Tuesday, August 25, 2009

Clinical Practice? Evidence Based. Health Care Policy? Just Argument

Pity Victor Fuchs. He's a Henry J. Kaiser, Jr., Professor of Economics and of Health Research and Policy at Stanford. He has all those articles in the New England Journal, JAMA and Health Affairs and his sensible suggestions are not seeing the light of day in the health reform debate. According to Kaiser Health News (KHN), he's disappointed with the President. He's just so plain wrong on:

Prevention: 'there's hundreds of studies showing you don't save money on that stuff.' The DMCB agrees, but don't take its word for it.

Electronic Health Records: "you are just throwing money away." Hear hear says the DMCB.

The Public Plan:' 'cost shifting' doesn't do anything about the real cost of health care.' The DMCB wonders if it read some of Dr. Fuch's articles in an unremembered past, leading to its current point of view.

Keeping What You Have: 'Most of these stories [Mr. Obama] tells about the way he’s going to save money don’t ring convincing to me when they are accompanied by the repeated insistence, 'If you like what you have, you can stay with what you have.' A big part of the problem of the high cost of medicine is precisely because of the system we have. If you don't contemplate changing that system, everything else is kind of a pretense.'

According to Dr. Fuchs, the system is riddled with bloated overhead (brokers, administration, marketing, bureaucracies, specialists), excess capacity and open ended financing. How he proposes to fix this was left unsaid in the KHN interview, but he likes the idea of handing out risk adjusted vouchers that cover a pre-defined benefit.

The Disease Management Care Blog is sympathetic. It's ironic that clinical practice is supposed to be evidence-based, while it's OK to simply argue past one another on healthcare policy.

There may be some good news for our democracy, however. Check out this article from the New York Times that suggests, while some raucous Town Halls have been spotlighted by the media, the a majority of them were civil and informative. Maybe some of Dr. Fuch's points have gotten through.


Michael Halasy said...

Yep, Victor knows his stuff. And he's completely right on all of it. As far as preventative care, the CBO looked at this last December, and found that while it might save a little money, it certainly won't save as much as many think. Personally, I think Victor's plan with Zeke is the best healthcare plan out there, but unfortunately, it makes so much sense, that it'll never see the congressional floor. Check out the Guaranteed Healthcare Access Plan.

Jaan Sidorov said...

I didn't know this but they even have their own web site. Checked it out AND I wrote to them. Let's see what they say......

Thanks Michael!

Michael Halasy said...

No worries. Guy by the name of Blake handles all of the GHAP stuff. Zeke's a great guy too.