Social Networking and Health Care

Social networking has taken over the world. Facebook and YouTube are two of the most trafficked sites in the world, with MySpace and Twitter not far behind. Aside from these major sites there are an infinite number of smaller forums, where people get involved in ‘virtual communities.’ Some of them, like patientslikeme.com, are about people’s health. I spoke with Oakland University Professor of Management Information Systems Balaji Rajagopolan, about the good and the bad when it comes to this type of virtual community.

Professor Rajagopolan is currently beginning research on health related social networks for a new study about the interaction between virtual communities and health information. “We chose to study health care because of the extent to which people are relying on the internet for health information,” he says. According to a recent Pew Internet study 61% of Americans are looking online for health information, 60% of these say what they read affected their decision about how to treat an illness or condition, and 53% said it led them to ask their doctor new questions or get a second opinion.

Obviously the amount of information out there to inform patients is very useful, especially coming from a trusted website. When the information is coming from a social network, where anyone can say anything, it’s harder to know what information is trustworthy. Individuals who are ignorant but sound knowledgeable could be giving out bad advice, or a corporation itself could use employees to create fake users to subtly promote their own products. “There is an opportunity for an organization to come in and set standards, to see how communities are maintained, so erroneous info is not part of the content,” the professor says. Something like a Better Business Bureau for social networks.

Aside from the risks of bad information, what about privacy? “The extent to which people are willing to share personal information on social networks is astonishingly high,” Professor Rajagopalan says. Anyone can go on the incredibly interesting website patientslikeme.com, and find out what diseases a random user has, or how depressed they are feeling that day, within seconds. The users don’t usually reveal their real names, but many of them do put their (seemingly) real pictures up. In addition to that, patientslikeme.com makes money by selling aggregated information to drug companies, and its partner Novartis uses the site to recruit for clinical trials. This does raise some ethical questions as this information is not clearly made known to the user at sign up.

However, in the end these issues may not be very important to those who frequent these virtual communities, because the main reason people join is to connect with others who are facing similar challenges. With the virtual communities, it’s possible someone who was just diagnosed will find another person who is in the exact same situation they are, who can give them very specific advice. “If you look at their physical network, it is very unlikely they will find this kind of support in their real life relationships,” the professor says, “Participating in virtual communities opens the doors and provides great benefits.” The question is, when it comes to information on the internet, do people just make low risk decisions based on what they read, or are they willing to make high risk decisions based on it? Finding the answer to this question is one of the goals of Professor Rajagopalan’s research.

Jennifer Granholm Speaks on Health Care

Last night CNBC aired a special entitled "Meeting of the Minds: The Future of Healthcare," which featured Michigan Governor Jennifer Granholm as one of seven panelists. She was the representative of the Democratic Party on the panel. Other panelists included the President of the AMA, the CEO of WellPoint, and the Chairman of the Cleveland Clinic.

Here is a short clip of her appearance. The entire special re-airs Sunday night at 8pm, and Monday night at 9pm on CNBC.

Health Insurance Reform not Health Care Reform

One of the more interesting things about President Obama's news conference last night was his decision to try to reframe the debate on health care reform. The administration is no longer calling it health care reform at all, they are calling it health insurance reform. Newsweek's 'The Gaggle' blog claims the reasoning behind the change is that people don't exactly know what health care reform is, but they do know they don't like health insurance companies.

Aside from that, there was only one other thing I thought was noteworthy. This was when Obama mentioned single-payer health care, "I want to cover everybody. Now, the truth is that, unless you have a -- what's called a single-payer system, in which everybody is automatically covered, then you're probably not going to reach every single individual."

In the past, one of the main attacks on Obama's health care policy was that it was just the first step on a slippery slope to single-payer health care. So I figured this innocuous comment would definitely restart that line of attacks, but from what I have seen not many people cared, I did find a few liberal blogs mentioning it, but I haven't found many mentions of it in my searching of the Internet.

Finally, I mentioned intrade.com before, and I decided to see if the Obama press conference moved the needle with the 'traders' on that website, and it has. Currently intrade.com places the odds of health care reform passing this year at 50/50. Last time I mentioned it, there was only a 39% chance.

How To Lower Health Care Costs Without Doctors

What is the best possible way to lower health care costs? Many people, including Oakland University Marketing Professor Mukesh Bhargava, believe that it is wellness programs. Wellness programs, and social engineering.

Currently two thirds of all companies have some sort of wellness program, which can range from flu shots, to health screenings to fitness programs. These programs are supposed to motivate people to take care of themselves, leading to a decrease in costs for an organization. Currently, the way organizations reduce costs is by reducing coverage and increasing co-pays.

When Professor Bhargava was part of the wellness program at Oakland University, the employees were measured for vital statistics, told their ideal body measurements, and what exercises they needed to do to reach those goals. There was one advisor for a group of four employees and they kept track of progress. Although Professor Bhargava believes wellness programs are the way to go, he admits he was not serious about it at first. In fact, it wasn’t until he was out of the program that he became serious about his health. He says it got him used to going to the gym, “in the short run the program didn’t work, but a year later I started going to the gym.”

Professor Bhargava eventually began to take the program seriously, but how can employers convince all employees to do this? The Professor uses the example of smoking. People who smoke get their insurance rates bumped up, but usually this negative incentive is not enough to get them to quit. He believes that small positive incentives would be better at motivating employees. What exactly those incentives should be would depend on the situation.

Smoking is also socially unacceptable. Smokers are forced to go outside, people do not like the smell, etc. In order to increase overall health, unhealthy foods need to be equally socially unacceptable. Professor Bhargava reference the book Nudge by Richard H. Thaler and Cass R. Sunstein, which argues for “libertarian paternalism.” He says it is about letting people choose, but choosing among the right things, like choosing from three types of salad. “Depending on the order of the items on the menu people change their choices from 30-40%,” he says.

Why would restaurants bother doing this on their own, won’t it take government action to force restaurants to be health conscious? “The government should not get involved with this,” he says, “McDonald’s doesn’t score in terms of what people want, if they are smart they will do something about it with the young.”

Regardless of whether or not the government should be getting involved, they are. The Senate is working on a bill that would require restaurant chains to post the calorie count on the menu, and this is already the law in New York City.

What the Blogosphere is Saying About the House's Health Care Proposal

On Tuesday, the House released their 1,018 page health care proposal, so I decided to sum up what the blogosphere has been saying about it. There is a lot more interest among conservative blogs, but this is to be expected since blogs are often used as attack vehicles when it comes to things like this.

Conservative blogs are saying that under this plan an individual who currently has insurance coverage will not be able to change their plan at all, insurance companies will not be able to raise premiums on individuals to adjust for risks, and insurance companies will not be allowed to write new policies after the public option becomes law. They compared this public option to medicare, saying it will similarly destroy private health insurance altogether just like medicare took out health care for seniors. Finally, they attacked the policy on taxes and spending. They say requiring small businesses to provide insurance or face a 8% payroll tax will destroy them, those earning under $350,000 would have to pay a tax as high as 3%, and the total cost of the plan was not mentioned in the entire document. There are also a lot of references to this Investors Business Daily Editorial.

It was not so easy to find everyday liberal blogs talking about this proposal. However, the comment section of this blog argued that nothing is worse than the current system and insurance companies should not be protected because of their past sins. Paul Krugman argued that the estimated $1 trillion cost over the next decade to give people health insurance is a bargain compared to the $1.35 trillion Bush tax cut. Finally, Robert Reich argued that the House got it right, by planning to tax the rich to pay for health care.

People Place Their Bets Against Health Care Reform Happening This Year

President Obama wants a health care reform bill on his desk by the August recess. As time continues to tick by, it is beginning to seem less likely. Obama has said "“Inaction is not an option. And for those naysayers and cynics who think that this is not going to happen, don't bet against us.”

Well, people are betting against him on the website intrade.com. If you click on this link you will see the "contract" that shows the intrade market predicts a 39% chance of health care reform passing this year. Intrade.com is like the stock market, except instead of stocks it trades things like "will Mahmoud Ahmadinejad win the Iranian election" or "will Harry Potter gross over $70 million." It did a pretty good job predicting the election results last year, so we'll see if the market is right about health care reform as well.

OU Professor Comments on the US and Canadian Health Care Systems

In the health care debate, saying the United States is headed towards a “Canadian” style health care system is often used as an insult and a nightmarish scenario for Americans. Should this be the case? We have all heard anecdotal horror stories about people in Canada being forced to wait months for surgery , so is the Canadian health care system really that bad? Or is it worse in the US?

Oakland University Marketing and Management Professor Mukesh Bhargava lived in Canada for several years, and experienced both systems. He feels that the Canadian model is superior to the current US system. “It was refreshing that any treatment you want you can get. If it’s a matter of life and death I know I’d get good coverage,” he says. He believes the system as a whole is better in Canada, and in countries with universal coverage in general. In other countries, the doctors decide what sorts of surgeries are critical, and which are not. The doctor decides whether the government should pay for teeth whitening, or not.

He does not believe that health care should be market based, he feels it should be a right and not determined by who has the money. “What does it say about a country if people can’t get minimal access, what if the same thing was applied to education? Only for those who can afford it. What if you could only take your case to court if you are rich, and if not you couldn’t?”

In Canada, pharmaceutical companies are forced to cut prices by 2/3 of what they are here, and the doctors get paid less, but he assures me “they are not doing that poorly.” A common argument against making drug companies cut costs, is that if they had to cut costs like in Canada, then they won’t be able to afford to do the important research to find new drugs. The professor is quick to point out that “pharma spends more on marketing than on research.” The drug company Pfizer spent 8 billion on research and development last year, as opposed to 14.5 billion on selling, general, and administrative expenses.

“In the US it costs a lot to get your message to the doctors,” he says. He is concerned about the way products are marketed to doctors in the United States, worrying that whichever company gives the best perks to the doctor is going to get their drug prescribed. He compares it to the textbook companies, who all send him free books. “When I choose a textbook I badger them about price, I don’t know how many doctors know the cost of medications they prescribe.”

Professor Bhargava supports the Obama plan, and believes the health care system in the United States needs to change. He recommends this New Yorker article about two Texas towns with a large disparity in health care costs. So that makes at least one person who has experienced both systems, and actually thinks the Canadian system is better.