Tuesday, August 26, 2008

Another Panel, Another Lack of New News or Insights

The Disease Management Care Blog recommends you don’t bother taking the time to view or read the New England Journal of Medicine 2008 Shattuck Lecture. The DMCB did both. Save time and read this blog instead.

Arthur Miller led a distinguished panel of ethicists, insurers, lawyers, physicians and policy makers, using ‘real-person’ dilemmas to prompt a meandering discussion over the failings of U.S. health care, ways to improve physician payment, the merits of the electronic medical records, the burden of rising drug costs and the path to universal health care. There was no ‘aha’ consensus anywhere. If an erudite group made up of Arnold Epstein, Charles Baker, Arthur Caplan, Karen Davis, Susan Dentzer, Bill Frist, Robert Galvin, Stephen Schroeder, Reed Tuckson, Ruben J.King Shaw, Thomas Lee, Jonathan Oberlander and Sara Rosenbaum were unable to envision a ‘solution,’ the DMCB doubts anyone will be able to. That was the biggest lesson.

What was said that was interesting:

Physician payment will eventually involve a blend of payment mechanisms that will include fee for service. No one predicted that FFS will go away.

Pay no attention to any of the current unreal health care proposals from any corner of the current political debate. The truth of the matter is that a future President will need to decide if he or she* wants to stake political capital on expanding insurance coverage after his or her inauguration. That will depend on a very hard calculus involving the make-up of the House and the Senate, the likelihood of coalition building and how willing everyone will be to accept their second choice. Moral outrage alone over what is right or wrong will not and never has been a factor.

Mainstream working Americans are not feeling sorry for the underpaid and overworked primary care physicians. Not when they are seeing their houses decline in value by tens of thousands of dollars and gas is between $3-$4 per gallon. Welcome to the their world.

The electronic health records have yet to close the deal. Maybe Charles Baker of Harvard Pilgrim summed things up best by saying the EHR vendors and advocates have over-committed and over-promised.

Never mind trying to decide how much a quality adjusted year is worth - or even WHAT it is. How about trying to decide right now if insurance should cover an intravenous anti-cancer drug that costs hundreds of thousands of dollars and maybe results in a few extra months of life? The panelists were stymied over how to cover this - along with the rest of us.

And now for some criticisms:

What was said that was not recycled:


What was not said:

C'mon panelists, we know prevention and wellness has it's limits, especially over the short run. How can health care costs really be controlled?

The best part about this panel was:

Charlie Baker of Harvard Pilgrim. He talked like a CEO that knew a lot, had little to say, but when he spoke, people listened.

The second best thing about this panel was:

No disease management bashing from the academics, no kidding.

The worst thing about the panel was:

Karen Davis: She really needs to get over this notion that the U.S. can stop being 19th out of 19 countries by being like the other 18 countries.

Second worse thing about the panel was:

Arthur Miller. He was insufferably out of his league by rhetorically leading the panelists to too many reductionist, uni-dimensional bromides.

Third worse thing about the panel was:

A continued fixation on the physician as the nexus of how to fix all that ails the health care system.

The question that the DMCB wanted to ask:

If quality and systemness are the key ingredients to cost control, then why isn't No. 1 Harvard Pilgrim leading the way in reducing health care costs and charging less for its services?

*interpret that however you like

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