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“Comparative effectiveness research”
They say, “No one wants to live to be 100 except the guy who’s 99.” Michael DeBakey, the world-renowned cardiovascular surgeon who invented the roller pump that made open-heart surgery possible, was a mere 97 when he said “no” to a heart operation to fix a main artery. But his family said “yes,” and the procedure bought him two extra years of productive life.
DeBakey is the kind of example that drives me nuts. I personally don’t think I would feel good about consuming medical resources that could go to someone half my age (assuming this was a zero-sum game)—or about being ahead of a 20-year-old on a list of organ donor hopefuls.
On the other hand, I don’t think I would feel good about living in a country that bumps me off a list because of some arbitrary, government-mandated age requirement (“Too old for health care”), or that doesn’t consider a procedure “cost effective” for me because the actuarial tables say my life’s not worth living anymore. I’d like to make that decision myself. It reminds me too much of the SS “selections” at Auschwitz, where new arrivals were directed either into the work force or the gas chambers depending on their perceived fitness.
Charles Krauthammer is as baffled as anyone about how President Obama is going to pay for his “vastly expanded welfare state.” Assuming that Obama is not totally off his rocker, the conservative commentator has come to the conclusion, by picking up on the president’s hints about “additional adjustments” in the health care system, that the money to pay for his ambitious plans will come from rationing. This, surmises Krauthammer, is the real aim of Obama’s “comparative effectiveness research,” to be carried on by a new government agency that will assess the relative effectiveness of treatments.
I like the idea of CER if it means an end to unnecessary procedures, and to cover-your-behind redundancy of testing. (I’m wondering if my upcoming MRI is really necessary, or just a hyper-conservative measure done more for my radiologist than for me.) Is there a wise man in the house?
To hear commentaries by Andrée Seu, click here.
back to top17 Comments to ““Comparative effectiveness research””
Or in the senate?
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“Comparative Effectiveness Research” sets us up for what’s been called “the Tyranny of the Measurable.” That is, doctors, medications, hospitals and procedures are compared to one another based on things which may be measured. Unfortunately, there are many unmeasurable things which are more important in good medicine.
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I like the idea of CER if it means an end to unnecessary procedures, and to cover-your-behind redundancy of testing. (I’m wondering if my upcoming MRI is really necessary, or just a hyper-conservative measure done more for my radiologist than for me.) Is there a wise man in the house?
StuBob is obviously the expert on this, but I suspect that cover-your-behind redundancy testing will continue until something is done about litigation.
Every day you hear ads on the radio asking if your father worked with asbestos. You stand to make millions of well diserved dollars. Somebody out there has money; and it could be yours.
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I recently put this question directly to a person who works as a financial manager for one of the largest managed healthcare companies in the US. How did a managed approach using CER and other tools improve healthcare and lower costs?
She said that the “decisions” about healthcare were no longer based on financial gain (for the provider), but instead were based on what was best for the patient. And the company in question paid bonuses to providers solely based on patient evaluations of the care they received. These policies allowed them to direct the scarce healthcare resources far more efficiently towards those who needed them–thus they actually removed “scarcity” from the equation.
I asked how their company could guarrantee that these policies wouldn’t change. She said their CEO was a wonderful person and his character was the reason she had confidence in the system. She admitted, on further probing, that when that CEO was gone that everything could fall apart.
Thus, it seems that CER can be good in the hands of the right people but bad in the hands of Ob… , er, others.
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fear mongering
And if #4 is correct that CER depends on the leadership, would it not be better for the public to be able to vote on the leader (public) as opposed to a CEO appointed by a Board of Directors (private). In other words if health care was managed privately, you are dependent on people you have no control over nor ability to influence but in public health care, you can always vote the leaders out or put pressure on the gov’t to respond to public needs.
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Rationing isnt the only way to save costs.
At the preset time, the US spends more money per capitia than any other country on health care yet is the only one who doesn’t cover everyone. Public health care would eliminate the redundant private bureaucracy, increase bulk buying power, and put pressure on medical salaries.
