Global payment and fee for service: They've been to the mountaintop

As a 13-year-old Jewish boy in April 1970, I read aloud and lectured to the congregation on the biblical rules telling the priests, who served as doctors, how to diagnose leprosy and other skin problems, in Chapter 13 of Leviticus. In ancient times, the Levites served as teachers, doctors, and medical assistants. They'd been chosen for those roles because of the good judgment, loyalty, and mettle they'd shown in times of hardship.

Nowadays, our best teachers and healthcare professionals are often secular. Paul Levy, for one, may or not genuinely be a Levite. And he certainly doesn't spout much dogma. He has certainly been tested; the job of a hospital president may be the most complex job. And Beth Israel Deaconess Medical Center, where he played a starring role, is an excellent place for a patient visit or inpatient stay - but it's tough on its presidents.

Paul will speak on Thursday, April 12 in Boston about his politically incorrect views on global payment. Some of his earlier thoughts on global payment have clashed with current dogma. The talk will be part of a conference on payment reform, organized by the Massachusetts Health Data Consortium. Joining Paul will be the deliciously tart Dolores Mitchell (on a later panel on cost control), fellow contrarian and CEO Charlie Baker, and other insightful speakers who've been to the mountaintop, so it should be very thought-provoking.

A strong step in the right direction: What Massachusetts Voters Did Not Say

Here's my letter to the editor after the election of Scott Brown to the U.S. Senate:

Massachusetts citizens have consistently supported the state's universal health insurance law. The most recent survey, in September, found that 79% want the law continued. The law has the support of Republicans and Democrats, including some prominent ones. The Republican front-runner in the gubernatorial race, Charles Baker, calls the law "a strong step in the right direction" and indeed, calls for expanding services, according to his campaign's website. Sen. Scott Brown voted for the law as a state senator, and in his recent campaign for the U.S. Senate, did not ask for its repeal. Republican Governor Mitt Romney signed the bill into law. Massachusetts' Republicans and Democrats generally support the law.

The meaning of Massachusetts voters' election of Scott Brown to the U.S. Senate is unclear – but it clearly does not show general dissatisfaction with universal health insurance as it is in effect here. It would be a tragic mistake, harming the health of tens of millions of Americans, to conclude that Massachusetts residents have spoken against expanded health insurance coverage.

Read Dr. Atul Gawande's opinion on the effects of Massachusetts’ near-universal health insurance coverage.

Advice: Forward this to your U.S. congressman.