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Likely presidential hopeful Tim Pawlenty urged a roomful of skeptical doctors Friday to be leaders rather than be dragged into what he sees as the future of health care -- giving consumers more information and choices and rewarding providers for quality over volume.
The former Minnesota governor was the latest politician to participate in the Health Policy Grand Rounds program that Dartmouth-Hitchcock Medical Center has organized for its staff during the past two presidential campaign cycles. Using Medicare and Medicaid as examples, he criticized the notion that government-run health care will produce efficiency and said the answer lies in empowering consumers.
"I don't like movements toward big government bureaucracies, particularly when we see the track record of the two we have," said Pawlenty, a Republican. "They're well-intentioned, but inevitably they become slow-moving, lacking in entrepreneurial qualities, lacking in flexibility, financially quite inefficient and ultimately insolvent. We need a different model."
He described his state's efforts to give financial bonuses to providers who meet quality and cost benchmarks for patients with certain chronic diseases, which he acknowledged was easier to do in Minnesota where the world-renowned Mayo Clinic sets the standard.
When an audience member asked him who would pay for the research needed to determine those benchmarks elsewhere, Pawlenty didn't answer directly but said the medical profession should take the lead in developing such standards.
"The best thing we can do is get the medical profession itself to be the curators and the caretakers and the custodians of those standards. I don't think you want the politicians to do it for sure," he said. "But it's gonna happen. This toothpaste is out of the tube. ... I would just encourage you to get out in the lead on that and not be dragged to it."
Several hospital staffers, including former U.S. Senate candidate Dr. Jay Buckey, took issue with Pawlenty's criticism of Medicare. Buckey, a Democrat, faulted Pawlenty for mentioning the growing cost of Medicare without pointing out that the program covers the sickest population, and one that is growing. And he pointed out that President Barack Obama's health care overhaul law calls for slowing the growth of Medicare spending.
Asked if he supports that aspect of the law, Pawlenty said Obama hasn't specified where the cuts will come.
"I frankly don't believe they're going to materialize in the real world," he said.
Dr. Ken Dolkart, who specializes in geriatric medicine, referred to a 2007 survey of 514 New Hampshire doctors in which 81 percent said they favor a single-payer health care system. Only one-third agreed that the free market system was the best way to create a high-quality, affordable and accessible system.
"Your comment about the wisdom of the marketplace and of the individual consumer applies to Fords and Cadillacs and lots of products," but not health care decisions, he said.
Pawlenty, who is expected to soon announce whether he is running for president, was wrapping up a two-day trip to New Hampshire, which holds the nation's earliest presidential primary and is seeing increased candidate traffic this month.
Health care also was a focus when former Massachusetts Gov. Mitt Romney spoke to Republicans last week in northern New Hampshire, with Romney contrasting the health care overhaul he signed into law as governor with Obama's law.
Asked by reporters to give his opinion on the Massachusetts law, Pawlenty demurred, saying at most "I just took a different approach."
"You guys just can't let this go," he scolded reporters.