A fan letter to Uwe Reinhardt

Dear Dr. Reinhardt:

This is a fan letter to Uwe E. Reinhardt.  Its 4:30 am on a snowy Saturday morning and my daily read led me to your most recent post to Economix .  It has been almost a year since I heard you speak at a national conference and was able to share breakfast with you.  I had read your articles for years and followed your thoughts as a national thought leader in healthcare. 

 The breakfast and presentation was a highlight.  Your ability to provide thought provoking content, difficult theory, and spot-on health economic theory with humor and a unique wit is amazing.  For someone who sat through their MBA economics courses in fear, you are a breath of fresh air and a motivation to dig deeper into the science of economics.

One paragraph in your most recent article really hit home for me:  “As we were fiddling late one night with an elaborate new fee schedule toward that purpose, an exasperated physician from Texas who served on the commission wailed plaintively: “Why are you doing this to us physicians?”[i]… “Because you insist on being paid piece-rate, Jim-Bob,” I explained. “If Princeton priced itself that way we’d be in the same soup.” Initially, the idea of members of the Physician Payment Review Commission (Medicare Payment Advisory Commission) fiddling with the fee schedule painted a very interesting picture in my mind.

As a former senior leader of a single specialty group practice, the fortunes or lack thereof for the practice rested with MedPac and the physician fee schedule.  The release of annual reimbursement levels was an annual milestone for forecasting and budgeting.  In the depth of fiscal planning the notion of a group of people fiddling adds a layer of common sense to a mindless and emotional exercise.

Dr. Reinhardt, your vitae defies anyone questioning your inclusion of a twinkle or giggle to healthcare economics and policy.  I started thinking and began to look through previous days, weeks, and months of meetings in my electronic day planner.  Hours and hours of talking coupled with reams of paper devoted to agendas, best practice models, and clinical and financial calculations blurred into swooshes of color on a flat screen.  All that work and the healthcare system remains disjointed and fiscal stability is like the Tonight Show game Stump the Band.  Rooms filled with intelligent men and women addressing issues that ultimately would mean life or death for the patient entering the health system.

All this brain power and quality and medical safety are still the brass ring just out of our reach.

You, Dr. Reinhardt, offer humor with a message.  As a devotee of your writing I wouldn’t recommend leaving your day job for a regular gig at Dangerfield’s.  If I had been a student under your tutelage the fear and pain experienced in school might have been absent.  The ability to take ourselves a little less seriously allows time to focus on the strategic issues.

Take my healthcare system.  Please!