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Return of the Health Care Villains
Don't let the bums who killed Hillary's plan play the same tricks all over again.
The Washington Post reported Tuesday that $1.1 billion of President Obama's stimulus package will be spent on something called "comparative effectiveness research" in health care. The idea is to look at different treatments and see which ones work better or work just as well for less money.
"Comparative effectiveness research." What a concept! Can there be any product or service sold anywhere in the world except for health care in the United States where they even feel they need for a fancy term for this? In the rest of the economy and the rest of the world, when you look at the pricetag before you buy something and ask yourself whether it's worth it, they call this "shopping." Eskimos have 23 words for snow. (Yes, I know, they really don't, so humor me.) That's because they've got so much of it. And when the American health-care industry sees common sense, it's such a strange sight that they need to invent a term to describe it. Comparative effectiveness research.
Telling people they can't have treatments that are proven wastes of money isn't rationing. It's sanity.
And not just that: It's actually controversial. You probably think that if you visit your doctor with a bunch of symptoms that aren't wildly unusual, and he or she is able to diagnose what's wrong with you, what happens next will usually be pretty clear: The doctor will prescribe whatever treatment has worked best for others. A country of 300 million people is a permanent floating controlled experiment. Or it would be if anyone collected and compared the results. But no one does. Kaiser Permanente, the country's largest HMO, keeps records of its own patients, their treatments, and the results. And "outcomes" data also plays a big role in Britain's National Health system. But in this country, most of this valuable information is never collected and never analyzed.
Hillary Clinton's health-care plan 16 years ago included a provision for collecting outcomes data. Opponents misrepresented this as a massive invasion of your privacy, and it helped to kill that effort. Another charge about keeping outcomes data is that it will lead to rationing. People will be told they can't have the pill or the surgery they want because it is too expensive and outcomes data show that it doesn't work. Or it works no better than some other therapy that is cheaper. I suspect that this latter concern is realistic. But the notion that it can be avoided is not. Telling people they can't have treatments that are proven wastes of money isn't rationing. It's sanity. And refusing to find out what doesn't work, for fear that we will be told we cannot have it, is doubly nuts.
The problem will arise when an expensive therapy turns out to be, not worthless, but just a tiny bit better than a cheaper alternative. At that point some agonizing decisions will have to be made. But isn't it better to make them with knowledge than in ignorance?
There are people who think that comparing therapies and finding out which ones work better than others is a bad idea. Betsy McCaughey, for instance, identified in the Post as a "fellow at the conservative Hudson Institute." McCaughey told the Post that comparative effectiveness research "treats health care the way European governments do: as a cost problem instead of a growth industry."
Now there is a woman who sees the glass as half-full. Half-full of what, we can only speculate. Which is more fatuous? Is it her use of "European" as an all-purpose pejorative, when the Europeans spend less on health care and live longer than we do, drinking and even smoking all the way? Or is it the notion that inexorably rising costs equals a "growth industry"?
She almost single-handedly killed Hillary Clinton's health care reform a quarter-century ago by writing an influential article in the New Republic in which she charged that Hillary's plan would force people into health-maintenance and preferred-provider insurance programs where they wouldn't be able to choose their own doctors. This wasn't even true. What was true, though McCaughey seemed blissfully unaware of it, was that when her article was published, private employers—including the New Republic itself—were pushing their employees into HMOs and PPOs as fast as they could. Almost nobody anymore—except for the elderly on Medicare (and not even all of them) can choose his or her own doctor, at least not without paying extra if that doctor is not part of your employer's chosen-provider network.
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Lloyd Grove is editor at large for The Daily Beast. He is also a frequent contributor to New York magazine and was a contributing editor for Condé Nast Portfolio. He wrote a gossip column for the New York Daily News from 2003 to 2006. Prior to that, he wrote the Reliable Source column for the Washington Post, where he spent 23 years covering politics, the media, and other subjects.
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Michael Kinsley is a columnist for the Washington Post. He was founding editor of Slate. He has been editor of The New Republic and Harper's, editorial and opinion editor of the Los Angeles Times, American editor of The Economist, and managing editor of the Washington Monthly. He has written for numerous publications including the Los Angeles Times, the Wall Street Journal, the New Yorker, and Condé Nast Traveler. For six years he was co-host of CNN’s Crossfire.
