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Or, Why You Can’t Get There From Here.

The blog debate continues to rage over the arguments in Michael E. Porter and Elizabeth Olmsted Teisberg’s book, Redefining Health Care. For the uninitiated, these authors argue that health care reform should be about ensuring market competition that focuses on three principles: 1) the goal is value for patients. 2) medical practice should be organized around medical conditions and care cycles, and 3) results — risk-adjusted outcomes and costs — must be measured.

Distinguished policy wonks on the Health Affairs Blog have come out in force on the book over the last several months including James C. Robinson, Uwe E. Reinhardt, Alan Maynard, and Gail R. Wilensky. And they’ve been followed by notable contingent of commentators on related issues.

After digesting the book for a few months and taking note of the blogging frenzy, I’ve come up with my own “Top Ten Reasons Critics Say ‘Value-Based Competition’ in Health Care Won’t Work.” So here goes:

1. Their ideas are too politically naive and not realistic. (A conversation stopper by reality insiders.)
2. Health care is way too complex for these notions to work. (So many variables, so little time.)
3. The private market can’t and won’t do it. (What does Enron and single payer have in common?)
4. Fees and incentives rule provider behavior, not value. (We all know that right? Right?)
5. Health results are really damn hard to measure. (Gosh, this is tough!)
6. They don’t appreciate the conditions under which real health care decisions are made. (Emergencies don’t wait. But colonoscopies?)
7. The Medical Industrial Complex really doesn’t care about this adding-value-to-health-care crap. (O, ye of so little faith.)
8. The docs will never buy into value-based competition. (See #4.)
9. Consumers aren’t demanding value-based competition anyway. (Patients don’t read the memos or anything!)
10. Authors are annoying carpet-bagging Harvard professors too new to health care to be taken seriously. (Who do these guys think they are?)

There are other criticisms floating around but these top ten go a long way to persuade me that Porter and Teisberg must be on to something. Stay tuned.