It may have been a little confusing for viewers last night on Emily Rooney's Greater Boston television show on WGBH. There we had a doctor from Tufts Health Plan debating a doctor from Tufts New England Medical Center about the insurer's decision to put restrictions on bariatric surgery.
This has been a controversial move by the health plan. I usually don't get into the "who won the debate" game, but four of us watching the show thought the Tufts-NEMC doctor won the night. In particular, he noted that THP's program conflicted with the recommendations of an expert panel convened by the Betsy Lehman Center for Patient Safety and Medical Error Reduction. This had been previously pointed out by Nancy Ridley, associate commissioner for the state DPH and director of the Center. The health plan MD was put in the position of saying, "Well, our evidence-based medicine is better than yours" -- not very persuasive against an expert panel than had met for months to review the situation.
Also, people are less inclined to believe an insurance company on such matters, anyway. Maybe that's not fair. But a friend viewing the show with me said, "They just want to make money by denying payment for treatment. That's all insurance companies ever want to do." Knowing the folks at THP -- and let's remember they are a non-profit with a long reputation for progressive policies in health care management -- I believe they have much better intentions than that. But this tv show demonstrated how difficult it can be for an insurer to win the public debate in these matters.
(Disclosure: BIDMC carries out bariatric surgery, and Dr. George Blackburn from our staff was intimately involved in the Lehman Center report.