Health-care reform could launch despite a federal shutdown
Our health-care system is arguably the best in the world at dealing with the very sick. What we’re bad at is dealing with everything that happens outside the hospital — all the things that keep making these people very sick. And so long as all those other things go unfixed, these people keep getting sick, and they keep racking up huge bills — not to mention facing enormous suffering. Yale’s Elizabeth Bradley conducted a striking study making this point.
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Health-Care Costs Are Driven By Technology, Not Presidents
“This seems to say that if there is an issued contract, the contractors can keep working,” said Van de Water. CMS declined to say whether the IT contracts forObamacaremeet that criterion. IT operations are allowed to continue only under limited circumstances, according to the OMB memo. One circumstance is if “their continuation is necessarily implied from a congressional authorization or appropriation of other continued functions.” States running their ownObamacareexchanges are also uncertain about whether their own employees will get paid in the event of a shutdown, and whether they will have access to the federal grants that support their operations. The ambiguity stems from the fact that the grants, totaling tens and even hundreds of millions of dollars, did not come in the form of a lump payment deposited in a state’s bank account. “These are draw-down grants so the money is not in our bank,” said Oregon’s King, referring to a system in which the federal government deposits funds in accounts that states draw from as expenses are incurred.
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Several people argued rather hopefully that the government could do this — and maybe even would do this, with moves, in Medicare and Obamacare, toward bundled payments and Accountable Care Organizations. But no one offered any reason to believe that the government, or the ACOs, would only shut down bad innovation. Five years ago, when the national health-care debate began in earnest, I worried that national health care would slow innovation. The U.S. is not an efficient user of health care, I argued, but our lavish reimbursements fund innovation. Much of that innovation is bad, which is true of basically any technological frontier; it takes a lot of users, and a lot of iterations, to figure out what works and what doesnt. But some of it is good — life enhancing, or even extending.
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Transforming Health Through Technology: What Works – What Doesn’t?
eLearning or distance learning, has grown tremendously in developing countries, where most students either cannot afford to leave their homes to attend school in urban areas, or they simply cannot take time off of work for an education. eLearning does both: Brings the education to the student in hard-to-reach communities and allows the student to continue working while they are studying. This is especially important for nurses or midwives in remote communities, where health workers are few and their absence would have a significant impact on the local population. Technology has been one of the key elements in expanding Africa’s health workforce. Seven years ago in Kenya for instance, 22,000 nurses sought to upgrade their skills from certificate to diploma level. But there were only four existing nursing schools in Kenya whose enrollment absorbed a mere 100 students per year.
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