Social Networks and Health Care Reform: An Experiment

by francine Hardaway on December 29, 2008

Between Christmas and New Year’s I decided to try a “noble” experiment. I decided to invite people from my Facebook and Twitter networks to an Obama Health Care Reform party at my home. I want to see if the Obama administration’s social networks are real, and if the information flows both ways. You have to understand that my friends are an eclectic group of everything from ordinary senior citizens to A-list bloggers to idealists barely out of their teens, because each person belongs to several categories.

We have the power to help Obama in a big way if he truly wants to produce health care reform, because we understand the virality of social networks.
Example: People who couldn’t come for one reason or another wrote on the wall for my event. One man was even going to fly his plane from Arizon to California to attend, although he was ill on the day of the event. (He sent copious background information for us, because he’s a retired health care executive.)

And immediately before the event, an edition of NewsgangLive devoted part of its discussion to health care reform. If the show’s not posted yet, it will be up by the end of today.

Two of the people on the show shared their personal stories about the need for health care reform. If they want to identify themselves, they will☺

There’s a section in the reporting document that asks the moderator to fill out the answers to questions the Obama people are thinking about. Below is my summation of what I think the group(s) discussed. I could be wrong, because I was both note taker and hostess. But the great thing about the blogosphere is that if I am wrong, I will be corrected below in the comments!

Caveat: these guests were not really ordinary people. They are Silicon Valleyites. One is a health writer, one an A-list blogger, Scobleizer. I’m trying to get him and Fast Company interested in this issue, which is a big one for Fast Company’s viewers and readers since many of them are without insurance. There’s a place to ask if the press showed up. What should I say? Half of my friends could be considered “the press.”

The major takeaway: we can help, if the government lets us. The social networks would like nothing more than to use their power to good end. MyBarackObama was cited as an example of the use of social networks for social good.

What does the group perceive as the biggest problem in the health system?
Access and expense. Our economy, one person pointed out, it moving from employed to self-employed, and insurance is still mainly provided through employers. As a nation of self-employed, we need to create a large enough risk pool to provide ourselves insurance. Organizations such as the NASE were considered “scams” that provided only minimal insurance and did not cover what people thought should be covered: primary care and prevention. One participant proposed a back door system, in which hospitals and doctors allowed use of equipment and facilities for reduced prices at odd hours in order to better use equipment. And people would pay cash☺ An Underground Economy of health care.

How do attendees choose a doctor or hospital? Informal networks.
Where do attendees get information in
making that decision? From friends and doctors.
How should public policy promote quality providers? Personally, I think Health 2.0 is moving in that direction, through companies Matthew Holt can talk about. Several startups are doing quality ratings on doctors, including Yelp.

People discussed their problems with Stanford as a teaching hospital and other good hospitals in the valley for childbirth (some new parents in the room). Teaching hospitals were said NOT to provide quality care in most situations. Sequoia Hospital and Mills Peninsula were considered great places to have a baby. People got their information from word of mouth, their doulas, their friends, and their OBGYNs.

Have attendees or their family members experienced difficulty paying medical bills? Start back further in the process: people are having trouble making their premiums and paying their co-pays. Everyone has had trouble paying their medical bills, or knows someone who has. More important, everyone is terrified of losing their jobs and getting sick. We have all seen how sick people are economically ravaged by health care expenses or forego treatment.

How can policy makers address this problem? By encouraging different use of the heath care system that lowers costs, such as rationing care at end of life, eliminating unnecessary treatments that have no outcome studies to prove them effective, automating the health care system through things like remote patient monitoring and patient education and electronic health records.

In addition to employer-based coverage, would the group like the option to purchase a
private plan through an insurance-exchange or a public plan like Medicare? YES!!!!
The most common suggestion here was to expand the government (Congressional) health care program to people who want to be on a government-sponsored plan. Put the people on a single payer system who believe in it, and let others choose private plans.

Did attendees know how much they or their employer pays for health insurance? What
should employer’s role be in a reformed health care system?
Everyone would hope the employer would have a role in a reformed plan, but so many of the people were “unemployed” in the sense of lacking employer-provided health insurance that there wasn’t much discussion about the employer. There was a real tacit divide in the room between people with conventional jobs and health insurance (who are generally less interested and informed on the issue) and people who are self-employed.

