Signs of Change?

From the Avalere Health Diabetes Forum, Washington, D.C.:

Image courtesy of Flickr

Image courtesy of Flickr

Lots of folks here in the capital are chattering about health care reform and those speaking at this meeting are no exception.

Not surprisingly, several speakers said that the odds of achieving major reform appeared better this year than they did in 1993 during the Clinton administration, the last time it was tried. But Allan Rivlin of Hart Research, a polling firm, tried to throw a little cold water on that notion. Actually, he said, if you compare polling data from then and now, you find very little difference in how dissatisfied people are with the current state of health insurance. Back then, 77% of Americans said they were either “satisfied or very satisfied” with their own health care coverage; today that number is – wait for it – 82%.

When I asked him about those results, he admitted that he wasn’t sure he entirely trusted the data because it was from Harris Interactive polls, which he said are not the most reliable polling instruments. And he added that the people least likely to be insured are also the people least likely to be polled. Still, the numbers do give the general idea that overall satisfaction with health care hasn’t changed all that much in 16 years.

On the other hand, Obama administration officials seem to have a couple of things in their favor. First, they learned from “Hillary Care I,” as Mr. Rivlin called it, not to seek too much change too fast. “Already, they’re messaging, ‘If you like the health care you have now, you can keep it.’ ” Second, with the economic picture growing dimmer, more people could see their health insurance disappear or become more expensive, increasing support for major reform. And Obama staffers are good at “riding the wave” of public opinion and know that they need to stick with a policy even if it goes down in popularity, because support for it will begin building eventually, he said.

The other subject garnering a big response from audience members was the $1.1 billion in  the stimulus plan for comparative effectiveness research (CER). CER is designed to “make doctors and providers smarter” by letting them know which treatments are the most clinically effective and the most cost-effective, according to Wendell Primus, senior policy advisor to House Speaker Nancy Pelosi (D-Calif.). He said CER was not “cookbook medicine,” but was just aimed at producing “better public knowledge.”

This didn’t sit well with Dan Elling, minority staff director on the House Ways and Means Health Subcomittee, whose boss is Rep. Dave Camp (R-Mich.). “We’ve seen how they apply [CER] in other countries,” he said. For instance, the policy at the U.K.’s NICE (the National Institute for Health and Clinical Excellence), the organization that determines which treatments the National Health Service will pay for, says that “if you want the expensive drug for macular degeneration, you have to go blind in one eye before they’ll give it to you for the other eye,” he said. “That’s CER right there.”

At the cocktail reception after the sessions ended, one physician expressed concern that no one knows what the criteria will be for deciding if something is effective. With diabetes drugs, for instance, if they are judged solely on how well they reduce HbA1c levels, “insulin and metformin will win every time,” even though they may not always be the best therapy for a particular patient, the physician said.
—Joyce Frieden

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Filed under Endocrinology, Diabetes, and Metabolism, Practice Trends

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