Tuesday, November 24, 2009

Ten Ways to Boil Health Reform Oceans

I keep asking the same question: How can the Democrats ram anything as big and complex through as these health care bills with approval ratings--now in the 35% to 40% range--so low?

They seem intent on showing us

Robert Laszweski, “Public Anxiety Meets the Democratic Effort to Get Health Care Done at All Costs,“The Health Care Blog, November 23, 2009, Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades.

Dear Robert:

You ask how Democrats can can get reform done in the face of soaring costs and disapproval of the American people. From out of blue heaven, this inspired ten part Eureka and Nirvana-based answer came to me.

One, kill the lawyers! Shakespeare and the American people distrust lawyers, especially lawyers in the House and Senate. Americans consistently rank lawyers down there with used car salesmen. As I write, Congressional job approval is at a minus 65 percent, meaning nearly two-thirds of Americans disapprove of the job Congress is doing. Therefore, we can start reform by ridding ourselves of lawyers, particularly incumbent lawyers who double as politicians.

Two, ban the lobbyists! Everybody knows special interest lobbyists shape health reform legislation. For every legislator, there are over 30 lobbyists collecting roughly $300 million in misbegotten fees. Lobbyists are even writing the press releases and talking points for Congressmen and Senators. Politicians, in turn, are gathering contributions to assure their reelection. Outlaw lobbyists!

Three, put doctors on salary! Remove incentives for doctors to do more for patients. Herd doctors into large groups, into integrated organizations like Mayo, Kaiser, and Geisinger, salary them, strip them of incentives to make more money, regulate them. Remember: once you’ve got them by the tender part of their anatomy – their wallets – their hearts and minds will follow.

Four, put Washington in charge of who gets what at what price! Only Washington knows what constitutes “rational” thinking; how federal dollars should be distributed and for what reasons; and who should get the money. Reform is about social and redistributive justice. Patients and doctors, in short, who get the short end of the stick, must bow to superior beltway wisdom.

Five, adopt health systems of other countries! Everybody knows other countries are morally superior. They cover more people at half the cost that we do and with better results. Ignore the fact that these countries have more homogeneous populations; have lower rates of violence; supply health care by suppressing access to life-saving and life-style restoring technologies; and offer services that aremuch less responsive to patients with fewer amenities.

Six, move lower-cost health systems off shore! Follow the example of an India physician who is building a high tech hospital in the Cayman Islands, one hour by plane from Miami that will perform open heart surgery for $2000, versus $20,000 to $100,000 in U.S. Focus on volume. Restructure. Introduce new business models. For details, see “Indian Doctor Tagged ‘Henry Ford of Heart Surgery’ Drives Down Costs,” WSJ, November 23.

Seven, digitize health care! Everybody knows that the American economy is moving at Internet time, that the computer promotes transparency, clinical efficiency, outcome effectiveness, price comparisons, relevant provider value, and empowers consumers to make the right choices for the right reasons at the right places with the right results. Never mind that it may be personally intrusive, violate privacy, and disrupt the patient-physician relationship. Data uber alles. Digitize upper alles.

Eight, Base everything on scientific evidence! Everybody knows medicine is Science not Art, and that government, health plans, and consumers should pay only for what works and what is rational in the eyes of payers. Never mind that what is paid for may not fit the hopes, needs, and expectations of patients and that human values, such as the quest for individuality and personal freedoms, may be subjective and irrational.

Nine. standardize everything! In a top-down system, everybody knows that everything must be certified, standardized, and homogenized - the contents of every plan, the benefits provided, the choices offered – regardless of age, sex, socioeconomic conditions, cultural or health status. Everybody is equal, but some are more equal than others, depending on your politics.

Ten, end the profit motive, and you can’t end it, tax it! Everybody knows profit is the root of all health care evils. Therefore, all incentives to innovate to make more money must be eliminated. If the profit motive persists among hospitals, doctors, health plans, device makers, and drug firms, tax their profits. Let no good innovation go unpunished.

Caveat: If you plan to boil health reform oceans, boil one ocean at a time.