Highlights of the 15th Annual Meeting and Clinical Congress of the American Association of Clinical Endocrinologists

April 26-30, 2006

Zachary T. Bloomgarden, MD

Disclosures

August 08, 2006

In This Article

Newt Gingrich Is Fascinated With Diabetes

Speaker Newt Gingrich gave the final lecture of the morning on the topic, "Transforming Life and Transforming Health."[5] He offered listeners both an optimistic view of the future and, perhaps inadvertently, a hint at coming challenges that may place further obstacles in the path of physicians caring for persons with diabetes. He chided doctors, along with scientists and entrepreneurs, for feeling "I am so busy doing what I do really well that I wish those stupid [government] people would stop bothering me." "If you know [what should be done] better than Congress and the CMS [Centers for Medicare & Medicaid Services] bureaucracy," then you need, Gingrich proposed, to actively create solutions. If endocrinologists do not create usable and appropriate guidelines, then they should "assume really stupid people are going to create them for you."

He went on to point out that he is "fascinated with diabetes." Diabetes is, to Gingrich, the largest single cost driver in Medicare and a "largely controllable" condition. We could, he suggested, less expensively improve the quality of people's lives if we knew how to deliver the control of lifestyle factors that cause diabetes and its complications. Such an effort would, however, require patients to "go through real change" to acquire correct habits and behaviors. The clear implication, which many who suffer from diabetes might find unwelcome, is that the individual developing diabetes has placed an expensive burden on society that he or she could have avoided with a different lifestyle.

He then began what at first appeared to be a fascinating diversion, asking the audience to ponder how many of the topics discussed this week would not have been possible 15 years ago, and suggesting that there has been an "amazing rate of change" in healthcare. This "scale of new knowledge unlike anything we've ever seen" will allow us to "acquire knowledge literally unthinkable 15 years ago." He suggested, however, that "real change requires real change," recalling Einstein's assertion that "doing more of what you're already doing" cannot lead to changes in outcomes. A focus on prevention, he suggested, "is a very important part of where we want to go as a country," and reinforces the importance of endocrinology to the future of healthcare. In the next 25 years, there will be 4-7 times as much science as we had in the past 25 years. In practical terms, 4 times "is as though you were sitting in 1880... no cars, no electric lights, no telephones, no television, no radio," while 7 times is "as though you were sitting with Sir Isaac Newton." Given the expectation that such massive change will continue, we should follow "a constant improvement model" rather than strive for "best practices." Information technology will, he suggested, allow much improved health records, and "extended real time, wireless capability" will allow persons to be "permanently part of an information flow" that will lead to greatly improved care.

Gingrich then returned to his main argument, making the surprising suggestion that these considerations imply that there will be "constant downward pressure on pricing." He declared this to be "not the same as deflation," in which money becomes more expensive. Rather, he stated, lower reimbursement rates should be expected and will reflect the true provision of less expensive services. "If prices come down everywhere around you," he stated, "the pressure to lower prices on healthcare" will be very high. There are other factors lowering reimbursement for healthcare services. Gingrich noted that "insurance companies take too much money for administration, lawyers take too much money for litigation," and these 2 groups account for 40% of healthcare expenditures. He urged physicians not to consider a national healthcare system as a solution, suggesting that such systems always become "underfunded," although his proposed solutions were somewhat unclear.

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