Wednesday, June 22, 2011

Platonic Medicine and the ACA with its IPAB

 A recent commentary by one of favorite bloggers,Dr. Robert Centor, spoke favorably about IPAB, one of many,many provisions of ACA.See here.I made a brief reply to his entry. I recalled this earlier blog entry and if Dr.Centror's comment stir up much furor  I want to add this earlier blog post to the kerfuffle.Originally published  6/22/11 and now submited with little editing.

I had been sketching out some comments about what I was going to call "Platonic Medicine" referring to the "leaders with ideas" who will lead the way to transform medicine based on the underlying premise that "medicine is too complex and important to be left to the individual physician and the individual patient" and therefore it should be controlled and directed by the wise medical elite who will determine the collective utility of a given approach and its value.I have commented before about Don Berwick's advocacy of that view.

However, someone had written something in that regard better than I could.See here.

Hat tip to the Pacific Legal Foundation who filed a friend-of-the-court brief to challenge the constitutionality of IPAB on the grounds of violation of the non-delegation doctrine and for the above mentioned link which alerted  me to Jost's frightening comments.

It turns out that an outspoken advocate and supporter of Obamacare,law professor, Timothy Jost has already praised that legislative act in part because of what the IPAB will provide. He said:

A board of “Platonic Guardians” to govern the health care system or some aspects of it. The cost of health care is spinning dangerously out of control…. [O]ur traditional political institutions—Congress and the executive administrative agencies—are too driven by special interest politics and too limited in their expertise and vision to control costs. Enter the Platonic guardians…an impartial, independent board of experts who could make evidence-based policy determinations based purely on the basis of effectiveness and perhaps efficiency.

Incredibly Jost is asserting that this board will be immune to the influence of special interests and will make decisions rationally and in a proper evidence based manner.From what planet will these board member be chosen? Philosopher kings in charge,what could go wrong with that?

The PLF commentary pointed out that a Platonic government was definitely not what the founding fathers had in mind and Jefferson and associates were not big fans of Plato.

In the commentary that I was considering I thought perhaps calling the panel members Platonic Guardians would earn me the accusation of being overly dramatic and hyperbolic, but now we see an IPAB advocate using the same characterization and believing that to be a very good thing.

Dictating the coverage to control the cost for Medicare and Medicaid may not be enough for the medical Platonic elite as is illustrated by this quote from Dr. Robert Berenson:

"we ought to consider
setting all payer-rates for providers." He continues "but the country's antigovernment mood renders such a discussion unlikely,at least for now".

I wonder who the "we" is that Berenson references.

Finally, another chilling quote from Mr. Jost:

"In the long run, Congress may not be able to cap Medicare expenditures without addressing private expenditures as well. If the IPAB opens the door to rate setting for all payers,it may well be the most revolutionary innovation of the ACA".

Yeah, it just might be.


Anonymous said...

One of the stated reasons that the ACP was critical of the current model of IPAB was that it did not have a representative of primary medical care but they did not seem to object to the concept generally.

Maybe if a representative of ACP were chosen as one of "Plato's guardians",they could be more supportive.

Andrew_M_Garland said...

Retired Doc: "I wonder who the "we" is that Berenson references."

The "we" is the collective, colloquially "The Borg". They are certain, all together, that their higher intelligence and dispationate love for statistically determined medicine is the best for the mass of humanity which must be assimilated.

They were hyperlinked while attending elite colleges and working as assistants to politicians. They belong to a subtle and powerful network. We plebians will never know the joy of that interconnection, nor the joy of having government and academic health benefits which exclude them from the enlightened policies which they will administer.

These are the people who hated mathematics and statistics in college, and didn't understand them one bit. Now, they embrace the results of any statistical "study" lumping together the medical results of thousands, to produce a one-size-fits-all protocol to reduce costs, forced on everyone who is non-Borg.

Their motto: "I have found my calling in life as an efficiency expert." They dream of returning to the 1950's. They think that progress will come from standardizing the assembly line, rather than inventing new products.

james gaulte said...

Yeah,you know who the "we" are.