healthy4u

Hedge Fund U

We previously <a href="http://hcrenewal.blogspot.com/2008/12/screamer-who-got-his-way-madoff-case.html">posted</a> about how the Bernie Madoff scandal shed light on problems in the governance and leadership of one major university (which includes a well-known medical school). Yeshiva University, which includes the Albert Einstein College of Medicine, reportedly lost more than $11o million of its investments with Madoff. Not only was Madoff on the university's board of trustees, but also the chairman of the board's investment committee was hedge fund leader Ezra Merkin. Merkin invested the university's money in his own hedge funds, which, in turn, turned over the money to Madoff. This week, Merkin, who like Madoff has left the Yeshiva board, was charged with civil fraud. As <a href="http://online.wsj.com/article/SB123903070566093099.html">reported by the Wall Street Journal</a>, <blockquote> J. Ezra Merkin, a money manager who funneled $2.4 billion from universities and nonprofit organizations into Bernard Madoff's firm, was charged Monday on allegations he "betrayed hundreds of investors" by repeatedly lying to them about how he invested their money. Mr. Merkin, a New York philanthropic leader and the former chairman of finance company GMAC, raised billions of dollars for his three hedge funds, telling clients he was managing the money himself. But instead, according to a civil fraud complaint filed by New York state's attorney general, Andrew Cuomo, Mr. Merkin collected hundreds of millions of dollars in fees over more than a decade while weaving a 'panoply of lies' to conceal that he was channeling much of his clients' funds to Mr. Madoff. 'Merkin held himself out to investors as an investing guru...In reality, Merkin was but a master marketer,' Mr. Cuomo said in the complaint. Mr. Merkin, who met Mr. Madoff in 'the very late 1980s, maybe 1990,' according to his testimony, has emerged as a prominent figure in the Madoff scandal because of his stature among charities, universities, funds and even sophisticated value investors. Many of his clients were entities he courted through his social ties among monied New Yorkers. Mr. Merkin sat on the boards of some charities whose money he managed. The sales pitches for Mr. Merkin's three funds -- Ascot Partners LP, Gabriel Capital Corp. and Ariel Fund Ltd. -- included promises that he actively managed their funds, according to the complaint. Mr. Cuomo said the Ascot fund was formed by Mr. Merkin in 1992 as a 'feeder' fund for Mr. Madoff. It grew to hold $1.8 billion from 300 investors by the end of December 2008. Mr. Madoff pleaded guilty last month to using the money in a Ponzi scheme, where funds from new investors were used to pay existing ones. About 85% of investors in the Ascot fund didn't know their money was flowing largely to Mr. Madoff, Mr. Cuomo's complaint said. In two meetings with Ascot investors in his offices at 450 Park Ave. in Manhattan, it says, Mr. Merkin pointed through a glass partition to a trading area and said his staff 'right here' was doing the work of managing their money. Mr. Merkin collected an annual fee from Ascot's investors amounting to 1% to 1.5% of the fund's total assets, which included the fictitious Madoff returns, Mr. Cuomo's complaint said. By 2008, Mr. Merkin was collecting about $25.5 million a year from managing Ascot -- generating management fees of about $169 million from Ascot from 1995 to 2007, the complaint says. Mr. Merkin told investors that 60% of his Ascot fund was comprised of money that came from his personal family trusts, the complaint alleges. But all told, Mr. Merkin invested personally and through family trusts and foundations $7 million in Ascot through 1998, and less than $2 million over the following 10 years. </blockquote> Seeing how readily Madoff's institutional investors, in particular, the leadership of Yeshiva University were bamboozled, I thought maybe it was time to see who that leadership actually was. Yeshiva's current Board of Trustees is listed <a href="http://www.yu.edu/board/">here on the University web-site</a>, but without any detail about the people whose names appear there. A bit of Google searching revealed that the group included, besides Merkin and Madoff, - Morry J Weiss (chairman), who is <a href="http://spider.mc.yu.edu/news/articles/article.cfm?id=100763">on the advisory board </a>of <a