Viewpoint from Beth Haynes, MD – BRI Medical Director

February 14, 2019

Recently I sat down to write a short comment on the recent HHS plan to tackle one aspect of rising pharmaceutical prices. In trying to comprehend this one small piece of our healthcare economy juggernaut, I was impressed yet again by the complexity of moving parts.
Anyone who tells you they know what will happen is lying or deluded.

An uncounted multitude of complex (and frequently contradictory) regulatory and legal requirements attempt to steer the operations of Medicare – which are different from regulations and laws directing Medicaid, which are different from those on private companies. And within private companies, there are different rules for profit and non-profit entities, and for the many subcategories of each. The result is that any one action (such as a change the regulations of one sector) sets off an unpredictable and uncontrollable cascade of reactions and interactions like a gigantic multidirectional, perpetual Rube Goldberg machine. (You can begin to see what I mean by reading this white paper: “Prescription Drug Pricing: An Overview of the Legal, Regulatory and Market Environment.)

So what can we do?

In the ER, when faced with a catastrophic emergency which requires immediate action in the face of limited resources often with inadequate information, the proper response is to get back to fundamentals. Identify and focus on the sickest yet still salvageable by stabilizing vital functions, conveniently referred to as the ABCs: Airway, Breathing, and Circulation.

In medicine, we have rigorously identified those fundamentals (though not without controversy and disagreement). This country is nowhere close to agreement on the fundamentals of economics and healthcare – the clarity of which we desperately need to guide effective change.
What are the primary, inescapable laws of economics to which we must adhere in order to have a healthy, functioning economy? What essential ethical (personal, social and political) principles should guide first our triage, and then our subsequent actions to facilitate a peaceful, prosperous society, and within that framework, medical care?

Until these questions are adequately addressed, any changes made in healthcare policy will be arbitrary, random, and rudderless.

There’s no answer that fits in a brief essay except to call for civil and thoughtful conversations aimed at open and honest inquiry into these most important matters.

THIS is BRI’s mission. Let’s keep inviting others to join us in this most important task.

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