• The right solution for the ‘population’ may be the wrong solution for the ‘individual’

    Posted over 5 years ago
    by pnblog}

    This week's question for the Washington Post Health Care Rx blog was:

     

    What does the debate over mammography screening teach us about the challenges in moving to evidence-based medicine in a revamped health system?

     

    The debate truly highlights how much work is yet to be done to build a health-delivery system that generates enough accurate data so that we can truly 'know' the evidence! More importantly, however, it underscores two fundamental issues impacting broader health care reform:

     

    1.   The USPSTF made a recommendation for an 'overall population' vs. an 'individual' choice for a doctor and patient. The funny thing about statistics is that they're about percentage risks for a population, but individuals have different genetic profiles/risks, and attitudes and priorities around health. There is no one right answer for everyone. If the health sector were more market-oriented like other industries (people have different 401k investment plans, different savings rates and the like) and not driven by health insurance companies or the government making determinations about what is 'right', consumers would explore the information available and make their own choices with their physicians.

     

    2.   Insurance should address catastrophic events, not every day expenses. Yet people expect insurance to cover every doctor's visit, test and treatment, which is economically inefficient and establishes the wrong incentives for providers and consumers. People should pay for routine care -- doctor's visits, mammograms, routine medicines -- and only tap into health insurance when they need to cover major, unpredictable issues. If people were in charge of paying themselves, they would be more engaged in their health and understand how their choices impact themselves and others. Differentiating major medical coverage from full health coverage would reduce the incentive for some to over-consume health resources. This would enable more innovation in insurance and health delivery and make health care more affordable for all.

     

    Evidence-based medicine is the 'brass ring' for health-care reform. Medicine is going to continue to evolve and improve, and we need the right system in place to ensure that individuals have the information they need to make informed choices about their care to drive the best outcomes for their health.

  • Health Reform -- Fixing the Core Problem or Just Symptoms?

    Posted over 5 years ago
    by pnblog}

    The health reform debate has passed another milestone, but the question I keep getting asked by friends and family is whether the proposed legislation will actually improve our health delivery system.  I want to be optimistic, but I’m skeptical that the kind of comprehensive change we need to truly reform the system will happen.  

    As I talk to so many folks across the country (and around the world), I find that most agree on one thing -- our current system is ‘broken’, and it can and should get better.  But when it comes to getting to a deeper understanding and discussion of the details -- the core problems, the choices for change, the costs and impact of these changes, and so on, folks just aren’t getting a very clear picture from the MSM.  Often what’s highlighted is the political drama versus the real issues, the real story.  

    I don’t claim to fully understand the actual legislation or even to comprehend the hysterical politics that seem to surround the conversation.  But I do know that the central question people want and need answered is HOW to make the system better.  As a business guy, when I try to solve a problem, I focus on understanding the ‘root cause’ to make sure I’m fixing the core problem and not just a symptom or secondary effect.  And I think we’ve got to do the same when it comes to solving ‘health’.

    Everyone (citizens and politicians) wants more and better ‘health’ -- a better health delivery system, more prevention, more therapies to cure complex diseases like cancer, more and better doctors and the like.   And we all recognize that more ‘health’ is not free.  The current system has lots of waste and inefficiencies.  If we could figure out how to remove these from the system, we would get more ‘health’ for the same amount of money.  This is clearly very hard, from both a legislative perspective (why neither bill really tackles it) and from a practical implementation perspective.  But it needs to be done, and after we get it done, we then have to figure out how to invest the dollars to provide more ‘health’.  Alas, more health insurance does not necessarily turn into more ‘health’.

    Practially, there are several fundamental questions we need to answer.  First and foremost, what framework or system of rules, incentives, relationships, markets etc. will lead to more ‘health’ for Americans over time?   Should we as a society, provide healthcare (unlimited?) to all citizens?  And then, how should we finance this new economic liability?  What role do individuals play in being responsible for their own health -- in terms of paying for it, being accountable for healthy or risky behaviors and consuming health delivery resources? 

    It is hard to be a market oriented capitalist today, particularly in the health debate.  Everyone loves to hate the insurance profiteers, the bad drug companies and the greedy medical device companies.  The public seems to easily forget that economic growth and the principles that support economic growth are the reasons that we can even have a conversation about providing subsidies for the less fortunate.  

    Ten years from today, we could have a society with a GDP of $16 trillion or one of say $17 trillion (the actual numbers don’t matter).  In the scenario of higher economic growth, where society has created $1 trillion more dollars of GDP, we could make a choice to consume/finance more ‘health’ than if we were to have a smaller GDP.  Given the inevitable pressures on the health care system -- an increasing proportion of the population over 50 and people living longer -- as a society we know we would like to be able to afford more ‘health’ not less.  Just raising taxes alone without creating more wealth might patch things in the short run but not in the long run.  One illustrative example is the Medicare system -- which is projected to go bankrupt in a few years, even after increasing taxes to support it.  There are really only three approaches to preventing it from going bankrupt;  cut benefits, grow GDP faster, and improve value (more ‘health’ for the same dollars). 

    To have a meaningful debate about ‘health reform’, we’ve got to consider  the overall context of the principles leading to economic growth and the core questions raised about rules, roles and incentives in the health delivery system.   Creating substantive legislation in a democracy is messy.   But for a democracy to thrive, it needs an informed and engaged public, a transparent legislative process and stakeholders who are willing and able to advocate without fear of being penalized.     

    From what I can read and learn -- in this critical debate and time – it seems like we may be failing in all three areas.    

  • The Top Ten Medical Advances of the Decade. What’s Wrong with the Picture?

    Posted over 5 years ago
    by pnblog}

    Sometimes it’s fun to peruse year-end lists—best shows, best moments, best  songs, best presidential gaffes, best viral videos, and the list goes on….  which gets even longer with the end of decade or the century.   

     

    In this spirit, ABC News just ran a story about the ‘top ten’ medical advances of the decade, which I found very interesting.  They reached out to more than 800 specialists for their suggestions, and  those suggestions were sent to the American Association for the History of Medicine,  which narrowed down the list to the medical advances this decade that have had the MOST IMPACT.

     

    Here they are:

    1.     Human Genome Discoveries Reach the Bedside

    2.     Doctors and Patients Harness Information Technology (moving away from pad and paper)

    3.     Anti-Smoking Laws and Campaigns Reduce Public Smoking

    4.     Heart Disease Deaths Drop by 40 Percent

    5.     Stem Cell Research:  Laboratory Breakthroughs and Some Clinical Advances

    6.     Targeted Therapies for Cancer Expand with New Drugs

    7.     Combination Drug Therapy Extends HIV Survival

    8.     Minimally Invasive Techniques Revolutionize Surgery

    9.     Study Finds Heart, Cancer Risk with Hormone Replacement Therapy

    10.  Scientists Peer Into Mind with Functional MRI

     

    The list is a great reminder about how big an impact knowledge can have in improving life – sometimes through science, sometimes through changes in policy and sometimes through applications of technology.   From the perspective of other industries or aspects of life, it’s hard to believe that doctors and patients harnessing the power of Information Technology—moving away from pad and paper—makes the top ten list.  It’s pretty ironic with all the amazing medical advances that our health delivery system is so far behind….but it really highlights just how much opportunity there is for us to improve it.

     

    It’s my first wish for the new year that #2 isn’t on the list in the next decade – that we see something about the impact of information technology on the whole system—in the form of improved health outcomes and efficiency gains.   My second wish is that we continue to see dramatic innovation in knowledge (science, technology, policy) improving life here and in the rest of the world.