href="http://www.primuscapital.com/">Primus Venture Partners</a>, a private equity firm - Sy Syms (vice chairman), who is <a href="http://www.sec.gov/Archives/edgar/data/724742/000093041308003580/0000930413-08-003580-index.htm">on the board of the Israel Discount Bank of New York</a> - Alan E Goldberg (treasurer), who is <a href="http://www.lindsaygoldbergllc.com/#/team/">co-managing partner and co-founder of Lindsay Goldberg</a>, a private equity firm - Israel A Englander, who is co-founder if <a href="http://iaenglander.com/">I A Englander & Co</a>, a financial derivatives trading firm, and founder of Millennium Partners, a hedge fund (also note that Millennium Partners and Mr Englander personally settled lawsuits in 2005 that charged they used an elaborate scheme using market timing, as per <a href="http://www.nytimes.com/2005/12/02/business/02fund.html">this NY Times story</a>) - Ruth L Gottesman, <a href="http://www.aecom.yu.edu/home/fullstory.asp?id=198">the spouse of David Gottesman</a>, the founder and senior managing director of <a href="http://investing.businessweek.com/businessweek/research/stocks/private/snapshot.asp?privcapId=4613435">First Manhattan Company</a>, an investment adviser, (and also a former chairman of the Yeshiva University board) - Lance L Hirt, another <a href="http://www.lindsaygoldbergllc.com/#/team/">partner at Lindsay Goldberg</a>, a private equity firm (see above) - Michael Jesselson, the president of <a href="http://investing.businessweek.com/businessweek/research/stocks/private/snapshot.asp?privcapId=2567724">Jesselson Capital</a>, an investment company - Henry Kressel, a <a href="http://www.warburgpincus.com/people/ViewEmployee,employeeid,69.aspx">partner and senior managing director of Warburg Pincus</a>, a venture capital company So, before the resignation of Madoff and Merkin, nine of the 40 officers and trustees of Yeshiva University were in finance, all in leadership positions (and the board also included the spouse of another financial leader). Most were not in retail banking or retail stock brokerages, but in the more exotic areas of finance that are most associated with the global economic collapse, including derivative trading, hedge funds, private equity, etc. On one hand, it would appear that a board so heavily stocked with finance leaders ought to have been sophisticated enough to do the due diligence their role required in evaluating the university's investments. On the other hand, perhaps the enrichment with finance people created a clubby atmosphere that discouraged questioning their fellow financiers too closely. That almost 25% of Yeshiva University's board was composed of finance leaders is striking, given that the <a href="http://www.bls.gov/emp/empmajorindustry.htm">US Bureau of Labor Statistics estimates </a>that less than 6% of employed people work in finance. But note that we previously <a href="http://hcrenewal.blogspot.com/2008/12/what-linked-parallel-declines-of.html">found</a> that 50% of the Harvard Fellows (the equivalent of their board of trustees' executive committee), and <a href="http://hcrenewal.blogspot.com/2008/11/leadership-of-elite-american-university.html">69%</a> of Dartmouth College's charter (self-appointed, as opposed to elected by alumni) trustees were leaders in the financial sector. This is somewhat anecdotal evidence, but it suggests that leaders of finance are much more prevalent among the top leadership of elite US institutions of higher education than would be explained by their prevalence in the population. This raises the question of why financial leaders seem to have become so prevalent in academic leadership. This question is important, since this prevalence seems to have increased in a time when the culture of the leadership of the financial sector seemed to become more and more alien to the values that academic leaders ought to support, culminating in a global financial collapse that many blame on the sector leaders' arrogance, greed, and sometimes outright corruption. At least it seems a reasonable hypothesis that some of the problems of academia, and particularly the problems of medical academia, may have been at least enabled by leadership more used to working in an increasingly amoral marketplace than to upholding the academic mission. We hope that there will be more interest in who now leads academia, especially medical academia, how they got there, and what they have wrought.

