ARTS & FARCES internet

As an end-stage renal disease patient I take a lot of drugs. No, not like that. The western medical model is based on prescribing chemicals for every ailment and side-effect. Finally, here’s a list of commonly prescribed medications for ESRD patients complete with the ones that should be avoided.

Network 8, Inc. contracted with Medicare to establish an ESRD medication baseline for the implementation of the prescription drug “benefit” (aka Medicare Part D). The job was subcontracted out to the University of Mississippi’s department of pharmacy administration. The result was this final report to Medicare.

In short, don’t take anything your doctor prescribes without looking at this report first.

Until recently—very recently—I’ve always thought very highly of Consumer Reports (the publication) and Consumers Union (the parent company). No longer.

Consumer Reports WebWatch is planning to run an ad next week in the New York Times, Washington Post, and USA Today. And it’s pitching web publishers to commit to a set of trustworthiness guidelines. The ad pitch to web publishers is a very simple affair: two columns; one black text on white background, and one the inverse, white type on a black background. At the top of the left (white) column is the head: TRUST WORTHY. On the top of the right (black) column is the head: TRUST WORTHY? Underneath each is a list; those that are trustworthy and those that aren’t.

The trustworthiness guidelines are fairly straightforward, dealing with identity, clearly delineating advertising, customer service accessibility (especially with regard to third-party financial relationships), corrections policy, and privacy guidelines. Almost all legitimate websites already strive to meet these criteria.

Fair enough if the pitch to be included (free of charge) in the list of TRUST WORTHY. publishers were the end of it. But it’s not.

The latest part in what should be an award-winning New York Times series, “Being a Patient,” was published today. It begins to cover the financial aspects of the American healthcare system. The insurance companies, predictably, deny that any of the problem is their responsibility. In fact, Dr. Alan Sokolow, chief medical officer at New York’s Empire Blue Cross Blue Shield is quoted as saying, “even though the amount of paperwork a patient has to deal with might seem to be a lot, it would be much worse if there wasn’t a unifying organization like a health plan easing that burden.” Yeah, right. Insurance companies are responsible for the endless string of indecipherable explanation of benefit (EOB) forms that arrive regularly in patients’ mailboxes.

One of the biggest problems is that everyone from the healthcare providers to hospitals to the insurance companies use different and incompatible sets of keycodes, so it becomes an unsolvable puzzle to discover who did what when and where. It’s gotten so bad that some of the patients profiled by the Times have taken to hiring private social workers to help them manage the paper nightmare attached to illness. That’s inexcusable but nearly mandatory for all but the simplest, single-shot episodes with the healthcare industry in this country. In my own case, my wife spends more than 20 hours a week managing this part of my end-stage renal disease. That’s just wrong.

The best quote in the Times article came from a most unusual source, Dr. David Brailer, National Coordinator for Health Information Technology, in the Department of Health and Human Services:

“Suppose you walk into a restaurant,” he said, “and you don’t get a menu, you don’t get any choice of what food you’ll eat, they don’t tell you what it is when they’re serving it to you, they don’t tell you what it’s going to cost.”

“Then, weeks or months later, you get a bill that tells you all the food you ate and the drinks you had, some of which you remember and some you don’t, and although you get the bill, you still can’t figure out what you really owe.”

The President’s Advisory Panel on Federal Tax Reform has issued a report that calls for limits on the home mortgage interest tax deduction and deductions for employer-provided health insurance. The nine-member panel’s final report is due on 1 November.

The mortgage interest cap for a married couple filing a joint tax return is currently US$1 million. The panel advises that a much lower cap—US$350,000, or the maximum mortgage insurable by the Federal Housing Administration—would be more appropriate. Additionally, the panel calls for capping the deduction for employer-provided health insurance at about US$11,000 per year per employee.

The panel appears to be rejecting the idea of a consumption tax—in the form of a national sales tax or a European-style value-added tax—because it would hit the working poor much harder than any other class. A flat tax—which similarly falls disproportionately on the poor—is still in reportedly in play, according to David Rosenbaum’s account in the New York Times.

Even before Vannevar Bush began specification work on his memex, Paul Otlet was developing the first mechanical database: a rotating, wheel-shaped desk through which users could browse and annotate millions of index cards. Most surprising was Otlet’s concept of someday being able to access the database remotely using an “electric telescope” connected to the telephone lines.

boxes and arrows, the information architecture resource, has published the best overview of Paul Otlet’s work I’ve found. Truly fascinating.