Sunday, April 29, 2012

Experts  Versus Behavior of Patients and Physicians:  Opinions, Reality, and Common Sense

Common sense is not so common.

Voltaire (1694-1778),  Dictionaire Philosophique (1694-1778), Common Sense

April 29, 2012 – Call me jaded. Call me cynical.  Call me over-exposed to experts.

But ever since 2005, when I wrote Voices of Health Reform, a book composed of 40 interviews with experts,  I’ve been skeptical of opinions of experts on health reform.

An article in today’s New York Times reinforces my prejudice.  Its headline  reads. “In Hopeful Sign, Health Spending is Flattening: Surprising the Experts.” 

As I read the article and the headline,  I thought:   Maybe there is something to those tired clichés:   An expert is someone from out of town.  An expert knows more and more about less and less. An expert is someone removed from reality.   Say what you will,  health reform experts are usually not someone in the clinical trenches who pays for, receives, or delivers health care.

The experts are confused and vague about why the slowdown is occurring.

·         Karen Davis,  president of the Commonwealth fund,  a liberal think tank,  says, “The tectonic plates may be shifting, “ whatever that means.

·         David Cutler,  Harvard economist and Obama’s chief health reform adviser, who I interviewed for Voices of Health Reform,  chimes in, “The recession just doesn’t account for the numbers we are seeing.” Well, what does.

·         Gail Wilensky,  head of Medicare and Medicaid under   President Bush,  is mystified, “If there’s something going on, we don’t know what it is yet.  The most honest thing to say is:  one, the reduction is use is greater than the recession; two, we don’t understand it yet; and three, you’d be a fool to say we can understand it.”

Let me give the experts a clue:   the low rate of inflation is the common sense of the American people kicking in.    
Because of:
·         the unaffordable costs of care;
·         effective unemployment of 16% or so; 
·         the 35% explosion of high deductible plans,  in which people have to spend their own money and who think twice before parting with their health care dime; 

·         increasing high co-payments of ER care, sometimes $100 or more;

·          proliferating  lower cost options,  such as urgicenters, walk-in clinics,  retail clinics,  and direct-cash options; people watching their dollars and practiciing home care and self-care;

·         I\increasing use of generics and doctor sensitivity of costs,

health spending is coming down.

I was speaking yesterday to the manager of an urgicare center.   I asked her about the center’s patient mix.   

She replied,”  About 25% are uninsured who are paying out of pocket;  about 25% are Medicare and Medicaid’ about 25% are on high deductible plans; and about 25% are on regular health plans.  She added, “ Look the co-pay for the ER is now about $150, so patients are coming to us, or going to their regular doctors.”

I queried, “But what about accountable care organizations.” She responded, “What about them?  There aren’t any around here, and patients have never heard of them.”

I pressed, “”What about the health care law?”  “Nobody, “ she answered, “ every mentions or asks about it.  It is irrelevant to them. All they know is that costs are going up, and employers are dropping some of them from their plans."

Tweet:  Health inflation slowed to 4% in 2009 and 2010. Experts don’t know why, but patients paying health bills and provider delivering icare do.

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