Dana Blankenhorn

Why ObamaCare Will Be Upheld

All the TV analysts are agreed that the Affordable Care Act, aka ObamaCare, is going to be struck down by the Supreme Court.

The attitude is based on oral arguments in which all five conservatives asked skeptical questions, including the presumed “swing vote,” Anthony Kennedy, who seemed to see this as a basic question of liberty, the freedom not to participate in the market.

But here's my prediction, for what it is worth. The law will be upheld. Most likely, by a 6-3 vote.

The reason is basic. Without this law regulating insurance the government has no control over one-sixth of the economy, short of taking it over, which it is otherwise in the process of doing. The current law is a Republican solution, first proposed by Richard Nixon a generation ago, and implemented by Mitt Romney less than a decade ago.

Why ObamaCare Works

Think of this as Volume 16, Number 9 of A-Clue.com, the online newsletter I've written since 1997. Enjoy.

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The Affordable Care Act, aka “ObamaCare,” is the Nixon Shock of our time.

Just as the Nixon Shock let the economy deal with the natural deflation of Moore's Law, so ObamaCare is essential to dealing with the natural inflation of health care costs.

Obamacare makes medicine part of the social contract. Rather than focusing on “cures,” it makes the market focus on “health,” which is the only way of dealing with the vast demographic changes taking place in our society.

I'm getting older. So is the whole baby boom. As we age labor shortages will increase. There will be fewer-and-fewer workers around to pay for our care, and our comforts. This would break the present health care system, leaving our economy uncompetitive, our seniors wasting away with no care, and our life expectancy headed downward. Life under the present regime is becoming nasty, brutish, and short.

Can IBM Succeed Where Obama Failed?

There was a lot of chuckling over WellPoint's  announcement that it will be partnering with IBM to use that company's Watson supercomputer for medical diagnoses.

The idea is that Watson will combine patient medical histories, tests, medical literature and (perhaps most important) clinical best practices to decide quickly what doctors should be doing.

It's not the only such deal in the market. Other tech companies have similar initiatives. AT&T calls its program ForHealth. 

The idea in all these cases is the same, to take some measure of decision making out of the hands of doctors, and give insurers a rationale for denying expensive treatments when less costly ones are available. 

Another term for this is comparative effectiveness. You look at what a lot of people have done in similar situations, what happened, then do what works best.

The Real Impact of Cloud Computing

A lot of people are talking about cloud computing, but what they mainly see is an industry or (perhaps) a second industry (social media) spawned by it.

They're missing the point. The real impact of "the cloud" has yet to appear.

We're starting to see snatches of that future in things like this, IBM and ETH Zurich using clouds to to analyze disease-causing proteins and, hopefully, fight bacteria that are resistant to current antibiotics. It's one of the great "oh noes" that has the doom-and-gloom crowd expecting the destruction of civilization at any moment, the idea being that flesh-eating bacteria are going to get all of us and there's nothing we can do about it.

Well, now there is. Clouds let you set up immense jobs and run them in real time, combining two great breakthroughs of the last decade -- distributed computing and virtualization. What it means is that asking the question in the right way is the whole of experimental design, that the answers to big questions arrive faster.

In addition to handling big questions, clouds also can handle huge data sets efficiently. Not all the implications of this are good -- people don't like their lives being an open book to the police. What must be controlled are what police agencies do with this new power. We need to trust that there are relatively few terrorists and big drug runners out there, compared with the general population. And you know what? There are.

A Few Words About Google Health

Google Health was doomed from the start.

It was based on a legal fallacy and a technical one.

• The legal fallacy was that you own your health data, and can control it. That may be the law, but that's not the fact. The people who collect your data control it, and that control is important to them.
• The technical fallacy was that most people are versed on technical subjects, and either have the patience to input their own data or go through a complex download-transform process to get it.

Both these fallacies have been pushed for years by so-called privacy advocates, mostly shills of insurers, who use Fear, Uncertainty and Doubt (FUD) about technology to keep it out of doctors' offices. Through laws like HIPAA, and their continuing campaigns against reason, these "advocates" make it necessary for you to keep filling out the same damned forms -- over and over again -- whenever you see a new doctor.