Were attendees familiar with the types of preventive services Americans should receive?
Had attendees gotten the recommended prevention? If not, how can public policy help?
This is where the boldest ideas surfaced, including using Facebook and MySpace to promote prevention and distribute educational materials to using iPhones to monitor workouts and food intake. One of the attendees suggested giving “reward points” for good behavior, and allowing people to develop social capital for healthy lifestyles.

How can public policy promote healthier lifestyles?
There was a real divide between idealists who thought education and public pressure could promote healthier lifestyles and cynics who thought people would never change, and should just be denied heart and liver transplants if they smoked and drank. Holding people responsible for their own health habits and how those habits cost the entire system money is a desire, but everyone thought it would be politically impossible to do.

I found this a personally inspiring and awesome experience, especially since my family came and shared its own experiences, and my ten-day old grandson was in attendance, proving the importance of the subject for the future☺

{ 15 comments… read them below or add one }

Kat Summers December 29, 2008 at 5:43 pm

Francine–Thanks for the invitation to your “noble experiment.” I came away from the discussion with much food for thought. Ideas:

1. Real prevention strategies are key to lowering our health care costs (exercise, eat right, manage stress–we know this).
2. We still need to find a way to insure and adequately treat every American, no matter what their zip code or work situation.
3. To help afford this, we could benefit from cutting some of the chaff. For example, how about more research to identify where money is wasted on ineffective treatments? Also we can stop pushing unwanted treatments on people, such as some of the end-of-life stuff you mention above. Not everyone wants to die in the hospital with 20 tubes sticking out of them just to extend life a few more days or weeks.
4. Stop over-treating people. (Read Shannon Brownlee’s excellent book Overtreated: We don’t all need a CT scan just because it’s there. Use the expensive treatments and technologies on folks who really need it. If that’s you, see #1.

Michael R. Bernstein December 29, 2008 at 5:49 pm

“People who couldn’t come for one reason or another wrote on the wall for my event.”

What is this ‘wall’ of which you speak?

Sam Bradley December 29, 2008 at 7:50 pm

This is an awesome post. Thank you.

I woke up thinking about exactly this in conjunction with my academic research, and I am lucky to have run across this on Twitter.

I’ll be in touch if I can ever get our project together on this end.

francinehardaway December 29, 2008 at 7:58 pm

The Facebook page for the Obama Health Care Reform party last night.

Gregg Masters December 30, 2008 at 2:08 am

Hi Francine:

I am passionate about health care system and finance reform both from a personal (I am uninsured) and professional POV (25 + years in the hospital, physician and managed health world).

I too have dialed into the health care reform conversation via and am committed to contribute to the conversation, though no events yet. Am now following you on Twitter. I post under @2healthguru.

