“Déjà vu All Over” by Dolores L. Mitchell

A few blogs ago, I stuck my neck out, and predicted that we could and would pass a national health care reform bill by the end of the year. Well, what a difference a stimulus package makes! The progress of the bill through the Congress has resuscitated a host of old scare tactics that I thought had been discredited and discarded during this first decade of the 21st Century. But here they are again. Comparative effectiveness research? How can a rational person be against trying to find out what works, without harming patients, and what works as well as, if not better than what’s already on the market? Have these alarm sounders missed all the highly publicized examples of drugs that turned out to have serious negative effects once they were distributed country-wide? And what about the dozens of drugs that are “new” heavily advertised, and expensive, but are really just “me – too” drugs that delay the roll out of generic substitutions.

Have they not read the debates over non-surgical treatments that are alternatives to surgery for half a dozen conditions, from low-back pain to prostate problems to cardiac care? Surely these alarmists are aware that these debates over clinical approaches have been going on for years, and that the answers have enormous financial as well as personal consequences. We have an imperative to spend our healthcare dollars prudently if we are to succeed in covering everyone. So what did we hear from the nay-sayers in Congress and, of course, from Rush Limbaugh baying in the background? What? You want government to tell your doctor what he can prescribe? This will lead to the government running health care for the whole country (clearly a bad thing in the view of the speaker). Government’s very positive role in providing the kind of analysis all the players in the system need, to make decisions – be they policy makers, providers, payers, or patients – is currently a gaping hole in our knowledge base, and they are raising the red flag of government “interference” in the doctor-patient relationship all over again. We have the expertise. We have the data sources. We have some models from other countries. We have some small pilots already on the ground. We are ready. We are able. The question is, are we willing? Will we allow ourselves to be distracted by the same tired old devils in the closet rhetoric, or can we be firm, positive, and keep our eyes on the prize. So, before I commit one more cliché, let’s keep the successful year-end passage of a true reform bill as our goal – a goal we still intend to reach.

Dolores L. Mitchell
Executive Director of the Group Insurance Commission of the Commonwealth of Massachusetts, the agency that provides life, health, disability and dental and vision services to over 300,000 State employees, retirees and their dependents.