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1. I think it is unfortunate, but very typical, that when a major industry like healthcare needs to undergo significant change, there is strong resistance from every quarter. The resistance can relate to everything from fear of change, potential loss of income (or even one’s job), loss of power, etc.
   My question for every interest group is the same one I’ve asked before — what’s your alternative? Lawyers, for example, oppose health courts as an alternative mechanism for resolving malpractice suits because it threatens their income, but they claim it deprives individuals of their “day in court.” Doctors don’t want rating systems because they are complex and imperfect. However, I think it is clear that equally competent doctors might vary widely in the number of tests they order because of a defensive medicine or CYA mentality. Or why does Medicare spend three times more per beneficiary in South Florida than in Minnesota? Surely, people in South Florida are not getting three times better care. I suspect that hospitals and other providers would raise ethical concerns about serious attempts to methodically limit end of life care based on QALY metrics or even resist efforts to significantly increase the number of people who execute living wills because all of that care that might be eliminated means reduced income and job opportunities for those who provide it. Insurers resist pricing transparency (for both patients and doctors), along with competition from AHP’s because they don’t want to have to compete on the basis of cost efficiency and quality customer service. Consumers don’t want to accept more responsibility for paying for routine care out of pocket because they prefer to have the employer continue to pay for it through comprehensive, tax advantaged health insurance. It’s no wonder the system is a mess and on the verge of meltdown.
   It’s time for each interest group to put up or shut up. We are all part of the problem. The good news is that there is a lot of brainpower in each of these groups. Why not use it to develop your contribution toward solving the problem rather than cling to the status quo and exacerbate the problem?

2. Very nice, Matthew. To make the House analogy stand out better the symptoms need to be gorier, all found in the same patient, and should be apparently contradictory. Put all this up front in the space of one paragraph, and put the wonky analysis further down, pyramid-style:
   Health insurers seem to have come down with a burning, bright-red rash that makes other people itch, coincident with a huge increase in appetite, and their traditional customers are doing what was traditionally done to rash-sufferers: shunning them. But this, perversely, spreads the disease even faster, and so the lepers have turned to some of the brightest diagnosticians around for help sorting through this complex of symptoms, and have finally begun to accept that their own behavior has caused the problem in the first place.
   … now do the wonky stuff.
   McGuire has $1.6B because he was allowed to time the option grants; this circumstance is not a kicker to it. All the same, United’s compensation committee should be hung for permitting it.
   It would be interesting to know how publication of either cost or of quality data by the payer side would every be percieved by the provider side as other than “heavy handed”. The newspaper story is pretty good, and makes the same prediction as did Dr. Hinson: the best rated docs will be swamped, and people will end up seeing the less-than-best rated docs anyway. The best thing I think will be for the docs themselves to address practice variation. But if they don’t (soon) someone else will, and it will not be pretty.
   t