Thursday, June 17, 2010

Rehashed Arguments From the White House - Again

With the Disease Management Care Blog's advancing age, it's come to appreciate the ready access to convenience. If it's too far, it can take a taxi. If it's too warm, a dial thingy on the wall can make it cooler. If it's not completely sated, it can order basil flavored ice cream with its cappuccino. Problem solved.

Too bad the same isn't true for the problems facing U.S. Presidents. Stopping the Gulf oil leak remains stubbornly out of reach, while twin toxic "plumes" of red ink and voter discontent are lurking below the waves of health reform. Since expedient solutions remain out of reach, the White House solution seems to be to repeatedly tell anyone who will listen that its not too far, it's not too warm, there's enough food, they're in charge of BP and that the Affordable Care Act (ACA) will lead to savings.

Case in point is a recent Perspectives piece on the merits of health reform authored by none other than the Office of Management and Budget's Peter Orszag and Ezekiel Emanuel.

This is a litany of the usual Administration arguments of how the ACA is the legislative breakthrough that will a) reduce fraud and abuse (with a return on investment of 1:17), b) lead to administrative simplification, forcing commercial insurers to adhere to a common set of standards for claims submissions c) promote faster generic biologic drug approvals (so that they are merely very expensive, not shockingly expensive), d) reduce imaging costs by unilaterally cutting the fee schedule for radiology studies, e) reduce Medicare Advantage payments f) impose an excise tax on "Cadillac" plans and g) promote the three "I's" of information (a.k.a., electronic health records and effectiveness research), infrastructure (medical homes, accountable care organizations and post-discharge care to avoid readmissions) and incentives" (payment rates that act as both carrots and sticks to reduce avoidable complications and along with various pilots programs).

In addition to this, Drs. Orzag and Emanuel point out that an Innovation Center will develop, test and evaluate new policies and programs and that an "Independent Payment Advisory Board" will develop and propose policies for reducing health care cost inflation.

Readers may find that this article is a handy reference, suitable for building a PowerPoint slide or quoting over shared morning lattes. However, if the White House feels that publishing this in the New England Journal is going to reduce citizen-physician skepticism, they need to know a) there is nothing new here; these are the same recycled arguments and b) much of the Journal's readership is probably already predisposed to accepting the White House's nostrums. Just saying it over and over in a friendly venue isn't likely to advance the political discourse.

The DMCB is looking for better arguments that genuine health reform isn't too far away, that the cost trend can be cooled and that it can have it's ice cream and eat it too.

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