Monday, September 28, 2009

The Imperfect Expert Class: Another Risk of Health Care Reform

The Disease Management Care Blog has seen these kinds of folks in action. Astonishingly bright, widely published, exquisitely educated and supremely confident, they never fail to dazzle and amaze those of us with lesser pedigree. Sure, you can try parrying with a quote from an obscure study or last month’s conference, but your pitiful verbal swordsmanship will be bested. You are an amateur. These folks are professionals, hardened by years of having yokels like you for breakfast.

So when Rhodes Scolar and Harvard Law graduate Nancy-Ann Min DeParle, Director of the White House Office of Health Reform speaks, it’s only natural we shush and listen respectfully. And when they and their colleagues are rolled out by the Administration armed by charts and wotnot, even U.S. Senators will listen.

The Disease Management Care Blog admits to also being repeatedly smitten by smart-person-in-the-room eye over its 25 year health care career. Yet, once The Über Expert recedes from view, the DMCB recalls similar mesmerizings often being dashed by cold hard reality. RBRVS, HMOs, predictions of physician oversupply, physician risk contracting, certificate of need and physician profiling are all examples of failed past divinations by brainiacs armed with faux special insights about just how to manipulate the levers necessary to create health care wonderfulness.

Sure, you say, the DMCB is being a cynical weenie-wagging curmudgeon. For the record, the DMCB denies being cynical, but can't help it that its experience has taught it to doubt the experts. Despite their serene assuredness, their prognostications on how the latest suite of reform ideas are likely to play out in the coming years may be wrong. Really wrong.

But don’t take this blog’s word for it, check out the this interesting article by the also vastly intelligent Henry Aaron and Paul Ginsberg.

Two telling quotes:

Exactly why Americans spend so much on health care is not well understood’

and

The unsurprising verdict is that several factors contribute to excessive spending and to unduly rapid growth, but that devising ways to correct both problems in ways that promote welfare is politically challenging and technically difficult.’

It’s remarkable because the authors, whether they realize it or not, point out how little is known about the underlying basis of the United States’ high health care costs. We really don’t know if high technology is necessarily accompanied by inefficiency or if our market is targeting dollars toward the treatment of disability instead of death avoidance. We don’t understand the impact of our unique complex mix of competition and regulation or the lessons from areas of medicine where increased spending does result in higher quality. If we don't know the basis of our problems, how confident can we be that the solutions out there are really.....solutions?

The DMCB understands modesty, temperance and hedging is unlikely to score points in the current political climate. But it also knows that one understated risk of health care reform is the unforeseen consequences of good ideas developed by a repeatedly imperfect expert class.

2 comments:

Robert said...

Two thoughts for your readers:

Einstein said, "You can't solve a problem with the same mindset that created it." This observation lends credence to your concern that the "experts" may get it wrong...again. In fact, based on what it is that we are actually debating, I would say the odds of that happening are pretty high.

Einstein also said, "Make it as simple as possible...and no simpler." In the ocntext of trying to answer the question of why are costs are so high, the "simple" answer is because we have too many sick people demanding services. While there are, obviously, many other factors that contribute to high costs, we stillpay for health care in this country "by the click." Reduce the number of clicks, even moderately, and the costs go down drmatically.

Jaan Sidorov said...

Well said Robert, though it's ironic reaching to the wisdom of a genius to gain insight on the misbehavior of other geniuses.

The Health Affairs article I quoted also pointed out that the unit cost of the services also seems inappropriately high. And while we have our fair share of sick people, each sick person seems to generate an excess of services. How well the current proposals address all of these problems remains to be seen, even if the Einsteins are telling us they have everything under control

Thanks for yoru comment!