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Michael Kinsley is a columnist for the Washington Post. He was founding editor of Slate. He has been editor of The New Republic and Harper's, editorial and opinion editor of the Los Angeles Times, American editor of The Economist, and managing editor of the Washington Monthly. He has written for numerous publications including the Los Angeles Times, the Wall Street Journal, the New Yorker, and Condé Nast Traveler. For six years he was co-host of CNN’s Crossfire.
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Michael Kinsley is a columnist for the Washington Post. He was founding editor of Slate. He has been editor of The New Republic and Harper's, editorial and opinion editor of the Los Angeles Times, American editor of The Economist, and managing editor of the Washington Monthly. He has written for numerous publications including the Los Angeles Times, the Wall Street Journal, the New Yorker, and Condé Nast Traveler. For six years he was co-host of CNN’s Crossfire.
Thanks for pointing out the fact that almost everyone with so-called "private" insurance is actually enrolled in a sort of HMO. Most of us pay big deductibles. We are told which doctors we may choose, which medicines we must take and if we want a doctor, treatment or medicine not covered, we must pay for it ourselves. I wish people would stop listening to Harry and Louise.
The data shows that 75% of our health care dollars are spent during the last year of life. So your solution to health care is to let these people die and our expenditures on health care will be on par with European nations. Compariative effectiveness is code for rationing. Good luck with this notion. And, oh by the way you are not an expert on health care. That is obvious from your article.
Having worked in the medical field for many years, I thought we had such a system. It is called "The Medical Literature". Doctors are trained using a null hypothesis method of decision making. Hundreds of studies are done every day and are readily available to doctors who then exercise their discretion. Your system will require doctors to use the decision of the same people who run the Post Office.
What we are headed for is a two tier system. Everyone will be covered and you will be subject to the Post Office system of medicine, unless, like in the UK where 40% buy private coverage, you can buy your own. Their NHS system recently bought private insurance for its own employees because even they couldn't get in to see a doctor and NHS rationalized the private care kept the lines moving faster. Those old "rich" will buy their their own coverage. This will spark an even greater class warfare than Obama is trying to spark now.
My 81 year old mother needs a knee replacement. The doctor told her it is either that or a wheel chair. Her chances of getting that care under your system would be very slim. She would deteriorate and fade away. Maybe that is how they plan to fix Social Security.
As a healthcare entrepreneur, I can't wait. The opportunities to provide private care will be robust. However, the human suffering and death caused by decisions taken out of the hands of your doctor will be heartbreaking.
Ah, healthcare, where to begin? "Comparative effectiveness" may be preferable to "cost-benefit analysis" because it sounds more expensive already. There are several ineluctable factors that contribute to healthcare's status as a "growth" industry. Treatment of chronic disease accounts for roughly 2/3 of all healthcare costs, siphoning resources away from routine preventive care. This is the primary healthcare dilemma. R&D costs for new treatments are the second dilemma, and have the same negative impact on primary care. Addressing these two issues reminds me of the old adage- We're too busy fighting alligators to remember that our job is to drain the swamp.
Finally, the law of supply and demand is always in effect. If demand for a cure is insatiable, as it often is when survival depends on it, and supply is very limited or nonexistent, the price is exorbitant. All the "comparative effectiveness" analysis in the world isn't going to change that.
How do you begin a conversation with someone who
believes that health care is not a right
but a privilege?
Apparently, only the wealthy
deserve to see a Doctor.
Our shameful and corrupt
system is a monstrosity
that protects vested interests
who treat people like ATMs.
Keith Olbermann
did a very interesting segment
on Ms. McCaughey
This Daily Beast will not accept the link
But go to MSNBC/Countdown
February 12, 2009
Ritarita, I'm very interested in why TDB would not accept the link. Did they give you a reason?
The problems with our health care system can all be traced back to a single development---the tax free provision of health care by employers. Created by that one provision is a set of transactions that create all the wrong incentives. First of all, instead of a simple indemnity policy for low risk, high cost occurrences (coronary, cancer, disabling or severe injury...) almost all Americans have two component coverage which includes a prepaid health care plan. It's that prepaid care that makes premiums so costly. When employers select coverage, the most important factor is cost, so long as policy provisions are not sufficiently parsimonious that employees would leave. So insurance companies have to compete on the basis of premium pricing. Then after they win business, the insurance company is faced with the challenge of staying in the black. Since the premium was trimmed to sell the coverage, the only way to stay solvent is to hold down the amount of care that is actually consumed. To accomplish that, the insurance company hires "benefit managers" whose job is to say "no" to all but the most routine and inexpensive care. It's called "managed care" and if we go to a nationalized system, we'll have a LOT more of it. The only change will be that the insurance company bureaucrats will be replaced by government bureaucrats. Think VA hospitals.
