|WHAT WE’RE READING
Stuff we read this week that made us think.
Taking an end-of-career run at battling healthcare costs
NPR ran a terrific piece this week from ProPublica, a nonprofit investigative news service, telling the story of Marilyn Bartlett, the head of Montana’s state employee health plan. Bartlett came to the job a few years ago after roles at a Blues plan and a benefits management company, and brought a no-holds-barred approach to addressing rising the rising cost of care for Montana’s employees. Nearing the end of her career, Bartlett viewed the Montana job as an opportunity to take on some of the root causes of high spending, without worrying about upsetting entrenched interests. “I’m 67, so I could give a s***,” the piece quotes her as saying. “What are they going to do, fire me? I’m packin’ a Medicare card.” (Call it a Montana-style “Granny Oakley” approach.) Her strategy to address benefits costs had two components: a shift to reference-based pricing for hospital services, and an attempt to eliminate spreads and capture rebates from pharmacy benefit managers.
Her crusade to move the Montana plan to reference-based pricing, in which the state would agree to pay hospitals a take-it-or-leave-it price for high-cost services, led to several confrontations with hospital executives, industry lobbyists, and even representatives from Cigna, the state’s insurance partner. Along the way, Bartlett was met with resistance to opening up secret contracts between hospitals and insurers, restrictions on her ability to show lawmakers the range of prices charged by various providers, and even unwillingness on the part of Cigna to share information on care costs with the state, even though the insurer was only serving as a third-party administrator to the state’s self-funded insurance plan. In the end, Bartlett was able to push through her reforms, and saved the state of Montana millions of dollars annually on health spending. We hear a lot about high healthcare costs, and there are myriad problems causing inefficiency and waste across the system. The ProPublica-NPR piece does a particularly good job of lifting the curtain to show some of the complicated dynamics driving cost growth. Well worth a read, and worth sharing with those who may not be as deeply versed in the day-to-day of healthcare as you are.
China’s health system in crisis
If you’re feeling frustrated with the pace of reform in US healthcare, check out this outstanding New York Times article describing China’s healthcare crisis, which puts our challenges into perspective. The piece provides a detailed look at problems that both patients and doctors face in ensuring even basic healthcare access to China’s aging population of 1.2B people. Primary care was once a strength of the Chinese healthcare system. In the 1960s, Maoist reforms created an army of “Barefoot Doctors”, sent into rural communities with limited equipment after a brief training period. The Barefoot Doctors proved effective, cutting China’s infant mortality rate by more than 90 percent, and supporting a dramatic increase in life expectancy.
In the 1980s, cuts in funding reduced doctors’ pay. In a society where income is highly correlated with social status, many doctors sought specialist positions at hospitals—and became vulnerable to kickbacks from wealthy patients and businesses. These shifts led to a pervasive lack of primary care services. Many patients now seek care at hospitals for simple issues like sore throats and headaches. Crowded emergency rooms, long wait times and poor service have frustrated patients and physicians alike—and sparked frequent episodes of violence against doctors.
These issues, coupled with declining outcomes and worsening health status, have led the government to launch “Healthy China 2030”, the first long-term healthcare blueprint since the country’s founding in 1949. Making the bold promise to increase both innovation, access and health equity, the plan includes top-down reforms to bolster the number of primary care physicians (PCPs)—and requires all citizens to sign up with one by 2020. The government is promising that channeling access through PCPs will improve the average patient’s ability to reach prominent specialists—echoing the promises of many managed care experiments around the world. China’s current system shows the challenges of an unregulated healthcare market, where the rich pay large sums for preferred treatment and crowd out access for average consumers. For reform to work, the government must not only create new access channels and safeguards for patients, but also put some limits on wealthier consumers’ ability to buy-up large portions of the system’s capacity.
A new wave of politically-active doctors
Physicians have long been considered a politically conservative (and if we’re honest, pretty politically inactive) profession. This may be changing, as a recent Kaiser Health News article suggests, pointing to a growing number of younger physicians who are taking up liberal political causes—and using their profession as a platform for political activism. The article highlights how the move toward political organizing is beginning in medical school, profiling a conference that attracted over 150 students early on a Saturday morning to teach them how to amplify their voice and connect with patients on key issues—and how to avoid politically-charged terms like “socialism”, and forget “decrepit old physicians only worried about money” whose “minds will never change”.
There is growing evidence that that younger, left-leaning doctors are changing the political gestalt of the profession. Case in point: the American Medical Association (which has had concerns about attracting younger members) dropped its opposition to single-payer healthcare, vowing instead to “study” the issue. More doctors, especially women and younger physicians, are running for office. We find these moves intriguing but not surprising, given demographic shifts and changes in the organization of physician practice away from entrepreneurship toward group practice. Regardless of political leaning, doctors generate an enormous amount of admiration from their patients. This relationship and respect will help to amplify the voice of any physician who chooses to become politically active. Who knows? Perhaps doctors could someday give lawyers a run for their money as the “political profession”.