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From my read Americans want it all and for less money. In order to do something else, somebody's ox will have to be gored. Which ox? So for now, we are looking for the ox who will be the least missed. Cost-control (voluntary) is a nice offer by industry. They hope to deflect further scrutiny. The ama is all for increasing primary care compensation as long as specialty compensation mirrors the increase.. We can push on pharmacy a little- but don't go to government bulk purchasing. Insurance is ok with decreasing payments or increasing them, as long as the dollar flows through them. The only forces out there that cant tolerate the situation as it is, are employers and perhaps the American public. But do they count? -----Original Message----- From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On Behalf Of Starfield, Barbara Sent: Tuesday, July 14, 2009 10:49 AM To: [log in to unmask] Subject: Re: WSJ attacks NICE again - but 62 US Medical Societies speak out in favor of CER Well I guess that Joe is right-iin part. The Dartmoiuth group has been railing about overuse for almost forty years. But, you know, if you listen to people interviewed on NPR, even they don't mention primary care and overuse as issues. And no one--no one!i-iwill dare to say that a big culprit is academic medicine. The news today is of Harvard oncologist(s) calling for stronger linkages between medical schoools and industry--as if we didn't already have it. Perhaps the press does report it but in the context of ethics rather than effectiveness and safety i.e. health services reform. There are 3 reasons for high costs--one-third each: prices, adminoistrative, and overuse. They are all tied together. I don't think that the media get it and if they don't get it, they don't convey it. ----- Original Message ----- From: Joe White <[log in to unmask]> To: Starfield, Barbara; [log in to unmask] <[log in to unmask]> Sent: Tue Jul 14 09:25:21 2009 Subject: RE: WSJ attacks NICE again - but 62 US Medical Societies speak out in favor of CER So much of this debate, I guess, is informed by one's own views of what the result should be. It seems to me that Barbara and many others start from the premise that the world should be changed in a certain way, and then, since the world hasn't been changed in that way, conclude that their message isn't getting out. I remember listening to the Brookings economists back in the 1980s complain that nobody was paying any attention to the budget deficit, presumably because it wasn't getting fixed. It certainly couldn't have been for a lack of media coverage and elite focus on the issue -- Aaron Wildavsky and I wrote a book about how it dominated American politics in the 1980s, and Bob Reischauer described the entire policy debate as "fiscalized." But it is hard for advocates to accept the alternative theory that their truthful message is being propagated broadly but rejected. To me, being more of a skeptic of the delivery reform agenda, it seems that delivery reform dominates the debate, at the expense of what to me seem more easily implemented measures such as better price regulation (Barbara and I would agree, I believe, that the relative payments for primary and specialty care need to be adjusted to improve the relative payments for primary care, though there are definitional issues there. But I'm more interested in paying specialists and hospitals less than in promotion of primary care per se). I look at the policy debate, for example common claims that the public is not supportive of cost control, and get aggravated because common arguments seem to associate cost control entirely with restrictions on delivery (public opinion broadly favors paying less per service). At any rate, if you want to see what politicians are hearing, check out the Senate Finance Committee's hearing in May: http://finance.senate.gov/hearings/48952.pdf . You will find lots and lots of references to delivery system reform. As for the press, there was a whole New York Times series on overuse earlier in the year. And if you want an indicator of conventional wisdom, there is nobody more conventional than David Broder, the "Dean" of Washington political journalists (and co-author of a major book on the last reform debacle); so check out his column on July 12. To me, it seems like the "unnecessary care" argument permeates elite discussions of cost control. If mass opinion doesn't buy it, that's not because the message isn't being sent. Best, Joe -----Original Message----- From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On Behalf Of Starfield, Barbara Sent: Tuesday, July 14, 2009 7:34 AM To: [log in to unmask] Subject: Re: WSJ attacks NICE again - but 62 US Medical Societies speak out in favor of CER The crux of it---in my view---is to get across the notion that more is not better. That is why the literature on adverse events and the importance of avoiding unnecessary specialist visits and interventions has to be a big message. There is lots of evidence out there but it hardly gets any big-time press. Guess why. Barbara -----Original Message----- From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On Behalf Of Adam Oliver Sent: Tuesday, July 14, 2009 4:41 AM To: [log in to unmask] Subject: Re: WSJ attacks NICE again - but 62 US Medical Societies speak out in favor of CER Richard Who does? But, you're right - more Americans should contribute to the list. I hope you've spurred them on. But you've got to admit - it makes a change from Americans telling the rest of the world what they want... -----Original Message----- From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On Behalf Of Richard Scheffler Sent: 14 July 2009 09:38 To: [log in to unmask] Subject: Re: WSJ attacks NICE again - but 62 US Medical Societies speak out in favor of CER I have listened to enough about what Americans want From Non Americans We donot want explicite Rationing of any kind Don't ask don't tell Richard Sent via BlackBerry by AT&T -----Original Message----- From: Adam Oliver <[log in to unmask]> Date: Tue, 14 Jul 2009 09:23:05 To: <[log in to unmask]> Subject: Re: WSJ attacks NICE again - but 62 US Medical Societies speak out in favor of CER I know all this Alan. I've written about it quite a bit, sometimes with you (I think). But it seems to me that you have to stay within the bounds of the politically possible. Many, probably most, Americans, don't want 'economics'-based rationing (heck, most Brits don't want it either). That partly explains the late 1990s backlash against HMOs. I guess, sometimes, it might not be an elephant, but if it looks like an elephant, smells like an elephant, walks like an elephant, is afraid of mice and has a great memory, it might as well be a bloody elephant (that's my Sarah Palin-ism for the day). Best, Adam -----Original Message----- From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On Behalf Of Alan Maynard Sent: 14 July 2009 03:31 To: [log in to unmask] Subject: Re: WSJ attacks NICE again - but 62 US Medical Societies speak out in favor of CER Adam Rationing is universal! The Americans ration by willingness and ability to pay.They discriminate against the poor whereas Europeans try to discriminate on the basis of whether medical care is any use to you as a patient and taxpayer. Those who argue only UK-EU states ration care should be confined to institutions for the care of folk with unsound minds! Alan On Jul 13 2009, Adam Oliver wrote: >Hi > >I think this is quite interesting. We have Alan telling us that >cost-effectiveness analysis is the only way to go, and Calum telling us >that if we (or rather you, Americans) go that route then the spectre of >'rationing' will undermine major reform effort. > >Perhaps we should worry about value for money only when everyone is >covered? But, then, neither Congress nor the CBO would allow that, would >they? > >I think I would say focus on comparative effectiveness for the time >being, and remove from the system (if you can, and if there are any) any >ineffective interventions. It would be a start. > >Best, >Adam > > >-----Original Message----- >From: Anglo-American Health Policy Network [mailto:[log in to unmask]] >On Behalf Of Alan Maynard >Sent: 11 July 2009 09:16 >To: [log in to unmask] >Subject: Re: WSJ attacks NICE again - but 62 US Medical Societies speak >out in favor of CER > >As ever necessary but not sufficient Simon! EBM stands for economics >based >medicine, not mere evidence based medicine! But gather the CBO >interprets >comparative effectiveness as cost effectiveness Alan > > >On Jul 10 2009, Stevens, Simon L wrote: > >>In case you didn't see it, attached is a constructive intervention in >>the comparative effectiveness debate from 62 medical societies. They've >>apparently now written to the Senate in defense of the idea... >> >> >> >>Simon >> >> >> >> >> >>Simon Stevens >> >>UnitedHealth Center for Health Reform >> >>www.unitedhealthgroup.com/reform >> >> >> >>________________________________ >> >> >>>From: Anglo-American Health Policy Network >[mailto:[log in to unmask] >><mailto:[log in to unmask]> ] >>>On Behalf Of Jost, Timothy >>>Sent: July-08-09 8:45 AM >>>To: [log in to unmask] >>>Subject: WSJ attacks NICE again >> >> >> >> >>This e-mail, including attachments, may include confidential and/or >>proprietary information, and may be used only by the person or entity >>to which it is addressed. If the reader of this e-mail is not the >intended >>recipient or his or her authorized agent, the reader is hereby notified >>that any dissemination, distribution or copying of this e-mail is >>prohibited. If you have received this e-mail in error, please notify >the >>sender by replying to this message and delete this e-mail immediately. >> > > Please access the attached hyperlink for an important electronic > communications disclaimer: > http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm Please access the attached hyperlink for an important electronic communications disclaimer: http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm Please access the attached hyperlink for an important electronic communications disclaimer: http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm