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Perhaps his health ideas make too much sense
© St. Petersburg Times WASHINGTON -- John E. Wennberg would probably be a more successful physician if he had chosen to treat something other than the most insidious disease of them all: inertia. Wennberg, a scholar at Dartmouth Medical School, advocates a number of common sense reforms that would dramatically improve the nation's health care delivery system. And as a result, he's got many powerful politicians and physicians aligned against him. Recently, Wennberg published a study showing that while Medicare expenditures for health care vary widely in different parts of the country, there is little or no difference in the quality of the health care provided overall. In other words, seniors in Miami whose health care costs the government an average of $8,414 in 1996 were not any healthier than those in Minneapolis whose care cost an average of $3,431. The implications of this study are obvious. It suggests the government could save a lot of money -- without affecting care -- simply by trying to eliminate the regional variations in Medicare spending. "In theory," Wennberg wrote, "the savings (estimated at $40-billion a year) could be used to fund a prescription drug benefit without any increase in taxes or in elderly persons' premiums." Wennberg acknowledges that such a change might cause patients in high-costs regions to lose some nonessential services. But he notes: "Every region ultimately would gain . . . because the elderly would receive prescription drug benefits of great value to them and would lose medical services of little, or possibly negative, value." You would think that Wennberg's findings would be well received in Washington, where politicians claim to be working day and night to find a way to finance a prescription drug benefit for seniors. Instead, Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee, dismissed the idea as unworkable. "Policymakers are eager to experiment with new solutions to America's policy dilemmas, as long as these experiments do not disrupt the status quo in their own state or district," Baucus said. "Policy ideas must not only be backed by force of logic, they must also be politically viable." Likewise, Rep. Nancy Johnson, R-Conn., chairman of the House Ways and Means subcommittee on health, observed that doctors have long opposed any effort by Medicare to interfere with the practice of medicine. "Therefore," she added, "local practice patterns have evolved on their own with little intervention by the federal government." At the same time, both Baucus and Johnson recognized that Medicare would be much improved if the program could correct the problems underscored by Wennberg. Johnson noted that Medicare reimbursement is controlled by "a confusing web of detailed payment and regulatory policies that defies rationality and rarely reflects the true cost of delivering health care." Furthermore, she said the policymakers never have up-to-date data about the program. They are trying to set the level of hospital payments in 2003 using expenditure data from 1999. This is not the first time that Wennberg has assailed the status quo in an effort to improve health care. Nor is it the first time his ideas have been rejected out of hand in Washington. He is the originator of an initiative designed to allow patients to determine the course of their own treatment. His theory is that patients will make an informed choice if they understand options for treatment, along with the hardships and the likelihood of success for each option. But the American Medical Association is strongly opposed to this idea. He also argues that the regional variations in health care under Medicare are what make it so hard for the government to adequately compensate HMOs for providing services to the elderly under the program known as Medicare+ Choice. But the HMOs and the Bush administration ignore his analysis and instead insist on granting the HMOs higher compensation across the nation. Whenever I see health care interest groups rejecting common sense solutions such as Wennberg's, I am reminded of a cockamamie resolution that was adopted by the AMA's annual convention in 1994. In essence, it said that physicians who are unlawfully overpaid by Medicare should be permitted to keep the extra money. This is the kind of lazy, self-absorbed thinking that Wennberg is trying to overcome. -- Sara Fritz can be contacted by e-mail at fritz@sptimes.com or by telephone at (202) 237-3140.
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Times columns today Howard Troxler John Romano Sara Fritz Gary Shelton |
