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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.
The New Republic later renounced McCaughey's article and apologized for running it. McCaughey herself became lieutenant governor of New York. Wikipedia deadpans, "McCaughey was a political novice at the time of her election as lieutenant governor. She and George Pataki did not know each other when he asked her to be his running-mate. She was selected on the recommendation of former US Senator Alfonse D'Amato, who was impressed by her writings on health-care reform."
Is there anyone in America whose views on health care ought to be of less interest than Betsy McCaughey's? (Anyone, that is, except possibly Al D'Amato?) Is it even possible to discredit yourself to the point where you are dropped from the list? Apparently not. The author of the Post article is one of that newspaper's best reporters. Soon, the TV bookers will be calling. (Among her other assets, McCaughey has the leggy blonde Ann Coulter-looks that producers like in their right wingers.) The rule seems to be: Once an expert, always an expert.
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.
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luigia
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.
everyman
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.
flyoverland
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.
genoftheheart
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.
Ritarita
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
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doodle6
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.
barryotoole
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.
jgosnellc
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!
Granite
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.
mbstrong
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.
DWinch
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 ....
myriad
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.
gwlaw99
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.
benjoe
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.
Thank you.
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