Archive | August, 2018

Health Reform Won’t Come from Boston or Buffet

27 Aug

The following is an op-ed that I submitted to a few daily newspapers about the hiring of Harvard’s Atul Gawande to reduce health care costs for three large companies.  No one accepted it so it now goes on the Bhatany Report.

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The splashy venture to reduce health care costs by Warren Buffett, Jamie Dimon, and Jeff Bezos has now found their splashy new CEO, surgical oncologist Dr. Atul Gawande.  Their efforts will fail as will any private sector effort to reform our immoral, dysfunctional, for-profit health system.

The Harvard physician, New Yorker writer, and author of The Checklist Manifesto will find that he has bitten off more than he can chew.  Having spent his career blaming greedy doctors, end of life care, and “diagnostic complexity” for the exponential increase in US health care costs, he has studiously ignored the role of price fixing, bloated administration, and hospital mergers (including his own employer, Brigham and Women’s Hospital) in ballooning health care costs.  He has instead consistently advocated for a patchwork of local reforms and band-aids for our health system, but no systemic solutions.

The gradualist Dr. Gawande, working for three large employers, won’t be able to address much for the 1 million employees.  Without controlling a health system, he cannot control the urban, suburban, and rural distribution of health care workers and resources nor unify EMRs for all his workers everywhere.  Without that, he cannot improve coordination of care in a useful manner.  Nor can he address the prescription drug crisis of costs; that can only be addressed by a national drug price negotiation.

I do not think nothing will be done in the venture.  What will likely happen is the companies will improve the health of their employees to the extent that improves their productivity and reduces sick days.  Expect free FitBits, weight loss programs, wellness days, non-hiring and firing of smokers, and health insurance discounts for employees seeking preventive care.

But occupational medicine has always had a classic conflict of interest.  What happens when the health of the worker conflicts with the needs of the employers?  Berkshire-owned railroad drivers spend a majority of the time on the road, leading to poor diets and unpredictable hours (I should know, I have treated them).  JP Morgan traders work around the clock making mergers and acquisitions, infamously leading to the death of one overworked banker in 2015.  Amazon warehouses infamously lack air conditioning and treat passed out workers with fans.  Will a more relaxing schedule, air conditioning, or hiring more workers be permitted if it cuts profits?

The only solution has always been a single payer national health plan that eliminates the employer’s role in health insurance.  Only with a Medicare for all plan can we reduce administrative complexity, negotiate hospital and drug prices, and re-orient health spending towards socially useful spending instead of health care that turns a profit.  Dr. Gawande will not push for that, as it will put him and all private sector health bureaucrats out of a job.  But it is exactly what we need.

There will be little to show for the effort except publicity, profit, and nothing for the health of the public.  We do not look to Amazon, Chase, and Berkshire Hathaway for our health now and we should not in the future either.