AHLTA Connections Given Control of VistA Open Source Project

Fred Trotter writes about a very scary story out of Washington.

The custodian for the new VistA system, the open source software that's supposed to replace what the Veterans Administration is now using, will be a long-time Defense contractor with no ties to open source whatever.

This is important for two reasons:

1. DoD is not as enthusiastic about open source as the VA. 
2. The DoD's health care software system, called AHLTA, sucks. It sucks because it's built on a contractor model, with proprietary software companies holding their own intellectual property close to the chest, refusing to cooperate until they're paid by everyone else around the table.
3. Eventually, AHLTA and VistA are supposed to be merged, under the new open source process.

Can Open Source Save Big Pharma?

Big pharmaceutical companies like Johnson & Johnson, Pfizer and Abbott Labs  have a problem software companies can relate to.

The costs of drug discovery, and drug trials, have grown exponentially, resulting in a smaller pipeline of new drugs and massive consolidation throughout the industry.

For software, open source provided a partial answer. By pooling basic technology through groups like the Eclipse Foundation and Apache, software companies have been able to reduce costs while retaining the power to innovate and sell innovations.

While health IT has used the open source process, both publicly (through the VA's redevelopment of its VistA platform) and privately (through groups like Open Health Tools) drug delivery itself remains a proprietary affair.

Now Pfizer is taking the first baby steps away from an all-proprietary formula by sharing the design of its first all-electronic drug trial, for the bladder control drug Detrol.

A number of companies are providing technology that lets Pfizer recruit trial participants online and have those people manage their own therapy. Myrtus is working on the front-end. Exco inTouch provides the mobile e-diary equipment. Perceptive Informatics is providing the back-end processing. The University of California is providing third-party validation.

The Medical Issue

Think of this as Volume 15, Number 23 of A-Clue.com, the online newsletter I've written since 1997. Enjoy.

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I spent some time yesterday looking at an American medical success story.

One of my oldest friends needed cataract surgery. Unlike me, however, he's a veteran, so he could get it done.

I drove him there and back, which is required when the patient is getting anesthesia. What I found was a crowded, bureaucratic, but efficient hospital where the workers always treat patients and families with civility. There was no luxury. There was a line for everything, even though we had an appointment. All the workers were on salaries dictated by a government schedule. But the veterans knew they had a good deal, and everyone from doctors down to clerks was polite and cheerful – even to me.

Google's Android Vision is Always-On

Back in 2003, at the bottom of the last recession, I began writing about what I called “the world of always-on,” where single-chip computers on a wireless network would let you automate your home, manage its contents, even save your life.

Google has now embraced that vision with its Android@home offering, announced yesterday.

While most reporters focused either on the home entertainment legalities or the early peripherals  running on the service, the bling of the thing, I think it's the overall vision that's more important.

The vision is based on a single word. Linux. Android, wherever it lives, is a Linux, meaning it's a fully-featured operating system with 45 years of experience behind it, which can run on mainframes (or the cloud), home servers (tablets etc.) or clients (phones, home stereos, robots, cars, etc. etc. etc.)

New clients can be implemented through Arduino (right), an open source prototyping system that currently only supports USB, but which will quickly evolve under Google's direction into single-chip systems controlled through wireless protocols like Bluetooth, NFC, and WiFi.

Paul Ryan, Deficit Chickenhawk

Rep. Paul Ryan (R-Wis.) loves strutting about claiming to be a deficit hawk. He hates deficits, he claims. He demands we cut spending because we're broke.

Yet when Epic Systems Corp., which is based in his home state of Wisconsin, passed around a letter recently demanding that the VA's move to replace its open source VistA system with an open source process be halted, Ryan signed it. The letter claimed, laughably, that the benefits of a commercial system had not been given "appropriate consideration.”

This is bullshit. Commercial systems got plenty of consideration. It was called AHLTA – the Armed Forces Health Longitudinal Technology Application.

Based entirely on proprietary technology, AHLTA has been a big, long, frustrating failure. Meanwhile VistA, which was shared as “public record” a decade before anyone knew what open source was, has been giving our heroes the most efficient care anywhere for 30 years.

That's a market test, Congressman. You remember the market, don't you? You once claimed to be a supporter of it.