Inaugurating Health Care Reform: Comprehensive Managed Care in 2010 (Part I-f)


"The next steps will be harder. Based on what the data show, Medicare will have to stop reimbursing some expensive treatments that don’t do much good."

Continuing from last week's post, Part I-E...

To do variation analysis, helpful in understanding report cards, continuous quality improvement and utilization review, one needs

• Longitudinal data and comprehensive databases.

• It is easier to obtain those data with electronic health records that are privacy protected, of course.

But, as Peter Orszag, health care budget analyst says: "The next steps will be harder. Based on what the data show, Medicare will have to stop reimbursing some expensive treatments that don’t do much good. Private insurers would likely follow Medicare’s lead, as they have on other issues in the past. Doctors, many of whom make good money from extra treatments, are sure to object, just as Mancur Olson [vide infra] would have predicted. They will claim that, whatever the data show, the treatments are benefiting their patients. In a few cases—though, by definition, not most—they may be right. Even when they are not, their patients, desperate for hope, may fight for the treatment."

"The Big Fix" (NY Times Magazine, January 31, 2009;22-29;48-51)

Beware, "Those who cannot remember the past are condemned to repeat it."

George Santayana, The Life of Reason, Volume 1, 1905

Mancur Olson tells us why we got into political hot water with healthcare:

"[S]uccessful countries give rise to interest groups that accumulate more and more influence over time. Eventually, the groups become powerful enough to win government favors, in the form of new laws or friendly regulators. These favors allow the groups to benefit at the expense of everyone else; not only do they end up with a larger piece of the economy’s pie, but they do so in a way that keeps the pie from growing as much as it otherwise would. Trade barriers and tariffs are the classic example. They help the domestic manufacturer of a product at the expense of millions of consumers, who must pay high prices and choose from a limited selection of goods."

In summary, measure and manage, comprehensively, coherently, fairly and constructively. Know that the current economic crisis may, hopefully, serve as a catalyst for change, that is, if we 'strike while the iron is hot' and do it right.

Finally, here are some of the critical goals and objectives of healthcare reform that I want to see; I presented some of these in Part I-C, and I am repackaging them here for emphasis:

•Universal coverage


•Early detection and prevention



•Aligned incentives

"It's the patient, stupid" thinking, and so forth, even as the crisis cleans house of those with vested interests and we pull away from the status quo.

Readers: can we get there from here or is this too much of a paradigm shift?

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