Seven years ago, George W. Bush dropped a small bombshell during his State of the Union address. In a brief aside in a speech that otherwise focused heavily on national security, he gave a plug to health information technology: “By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care.”
I was working at a health IT publication, and we treated those 15 words as seriously as John F. Kennedy’s moon-shot pledge. Within months, Bush had installed a health technology czar and earmarked $100 million to help information technology transform the entire health care system. It’s not hard to draw a direct line between that one sentence by Bush in 2004 and the current vogue for government efforts to promote electronic records and clinical information systems.
The “computerizing health records” line was a reminder that every phrase in the State of the Union speech is carefully considered and heavily lobbied for, even if the event is still considered largely political theater, and it left me scouring the text of President Obama’s address Tuesday night for hints as to what the ongoing priorities would be for the health care sector.
It was noted that the topic of health reform — the domestic issue that has defined Obama’s presidency — accounted for just over 200 of the nearly 7,000 words of his speech, though those words carried a great deal of punch (the President offering, among other things, to take on malpractice reform and a quirk of the reform bill that heaped paperwork on small businesses).
But, perhaps more important than those specifics were the unspoken priorities: even as he called for a freeze on discretionary spending, he seemed to give a wink to medical innovation, noting that “our government has provided cutting-edge scientists and inventors with the support that they need” and telling the nation that his new budget will “invest in biomedical research,” one of only three areas of innovation that got a specific mention.
The problem with the State of the Union is that it’s not immediately clear what the upshot of the lofty talk on innovation will be. It took months before any details of the Bush health-IT pledge were hammered out and years before they began to have an impact on the system as a whole. Will the innovation push mean that the White House will put its weight behind an effort to make the R&D tax credit permanent? Will it mean that the NIH gets shielded from the budget ax? Some of these questions will be answered when Obama releases his proposed budget in a few weeks. Others may take far longer to get resolved.
Of course, the speech can be a Rorschach test, too: I saw in the speech it a call for NIH funding, but I’ve been clear that I think that’s hugely important. I’m curious: what nuggets did you see amidst the rhetoric?