How Not to Do a Health Care Plan

A proposal called the Health Care Dialog was issued Friday by a diverse group and commented on by the Wall Street Journal and Politico amongst many others. The Plan suggests:

"1. INCREASING COVERAGE AND ACCESS

...Seek to ensure coverage for all; strengthen public safety-net programs for low-income families; make private health coverage more affordable; and provide fair and adequate reimbursement for care.

2. STRENGTHENING WELLNESS AND PREVENTION

...The Centers for Disease Control and Prevention estimate that eliminating three risk factors — poor diet, inactivity, and tobacco use — would prevent 80 percent of heart disease and stroke, 80 percent of Type 2 diabetes, and 40 percent of cancer.

3. ENSURING QUALITY AND VALUE

• Develop infrastructure to close gaps in quality and outcomes.
• Conduct comparative clinical effectiveness research (CER) studies via a public-private partnership to provide additional information that can help improve care decisions.
• Expand and accelerate the development of meaningful quality measures.
• Expand reliable data sources to build an evidence base for quality care...."

They go on to say:

"The Congressional Budget Office (CBO) estimates that total health spending will rise from 16 percent of Gross Domestic Product (GDP) in 2007, to 25 percent in 2025."

Politico starts its report by saying:

"A coalition of special interest groups that met privately for months to reach a consensus on overhauling health care ended up sidestepping the most contentious issues: coverage mandates, a public insurance plan and financing..."

Whereas the WSJ says:

"A collection of health care groups calling itself the Health Reform Dialogue issued a set of recommendations today aimed at governing the debate over restructuring health care, and their ideas are generally consistent with the direction Democrats are heading..."

The Politico post appears as if some gang got together and put up their goody list whereas the second states that they aligned for the first time with the Democrats. What is amazing is how anything can come of a process like this. I have sat on many such panels and they result in group-think where any one having a good idea is shouted down by the others because they want their ideas included and the net result is the least common denominator.

The process of doing this health care reform is quite complex. I can see that academics are generally clueless, they generate arcane and often self-serving solutions that reflect their local politics less than true reality, a reality that they are in no way able to grasp. Physicians are too mired in the day-to-day practice of medicine and its ensuing overhead to get together and accomplish anything. Although the physicians often have the most to bring they are so close to ground zero that they cannot step back and propose. The physicians are not after all like lawyers who thrive on confrontation and posturing. Government bureaucrats have their agendas, lobbyists have their clients, and all other groups have the natural dynamics that lead the to LCD result.

Perhaps it is the ever present outsider who can bring some light to this issue. What seems to be missing again and again is the modulation of demand. Clearly the CDC recognizes the problem, cancers and type 2 diabetes, but somehow modulating obesity via market mechanisms may be politically incorrect.

As is remarked in the New York Times Magazine of today in the story about Freeman Dyson:

"What may trouble Dyson most about climate change are the experts. Experts are, he thinks, too often crippled by the conventional wisdom they create, leading to the belief that “they know it all.” The men he most admires tend to be what he calls “amateurs,” inventive spirits of uncredentialed brilliance like Bernhard Schmidt, an eccentric one-armed alcoholic telescope-lens designer; Milton Humason, a janitor at Mount Wilson Observatory in California whose native scientific aptitude was such that he was promoted to staff astronomer; and especially Darwin, who, Dyson says, “was really an amateur and beat the professionals at their own game.”

Thus it may take a Darwin working alone and working against the grain. It must then take a group who believe in the new Darwin and become zealot like in their promulgation of the well thought out solution. Groups just always seem to miss the mark.