Hedge Fund U

We previously posted about how the Bernie Madoff scandal shed light on problems in the governance and leadership of one major university (w...

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Have we suffered a complete breakdown in the scientific method with regard to EHR and clinical IT?

Have we suffered a complete breakdown in the scientific method with regard to EHR and other clinical IT? I read announcements like this with trepidation: <div style="margin-left: 40px;"><a href="http://govhealthit.com/articles/2009/03/31/sebelius-confirmation.aspx" style="font-family: arial;" target="blank">http://govhealthit.com/articles/2009/03/31/sebelius-confirmation.aspx </a> “The goal,” Sebelius said, “is to provide every American with a safe, secure electronic health record by 2014." The nominee also endorsed efforts to use data gleaned from electronic medical records to conduct “comparative effectiveness research" (CER) to provide information on the relative strengths and weaknesses of alternative medical interventions to health providers and consumers.” </div> Recovery Act funds have been allocated to NIH specifically for comparative effectiveness research. NIH has further specified the definition of CER as: <blockquote>"[A] rigorous evaluation of the impact of different options that are available for treating a given medical condition for a particular set of patients. Such a study may compare similar treatments, such as competing drugs, or it may analyze very different approaches, such as surgery and drug therapy."</blockquote> NIH states that such research may include "the development and use of clinical registries, clinical data networks, and other forms of electronic health data that can be used to generate or obtain outcomes data as they apply to CER." The problems I foresee concern the word "rigorous" as in the above definition. The use of EHR data to reliably detect uncommon (but strong, discrete) early warning signals from a single drug or treatment -- to then be subject to more rigorous study with reasonable controls -- is itself a Medical Informatics "Grand Challenge." An example would be finding VIOXX's association with myocardial infarction earlier than we did, via an EHR-based automated postmarket surveillance process. Doing this is a "grand challenge" due to the nature of EHR data, which is as far from "clinical trials clean" as possible. It is what might be called highly uncontrolled. The statistical methods needed to reliably pull signals out of the muck for even a single drug are still exploratory, the problems formidable if one wants to stay scientifically sound. I wrote about the experimental nature of such efforts a few years ago <a href="http://www.scribd.com/doc/12392184/A-Medical-Informatics-Grand-Challenge-the-EMR-and-PostMarketing-Drug-Surveillance-" target="blank">here</a>, and believe an effort got underway at U. Indiana/Regenstrief to test such methodologies for postmarket surveillance about the same time. Now we have had what appears to be a leap of faith and logic of irrationally exuberant proportions, and probably a deviation from sound science as well. The government has announced enthusiasm for EHR data-based comparative effectiveness research (CER) not to aid science, but to cut costs (implying skipping the rigorous confirmatory phases) through elimination of more costly drugs and treatments deemed less effective or at effectiveness parity compared to less expensive choices. Following this thinking, perhaps in the future a metric will be developed for an "acceptable" improved benefit/cost ratio for expensive drugs that are better than cheaper alternatives? This overconfidence in EHR data is of concern. To detect relatively less concrete (i.e., than major ADE) "outcomes differences" between two or more drugs or treatments via EHR data - did treatment A lower blood pressure more than drug B, did drug C lessen depression more than drug D - rises to the level of "grand overconfidence in computing." To accomplish this task with reasonable scientific certainty from reams of EHR data, originating from different vendor systems, input by myriad people of different backgrounds with differing interpretations of terminologies (students/MD's/RN's etc) under different pressures (time, reimbursement maximization), and so forth, seems a stretch. What will the p values and predictive values be for such studies? Yet our incoming HHS secretary touts such methods? Ironically, the gold standard in medical science is the controlled clinical trial, yet EHR-based comparative effectiveness research itself as a research methodology, now touted by our government, seems to have gotten a pass. Even what I would consider minimum requirements for scientific treatment comparisons, such as well designed and reasonably controlled registries as developed <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=Cardiology%20story">here for interventional cardiology</a>, with hundreds of granular, finely defined and "tuned" data elements, appear to be bypassed in EHR "miracle claims." Such precise registries take months or years to develop, implement, and train users to interact with properly. Further, such registries are not portable and must be created for individual medical domains and subdomains. Uncontrolled EHR data is no substitute for such efforts. The following question arises: Where are the comparative effectiveness studies that compare 1) EHR-based comparative effectiveness studies of drugs and treatments to 2) controlled clinical trials-based comparative effectiveness studies? In other words, where are the meta-clinical trials that compare EHR data mining-based comparative effectiveness research as a methodology, vs. the "traditional" gold standard methodology of controlled clinical trials to compare drugs or treatments? How do we know EHR-based CER studies will not produce GIGO that will cause harm through ham-fisted elimination or defunding of useful treatment options? While there are initial efforts underway to increase understanding of CER, e.g., <a href="http://grants.nih.gov/grants/funding/challenge%5Faward/High_Priority_Topics.pdf#topic_05">"Broad Challenge Area 5</a>" (PDF) of the NIH RC1 Challenge Grants in Health and Science Research, ominously, there is a lot of potential advantage to be had with terabytes of uncontrolled data and a political agenda. I fear that what will come from "comparative effectiveness research" that draws upon uncontrolled EHR data will be politics masquerading as comparative effectiveness research. Good luck to private practitioners and medical innovators. Good luck, pharma. Good luck, patients. This movement towards EHR uncontrolled data alchemy represents a further deviation from medical science towards the Syndrome of Inappropriate Over-Confidence in Computing (a.k.a. SICC Syndrome) writ large. It seems the IT industry has now rendered a scientific approach to HIT and its use obsolete. We see this "post scientific era" phenomenon in the takeover of clinical IT by vendors who contractually demand suppression of sharing of problems, we see it in a remarkably uncritical push for EMR's by 2014 now involving force of government (only financial at present, but will punitive licensure issues and other measures be off the table?) despite a growing body of literature advising caution, we see a consortium of big business/payers/vendors/myriad secondary feeder organizations gunning full blast for this technology without consideration of the possible downsides. Biomedical informatics, a scientific discipline (at least those parts of it not yet compromised by conflicts of interest), as a relevant field is very much a minority player in today's health IT. Even the contributions from experts and pioneers in the field of Biomedical Informatics, in the form of the Jan. 2009 National Research Council's report that "Current Approaches to U.S. Health Care Information Technology are Insufficient" (<a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=NRC">here</a>) has not had much impact. I see Biomedical Informatics' death as a relevant discipline that anyone of importance pays attention to, not too far down the road as well. -- SS Addendum April 20: We've seen this phenomenon in our economy. WSJ "Information Age" writer L. Gordon Crovitz <a href="http://online.wsj.com/article/SB124018430498933171.html">notes</a>: <blockquote>... In a paper for the scientific journal of the Royal Society back in 1994, Harvard economist Robert Merton wrote that "any virtue can become a vice if taken to extreme, and just so with the applications of mathematical models in finance practice." We know even better now that some risks can be calculated and thus reduced, while some unknowns cannot be turned into probabilities. "The mathematics of the models are precise, but the models are not, being only approximations to the complex, real world."</blockquote> I believe EMR data at best is a very loose approximation to the real world. It contains many "unknowns" regarding quality and reliability that cannot be turned into probabilities no matter how fancy the math. Asking too much of EHR data becomes a vice, not a virtue. -- SS

