In the President's weekly address today he said:
"And we’ve all heard the charge that reform will somehow bring about a government takeover of health care. I know that sounds scary to many folks. It sounds scary to me, too. But here’s the thing: it’s not true. I no sooner want government to get between you and your doctor than I want insurance companies to make arbitrary decisions about what medical care is best for you, as they do today. As I’ve said from the beginning, under the reform we seek, if you like your doctor, you can keep your doctor. If you like your private health insurance plan, you can keep your plan. Period."
The problem is that the section on Comparative Clinical Effectiveness in the bills is really establishing and institutionalizing a Government entity to specify what procedures to perform when. There is a great deal of benefit from CCE studies. As I have written before this process goes on in the medical profession on continuing basis. For years I have taken the semi-annual tests from the NEJM/Massachusetts Medical Society reviewing hundreds of paper for annual CME credit. It forces you to remain current in terms of what you may not see on a day to day basis. It looks at one study after another yet from year to year they change and from physician to physician they have varying levels of acceptance. The existing CCE process is the publishing of reports, looking at at hand clinical data and responses, and interacting with peers.
I have just read the book by Dr. Newman at Columbia P&S entitles Hippocrates Shadow and it is both well done and enlightening. It is a treatise if you will on what can go wrong with CCE especially if done by the Government. Newman gives a multiple of examples where physicians differ amongst themselves when diagnosing a disorder as well as what the best way to proceed is. Most physicians recognize this from the beginning.
The President most likely does not understand the details here and those proposing this fall it appears in two camps.The first camp are those who see this as a way to control costs, getting the "best" procedure and having everyone avoid spending money on procedures which have no benefit. The second camp are the academic physicians who have abstracted an ideal, the Platonic physicians if you will, and they feel that they can apply that ideal to all.
The reality is that the ideal just does not exist for very many reasons. I list a few:
1. No patient is like any other patient. People are different and as a physician you must understand and work around the differences.
2. Diseases are different even the same diseases. Pneumonia may not be the same in every patient and what one physician sees as pneumonia another may see as a pulmonary embolism, as Newman recounts.
3. Physicians make mistakes. True fact, they do. They most likely are not deliberate or due to incompetence but most likely due to some predisposition or lack of time to reflect. In a pressured environment of an office or an ER there is a continual flow of patients and the physician may just misinterpret or not see or hear a key element.
4. Patients never tell the same story twice. Patients are notorious for not telling all and telling too much of what is not relevant. They are scared and they are not trained observers. Even a physician as a patient does not get it right. Thus as a physician you are trying to get the trajectory of a moving target which is sending out chaff, a difficult task.
Thus the CCE model as proposed in the health care bills is in my opinion one of the worst elements. As the President has said, "...I no sooner want government to get between you and your doctor than I want insurance companies to make arbitrary decisions about what medical care is best for you, as they do today..." the only way this can be accomplished is to leave CCE in the hands of the Medical profession and NOT move it to the Government.
The President seems not to understand that people are reading the words of the bills and as they do so they see a disconnect from what he says and what is in writing. I am not saying that he is in any way misrepresenting the intent, he rightly seems to mean what he says, but someone should read what HR 3200 says and inform him, it does NOT say what he does.
"And we’ve all heard the charge that reform will somehow bring about a government takeover of health care. I know that sounds scary to many folks. It sounds scary to me, too. But here’s the thing: it’s not true. I no sooner want government to get between you and your doctor than I want insurance companies to make arbitrary decisions about what medical care is best for you, as they do today. As I’ve said from the beginning, under the reform we seek, if you like your doctor, you can keep your doctor. If you like your private health insurance plan, you can keep your plan. Period."
The problem is that the section on Comparative Clinical Effectiveness in the bills is really establishing and institutionalizing a Government entity to specify what procedures to perform when. There is a great deal of benefit from CCE studies. As I have written before this process goes on in the medical profession on continuing basis. For years I have taken the semi-annual tests from the NEJM/Massachusetts Medical Society reviewing hundreds of paper for annual CME credit. It forces you to remain current in terms of what you may not see on a day to day basis. It looks at one study after another yet from year to year they change and from physician to physician they have varying levels of acceptance. The existing CCE process is the publishing of reports, looking at at hand clinical data and responses, and interacting with peers.
I have just read the book by Dr. Newman at Columbia P&S entitles Hippocrates Shadow and it is both well done and enlightening. It is a treatise if you will on what can go wrong with CCE especially if done by the Government. Newman gives a multiple of examples where physicians differ amongst themselves when diagnosing a disorder as well as what the best way to proceed is. Most physicians recognize this from the beginning.
The President most likely does not understand the details here and those proposing this fall it appears in two camps.The first camp are those who see this as a way to control costs, getting the "best" procedure and having everyone avoid spending money on procedures which have no benefit. The second camp are the academic physicians who have abstracted an ideal, the Platonic physicians if you will, and they feel that they can apply that ideal to all.
The reality is that the ideal just does not exist for very many reasons. I list a few:
1. No patient is like any other patient. People are different and as a physician you must understand and work around the differences.
2. Diseases are different even the same diseases. Pneumonia may not be the same in every patient and what one physician sees as pneumonia another may see as a pulmonary embolism, as Newman recounts.
3. Physicians make mistakes. True fact, they do. They most likely are not deliberate or due to incompetence but most likely due to some predisposition or lack of time to reflect. In a pressured environment of an office or an ER there is a continual flow of patients and the physician may just misinterpret or not see or hear a key element.
4. Patients never tell the same story twice. Patients are notorious for not telling all and telling too much of what is not relevant. They are scared and they are not trained observers. Even a physician as a patient does not get it right. Thus as a physician you are trying to get the trajectory of a moving target which is sending out chaff, a difficult task.
Thus the CCE model as proposed in the health care bills is in my opinion one of the worst elements. As the President has said, "...I no sooner want government to get between you and your doctor than I want insurance companies to make arbitrary decisions about what medical care is best for you, as they do today..." the only way this can be accomplished is to leave CCE in the hands of the Medical profession and NOT move it to the Government.
The President seems not to understand that people are reading the words of the bills and as they do so they see a disconnect from what he says and what is in writing. I am not saying that he is in any way misrepresenting the intent, he rightly seems to mean what he says, but someone should read what HR 3200 says and inform him, it does NOT say what he does.
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