Return of the Health Care Villains
Don't let the bums who killed Hillary's plan playthe same tricks all over again.
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 .