Friday, March 24, 2017

In The Land of The Experts



Arguably, the most consequential moment of the nascent Trump administration did not place  today when Congress Votes on the first iteration of the bill known as the American Health Care Act (AHCA). If the success or failure of the bill to this point is to be judged by its reception from policy thinkers on most sides of the political spectrum, it is already an unmitigated failure.
It should be noted, and hopefully a sign of careful thinking, rather than political gain, the GOP reneged on passing a 'rush to completion" bill.
My estimation is we are only in the first trimester of the embryonic AHCA.  Delivering it now would insure a premature death.
It should be worth noting, however, that healthcare in America is a massive business accounting for 3 trillion dollars in spending with powerful stakeholders. Any real attempt at reform is bound to be opposed by those who would naturally resist attempts to dam the river of dollars that flows to them. The resistance from these parties always comes in the form of entreaties to think about patients harmed by whatever change is trying to be made.
Figuring out which stakeholder actually has the patients best interests at heart is akin to playing a shell game. All the cups look the same and its entirely possible the marble is underneath none of the cups. As a physician, I am of course, another stakeholder with inherent bias but I would submit that practicing physicians, among all the players at the table, have their interests most aligned with the patients they must directly answer to every day.
Of course the actual language of legislative bills defies understanding by mere physicians, and while my grand wish would be to leave it to the healthcare policy experts to hash out, the last eight years suggests that it is folly for the practicing physician to pay no attention to these machinations. While it may seem obvious that all parties at the table would seek to ensure the primacy of the physician-patient relationship, one can never underestimate how deep health care policy experts have their heads buried in the sand.
Rand lists those who they think are the 'experts'.  Are they those who publish the most, who have had the most governmental positions, hold high positions in health care administration, or some other unknown selection by an algorithm ?  How many of them are physicians ?

What will be the effects of repeal, or amendment of the ACA?




Overall Rand Approach from Rand at Congressional Briefing




After reading and watching the above, hopefully we can distill who makes decisions. (If Congress really listens)







In The Land of the Experts
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