Wednesday, August 27, 2014

Health Reform and The New England Journal of Medicine’s Agenda

Everybody has an health care and health reform agenda.


I avidly read each issue of the New England Journal of Medicine. The Journal is the world’s most prestigious medical journal. Each issue features meticulously edited scientific and general articles.

In recent years, the Journal has contained a Perspective section. The section precedes original articles, editorials, special reports, and correspondence.

The Perspective section features comprehensive pieces on reform and health care issues of the day.

In reading the Journal, I am aware of its hidden agenda – to advance the causes of government and global health care and health reform without, of course, being overtly political about the agenda. Its articles on health reform invariably have multiple authorship for government agencies and academic institutions , voluminous data, charts and graphs, multiple references, and content evaluating top-down government or academic reform.

Rarely do the articles reflect the point of view of independent practitioners. There is nothing wrong with this agenda. It simply reflects a nearly universally held world view in government and academic circles, as opposed to bottom-individual physician practice point of view, which more often than not, looks askance at ObamaCare.

To show what I mean, consider the titles and sources of authorship in the six articles in August 28 issue.

One, in Perspective, “A VA Exit Strategy,” by William Weeks, MD, and David Auerbach, Ph.D., from the Dartmouth Institute of Health Policy and Clinical Practice and RAND, Boston.

Two, in Perspective, “Reforming the Financing and Governance of GME G.R. Wilensky and D.M Berwick, co-chairs of the Institute of Medicine Commmittee on the Governance and Financing of of Graduate Medical Education, with 19 members of the Committee.

Three, in Perspective, “ Innovation in Medical Education,” David Asch MD and Debra Weinstein, MD, from Center of Health Care Innovation, Pennsylvania School of Medicine, Wharton School, Department of Medicine, Massachusetts General Hospital, Partners Health Care System, and Harvard Medical School.

Four, in Perspective, “Updating Cost-Effectiveness The Curious Resilience of the $50,000-per-QALY Threshold,” (QALY stands for Quality –Adjusted life-year), Peter Newmann, Sc.D., Joshua Cohen, PhD, and Mllton Weinstein, phD, The Center for the Evaluation of Value and Risk in Health, Tufts University, and Department of Health Policy and Management, Harvard School of Public Health.

Five, in Health Law, Ethics, and Human Rights Section, “Money, Sex, and Religion – The Supreme Court’s ACA Sequel,” George Annas, JD, Theodore Ruger, JD, and Jennifer Ruger, PhD. Department of Health Law, Bioethics, and Human Rights, Boston University, Pennsylvania School of Law and Leonard Davis Institute of Health Economics.

Six, Special Report, “Health Reform and Changes in Health Insurance Coverage in 2014,” Benjamin Sommers, MD, and five others, Office of the Assistant Secretary for Planning and Evaluation, HHS, and Department of Health Policy and Management, Harvard School of Public Health.

I will not get into the details of these articles. Suffice it to say, the authors view health reform from the top-down government and academia perspective. Most question but favor national health reform, e.g. the last article notes “These results are consistent with studies of previous insurance expansions that have shown that gains in coverage can lead to rapid improvements in access.” One graph shows the number of uninsured have declined from 20.5% to 16.3% since 2012.

No comments: