Health Care Basics

As a nurse, I listened to one of the round tables at the president's health care summit on C-SPAN radio and his roundup Q&A. I am still amazed at how much he "gets it" and I do hope that as the economy continues into the crapper that the demand for action will be greater than the special interests' ability to stop it in its tracks. I see three key pushbacks.

1. Comparative effectiveness research. Also called evidence-based care, this approach essentially means that we should be prescribing medications and doing procedures that are supported by research. Quality report cards, like this one from Medicare for different aspects of hospital care, audit medical records to see what percent of patients with a given diagnosis get the treatment research says is most effective. The problem? Lots of this research is funded by big Pharma, with growing evidence that results are biased in favor of the funding group. Generic drugs are not studied because there is no company with enough of a financial interest in the outcome to fund the research. The Agency for Healthcare Research and Quality does what it can with limited federal funds.

2. Malpractice. Without getting into this whole ball of wax, if payment is going to be tied to research-based care, healthcare providers will need some sort of insulation from liability when following research-based recommendations, without having to defend their practices in a costly lawsuit. Malpractice insurers will continue to raise rates as their investments lose money, doctors will continue to practice defensive medicine and the attorneys will continue to get rich. Maybe we should all just go to law school. They seem to be the only winners in this mess.

3. Insurance. In just one example, Medicare Advantage plans, administered by insurance companies, cost the government 13% more than traditional Medicare. Paying that extra layer of bureaucracy to "manage" patients' care didn't save money after all, and just made health care for seniors that much more complex. Hopefully, these plans will go away if President Obama has anything to say about it. And, being from the insurance capital, we know how hard this industry will fight any efforts to reduce their influence.

Unless these key issues are tackled up front, healthcare reform doesn't have a chance. Let's hope the folks invited to the White House are ready for pushing back against these special interests -- and push back hard.

How do you think these issues should be solved? While you're thinking about that, here is a report from a CT group that participated in the Obama health care community discussion. The full report is here.