As both a healthcare provider and consumer, I believe that the reform is needed ASAP. For two decades, the Health Insurance carriers have defrauded both the patient and their doctors, by refusing treatments to the former and payments to the latter.
That a universal healthcare plan, if run by the government, would prevent you from seeing the doctor of your preference is a deceitful argument. Under the current plans most Americans have, you can see only the doctors who are "in the network"; seeing a physician you may prefer could cost you a bundle in 'copay' if he/she is "out of network". The same goes for medication, and most recent drugs are "non-formulary" in most plans, and you'd pay almost the full price if that's what you're prescribed.
So, please don't show me the disinformation in the Harry and Louise ads the insurers ran 16 years ago. While the patients don't get treatment, and doctors aren't paid, the CEOs of the leading HMOs occupy the top-ten Forbes list of the best paid CEOs.
In addition, because the healthcare is considered a 'privilege', there is little or no payment for preventive medicine because it costs a lot up front. That it results in Americans being one of the unhealthiest people in the industrialized countries.
Though I am aware that the private sector does things more efficiently, the only thing they have been effective in, as far as healthcare is concerned, is denial of service and payments. Sadly, this problem won't be solved unless we have a single-payor system, which will most likely be the government.
I am always amused when people who have no direct experience with European health care continue to spout the Socialized medicine nightmare line. I am an American living in France -- have worked in the UK, Ireland and Belgium in the last 5 years and have been a part of their health care. The health care I receive have received has been better in some countries than others. For example France is always outstanding as is Belgium -- UK and Ireland less so but it has always been there when needed as well as follow up to completion of whatever the condition may be.
Of course taxes are higher to pay for this. No one seems to think that there is a free lunch to be had unlike others. If Americans would actually calculate what is payed for a families health care -- what the employer pays, the employee and all the co-pays and deductibles and compare this with perhaps a VAT tax that would give everyone a secure source of health care, financially they would more than likely come out ahead.
When I return to the US I personally will have access to health care due to my Veterans status but my family will not. I hope people start thinking for themselves rather than letting all the vested interest who are making a fortune in the crazy US health system doing it for them!
Let's face it our healthcare system is a racket from start to finish.
It starts with medical schools limiting the number of students they admit every year so as not to flood the market with too many doctors. To many doctors would create too much competition and the price of doctors fees to go down.
No one wants to make less money--not the doctors, not the insurance companies.
flyoverland: We already have a 2-tier health care system: one for those that can afford health care or have it provided by their employers and none for the 46 million who are uninsured. Last year, my family moved into the uninsured category when our business went under, after 10 years of paying every-increasing premiums for ourselves and our employees. Even if difficult choices have to be made, I would prefer having SOME type of coverage I can afford rather than hoping no one gets sick or injured.
re Betsy McCaughey's anti-HillaryCare New Republic article, it appeared in early 1994, as I recall, so "a quarter century ago", Mr Kinsley?? we are not that old.... and who was the editor of TNR then? Andrew Sullivan? Here we go again ....
I think Americans should look at our system here in Canada. P.S. - the post office works fine, what's the problem. So do other government-run services, like police, fire, roads, army, coast guard, all sorts of things. Not perfect - perfection is not possible. The American health system is efficient, as barryotoole says, in denial of service and, I might add, making money for insurance companies. Government-run is not-for-profit, and that's an advantage when it comes to life-and-death matters.
Did I miss something? I don't see any healthcare plan here. All I see is Michael attacking an opponent of someone else's plan.
Why is it that some people demonize some times good legislation and policy as "European"? If it's a good idea it's a good idea we shouldn't care where it comes from. If the Europeans can have health care be affordable and actually make sense then we should look at what they are doing and try to emulate it. It's how society progresses, I mean a few cavemen learned to make fire and other emulated them to make fire, and look at what that did.
In 1960 about 6 percent of the GDP was spent on health care. We are currently at 16 percent of a much higher GDP. That number is projected to rise to 20 percent by 2020. To put that in perspective, A worker would devote about 2.7 years of his working life (45 years) to health care at the 1960 rate. That number is now about 7.2 years. And over that period our life expectancy has increased from around 70 years to about 77 years. We are devoting about 4.5 years of our productivity to live another 7 years. And that is 4.5 of the most productive years where we can enjoy good health for 7 years which we largely entail an existence which is more and more being characterized by hip and knee replacements, heart surgeries and dementia.
