Supreme Court portrait

Why Tech Should Care About the Fate of Obamacare

Supreme Court portraitYou probably haven’t heard of Section 10330 of the Patient Protection and Affordable Care Act. It takes up just one of the law’s 2,700 pages, buried deep in a list of miscellaneous provisions.

But Section 10330, one of the many provisions far removed from controversies over individual mandates that could be lost if the Supreme Court rules the entire law unconstitutional, is important to the future of both health care and effective use of information technology by government. The substance of the section is so brief that it is worth reading in its entirety:



(a) IN GENERAL.—The Secretary of Health and Human Services
(in this section referred to as the ‘‘Secretary’’) shall develop a
plan (and detailed budget for the resources needed to implement
such plan) to modernize the computer and data systems of the
Centers for Medicare & Medicaid Services (in this section referred
to as ‘‘CMS’’).
(b) CONSIDERATIONS.—In developing the plan, the Secretary
shall consider how such modernized computer system could—
(1) in accordance with the regulations promulgated under
section 264(c) of the Health Insurance Portability and Accountability Act of 1996,
make available data in a reliable and timely manner to providers of services
and suppliers to support their efforts to better manage and coordinate care
furnished to beneficiaries of CMS programs; and

(2) support consistent evaluations of payment and delivery
system reforms under CMS programs.

The problem is simple. The Centers for Medicare & Medicaid Services, like many government agencies, is sitting on a treasure trove of data. Applying modern data analytics to this “big data” information could yield tremendous benefits to the public, from detecting fraud in medical payments to understanding regional disparities in pricing of services to–most important of all–learning which treatments provide the best outcomes for patients.

CMS, which administers Medicare, Medicaid, and the State Childrens’ Health Insurance Program (sCHIP) would be an analytics paradise if only it could figure out how to use its data. But the system described in the white paper “Modernizing CMS Computer and Data Systems to Support Improvements in Care Delivery,” Medicare payment information is stored in “in at least 25 different databases used for different program purposes.” These systems mostly have no way to communicate with each other. States maintain their Medicate data in 50 separate state databases, generally without even common data definitions.

Similar problems plague information systems throughout the federal government. The big difference is that in health care, Congress has at least tried to do something about it. The Health Improvement Technology for Economic and Clinical Health (HITECH–they obviously come up with the acronyms first) Act, part of the 2009 stimulus bill, created incentives for a switch to electronic medical records and started the process of CMS tech modernization. But the Affordable Care Act takes on the heavy lifting, authorizing a top-to-bottom overhaul of a technology infrastructure that, among other things, still depends on mainframes communicating over IBM’s 1970s-vintage Systems Network Architecture.

It’s tempting to argue that the overdue and uncontroversial IT modernization mandated by Section 10330 would survive even if the Affordable Care Act as a whole is struck down. It’s also almost certainly wrong. In today’s Washington, nothing is uncontroversial and almost nothing gets done. What is more likely instead is that any attempt to sweep up and resurrect the many technical provisions of ACA would instead end up being held hostage to the broader health care, economic, and political agenda of one side or the other.

I have no illusions that I can influence the Supreme Court, especially at this late date. But I would hope that in the general interest of progress, if the justices decide that the individual mandate is unconstitutional they would at least let the rest of the law go forward.




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Steve Wildstrom

Steve Wildstrom is veteran technology reporter, writer, and analyst based in the Washington, D.C. area. He created and wrote BusinessWeek’s Technology & You column for 15 years. Since leaving BusinessWeek in the fall of 2009, he has written his own blog, Wildstrom on Tech and has contributed to corporate blogs, including those of Cisco and AMD and also consults for major technology companies.

16 thoughts on “Why Tech Should Care About the Fate of Obamacare”

  1. Steve

    as you said, this is a treasure trove of data and one would think that if this is really that big a deal that if the entire law was struck down someone would bring this back up and get it passed. (I think the Republicans have said many times that there are parts of the law that they would have passed and would pass going forward, just not the whole thing)

    I’ll also add that if this data is so valuable, someone in the private sector (i.e. the tech sector) would want to get their hands on it and create a business out of the analysis. So if the feds were to enact some legislation that allowed “reputable” (define that how you like) companies to get access to the data, then it may not cost the taxpayer a dime to do the work. Even better!

    1. Yes, the data is quite valuable and there are many corporations that would love to get their hands on it. However, it is all confidential patient information and the government has absolutely no right to share this data in any way with any private corporation now or at any point in the future. I don’t care about savings to the taxpayer. Some things are worth paying for to have them done right.

      1. I happen to believe if done right the private sector is probably better at protecting your valuable information than the government is. As examples, the government has been trying to upgrade the air traffic control system and the IRS computers for years. It’s become so politicized that everyone wants to get some of the action in their district that nothing happens. Where a private company like Google has been able to build data center after data center efficiently and with relative ease.

        What’s happening now is that large hospitals are consolidating data, but people who move (like me) have no way to get the stuff into Sutter that came from Mass General when I lived there. Thus, every time I go somewhere new I have to fill out piles of paperwork, answering the same questions and trying to remember when was the last time I had a a DPT vaccination instead of someone logging into a healthcare database that showed exactly what was going on.

        Given the right controls, I’d be happy to have a private company doing this for me. There is no way that I’d trust it to the government.

