February 28th, 2010 by DrRichardCooper in Better Health Network, Opinion
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An important article appeared in the NYT recently, describing a new paper by Peter Bach, which is in today’s NEJM. Peter’s paper (“A Map to Bad Policy“) debunks the Dartmouth Atlas and cautions against its use. As I said in the Wash Post in September, the Dartmouth Atlas is the ”Wrong Map for Health Care Reform.”
More damning even than Peter’s analysis was Elliott Fisher’s reply: “Dr. Fisher agreed that the current Atlas measures should not be used to set hospital payment rates, and that looking at the care of patients at the end of life provides only limited insight into the quality of care provided to those patients. He said he and his colleagues should not be held responsible for the misinterpretation of their data.” Really? It was someone else’s interpretation? OK, Elliott, you’re not responsible. Just stand in the corner. Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
June 29th, 2009 by EvanFalchukJD in Better Health Network, Health Policy
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Everything is McAllen, Texas.
It’s all part of our “uniquely American” approach to many issues: oversimplify the problem, so we can solve it. Ideally, on an artificially short time line.
In the case of health care reform, let’s say we get ‘er done by August 1.
When we talk about health care reform, we are really talking about dozens of different issues. Is health care reform about covering the uninsured, or about cutting costs for employers? Is it about having a publicly-funded health plan, or changing reimbursements to doctors? Is it about longer life expectancies or creating insurance cooperatives? Is it about caps on medical malpractice awards, or comparative effectiveness? Is it about healthier lifestyles, or cutting the cost of prescription drugs? Is it about cutting administrative waste, or incentives for more people to go to medical school? Is it about implementing new health care IT, or preventing insurers from making excessive profits?
It’s about all of these things, and more. And that’s the problem, if you’re an ambitious reformer. There is no simple way to get all of these things under one roof.
Well, until Atul Gawande introduced us to McAllen.
The President quickly made Dr. Gawande’s article on McAllen required reading at the White House, telling Senators this is the problem we are trying to solve. His point man on health care, Peter Orszag, has been blogging about it repeatedly. Members of Congress and the press have taken to talking about McAllen as the center of the health care debate. Even doctors from McAllen are calling on the President to come and see for himself.
Others are using it, too. Paul Krugman, in his blog, took on Harvard economist Greg Mankiw for saying that some comparisons of the US and foreign health care systems may be flawed as a premise for U.S. reform. In response Krugman said “read Atul Gawande!” I saw this, too, when I questioned Steven Pearlstein about why he had such a problem with doctors. His only response was “Maybe you should talk to Atul.”
The problems of McAllen make easy talking points. But they are also a convenient way of avoiding dealing with the enormous complexity of the health care system. There are nearly 650,000 doctors in America, millions of patients, thousands of hospitals, tens of thousands of insurance and pharmaceutical companies, hundreds of thousands of employers who provide health benefits, and thousands of other charities, academics, consultants, government agencies and others who have strongly held views about our system. Too often, their voices are not being heard in all the loud talking about McAllen.
And so, if reforming our health care system is, as the President says, a “moral imperative,” why can’t we have a process that treats reform that way? Why the rush to pass reforms that have to be sold under the premise of solving the problems of McAllen?
The President and the Congress are perfectly capable of putting together a respected commission of experts to study health care, in depth, and then return with serious, comprehensive recommendations that Congress and the President can work to enact. Polls show great public support for the idea of reform, but mixed understanding on what reform means. As we see from the evaporating support for reform in Congress, this gap is a serious problem.
We need effective health care reform in America. McAllen isn’t enough to close the deal.
*This blog post was originally published at See First Blog*
