Evidence-Based Medicine Examined

? Every Little Bit Helps

? Evidence-Based Medicine Examined

? Rules of the Road for HSAs

? Blues Promise National HSAs by 2006

? Docs Should Talk-Up HSAs

? HSAs Bursting Out in New York

? Dirigo Health Fizzles

Every Little Bit Helps

I thank you for your interest and support over the past year. It's always fun to meet readers when I'm traveling and hear that they enjoy this publication. The Galen Institute has its work cut out for it in the coming year and we hope you will consider supporting the effort with a year-end tax-deductible contribution. For the first time, we are able to accept on-line donations. A gift of any amount would be appreciated and would be the kind of vote of confidence that really matters.

SOURCE: http://www.galen.org/join.asp#online

Evidence-Based Medicine Examined

Twila Brase, the president of the Citizens' Council on Health Care in Minnesota, has issued a powerful review of the Evidence-Based Medicine (EBM) movement. Her paper, "How Technocrats are Taking Over the Practice of Medicine - A Wake-up Call to the American People," is a landmark analysis of the attempt to bureaucratize medical practice, which has been happening largely under the radar screen of most Americans. In 25 pages, with 226 footnotes, she explains how the underlying assumptions and practical applications of EBM will turn physicians into pawns of the payers at the expense of their patients. EBM assumes, for instance, that variation in medical procedures is inherently bad and should be rooted out so that all physicians do the exact same thing. It ignores that variation in patients may require variation in practice. It assumes that there is one best way to do medicine - and that we know what that one best way is. It ignores that medical knowledge is exploding and what seemed to be right last week may be wrong next week.

One of the most powerful arguments in the paper discusses the validity of practice guidelines, and notes, "In 2000, a group of researchers determined that more than 75 percent of the guidelines developed between 1990 and 1996 needed updating." Ms. Brase says that "they discovered that half of the guidelines were outdated in 5.8 years." Yet the development of guidelines is slow, cumbersome and expensive, taking as long as two years and costing as much as $100,000 - unless the government does it, in which case it costs $800,000.

The guidelines themselves are based on "research" that may be biased, incomplete or self-interested. Certainly we have seen numerous examples of research not getting published because it contradicts the claims of the sponsors of the research. Even the decision of what research to fund is often made for political, not medical, reasons.

Research is often contradictory. Hormone Replacement Therapy was found to lower the risk of heart disease in the Nurses Health Study, while the Women's Health Initiative study found that it increased heart attacks by 40%. But neither study can tell a clinician how to treat one particular woman with one particular genetic profile and one particular set of risk factors and co-morbidities. Population-wide information may be interesting, but it is no substitute for individual diagnosis and treatment. Relying on averages never works when dealing with individuals. In fact that may be the biggest problem with EBM - it is trying to standardize medicine at the very time when we should be customizing medicine so that each patient gets precisely the treatment that is best for his or her particular needs.

Still, research and guidelines for all their flaws can be very valuable in growing the knowledge base. The danger is not the research, but how the bureaucrats want to use the research. They want to control physicians who comply and punish those who do not through the use of financial incentives, malpractice exemptions, and even hospital privileges and licensure, all tied to compliance with EBM guidelines.

This is the polar opposite of consumer empowerment and choice. EBM advocates want only to empower themselves, and we all owe Twila Brase a hearty congratulations for bringing this to the attention of the American people.

SOURCE: http://www.cchconline.org/pdfreport/

Rules of the Road for HSAs

Another important paper and resource has been published by the HSA Coalition and authored by its president Dan Perrin. "HSA Road Rules" provides in 23 pages virtually everything one needs to know about the laws and regulations creating Health Savings Accounts. It includes sections on HSA eligibility, HSA deposits, HSA spending, and specific sections devoted to HSA trustees, employers and insurers. The material is all presented in numbered bullet points that make it easy to reference. It also includes tables on the "catch-up" provisions, investments, and allowable spending. It is a great supplement to the HSA Coalition's web page and vendor listings.

SOURCE: http://www.hsainsider.com

Blues Promise National HSAs by 2006

The "HSA Road Rules" couldn't come at a better time, as virtually all health insurers are launching HSA products. "AMNews" reports that Blue Cross Blue Shield will be offering HSAs nationally by 2006. The article by Robert Kazel says that 23 Blue plans are already offering them, but that will grow to 39 plans by the end of 2005, presumably with some national identity and marketing effort. The Blues expect a premium differential of 15% to 20%, which sounds low compared to other carriers. Kaiser Permanente, for instance, has reported about a 50% reduction in premium for its HSA-compatible product. The question, as usual with the Blues, is whether they are committed to the product or just offering a token to protect market share until this new annoyance passes over. In the article, Aon consultant Bill Sharon is quoted as saying, "Blue Cross has to have the HSAs or they risk losing HMO and PPO business they have." At least one Blue executive seems to "get it." Cary Badger of the Regence Group says, "Our research shows people don't want others to make decisions about their health care, except their physicians maybe." Hmmm. Maybe that means Regence will shun the Evidence Based Medicine movement reported on above.

SOURCE: http://www.ama-assn.org/amednews/2004/12/13/bisb1213.htm

Docs Should Talk-Up HSAs

Another issue of "AMNews" includes an editorial urging physicians to talk-up HSAs with their patients, and offering a new brochure from the AMA to help them do that. It says, "The brochure is a concise primer on HSAs. It explains how they work, what patients should do if they want one and their employer doesn't offer one, and gives sources of additional information." The brochure, "Health Savings Accounts at a Glance," may be downloaded from the AMA web site.

SOURCE: http://www.ama-assn.org/amednews/2004/12/20/edsa1220.htm for the article and, http://www.ama-assn.org/ama1/pub/upload/mm/363/hsabrochure.pdf for the brochure.

HSAs Bursting Out in New York

The "New York Daily News" reports "a burst of interest [in HSAs] now in New York." It says, "for 2004, the new HSAs were slow to catch on," but Mercer predicts that "in 2005

12% of all employers will likely offer a so-called 'consumer directed health plan,' most of which will be HSAs." (This "slow to catch on" expression is annoying. The "AMNews" editorial above used the same expression. Most people are predicting 2.5 million people on HSAs and another 2.5 million in HRAs by the end of 2004. What is slow about going from zero to 2.5 million in one year?) Still, the article quotes Carmine Morano, president of PerfectHealth, as saying, "We've undertaken more presentations to employers on HSAs since the beginning of November than we did during all the rest of 2004. We believe HSAs are the wave of the future in health care financing."

SOURCE: http://www.nydailynews.com/business/v-pfriendly/story/261426p-223898c.html

Dirigo Health Fizzles

Finally, those of you watching the train wreck of TennCare in Tennessee may want to check into the web site of the Maine Heritage Policy Center to keep your other eye on the fizzle of Dirigo Health in Maine. The Center issues a periodic "DirigoWatch" publication that explains the mind-numbing intricacies of the program. I won't take the time here to repeat it, but it will make you happy that you don't live or pay taxes in Maine.

SOURCE: http://www.mainepolicy.org/portals/0/Final%20DirigoWatch%20II.pdf (This is the Spring, 2004 issue. For some reason the Fall, 2004 issue doesn't appear to be on the web site.)

Please send all comments/questions directly to me at gmscan@aol.com.

"Consumer Choice Matters" is a free weekly newsletter published by the Galen Institute, a not-for-profit public policy organization specializing in research and education on health policy. Visit our website at http://www.galen.org for more information.

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The views expressed in this newsletter are the opinions of the authors and do not necessarily reflect the views of the Galen Institute or its directors.