Sunday, July 5, 2009

E-Medicine, Internet, Electronic Medical Records - Obama's E-Based Health Reform Push

Prelude: What follows is from my book Obama-Doctors, and Health Reform: A Doctor Assesses Odds for Success, now available on

As we ponder modern politics, it is becoming increasingly evident that the Internet will offer yet another opportunity for a great leap in communications, bringing a customized one-on-one dialogue into the home of each voter. Instead of the one-size-fits-all television campaigns that dominate our politics, the Internet in general – and e-mail in particular – will make possible a conversation between each voter and each candidate about issues and ideas. The interactivity of the Web means the end to “I talk, you listen” politics, and the beginning of a two-way discussion as the basis of political communication. Some feel this is long overdue.

Dick Morris, Power Plays: Win or Lose – How History’s Great Political Leaders Play the Game, Regan Books, 2002

As part of the administration’s efforts to tee off a movement toward legislative action on health care, it also set up a new Web site,

Kate Phillips, “White House Plans Regional Health Care Forum,” New York Times, March 5, 2009

The world is moving on Internet time. This reality has seemingly dawned on the whole world at once. It is the factor leading to the wide-spread belief that a interoperable , all-purpose, all-reaching, all-the-time available, on-line system holds the key to improving access and quality of our health care system.

President Obama and his advisors believe this. And for good reason. The Internet is an efficient, instantaneous, and inexpensive way of reaching millions with a click on the keyboard.

One tactic Obama used successfully to win the presidency was mobilizing support and money over the Internet. He raised a record $750 million and kept e-mail addresses of millions who contributed to this campaign over a two year period. Now Obama has became an e-health reform organizer, an extension of his knowledge gained from Internet fundraising and his community organizes efforts. This includes you, the patient, who can access the Obama administration’s multiple website, to see his thoughts for the day and his progress on multiple health care fronts.

Current E-Reform Efforts

President Obama is an engaged in an extensive Internet campaign promising to provide universal coverage by the end of his first term. The dimensions of this e-campaign are becoming evident and include.

1. The Obama-Biden website which says.

- Obama will make affordable and accessible health care for all

- Obama will lower health premiums by $2500 per year per family

- Obama will promote public health

In addition, the web site asks for comments (it claims to already have over 10,000 citizens suggesting and offering free access clicks to Obama videos on health care.)

2. Regular Obama Facebooks, with videos featuring Obama talking health care
basic promises.

3. Virtual Online Townhalls – On March 25, President Obama held what promises to be first of a series of virtual townhalls. In this first online townhall, he responded directly to six questions winnowed from more than 100.000 submitted directed by emails from citizens. The media dutifully televised the event. It also appeared on online video, and was broadcast it to the nation on mainstream and cable television.

Clicking Away

Through these instantly accessible e-sites, Obama can efficiently click away again and again at his basic promises and premises.

- Savings through prevention, EMRs, chronic disease management, medical homes

- Expanding coverage through private and government-run health plans

- Making large businesses cover employees or pay a fine

- Mandating that health plans accept those with pre-existing illnesses

- Having government negotiate Medicare drug prices

- Reforming health care as an integral part of his economic salvage plan

Prospects for Success

Given his election margin (53% vs. 47%), large Democratic majorities in the House and Senate, his successful Internet deployment during the presidential run, his cache of millions of email addresses from supporters, the presence of personal computers in 80% of American homes, and his promise of $2500 premium savings for the typical American family, Obama’s electronic mobilizing tactics for health reform may succeed.

President Obama has a simultaneous top-down , i.e. daily dominating the national radio, mainstream and cable television, and Internet media, and a bottom-up strategy, i.e, while at the same time soliciting and responding to hundreds of thousands, indeed, millions of emails.

In his book Power Plays, Dick Morris asks and answers, ”Will the new techniques and strategies improve our political process? Likely they will. Each development seems to move in the same direction – greater direct democracy and more public participation. Certainly the Internet and the two-way political dialogue it fosters will tend to make our democracy more direct and citizen involvement more consuming.”

As with any political development, there may be a darker side. Rush Limbaugh, the conservative radio talk show host, believes the Obama daily dominance of all media has Orwellian, Big Brother overtones, and may lead to totalitarian tyranny of our minds. I would not go that far. I give President Obama his due. It is a brilliant ongoing political communication strategy, transforms politics, and will have to be countered by his political opponents.

I would not bet against significant incremental health reform. What might prevent Obama-style health reform are the economy, the soaring federal budget deficit, and the Department of Health and Human Services current $708 billion budget, 25% of federal spending and Medicare on brink of bankruptcy, but Obama is not one to let billions, even trillions of dollars, stand in his way. He will persist, and he will let the government printing presses roll.


Barack Obama is our first Internet President, which is altogether without precedent. The President uses the Web to issue a daily report and to mobilize wider political support. That e-tools help his agenda is evident. For Obama, Internet politics is good. For all of us that fact has to be understood. Obama Internet supporters helped get him where he is today and elevated him above the ordinary political fray. For Obama the Internet was the little Engine that could. Say about Obama’s Internet strategy what you will. Say that it’s shows the mark of remarkable political skill. Say that it smacks of George Orwell’s Big Brother. Say that it brings all media under one giant cover. Say what you will: The Internet is now routine grist for the political and health care mill.

No comments: