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POLICY: Jonathan Weiner, pulling no punches on what’s wrong

Jonathan Weiner, Professor of Health Policy and Management at Johns Hopkins, tells it like it is in a great interview at Managed Care magazine. It’s so good I’ve extracted several real zingers. I particularly love the last one about “getting the government out of the way of the market.” Here’s a selection:

“Other developed countries have come to two realizations that we have not come to. One is that it is immoral — or at best, amoral — not to provide health care to everybody if we believe that basic health care is a sign of a developed country.”

“The second realization is that other countries acknowledge that the collective — social insurance programs like the sickness funds of Germany, government agencies, or third parties that look very much like our insurance or managed care companies — cannot provide everything for everybody.”

“When managed care plans, working mainly as agents for employers and government, tried to make some necessary changes and do the right thing, nobody would let them. We shot the messenger. We’re lousy at doing what’s necessary in our health care system. Tightly controlled managed care as envisioned in the ’90’s in the Clinton reform plan is not managed care today. I’m a big supporter of good forward-thinking managed care on the part of executives and clinicians, and I definitely support the appropriate role of the market and consumerism. But we can’t lose sight of population-based care and public policy issues that don’t come naturally to managed care organizations facing pressure every quarter to make a profit and keep investors happy.”

“Within a generation or two, we’ll see the positive side of health information technology. Health care will actually get more humane, with more human interaction and more communication, because the technical side of what doctors do now will be handled by the electronic box. Things like figuring out what tests should be ordered, what drugs should be used, looking at an EKG and comparing it to the evidence will all be done better by electronic systems, using algorithms developed by doctors at places like Cleveland Clinic and Johns Hopkins. Doctors will need to be communicators, facilitators, coordinators, and coaches. I believe that model will favor women doctors, because they happen to be better at those skills.”

“Every advanced HIT system I’ve studied — the British, Hong Kong, Kaiser Permanente, and Geisinger Health System in the U.S. — has a centralized rational entity that looks at the big picture and sees itself as being in this for the long haul.”

“Our health care system is the most expensive in the world by a factor of two, and the most inefficient probably by a factor of three. Yes, we pay our doctors and administrators more and patients who get care get a lot more, but a lot of the cost difference is due to waste. We need clinical research of the type funded by NIH, and we need more operational population-based research. The Agency for Health Care Research and Quality is terribly underfunded now, and once genomics come more fully on line, research into cost effectiveness will become even more important”

“I serve on the Medicare Coverage Advisory Committee, an academic group, and I can tell you that Medicare has nowhere close to the authority it needs. There’s a lot of good people at CMS trying to do a good job, but their hands are tied by legislation. In most cases, they are not allowed to look at cost-benefit issues.”

“Q: Who’s persuading Congress to maintain the status quo? WEINER: Device manufacturers, pharmaceutical companies, everybody and their mother. God bless Big Pharma for keeping the new technology coming out. We may all need it one day, but it doesn’t all work equally well, and it certainly isn’t all cost effective. We cannot as a society pay for everything for everybody. That is absolutely impossible and totally unethical as long as we have 18,000 people a year dying — the equivalent of fifty 747’s going down — because they lack health insurance. My tone and tune will change once we have basic health care for all. We are a rich country and we absolutely can afford it, as long as we operate within a budget.”

“When a young doctor or medical school dean tells me that in this country the market does what the market should do, and government should keep out of it, I tell them that’s fine, as long as they’re willing to return the million and a half dollars in federal and state subsidies for each doctor trained. A plastic surgeon practicing in the fanciest suburb in any city gets more of a subsidy than the family doctor practicing in an inner city or rural area, and that’s not right. Moreover, the plastic surgeon can make a half million dollars a year, while the inner city doctor is making a hundred thousand.”

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Tom LeithIrwin Tylerjamzomattjoe blow Recent comment authors
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Irwin Tyler
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Irwin Tyler

Tom, thanks for your comments. >”you are on your way to reproducing Alain Enthoven’s ideas.” Actually not but I have no problem combining and merging where the outcome is better than either alone. One difference we have is Enthoven envisions “large” groups as approaching 1 million. I think that is still too small. From what I have been able to learn of his approach, which may have recent changes I don’t know about, he still seems to accept “employer financing” and the continuation of government health programs. This still excludes people, places unequal burdens on companies, and complicates the financing… Read more »

Tom Leith
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Tom Leith

I think you have not told us: 1) How costs are to be kept in check, or 2) What exactly you think the competing insurers are competing to provide. “Coverage” is a non-answer. You are unrealistic about the need for subsidies. Medically-underserved areas are usually rural, and are avoided by physicians primarily on lifestyle grounds. I think you’re wrong to think that this will change under your proposal. I think there is no difference whatever between a government mandate to buy something and a tax. Therefore, the premiums could be paid to the competing insurers by the government with no… Read more »

Irwin Tyler
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Irwin Tyler

Everyone speaks of the need for health care reform, of rising health insurance costs and of the 46 million Americans uninsured. One major contributor to all of these problems is the way our health insurance industry functions. Let me illustrate the state of our health insurance “system” with the following analogy: You own a very competitive widget sales business. Every customer wants a slightly different widget. You accomodate many of these wishes by offering lots of variety and different pricing for each. Every customer wants a discount, which you provide based on a wide variety of characteristics of that customer,… Read more »

joe blow
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joe blow

He’s not a medical doctor, he’s a professor of “health policy” aka one of the middle men who adds no value to the system at all but would love to make money as a “consultant”

jamzo
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jamzo

he complaisn but he doctor is satisfied with the status quo the doctor is not an agent for change “Our health care system is the most expensive in the world by a factor of two, and the most inefficient probably by a factor of three” “Yes, we pay our doctors and administrators more and patients who get care get a lot more, but…” “God bless Big Pharma for keeping the new technology coming out” “My tone and tune will change once we have basic health care for all. We are a rich country and we absolutely can afford it, as… Read more »

matt
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matt

“The managed care industry could follow the lead of other countries and set up a not-for-profit research institute. It would be at arm’s length from health plans while representing their interests to academics and government. It would be guided by population-based principles of budgeting and benefits.”
But they won’t…and they’ll use Blue Health Intelligence for collective underwriting and marketing purposes.

matt
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matt

Of course there are no negative consequences arrising from having 40M+ uninsured Americans.
Aren’t the uninsured, in fact, the best example of people operating in a free-market healthcare system?

joe blow
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joe blow

That guy is an absolute liberal loon. HE’s an outsider who understands NOTHING about medicine trying to get his grubby fingers into the pie. He wants to be “in charge” of a new system so he can feel important. He obviously loves to make healthcare decisions for everybody else, because we’re “too stupid” to figure it out on our own.
God help us if he ever gets a real job in healthcare besides his ivory tower philosophy gig.
P.S. I want single payor socialized medicine, but that doenst change the fact that this “professor” is an idiot.

COD
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COD

Yes, 18,000 death certificates per year list cause of death as “No health insurance.”
No one – NO ONE – can be denied care at a medical facility. If they are, that is a crime.
I’m glad he wasn’t my professor.