Wednesday, May 25, 2011

The Offer They Won't Refuse

"Hello, Doctor Johnson, this is Madam Secretary."

"Nice to hear from you Kathy. What can I do for you?"

"I enjoyed our last get-together, Dr. Johnson. May I call you William?"

"Please do."

"Thank you. You know, William, we've appreciated your contributions to our various health care initiatives over the many years and we've reviewed your public policy statements on the cost of Medicare and the waste inherent to the system. Brilliant work, really. Seeing that you're a tenured professor at the University of Greatness with such national prominence we thought we could turn to someone with such an impressive set of credentials and publications. Add to that, your contributions to the President's campaign haven't gone unnoticed."

"Thank you, Madam Secretary."

"William, let me cut to the chase: we're in need of like-minded individuals like you that see the value in preserving Medicare as we know it. Thanks to your efforts in the past, the President and I thought you'd be a perfect candidate to sit on our Independent Payment Advisory Board for the next nine years to help guide us to better health care with lower costs."

"Seriously? Me? Oh. My. Goodness!"

"Yes, William, that's right. And this position, as you and I both know, will make your tenured position at the University of Greatness look like relative chump change. Press releases, life-long consultancies, the works! And your salary? How does a million bucks a year with annual cost-of-living adjustments, coverage of your travel and moving expenses, and guaranteed unrestricted health care for you and your family for the rest of your lives grab you?"

"Seriously, Kathy? I had no idea that the conversation that last cocktail party would come to this! I'm looking forward to shifting our emphasis from providing so many options to people that are so expensive to standardizing care. Like all those drug-eluting stents in cardiology when bare metal ones can do the same job..."

"It'll be your chance to shine, William. And best of all? No. One. Can. Touch. You. No independent or judicial reviews. You won't have to take any more crap from anyone! And Congress? If they fail to act on any of your recommendations, bang-oh, they're enacted. (Snickering now) When was the last time you saw Congress agree on anything? (Laughing together) That, sir, is power personified! We're making this offer to only fifteen people, William, and with all of your impressive credentials, you are one of 'em!"

"But Madam Secretary, to be fair, I don't know anything about most of the other specialty fields out there. I'm just a pediatrician - and one that hasn't been practicing clinical medicine for the past 10 years... What will my colleagues say when I take a position on stents? I mean, I respect doctor Frigamafratz's position on the need for less stent thrombosis..."

"William, don't worry, you can still make them part of a special 'Presidential Advisory Panel.' You know the drill: put 'em on a panel and let him feel all important - like he's part of the solution! But it will still be you making the call! Get it? And as far as the other regular cardiologists out there are concerned, how are they going to compete with your presence next to a podium with an American flag and the symbol of Asclepius emblazoned behind you on TV?"

"Heh. Yeah. I love the way you think, Kath! What was I thinking? Very efficient, really. A fantastic board with national impact almost instantly! Amazing. When can I start?"



shadowfax said...

Got a few errors of fact here. First of all, they won't be making $1M/yr -- they come in at a civil servant wage of $165,000 (on the 2011 scale). That's well below what most any of them could make in the private sector. Worse, they are full time government employees, which means that they are prohibited from accepting any outside employment or fees for the duration of their appointment. Oh yeah, and they need to be confirmed by the Senate. That'll be fun, won't it? Also, terms are six years, not nine, though they can be re-appointed to a second term.

I'm sure you'll update the post with those corrections.

So, you have to take a six-year break from your career, move to DC, take a major pay cut, can't practice medicine or moonlight or take any consultancies, endure a grueling confirmation process that may take years. And for that you get to ... be part of a panel making recommendations which may prove hugely unpopular, and may be over-ridden by congress. Sign me up!

A number of policy folks have wondered whether we'll get anyone willing to take that job, let alone anyone qualified.

source: KFF report (PDF)

Note: the KFF report says only the chair needs confirmation by the senate; it's been reported in other places that all members need to be confirmed. I don't know which is correct.

DrWes said...


Thanks for your corrections on timelines and salaries for the IPAB in my satirical piece. I'm not sure I feel better after reading them, though.

A few facts that are correct in the piece: (1) The IPAB will be "15 full-time members appointed by the President and confirmed by the Senate" who are supposed to know all about all the best approaches to manage care amongst all of the specialites and subspecialties in medicine (same source you site), (2) and from the same source: "it would appear that medical professionals, patient advocates, or policy experts who are otherwise employed on a full–time basis would not be permitted to serve on IPAB." In other words: policy wonks will be driving our bus. Should doctors be happy with this construct?

Worse, what kind of policy makers will look forward to this thankless work for $165,000 per year?

Jodi said...

I am not sure the salary or other job details are the real problems. There are plenty of people who are strictly ego driven to take those positions, especially those close to or at retirement age who have made all their money and would love to have six years with no call time.

And they will not find people who are "qualified" because nobody is qualified to make blanket decisions for millions of people - because it's not a rational way to manage the problem.

Tim said...

And who will police the Health Care Police? We've already seen that some "Best Practices" under Medicare are wrong! Jerry Groopman of Harvard said he knew that there were bad requirements because, as he said, "I wrote some of them!" I'm sure I'm not the only one who will refuse to practice bad medicine just because the government/insurance company dictates it!.