Which of These Four News Reports Is False? Insights from the Wacky World of Health Care Reform

Baron Von Munchhausen

Despite host Peter Segal's occasionally highbrow insider cleverness, The Disease Management Care Blog remains a loyal fan of NPR's "Wait Wait... Don't Tell Me" radio show.  While the DMCB has its suspicions about the ratio of truly spontaneous wit to pre-planned ripostes, that won't stop it from turning to a part of the show called 'Bluff the Listener' for bloggy inspiration.

BtL has guests try to guess which of three funny stories is based on a real true news report. The DMCB thinks health care is so wacky that it'd be more challenging to guess which of the four stories below is false.

Unfortunately, if you win, getting the DMCB to put its voice on your home answering machine is unlikely to impress anyone. However, if you can pick out which story is a complete Munchhausenesque fabrication, you will deserve the respect of your friends and co-workers.

Ready to try to get some bragging rights?

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Even doltish man-trolls know better than to try to organize an all-male blogging conference. Unable to reach out to that demographic, HHS Secretary Kathleen Sebelius did what's best: appeared before the annual "BlogHer" Conference in an appeal to women bloggers to tout the benefits of Obamacare. Her outreach supplements plans to rely on celebrities to help with a nationwide drive to increase enrollment through the insurance exchanges. Next up will be effort to recruit motor scooter owners to sport pro-Obamacare ads on the back of their helmets.  Then it's on to asking members of the European Beret Society to host recruitment drives at their monthly chardonnay tastings.

Answer here.

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Al Lewis and Vik Khanna condemned the wellness industry in a Wall Street Journal editorial when they proclaimed that "workplace programs don't work." They went on to say that they are "ineffective at reducing costs, lack support in the medical literature, are unpopular enough to require incentives and are occasionally even harmful." Yet, the Khanna On Health Blog's “workplace wellness consulting” page suggests the authors’ unique consulting insights can help potential customers “do wellness right.” Did the DMCB mention that both individuals are lawyers?

Answer here.

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Writing in a separate issue of the Wall Street Journal, former Vermont Governor and Democratic National Committee Chair Howard Dean actually attacked Obamacare by criticizing its Independent Payment Advisory Board as a rate setting enterprise that is doomed to failure. Brazenly using Tea Party terms such as "bureaucrats" and "health rationing," Dr. Dean's liberal-progressive apostasy prompted ACA architect Peter Orszag to curiously opine in a separate article in Bloomberg that the argument favoring IPAB is that it will be a much better rate setting body than Congress. If this keeps up, even labor unions will start criticizing Obamacare.

Answer here.

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While partisan blood continues to spill over Obamacare in Washington DC, there is much good news outside the beltway.  It's been announced that the IRS will not only rely on self-reporting of income levels in setting premium subsidies. Even better, individuals who qualify for tax credits while buying their health insurance with the on-line exchanges will get a two-fer: 1) the option of applying the rebates to reduce their monthly premiums, and 2) confidence that there won't be any tax liability "claw backs" should their final income be higher than anticipated. Interest and penalties will be optional.

Answer here

The National Public Radio (NPR) Interview on Health Reform: Dr. Howard Dean, You Need to Regularly Read This Blog

When interviewed last Friday on National Public Radio's All Things Considered, Howard Dean explained the polls showing declining support for health reform by saying:

'And we do know from polling - because I've seen some polling about messaging - is that when you talk about health care reform, a lot of people disapprove of it. When you explain the president's health care reform views and his bill, then people support it overwhelmingly.' [bolding from the DMCB]

Aha! So the concerns out there are the result of an information gap.

Readers may recall that Howard Dean is not only a former Vermont Governor and former Chair of the Democratic National Committee but is an academically trained general internist. And in the quote above, he demonstrated a classic sign of the syndrome of Chronic Unremitting Insufferable Physician-Centric Generalinternistitis (CUIPCGI). This is an abiding belief that education is the single ingredient that transforms patient non-compliance into compliance. Its dysfunction becomes extreme when this delusion intrudes in other aspects of living, such as national politics or changing a spouse's mind about the merits of letting the porch go uncleaned. The Disease Management Care Blog is also similarly trained internist physician and has observed that CUIPCGI frequently among members of its specialty, in much of the academic peer reviewed literature and among many of the Brahmins advising the Obama Administration.

For the longest time, patient care was built on the notion that the transmittal of facts from Those-In-Possession-of-Knowledge to Those-Not-In-Possession-of-Knowledge was suffuciently transformative. We believed it made the dumb smart, the lazy energetic and the disinterested inspired. Accordingly, the uncontrolled diabetics would become controlled, hypertensives would become normotensive and the obese would become thin.

Unfortunately, victims of this disorder soon suffer severe consequences: 1) the subjects of their belief system often discern they are incorrectly being labelled dumb, lasy and disinterested, 2) persons with chronic conditions don't make much progress in disease control and 3) stymied by a lack of buy-in, these unfortunates paradoxically inflate their confidence in the merits of education and compensate by framing the same facts with accelerating degrees of bias.

Fortunately, for the many otherwise excellent professionals who are afflicted, there is a cure. It involves humility and paradoxically applying the same educational standard to oneself, starting by reading some of the vast amount of peer reviewed scientific literature from the last ten years that has revolutionized the science of patient behavior change. It has amply demonstrated that recounting of 'facts' are only the beginning. 'Expalining' the facts is necessary but not close to being sufficient when it comes to getting patient buy-in and behavior change. The literature on this is not hard to find and examples include this, this, this and this. There is a good review of the topic at AHRQ and the Population Health Journal has this thoroughly researched description of various approaches to behavior change. Last but not least, regularly surfing, RSSing and Twittering the modest DMCB is also a good way to keep up on care management. Regular readers know the bottom line is that when state-of-the-art patient engagement is applied, variations of shared decision making centered on the patients' knowledge and values results in a mutually acceptable care-plan.

Viewed through the prism of population-based health care, therefore, the August recess Town Halls are one stop in the process of a sort of shared decision making that could lead to a national 'care-plan' consensus on healing our broken health care system. While rancorous and sometimes loopy disagreement has slowed reform's momentum, responding by smugly 'explaining' the President's views to the opponents is insufficient, implies they are lacking in knowledge, is disparaging and damaging to our national dialog.

The DMCB is unaware of Dr. Dean's readiness to change, but if the DMCB was using motivational interviewing to help him, it would reflectively listen and offer up the option of reading this blog as one way to be a more constructive force in getting to meaningful health reform.

A less clinical way of saying the same thing is to bluntly point out that our national discourse and the listeners to NPR deserve better.