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Fear and Loathing over the Stimulus Bill

CapitalThe reaction in certain quarters to the healthcare reform provisions of the stimulus bill now clearing 
Congress lays bare the nature of opposition to the forthcoming fight for real change in healthcare: It will be viciousness at the top of the lungs.  It will be a scorched-earth campaign.  Its main weapon will be fear. It will be unencumbered by any actual knowledge, subtlety, awareness of history, or access to the thoughts of people who actually know what they are talking about.  Its fury will be unloaded not just in service of narrow and inflexible political nostrums, but in the service of sectors of the industry which fear that a truly efficient and effective healthcare system would cripple their profit margins.

The fulminating rages across Rush Limbaugh's radio rants, Matt Drudge's blog, the editorial pages of the Wall Street Journal, and commentaries issued by conservative think tanks, all echoed around the blogosphere. The connections and logical leaps that they consistently make are rather startling to anyone who has been working on the systemic problems of U.S. healthcare for the last few decades. The prime targets of this offensive are comparative effectiveness research, to which the bill allocates $1.1 billion, and help for digitization. The federal government already pours over $300 million per year into comparative effectiveness research – using powerful medical and statistical techniques to determine the most effective and least costly ways to treat disease – through the National Institutes of Health and the Agency for Healthcare Research and Quality. But to Limbaugh and company, actually finding out what works and what doesn't automatically means having committees of government bureaucrats tell your doctor what to do. Research equals socialism. In this frame, digitization, which seemed to work out okay in airport kiosks, grocery stores, and the ATM down at the bank, means something entirely different in healthcare.  It means the end of all medical privacy, all ability to choose, and all security in one's access to healthcare.

The irony is that these folks are all about the free market, about choice, about one of America's great skills, shopping. But Americans, and America, are truly dismal shoppers when it comes to healthcare, because we have no idea what we are buying. Neither we nor our proxies (the government, health plans, employers) have any clue what actually will keep us healthy or cure us, who is really good at it, or what it will really cost. As situations go, this is double-plus ungood.

The really sad irony is that we already have, in our system as it works today, every bad outcome these folks are imagining.  We already have bureaucrats telling the doctors what they can and cannot do, and telling consumers what doctors they can go to, they're just private bureaucrats working for health plans, informed more by the balance sheet than by effectiveness studies. We already have people's private medical records being used to deny them coverage – by everyone except the government.  We already have healthcare rationing, we just do it by ability to pay, by whether you still have a job, and by whether you have been visited by the dread "pre-existing conditions." With our current patchwork of plans tied to employment, many with very high deductibles and co-payments, many subject to rescission when they are most needed, most immune to lawsuit under ERISA, no American under the age of 65 can feel secure in their access to healthcare.

There is a good chance that this toxic brew will be effective.  Comparative effectiveness research in political methodology shows that fear and ignorance are a powerful combination when administered in high enough doses. As the debate over the actual healthcare reform bill moves forward, we can expect massive volumes of this combination to be dumped on the public, and on those of us who have been trying to roll this boulder up the mountain for a long, long time.

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KatelynJoe SimonsBradPeterSusanna Recent comment authors
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Katelyn
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Katelyn

My question is this..If the goverment is going to help people with their healthcare costs who cannot afford it (medicaid) and if the health reform bill passes and more people must be helped in order to have insurance, many of those people choose to spend their money on non-life saving medicines but refuse to pay for the ones they really need. Also, why should people go to jail for not being able to buy health insurance but we are keeping and at many times giving free healthcare to illegal immigrants. Many parts of the bill could be good, but also… Read more »

Joe Simons
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How to buy prescription drugs…? My doctor prescribed vicodin for a while back, my back hurts, I think it is a great help, but in my country it is difficult to find, it is paramount to have my information on it and found information about findrxonline.com the medicine, because it provided me.

Brad
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Brad

is better than trying to navigate the Soviet bureaucracy here in the United States.
————–
And getting government involved is supposed to improve this? We do have socialized medicine run by the government. It’s called the VA and it is terrible.

Brad
Guest
Brad

I am a Finn living in the United States and here is my situation: at home in Finland I have the choice between a) Almost-free national health care. b) Immediate access to any private doctor in any specialty (you can usually get an appointment same day), for a fraction of the cost of same in the US. c) Immediate access to emergency health care. The health care is some of the best in the world. Just one statistic off the top of my head is infant mortality – next to nothing in Finland, whereas the US is something like number… Read more »

Brad
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Brad

I’d just like to know where the Constitution authorizes any of this? And please, don’t say “promote the general welfare.” The Constitution lists specifically what government can do to promote the general welfare. Nowhere does it say anything about health care.

