A Look At Howard Bauchner’s Wish List For 2021

December 28, 2020 By Michael D. Shaw @ HealhNewsDigest

Howard Bauchner, MD is Editor in Chief of JAMA, and posted an editorial entitled “A Medical and Scientific New Year’s Wish List.” Bauchner has a long career in academic medicine.

As regular readers of this column know, I am not a huge fan of academic medicine for a host of reasons. Many of these stem from the fact that it is owned by the government and Big Pharma, and can be counted on to promote the establishment viewpoint most of the time. As to the American Medical Association, although its public perception is as the voice of doctors, this is no longer the case. A significant portion of the AMA’s revenue stems from selling billing, coding, insurance, and other products. Needless to say, the intrusion of such items into the practice of medicine is despised by most practicing physicians—even if the younger ones never knew anything different.

The preamble to Bauchner’s piece takes an unsupported swipe at the outgoing administration’s attitude toward “science.” Apparently, inflated research budgets—or lack of results—are never to be questioned by those outside the hallowed halls of academia. He decries the heavy administrative burden that is a sad reality of today’s medicine, seemingly unaware of the AMA’s role in bureaucratizing the profession, and academic medicine’s fanboy embrace of the very electronic health records that he criticizes.

On to his ten wishes…

1. The first asks for respect for science. But, respect must be earned and not all contemporary “science” is worthy of it.
2.  An improved national response to the COVID-19 pandemic, in which he cites the usual platitudes and nothing more. Perhaps he could do something about the efforts to crush all dissent—whereby thoughtful physicians are regularly silenced.
3. A true national commitment to healthcare as a right and not a privilege. Older readers will recognize the “right versus privilege” distinction appearing in the vehicle codes of most states, emphasizing that being allowed to drive meant you needed to obey certain rules. In what fantasy world is healthcare a “privilege” in the US? One might argue that getting good care is a privilege, but what is “good care”? Perhaps Bauchner would create an AMA star chamber to rate all providers for their quality of care, while establishing a schedule of just how much healthcare per person is a “right.”
4. A national debate about a single-payer system. Oh yes, since Medicare works so well now, an even more gigantic bureaucracy would fare better. Notice he avoids the practical scheme proposed early on of the government only taking care of the hard cases, while reforming private insurance. Back in the day, the AMA was against the ideas of socialized medicine and Medicare, and they were right. How far the mighty have fallen.
5. Promoting the interoperability of electronic health records. Never mind that this was promised from the outset, and could have been achieved easily, but for the greed of the software companies and the stupidity of the government regulators. Now, he wants to take a mulligan?
6. Reducing administrative costs and eliminating barriers to healthcare access. Let’s see. Would the fulfillment of wish number four reduce or increase these costs and barriers? Has he really thought these through?
7. A national campaign to identify and treat every individual with hypertension in the US. Surprise! An actual healthcare idea. A good start would be offering a tax credit for purchasing a home blood pressure monitor, and encouraging people to use it every day.
8. Broad agreement on a limited number of high-priority national outcome measures. Population health under another name. Sounds great to the uninitiated, but discourages physicians to consider individual differences, and can lead to overtreating various chronic conditions (hypertension and diabetes, to name but two).
9. A greater appreciation that simply creating more knowledge (and science) does not necessarily improve health outcomes and may exacerbate health care inequities. While I agree with this wish, doesn’t it seem to contradict wish number eight—at least in part?
10. That the US returns to a time of civility, healthy debate, and respect for the opinions of others. However, how much respect does the AMA have for the opinions of practicing physicians, including those who don’t accept the revealed wisdom of those officials in charge of our pandemic response? Under what forum does this “healthy debate” take place in today’s cancel culture? Will he defend Dr. Michael deBoisblanc? (Editor's Note: Make sure to follow the link.  RK.)  If not, his tenth wish is just more disingenuous posturing.