Monday, November 16, 2009

How the critics' lies are making it harder to control health care costs

An op-ed by Rep. Earl Blumenauer (D-OR) in yesterday's New York Times is a "must read" account for anyone who wants to understand why the health care reform bills don't do more to control health care costs. He writes about how an eminently sensible, modest (and bipartisan!) provision to reimburse physicians for discussing advance directives with their patients became fodder for critics who willfully distorted the proposal as creating "death panels" that would pull the plug on grandma.

One of the principal villains in Rep. Blumenauer's story is Betsy McCaughey, former Lieutenant Governor of New York, now with the Hudson Institute, who first made the claim that "would make it mandatory, absolutely require, that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner." Her statement was immediately disproven by respected and independent fact-checking organizations, including the Pulitzer-prize winning and, but this didn't stop her lie from becoming a staple of the attacks on the bill.

McCaughey is at it again: in a November 7 Wall Street Journal op-ed she makes so many false or misleading claims about H.R. 3962 that it is almost impossible to keep up with them all, but one is of particular concern to ACP. Citing a provision that would fund Medicare pilots of the patient-centered medical home, she opines that "the medical home is this decade's version of HMO-restrictions on care." She never bothered to check with ACP, the American Academy of Family Physicians, the American Academy of Pediatrics, the American Osteopathic Association - the four organizations who authored the joint principles on the medical home, and who have called for the health reform bills to include expanded testing of the model - before making this ill-informed and misleading claim.

Blumenauer's account explains why the willingness of some critics to say anything to scare the public - what is more scary than putting old people to death? - is denying the American people a serious debate about how best to control health care costs. Many of the critics like to have it both ways: decry the lack of cost controls in the bill, and then do everything possible to undermine public backing when ideas are proposed to lower costs. Even ideas that the medical profession itself has championed and that have had strong bipartisan support in Congress - advance directives, care coordination in a medical home, and research on comparative effectiveness - become branded as government rationing.

It shouldn't be surprising then that the health reform bills don't do enough to control costs, but that they do so much, despite the attacks and falsehoods. John Iglehart writes in the New England Journal of Medicine that "the bills contain no shortage of ideas for reforming the delivery system, enhancing the quality of care, and slowing spending. Pretty much every proposed innovation found in the health policy literature these days is encapsulated in the measures."

Could the bills do more to control costs? Sure, but I don't see that happening as long as the Betsy McCaughey's of the world - and politicians who echo them - are willing to make truth a casualty in their battle to stop the health reform bills from becoming law.

Today's question: What is your reaction to Rep. Blumenauer's story and what it bodes for health reform?


Jay Larson MD said...

Liked Rep. Earl Blumenauer's op-ed.

In regards to Betsy McCaughey, et al....
"You can't fix stupid" Ron White

Robert J. Sobel, M.D. said...

I do think it is fair to critique the introduction of quality measures as anything but further dilution of effort and time from patient focus. Caring for modern humans is not reducible to a cookbook format. The idea of carving out each legitimate concern and including them in legislation should be challenged. In this case, I am quite pleased with the AMA's updated comments. I still don't see how independent practice is served by a medical home bureaucracy. Pay me fair for my service. Let's tone down the quality over quantity rhetoric before we institute more barriers to care focused on the patient.

OmTatSat said...

"Where angels fear to tread..."
(McCaughey finds an opportunity)