RCP contributor Richard Porter joined the RealClearPolitics podcast on Tuesday to discuss his experience with an early-detected cancer in a post-Obamacare health care system, which he wrote about in his new piece: A Persistent Patient’s Story: Grail’s Galleri Test and the Cancer Business.” “Doctors today are employees of medical groups and hospital systems,” Porter said. “Before Obamacare, doctors, particularly specialists, tended to be entrepreneurs, and the hospital was a utility that merely rented out the bed.” “The industrial policy behind Obamacare was that we can control medical costs if we control the doctors,” he continued. “What doctors do today depends on two things: what gets reimbursed and what the government has approved as a protocol.” “At least in the cancer business-and my suspicion is that this is in other sorts of major areas as well-they now are in a color-by-numbers business,” he said. “The doctors don’t even know how it’s approved to be covered. Here’s the rub. There are no protocols for very early-discovered cancer.” “Doctors don’t like blood tests because the results are not always 100% accurate. There are false positives and false negatives. They want certainty, and blood tests don’t provide certainty-they provide indications,” he said. “How do hospitals manage risk? You make sure the care you provide is reimbursable, and you make sure doctors follow the government-approved protocol.” “And that’s what led me on my five-hospital-system journey, because they all wanted to give me the kind of care I would have if I had stage four cancer. I had so little cancer you could barely see it. And the good news is, I think I’m cancer-free. Knock on wood,” Porter said. RCP Podcast host Andrew Walworth asked: “So if Bobby Kennedy Jr. at HHS called and asked, what’s the public-policy change that would help facilitate a better result?” “I think the Right to Try Act for drugs is a good model,” Porter said. “That gave patients the right to try experimental drugs before they were fully approved by the FDA. And they would sign off, and by doing so, the doctors providing the care were protected against liability.” “Doctors don’t have an incentive to provide innovative care or to try things based on customizing it to your particular circumstances. We need to address the risk that doctors face when they provide care that’s unique and different, right?” “Plus, I think that the people who are donors to hospital systems need to understand that hospitals are inherently conservative organizations, and that you have to start thinking about this from a philanthropic point of view to incentivize creative solutions. In other words, innovation isn’t necessarily rewarded within the hospital system because it takes so long for things to be reimbursed,” Porter continued. “We need to create new incentives for innovation to customize care. You see ads all the time about, you know, we’re going to give you customized care. None of that’s true.” “In order to do that, we need to address the actual industrial organization, the way the hospital systems are set up, and the incentives, and fight against that both through some legislation to protect those who choose to pursue an innovative care approach, and then secondly to create incentives. They’re not necessarily market incentives. Maybe they’re reward incentives or sort of quasi-market incentives for doctors to try innovative responses to new developments.” “It’s your job to manage the doctor,” he said. “AI is a resource for patients. It’s a way to manage the health care system that’s trying to manage you.” “If you know what they know, you’re in a better position to ask intelligent questions.”
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