Billy Beane, Newt Gingrich and John Kerry on Healthcare Reform

Billy Beane, Newt Gingrich and John Kerry say in an NY Times Op-Ed piece today that our healthcare system has a lot to learn from modern baseball. They state:

Remarkably, a doctor today can get more data on the starting third baseman on his fantasy baseball team than on the effectiveness of life-and-death medical procedures. Studies have shown that most health care is not based on clinical studies of what works best and what does not — be it a test, treatment, drug or technology. Instead, most care is based on informed opinion, personal observation or tradition.

They go on to say:

Similarly, a health care system that is driven by robust comparative clinical evidence will save lives and money. One success story is Cochrane Collaboration, a nonprofit group that evaluates medical research. Cochrane performs systematic, evidence-based reviews of medical literature. In 1992, a Cochrane review found that many women at risk of premature delivery were not getting corticosteroids, which improve the lung function of premature babies.

Even though this Op-Ed seems to be saying what we (HPfHR) are saying, there are several things that bother me.
The first is the statement that:

Studies have shown that most health care is not based on clinical studies of what works best and what does not — be it a test, treatment, drug or technology. Instead, most care is based on informed opinion, personal observation or tradition.

They give no reference for this, but I suspect that if there is literature on it, it is pretty old. As most healthcare professionals know, there has been a significant shift to evidenced based medicine over the last decade that has come from many sources, not just private groups like the Cochrane Collaboration or the Intermountain Healthcare Foundation. In fact most of the recent impetus has been physician driven and is increasingly more readily available for healthcare providers through publications of "Guidelines and Standards" or "Position" documents in major medical journals.
This brings up another thing that bothers me, namely that once again it is the politicians (and now baseball managers!) who are trying to tell the healthcare profession how to practice medicine! I think that we all would love to think that practicing medicine is similar to managing a baseball team. All we have to do is master some empirically derived formulas like "VORP (value over replacement player) or runs created — a number derived from the formula [(hits + walks) x total bases]/(at bats + walks)" and we can cure our patients and bring down costs!
Even though it seems absurd to healthcare professionals that all we need are a set of statistics and a good database system, this will be what is presented to the public by groups like the authors of this piece!
Finally, as to the statement:

Working closely with doctors, the federal government and the private sector should create a new institute for evidence-based medicine. This institute would conduct new studies and systematically review the existing medical literature to help inform our nation’s over-stretched medical providers. The government should also increase Medicare reimbursements and some liability protections for doctors who follow the recommended clinical best practices.

I think that although the "institute" sounds like our "Board" it has several significant problems. First is the involvement of the private sector. Although the private sector should have some representation on our "Board", I suspect that in this "institute", the private sector will hold too much sway and as usually occurs when the public and private sectors compete, costs will go up and efficiency will go down. Secondly this proposal will not work in the current system, since Medicare does not cover the entire population and the institute will have no control over spending.
Billy Newt and John, its a nice thought, but I think that you should let the healthcare professionals take control of this. We promise we won't tell you how to manage a baseball team! (BTW: How did the Oakland A's do this year? Was it 10/14 in the American League?)
Gil

Addendum: In the print addition of the piece, it states that the Intermountain Healthcare Foundation is part of Newt Gingrich's "Center for Health Transformation, a for-profit organization". So much for altruism...

The Presidential Candidates in JAMA

Tomorrow's issue of JAMA has statements from the two presidential candidates about their healthcare plans. In reading the two statements, I noticed two things. The first is that neither plan addresses exactly how it will improve outcomes (except to say that this needs to happen). The other thing is that both clearly feel that healthcare reform is needed. This is good news for our group.
When discussing his plan, McCain says:

We must find better ways to diagnose, manage, and—most importantly—prevent chronic conditions such as cancer, heart disease, high blood pressure, diabetes, and asthma. Many of these chronic conditions are linked to the epidemic of obesity in our country, which is growing at a particularly alarming rate among children. We must find innovative ways to draw on our public health infrastructure, invest in early intervention programs, and find new models to promote healthy habits and begin to roll back these troubling statistics.

He doesn't give any solutions but the very fact that he states that we should "find innovative ways to draw on our public health infrastructure", "invest in early intervention programs" and "find new models to promote healthy habits", is very encouraging that he will be receptive to our model.
Obama's plan does seem to have a bit more detail regarding how it may affect outcomes, but I think that there are some undiscussed assumptions about how well "Requiring disease management programs and integrated preventive care" and "Devoting more of our health care funds to prevention" will really work in the current system. As previously discussed, David Katz points out that even when preventive services are available, people generally do not take advantage of them unless one can build in a good incentive within the system. The HPfHR system's structure will allow for built in incentives (such as receiving Tier 2 coverage if one completes 80% of Tier 1 preventive care goals) without necessarily requiring a larger amount of funds.
So it seems that who ever wins this election, there does appear to be some role for our plan.
Gil

Paul Krugman wins the Nobel Prize!

Today's announcement that Paul Krugman won the Noble Prize in economics, I think, is a very good development for the chances of getting meaningful healthcare reform. Krugman is an outspoken advocate of single payer systems, and for publicly financed systems like Medicare over private insurance. Despite the fact that he won his prize in a completely unrelated field I think that his opinions now will have significantly greater weight than even last week (this seems to be true with many Nobel Prize winners).
Gil

Reading between the lines?

Although there has been a lull in this blog, it isn't that there is nothing going on in healthcare reform.
First, we have sent in our EMBRACE Healthcare Plan proposal to the Annals of Internal Medicine on Wednesday 10/1. This typically takes a few weeks for a response...
We have also heard a lot of mention of healthcare reform during the Presidential debates last week and the Vice-Presidential debates this week. One very interesting thing that Paul Krugman picked up was the source of Sarah Palin's reference to Ronald Regan in her closing remarks:

It was Ronald Reagan who said that freedom is always just one generation away from extinction. We don’t pass it to our children in the bloodstream; we have to fight for it and protect it, and then hand it to them so that they shall do the same, or we’re going to find ourselves spending our sunset years telling our children and our children’s children about a time in America, back in the day, when men and women were free.

It turns out that this was a recording he made for Operation Coffeecup — a campaign organized by the American Medical Association to block the passage of Medicare. Doctors’ wives were supposed to organize coffee klatches for patients, where they would play the Reagan recording, which declared that Medicare would lead us to totalitarianism. (you can hear the full recording here on mp3).
Even though Palin did not use it in conjunction with healthcare reform, it still is interesting (maybe ominous for healthcare reform as a whole) that this is still clearly in the "library" of those who may oppose government supported healthcare. This may be an indication of what we may be facing in promoting our plan.
Gil