Author Archives: Friedman Jerry

Change is good, you go first: implementing health care reform:

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By: Jerry Friedman
Associate Vice President in the Office of Health Sciences

There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things. For the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new order, this lukewarmness arising partly from fear of their adversaries … and partly from the incredulity of mankind, who do not truly believe in anything new until they have had actual experience of it.
– Niccolo Machiavelli, The Prince

Mindful that the Senate has yet to vote on the reconciliation package, one cannot deny that we are near the end of the beginning.  The work of animating the words on the legislative page and applying them to this country’s fragmented, proprietary, volume driven, risk aversive system must begin.

Can doctors lead?  In many ways the medical profession gave up the reins when they allowed HMOs to assure them stable volumes and regular payments.  Since then, the business of insurance and the business of medicine have been locked in a battle for the patient’s health care dollar.   Insurance likes you when you are healthy, medicine likes you when you are sick. After all, “health insurance” is really sickness & accident insurance. Continue reading

How Much Health Care Can We Afford?

By: Jerry Friedman
Associate Vice President in the Office of Health Sciences

The State of the Union address is the CEO’s annual report on the American enterprise.  The 70 minute speech about the health of our country was long on economics and short on health care reform, or as it has come to be known “health insurance reform,” devoting less than 5 minutes to the subject).

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Health care was presented in context.  People are suffering.  The cost of care has become unaffordable for individuals and unsustainable for the nation.   Continue reading

“When you come to a fork in the road, take it.”

The short history of government intervention in stimulating or retarding the supply of physicians and other health professionals has been checkered at best. Evolution of the profession from the proprietary schools of the 19th century through the Flexner influenced  growth of science- based practice and the modern university medical school relied in large part on the natural ebb and flow of society and the marketplace to right size the supply.

Fast forward to the mid 20th century where the growth of employer based insurance and passage of government sponsored medical care coverage through Medicare and Medicaid provided new sources of revenue and different economic incentives. Government support for expanded physician education and training also grew as the demand increased.

As that century progressed the cost of providing medical services grew and the health of our population declined. Even as life expectancy increased through the advancements of science & technology, our reliance on medicine as a sick care system has fostered lifestyles and behaviors that have lead to an increasingly unhealthy population. The prevalence of obesity and chronic illness amplify that health does not happen in a doctor’s office.  The rising cost of health care was becoming unaffordable for individuals & unsustainable for society.

In 1997, Congress capped the number of interns & residents that the government would pay to subsidize the training of through the Medicare and Medicaid programs. Insurance companies, transitioning from non-profit mutual companies to publicly traded for profit entities also denied responsibility to fund this public good.  Teaching hospitals met the growing demand and lack of explicit revenue by exercising its redistributive black box and shifting the costs for training as well as the increasing costs of uncompensated care, to its decreasing percentage of privately covered patients.

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