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Another Voice, A Familiar Face

By on February 15, 2012

Dr. Emmanuel

After posting yesterday, I caught up with a similar article on health care costs and reform in the January 4, 2012 issue of the Journal of the American Medical Association authored by Ezekiel Emmanuel. M.D.,PhD. Dr. Emmanuel is currently the Provost and Head of the Department of Medical Ethics and Health Policy at the University of Pennsylvania School of Medicine. He served in the Obama White House as an advisor during the years of Health Reform efforts. He is an oncologist, and interestingly the brother of Rahm Emmanuel, current Mayor of Chicago and former Chief of Staff for President Obama. He is also the author of Healthcare, Guaranteed (Public Affairs, 2008) written before he joined the Obama Administration. He has written an article Why Tie Health Insurance to a Job? that should be required reading for new members of Congress.

Clearly this man has the credentials. In his article he reviews the  often cited causes of high health care costs, examines the real numbers, projects them out into the future and, like Dr. Relman, focuses on payments and reimbursements as the most fertile ground for real reform. It is an excellently written piece, accessible for the layman, and worth a close read. (see link below)

However like Relman, he steers clear of the 800 lb. elephant in the room (nation) technologic advances and price-tags of the same. We live in an age when one can have multiple joints replaced, multiple stents inserted into one’s coronary articles, multiple stroke operations and aneurysm repairs before rupture.  The remarkable story of Representative Gabrielle Giffords is as much a testimony to the capability of modern American medicine as it is to the spirit of this extraordinary public servant. We have not read the price tag.

Rep. Giffords

We are truly blessed to live at this time. Fifty years ago, none of this was possible. These remarkable advances are performed by skilled doctors and technicians in specialized settings requiring sometimes very costly instruments and hardware. What follows may be extensive therapy and convalesence. This cost big bucks, and when the result is that of Rep. Giffords worth every penny someone has paid for it.

We can and should reform payment systems that encourage unnecessary and, sometimes, harmful excesses in medical care. There is still a perception in the US that one cannot get too much medical attention. I have seen first hand the folly of this, people dying or disabled from unnecessary procedures. It is a misconception that needs to change. Here is where future reform efforts rightly should to go.

But we also need to start talking  the  intelligent use of new technology and medical planning. Politicians universally regard the fruits of these explorations as toxic to their careers and steer clear. So do many policy advocates. But without serious addressing this subject, we will never get on top of the kind of future catastrophe in costs that Dr. Emmanuel accurately predicts — a day  where one of every three, later every two, dollars spent in the US is for medical care. That is where we are heading and it will surely bring our economy down.

This is not a veiled criticism of Dr. Emmanuel who has tackled this subject elsewhere. Just a ‘heads up.’ Politicians and policy makers will not give clear answers to these critical health care challenges until intelligent, informed Americans demand them.

Tom Godfrey

 

Link to Jama issue and article Where Are the Health Care Cost Savings:

http://jama.ama-assn.org/content/307/1.toc

About Tom Godfrey

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