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“Let the government control healthcare costs” – OMG

July 7, 2011

After reading the editorial cited below, I had to respond in some way.  So here it is:

Froma Harrop is a columnist and editorial board member of the Providence (R.I.) Journal

Published in the July 4, 2011 edition of the Birmingham News

 “Let government control medical costs”

In her editorial, Ms. Harrop, discusses the statement published in Reason magazine by Peter Suderman that states, “Centralizers say that the responsibility for making tough decisions about how to keep health care costs under control ought to be made by enlightened, well-intentioned policy elites.”  The article goes further in pointing out that, when people use their own money to buy healthcare, the theory goes, they are more careful about costs.  Ms. Harrop then goes on to say, “I don’t know. These “elites beat the heck out of corporate interests trying to sell me treatments I don’t need or whose results can be duplicated at far lower cost”.  The point of the discussion is Ms. Harrop’s assertion that “what patients and doctors need is a U.S. Government website run by an enlightened, well-intentioned policy elite that studies various treatments for the same condition and compares their performance.  That’s how we can find effective, less costly, care.”  The concept of quality at a lower cost is hard to beat.  The method suggested – now that s a problem.

Unfortunately, the elements of real world answers that exist in the editorial get tied up into discussions about Republican’s fearing this approach leads to “death panels” and the fear of “corporate interests” running the show.  So, instead of focusing on answers, we get into the political debate.  And now, the public is to believe that “an enlightened, well-intentioned policy elite, can separate itself from those very issues.  Interesting thought but probably unrealistically hopeful.

In reality, decisions about healthcare are fairly basic.  Get the highest quality for the lowest cost.  Most of us do this every day as we look for low gas prices, sales on quality goods, etc.  However, there are always those who want someone else to take that responsibility, give the consumer information that the consumer acts on it, and sues someone if the information is wrong.

The truth is that we, consumers and the healthcare industry, needs to take on this responsibility ourselves.  When you go to your doctor and they say, I think you need this test or go see another doctor we typically do what Ms Harrop suggests in her comment that, “consumer-driven healthcare will mean that when the doctor says go get an MRI, the consumer drives himself to the clinic”.  That’s instead of asking exactly what are we looking for, what kind of equipment will be used,  who will be interpreting the test(s), what are their qualifications and what are their results from an accuracy and outcome standpoint.  Of course, one argument is that most providers don’t have that information in any detail about who they refer their patients to for evaluation and / or further testing.  That’s a problem and the patient, consumer, has the right to know this.  The days of Marcus Welby, MD, where everyone trusted everyone, are gone.  Things are just too complicated to base things on where someone went to school, practices medicine or gives the best talk.  So, when a patient asks these questions, it’s the physicians’ responsibility, to the best of their ability,to have the right answers, find out the answers or watch the patient exercise their right to go somewhere else.  We have lived too long in the time where patients don’t want to question or second guess their doctor because” they might get mad or not like me”.  If that’s really the case, the patient should run as quickly as they can to another doctor.

Now, the next argument is that “this information is not always available”.  Okay, let’s start with what we have.  The government and private payers have claims data which translates to cost data.  If providers aren’t careful, what’s what will be used to make healthcare decisions because, as imperfect as it is, that’s what exists.  Primary care providers need to find ways to get the appropriate information from their specialists.  This can include things like experience, disease severity, hospital length of stay and a myriad of other indicators.  If I’m a specialist, then I need be about my business putting this information together, as completely as I can, to have available to referring doctors and patients.    We have to get started now before a “well-intentioned policy elite” makes these decisions for us.  If providers can quit looking in the short-term and think long-term, they will actually have a chance to control their own destiny by providing cost-effective, high quality medicine.

The answer is for payers and providers to work together to develop this information.  Except for in a few major systems, payers have cost data and providers have quality data.  It just seems like working together to put the two pieces together makes sense.  One result of course is that someone (a provider) might not make the cut based on cost and quality measures.  The answer is, they have the right, and responsibility, to make the appropriate adjustments in their practice style.  Just like patients have the right and responsibility to manage their healthcare instead of relying on a centralized panel take care of them.  All that sounds like the often politically incorrect issue of personal responsibility.  That’s too bad because we either, as the aforementioned consumers and providers, do what is right ourselves or, we get to live with the consequences.

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