Have we suffered a complete breakdown in the scientific method with regard to EHR and clinical IT?

Have we suffered a complete breakdown in the scientific method with regard to EHR and other clinical IT? I read announcements like this with...

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Click-to-Buy expands to 8 new countries

Whether you come to YouTube to watch a specific video, discover related content, or engage and interact with people and videos from all around the world, our goal is to put you in control of your online video experience. This means making it easier for you to find what you're looking for (like dedicated channels for <a href="http://www.youtube.com/music">music</a> or <a href="http://www.youtube.com/browse?s=mphd">HD</a> videos) and offering you new and innovative ways to engage with that content. One way we already offer you this kind of deeper experience on YouTube involves music videos on the site: <a href="http://googleblog.blogspot.com/2008/10/i-clicked-to-buy-and-i-liked-it.html">Click-to-Buy</a>, our eCommerce platform, helps you find products (like songs and DVDs) related to the videos that you're watching. <a href="http://news.bbc.co.uk/2/hi/technology/7967908.stm">A recent study</a> found that after watching a music video on YouTube, 50% of adult users in the U.K. then go on to purchase music from that artist. And we've seen these results for ourselves — three of the four major music labels are Click-to-Buy partners and are already selling millions of songs a year from these links on YouTube. We're excited to announce that today we're rolling out Click-to-Buy links on music videos in 8 additional countries: Australia, Canada, France, Ireland, Italy, Japan, New Zealand, and Sweden. Now Click-to-Buy partners can offer music downloads to hundreds of millions of people around the world. We enjoy working with our music partners to provide them with these kinds of opportunities, and we look forward to further expanding the program in the coming months. Posted by Thai Tran, YouTube Product Manager

Click-to-Buy expands to 8 new countries

Whether you come to YouTube to watch a specific video, discover related content, or engage and interact with people and videos from all arou...