Peter
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Peter

Apologies if this double posts as my first attempt seems to have disappeard in the electronic black hole.
Nate, your math is a little sparse.
The Y in your calculation is made up of P(profit) at each level of the chain. So included in Y is P+P+P+P+P. That determines an X that is about twice what other countries pay. In a single-pay system the X is also made up of P but it’s small p as the components are regulated. P can also be eliminated from the insurance part along with a smaller A (administrative costs).

Eric Novack
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Eric Novack

Spike- what I am saying is this: if YOU want to turn your health, and that of your family’s, over to some ‘data mining software’ and a complete reliance on available evidence for every possible diagnosis you could have, by all means it should be your right to do so.
Just do not coerce and compel the rest of us to be a part of that system.
Joe- then shame on you for not recognizing the policies being promoted today are the same fallacious ones that characterized the stagflation of the 1970s and the Ted Kennedy driven HMO Act of 1973.

Peter
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Peter

Nate, your math is a little sparse.
Profit is extracted at all levels of the chain. To get to Y you need to add profits (P). So Yt(total) equals P+P+P+P+P+P. The X then is inflated far beyond what is sustainable and hence why we pay twice as much as other industrialzed countries.

Tom
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Tom

Ok, it appears we accept that healthcare isn’t a “right”. Didn’t see a response to who might be forced to provide it… which begs the next question: Under what circumstance is it ok to forcibly take from one what was justly acquired to give to another? Perimeter defense comes to mind… but doesn’t that sort of benefit everyone equally? Not to mentioned being a basic requirement of continued existence? I would expect of a truly enlightened society (one that actually learns from history) a better grasp of the utter infeasibility of forced, collective redistribution to be a catalyst for human… Read more »

Margalit Gur-Arie
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Hello Nate,
I think you may have a Freudian slip in your algebra up there. If you look at your assumptions:
X=T and U>Y
then T-U=Q MUST be smaller than X-Y=Z.
Since Q denotes the waste in a public system and Z the waste in a private system, I must conclude that your math agrees with my logic, even if you do not 🙂
Have a good evening….

Susanna
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Susanna

I am a Finn living in the United States and here is my situation: at home in Finland I have the choice between a) Almost-free national health care. b) Immediate access to any private doctor in any specialty (you can usually get an appointment same day), for a fraction of the cost of same in the US. c) Immediate access to emergency health care. The health care is some of the best in the world. Just one statistic off the top of my head is infant mortality – next to nothing in Finland, whereas the US is something like number… Read more »

Randall Oates, M.D.
Guest

Clarification…. Usually, in a setting such as this BLOG, this type of question is just ignored (in the BLOG). In this setting, “Experts” commenting in most blogs seem to usually be well-intended, but have little to no concept as to how their proposals are typically not possible or practical for the majority of medical practices (i.e. 1 to 3 clinicians). They are often in error, yet seldom in doubt. Their “deer in headlights” response to questions is a frequent give-away as to their lack of perspective in the settings a majority of care is delivered. The evidence is that attempting… Read more »

Nate
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Nate

Margalit Gur-Arie “The math is very simple: there is X amount of money going into the system. There is Y amount of money spent on actual care delivery and administration. There is X-Y=Z amount of money leaving the system in the form of profits extracted by insurance companies. We can save Z amount of money if the “for-profit” notion is eliminated. A bit simplistic? Maybe, but true in principle.” Actually it’s very untrue in principal, your missing most of the equation. For Profit system X-Y=Z Public system T-U=Q T=Amount of money going into system Y=is amount spent on care Comparison… Read more »

Dr. Rick Lippin
Guest

Maggie Mahar is on a roll over at HealthBeat Blog. With last week’s Reinhardt/ Aristocracy/Fairness articles and two this week on comparative effective resesarch,as a journalist, she is articulating our best hopes for US health care reform.
Peter Orszag as head of OMB is defintely key.
Dr.Rick Lippin
Southampton,Pa
(Charter “Hadlerian”)

Randall Oates, M.D.
Guest

When will the discussion get to the evidence of what actually works within the highly fragmented, widely dispersed,small medical practices that actually deliver the 70% of health care in the U.S.?
Usually, in a setting such as this, this type of question is just ignored. In person, the asker nearly always is left with little more than a “deer in headlights stare.”