I spent all day yesterday at the Microsoft Connected Health Conference in Bellevue, Washington. I had to miss todays’ wrap-up sessions in order to attend a few other meetings, and was generally crippled through the whole event thanks to an airplane-acquired something-or-other, but it was still a very interesting day. One of the great things (if not the only great thing) about a sore throat is that it gives you an excuse to listen to other people.

The conference opened with a very nice panel, featuring Peter Neupert, Microsoft’s Corporate VP for the Health Solutions Group, Uwe Reinhardt of Princeton University, former Secretary of Health and Human Services Michael Leavitt, and David Kibbe of the AAFP. The topic was one that we’ve all rehashed dozens of times – how do we fix the US healthcare system, what role can Information Technology play, and if IT is valuable in the long term, what do we have to do to get it into place?

That’s an important distinction, by the way, that many events miss. Health IT adoption is not a goal in and of itself. The fact that my physician types rather than uses a pen is of no intrinsic value to me. The value comes in faster, more accurate, safer, cheaper and more effective healthcare.  That’s the goal – investments in Health IT are just one of several non-exclusive paths to a more functional healthcare system.

In the end, the panel concluded that it all comes down to Congress. When I was at HHS myself, we had all kinds of things we wanted to try, but we generally couldn’t – not enough money, or not enough Congressional authorization.  A great example of this phenomenon (which Leavitt mentioned in his remarks) was a recent program to require bidding for Medicare Durable Medical Equipment contracts. Congress actually authorized the program, which went into effect on July 1, 2008, and was projected to save the government about a billion dollars (and that from just ten products in ten regions). The DME industry went to Congress, and on July 17th the program was shut down. At CMS and on the AHIC Chronic Care workgroup we looked at trying to do a demonstration program for electronic patient visits, but were blocked because the Medicare telemedicine statutory restrictions are very, very tight.

Another point of (at least apparent) consensus on the panel was that while the Medicare reimbursement system was fundamentally flawed, its status as the 800 pound gorilla of the US healthcare system means that every hospital and small practice has to set themselves up around the Medicare fee for service model.  Fee for service payments are not good at aligning incentives between participants in a market. So what happens if (as some propose) we extend Medicare to the entire population? Will centralized ownership of risk lead to the kinds of preventive medicine programs and support for (appropriate) technology investment that will ultimately take cost out of the system? Or will the system ossify under Congressional supervision?

I offer no answers, of course. I’ll post some other thoughts on the conference later (paticularly around HealthVault and Amalga), but for now, I leave you with a great, if slightly paraphrased,  Leavitt quote from the keynote panel: “The problem isn’t a lack of political will. It’s an overabundance of political will. Whenever we get close to actually making a change people start unholstering their political will on each other.”