An open letter to Don Berwick
I was really glad when President Obama chose you to lead the Department of Health ad Human Services. First of all you’re a pediatrician; that means you chose to forego the higher income specialties to provide primary care to children. Then your work with the Institute for Healthcare Improvement was also a step in the right direction; except you didn’t step far enough.
You wanted to establish a way to pay doctors, not just for services, but for good services. You wanted better results from the system. You wanted to instill some accountability. Your arguments and wishes were given a big boost when the Affordability Care Act included the establishment of Accountability Care Associations–groups of health care providers who would provide this better care, and get paid more for it.
The way you intend to insure the better results is to make sure that best practices are followed. That sounds good too.
But it begins to sound familiar. A few years ago we had an educational crisis that we resolved by making schools and teachers accountable. That sounded good too. We started doing a whole lot more testing to make sure that the students were learning what we thought they should know. Now students are taught to the test, other programs are sacrificed, and principals and teachers are caught cheating to make their scores better. Indeed the whole program was built on one of President Bush’s favorite Houston schools, that was later found to have been cheating. And now it appears you are heading down the same road in healthcare, and if you think that educators are the only ones cheating and gaming their system talk to some of the experts in your own fraud department.
It is a general conclusion that No Child left Behind is a miserable failure. Please don’t take us there in the health care professions. We have had our fill of gaming the endless regulations the government has put on the profession in the attempt to control costs. More regulation, more testing, more ‘best practices’ and evidence based medicine is not going to get us there; it’s going to spur the gaming, just as it did in education.
What will get us there is finding a way to empower the American people with the information they need to make wise health care decisions and the financial ability to execute them. In nature we see very soon that the health of an ecosystem is reflected best by its diversity. The diversity and the health of our health care system would be effectively destroyed by regulated best practices and evidence based medicine. I don’t think that is what you want.
The need to take the bigger step to realizing what we are dealing with in these decisions is outlined more fully in The Boids and the Bees: Guiding Adaptation to Improve our Health, Healthcare, Schools, and Society, published by the Institute for the Study of Coherence and Emergence and available at their web site, www.emergence.com
Lon Jones DO