Washington – big brains with no answers

I want every problem to be like a blocked-up bladder; you just stick in a catheter and sweet relief flows down the tube. So I went to a big health care policy conference in Washington, D.C., recently, looking for answers to America’s health care problems from some of the biggest brains in the business. They did not have any, and I’m not saying I wasted the time, but let’s just say health care is no blocked bladder and there will be no sweet relief from its rapidly rising costs. Let’s just say, to mix metaphors, that if we were fish we’d be scrod.

In three days of presentations on how to rein in costs of Medicare, Medicaid, private health insurance, health care costs for business and patients, there were no bright beacons of hope. There was nothing on the cutting edge of ideas that had a prayer of significantly cutting the rate of health care costs increases any time soon. It was depressing even for a guy so optimistic he thinks last year’s Red Sox are the start of a dynasty.

In a roomful of some of the smartest health care policy wonks in America there was a lot of wonking but no Rolaids idea, nothing that spelled relief from double-digit health insurance policy premium increases each year for at least the next few years. There was nothing that looked like it would change the fact that we pay more per capita for health care than people in any other western nation but are consistently less healthy.

The wonks were not the only ones without answers. Some of the sharpest tacks in the federal government were there, too, senior health care staffers from the U.S. Congress and Dr. Mark McLellan, the man who oversees Medicare and Medicaid for the Bush administration. They had agendas, they had ideas, but they had no answers for us down here at ground zero of health care. Big ideas were the ones to save Medicaid $60 billion over the next 10 years, President Bush’s plan for tax breaks for uninsured who buy health insurance, and health savings accounts. Those are important ideas, but amount to nothing compared to the kinds of solutions we need, and none of them will provide any significant relief in the next few years.

Some big brains from American business were there too, but most of the hot ideas in business these days are aimed at shifting health care costs and decision-making responsibility to workers. That means business, the biggest power in health care after the federal government, is throwing up its collective hands in frustration after two decades of aggressive and largely unsuccessful efforts to control employer health care costs.

Everyone at the conference talked about how to improve the cost effectiveness of the money we spend by improving the quality of the health care and thereby getting more bang for the health care buck. The feds, big business, the policy wonks, etc., are all singing quality of health care songs, and intend to use the candy and hammer approach to bring the health care providers – primarily doctors and hospitals – into the choir.

The new hit song on this issue is called PFP – Paying For Performance. The idea of PFP is that payers, including government and business, will pay more to specific hospitals and physician practices when their quality of care exceeds certain standards. PFP is in its infancy, but will break out of the crib in a big way in 2006 when Medicare starts to adjust payments to hospitals based on how well hospitals perform in certain areas of patient care.

At the end of the conference the attendees all applauded enthusiastically. That’s proof, I think, that the room was full of heavily medicated optimists with stratospheric IQ’s and good manners, because none of them missed the harsh realities of American health care casting a pall over the conference. There are three in particular that gather the gloom.

First, and to repeat, in a conference full of ideas there were none that will produce substantial change in the near term. Second, and worse, we do not even have the tools necessary to get to solutions any time soon, because all of the parts of the health care system move faster and more independently than children on a playground. Our political leadership changes frequently and therefore so does its policy direction, the public does not agree on any underlying philosophical approach to health care (e.g. free market vs. government-managed), the technology and cost of health care move at light speed, there is little control of the health care business market, and the patient is a relative free spirit with a voracious appetite for health care. Chaos is the defining characteristic of American health care policy planning, and it will be easier to herd cats on amphetamine than to make effective policy changes in the context of that chaos.

Third, a lot of money is going to get cut out of the system in the next decade by the biggest players – government and business. That means our health care system will still be a mess, but a less well-funded mess with more cost shifted to the patient, because the money will be sucked out without the benefit of the system carefully planning how to do well with less.

If I was a drinking man I would have brought Dr. Jack Daniels and Dr. Mickey Loeb with me to the conference; the situation would not have looked better but I would not have cared.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.