When most Americans think about "health care," they probably think about medicine as a tool for health, about doctors and patients and hospitals, about discoverers, and so on--the stuff of life, health, and death. But when the health care industry thinks about "health care," the vision is different: Those inside the health care sector, if one recent "most influential" list is any guide, see health care as mostly consisting of politics and financing. No wonder Serious Medicine is getting the short shrift.
On August 24, ModernHealthCare.com offered its list of "100 Most Powerful People in Healthcare." The list is quite interesting--and revealing about what might be called the "Political and Economic Transformation of American Medicine"--with apologies to Paul Starr, author of the hugely influential 1984 book, The Social Transformation of American Medicine.
The ModernHealthCare list tells us everything we need to know about the way that health and medicine are perceived these days, at least by these inside players. And perhaps, if the list is an accurate depiction of the status quo, then the "100" tells us why health and medicine have fallen into such a morass.
The "top ten" on the list are all politics--all ten of the top ten work inside the Beltway. #1 on the list is Barack Obama, #2 is Kathleen Sebelius, and #3 is Nancy-Ann DeParle. Interestingly, that's three officials in the Executive Branch, before we get to two members of the Legislative Branch, Senators Max Baucus, #4, and Chuck Grassley, #5. Is that really the right power-ranking? To put Sebelius and DeParle--both unelected bureaucrats, in their posts for just a few months--ahead of two Senators, each of whom has more than 30 years of elected-office experience? As they say in Washington DC, the President proposes, and Congress disposes.
There are some other interesting choices on the "100." #6 on the list is David Blumenthal, "national coordinator for health information technology"--that's one of those jobs that seems obscure, until one realizes that all the whole spending-trajectory ambitions of OMB Director Peter Orszag, #9, depend on gaining control of America's health IT. Not just federal health IT, but American health IT.
But of course, health care is not just a Beltway battle; it's a battle of activists. So one sees names such as #10, Andy Stern of The Service Employees International Union, headquartered in DC's trendy Dupont Circle; although, of course, the SEIU is a major grassroots force.
And #13 is Bill Gates, of the Bill and Melinda Gates Foundation. Other interesting choices pop up on the list, including #24 Newt Gingrich, who is now (among other things) the president of the Center for Health Transformation in DC. And yet John Rother, EVP of the mighty AARP, is all the way down at #97. But for the most part, the "100" is dominated by health insurance company executives and hospital executives, and medical trade groups of various kinds.
Does this "100" list represent a true snapshot America's medical system? Oops, make that "healthcare," because "medical" and "medicine" seem to have gone out of fashion in the last few decades. "Health" is the more popular word nowadays--perhaps precisely because "health" slides the focus away from medicine and molecules and the Hippocratic Oath and all that toward a vaguer focus on medicine and a tighter focus on finance. That transformation was prefigured, in a way, by Starr's book, which is a great book, even if it is basically an attack on the medical profession and a call for the demotion of the healing arts. Twenty-five years later, medicine and healing have been demoted, but the big winners in the years since have not been politicians--as Starr probably hoped--but rather the financial types, the MBA's, and the Wall Streeters. Maybe the politicians will gain power in the years to come--that certainly is the Obama agenda--but if public-sector bean-counters gain power away from the private-sector bean-counters, it's hard to see how Serious Medicine will gain a whit.
As Jeremy Shane, a veteran health care expert, observes, "There's not a single practicing clinician or surgeon on the list. But it's the Faucis, Jarviks and Ventners of today and tomorrow who will shape health care as much as administrators and policymakers." That's Anthony Fauci, director of the National Institute of Allergy and Infection Diseases, and Robert Jarvik, the creator of the artificial heart, and Craig Ventner, the key discoverer of the human genome. Those are the kinds of visionaries that have, are, and will medicine the source of cures, and gives people hope for life. Fauci, Jarvik, and Ventner are apostles of Serious Medicine.
So the ModernHealthCare list is worth studying, not only for who is on it, but for who is not on it.