Archives for February 27, 2009

The AMA’s statement to the President about Health Care Reform

Here’s a .pdf file of the statement, signed by the President of the AMA and several professional organizations and specialty boards.

It is well written and well intentioned.  It’s also just filled with the gobbledygook that comes from big groups that don’t get the problem.  It’s ideal from a big-group perspective, in that all but one or two of the goals is already underway, and the hardest one isn’t under their control (interoperable EMR’s).

As the letter is 3 1/2 pages long I could spend a lot of time analyzing every aspect (several of which I agree with), but I’m going to focus on the thing that jumped out at me.

…We are committed to creating a cultural transformation that better supports delivery of the highest quality care for individual patients and communities and which, among other strategies, will allow for a more appropriate allocation of finite resources.  These two elements are extremely important, and we hold ourselves accountable to achieve them.

Buzz-words: “cultural transformation” and “appropriate allocation of finite resources” are the two that make me cringe, but feel free to find your own.  What does ‘cultural transformation’ even mean?  There’s no vision for changing any culture in the document (it’s a nice list of goals to increase efficiency, but that’s not a ‘cultural transformation’).  It talks about being patient centered then talks about all the things medicine needs to do, and nothing about the patient.  It’s patently dumb to continue to see the self-contradictory statements ‘highest quality care for the individual’ and ‘appropriate allocation of finite resources’  jammed together unironically.  As a physician my duty is to my patient, not some theoretical need of another patient or patients with the same or different concerns.  The idea individual docs will act paternalistically about the husbanding of resources while engaging in a true beneficent relationship with their patient makes no sense (thanks, mandatory ethics class).

You know what would be a cultural transformation? Cost transparency in medicine, linked to patients spending their own money on their care*. It’s irrelevant what an MRI costs if you’re not paying for it directly.  Think there wouldn’t be some competition in the marketplace then?  Of course, to do that you’d have to get the government and insurance companies out of the way, let doctor groups negotiate just like every other industry, etc.  There’s a culture change.

Free=more.  There is no Nirvana where people get everything they want for free that doesn’t cause shortages and skyrocketing costs.  There has to be some moderator on the continuous and enormous increase in healthcare spending, a point everyone agrees on.  In the current model prices are invisible, payment is unfathomably byzantine and not borne directly by the patient (unless you’re uncovered, then you’re really in a tough spot), so there’s little reason not to get another MRI, CT ‘just to be sure’, etc.  Prices spiral.

So, give us a market, get Uncle out of the way (mostly), and let people decide on their care based on a true cost/benefit ratio.  There’s a real cultural transformation.

* Yes, I am aware most people with health insurance pay through payroll deductions, and it can be a very very big number; yes, you are paying for your care but in a very inefficient way, paying monthly and probably not using care monthly.  Additionally, what you’re paying usually isn’t the entire cost your employer pays.

A belated congrats to Kevin, MD

Adding rungs on his ladder to the top with two different Op-Ed’s, one in USA Today and one in the NY Times.

Way to go, Dr. Pho!

Reglan now gets a Black Box.

News from The Associated Press
WASHINGTON (AP) — Federal health officials are adding their sternest warning to a heartburn drug that has been linked to muscle spasms.

The Food and Drug Administration said the drug, widely known as Reglan, has been shown to cause spasms and tics when used for long periods of time or at high doses. The problems include uncontrollable movement of the limbs, face and tongue, and are usually irreversible, even after patients stop taking the drug, according to the FDA’s warning.

The agency is requiring drugmakers to add a black box warning, the most serious type available, to their products.

I’ve said it before, but soon they’re going to have to make a replacement for the black box, which is now used not for life-threatening medication interactions, but now also for serious side-effects.  We need to know which is a killer right out of the box, and which has side-effects that the FDA wants to be sure we’re aware of.