Smorgasbord Anyone?

June 15, 2010

The recently passed “Patient Protection and Affordable Care Act” a/k/a “health care reform” is a monumental piece of legislation, both literally and figuratively. Despite its supposed intent to “reform” the health care system, however, it is quite tepid on reform and very aggressive on enhancing coverage.

The legislation contains a virtual smorgasbord of programs, directives, initiatives, instructions, orders, regulations, requirements, recommendations, exchanges, options, incentives, rewards, pilots, demonstration projects, commissions, task forces, centers, institutes, fees, grants, taxes, tax credits, and mandates. Unfortunately, very few of these components address, in any serious manner, what many clearly feel is the most critical problem of our current health care “non-system”: the ability to constrain the unrelenting and unsustainable increase in the cost of care.

For example, the chance to implement meaningful tort reform, substantially revise the provider reimbursement structure to reward value (quality) instead of productivity (quantity), improve end-of-life care, or link cost-effective analysis with coverage decisions was either relegated to small pilot programs (malpractice and reimbursement) or ultimately dismissed because of a lack of political courage (cost-effective coverage decisions and end-of-life care). The end result is that the legislation largely addresses coverage expansion and essentially ignores the underlying structural cost drivers. To put it more succinctly, the bill “dumps’ over 30 million newly insured members into a highly dysfunctional, inefficient, fragmented, and extremely costly health care non-system.

Notwithstanding the rhetoric of the bill’s partisan supporters that it will reduce health care costs (by “eliminating waste, fraud and abuse”!) and the federal deficit (by “bending the cost curve”!), the final result will inevitably be an acceleration and heightening of an already out-of-control cost issue. I would suggest that anyone who thinks otherwise probably needs an urgent head CT scan, immediate detoxification or an emergency psychiatric referral (or perhaps all three!). All of these services by the way will be readily available, at little or no cost and with little or no scrutiny, under a poorly designed, heavily regulated, quasi-government run, plan.

What is unfortunate about this situation is that our “leaders” had a real opportunity to truly “reform” (revolutionize?) the health care system but that chance is probably now lost. It is highly unlikely that any substantial or meaningful efforts or revisions along with these lines will be forthcoming in the near future. Instead, the focus will be on establishing the detailed rules and regulations that will govern the existing legislation. Attention will therefore be on the trees instead of the forest.

Smorgasbord sandwiches often taste good initially but when completely digested, the full effects become readily apparent. Under the circumstances, consulting your local gastroenterologist would seem to be a prudent next step.


Guest blogger Douglas R. Woll, M.D. recently retired from his position as senior vice president and chief medical officer for Blue Care Network of Michigan, the HMO subsidiary of Blue Cross Blue Shield of Michigan. Prior to joining the Blues in 1998, Woll spent almost a decade at SelectCare, where he served as senior vice president and chief medical officer. He served as a senior staff physician at Henry Ford Hospital from 1980 through 1989. Woll is certified by the American Board of Internal Medicine, and was elected a fellow of the American College of Physicians in 1998. He is involved with several professional organizations, including the Quality Committee of America’s Health Insurance Plans.