DBM December 30, 2008 at 2:18 am

I just left this post on @karoli’s page too – but will expand post here too per your suggestion. My husband has been a family physician for 20+ years. He has an offer to go corporate and has to decide in 2 wks what he will do. He has a life calling to be a physician, this is awful for him. Simplify? How about working w a patient for an hour to find what meds are covered under their plan, or to get tests they need approved, fighting w insurance companies on their behalf – he has to do it. It’s not something he can delegate because it is too complicated to argue. In our area of the state a doc gets approximately $42 for a reg visit from BC/BS, which owns 80% of the market. Medical asst will cost $20/hr. Front office person $18/hr. Benefits for all. Malpractice (ugh). Rent, phones, supplies – it costs HIM money to see patients many times. Now our kids are starting college. He can’t do it anymore. The system rewards production, fast fast visits – a patient with a sore throat? Here’s a pill. Goodbye. That is “standard of care”. What if the physician notices something more? One problem per visit, no time to address root causes or properly manage prevention or chronic disease. What if he wants to spend more time to work with the patient? No extra money just extra time and lost money from another patient. What if he wants to use electronic medical records and needs to input critical information? No extra money, just extra time he would be paid if he saw another patient. Extra time, but he would never turn away a problem, and he insists on quality of care and inputting to electronic medical records. 99th percentile every time he takes the specialty boards. He loves his calling. But nobody pays for this kind of care. He cannot do it any more, it is choosing between our kids in college or him seeing patients.
Also, just speaking to him after I posted this on @karoli’s – fyi he is very politically active on the state level – on the county board of health, board of county medical society, etc – and evidently there has been no reaching out whatsover by Obama administration officials to physicians, nurses, or primary care providers although he has seen plenty of reaching out to insurance executives, lobbyists supporting insurance sponsored think tanks, etc. A major problem is that primary care physicians are on such a survival treadmill – see another patient see another patient – that they don’t have time to be politically active. Their time is their only asset, progressively devalued by the healthcare system – so they have no time to walk away and try to fight while continuing to pay the army of staff. There are pre-certifications and pre-authorizations for even the most simple day to day standard of care decisions they make on the patient’s behalf – which were erected under the guise of reducing costs! when in fact all they do is require the primary care physician to hire an army of staff and makes their time even less efficient. One in four prescriptions, even for standard generic medications, is denied, requiring a pre-authorization process to provide basic care. To call in a simple refill at a regular local pharmacy costs less than 30 seconds and the pharmacist answers the phone for the doctor. With prescription benefit management companies, sponsored by insurance companies and Medicare, a simple medication refill or medication request can take the staff well over an hour to complete – negotiating a maze of “press one press two”.

By the way, Blue Cross/Blue Shield of Pennsylvania (Southeastern PA, our region) charges $1800 PER MONTH for their PPO plan for a full family. Granted this includes prescriptions but my husband and I are in our mid 40s, our 3 children range in age from 15 – 18.

DBM December 30, 2008 at 2:30 am

P.S. As I read the other posts, I am just so surprised that nobody addresses the primary care provider’s problems. It’s all about insurance and hospitals and nothing from the guys in the trenches who are suffering. They are too busy treating people. Being a primary care is conceptually a wonderful career. But it has become a horrible job. We will not get more primary care physicians, the residencies are not filling up. Why spend 4 years of college, 4 years of med school, 3-5 years of residency and roughly 200k in loans when it’s all over (30 years old approximately) and making their first dollar – if they cannot make a decent living. Our local hospital system starts these primary care physicians out (at 30+ years old) at a base salary of 80k. If they are fantastic producers (masters of one problem per visit, 30 patients per day), they may make 120-150k. No upside, that is as high as it will ever go because they only have so many hours in a day. Remember the loans to pay back. I am quoting my husband as I write.

Adam M December 30, 2008 at 2:34 am

LOL at expecting government health care to increase access and reduce prices.

Those are the two things that only the free market can do – government can only reduce access and increase costs.

It blows my mind that entrepreneurs of all people are under the illusion that this can, or should, flow from government.

Regulation is the control mechanism of the monopoly system created by government. They grant monopoly status to the AMA, create a drug approval process that only multinational companies can afford to participate in, and reduce personal choice. No wonder the health care system is in disarray. The state created the problem – they are not the solution.

Steven Geanopulos December 30, 2008 at 3:59 am

I understand why this particular group would not want to address the employers point of view, however lets not forget that they are currently the major financiers of health care today. This is likely to continue. Employer financing should continue because it is the workplace where the clture of wellness can sucessfully be promoted. The governments job is to provide the financial incentives to do so. A workplace that has a culture of wellness will likely not be a comfortable place for a smoker to work, by the sheer force of peer pressure. People are more likely to change behavior if there are social consequences. Our government should take advantage of the very real live “social networks” that are already in place, where people are living, breathing and interacting with one another. The employee however should have a completely portable policy they carry around for a lifetime. This should not be in the employers hands. The policy should remain in effect even after the job is lost. This could be paid for by putting away a certain amount of the premium into an acount or perhaps additional money could be deducted to provide so many months of insurance to protect the premium costs between jobs. Having the same policy from H.S. graduation through 65 years of age will likely change the behavior of insurance companies to invest in the long term health of their policy holders. Why would an insurance company invest in the long term health of a policy holder who is going to leave in 2-5 years when they change jobs.

