Over at the New America Foundation’s New
Health Dialogue, Joanne Kenen, who covered Congress for more than a decade
before becoming a healthcare maven, reports that at least “one well-placed
Senate source is quite worried that this could be another knock-down drag it
out Bunningesque confirmation fight. After all the Republican talk about saving
Medicare,” Kenen writes, “we sure hope they don’t block the guy who can do it.”

Many
thanks to Kenen, who was supposed to be on vacation today, and was at home, “elbow
deep in matzoh balls and macaroons (home-made…hear that Ezra?),” while also tracking
down sources.

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Hannah
Fields, a med student at Mayo who has just begun blogging, offers a provocative essay
on medical care that “fits”—not the doctor’s beliefs or even objective medical
evidence, but “the patient’s reality.”

 She writes: “In the real world, we must use
different tools and ways of practicing medicine to determine the shared goal  with as much agreement as possible between
doctor and patient, and to find treatments that are within the capacity of the
patient and can be accomplished using the patient’s available resources.” http://minimallydisruptivemedicine.org/2010/03/26/hannah-fields-discusses-mdm/  (Many thanks to vmontori for calling my attention
to Hannah’s blog on twitter. http://twitter.com/vmontori

Hannah
calls this “minimally disruptive medicine”:

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The rumors that I wrote about Friday are, in fact, true. President Obama will name Dr. Donald Berwick, president of the Institute for Health Care Improvement (IHI), to run Medicare and Medicaid. Berwick, who is a professor of pediatrics and healthcare policy at the Harvard Medical School and a professor of health policy and management at the Harvard School of Public Health, will have to be confirmed by the Senate Finance Committee.

Just how tough will the confirmation hearing be? I’m not worried. Berwick can handle himself.

Granted, yesterday the New York Times called Berwick “iconoclastic,” i.e., someone who “smashes sacred religious images” or “attacks cherished beliefs.”   But most who know him describe him a “visionary” and a “healer,” a man able to survey the fragments of a broken health care system and imagine how they could be made whole.  He’s a revolutionary, but he doesn’t rattle cages. He’s not arrogant, and he’s not advocating a government takeover of U.S. healthcare.

Berwick stands at the center of a healthcare movement that would reform the system from within. In 2005, Modern Healthcare, a leading industry publication, named him the third most powerful person in American health care. In contrast to others on the list, Berwick is “not powerful because of the position he holds,” Boston surgeon Atul Gawande noted at the time.  (Former Secretary of Health and Human Services ranked no. 1, while Thomas Scully, the head of Medicare and Medicaid services captured the second slot.) “Berwick is powerful,” Gawande explained, “because of how he thinks.”

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A surprising number of Congressmen would acknowledge, privately, that in the past, legislators have meddled with Medicare reform, blocking Medicare’s best efforts to squeeze waste out of the system. When it comes to listening to appeals from powerful lobbyists, legislators just can’t help themselves. Lobbyists generally don’t like change– certainly not when the status quo is generating billions in profits.

At the same time, virtually everyone in Congress recognizes that we cannot afford the status quo. And most legislators do care about the public good. At the very least, they don’t want to see Medicare go under.  So they have chosen to tie their own hands. (This is the evidence that, in their heart of hearts, many Congressmen recognize that they themselves represent the major obstacle to reining in health care inflation.)

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Within the past hour  both New America Foundation’s Joanne Kenen and Wall Street Journal blog “Washington Wire” have reported the rumor—not yet confirmed—that President Obama has chosen Dr. Donald Berwick, the president and founder of the Institute for HealthCare Improvement (IHI) to become the new director of the Centers for Medicare and Medicaid (CMS).  Readers who have seen Money-Driven Medicine, the documentary based on my book will recognize Berwick’s name: he is one of the stars of the film.  (See clips of Berwick from the film, which is being distributed by California Newsreel here. )For more information on the film, go to www.moneydrivenmedicine.org.