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Search the rainbow

No one likes to take work home, but lately I've been looking forward to it. That's because I've been working on our new color filter in <a href="http://images.google.com/">Google Image Search</a>, and my daughter and I have been having a great time together looking at all the colorful animals that we've seen in the tide pools. "Papa, do the <a href="http://images.google.com/images?q=sea+anemone&imgcolor=green">green noodle fish</a>." <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjiHd4AN7JA2jCcVzsSi84z-7-hZciL4mstu1HWYX0c5GJg-QvJd8es3u8OhyphenhyphenOnD8Ziu5tLLaIcEj4Z2FjLhXSvxjxxpUE4WSzRWd1lfPn1VMYu2dASmwEgMN1gnS5SxqWCYbqiChqk6dS/s1600-h/sea_anemone_green.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5322371710364923394" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjiHd4AN7JA2jCcVzsSi84z-7-hZciL4mstu1HWYX0c5GJg-QvJd8es3u8OhyphenhyphenOnD8Ziu5tLLaIcEj4Z2FjLhXSvxjxxpUE4WSzRWd1lfPn1VMYu2dASmwEgMN1gnS5SxqWCYbqiChqk6dS/s400/sea_anemone_green.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 88px;" /></a> "Papa, now do the <a href="http://images.google.com/images?q=sea+anemone&imgcolor=red">red one</a>." <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjI8XH1ZzVhW0-lM_PoBHya_BlRzM3fhg5sHNb0N9bf3AyX9kkL0rvXXAk5We8crjV6Z2ShQkTHFrt7GrxqHvm-aRQ9SNe7bB9tS3KQh6Lp-EtgNZ09mbuummoQKKwvfXhKksePUVXknrq/s1600-h/sea_anemone_red.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5322371711237139490" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjI8XH1ZzVhW0-lM_PoBHya_BlRzM3fhg5sHNb0N9bf3AyX9kkL0rvXXAk5We8crjV6Z2ShQkTHFrt7GrxqHvm-aRQ9SNe7bB9tS3KQh6Lp-EtgNZ09mbuummoQKKwvfXhKksePUVXknrq/s400/sea_anemone_red.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 95px;" /></a> She loves it. Today, I'm happy to announce that you too can use our color filter in your own image searches. Just search for something the way you normally would, such as [<a href="http://images.google.com/images?q=tulips">tulips</a>]. On the results page, click on the "All colors" drop down in the blue bar and choose a color. For example, try restricting your results to [<a href="http://images.google.com/images?q=tulips&imgcolor=yellow">yellow tulips</a>]. Want to see purple tulips instead? Simply click on the color filter again, select purple, and <a href="http://images.google.com/images?q=tulips&imgcolor=purple">voila</a> — you have pages of beautiful images! You can also combine the color filter with any other image filter to further refine your search. For example, if you're looking for an image of an orange butterfly, try restricting to <a href="http://images.google.com/images?q=butterfly&imgcolor=orange&imgtype=photo">photos</a> or <a href="http://images.google.com/images?q=butterfly&imgcolor=orange&imgtype=clipart">clip art</a>. Color is one of the basic visual elements of an image. Whether you're browsing through photos of sea creatures and flowers or searching for the perfect orange butterfly, we hope you like our new color filter. We've been rolling this out gradually, but it will be available to everyone soon. Posted by Donald Tanguay, Software Engineer

Search the rainbow

No one likes to take work home, but lately I've been looking forward to it. That's because I've been working on our new color fi...

