Friday, December 5, 2008

Health Care and the National Health Czar

The majority of Americans in the post-election era of 2008 who are still in the honeymoon phase of the president-elect relationship are practically giddy over the new administration and its desire to "change" our political landscape. In an attempt to satisfy the Democratic masses yearning for universal health care, Mr. Obama will likely name a health care czar to overseeing the dismantling of the free market health system for a single payor type arrangement--essentially allowing the US government to determine what doctors you will see and whether or not you are eligible to receive medical care.

Sound harsh? Government mandated health care is definitely on the agenda for the new administration. How it shakes out will be worth serious consideration by not only the medical community including doctors, hospitals, specialty clinics, labs and all other health care providers, but also both Democrats and Republicans at the federal level of government and all Americans who have a stake in the decision.

Whether you agree with the government making such decisions for its citizens or not (and such rationing is routine in European government-controlled health care systems), the decision about government rationing of granny's health care should occur out in public, not hidden away from the public in this legislation. According to, the Democratic Congress and President Obama have disgraced themselves in their desire to ram through major changes to health care. As the American people discover how vicious and ruthless their new "nanny" health care system would be in rationing care, they will punish those who caused and enabled this.

President Obama says this person will keep a close eye on the healthcare industry according to NBC News. He will be monitoring treatments to make sure doctors are doing what the federal government defines as appropriate and cost effective. The system that the Czar will head, will consist of a health care network that will be able to electronically transmit patient records in an effort to reduce medical errors. The plan will also enforce national guidelines for doctors, nurses, and other medical personnel. Hospitals and doctors that don't follow the new system will face penalties.

One of the potential models that has been floated is to create a board, similar to the Federal Reserve, that will oversee national health care according to Investor's Business Daily (IBD). The entity would be like the United Kingdom's National Institute for Health and Clinical Evaluation, or NICE, which is "the single entity responsible for providing guidance on the use of new and existing drugs, treatments, and procedures." NICE doesn't simply tap the expertise of professional bodies but also weighs "economic evidence — how well the medicine or treatment works in relation to how much it costs." would compare drugs and treatments, then use the federal government's enormous buying power (Medicare, Medicaid, VA) and influence (published reports and public statements) to push the rest of us along. "In choosing what it will cover and how much it will pay, the US version could steer providers to the services that are the most clinically valuable and cost effective, and dissuade them from wasting time and money on those that are neither." They even suggest that the board would recommend to the NIH and NIMH what to fund.

There are problems with this model according to IBD. For one, it goes beyond the role of the Fed, which effectively sets just one price. It also goes well beyond the role of any equivalent health body across the Western world. For the most part, NICE looks at the funding of new drugs and devices — generating incredible controversy and criticism. A health superboard is so bold as to be impractical. Can a government body really measure the "value" of every health service performed in the United States? Can it judge what's good care, right down to the level of the clinician and his prescription pad? There's some precedence for this: Medicare, which has an endlessly complex pricing system, attempts to attach a dollar figure to 9,000-plus services — winning bipartisan criticism, since it badly overpays certain services (cardiac surgeries, for example) and underpays others (like ER care). Medicare also has spectacular inconsistency, paying twice as much for a Florida man as his Minneapolis cousin, with no difference in health outcomes — a testament to the limitations of central pricing.

According to IBD, that's not an attack on the fundamental ideas of weighing in on issues of quality and appropriateness and empowering people to make better choices for their health care. Americans need not look to Britain for inspiration; in most of the economy, the market works, giving us information. Because of archaic pricing and regulatory hurdles, a government hand would be needed to improve health care transparency. The US can find good ideas in the work already done by the Bush White House. Also, the American system can push further: releasing more Medicare and Medicaid data and standardizing electronic medical records. The former will shed light on billions of dollars of health spending; the latter will allow us to better study health outcomes. Together, these steps, not bureaucrats, will help Americans make better decisions.

A health care czar may sound like a good idea in theory, but in practice the work could be done with a new HHS Secretary that had valuable, seasoned, respectable experience in the health care industry and a staff that had a mandate to push for better quality of care, more effective record keeping, and hands off government control of medical providers.

Until next time. Let me know what you think.

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