There are at least two conversations going on in the health care marketplace today, each focused on one of two key questions. One is: How can we achieve the Triple Aim? The other is: Why do they get to do that? (It’s not fair! I want more!)
Until we stop asking the second question, we can’t answer the first question. Why? Because all too often the answer to the second question is the equivalent of: It’s OK, Timmy, I’ll buy you TWO lollipops; pick whichever ones you want.
It’s the tragedy of the commons, transposed to the health care marketplace.
Recent cases in point:
- Avastin
- Tufts Medical Center – Blue Cross Blue Shield of Massachusetts grudge match
- Mammography and PSA guidelines
1. Avastin. Late last year, the FDA yanked its breast cancer treatment approval for Avastin, based on a finding that it does not meet the “safe and effective” standard. CMS says it will still pay for the drug anyway, as will many commercial payors, based on physician judgment.
2. Tufts Medical Center – Blue Cross Blue Shield of Massachusetts. The contract negotiation (out in public view) focused, in part, on Tufts’ complaint that BCBSMA pays way more for health care services provided by another network, Partners Health Care, and that it should be compensated on the same scale. (Others have noticed this disparity too, and have found that higher payments were not accompanied by higher quality — see reports by Massachusetts state agencies.) In the context of the present discussion, we may wish to consider whether Partners should be paid less, rather than whether Tufts Medical Center should be paid more. This episode, according to some, will pave the way for more regulations.
