July 13, 2009

Relman Says Current Versions of Health Care Reform Won't Work

Update 8/8 -- Dr. Relman offers more perspective and ideas.

Former editor-in-chief of the New England Journal of Medicine and retired Professor Emeritus of Medicine at Harvard Medical School M.D. Arnold Relman says President Obama's health care plan won't work (NPR, Talk of the Nation).

Why won't the current (7/10/09), leading reform plans in Congress work?
Relman: "...if the bill gets passed that [Obama] wants, a lot more people will have health insurance. The basic problem with the health care system is not going to be resolved [under this plan]. In fact, it will probably get even worse. The basic problem is that we can't afford the rising cost of health care. It's breaking the bank. It's breaking in the private economy, and in the public sector. There's nothing in the bills that are winding their way through Congress now [7/10/09] that effectively controls health cost inflation."

Congress needs to pay attention to all the people saying this.

"What the President is asking for isn't enough. What we have to have is a reform not only of health insurance, but of the health care delivery system, because that is where the basic problem lies. The delivery system is inefficient, expensive, wasteful, and it has the wrong incentives. It's become a business, and as a business it wants to constantly increase its sales, and until we change that, we're not going to have real health care reform."


"[Medicare] is going broke.... A federal plan is not going to help unless and until we change the way we provide health care."

You just can't get more clear than that. Dr. Relman then lays out his good way to structure health care delivery. It's based on working systems here and overseas -- things proven by experience to work well. We could do very well for instance to use changes Dr. Relman recommends. Any real reform that controls cost inflation is better than any reform that doesn't. (For specific reforms, see my own summary of months of sifting the best ideas here.) Instead of transcribing the entire interview, of about 10 minutes, I suggest everyone listen for themselves.

But one more piece I just have to transcribe:

"...[we could] get excellent medical care at [as much as] 40% less than what we spend now. More than enough savings to cover everybody. Our problem is not that we can't afford good health care. We're spending plenty of money now. Our problem is that we have a terrible system."

This makes sense. The U.S. spends about twice as much per capita as France, which has the world's top rated system.

A New York Review of Books review piece by Dr. Relman is here.

Now, Congress and the Administration, read, listen, and live up to this moment.

If you can't go 100% of the way to Relman's pragmatic good ideas, at least do something real. Make Mayo Clinic-type organizations easier to spread. Incentivize. Do something real. Actual. Something that works. Use a good alternative, anything, just something that actually addresses cost, fundamentally. Something that will work.

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