First is the assessment from the one who seeks to just pass
on when he turns 75 I believe[1]. His
assessment is mixed but full of praise. What is most telling is his last set of
comments. He states:
Even though the ACA is not a perfect bill, it has
improved the US health care system. If venture investing is a trustworthy
indicator and if additional reforms enabled by the ACA, such as more payment
change and drug cost controls, are implemented, Americans can be optimistic
about the future of the US health care system.
This single paragraph is in my opinion the most telling.
First he admits the ACA is not perfect. Far from it. As we have already noted
it has added some 15 million new participants costing the taxpayers about
$15,000 per year per participant. This is more than Medicare participants who
being older should have been costlier albeit having paid some 50 years’ worth
into the system. The conclusion of efficacy is not justified. Second the grab
to venture investing as a proof of success is truly mind blowing! There is no
basis for this assertion. Why not indicate the rise of ISIS as well?
Coincidence is not correlation is not a proof!
The second horseman is the fellow who brought us Meaningful
Use and the EHR[2].
As we have seen since its inception the CMS mandated HER has in my opinion led
to higher costs, less patient interaction, and less inter physician
communications. The design in my opinion is fatally flawed by setting up
islands of non-interconnected data elements with the patient nowhere to be
found. As he states as a key step in his proposal[3]:
Third, Shift the Business Strategy From Revenue to
Quality: Maximizing revenue continues too much to dominate the business models
of health care organizations. That reflects short-term thinking. A better, more
sustainable route to financial success is improving quality. This requires
mastering the theory and methods of improvement as a core competence for health
care leaders. It also requires that the CMS and other payers continue to unlink
incomes from input metrics, such as “relative value units” for specialists’
incomes, which are not associated with quality and drive volume constantly
upward.
Now as we have noted frequently the term Quality is in the “eye
of the beholder”. Quality means what and to whom? The CMS has also promulgated
mandatory “quality” measures. If one looks at them there is nothing more than a
useless list of check marks adding costs and detracting from the delivery of
services!
Now the third horseman. He was the strategists again on
health care information. As he stated just after the ACA[4]:
The widespread use of electronic health records (EHRs) in
the United States is inevitable. EHRs will improve caregivers' decisions and
patients' outcomes. Once patients experience the benefits of this technology,
they will demand nothing less from their providers. Hundreds of thousands of
physicians have already seen these benefits in their clinical practice.
And how did that work out for us. More cost and less care.
We have physicians becoming typists or if they can’t type hiring a third party
to sit in the examining room typing away and interfering with patient-physician
contact. The result, better patient care and lower costs, it does not seem so.
In his most recent paper he states[5]:
Given some Americans’ skepticism of
foreign experience, home-grown examples may be more compelling. The
Commonwealth Fund State Scorecard suggests that
(1) if US health spending per
person averaged the same nationally as among the 5 lowest-cost states (Utah,
Arizona, Georgia, Idaho, and Nevada), an estimated $535 billion (approximately
20%) less would have been spent on personal health services in 2014;
(2) if rates of health insurance
coverage averaged the same nationally as among the 5 areas with the highest
rates (Massachusetts; Vermont; Hawaii; Washington, DC; and Iowa), an estimated
20 million more Americans would have been insured in 2014; and
(3) if the national levels of
mortality amenable to health care averaged the same as among the 5 states with
the lowest rates (Minnesota, Vermont, New Hampshire, Utah, and Colorado), an
estimated 77 000 fewer deaths would have occurred in 2014.
Let’s look at the above and examine it
for facts. First the states of Utah, Nevada, and Arizona have high Mormon
populations. Mormons live health life styles. So perhaps it would cost less.
Georgia just has less access.
Second, Massachusetts has world class
hospitals that do leading edge care. Idaho does not. Vermont is a socialist
state in many ways and people pay for that. Hawaii always has high costs, buy a
gallon of milk!
Third, look at the demographics of the
states with lowest mortality. I reside part time in New Hampshire. It soon will
see a rise as obesity takes its toll but for the most part it is rural and of
modest income.
Frankly in my opinion this type of
sweeping ad hoc propiter hoc argument is baseless. One must ask why. But that
does not seem to be in the vocabulary.
It is worth reading the comments of
these three who played so much of a role in what has happened. This is the left
wing of medicine, yet they managed in my opinion to set the agenda for the next
generation, and the cost may be overwhelming.
Then of course one asks who is the Pale Horse?
Posts
