Has Stifling Reasonable Dissent Hit Health Affairs? Much is made in the press that Americans are divided into camps and don't talk with each other. On May 23, 4 current and former MedPAC members published a dissent on the MedPAC MA recommendations. The authors concluded that MedPACs new model is incomplete and overestimates certain effects. It does not suggest that the current situation is copacetic; its a matter of degree. (Link in comment) On July 1, in a rebuttal to the rebuttal, 4 Health policy experts write that the rebuttal was wrong. I won’t belabor analytical details from the July article (I intend to follow up.) But in an example, the July article says MA is out of whack because plans report codes for CHF for a diabetic with that condition because the payment is higher. This is sadly outdated, just google the 2019 AHA scientific statement on the importance of treating to both so the medication is correct. I share my concerns about the July 1 conclusion below: First, the study says the Commission operates by consensus. The law only requires reporting individual votes. No Congressman would write a requirement for consensus (and I can personally validate the rationale for the language.) Second, it characterizes the May rebuttal as an “attack’ on MedPAC that was “highly unusual”. Why do the July authors say a disagreement is an “attack"? Strong word. Instead could they have not contacted or asked the May set "why did you make a rebuttal" and reported on that rather than say "unusual" (gaslighting term)? Finally, the July piece says the May rebuttal reflects the authors’ "normative values.” What does that mean in this context? Was it their desire to see "Medicare as a sacred promise”? Or, the premise of “holistic thinking”? A political comment? You got me. In contrast, Gail Wilensky and I wrote a letter to MedPAC laying out questions on the MA analysis this winter. We were received graciously by Chairman Chernew who followed up and spoke to us for an hour (even tho he was ill). I still have two questions and will lay those out in the later correspondence. #MedPAC #MA Eric Hargan Lisa Grabert Kenny Kan Abigail Chance Colin Yokanovich Gail Wilensky Brian DeBusk Matthew Hittle Brian Miller Craig Samitt, MD, MBA Charles Chapman
MedPAC’s chapters are not ‘peer reviewed’ in the same way that journal articles are ‘peer reviewed’ Yes, MedPAC does have reviewers, but those reviewers don’t have a chance to conduct additional reviews. MedPAC can accept or reject comments as it sees fit. That’s more of a rubber stamp process than true ‘peer review’. And I have experienced this as a reviewer of previous MA chapters during my time at AHIP.
Generally speaking, in an intentional dualistic society, we are often taught that dissent is an attack on the questioned party, and questioning within a group would be a betrayal to the authority of group and/or leader, leading to induced compliance.
Health Policy Regulatory and Legislative Expertise; Market Innovator
3whttps://www.healthaffairs.org/content/forefront/need-holistic-policy-thinking-medicare