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New features and an early look at Java for App Engine

Scarcity brings clarity, and many companies are taking important steps to adjust to today's economic climate. At Google, we've started changing the way we build and release products. In the past six months alone we've launched nearly 50 projects and small products on <a href="http://code.google.com/appengine">Google App Engine</a> -- from <a href="http://moderator.appspot.com/">Google Moderator</a> and <a href="http://googleappengine.blogspot.com/2008/10/when-we-find-tools-that-work-well-for.html">Labs for Google Apps</a> to internal-facing tools for both our Ads and Web teams. In all cases we found it quicker, easier, and more cost-effective to leave the infrastructure to App Engine, and the actual product-building to our engineering teams. Running our internal and external apps on App Engine isn't without difficulty, however, and we've learned a lot in the process. Tonight at <a href="http://code.google.com/campfire">Campfire One</a> we released a new set of features -- based on community and internal feedback -- that helps App Engine interface more easily with businesses' existing technologies: <ul><li>App Engine's <a href="http://code.google.com/appengine/docs/java/gettingstarted/">early look at Java™ language support</a> includes a Java runtime, integration with the new <a href="http://code.google.com/webtoolkit">Google Web Toolkit 1.6</a>, and a <a href="http://code.google.com/eclipse/">Google Plugin for Eclipse</a></li><li>The <a href="http://code.google.com/securedataconnector/">Google Secure Data Connector</a> enables centrally-managed access to on-premise data from Google Apps</li><li>The <a href="http://code.google.com/appengine/docs/python/tools/uploadingdata.html">database import tool</a> makes it easier to move gigabytes of data into App Engine (and export functionality is coming within the month)</li><li><a href="http://code.google.com/appengine/docs/python/config/cron.html">Cron support</a> can execute scheduled tasks like report generation and DB clean-up at regular intervals</li></ul>By reducing the administrative headaches that come with scaling and distributing an application, we hope that App Engine will continue to let developers do what they do best: launch services that delight users. Take a look at videos from tonight's Campfire One below: <object height="385" width="480"><param name="movie" value="http://www.youtube.com/p/DFDBB63922B90A70&hl=en"><embed src="http://www.youtube.com/p/DFDBB63922B90A70&hl=en" type="application/x-shockwave-flash" width="480" height="385"></embed></object> To learn more about Google App Engine or today's announcements, feel free to check out the <a href="http://google-code-updates.blogspot.com/2009/04/new-features-for-app-engine-announced.html">Google Code Blog</a> or <a href="http://code.google.com/appengine/docs">online docs</a>. You can also register for our annual developer conference, <a href="http://code.google.com/events/io#utm_source=googleblog&utm_medium=link&utm_campaign=io2009_campfire">Google I/O</a>, as the App Engine team will be there to answer any questions you might have, as well as unveil a few surprises. Java is a trademark or registered trademark of Sun Microsystems, Inc. in the United States and other countries. Update at 10:44 pm PDT: We've just added the videos from tonight's Campfire One. Posted by Kevin Gibbs, Tech Lead, Google App Engine

New features and an early look at Java for App Engine

Scarcity brings clarity, and many companies are taking important steps to adjust to today's economic climate. At Google, we've start...

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Who Is Warning Us About the Perils of a Government-Run Public Health Insurance Plan?

