Leaders, Not Laggards, On Health Reform

It has become a virtual tautology to say that the nation’s long-term fiscal problem is really a health care cost problem. But the unfortunate reality, so we are told, is that no one—no insurer, no state—has cracked the code on bringing health care costs under control.

That is, except a team of researchers at Dartmouth Medical School who publish the Dartmouth Atlas, a research project that has shown definitively that the growth in health care costs could be arrested if all health-care providers were to simply bring their spending in line with that of low-cost providers. The Dartmouth researchers have even found that patients who receive more care—through more frequent tests, procedures, and hospitalizations—have health care outcomes that are either no different or worse than those who are treated at places with lower costs.

Yet if one thing is known about Harvard Medical School’s two largest affiliates hospitals—Mass General Hospital and Brigham and Women’s Hospital, both owned by Partners HealthCare—it is that they are the poster children of the sort of fragmented and wasteful care that explains much of the rise in health care costs. For years, Partners had a sweetheart, handshake agreement with the commonwealth’s largest insurer, Blue Cross Blue Shield, to pay substantially higher reimbursements than other providers for performing the exact same treatments, according to a Boston Globe investigation.

It should be little surprise then that Partners hospitals have been consistently singled out by the Dartmouth researchers as cost villains. But until recently, it was scarcely known just how far Partners executives had gone to protect the status quo.

As former Wall Street Journal reporter Ron Suskind reports in his new book, “Confidence Men,” one of Dartmouth’s experts, James N. Weinstein, was invited by the White House to draft a section of the health care bill mandating comparative effectiveness analysis based on Dartmouth’s data. The proposal, however, was blocked by Senator John F. Kerry “under pressure from Harvard's noted medical centers, so aggrieved were they at how Dartmouth's effectiveness data had revealed flaws, inefficiencies, and unnecessary treatments even at the world's most noted hospitals.” The result is that Dartmouth’s name appears nowhere in the health care bill.

As Massachusetts’—and perhaps the country’s—preeminent center of medical education, HMS ought to expect its principal affiliates to be at the forefront of cost control, not using their influence to block important reforms. When he was appointed to his deanship four years ago, HMS Dean Jeffrey S. Flier told The Crimson that Harvard should be “forcefully engaged” in national discussions about health care reform, as it was a “complicated subject” where Harvard’s expertise could play an important role. And while some HMS professors—notably Atul Gawande, author of the debate-shifting New Yorker article explicating the Dartmouth data, and Donald M. Berwick ’68, the director of Medicare and Medicaid and a pediatrician who specializes in evidence-based medicine—have made enormous contributions to tackling this issue, HMS should use its clout and prestige to ensure that the Partners hospitals too are leaders rather than laggards.

Because, as Gawande made clear at his HMS Class Day address last spring, the stakes are simply too high. In his speech, Gawande recounted a conversation he had with superintendent of his children’s school district in Newton, Mass, which recently cut his children’s art class.

“You know what I spend my time working on?” the superintendent asked. “Health-care costs.” With the district’s health costs up 9 percent and revenues flat, program cuts were his only alternative.

That we’ve reached the day when health spending has crowded out arts programs for children is sad and portends an even dimmer future for this country if nothing changes. Tackling this challenge, an existential economic threat to this country if there ever were one, is something worthy of Harvard’s best minds. But lest Harvard forget, there is no better way to lead than by example.

Paras D. Bhayani ’09 served as managing editor in 2008, and June Q. Wu ’11 served as associate managing editor in 2010. They covered and supervised coverage of Harvard Medical School from 2008 to 2010, including during the national debate over health care reform.