A repeat of history sent local healthcare expert back into the fray
By David Gulliver - posted 12:15 p.m. Wednesday, Oct. 7
A quick quiz: Name someone who has brought together doctors and insurance executives, hospital chief executives and university professors, business consultants and nurses, all in support of healthcare reform.
The answer: Not President Obama, in this case, but Clifton Gaus, who lives on quiet Anna Maria Island.
It might seem like a bit of a miracle until you understand Gaus’s background. He served as a healthcare official under Presidents Nixon, Ford, Carter and Clinton, including a turn as the director of the Agency for Health Care Policy and Research, now the Agency for Healthcare Research and Quality.
As such, his job was turning medical research into better care in American hospitals -- something being called “comparative effectiveness research” in the current healthcare debate.
In the early 1990s, the agency published guidelines that some back surgeries were ineffective and could do more harm than good. A Texas congressman, reportedly prompted by physicians, pushed to kill the agency’s funding and the guidelines program.
So when he saw comparative effectiveness once again assailed, this time likened to bureaucrat-restricted care, it spurred him to get out his rolodex.
“If there was any one thing that stimulated me to do this, it was the distortions the detractors were conveying,” Gaus said in a September interview.
“To compare that to rationing is just flat-out dishonest,” he said. “It is one of the most promising ways of lowering the increases in the cost of care.”
One example is how the leading methods of treating prostate cancer show little difference in effectiveness, though each grows exponentially more expensive than the last.
During the summer, he began talking to the contacts he developed in his career, both in government and as chief executive of insurer WellPoint, and set up Health Reform USA.
Then he worked up a letter calling on Congress to act, and not be distracted by the vitriol of the summer town hall meetings. (Read the letter and learn about his group here.)
“We are extremely concerned that a small but vocal minority of people in the current debate have misstated and distorted numerous facts in an effort to scare our citizens. This is unconscionable and you must not be distracted from the task at hand.”
The letter laid out a number of those distortions and countered them, leading with the one that Gaus knew well.
The bills, he wrote, “do not allow the government to ration healthcare. To the contrary, they promote the use of Comparative Effectiveness Research to give doctors and patients more information about the latest research so that patients can get the best care available. How can anyone be opposed to giving physicians the best information available to treat patients?”
The letter does not endorse any particular method or means of addressing problems in the system, but lays out key policy changes that all signers agree must be included., such as covering the uninsured, increasing competition in the insurance business, increasing preventive care and financing the improved coverage with contributions from all participants -- patients, employers, insurers, hospitals, doctors and drug companies.
Then he turned to his contacts. The early co-signers on his letter include some of the best-known names in health care.
- Donald Berwick is president of the Institute for Healthcare Improvement, known for its groundbreaking (and sometimes criticized) “100,00 Lives” campaign on reducing medical errors.
- Larry Lewin is founder of the Lewin Group, whose study on possible job losses resulting from the reform bills is frequently cited by opponents of the reform bills.
- Uwe Reinhardt is a Princeton professor and perhaps the nation’s leading expert on healthcare costs, whose work we’ve noted here. Judy Feder of Georgetown is another leading researcher.
- Elliott Fisher heads the influential Dartmouth Atlas project, which documents how the same types of care can cost vastly more in different parts of the country, and surgeon and author Atul Gawande popularized that work in an influential New Yorker article. (We've cited it in the primer, linked above, and here is a direct link.)
Other notable signers are Charles Kahn, president of the Federation of American Hospitals, Dr. James Block, former president of Johns Hopkins Hospital, two former executives from Kaiser Permanente and consultants from think tanks like RAND Corp.
The letter immediately received notice when President Obama cited it in multiple speeches. And Gaus is encouraged that the Baucus bill incorporates several of his group’s policy goals, like comparative effectiveness.
“It’s clearly a thoughtful bill for starting to get a handle on the costs of care,” he said.
After seeing healthcare reform founder when he worked in the Nixon and Clinton administrations, he said he believes this attempt will bring at least some improvement. “Everything we need to enact health care reform is in one or another of the bills. They just have to put together the pieces.”
Asked about the recent Census surveys estimating 45 million people uninsured in 2008, Gaus recalled his days as a graduate student, when he sat in on the hearings that resulted in the Medicare program . “Nobody age 65, nobody, had health insurance. Just imagine what a catastrophe that was,” he said.
