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Former Rep. Talks About Health Policy

BySanjay Basu
Staff Reporter

Former Massachusetts State Representative John McDonough discussed the future of health policy in America, during an evening lecture sponsored by the MIT Medical Congress.

McDonough, once Chairman of the Senate's Joint Committee on Health Care, announced his opinions on Medicare, HMO's, and the Clinton Health Plan to the small audience in attendance.

"Health policy is my life," he said as he began his talk. After turning away from the public spotlight and becoming a professor at Brandeis University, McDonough began analyzing the ways public policies work and don't work.

What he found, he told the MIT audience, was that the public often looked at health policy issues through a distorted lens.

"The American people want more benefits but they don't want to pay for them," he said. "This is the dilemma of the American policy-maker."

McDonough cited several statistics reporting the American public's desires for Medicare reform. The wish list includes payments for prescription drugs, long-term care coverage, and reduced age of eligibility. Statistics also show that Americans wanted these improvements without a tax increase.

Lecturer challenges public opinion

Though the audience passively listened to McDonough's historical reports and spreadsheets of statistics, eyebrows rose when the former Congressman began discussing his perspective on managed care.

"People talk about managed care and HMO's," McDonough said. "I would argue that the real quality problems have little to do with managed care."

"The real problems - the scandalous problems--have to do with the way we structure our approach to medicine."

McDonough then justified his unpopular opinion by citing what he called the "overutilization, underutilization, and inexplicable variation" of health services in America.

"While C-sections are performed even when they are not needed," he stated, "other health services, like the prescription use of beta-blockers against heart attacks, are almost never used."

"Some places even use different procedures at different rates, creating variation in health services for no reason. While some places use a lumpectomy instead of a mastectomy to treat breast cancer patients, others do the reverse. Both treatments are just as effective, but lumpectomy's are must more cost-effective and less invasive."

McDonough continued by comparing the health care industry to other industries in America.

"We're going to see a growth for health care inflation for the next few years," he said. "It won't be as bad as in '93 and '94, but it's still inflation."

McDonough also discussed his concerns about health access, stating that over 43 million Americans currently have no health insurance.

"Cost, access, and quality are our three big problems," he said. "And they're big ones if the health care industry was the airline industry, we'd have two jumbo jet crashes everyday."

"So what do we do about it?" he asked

Speaker discusses possible reform

McDonough said that the biggest task for policy makers of the future is dealing with the vast number of uninsured families in America, though that may not be a popular topic to discuss in Washington.

"We have reached a national consensus that requiring employer mandates that force employers to provide health care coverage is not a politically acceptable idea," McDonough said. He also said that virtually every candidate running for political office this year avoided the issue altogether.

McDonough also wants to "modernize" and "stabilize" Medicare, though he discussed the issue only vaguely.

"Medicare will go broke by 2008 and we need to bring it up to speed," he said. "It's funny that everyone is focusing on social security, because that program has at least another twenty years."

When questioned by the audience about his plans for the program, McDonough would only say that he and Congressman Ted Kennedy were considering a number of new avenues to help "make the program work."

"One of the problems we face is paying for prescription drugs. Because science is advancing so rapidly, new drugs are being pushed down the pipeline at an incredible rate."

McDonough then returned to his discussion of HMO's. Though he earlier stated that HMO's do not cause the main quality problems in health care today, McDonough did specify that managed care needs to be regulated on a larger scale.

"What will be the national standards on managed care?" he asked. "We still haven't created enough national standards, including ones about denying medical treatment, paying for specialists and specific procedures, and suing HMO's."

McDonough ended the discussion by briefly discussing the Clinton Health Plan, which he called "a fiasco."