Matthew Holt

Op-Ed: Why the Senate should be abolished, Parts 34-36

Irrelevant small states with no people in them that exist by an accident of history are chronically over-represented in this country — both in the electoral college and most obviously in the Senate. And those states are much more conservative than metro areas where people actually live, which means that even if they send Democrats to DC, they’re not exactly raging Trotskyites.

Hence we get Max Baucus, representing less than 1 million people, or one-sixth of an average state’s population, pushing moderate reform and saying that single-payer is a political non-starter. He’s right, but it’s only because of the political structure that guarantees him his power. If San Francisco, which has roughly the same population as Montana, sent a Senator to Congress I think the result would be somewhat different.

Meanwhile the same issue means that, as it stands, the stimulus bill which apparently is our only hope doesn’t have enough votes to pass, while a moderate Republican (yes, they found one) from Maine and a conservative Democrat from Nebraska (yes, they don’t just shoot them all there) are basically charging themselves with being “responsible” and scaling it back.

But don't worry, in health care the story remains the same. What are they trying to scale back?

Among the items that the Collins-Nelson initiative is targeting: $1.1 billion for comparative medical research <SNIP>. The medical research measure, aimed at developing uniform treatment protocols, is an Obama priority and part of the foundation he is trying to build for health-care reform

So the most sensible thing in the whole darn package gets cut. But just in case you were worried that we’re just going to cut comparative effectiveness research which any moron every health policy wonk will tell you is something we desperately need more of, here’s something to really make you despair:

And the chamber ended the night by unanimously accepting an additional $6.5 billion for research at the National Institutes of Health, pushing the cost of the Senate legislation — for now — to more than $900 billion.

We already spend nearly $30 billionish on research via NIH, and we spend a bucket of cold spit assessing what actually happens in the real world at AHRQ. And we wonder why we have so many ineffective widely used treatments.

Stalin would never have put up with this!

Livongo’s Post Ad Banner 728*90

22
Leave a Reply

22 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
10 Comment authors
joe blowcwatwaDeron S.Nate Recent comment authors
newest oldest most voted
joe blow
Guest
joe blow

Nate,
Doctors, nurses, pharmaceuticals are valuable commodities that provide services. Insurance companies are middle men who add NO VALUE to the system and instead siphon profits off the top.
You cant have healthcare without doctors, nurses, and drugs. You could easily have a healthcare system without ridiculous private insurance middle men stealing 30% of the take.
A socialized government run healthcare model will save billions of dollars over a private insurance scam.
GET RID OF THE WORTHLESS MIDDLE MAN!

Peter
Guest
Peter

Deron, a book’s intro does not revel much, it’s an easy read and not complicated at all, believe me. All I can do is lead a horse to water.
“It’s going to take a massive push for education.”
Very difficult when all people (including children) see is “super size me”. The biggest education program out there is corporate food marketing.

Nate
Guest
Nate

Peter,
I know you hate insurance companies and blame them for everything and think government is the problem….
but…
Any willing provider laws, passed by politicians, is one of the main reasons doctors are in every network. Like most succeful cost containment programs the very politicians you look to for salvation destroyed them. As you listen to me run on and on you’ll start to notice, hopefully, that politicians create the majority of the problems we have. When those evil insurance companies and free markets find a solutions it’s usually only a couple years till politicians break it.

Deron S.
Guest

I read the intro to Omnivore’s Dilemma. It seems like a very interesting, but possibly more complex the necessary, assessment of our problems. There’s no doubt that there are harmful foods being marketed and sold to us every day. Nonetheless, we still have self control issues as a society. Something as simple (or difficult) as controlling portion sizes would go a long way to improving our health status. How many reading this have had a snack when you weren’t even hungry? The cliche living to eat instead of eating to live really sums our problems up. What we’re putting in… Read more »

Peter
Guest
Peter

Nate, interesting you used PPO as example of how insurance has controlling costs. Not many people are noticing it working. Here’s the other side:
“http://en.wikipedia.org/wiki/Preferred_provider_organization”
“The rise of PPOs was credited by some[who?] with a reduction in the rate of medical inflation in the U.S. in the 1990s. However, as most providers have become members of most of the major preferred provider organizations sponsored by major insurers and administrators, the competitive advantages outlined above have largely been reduced or almost entirely eliminated, and medical inflation in the U.S. is again advancing at 150–200% the rate of general inflation.”

