A pair of physician-researchers from an AAFP-funded research institute spoke about integrating a career in medicine with a career in policy research. That was interesting to me as a medical student, but of general policy interest was their take on the future of primary care:
- They were surprisingly genial about specialists, and avoided playing the blame and recrimination game. This was welcoming and refreshing. Medicine is divided enough as it is.
- They count Nurse Practitioners and Physician Assistants as primary care providers. I would think that this undermines their cause slightly (“hey, if non-physicians can do the job…”), but I’m sure they have their reasons.
- I overheard one of the speakers talking to a student in the hallway after the main presentation. I caught a bit of their discussion about Qliance. They were both of the opinion that that sort of market-based, patient-centred model will be important to revitalizing primary care. The AAFP speaker was trying to cram the Qliance model into the “ACO” box, but hey… no one’s perfect. It’s great to see some of the professional societies recognize the need to get off the government-dependence gravy train before it derails completely.
Also of note was the following… special moment: one of the students in the audience objected strenuously to the speakers’ use of “industrial,” “corporate” terms like — wait for it! — “supply,” “demand,” “surplus.” He wanted to know how the sky would keep from falling so long as we keep referencing “that paradigm.”
Here are two health policy developments from the past week… near-poetic juxtaposition:
Via John Goodman, a link to Cato’s Michael Cannon writing at Kaiser Health News to take on the White House’s contention that the PPACA’s new insurance regulations collectively represent “consumer protections” that Republicans should be wary of tampering with. Cannon argues that this is a mis-branding, and that while these protections are superficially appealing, they will have (and have had) deleterious effects below the surface.
Via Jason Shafrin, an article by the American Health Lawyers Association outlining the existing legal barriers to the establishment of one of the PPACA’s much-hyped cost-control/delivery-improvement mechanisms: the Accountable Car Organization (ACO). The list of existing regulations that may need to be waived is extensive, including elements of the Stark Law, prohibitions on balance billing Medicare beneficiaries, and various anti-kickback provisions… the sorts of things that one might characterize as consumer protections.
Truly delicious, isn’t it?
This raises the question: if these longstanding consumer protections intended to prevent physician conflict-of-interest and Medicare beneficiary exploitation need to be brushed aside (for some entities, anyhow) to allow the Next Big Thing in health policy to go forward, what does that say about their worth and utility more generally?
Why should we be any less wary of tampering with these “consumer protections” than the ones allegedly found in the PPACA?
If you support “consumer protection” generally, especially those added in the PPACA, I’m curious: if the latter set of regulations do end up getting waived for nascent ACOs, as I expect they will in at least some cases, will those ACOs’ patients be worse off for the lack of protection?