Newtown, CT – June 21, 2013
Myths die hard, but that doesn't stop them from being myths – Earlier this week the Wall Street Journal published a point/counterpoint on pay-for-performance. I argued for (I really argued against FFS), while Dr. Woolhandler argued against (she really argued against any change!!!). The response, which has been substantial, can broadly be split into two groups of unequal size. In one corner, representing over 80% of the responses, are the physicians. In the other corner are regular consumers. The consumers agreed that payment to physicians should be adjusted based on results, and many were infuriated by the market's opacity. One respondent stated: "In no other part of business are prices told afterwards. This is completely immoral, anti-market, and a large reason for high healthcare costs and personal bankruptcies. Licensing should be removed as well. Currently it is a way to become gentry, not to provide quality services. For example, once a doctor has a license they can talk about quackery and risk nothing." But again, this was the minority. The vocal majority's response can be summarized by this physician: "The "pro-pay-for-performance" argument essentially reduces patients to widgets, assuming that change in input (i.e. physician skill, competence, etc.) results in better change in output. What is not factored into this model is that certain cohorts of patients, namely the uneducated, lower class, etc. are notoriously non-compliant with prescribed medications or lifestyle choices. In addition there will be no meaningful reduction in health care costs until tort reform is done first. The battery of useless tests run are primarily there for CYA purposes to preempt malpractice litigation." Need I say more? Perhaps…
What this means to you – Facts are stronger than myths, and we need to proclaim them from the mountaintops. Working our way up, let's first address tort reform. The most recent CBO report to Congress estimates that enacting all the reforms proposed would reduce national health expenses by 0.5%…..that's a little off "meaningful reduction in health care" in my book. But please read the report and disseminate it because it clearly shows how out of touch many are on this topic. Let's next address the "notoriously non-compliant lower classes" and forget the incredibly insulting qualifier for a moment. Non-compliance is a problem and has been. It's also multi-factorial, especially in the more disadvantaged and disenfranchised areas of the country. But….the Camden Health Coalition has shown us that these patients aren't voluntarily selling their future short, and that solid pro-active patient management can reduce complications from non-compliance to close to zero. And they're not alone. The AF4Q community – Better Health Greater Cleveland – has shown repeatedly that the quality of care of all can be improved, even if some groups of patients, such as those on Medicaid, are tougher to manage. Not because they're willfully ignoring their physicians, rather the incentives are stacked up against them as much as they are against the physicians. Tort reform and non-compliance of patients are the agents of the status quo's exoneration, and however shameful it might be, we must recognize the enduring power of these myths and the desire to lay onto others the cause of one's own failures – recognize but not accept. In fact we must slay these myths by dispelling them at the top of our collective voices and remember that the vocal minority is, in fact, the silent majority, and it's getting madder and madder by the day.
Francois de Brantes
Health Care Incentives Improvement Institute, Inc.