The Employer is the key to lifestyle change (they will do it when they see the impact to the bottom line) and the employer is the key to finance if the system is level across the country and insurance is allowed to act like insurance.

francinehardaway December 30, 2008 at 4:06 am

Adam, I don’t think this will flow from government except in the short term, because government can educate people to be mindful of their own health, which the free market insurance companies have not stressed for the past 50 years. The insurance industry got us into this, not the AMA. I remember when there wasn’t much government in the health care process, and the providers ran the show. Insurance, which was provided privately, ruined everything by putting an intermediary between patient and provider. Then the government stepped in to regulate things.

francinehardaway December 30, 2008 at 4:48 am

The problem with employer financed healthcare is that employers are struggling with the costs of providing it, and many don’t. Many more people are not employed by anyone but themselves. What do we do about them?

DBM December 30, 2008 at 6:40 pm

I was surprised when today I was reading an article that cited “rising healthcare costs” as a reason for the problem. People should know, the healthcare system (hospitals, etc) must set their prices at a certain rate in order to play a game with Medicare or other insurers – look at your last bill. Look at what the hospital charged, and what the “UCR” (usual and customary reimbursement) is. THAT is what they got (a small fraction of what was billed), and there are rules that fees providers charge must be a certain percentage above the UCR – well it is a mess. The TRAVESTY, to me, is that while the insurance companies hold the physicians hostage and make them accept their UCR (in our case, if BC/BS has 80% of the market and they said “we won’t make you a participating provider anymore if you don’t agree with our low reimbursement so you will have no patients” – thus blackmail if you want a patient base) – while the uninsured get the face charge on the superbill or hospital charge slip – and have to pay the full amount! They don’t get a discount like the insurance company who forced the physician to take theirs. They are liable for the insane number that is never paid paid by anyone, except by the uninsured. What’s wrong with this picture.
Still shocked that nobody else, no articles about reform, nothing discusses this and the plight of the providers, who essentially are blackmailed into accepting fees that in many times force them to pay money in order to provide care. Recently a flu shot cost a physician $12 to buy, yet Medicare only reimbursed him $8. Crazy? That’s our healthcare system. All anyone talks about is insuring the uninsured. And of course I agree, health insurance is out of control. But where is it going?? Perhaps fees would be much more “in control” if this disappearing money went into the pockets of either the regular people or providers. It is a great mystery, where this money goes. You can be sure it is not to providers or patients.

DBM December 30, 2008 at 6:55 pm

Lastly (I’ve said too much already)- how about an incentive at the primary care level to provide disease prevention. Instead of incentives being “production based” and forcing primary care providers to see patients as fast as possible, give them some type of reward or incentives for keeping their patients out of the hospital, for keeping them healthier. Make a new “level” of visit (now we have level 1 – 5, each with criteria that amounts to how many problems are addressed – but prevention is never one of the “problems”) – with ample financial incentive to allow the physician time to promote health. The system rewards those who do procedures and tests and make expensive scans. Our system pays the specialists, whose job it is to do procedures, handsomely. But it pays nothing to the physicians to keep those problems from happening – which of course would be far less expensive for everybody from every angle. Let’s not just manage disease, let’s manage health to prevent the disease.

Phillip Blackerby January 1, 2009 at 9:06 pm

Regarding employer-based health insurance, the U.S. is the only country on the planet pursuing this failed policy. It was started by the labor movement, as a way to increase benefits without increasing taxable wages in an era when income tax schedules were much more progressive. The U.S. was the first country to develop any mechanism for widespread health insurance, but no other country followed our model of employer-based health insurance plans.

Today, U.S. employers are at a competitive disadvantage relative to employers in other countries because of ever-rising employee health insurance costs. Virtually every other developed country taxes its citizens and businesses to subsidize health care, with modest co-payments from patients. In these countries, health care is either a citizenship right or a human right, not an employment right.

One consequence is that our manufactured goods–in particular–are relatively more expensive in international markets than comparable manufactured goods from other countries, just due to health insurance costs.

Another consequence is that U.S. residents are less-healthy than citizens in most other developing countries, and our health care costs are much higher per capita; we spend more for a lower level of health overall. In the U.S., insurance companies focus on how to off-load sick people to improve financial performance. Single-payor systems can’t off-load patients, so they soon figure out that health care prevention is cheaper than health care, and they invest significantly in preventative health care.

