"Let's Focus On Ideas Not Slogans" by Andrew Dreyfus

Too often, debates over public policy reduce complex issues into polarizing political slogans. This is happening in health care, both here in Massachusetts and on the federal level.

Earlier this month, the Boston Globe ran a story on the state Payment Reform Commission’s recommendation that we begin to move away from our fee-for-service payment system to one that rewards quality and efficiency through “global payments” for providers. By the end of the day, there were more than 150 comments posted online; most criticized the Commission’s recommendations, some asserting that it would lead to “Soviet-style” health care.

Similarly, when a proposal was made to include $1.1 billion in comparative effectiveness research (CER) in the federal stimulus bill, some groups in Washington quickly derided it as an unwarranted infringement of the doctor-patient relationship and the beginning of the rationing of health care. These criticisms continue and are intensifying. A recent New York Times article referred to CER as a “medical minefield.”

What these two proposals have in common is the speed and intensity in which critics reduced them into simple and incendiary arguments. Another common element? Both have the potential to improve the quality of care and slow the growth of health care costs: CER by telling us which treatments will help people the most and global payments by providing incentives for using those treatments that will result in better outcomes.

Listen to some local experts on these issues. In a recent article in the New England Journal of Medicine, Dr. Jerry Avorn, Professor of Medicine at Harvard Medical School, writes that CER “represents one of the best investments we can make to edge the health care system away from the fiscal catastrophe it faces, since such studies will help to reduce spending on poorer clinical decisions and to spare resources for expenditures that will help patients most (and most affordably).” Dr. Avorn writes that our current regulatory structure offers little investigation into the efficacy of many new medical treatments.

Similarly, upon signing our Alternative Quality Contract that features global payment paired with quality incentives, Dr. Barbara Spivak, President of Mount Auburn Cambridge Independent Physician Association, said, “This contract aligns well with our mission to provide the highest quality care to our patients. Our quality improvement department supports our physician practices in caring for their sickest patients and ensuring that more patients have the preventive tests and appointments that will keep them healthy.” Dr. Spivak understands that global payment has the potential to move us away from a fee for service system that pays for – and encourages – volume and complexity rather than quality and outcomes.

Let’s resist the urge to dismiss the value of ideas by simplifying important issues. Instead, let’s have a full conversation on these important proposals guided by our shared goals; to improve the quality and affordability of health care in Massachusetts and across the nation.

Andrew Dreyfus is Executive Vice President for Health Care Services at Blue Cross Blue Shield of Massachusetts and former President of the Blue Cross Blue Shield of Massachusetts Foundation

This program aired on May 18, 2009. The audio for this program is not available.

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Martha Bebinger Reporter
Martha Bebinger covers health care and other general assignments for WBUR.



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