Somewhere along the line we have become enamored with the idea that if we can just pump more3 and more of our efforts into science (in this case healthcare) we can somehow square the cost we incur when we would otherwise have the widest range of alternatives for "living well" with the value we will receive at the end of life when our bodies and minds are (despite the best efforts of Dr. Welby) are relatively more wasted.
Yes the prospects of ill health and old age are frightening. But we live in a culture which seems to place more and more value on what we might have and less and less value on what we do have.
As Mr. Kinsley suggests, we must come to realize that healthcare (and life) are not endless smorgasbords of choices without associated costs. It might serve us all well to remember that all of the wonders that science might someday bring us come at a cost today. For me, my wish for my children and grandchildren is not that they necessarily have more years, but more years of living well. Sometimes that means improved health and other times it means more intense living with the health "cards" that we are dealt.
What a shame that people like good ole Betsy can hold up the works with her selective misinformation. How does she sleep at night?
@connie 47
You'll notice a number of links
That others have attempted to post
They are all non-functioning.
I can only assume that it is Daily Beast Policy.
It's hopeless. It's trying to teach Godzilla to tapdance like Bo Jangles. When I think of the American bureacrazy, I think of King Kong on the tall building swatting at airplanes. A good working primer is the first section of the 9-11 report, with a blizzard of three-letter agencies frantically phoning one another like bees in a swarm and all after the last plane was on the ground. In his doting, any large beast will retreat to his primary limbic system keys. You utter the term "socialized medicine" and you kill all thought for the season.
It is called common sense because individuals commonly have it. NOT large faceless government institutions.
Health insurance should be for emergencies... not office visits for minor colds, standard vaccinations, check ups, physicals, etc...
Everything that is wrong is the government's fault.
Lets NOT give them more power to make decisions for us.
What does "cost effective" mean in this context anyway?
I could easily see it meaning "will not pay enough in taxes over the next x years to pay back the money we spend saving his/her life".
Logan's Run was a pretty good movie, you should watch it.
Fisher E.S., Wennberg D.E., Stukel T.A., et al. The implications of regional variations in Medicare spending. Part 1. Ann Intern Med. 2003; 138: 273-287.
Research suggests that approximately 30 percent of medical costs can be attributed to unwarranted variation in healthcare.
Had health care all my life. Eighteen years ago bought a small business and became self employed. Good private healthcare was available for about $125.00/mo. $500/Ded.
Now...similar policy is about $450.00/mo. $3,000/Ded. I'm forced out and I never thought it would happen. I too would like to have at least a choice that provided basic care on up. If your in the middle (ie: self employed and a U.S. citizen), there are no viable options. It disgusts me.
The anit-universal health care crowds methods and obfuscation are in my opinion, bordering on criminal. The lies they tell about european and canadian health care, the scare tactic shouts of "socialized medicine", et cetera, are reprehensible.
Medicare is socialized medicine, the VA is socialized medicine, and even with the complaints about those systems, they work and nobody legitimately claims otherwise. Could they be more efficient or streamlined, of course, nothing is perfect, but the facts remain that they DO work, and they are socialized medicine.
The people waging this campaign against universal health care obviously don't care at all about the vast number of senior citizens who have to make a choice each and every month between buying food, or their medication, their loyalties rest with the special interest groups, the lobbiests, the extremely rich fat cats who line their pockets constantly with "dirty money", basically amounting to bribes. Very nice indeed.
I pay more every month for health care than I do for the principal and interest on my mortgage, and I am as healthy as an ox, and even that policy has so many exclusions and conditions that I fear it will not cover much if I were to need it.
This is the 21st. century, in America. It's criminal that these special interest groups are allowed to place their own profit interests before the NEEDS of the people, and national politicians who receive this bribe money to stall a plan for our health care should be arrested, charged and incarcerated.
It makes me sick that a bankruptcy happens every 30 SECONDS in this country because of medical bills. That just amazes me. This is AMERICA, in the 21st century for petes sake.
Maybe "socialized medicine isn't the perfect answer, but I will continue to stand up and vote for it every single time, as long as the other option is for things to remain as they are.
Sickening.
Research suggests that approximately 30 percent of medical costs can be attributed to unwarranted variation in healthcare
look into InformedMedicalDecisions.org
A health insurance system predicated on private profit cannot provide affordable care for everyone.
Thank you.
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