Wednesday, March 5, 2014

Quality in the Eyes of Ekekial Emanuel, MD, ObamaCare Enthusiast

Come, give us a taste of your quality.

Shakespeare (1564-1616),  Hamlet

Occasionally I run across an article that strikes me  as unrealistic.  “Insurance Companies As We Know Them Are About To Die: and Here’s What Will Replace Them” by Ekekiel Emanuel MD,  former  chief medical advisor of President Obama, in the March 2 New Republic is such an article.

The article is essentially a promotion piece for his new book, which goes by the title of , Reinventing American Healthcare: How the Affordable Care Act Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error-Prone System” (Perseus Books, 2014).

A Rejoinder

A rejoinder from ObamaCare opponents might read:  Why the Affordable Care Act Is Overly Complex (They will cite its 2700 pages and 29 changes modifying to make it workable),  Blatantly Unjust(They will note the loss of health plans by 6 million Americans when it was known beforehand  this loss would occur),  Outrageously  Expensive ( the ACA is running 45% over-budget, has resulted in sharp increases in premiums and deductibles, and is projected to cost $2.7 trillion by 2024) ),  Grossly Inefficient (There is no evidence to data that ACA increases efficiency), and Error-Prone ( see for classic example of an error-prone system.)

From the titles of his article and his book,  it is apparent Dr. Emanuel looks down with disdain at current system and the ordinary mortals who participate in it.  Government elitists, after all,  know best.  His main target are Americans health plans who administer it, but other health care professionals are targeted  as well. 

Dr. Emanuel has an altitude and attitude problem.  The altitude problem manifests itself in his belief that top-down government knows best for people and what constitutes "quality." The attitude problem is reflected in his proclivity for assigning blame to others for the woes of the system.  He  fails to acknowledge that something may be fundamentally  wrong with a massive federal program that growing numbers of Americans oppose (now 57%) and that 64% say they wish had never been passed, and that 40% consider a “joke.”

The problem of the current system, asserts Dr. Emanuel. is lack of "quality",  outcomes for dollars spent.  To correct his problem,  he advocates  a government-mandated, coordinated, standardized,  integrated health system  using government-approved  quality guidelines based on evidence-based data. He envisions a string of accountable care organizations, composed of teams of health professionals,  managing, coordinating, collaborating, and concentrating on  this effort, which, he believes, will produce greater quality at lower costs and greater efficiency.

To achieve these quality goals,  he predicts these “megatrends” as set forth  in his Reinventing American Health Care treatise.

1)      End of insurance companies as we know them, effective date 2025

2)     VIP care for the chronically and mentally ill, effective date, 2020

3)     The emergence of digital medicine and closure of hospitals, effective date, 2020

4)     End of employer-sponsored health insurance, effective date, 2025

5)     End of health care inflation, effective date, 2020

6)     Transformation of medical education, effective date,  2025
      These are ambitious goals.  The goals  rely on ObamaCare succeeding, which it may not.   They rely on government knowing what is best for people, which it may not.  The people may yearn for more personal one-on-one care, not for team-based integrated care administered by government.
Tweet:   Dr. Ezekial Emanuel foresees end of health plans as we know them, employer-based coverage, and health care inflation, with the emergence of “quality” medicine.

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