Tuesday, July 7, 2009

Department of I Told Ya So

So, we're in the midst of major health reform. Time to look back a year! My friend Jim Mongan and colleagues published an article in the New England Journal of Medicine that posited possible reforms to the health care system that were politically possible. I objected to the modesty of their proposals. Here is my letter to the editor as published:

>>Volume 359:434-435 July 24, 2008 Number 4

Slowing the Growth of Health Care Costs

To the Editor: The limitation of the article by Mongan et al. (April 3 issue)1 on options for slowing the growth of health care costs is the acceptance only of reforms that will not irritate powerful, entrenched corporate and labor interests. Our system is costing us perhaps twice as much as it should. We need to target the fattest cats and slim them down. Hospitals currently seek consolidation rather than efficiencies, charge a fortune for routine services, and pay higher wages rather than taking strikes. Insurance companies add so little at so high a charge. Pharmaceutical companies advertise, develop frivolously repetitive drugs, and charge without restraint. Medical specialists in some areas operate and serve dying patients with little restraint.

The interventions suggested in the article are popguns against a profit-bound army. Restraint in our mixed system needs to come from government, not voluntary acts by corporations.2 Schlesinger3 has identified a cycle of government activism at 30 years, the last peak being 40 years ago. It is possible, then, that suggestions that are more challenging to entrenched interests should be entertained.

Budd N. Shenkin, M.D., M.A.P.A.
Bayside Medical Group
Oakland, CA 94609


Mongan JJ, Ferris TG, Lee TH. Options for slowing the growth of health care costs. N Engl J Med 2008;358:1509-1514. [Free Full Text]
Reich RB. Supercapitalism: the transformation of business, democracy, and everyday life. New York: Borzoi Books, 2007.
Schlesinger AM Jr. The cycles in American history. New York: Houghton Mifflin, 1986.<<


Budd Shenkin

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