Not a Health Care Soundbite

Jerome Groopman, Chief of Experimental Medicine at Beth Israel Deaconess Medical Center in Boston and author of How Doctors Think has an interesting article online at The New York Review of Books website about how medical "best practices" might be included in government health care legislation and how that inclusion might play out in the decisions of doctors and their patients. Groopman provides two viewpoints of how "best practices" might be legislated in health care reform, one that uses the established best practices as a "nudge" to get doctors to choose governmentally-approved health decisions, another that more aggressively promotes these "best practices" by providing financial incentives or negative consequences. President Obama's friend and advisor, Cass Sunstein, favors the first (providing doctors with some leeway not to choose always the established "best practice" method in dealing with a patient's health issue) and Peter Orszag, another of Obama's advisors and director of the Office of Management and Budget, prefers the more strong-armed approach:

Doctors and hospitals that follow "best practices," as defined by government-approved standards, are to receive more money and favorable public assessments. Those who deviate from federal standards would suffer financial loss and would be designated as providers of poor care. In contrast [to the Senate bill], the House bill has explicit language repudiating such coercive measures and protecting the autonomy of the decisions of doctors and patients.

I didn't know much about this debate until I read Groopman's article this afternoon, and I was fascinated by Groopman's discussion of how established "best practices" sometimes turn out to be wrong or not the best health choice for certain individuals. Thus, there are problems with aggressively pushing doctors to choose the "best practice" standard at all times in all situations. This situation reminds me of the debate over mandatory-sentencing laws.  When judges do not have any discretion over sentencing criminals, serious injustice sometimes results, for instance, first-time drug offenders given long jail sentences when they could have been put on parole, provided with rehabilitation, and given the opportunity to change the course of their lives (and thus not cluttering up the prison system and costing the taxpayers huge amounts of money).

What really struck me was the anecdote of Groopman's personal contribution to a "best practice" standard that proved to be wrong. You just got to listen to folks who are willing to admit their mistakes.

Anyway, it's a long article, published in another one of those magazines that some people sneer at for being "elitist," and thus won't be part of any health care soundbite--but it's worth reading: Jerome Groopman, "Health Care: Who Knows 'Best'?," The New York Review of Books, February 11, 2010 edition.

Cozy, Cozy, Cozy

Matthew Yglesias links to a Frank Rich column today in The New York Times, in which Rich describes the lobbyists' cozying up to Democrats. Those of us who cheered--especially those of us who care a lot about health care reform--when Barack Obama promised in his inaugural address that under his leadership Washington would "do our business in the light of day" are cheering less these days as it seems as if business is being conducted as usual in Washington. Just a few highlights from the Rich column:

• Heather Podesta, the high-profile lobbyist for "health care players like Eli Lilly, HealthSouth and Cigna"? She is married to "Tony Podesta, the brother of John Podesta, the Clinton White House chief of staff who ran the Obama transition."
  
  
• How do these close connections to the White House work out for the lobbying duo? Tony's "business was up 57 percent from last year in the first six months of 2009. Heather Podesta’s was up 65 percent."
  
  
• During the last administration, the place to meet, greet, and influence was Jack Abramoff's restaurant Signatures. These days, it's Ristorante Tosca, where the likes of Heather Podesta (lobbying against health reform for big healthcare companies) and Steve Elmendorf (former chief of staff for Dick Gephart now lobbying for financial clients such as Citigroup and Goldman Sachs) meet their clients and government officials they hope to influence.
  
  
• "[I]n early August...the UnitedHealth Group and its fellow insurance giants had already quietly rounded up moderate Democrats in the House to block any public health care option that would compete with them for business." Those lobbyists whose clients include UnitedHealth Group? Steven Elmendorf (Elmendorf Strategies), Tom Daschle (ummm, not officially a lobbyist, but a "special policy advisor"...), and "a former chief of staff to Steny Hoyer, the House majority leader."
  
  
• Of course, the Republicans may be out of power, but they're just as easily influenced as those in power. Eric Cantor and John Boehner "are big recipients of UnitedHealth campaign cash." And, of course, there's John Ensign (R-Nevada), who used his connections to provide clients for his mistress's husband--a special category of lobbyist influence all of its own.

But then, we knew that...and those of us who voted for Barack Obama hoped that he would deliver on his promise. As Frank Rich says, "If the Olympic committee has the audacity to stand up to a lobbyist as powerful as the president of the United States, then surely the president of the United States can stand up to the powerful interests angling to defeat his promise of reform."

Quotations from Frank Rich's op-ed column, "The Rabbit Ragu Democrats," The New York Times, 3 October 2009.

See also: Thomas Franks' column in The Wall Street Journal, "Obama and the K Street Set," 30 September 2009.