Nate
Guest
Nate

“Why do insurance companies and Medicare have the responsibility of “controlling costs” in the first place?” If everyone had to pay for their own insurance policy based on their health and lifestyle without any corporate or tax payor bail out they might actually stop smoking, take care fo themselves, and not waste money on questionable medicine. What the heck would politicians run on then? Without problems to solve we might actually wise up and question why we send trillions to washington every year. This also applies to education, what if parents kept all those billions in tax dollars and where… Read more »

cwa
Guest
cwa

“If San Francisco, which has roughly the same population as Montana, sent a Senator to Congress”
Doesn’t San Francisco already send two Senators (Boxer and Feinstein)? Not to mention the Speaker of the House.

twa
Guest
twa

Matthew – I normally love your stuff, and perhaps I am missing some sarcasm here, so forgive me – but:
As a transplant from a supposedly “relevant” state to one that is clearly “irrelevant” I can only say thank God I don’t have to do what people in SF think I should.
Our founding fathers were brilliant – don’t try to paint poor decision making by politicians as some kind of regional us (“enlightened elite”) versus them (“morons in the middle”). That would be very pelosic of you.

Peter
Guest
Peter

“Seems to me that individuals should be taking more responsibility for that.”
Everyone should be taking responsibility. Including food corporations who promote junk food to children, industry that pollutes our environment, food producers that continue to manufacture and sell product even though it contains salmonella, for which the FDA has been handcuffed by industry lobbyists so that it cannot be proactive and order a recall, toy manufacturers who use lead, etc, ect, ect. Deron, read, “The Omnivore’s Dilemma” by Michael Pollan if you want a real understanding of our bad food habits.

Deron S.
Guest

Why do insurance companies and Medicare have the responsibility of “controlling costs” in the first place? Seems to me that individuals should be taking more responsibility for that. It’s a shame no one wants to talk about that. I guess it’s not politically correct.

Nate
Guest
Nate

Nate, can you name any insurance program that has been effective in controlling cost
PPO
POS
UR
UM
Claim Audits
unbundling audits
medical record reviews
Formularies
leveled co-pays
generic substitution
disease management
educational inserts
nurse help lines

Peter
Guest
Peter

MD as Hell, sorry for the misread. I also get enraged when I hear about heroic attempt$ to get just one more month of life from an 80 year old, but can you imagine the outcry if docs have complete control of end of life. How do other countries handle single-pay without having “The fear factor” overwhelm the system? Is their culture that different? Barry Carol believes we should all be compelled to make a living will – not a bad idea and maybe a stipulation of coverage. In Taiwan system they have smart cards tracking patient healthcare use. When… Read more »

Peter
Guest
Peter

Nate, can you name any insurance program that has been effective in controlling cost – oh wait, yes; coverage denial, retroactive coverage cancellation, quoted pre-condition premiums Howard Hughes would have trouble paying, high deductibles people can’t pay. A profitable insurance industry equals a healthy population, or is it just a cherry picked population.

Nate
Guest
Nate

“This is the first step towards having CMS act like a responsible purchaser of health care.” Really docanon? I would have thought the first step would be a little easier, like making sure your not buying care for dead patients or care approved by a dead doctor. Maybe before they go running around the block they could learn to walk by making sure the care they pay for is delivered or the person being paid even has an office. “There’s no reason to inherently trust or distrust the government.” Said the person hoping we trust the government with more of… Read more »

docanon
Guest
docanon

I’m glad to see residency affords a little blogging time. There’s no reason to inherently trust or distrust the government. It is ignorant to assume that all people within government are untrustworthy and incompetent (or the opposite). Simplistic jingoism helps nobody…unless of course you have a political goal that includes winning the votes of those who can’t absorb a rational argument. That said, effectiveness + affordability = appropriateness. This is the first step towards having CMS act like a responsible purchaser of health care. Given the chronic underfunding of health services research, comparative effectiveness projects are about as “shovel-ready” as… Read more »