Harvard's Big Heart for Primary Care

Harvard Medical School sure knows how to make itself look good. This week's news is loaded with reports and accolades for Harvard's new initiative to support primary care.


But Harvard's record on funding for primary care research and education is actually pretty terrible. 


Harvard Medical School educates very few primary care doctors every year - only 10% of their 2009 class went into front line medical care, and that's the lowest rate of the region's medical schools. By contrast, the University of Massachusetts graduated 39% into primary care in 2009.

Also, Harvard's recent history of funding for primary care initiatives is dismal. Just a little over a year ago, Harvard made news for eliminating funding for its primary care division. This action caused a stir just as the nation was gearing up for a vote on health reform. We now know that health reform included several provisions that will shift massive amounts of new funding to primary care research, education and practice.

This new effort is welcome, but it is not funded by the generosity of Harvard's big heart, or even by a small dose of creativity. It's the direct result of hindsight on health reform. HMS now sees major new funding streams coming down the pike through accountable care organizations (ACOs) and through new initiatives in training of primary care doctors. 

The upshot of this? If you are a primary care center in Massachusetts and you see opportunities for growth as a result of reform, you're on the right track. Community Health Centers, for instance, stand to grow substantially. But these centers must beware of competition from the 800 pound gorilla. Harvard is positioning itself to gobble up as much as possible of the region's anticipated new primary care dollars.

Health Care Stocks Rise on Death of Health Reform

In "Markets Salivate at Prospect of Healthcare Reform's Defeat," Ken Terry hits the nail on the head: http://industry.bnet.com/healthcare/10001627/markets-salivate-at-prospect-of-healthcare-reforms-defeat/ . He reports that "investors are pumping up healthcare stocks in the hope that reform will fail and that the free market will continue to push up health costs- and profits for the health industry." The Wall Street Journal reports separately that Pfizer and Merck stocks rose on investor "hopes for more concessions to be made in health legislation."http://online.wsj.com/article/SB10001424052748704561004575013480490353788.html?mod=googlenews_wsj

Where will these higher health costs and profits come from? Expect health insurance premiums to go up. Expect little help from the government or from the proposed center for comparative effectiveness research. The proposed center, whose intent was to compare alternative treatment regimens and suggest incentives for those that work best, will die with health reform.

I don't think this is what voters in Massachusetts had in mind yesterday. They wanted compromise on health reform, not open season on their wallets. Pharmaceutical and medical device manufacturers, hospitals, some insurers, and many medical specialists can celebrate. Their stocks are on the rise and healthcare markets remain almost entirely in their hands.

Does Brown's Election Signal a Compromise or an End to Health Reform?

I've heard it suggested that Scott Brown's election last night to the US Senate may bring about a new compromise on health reform. There is speculation in the NYT http://bit.ly/8jFTPd about a compromise that could bring Olympia Snowe back into the fold, or perhaps some effort that could bring both Snowe and Brown over to the reform camp. Presumably, Brown has to tack to the left to be elected again in Massachusetts, in less than two years.

But I don't see a compromise happening any time soon. Currently, no Republicans support the reform bills before Congress, and there is little evidence to suggest that the GOP will suddenly get religion.

Brown has suggested that states should be left to do health reform as they see fit. Snowe wants limited and perhaps no additional Federal involvement in the health system after reform. Neither of these positions can bring about reform of our system. Health reform in the US has to be predicated on one major change: everyone has to participate in the health system, at least at a minimum level. Without this change, "reform" isn't reform at all. Call me a pessimist, but I don't see this happening without increased Federal involvement.

If health reform fails to reach nearly every US resident in every market, the private suppliers of high cost health care interventions will continue to carve up markets, charge whatever they want, invent new "interventions" that have little chance of improving health, and over-treat unwitting patients with aggressive and unnecessary care. The "suppliers" I am referring to include (but are not limited to) pharmaceutical and medical device manufacturers, hospital systems and many medical specialists. It doesn't hurt that many patients want unlimited access to new medical technologies, whether they can improve health or not. All of the incentives are pointed in the same direction: toward newer and more expensive health care.

The suppliers of health care thrive on high cost and high tech interventions, interventions that are oversold to the American public. While some patients need new and expensive technologies, not all of us do. We are suffering from a technology binge in every corner of the US health system. Americans spend 16 cents of every dollar on health care, and the suppliers of high cost care won't mind if we spend 20 cents or more in a few short years.

As if on cue, Pfizer and Merck stocks rose on news that Brown had won the election http://bit.ly/6J07tO . Investors went to Pharma "on hopes for more concessions to be made to health care legislation." Concessions to Pharma? Is this what voters meant when they said they wanted more compromise?

I just don't see Brown or Snowe coming over to a health reform package that has any teeth. If a bill survives, it won't be strong enough to achieve anything meaningful. We should expect premiums for a healthy adult to rise well past $1,000 per month in a few years. That's what it will take to fund our voracious appetites for high cost health care.