    2. Here’s a scenario. The Supreme Court strikes down the entire law. Some responsible, sensible folks in Congress try to salvage the sensible, seemingly non-controversial parts like Section 10330. First, even this isn’t entirely non-controversial. Their are interests strongly opposed to CMS getting better analytics because they really don’t want the effectiveness of treatments evaluated based on real data (for example, makers of cardiac artery stents) or that don’t want the government to be more effective at fighting fraud. Worse, as soon as the bill gets going, it starts attracting amendments. Like defunding of Planned Parenthood or something equally polarizing from the left, i can;t think of just what at the moment. Suddenly, this technical legislation is no longer either technical or noncontroversial and it gets ground up like everything else in the sausage factory.

      Seconding James Steinman’s comment below, this information is very sensitive and is wrapped up in some very serious privacy protections in both HITECH and HIPAA. CMS would have to aggregate it and scrub it before it could be turned over to third parties, and that is exactly what they currently lack the ability to do.

      1. And there would be very little objection to enabling a properly accredited organization to come in and do this, and to relax/bend/rewrite the HIPPA rules to allow it.

        In fact , I would bet that if the massive health care law were broken into logical, smaller pieces, most of it would pass easily. But Obama didn’t want that, he knew that the only way to get his ideology through would be to bundle it as a large take-it-or-leave-it package. he almost failed at that if it were not for the shenanigans that went on in December 2010. Now the court is going to strike it down (likely), possibly the whole thing.

        Will he regroup and do something that the country will support or will he continue on his scorched earth march to get what he wants?

        1. It would take a lot more than relaxing HIPAA. The reason I know about CMS IT in mind-numbing detail is my work as a technical writer on a CMS IT modernization proposal for one of the many private contractors involved. CMS currently is incapable of producing properly anonymized data for big data analytics. And they cannot turn the PII data they have over to private contractors without explicit congressional approval, something that is extremely unlikely to ever come. (The undesirability of doing that is something left and right agree on, albeit mostly for different reasons.)

          The fact is the HITECH-like legislation promoting electronic medical records had languished for years and only passed as part of the 2009 stimulus bill. Nothing passes easily.

          Incidentally, there is evidence that public-private sector partnerships can do very good things. It’s generally agreed among experts that the two best large-scale EMR implementations in the U.S. are Kaiser Permanente and the Veterans Administration. Both depend heavily on software developed by Epic Systems. So here we have a large nonprofit, a government agency, and a private for-profit company working together to make good things happen.

  2. Whenever people in civilized countries in the rest of the world hear Americans refer to “health care” as “Obamacare”, we laugh (and also cringe at the same time).

    Universal access to health care is a human right, just as are adequate food, water, clothing, and shelter. But some Americans consider health care a privilege that should be reserved only for those who can afford it.

    Americans are self-defeating when they make adequate health care for everyone a political Blue-Meany, and stick a label like “Obamacare” onto it.

    A tiny proportion of the U.S. population is wealthy (less than 1% of the population) and they don’t need to worry about their own health care expenses. But the rest of Americans who are fighting against their government’s efforts to initiate universal health care, are only harming themselves.

    Everyone, sooner or later, will need to have very expensive health care to either maintain their quality of life or to actually keep themselves from dying prematurely. When these health care expenses arise, those same people end up either having to do without essential, life saving treatment, or going into massive debt for the rest of their lives.

    Americans who are currently against universal health care (a.k.a. “Obamacare”) should think for themselves, rather than following the prompts of others who have political or financial motivations for blocking the rights to health care for all.

    Universal health care programs in other countries aren’t perfect, but people in those other countries are happy and secure, and they are thankful that they don’t have to worry about getting the health care they need, or struggling financially as most Americans do.

    1. I’m not going to get into a debate on healthcare or what the role of government should be in a free society. That would be hijacking this thread about the data mining and efficiency arguments pieces.

      But I cannot and will not let stand the statement that “Americans who are against universal health care should think for themselves….”

      I’m against it, I think for myself and read an awful lot about how health systems work around the world. Your insults aren’t appreciated and are no different than other racist, homophobic or sexist stereotypes. So stop it.

  3. The healthcare issue gets so politicised that it makes it tricky to understand the system in the US. It truly is a subject beyond the understanding of most people who have universal healthcare. My understanding may be wrong but from an outsider’s perspective it seems cost is the major opposition to UHC in the US. In the 60’s and 70’s, when Canada followed Saskatchewan’s first North American forays into UHC, the expenditure on health and medicine was similar to the expenditure in the US, around 10% of GDP if I remember correctly. Today Canada’s costs are slightly above 10% and US expenditures are well over 15% from the last information I have come across.

    It is a heart breaking simple fact that when a life depends upon seconds, efficiency is necessary if those seconds are to count. When a family member had to be rushed to hospital, there was never a moment when we worried that the ambulance might not take her or that paper work would have to be in order prior to a doctor attending her immediate needs. Every American deserves the same care.

  4. The federal government’s proven inability to develop complex replacement IT systems is legendary. Reference three decades at FAA air traffic control, FBI case management, White House email systems, IRS …. The odds that Medicare, Medicaid, and SCHIP data can be turned into a useful “big data” warehouse are Megamillions-slim. Passing a law cannot change those slim odds. Sorry.

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