I suppose that as every generation has aged, their conversations ultimately contain the phrase, "When we were young, life was so much simpler." Whether it was indeed "simpler," or just filtered through a personal lens that didn't focus quite so much on the complexities and responsibilities of adulthood, is a question that will likely be discussed forever. Nevertheless, when boomers -- especially those of us who are involved in health care -- meet these days, the inevitable subject is the incomprehensibly complex nature of the discussions taking place in Washington, D.C.
At one such recent discussion, an old friend raised the "old TV shows" metaphor. "If only we could get back to that simpler time of Wally and the Beaver, "My Three Sons" and shows like that, America would be a better place." Whether that is merely nostalgia or whether there is a grain (or more) of wistful truth in the argument, on the drive home from that discussion it occurred to me that my friend may have been on the right track, but he was on the wrong train.
Many of us recall the TV show "Father Knows Best." It debuted in 1954 and starred Robert Young as insurance salesman Jim Anderson. Jim's wife Margaret (Jane Wyatt), son Bud (Billy Gray), daughters Betty (Elinor Donahue) and Kathy (Lauren Chapin) were the other cast members. Margaret was the quintessential Mom, Bud was a likeable jock and Betty (called "Princess" by her dad) was a perky and pretty cheerleader. Kathy was the typically precocious youngest sibling.
"Father Knows Best" was a radio show (1949) before it made the jump to television. In the radio version, there was a question mark at the end of the title. While that punctuation didn't make it to the TV version, it should have, because often times, Father did not "know best." Jim would get angry and make pronouncements that were wrong. Wife Margaret -- portrayed as the prototypical apron-wearing simple-minded 1950s mom -- often brought the correctness of common sense to her winning arguments.
As Congress (aka "Father") conducts its rush to health care reform, it is painting the same kind of paternalistic and rosy scenario that was portrayed by the show's premise. We need to bring back that question mark -- and we need to do it soon! Our problem is much more insidious than the fact that many Americans believe the government will provide unlimited, free, on-demand health care. In fact, the predicate for our predicament as Americans -- much less as benefits professionals -- is already a done deal, not subject to the current "deliberations" in D.C.
Included in the "American Recovery and Reinvestment Act of 2009" (aka "The Stimulus Bill") was $1.1 billion to fund The Federal Coordinating Council for Comparative Effectiveness Research. When he was at The Brookings Institute, Obama budget director Peter Orszag became interested in a Dartmouth study indicating that despite wide regional disparities in payments for similar conditions, there was no corresponding improvement in outcomes. Additional fuel for the Council came from Senator Tom Daschle's book, Critical: What We Can Do About The Health-Care Crisis, where he argues for a council similar to the British National Institute for Health and Clinical Excellence, which goes by the acronym "NICE."
If the Federal Council in the stimulus bill is the beginning of this idea, NICE is the realization of what it could -- and most likely will -- become. A group of presidential appointees will begin reviewing treatments to decide which are more -- or less -- effective. This sounds innocuous and like the biggest no-brainer in the history of the universe, doesn't it? A frequently-cited example of the type of review that the Council might undertake would be to determine whether drugs and "watchful waiting" are a better treatment than surgery for back-related issues. Who could argue that expensive and risk-laden surgeries should only be done if they can be proven to be more effective than non-invasive treatments?
A discussion of how the Council's work might be brought into practice quickly leads to concern. For the moment, ignore those who, rightly in my view, believe that giving government access to our electronic personal health records in tandem with this Council's guidelines will ultimately create the medical equivalent of Big Brother. We need only look at NICE to see the likely outcome.
NICE guidelines center on cost effectiveness, not around quality of care. How long will it take for Americans to realize that our version of NICE will likely mirror our cousins across the pond? To help everyone along, I suggest that you invest eight minutes of your time to watch a video clip about my friend Beth Ashmore. Some of you know Beth as a former president of the National Association of Health Underwriters, though you may not know her mother's story. It is a shocking, firsthand account of what could be in store for us if we project the path of our current initiatives. You can find the video at http://www.nahu.org/media/singlepayervideo.cfm.
Critics in the medical community are becoming concerned about the Council's effect on their ability to practice medicine and the potential effect on their physician-patient relationships. Their concern centers on the research from the Council leading to a "one-treatment-fits-all" set of rules and that the government would become the third party in the exam room, so to speak.
Many of us recall the admonitions made nearly two decades ago about "accountants at HMOs making medical decisions." Absent a discussion of "medical necessity," the HMOs were excoriated for enforcing the terms of a voluntary contract between employers and the HMO -- terms which were known in advance. We've all heard the arguments about employees being the ones in that particular crossfire, and to a great extent that is true. The pros and cons of employer-based insurance will be the subject of another column in a future issue.
The salient fact of the matter is that those "accountants" or "bureaucrats" are about to have some real authority over the health care available to our citizens. The warnings of the early 1990s are about to be realized. The difference is that this time, those making the decisions will be working for the U.S. government. If you didn't think it was a good idea when you had the choice to enter into a contract whose terms were known in advance, guess how much fun it is going to be this time when there will be no other (viable or affordable) place to go for health care coverage.
Theodore Forstmann, founder of Forstmann Little, warned that, "The gentle government that promises to hold your hand as you cross the street refuses to let go on the other side." The path we are on seems serene and sensible enough at its outset. Yet, it is a very short distance indeed between "Father Knows Best" and "Mother, May I?"
Readers may write to David Saltzman at Carolina Care Plan Inc., 201 Executive Center Drive, Columbia, SC 29210. He is a past president of NAHU and has been a health, disability, life and employee benefits broker for more than 25 years. He is director of the large group segment for Carolina Care Plan.
