The Issues
In his new position, Blumenthal will oversee the creation of a national, electronic infrastructure for medical records.
The desired result is a single electronic file containing a patient's entire medical history, which his or her doctors could access and update regardless of the patient's location. President Obama would like all Amnericans to have access to electronic medical records by 2014, Blumenthal said.
Making the switch from doctors' scrawl to digital archiving has long been Blumenthal's cause. "Most American doctors and hospitals right now use information technology that dates from the time of Hippocrates," Blumenthal said, referring to the paper and pencils that are standard practice. "That's just not that was the world functions."
Blumenthal said electronic records will increase the efficiency of the American health-care system, and, as a result, improve the health of all Americans.
Blumenthal first discovered the efficacy of electronic records in his practice at Massachusetts General Hospital. Blumenthal tried to order a CAT scan for a patient. The computer automatically showed him that a similar scan had been done only three months before, with the view Blumenthal needed. He was impressed: "It was a big cost savings, it saved exposure to radiation, it saved patient-inconvenience," he said.
Though it may save money in the long run, the transition to electronic records will be expensive for hospitals and doctors' offices. They'll have to pay thousands to install new computer systems, train employees and scan decades-worth of old paper records.
Doctors and hospitals may try to make use of the $20 billion in subsidies enacted in the February 2009 economic stimulus plan to incentivize the switch to electronic medical records.
Cutting Costs
Electronic medical records are a key part of Obama’s proposed health-care reform plan. The electronic system would theoretically reduce administrative costs as well as expensive medical errors.
A May 2007 memo on the Obama health plan written by Blumenthal, Cutler and Jeffrey Liebman, describes three ways in which the Obama plan would reduce health-care costs: using new technology including electronic medical records; offering incentives for individuals and small business to buy into larger health insurance pools; and coordinating care among many specialists for patients with chronic illnesses — again, relying on electronic medical records. This would mean people with chronic illnesses get better care with less money wasted, they said.
The writers of the memo argued that these cost-cutting measures could save between $120 billion and $600 billion per year, but estimated that the number would actually be closer to $200 billion. They contended that universal health care means the federal government will pay between $50 billion to $65 billion per year in additional health-care costs. The plan proposes to pay for this by repealing the 2001 and 2003 Bush administration tax cuts for the top two tax brackets.
Universal Health Care
“The goal is to make sure everyone has high-quality insurance,” Blumenthal told a Harvard audience in a debate with McCain health adviser Gail R. Wilensky just before the 2008 elections.
Blumenthal supported Obama’s plan to offer health coverage to all Americans either through employers, private insurers or the federal government. Under that plan, no one is required to change their current options; instead, the government will offer more options.
Blumenthal joined Obama health advisers Raj Kumar and Cutler to elaborate in a Politics Magazine article: “For those who do not have insurance or are underinsured, his plan will make available new public and private insurance options that offer the same benefits that are available to members of Congress. The plans will accept all comers, will be portable, and will charge stable and affordable premiums,” they wrote.
Blumenthal told The Washington Post that Obama’s plan would not cover all of the 45 million uninsured people in America right off the bat. “But he claims that Obama will do a better job than Clinton in reducing the cost of health care premiums,” the Post reported.
Mandates
In criticizing Hillary Rodham Clinton’s 1993 health plan in the media, Blumenthal questioned the effectiveness of mandates that would require all Americans to purchase health insurance. "The only place in the U.S. that has attempted a mandate is Massachusetts, and we do not know if it is going to work here," Blumenthal told The Washington Post. "A mandate is not a slam-dunk solution. The key question is whether there is the political will to enforce the mandate once it goes into effect."
Blumenthal told the Post, “Obama might consider a mandate at a later stage, if his present plan does not achieve its goal of universal coverage.”
In February 2008, Blumenthal joined dozens of other health-care policy expert to sign a letter that put mandates into context. “Mandates alone, without strong incentives to comply and harsh punishments for violation, will have little impact on the number of uninsured Americans,” they wrote. “Indeed, as the Massachusetts experience illustrates, non-compliance with mandates is a large problem, absent harsh sanctions.”
Blumenthal has also argued that mandating the purchase of health insurance won’t necessarily increase the quality of care received by the medical care lower-income patients.
Training Doctors
Even if costs can be dramatically curtailed, Blumenthal contends that the country can’t skimp on training doctors and funding research. In a post on an Obama campaign blog, he was quoted as saying, “We need to be training more primary care physicians — and make sure that they have the incentives to stay in practice where they are most needed. And we must bring the medical research budgets supported by the NIH up to levels that will allow medical science to find the cures to many of our most serious health-care challenges.”
Obama’s Role Models
In an award-winning 2002 study, Health Care and the American Presidency, Blumenthal and co-author James A. Morone of Brown University analyzed the impact U.S. presidents from Franklin Roosevelt to George W. Bush. have had on health policy and health-care reform.
Rather than looking to the 1993 Clinton health reform debacle as a cautionary tale, Blumenthal has said that Obama may do well to look at how Lyndon Johnson quickly pushed Medicare and Medicaid through Congress in 1965. “He argues that Johnson succeeded because he was willing to leave the details to Congress, and even let others get credit,” NPR reported.
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