SOME ROADS LEAD TO ROME

A recent post in the ACC News Digest recently proclaimed:

Berwick Says As Much As 30% Of Health Spending Is “Waste.”

The New York Times (12/4, Pear, Subscription Publication) reports that Donald Berwick, in an interview on his last day as head of the Centers for Medicare and Medicaid Services, said “20 percent to 30 percent of health spending is ‘waste’ that yields no benefit to patients, and that some of the needless spending is a result of onerous, archaic regulations enforced by his agency.” Berwick “listed five reasons for what he described as the ‘extremely high level of waste.’ They are overtreatment of patients, the failure to coordinate care, the administrative complexity of the healthcare system, burdensome rules and fraud.”

The Hill (12/5, Baker) reports in its “Healthwatch” blog, “Berwick came to the job with a passion for delivery-system reform, and in roughly 18 months as CMS administrator he oversaw an aggressive push to implement pieces of healthcare reform that matched his vision.” Sen. Tom Harkin (D-IA) remarked, “This is a missed opportunity to have someone who really understands the healthcare system, who understands quality of care rather than volume of care, which has been his hallmark. I’m just so sorry to see this end like this.”

The actual articles are brief and worth reading. Dr. Berwick, a pediatrician, and I have reached strikingly similar conclusions about the state of health care. The 20-30% number for waste  and the remark, “The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open,” will sound familiar to those who have read my past rants on he health care crisis. Despite our areas of agreement, I find it harder to swallow the premise that the massive, complex law we’ve dubbed “Obamacare” is the road to our salvation. Forgive me if I also gag on his view that “[t]he government, unlike many private health insurance plans, is working in the daylight. That’s a strength.” The same article quotes him as stating, “Government is more complex than I had realized. Government decisions result from the interactions of many internal stakeholders — different agencies and parts of government that, in many cases, have their own world views.”

We’re dealing with a complex, multifaceted issue involving many people and institutions with their own agendas and are trying to regulate it with a complex, multifaceted institution with many people and institutions with their own agendas. Toss in a large dollop of corruption in both pots, and we have a recipe for disaster. Unfortunately, as with the overarching economy, we need real change, fast, because we’ve kicked the can down the road for too long. But change of this magnitude, implemented incorrectly, may sink us faster. Are we doomed? Maybe. But a good start would be to examine all the pieces, as I’ve done when I began this journey over two years ago, and set realistic goals.

Yes, Dr. Berwick, we will be rationing care. We always have, poorly. Now we have to do it rationally.

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