There has been considerable discussion lately about whether the US government should offer a publicly run health insurance plan similar to the current Medicare program for the elderly and disabled. A recent report has thrown a bit of cold water on the idea, as noted in <a href="http://www.google.com/hostednews/ap/article/ALeqM5jfURxbLWn8rhtoJfttnajw7d3JswD97D7P5O0">this AP article</a>: <blockquote>A public health insurance option for middle class families could help cover the uninsured but it may well put private insurers out of business, a respected consulting firm concluded in a study released Monday. The report by the Lewin Group, a numbers-crunching firm that serves government and private clients, said it all depends on details that lawmakers are far from deciding. Nonetheless, the report could provide ammunition for critics who say a public plan would move in the direction of government-run medicine. President Barack Obama and many Democrats want to create a government insurance plan to compete with private plans that now cover about 170 million Americans. The issue is major sticking point for Republicans and the insurance industry. The Lewin study found that if such a plan were open to all employers and individuals, and if it paid doctors and hospitals the same as Medicare, the government plan would quickly grow to 131 million members, while enrollment in private insurance plans would plummet. 'The private insurance industry might just fizzle out altogether,' said John Sheils, a Lewin vice president and leading author of the study. By paying Medicare rates the government plan would be able to set premiums well below what private plans charge. Monthly premiums for family coverage would be $761 in the government plan, compared with an average of $970 in private plans, the study estimated. Employers and individuals would flock to the public plan to cut costs. </blockquote> This new <a href="http://www.lewin.com/content/publications/LewinCostandCoverageImpactsofPublicPlan-Alternative%20DesignOptions.pdf">report by the Lewin group </a>also provided more ammunition to politically conservative commentators opposed to a public health insurance plan, e.g., see <a href="http://blog.heritage.org/2009/04/06/the-public-plan-threat-to-your-health-care-2/">this link</a>. I am not going to comment on the substance of the report, or the argument over the merits of a public health insurance plan, save to note that in my humble opinion, the biggest danger of such a plan would be to further exaggerate differences in payments made to primary care and other "cognitive" physicians and to physicians who mainly do procedures. We have posted before (e.g., <a href="http://hcrenewal.blogspot.com/2009/02/what-ruc-again-one-of-worlds-most.html">here</a>) on how Medicare has come to fix payments to favor procedures and disfavor primary care and other cognitive services. Increasing the number of patients covered by Medicare or a Medicare-like plan, without changing the current Medicare payment system, would only make these discrepancies worse. Note that this potential problem with the public health insurance plan was not mentioned in the Lewin Group report. Perhaps the nature of the Lewin Group influenced what this report did and did not emphasize. The group was described above as an independent consulting firm. Its <a href="http://www.lewin.com/WhyLewin/">web-site </a>says it is "a premier national health care and human services consulting firm." It also claims: <blockquote>The Lewin Group is committed to independence and integrity in our work. We combine professional expertise with extensive knowledge and a rigorous approach to analyzing and solving problems to deliver value to each of our clients and to the larger community as well. </blockquote> That's a somewhat self-contradictory assertion. It seems that delivering "value" to specific clients might be hard to do while maintaining "independence." Perhaps considering the nature of the Lewin Group's clients would clarify things. The group <a href="http://www.lewin.com/">says</a> its clients include "hospitals, health systems and providers;" "payers / insurers;" and "pharma/bio/device." The middle group seems most germane to a debate about The services provided to them include: <blockquote>The Lewin Group helps payers and insurers succeed in complex government, commercial, and long-term care markets. Based on our more than 20 years of experience, The Lewin Group offers our clients detailed understanding of the competitive marketplace and the expectations of purchasers. Based on rigorous, data-driven research, we provide our clients with actionable information grounded in practical, real-world advice. Our understanding of public policy through our work with government entities, including Medicaid and SCHIP, helps us understand how policies are shaped and how they impact our clients. With this insight, we help our clients strategize and succeed in public programs and new product offerings. </blockquote>So, the Lewin Group specifically offers to help insurers succeed in a complex market partially controlled by government. Maybe this orientation had some influence on the report they published now being used to support arguments for private, commercial health insurance. Finally, who owns the Lewin Group? The description provided in the news story above suggests it is independent, and perhaps is even not-for-profit. <a href="http://www.lewin.com/WhyLewin/">Per Lewing Group web-site</a>, it is neither: <blockquote>The Lewin Group is an Ingenix company. Ingenix, a wholly-owned subsidiary of UnitedHealth Group, was founded in 1996 to develop, acquire and integrate the world's best-in-class health care information technology capabilities. </blockquote> Ingenix has been in the news lately. See our posts <a href="http://hcrenewal.blogspot.com/2009/01/unitedhealth-and-ingenix-settles.html">here</a>, <a href="http://hcrenewal.blogspot.com/2009/02/aetna-settles.html">here</a>, and <a href="http://hcrenewal.blogspot.com/2009/02/wellpoint-settles.html">here</a> about legal settlements of charges that large health care insurance companies used a database created and allegedly manipulated by Ingenix to underpay out of network claims. So, the Lewin Group is a part of Ingenix, an organization that just settled claims that it manipulated data about insurance payments. Furthermore, Ingenix is in turn part of UnitedHealth. It is amazing how often UnitedHealth's antics have provided grist for the Health Care Renewal mill. See <a href="http://hcrenewal.blogspot.com/2009/01/unitedhealth-and-ingenix-settles.html">this post </a>for a summary of the company's more recent escapades. For balance, I must note that the Lewin Group web-page asserts: <blockquote> The Lewin Group operates with editorial independence and provides its clients with the very best expert and impartial health care and human services policy research and consulting services. </blockquote> But again, note that the focus is on making clients happy, not providing the public with unbiased knowledge. So a report being used to support arguments against government-run health insurance was published by a subsidiary of one of the largest commercial health care insurance companies and managed care organizations, a subsidiary that just settled charges that it manipulated data to increase insurance company profits. With a new administration in the White House, there is new interest in health care reform. It is not surprising that this has inspired some vigorous discussion. Nor is it surprising that some of the discussion comes from those with vested interests to protect. They have, of course, every right to make their views known. But it would be a more honest discussion if everyone were willing to put their vested interests on the table.

