Tuesday, August 31, 2010

Harvard Mindsets and Health Reform

Mindset – 1. an intention of inclination. 2. Deposition or mood.

Dictionary definition of Mindset

Over the next few years, the U.S. healthcare system will be in the hands of academics from Cambridge, Massachusetts. New CMS Czar Donald Berwick was a member of the Harvard Medical School faculty. Joe Newhouse, who has been the senior adviser to Medicare for as long as I can remember, holds appointments in three different schools at Harvard. David Cutler, Dean of Harvard’s Undergraduate College, seems a good bet to lead the Independent Medicare Advisory Board.

Countless of their colleagues and former students have taken key policy making positions in Washington… Whether they realize it or not, they are the vanguard of a movement bringing socialized medicine to America…The Obama administration has hired an army of academics to implement the new reforms. They bring with them the finest Cambridge pedigrees and promising ideas. They will write the first draft of the rules and academics everywhere will nod in approval at the cleverness of our colleagues.

David Dranove, “The Accidental Socialists,” The Health Care Blog, August 30, 2010

I once attended an 8-week course on health system management held at the Harvard Business School in Cambridge, Massachusetts with 60 other health care stakeholders. I was the only practicing physician. In 1994 the Hillary Clinton-led health care task force of 1200 or so contained not a single practicing physician or hospital administrator. The Obamacare team, centered in Cambridge, is about to make the same mistake of excluding health care participants on the ground.

The health reform law might be called the “Harvardization” of American health care. President Obama, a Harvard-trained lawyer inspired the reform law, weighed in when it is was in jeopardy, and pushed it across the finish line to passage. David Blumenthal, MD, a Harvard medical man, is Obama’s health information czar. Blumenthal is responsible for implementing and spending $27 billion on HIT to achieve a universal inoperative system of electronic health records.

The monumental, sprawling, massively-bureaucratic health reform effort rests on a set of Harvard mindsets. According to John Naisbitt, author of Megatrends (1982) and Mind Set!(2006),” Mindsets are the ground on which rain (information) falls. Mindsets are how we receive information. That is the key.”

Harvard reformers, mostly economists or academic technocratic experts, believe free market health insurance is imperfect and inequitable. Unregulated insurers leave too many individuals uninsured. Other individuals choose not to buy insurance. Still others “free-ride” off of taxpayer subsidized charity.

In the rarified academic heights of Cambridge , the solution to these societal ills is to tightly regulate the private insurance market and deploy “rational” technocratic mechanisms, perfected and directed from Washington, to create a more perfect health system.

Dranove, an economist at Kellogg School of Management in Chicago, says, “The preferred Cambridge solution is a combination of greatly expanded government insurance and a tightly regulated private insurance market. This is the essence of Obamacare.”

This mindset, when coupled with political power, transforms Harvard health reformers into high-minded social carpenters with hammers. Anything or anybody that doesn’t suit their fancy and fit their concepts looks like a nail.

Hammer for-profit health plans. Hammer fee-for-service doctors. Hammer hospitals that live off Medicare and Medicaid. Hammer anyone who needs profit to survive. Hammer the free-market crowd who believes in individualism, innovation, and free markets. Hammer anything and everybody that disagrees with you to nail down your concepts.

What are the Harvard health reform mindsets?

• Academic and government experts know better than people themselves what is good for them.

. You can trust government, but you can't trust markets.

• Equality of results and health care equity, with expansion of coverage, is paramount.

• Standardize and homogenize health plans into one-size-fits-all plans that offer comprehensive and coordinated care.

. The power if centralized government transcends the power of individual states.

• Make all health plans and all states comply with federal mandates and regulations.

• Health care is too important to be left to consumers, doctors, hospitals, and private markets.

• Health care technologies should, and must be, be assessed by government before and after introduction into the market.

• The practice of medicine is a rational, measurable science and its technologies and outcomes must be managed by outside experts.

• All physician and hospital practices must be digitized so they can be monitored and paid-for-performance based on evidence.

• You cannot depend on health care stakeholders or competition or markets, or consumers spending their own money, to be self-regulating.

• Big Government and Big Academe know best.

These precepts rest on progressive Harvard mindsets, on faith in government experts to do the job of reform, on the ability of experts to analyze and to manage complex systems, on sophisticated technocratic analysis, and on more analysis and rule-writing is as the most equitable solution to social breakdowns.

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