From: sean+@andrew.cmu.edu (Sean McLinden)
Newsgroups: sci.med
Subject: Re: Bashing, truth, etc.
Date: 3 Jan 93 08:28:22 GMT
Article-I.D.: andrew.gfFn16u00WBO81MXoH
	<BzKE9B.ICJ@mentor.cc.purdue.edu>
Organization: Carnegie Mellon, Pittsburgh, PA

>But the problems we face are often far more complex than our physicians
>have learned to handle, and a bureaucrat is usually even worse.  There
>is, in effect, a massive conspiracy to keep those of us who must use
>medical process from acquiring the information, and in many cases from
>making intelligent choices.  If anything, the situation is getting much
>worse, and if the regulation mania gets worse, we will only get such
>medical care as the bureaucrats are willing to permit.

As a matter of fact you are offbase. While I agree that privatization of
Federal data sources (which has been advocated by many influential people
in both major political parties) threatens access to information, the truth
is that the public has the potential to be more informed than ever. All
medicare claims submission data (minus patient identifying information) is
available from the Federal government to anyone who wants it. Also available
and published are morbidity and mortality rates for all US hospitals (hospices,
nursing homes, etc., are not available, yet). Many states require MEDIS groups
data on each discharge which can be used to compare patient outcomes according
to severity of illness and (combined with physician and UB82 data) even
physician. In fact, Pennsylvania just published patient outcomes data for
coronary artery bypass grafts which compared patient outcomes according to
hospital and even physician!

The truth of the matter is, dear doctor, that the fault lies not with the
bureaucrats nor with the physicians but with the public! Tell me just about
how many of the employees at Purdue question the University about the quality
of care they will be getting according to the University's group health plan?
Do you think the people who negotiated that plan cared about quality? I'll
bet not. In fact, NONE of the major managed health care plans take into
account the quality of care nor do they require monitoring for the quality
of care. They are interested in one thing, only, COST!

Your employer wants to keep you happy by giving you access to a health care
plan but they don't want to be bankrupted by this so they look for the lowest
cost plan. And since you, as the consumer (or rather, the 30K employees at
your organization) don't scratch below the surface to look at the quality of
the health care they are getting why should the employer. If you want to blame
anyone, blame the people who didn't care. There are a lot more of them and
they had a much bigger impact than any of those conspiring to keep you from
the truth.

Do you recall why Ford Motor Company began to build high quality cars? Because
after years of buying garbage the public got wise and started looking for
cars that wouldn't fall apart and didn't cost a fortune to operate. Ford wasn't
in that business but the buying public was and Japan came in and cleaned up.
Now, Ford is making better cars. But why? Because the public wanted them.

When enough people start thinking about quality instead of cost (although
I would argue that the highest quality is usually at the best cost) and
start demanding that their employers negotiate on the basis of quality and
not cost, you won't have any problems getting what you want. But the sad
fact is out of the many organizations to which we provide health care at
my hospital, only two, the State and the Federal Government, care anything
about the quality of the care. For the rest the only issue is cost.

And they are the ones that pay the bills.

Sean McLinden
Newsgroups: sci.med,talk.politics.medicine