Wednesday, August 16, 2006

COLUMN -- Candidates' health plan goes too far

Posted by Craig Westover | 5:38 PM |  

Wednesday, August 16, 2006

I am not a doctor. I do not play one on television. I do not impersonate one on the Internet. Nonetheless, after examination of the health care proposal of Independence Party gubernatorial candidate Peter Hutchinson and lieutenant governor candidate Dr. Maureen Reed, I can say their hearts are in the right place, their heads are screwed on correctly, but their vision is dangerously blurred.

Hutchinson and Reed hold the heartfelt conviction that health care is Minnesota's great economic threat and state government must do something about it. A piecemeal, easy-to-swallow approach won't cure the problem. Health care suffers from systemic problems, and only a system-wide approach can cure it.

But it's not just health care providers that get the Hutchinson-Reed treatment. To cure the dizzying spiral of health care costs, they also prescribe the sometimes-bitter medicine of personal responsibility.

Hutchinson and Reed identify Minnesotans, as aggregate consumers of health care, as the beneficiaries of an improved care system. But the Hutchinson-Reed vision gets fuzzy when one steps away from aggregate measures and looks at individual patients consulting with physicians and making decisions about their families' unique health care needs. Actions that produce aggregate good results might not provide good results for a given individual patient. Moreover, it can be argued that emphasis on the "best practices" aspects of the Hutchinson-Reed plan dangerously compromise the fundamental medical principle "First, do no harm."

A proper role for government? The Hutchinson-Reed prescription for health care system recovery consists of cutting administrative costs, improving quality, increasing access, motivating individual responsibility, providing consumer information and supporting those efforts with "most beneficial" public health actions. The plan is wide-ranging and encompasses many functions and responsibilities of state government. That is its strength. It's not feel-good political pandering. It's an honest attempt to reform health care.

That said, the plan gets caught up in its own grand vision. Some initiatives are clearly government's responsibility. Others push the limits of government intervention in private affairs. Still others dangerously ignore potential negative side effects of good intentions.

Providing consumer information and setting requirements for health care providers to the state are actions that government ought to be taking. The public health portion of the plan, however, which focuses on tobacco use and calls for a statewide indoor smoking ban, hints at some of the Hutchinson-Reed vision problems.

Sticklers for a systemwide approach to problem solving, Hutchinson and Reed seem to ignore that public health policy sometimes conflicts with a larger system of individual choice and property rights.

The conflict between public health and individual choice is even more evident when Hutchinson and Reed call for aggressive public health efforts to curb the "obesity epidemic," which, unlike a smoking ban intrusion on individual choice, isn't even supported by a crutch like "secondhand fat."

Aggregate benefits, but individual concerns. It is measuring and motivating physician quality, however, that really clouds the Independence Party vision. Pushing state-sanctioned quality of care objectives, like a 90-95 percent immunization rate, is a worthy pursuit on the surface, but such goals start from an efficiency perspective, not the "do no harm" principle.

A specific example — the past year has seen significant research supporting the theory that vaccines (containing varying amounts of mercury) given during the first six months of life can have negative neurological effects on some genetically predisposed children. Reed dismissed the immunization issue at a news conference, instead describing "best practices" for treating chronic diseases like diabetes, ensuring that every patient got proper care.

[Note -- following paragraph was edited for space in the column as published. Added here for clarity of the point.]

If a physician is graded for “quality” by the percentage of immunizations given, does he become a provider of information or a salesman for universal immunization? Does that not put some children at risk that do not fall within “normal” genetic parameters? What is a doctor to do with patients that can hurt his “quality” score by not vaccinating their children or requesting a delay in the vaccination schedule or, if pregnant, refusing a flu shot containing a mercury-based preservative? [End addition]

Kudos to Hutchinson and Reed for presenting a bold plan to address health care concerns, but it's a plan Minnesotans ought to evaluate very carefully. For all its good intentions and sound thought, the plan should not be accepted blindly.