Employer-based health care made sense only when no other country was investing in widespread health insurance and governments were reluctant to recognize health care rights. Today, neither of these conditions exist, but we remain stuck with this failed system.

Steven Geanopulos January 6, 2009 at 7:15 pm

Re: The employers role. As I stated in my previous comment, I do not believe the employer should be the provider of healthcare services (insurance) but they should continue to pay the premiums as they currently do (I understand you could give me stats as to how many people are not covered but the majority of Americans are and they are paid for by their employer). It is small business that does not offer insurance because it is cost prohibitive, but if I had an employee who had a premium of $100 per month to pay on their own policy I would gladly pay that in full, rather than pay 50%-100% of a $400 premium offered to small businesses. (No small business person in their right mind would say no to this since they know a nationalized system is going to increase their payroll tax more than that $100 per month)

People who are healthy between the ages 19 (if not a student) and 22 (if they are a student) should be mandated (some how) to purchase health insurance if they are employed. The minimum coverage acceptable coverage should be a catastrophic high deductible plan that has an IRA style incentive to deduct a small portion of each paycheck to fully fund the deductible (this account forever travels with the employee from job to job). The small deduction fro the payroll that funds the deductible may be put into an IRA style account to grow over time. If someone is employed for 10 years and then wants to leave the job to pursue some other dream, they will have an account that will continue to pay their policy while they are either unemployed or trying to become self employed. This way people will not feel trapped in a job they hate just because it provides health insurance.

For the largest population of uninsured, 19-29 year olds, the above plan would be very inexpensive since they are incredibly healthy and the majority of healthcare costs are the first $1500 which the employee will be self insuring (after all we each have $1000 deductible on our auto insurance). The employee / citizen who is spending the 1st $1100 for an individual and $2200 for a family will then be able to negotiate fees with the provider without the third party getting in the way, which results in a major cost reduction. Most high deductible health plans pay for 2 full physicals per year (so don’t worry about people not getting checked because they may have to pay for their physical). In most states the expense for this type of plan is just under $100 per month (for an individual $250 for a family) and would reduce the number of uninsured significantly thus increasing the size of the risk pool. By healthy people buying their own policies they do not have to join the high risk pool at the workplace where the same policy cost $400 for an individual ($1100 for a family).

The federal government will then give the employer the financial incentive to initiate workplace wellness programs which have been shown to significantly reduce the cost of health care in study after study. If your peers at the workplace apply pressure you are more likely to change your unhealthy behavior than if the federal government did an ad campaign. In this model the employer will have a significant reduction in cost. The employee will have a portable plan that insurance companies will have a real reason to pay for prevention since there is a good chance the person will have that policy across their career. Another comment made referenced the origins of company funded health insurance, they are right but that was also at a time when you were in the same company for 30 years. If it were so affordable to employers in other countries, European nations would not have a recent history of such slow growth and high unemployment. There is no such thing as free health care.

The healthy self employed, in most states (NY, NJ, California, Conn. and Mass. not included) can purchase insurance much cheaper than an employer, as stated above. This is why there needs to be a clear level playing field so insurers in Arizona can compete for policies in New York. This of course increases competition and decreases cost but then leaves the unhealthy out in the cold.

Once the majority of the uninsured are in the pool, (we still have to figure out what to do with the undocumented )you can establish regional risk pools to pay for the increased risk of the sick and incentivize changing behaviors like smoking and obesity, which will be funded publicly, much more manageable. We are a rich country, we can help those who cannot pay for themselves but we cannot afford to help those who can pay for themselves. We can certainly incentivize healthy behavior, not reward unhealthy behavior, and not punish the sick if we get a little creative.

This should be a forum for what is realistic politically not what is idealistic to the libertarian or the progressive. This is a country where every single political success over the past 200+ years has been a compromise. There are some great successes in our current system of healthcare and some great failures. Let us be creative and create something for the world to follow. We should not substitute our failing system for a system that is failing in other countries just because it is different. Idealistic rigidity will get us no where.

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