Change is inevitable, struggling with change is optional

When I experience the ideological resistance and the nit-picking dogging the creators of the Health Care Reform Act, such as what I just read in an e-newsletter put out by a big-4 accounting firm, it reminds me of what I read in the mid-1990's in the Rockland Journal News.  At the time, I had two children in the Clarkstown Central School District, in Rockland County, New York, so this particular local news item caught my eye.  A reporter for the Rockland Journal News had asked a Clarkstown teacher, who happened to be heavily involved in the New York State Teacher's Union, how the District was incorporating new computer technology into classroom curriculum.  The teacher's/union rep's response?  "We tried that in the '60s and it didn't work."  The article made no mention of the District's attempt to overcome the computer hurdles/union resistance experienced 30 years' before.  So I guess one could conclude that in the face of the most incredible technological breakthroughs in the history of mankind, the vaunted Clarkstown Central School District chose to sit this one out.  And the students suffered for it.

You see, the problem is that maintaining the status quo is very costly.  And when the spread widens between the status quo and what-great-things-are-possible-if-things-changed, those touting the virtues of status quo sound awfully foolish.  The more they talk, the more likely the dreaded change, because their position ultimately becomes indefensible even with a little bit of logical, sensible thinking.  More importantly, their talk unwittingly destroys what little credibility the status quo has left.

This big-4 Health Care Reform Act piece serves as a great example of status quo promotion, which usually depends on narrow thinking and twisted logic.  This is no exception.

"Arguably, the most contentious feature of health reform is the notion that access to diagnostic tests, surgery, medications and self-care treatments will be guided through other than a physician recommendation. For more than 100 years, the U.S. system has operated on a simple assumption-- a physician’s judgment supersedes all others in determining what’s best for patients. In the heat of the reform debate, the American Medical Association’s (AMA’s) theme was “nothing between the doctor and me”, reinforcing its strong belief that physicians alone should determine treatment options for patients."
 
The above big-4 e-newsletter text is in response to the launching of the Patient Centered Outcome Research Institute (PCORI), which is one of the features of the Health Care Reform Act.  Per ACA Section 6301, PCORI is an independent non-government organization created to help patients, clinicians, purchasers, and policy makers 'make better informed health decisions' by commissioning clinical research and providing mechanisms so consumers can understand treatment choices based on evidence.  It is governed by a 21-person board—19 appointed by the Government Accounting Office (GAO) to six-year terms starting September 23, 2010 plus the Directors of the Agency for Health Care Research and Quality (AHRQ) and the National Institutes of Health (NIH). In addition, a 15-person Methodology Committee will advise about methods whereby traditional and non-traditional studies of diagnostics and therapeutics will be considered.

Now, some logic might make sense here notwithstanding this big-4's political agenda, of which I am not terribly clear at this point.  (It was much easier for me to figure out why the teacher/union official would fight off PCs since PCs don't pay union dues.)  But putting the motivation for this status quo argument to the side for a moment, we would like to add:

• The person heading up the PCORI, Joe Selby, is an MD (it would seem that he would consider things from a physician's viewpoint since that is his training and ongoing orientation).
• Joe Selby works for Kaiser (sounds like business as usual -- what is this big-4 accounting firm so worried about?)
• Physicians routinely abuse reimbursement for unnecessary tests; this is costing Medicare (not to mention private insurance plans) billions of dollars every year; yes, physicians are 'professionals,' as the article puts it, but they are also business people, if you squeeze them on the fee end, they'll make up for it on the testing end -- does this help explain why there is a PCORI?
• Now, let's look at the structure of the PCORI; this alone would not allow anyone to take this government body seriously; when was the last time you got 21 people to agree on anything?  Oh, and just in case they are on the verge of some form of consensus, we've got a 15-person advisory group to make sure there is always a fresh wrench to throw into the works.
• If the PCORI has any impact, it will be to help build the "evidence-based" brand; the e-newsletter refutes its own points by statistically pointing out how physicians routinely ignore evidence and go with hunches; this is very costly and, in fact, deadly so any impact PCORI can have on promulgating evidence-based medical methodologies might not be such a bad idea.  Whether or not this quasi-government entity (see above bullet) helps advance the evidence-base cause remains to be seen, although we are skeptical given its construct.

At this point, everyone agrees that our medical system is breaking down (e.g., critical shortage of physicians, huge Medicare shortfalls down the road, Medicaid cuts at the State level), so any flagrant status quo arguments are practically self-dismissive.

At tPF, we support intelligent thinking -- grounded in reality.  Unfortunately, for all too many parties, logic and intelligent thinking are pushed to the side in the spirit of self-preservation within the constraints of the current status quo.  As far as we are concerned, the only constraints are poorly shrouded political agendas and bloated government committees.