Medco’s health reform debate

Last week PBM giant Medco hosted a discussion of health reform that was one of the better events I’ve encountered – better because the conversation was realistic, pointed, and quickly got into the reality of health care reform – it’s about cost.
Participants were David Snow, Medco CEO; Howard Dean, MD, Chan Wheeler of UnitedHealthGroup, and Ben Sasse, assistant professor of public policy at the University of Texas and a former U.S. assistant secretary of Health and Human Services during the Bush Administration.
Snow led off with a backgrounder on past health care reform efforts reaching back about a hundred years (perhaps I exaggerate). The key observation was fear is used by opponents to stop health care reform, to confuse consumers and grind it to a halt. Opponents of specific aspects of reform are focused on preserving and protecting their future, so they scare Americans so they choose to stay with what they have rather than risking the unknown. While this may seem obvious to some, it is important to remember what derailed reform in the past, as we will certainly see the same tactics used by opponents this time – and in fact, already are.
Snow did dwell on tort reform issues, as all big corporate execs do – to their detriment. For every misrepresented story of hot McDonald’s coffee there are dozens of med mal suits that never get filed. Medco has a solid business reputation, and the tort system is one of the few checks we have on companies like Purdue and Cephalon, companies that are in businesses closely related to Medco’s who damage the entire industry by their reprehensible conduct.
But I digress, if only a little. Snow did mention that there is a movement underway to use evidence based medicine as protection against lawsuits – if EBM guidelines are used appropriately then physicians would have some legal protections against med mal litigation.
Snow did a creditable job reviewing the history of past defeats of health care reform, noting the AMA was extremely effective in defeating pretty much every effort (with the notable exception of Medicare). And these guys have been very creative, becoming expert in employing grass roots efforts to stifle reform. Perhaps the most revealing was the AMA’s coffee cup campaign.
The coffee cup campaign was a very well financed effort by the AMA to defeat Medicare. Featuring a recording by none other than Ronald Reagan, the AMA rallied physicians’ wives (back then there were few female physicians) to support the AMA’s lobbying campaign. Snow pointed out, rather pointedly, that the AMA does a great job of not seeing the future; Medicare was anathema to physicians, yet Medicare has been a great boon to most physicians and other providers.

All panelists (and Snow) acknowledged that cost has not been addressed in any meaningful way in the reform discussions to date. Dean and Wheeler both agreed that their have been no substantive discussions of health cost control. Interestingly, it appeared to my ears that Dean came out against a single payer plan, saying it would not lead to the innovation and improvements that will help deal with cost and quality issues over long term. He forcefully argued for a public plan option, saying “If you don’t have a public plan [in the mix], you shouldn’t bother…”
I’m beginning to think he’s right.
Finally, one of the better lines I’ve heard came from one of the panelists, in referring to physicians, he described some as ‘partialists not specialists’.
A very accurate, and very useful, description.