Thanks to NewsLanc for bringing to my attention this very well-written piece by Dr. Arnold Relman, the former editor-in-chief of the New England, one of the most prestigious medical periodicals in the United States. The piece appeared in the New York Review of Books last October but makes compelling reading today for anyone interested in the growing health reform controversy. I have had the pleasure of hearing Dr. relman speak in person and know he is worth hearing.
The piece may be rather detailed for the casual reader, but everything he says makes good sense. He notes that the Affordable Care Act of 2009 did not squarely address rising costs and that it seems unlikely the current administration will do anything more, given the bitter opposition from Republicans, pledged to roll it back either legislatively or judicially. At the same time, he notes that the GOP plan advanced by Rep. Paul Ryan does nothing to control costs either, merely transferring future increases onto the back of consumers, particularly the elderly.
Dr. Relman goes on to describe the trend towards more specialty and multi-specialty group practices in the US. He says why this trend is growing and sees an opportunity there to revise the way government and insurance companies pay for medical services and bring down costs. The change would spring from a move away from fee-for-service, which rewards redundancy, unnecessary treatment and testing towards pay-for-performance methodologies. He speaks about how multi-specialty groups like the Mayo and Cleveland Clinics are addressing compensation. He details what a few states like Vermont are doing to try to wrestle down medical costs without simply passing the growing cost on to the patient or insurance subscriber.
I am less convinced than Dr. Relman that the trend to group practice has progressed to the point where this could be a nationwide solution. But like him, I do agree that there seems little prospect of genuine work on the costs crisis coming from either party. So proposals need to come from public sources. Thoughtful concerned parties must become vocal to keep the forces of reform alive. Those who would thwart change have been well-financed, and relentless in protecting their turf.
Certainly private insurance companies who have spend millions lobbying against reform would oppose what Relman proposes. I suspect sub-specialists will not like it either. But love it or hate it, this is a thoughtful piece by a respected expert writing about the cost problem at the heart of current crisis in American Health Care.
