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Comments on the TV Program "Meeting of the Minds"

This panel discussion had all of the pieces, or so it seemed.   The result was rather a collection of perspectives being stated, more in the appearance of talking heads than a meeting of the minds.  The basic issue that keeps coming up time and again is that the discussion of the core problems is not being addressed, and this was another instance.   The industry and the government was well represented, as evidenced by the resumes (see the link for details). 

Each stated their position and advocated a small change in the coming reform.   As is typical each saw a piece of the problem and wanted to fix the piece that concerned them the most.  The result is a composite that is akin to adding another floor to the existing structure of the healthcare system, like throwing a bunch of 2x4's in a pile to make a building.  One could restate each position by saying:  "if we just fix my concern then all will be well."   Does this sound like the process that lead to the 58 lobbyists per Congressman?  

Some of the data presented was good, although some data presented was just incorrect.  The praising of France seemed at best misplaced.  See Other Countries for more complete data on France and Canada.  Many of the conclusions drawn were incorrect.  the advocacy for the public option to increase competition in insurance misses a whole analysis on what is driving costs. See Insurance and Trends/History for some more complete data.  Perhaps the most surprising comment made was by the President of the AMA, when he said that "we do not have a free market in healthcare."  It is true, but surprising in that the AMA does not act in accordance with respect for the free market.

Perhaps the key point that most could agree with was the acceptance of a public and private healthcare system in the future.   A good deal of the issues currently have to do with accepting government's role to date in healthcare, not a cause of the issues, but rather inevitable.  This is huge leap and one that gets in the way of looking at the real cause of the problems today.  This role needs to radically change.

It was not clear if the majority of the panel members were in favor of increasing entitlements in America.   If they are, then cost cannot be seen as the issue, but rather coverage is the concern.  As was stated this is a key issue that we have to solve correctly.  It is a key sector of the economy, and it is about a key part of each of our futures, our health.  So why is that the discussion on the core problem is so difficult to discuss. 

One other opinion is that it is because after 40 years of increased centrist policy creation, the real business acumen and management leadership within the healthcare industry is scarce.    I can say unequivocally that a discussion like this would not have occurred in the electronics industry, for one thing it would not be so politically charged as healthcare has become. 

The bottom line is the problem a cost issue or a coverage issue?  If we want to drive costs down then how can this be done with government management?  Where is the case that says that this has ever occurred?  Is the Post Office a good model?  The answers are there is no case that has worked, and no the Post Office is exactly what Americans do not want.  HMO's were rejected, so can Obamacare be any better?  The leaders promoting Obamacare want us to think so, but it is simply not true.     

What about Maine?  which was reported recently in Business Week as follows:  Maine enacted universal coverage in 2005, also with no cost constraints. Premiums for the state-financed insurance plan have risen 74% since, and many residents have dropped coverage. Maine's uninsured rate is back at 10%, barely lower than the pre-reform level.

Why doesn't the government want to first fix Medicare, to show it knows what it is doing.  perhaps we should have a State of the Union where a new model is attempted, where the patient is empowered to be a strong part of the decision process on cost comparing and expensing, to enhance competition between all entities, as per that outlined in Proposal.  Give also the States like Maine, Massachusetts, Oregon a chance to make their version of Obamacare work.   I wonder how much better off the free market approach would be?  Any bets?

Our current system has incentives all our of balance, and must be fixed:

  • Pharma / Device “My job is innovation that helps people . . . it's up to the doctors to control use.”
  • Payers   “We want to pay for the right things there’s things, but there s little data…and our customers want us to control costs.”
  • Clinicians  “My job is doing everything I can to help my patient . . . if I say no to studies, I might get sued.” 
  • FDA   “Safety, not cost effectiveness, is my job.”
  • CConsumer-Patient   “I want the best of everything. Don’t ask me to pay more.”

To fix this we must understand the core drivers and manage change.  I would go further than to say reform, for the current system is driving these incentives to a set found in a compeitive industry.  Insuring that the lack of good business sense, that has been developing so for a long time, is reversed.  It will take time for the old lobbyists to learn new jobs.  Drive the special interests out of DC.