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StuBob is correct. And “comparative effective research” doesn’t make sense on the face of it. Most doctors will receive a good report because most people like their doctors. I wouldn’t go to a doctor I didn’t like.
As StuBob will verify, “bedside manner” is one of the most important factor in doctor-patient relationships.
But the doctor may not be treating the problem. I think CER is a fad that will be found worthless.
As for HRW’s suggestion that the public vote the leadership of CER, he will be a CER Czar appointed by a nobody who looks good on TV and can go from one teleprompter to another without missing a beat.
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There’s been some research done on why doctor’s get sued. Its not because they make mistakes but because they aren’t well liked by the patient. Malpractice insurance companies now recognize that its not competence but personality that is the deciding factor.
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CER Czar appointed by a nobody who looks good on TV and can go from one teleprompter to another without missing a beat.
As opposed to an anonymous CEO who is responsive only to shareholders demanding a profit?
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I like the idea of COST/BENEFIT ANALYSIS but CBA is normally done in the aggregate. I think the best strategy for those who want adequate health care in their elderly years is as follows: You marry early and stay married. You have a big family. You encourage your kids to pursue good education and lucrative careers. Ea of the kids contributes to a fund for your eventual higher health care needs in your elderly years. One kid will have power of attorney but all will vote on your end of life care (subject to your own Advance Directives)
I think with more and more folks marrying late or not marrying and not having as many children when they do marry, we will eventually confront lots of elderly never marrieds with no support at home. I feel sad for them. They will be burdensome “use-less eaters” and dealt with accordingly by a super socialist care rationer.
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#8 HRW,
I’ve heard this as well. A technically better skilled cardiologist was a more frequent lawsuit target than was an amiable smiling cardiologist. This despite the fact that the first man was objectively a BETTER heart surgeon.
What does this say about America? That some attorney could convince a person to bring a lawsuit on the basis of perceived personality quirk?
My brother had his dental medmal insu increased despite never even having a suit brought against him. He learned this was done because an aggressive tort lawyer was operating in the area.
Since most politicians are lawyers who have like Sen Edwards made plenty off of med mal lawsuits or their threat, I dont foresee any real reforms to bring down med costs. I do like the idea of state’s setting up “health courts” to focus exclusively on med practice tort law.
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10
traditional solution but history demonstrates that once income security has been achieved birth rates decrease.
super socialist care rationer.
or an anonymous private corporate bureaucrat.
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The use of tort often reflects an inability to obtain consumer satisfaction and protection by other means. Usually the states with the least amount of consumer protection have the highest tort rates.
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(1) Andrée Seu writes (in part): “Assuming that Obama is not totally off his rocker…”
Check that assumption, Andrée. False assumptions can lead to erroneous conclusions.
(2) I thought you’d had the MRI by this time. Keep us posted, please, many of us are praying for you.
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#12 You raise a valid point.. but with the private bureaucrats you can CHOOSE to have your care managed by a different bureaucrat working in another insurance company
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sawgunner post 15,
actually unmder the majority of private insurance programs, your company can choose to have your care managed by a different bureaucrats. You typically as an individual have little input on this.
And I suspect you will find signficant regions where today there is effectively only one health insurer.
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Obviously, the debate is driven by whether or not a person believes in free enterprise and competition. I definitely am leary of elected officials when they are elected by “the least of these”, i.e. by the uneducated undecideds who are swayed by hype during political campaigns. Government can and ought to (and does) regulate businesses to help ensure the benefits of free competition and choice in the marketplace. What’s needed is more tweaking of the regulations so as to produce the best business environment (not to micromanage how businesses run themselves).
But of course, other people favor government programs rather than free enterprise.
I believe my first post related to the character of “who” is in charge is relevent. Decent businessmen and decent politicians are both better than rogues in either category. And competition between businesses (and politicians) supposedly makes the cream rise to the top. But it is marketing and clever advertising that can make sludge look palatable.
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