The Main Stream May be a Little Wider Than We Thought

I just attended a health policy session on addressing rising health care costs. The four speakers emphasized these points, in order:

• We need to better address not just patients with chronic disease, but those with complex and/or multiple chronic diseases. We need to provide the practitioners who care for such patients the time and resources do so well.
• One reason for ever rising health care costs is that the current system often very generously reimburses particular services, treatments, and tests without any evidence that the services do very much good for patients. Instead, we need to make reimbursement proportionate to the value (presumably benefits/ harms) patients accrue.
• Unfortunately, we do not often actually know what the benefits and harms of services, treatments and tests are for particular patients under realistic conditions, and do not know the relative value of different management options for particular kinds of patients. We need to promote methodologically sound comparative effectiveness research to figure out what these absolute and relative benefits and harms are.
• Finally, despite lip-service, we have not promoted simple preventative measures and a public health approach. Doing so would likely do good for patients at comparatively modest expense, and forestall the need for expensive acute services or management of chronic disease for some patients.

Such a health policy session might now be considered mainstream at some more cutting edge primary care oriented meetings, e.g., those of the Society of Medical Decision Making. We have addressed, at least obliquely, most of these points on Health Care Renewal. We addressed complexity here, but the issue certainly has been covered more eloquently on Medical Rants, e.g., here. We have also certainly covered the related issue of how primary care and generalist physicians, who are in the best position to address the management of complex and multiple chronic diseases, are being driven out of business by declining reimbursement for such work, e.g., here and here.

We have addressed particular instances of pricing, particularly drug pricing, that seems wildly disproportionate to the value of the drug, e.g., here and here.

Recently, we have addressed comparative effectiveness studies, focusing more on the questionable arguments used by some of their detractors, e.g., here.

But I did not hear these presentations at a primary care meeting. Instead, I heard them at the Aspen Health Forum, the first ever health policy oriented meeting run by the Aspen Institute. And the presenters were not grumpy bloggers, but, in order, Dan Crippen PhD, Former Director of the Congressional Budget Office, Peter Orszag PhD, Director of the Congressional Budget Office, Ezekiel Emanuel MD PhD, Director, Department of Bioethics, NIH, and last but not least, Bill Frist MD, former Senate Majority Leader.

Some of the issues we talk about on Health Care Renewal seem to be becoming more mainstream than we think (although comments by one of the speakers suggested that not everyone has been happy to hear them.)

Kudos to the Aspen Institute for providing a forum for some people who are willing to go beyond the conventional wisdom and think about the unpleasant truths that underlie our current health care dysfunction.