Monday, July 20, 2009

An Irrational Argument

The current meme being bandied about by those opposed to President Obama's health care initiative is that the "public option" will result in "rationing health care." The fact that the insurance system currently in place already rations health care based solely on cost doesn't seem to ever get mentioned by these yahoos. In fact, as this Los Angeles Times editorial points out, the current system itself is an example of rationing health care, based solely on income:

The current system rations care by income, an approach that leaves millions of people who have limited resources and no insurance with few options beyond free clinics and emergency rooms. This situation is acceptable to many (especially the well-insured) because it doesn't involve the government deciding which treatments doctors can provide or which procedures insurance companies can pay for. Instead, services are available to anyone who can afford them, much as food and shelter are, with the safety net of Medicaid to support the poorest Americans.

What the yahoos are really objecting to is the concept of "comparative effectiveness" which would be part of the government program. Research would determine which of several treatment regimens or diagnostic procedures work best, under what circumstances, and at what cost. For example, most orthopedists, if they are being honest, will admit that if a patient comes in complaining of a sore back, a trial of physical therapy combined with muscle relaxers and/or anti-inflammatory drugs will usually do the trick. An expensive MRI is usually not necessary at the start of treatment unless the patient is already showing neurological signs of vertebral disc involvement. So, an MRI at that early point of treatment is not an effective use of health care dollars. What's so bad about that kind of rationing?

Admittedly, my example is a simple one, but surely the principle should work in more drastic and complicated ways, as the Times editorial points out:

As for comparative effectiveness research, Washington's efforts thus far have been focused on filling the huge gaps in knowledge about how best to treat various ailments. It's a process that will take years, but the promise is that patients and their doctors will be better able to compare treatments in terms of outcome and cost, leading to higher quality care. The work can also help reduce spending by curbing wasteful procedures. Granted, the idea raises the specter of bureaucrats setting age limits for hip replacements or ruling out some unconventional treatments for life-threatening illnesses. But federal and state governments already have that power over the Medicare and Medicaid programs, which hasn't stopped the rapid introduction of new treatments and techniques. And unlike the British government, which not only provides insurance but employs the providers, ours can't cap healthcare spending or bar the private sector from providing services simply because they're too expensive.

No, the arguments being raised by those opposed to any limits on the profits of private insurance companies and health care providers are disingenuous at best and downright dishonest at worst. The status quo is just fine for them. But for the rest of us, eh, not so much.

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Anonymous Dr. Wu said...

It's very logical. The government can't do anything right, so if it gets into the health insurance business, it will drive all the private-sector insurers out of business.

You'd think an industry with annual _profits_ pushing $10 billion could pay somebody to come up with an argument that an eight-year-old wouldn't laugh at, but I suppose when the media is willing to carry your water you don't need much of a message.

5:10 AM  

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