RSS Feed MenuIt’s true: they did it. The Democrats managed to get the words “comparative effectiveness” into the stimulus bill, just as many conservatives warned, which means that the infrastructure for rationing Medicare is now in place. The idea is pretty simple: a national health board will determine the comparative effectiveness of different treatments for different ailments, and then… well… you know, recommend them, in that coercive way that government does.
In Tom Daschle’s book, he contemplated, in a footnote, the idea of using such a national health board to regulate private health care plans, by threatening to take away the tax deduction for plans that don’t use the correct comparative effectiveness treatments. So, yes, the government will pretty much be running the health care system at that point. Well, it will be to a greater extent than it already is.
And yet, and yet, and yet… I’ll say it. Comparative effectiveness is good. Controlling the spiraling-out-of-control, eat-us-alive costs of Medicare is good. I’ll even go so far as to say that greater limits on the tax deduction for health benefits are good, good, good.
And I’m not sure why I should say otherwise, as a conservative.
I seem to recall a bill, passed in 2001, called “No Child Left Behind”. One of the main parts of that bill, the part that just about every conservative actually liked, was the part where they tied new grants to literacy programs that used, yes, comparative effectiveness research. The main program that benefited from that requirement was Direct Instruction, which was and is so effective that skeptical teachers tend to think that the whole comparative effectiveness idea — really, any form of accountability tied to method — is a total sham cooked up by The Man. No, they’d rather stick to the tried-and-true method of continually trying out the next (expensive) educational panacea promoted by the (well-compensated) textbook reps at the big conventions (at nice hotels), and buying all new (expensive) books and all new methods (that require expensive retraining seminars, possibly at that same hotel next quarter) every five years or so, all of which is based on research paid for, of course, by the textbook reps.
Good thing our free-market health care system isn’t anything like that. What a waste that would be.
I exaggerate for rhetorical effect, of course; it’s my right. But there isn’t a more conservative sentiment than “that’s all well and good, but not on my dime.” So, why don’t we make the argument; or rather, why does one side make the argument in one case, and the other side make the argument in the other?
Well, teachers and publishers are a Democratic constituency, and doctors and Pharma reps are a Republican constituency, by and large. That may have something to do with it.
It makes you wonder.
(Thanks to John Hawkins for the inspiration.)
Chekote // Feb 21, 2009 at 6:27 am
“I am working from problems to solutions, rather than from philosophy to solutions, dragonlady and chekote.”
Then you are a technocrat. Political parties and movements are about governing philosophy. I have posted several times that you can’t mobilize people to vote, contribute and volunteer under the “whatever works” banner. Most of the healthcare dollars are spent in the last six month of a elderly person’s life. By denying care after a certain age is reached, will dramatically lower healthcare costs. Children with special needs require expensive care. Should we force everywonan to genetic testing while pregnant and if an abnormality is found, then force her to have an abortion? These measures will dramatically reduce cost and since you are not guided by principles and only interested in finding solutions, let’s start drafting the legislation.
joemarier // Feb 21, 2009 at 7:16 am
A technocrat? Perhaps, to some extent. It’s a process thing: I come up with a solution, but I do stress test it against my principles. Certainly, I would oppose both of your solutions on principle, and I recognize that that’s the main concern with a national health board: that its decisions will violate the natural law in various and egregious ways. What I’m not sure of is whether or not such a board will violate the natural law automatically, if it’s limited to determining comparative effectiveness.
Chekote // Feb 21, 2009 at 7:29 am
Joe. The federal government does not need to get set up another layer of bureacracy just to share best practices. That is already been done in the private sector. It is another waste of taxpayer’s money. Just like No Child Left Behind, Faith Intiatives and so on. It also oversteps the constitutional authority of the federal government. There I go again with my principles! If we want to bring down healthcare costs – and that’s really the problem – first, malpractice reform. Doctors over prescribe tests because they want to protect themselves against lawsuits. Put the consumer in charge by allowing people to buy insurance across state lines, allow people to form pools outside employment.
Chekote // Feb 21, 2009 at 8:20 am
Joe. Why do you consider yourself a conservative?
joemarier // Feb 21, 2009 at 9:00 am
All fine ideas, but keep in mind that I’m thinking primarily of plans that are currently run by the government, like Medicare, Medicaid, S-CHIP. All of those plans have less oversight than your average insurance plan, and more — what’s the phrase? Oh yes — waste, fraud, and abuse. Particularly Medicare, which can only be fixed by lowering the cash that goes out of it, or increasing the cash that goes into it. Period. I prefer the former, because that will enable people who want more than Medicare offers, to go private with the cash that they save — or even better, to opt out of Medicare entirely and take the cash. Do you see what I’m driving at yet?
I’m sorry that you continually doubt my conservatism. I’m not sure what I can say or write that will prove beyond a doubt that I do not intend to sell the movement downstream at the first opportunity. But, I’ll keep writing, and I hope you keep reading.
Chekote // Feb 21, 2009 at 9:37 am
So you are going to create another layer of bureacracy to make the current bureacracy more efficient. Sorry Joe but the focus should be how to get government out of healthcare instead of increasing its role. The reason I doubt your conservatism is because you never answer my questions: what makes you a conservative? Why should people vote for the Republican Party over the Dems? It seems to me that if we want to build a conservatism that can win we need to first define conservatism. We need to answer the question of why should people embrace conservatism instead of liberalism. If we can’t answer these two basic questions, we can’t build anything.
joemarier // Feb 21, 2009 at 11:36 am
Fair enough. The question of how I came to the convictions that I hold is pretty complex, because it deals with my personal history, professional background, religion, and so forth. I’ll probably try and work up an extended answer and put it on my personal blog, next time I get a chance. But I do come out as conservative on the world’s smallest political quiz, as bad a metric as that may be.
sinz54 // Feb 22, 2009 at 8:52 am
Chekote: The problem with leaving “best practices” entirely up to the public sector, is that each private insurer chooses its own set of best practices. And those vary over time. If you have a chronic illness, one day you may find that your new (or even existing) insurer won’t remburse you for the treatments you’ve been relying on for years. I personally fell into that trap. I changed insurers, and my new insurer wouldn’t pay for the medication I had been relying on for years, because it wasn’t in my new insurer’s preferred drug formulary. If the private insurance industry got together and formulated national *standards* for drug formularies (similar to how the railroad industry in the 19th century all agreed on one standard gauge), then this problem would not happen. But they are not doing that, as far as I know. And there’s no way to find out these things in advance from the insurer, until some bureaucrat lets you know in a curtly worded letter. In our country, the government does have a role in setting standards. There are building codes for construction. There are health and safety requirements for restaurants. Etc.
Chekote // Feb 22, 2009 at 12:25 pm
sinz. Building codes set a floor of safety. I am not against addressing the problemsn you mention via regulation. If you want to be in the health insurance business you need to provide some basic services to everyone. Look, you believe that bureaucrats are better than the private sector. Fine with me. I don’t. Government is always subject to corruption and pretty soon the healthcare providors that make the most substantial campaign contributions will, miracle of all miracle, be the ones who provide the best treatments according to the government. Wink. Wink.
gerrysh // Feb 23, 2009 at 9:25 am
It makes everyone wonder why you are on a “conservative” blog.