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May 12, 2009

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I think that the line "there will be a bureaucrat between you and your doctor" will have less impact than it did during the Clinton health-care effort--because, in the ensuing 16 years, many more people have been in HMO's, and so have had just this experience with private insurance. Congresscritters, since they have their own plan, probably have not had this affect them.

bottom line:

we have an appallingly inefficient health-care system, because many of those appalling inefficiencies make certain people appallingly rich.

the pharmaceutical companies and device manufacturers have a vested interest in inefficiency: "inefficiency" is where they make their profits.

the insurance companies have a vested interest in inadequate and irrational coverage: "not covered" is where they make their profits.

these people are going to fight any improvements in the health care system, because improvements mean lower profits for them.

and they are going to tell a lot of lies to do it.

thank you, hilzoy, for fighting back against the lies.

John Griffing in the American Thinker, who .. adds, by way of explanation: "If you are picturing Germany circa 1930, you're right on."
I generally consider myself fairly well informed about history, although it's been a while since I read any histories of that period focusing on Germany. Still, I have absolutely no idea what provision of healthcare was like in Germany in 1930, and I suspect Griffing doesn't either. For that matter, I'm not aware that the German government of 1930 was especially dictatorial or authoritarian (or effective); usually the period is portrayed as being relatively anarchic, with the population facing the global economic collapse and street battles between supporters of the left and right wing fringes. Not a paradise, except perhaps compared to what followed, but somehow I doubt Griffing meant to invoke a confused, divided, and ineffectual government in his comparison. Perhaps he meant to invoke the Germany of a half-decade later?

But, Hilzoy, you are blind! Once it is clear what treatement will be paid for, all other kinds will be banned, forbidden, made illegal, not allowed to be used, declared anathema, done away with, interdicted, prohibited, outlawed, enjoined, barred. This is an ex-treatment!

The true irony is that insurance companies have been applying these techniques, of a sort, for years. There are certain treatment protocols, for example, that must be followed for treatment of back pain unless there is overriding evidence that the normal course of treatment would be ineffective.

There is also the refusal to pay for "experimental" treatment, even though it may be very effective, but costly. Applied Behavioral Analysis for treatment of autism is an example. Although around fro 20 years, ti is just now beginning to be covered by insurance on a regualr basis.

The conservative response to this in general certainly seems to be incredibly paranoid and/or delusional. (Just to be clear.)

But, while having a board just looking at the effectiveness at forms of health care has a strong logic behind it, I can also see why many people wouldn't want other options to be unaffordable to them (by means of not being covered by their plan).

So, as long as CER has no real authority outside of publishing its findings to the public at large, I'm supporting it as part of a new health care plan. If Germany and Japan are any indication, "excessive" health care need not conflict with fair and functional health care.

" For that matter, I'm not aware that the German government of 1930 was especially dictatorial or authoritarian "

That's usually the point when somebody likens something to 1930's Germany: The suggestion is that it might not look bad, but it will lead to 1940's Germany.

I don't think this kind of research is problematic in of itself, but it could certainly be abused.

The conservative response to this in general certainly seems to be incredibly paranoid and/or delusional.

it seems, to me, to be typically cynical and demagogic: lies for votes.

The situation is worse than described.

I work for a large hospital as a physicist and part of my job is to evaluate what imaging equipment the hospital would buy. I asked some friends at the FDA at a conference which PET scanner was the best. Their response was basically, "We know, but we are not allowed to tell you." There is some information coming from Britain, whose government actually performs tests to see what equipment works, but absent real information about the performance of complicated instruments, most of these decisions are based on the personal relationship between the physicians, administrators, and the salespeople from the manufacturers. Hospitals end up developing a brand loyalty to GE or Siemens or Philips the way some families would be Ford or Chevy families. I know more about buying a car from reading Consumer's Report than I can about buying major medical imaging equipment from reading the Radiology Journal.

CER sounds good to me, but when using it people need to remember that different drugs have difference side effects on different people. So the fact that drug A is 20% effective for 90% of people doesn't mean that you aren't in the 10% of people for whom drug B is more effective.

cherchez l'argent.

Not to mention, insurance companies are heavily regulated as to at least the general classes of services they must provide, by each state. The states either make those decisions at the legislative level based on information compiled by an Insurance Commissioner/Bureau/Department, or delegates the decisions to that body. Information like, say, what kind of treatments work and how they are provided. For example, my own state passed a Mental Health Care Parity law recently. In short, not just private but even government bureaucrats are already deciding what kind of care you can get insured for.

Difference is, this proposal might allow more fine-tuned & flexible decisions.

But don't count on it, because the real problem with federal CER reports are that, like the preposterous "food pyramid" chart most of us grew up with, they are perfect targets for lobbyist influence.

Since Congress already refuses to fund independent FDA safety studies, it surely won't fund independent comparison studies. Based on the way it generally handles large-scale research needs, it would rely on the manufacturers to provide the raw data and rely for the evaluations on academics -- who make most of their living from industry grants. The peer review system in the U.S. has been pretty thoroughly corrupted, so the government will get corrupt results, even assuming the bureaucrat in charge has not been influenced to push for some particular result.

There are ways to reduce this effect, of course, but they all cost money and require Congress to create a detailed bill instead of punting to the agency as usual, so don't expect it. To me, this proposal looks like a gift to Big Pharma.

they are perfect targets for lobbyist influence.

Here's my modest proposal.

Any natural human person who is a citizen of the USA can make contributions from their personal funds to any public office holder up to some limit. Make it a big fat generous limit, say $10K a year. Hell, make it $20K, or $50K, so the rich folks who think money is speech won't feel all put upon.

Nobody else can do so. No corporation, no union, no PAC, no lobbying organization, no government domestic or foreign, no Springfield Cat Fanciers Association.

Individual natural human persons who are citizens of the US. Not a dime from anyone or anything else, ever, for any reason.

And no cloning yourself to get around it, either!!!

Clearly Griffing has never heard of Godwin's Law.

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