impolitely ignored his question So I am asking AGAIN!

Either you are in favor of lowering the incidence of abortion or you are not. Which is it? It's completely nutty to set a policy that equates medicine that reduces unwanted pregnancy to be the same as an abortion.

Cease this quest, you work for ME, in case you have forgotten.

Posted by: Debra Curry | August 06, 2008 at 10:10 PM