Thursday, Inside Health Policy’s Brett Coughlin and Amy Lotven were the first to report the rumor : “According to several Washington sources . . . the White House has picked Harvard professor and pediatrician Donald Berwick to serve as CMS Administrator. A K Street source said that Berwick agreed to take the job ‘some time ago’ but only on the condition that health reform pass first. Although administration officials did not confirm the chatter, sources said that the announcement could come as soon as next week.” (via Politico Pulse)

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The following video segments are from the documentary Money Driven
Medicine , produced by Alex Gibney, directed by Andy Fredericks and based on Maggie's book. They and are presented courtesy of the film's distributor California Newsreel www.newsreel.org (The player uses Adobe Flash Player available here)

To view, click on the white arrow on the bottom of the screen

Is American Health Care the Best in the World?

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Those who oppose reform understand just how powerful this legislation is. They understand—better than many liberals—just what it means for a medical-industrial complex that has grown fat while profiting from runaway health- care inflation. Going forward, it will be much harder for lobbyists to block efforts to rein in health care spending. Conservatives understand the business of health care; they know just how much money is involved. And they know that while this bill will be good for patients, it will not be good for those who view medical care as a business.

Click on this link to hear a podcast that I recorded yesterday.

The figures are alarming: The cesarean rate in this country has increased 50% since 1996; hitting an all-time high of 32% of all deliveries. What could possibly be fueling this dramatic rise in surgery?

The latest figures come from a report released yesterday by the National Center for Health Statistics
and have added more fire to an already simmering debate over the increased use of cesarean sections. Cesarean deliveries carry greater risks for mothers and newborns; require longer recovery times and incur hospital costs that are almost double those for a vaginal delivery, according to the report.

In the past, some medical groups have attributed the rise in c-sections to factors like older mothers and an increase in multiple births. But the NCHS report found that the rate of c-sections rose in all age groups between 1996 and 2007; with women under age 25 experiencing a 57% increase in cesarean deliveries, the largest increase of all. Increases were found across the board in all racial and ethnic groups and at all gestational ages. And surprisingly, the rate of c-sections for single births increased substantially more than cesarean rates for multiple births.

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Appearing on CNN yesterday morning, Senator Orrin Hatch (R, Utah) groused about what he called the “Europeanization” of health care. Translated, that means that we have decided to take a more collective approach to survival. If you cannot afford health insurance, your fellow citizens will help you pay for it.

Hatch is correct: in 2014, a family of four earning $88,200 (or four times the federal poverty level) will get a subsidy to help buy insurance in the new Exchanges. $88,200 may sound like a fortune if you live in Idaho (where median income for a family of four is $58,000), but in Maryland, Massachusetts, Connecticut, and New Jersey, $88,200 is actually less than median income for a family of four. Even in New Hampshire, median income for a family of four is $87,396. (Half of all families of four earn less; half earn more. In other words, a family that size bringing home $88,200 in New Hampshire is smack dab in the middle of the pack.)  See this fascinating table that shows median income for individuals as well as families including of two to six people in all fifty states. It’s startling to see how widely incomes vary in different parts of the country.

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Writing on the New Yorker’s “News Desk” today, Boston surgeon Atul Gawande laid out the challenge that health care reform poses for hospital administrators, physicians, nurses and every other professional in our health care system. (By professionals, I mean people who realize that they must put the interests of a sick person ahead of their own interests. I have met pharmacists, lab workers, home health care workers and many others who take this responsibility seriously. In many cases, this is why they chose the job.)

Gawande writes: “What made the passage of health reform historic is that, after almost a century of effort to reverse this, hope has arrived.

“We as a nation—and in particular those of us in medicine—now have work to do to defend and deliver on this promise and to address the legitimate concerns about costs while making health care better for everyone. But that is the remarkable thing. We have finally been given the work to do.”

Yes, this legislation gives medical professionals an opportunity to take the power back from the for-profit corporations that now, to a very large degree, run health care in this country. Today, even nonprofit insurers and hospitals are affected by for-profits. They must compete with them, and thus, in many cases, they have begun to imitate them.

But health care professionals can help only if they understand that reform is all about rewarding  patient-centered, evidence-based medicine. Medicine should not be profit-driven. Those who think of medicine as a “business,” like any other, will be out of luck.