Who Is Warning Us About the Perils of a Government-Run Public Health Insurance Plan?

There has been considerable discussion lately about whether the US government should offer a publicly run health insurance plan similar to t...

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Enhanced Gmail and Calendar web app for iPhone and Android

Today we're happy to announce a new and improved experience when you access Gmail and Calendar through the browser of your iPhone and Android-powered devices. What's new? For Gmail, we've improved the user interface to make it easier to message on the go, and we've introduced "Floaty Bar," which makes sure common actions such as archive and delete are only a click away (check out the video tour below). You can also start the application, compose mail, and open recently read messages even when you're offline. With the new Calendar, you can edit or respond to an event and, like Gmail, the app is accessible even without a network connection. To quickly navigate between Gmail, Calendar, and other mobile applications, you can use the classic links that now always appear across the top of the screen. The "more" menu provides easy access to the full list of applications. To read more about what's new, take a look at the <a href="http://googlemobile.blogspot.com/2009/04/gmail-gets-new-engine-for-iphone-and.html">Gmail</a> and <a href="http://googlemobile.blogspot.com/2009/04/mobile-web-calendar-for-iphone-and.html">Calendar</a> posts on the Mobile blog. So you may be asking, "Why web apps?" Well, from a product perspective, web apps allow us to iterate quickly, so users benefit because they will see new features appear in the browser without having to download anything. We can experiment rapidly by learning how people use the features and then choose whether to invest further in that direction or move on. Using the browser as a delivery platform also means that users will see new feature releases happening more frequently because we can maximize our engineering efficiency by sharing code across device families. Looking at this release of Gmail, there is 90%+ code share between the Android and iPhone experience. As new devices come on the market with high-end browsers, most of the work is already done. (Hint to OEMs: you provide a world-class browser, we'll make sure Gmail and Calendar for mobile works on your platform.) To give it a try, visit gmail.com in your mobile browser. To access Calendar, click on the Calendar link at the top of the Gmail page. To make it easy to access Gmail and Calendar, we recommend creating a <a href="http://www.google.com/support/mobile/bin/answer.py?answer=31238">home screen link</a>. Please note, these web-based mobile products are only available on iPhone OS 2.2.1 or higher and on all Android-powered devices. We love feedback, so please<a href="http://www.google.com/support/forum/p/Google+Mobile?hl=en"> let us know what you think</a>. For more technical information on how we implemented these web apps using HTML5, check out the <a href="http://google-code-updates.blogspot.com/2009/04/html5-and-webkit-pave-way-for-mobile.html">Google Code blog</a>, and come visit us at <a href="http://code.google.com/events/io/">Google I/O</a>, our upcoming developer conference (May 27-28 in San Francisco). <object height="295" width="480"><param name="movie" value="http://www.youtube.com/v/v5J5sA48eV0&hl=en&fs=1&rel=0"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/v5J5sA48eV0&hl=en&fs=1&rel=0" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="295" width="480"></embed></object> Posted by Shyam Sheth, Product Manager, Google Mobile

Enhanced Gmail and Calendar web app for iPhone and Android

Today we're happy to announce a new and improved experience when you access Gmail and Calendar through the browser of your iPhone and An...

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