Tuesday, February 24, 2009

Comparative Research and Health Care Reform

Health care consultant Joe Paduda wrote a post the other day "debunking Rush Limbaugh," taking the radio talk host to task for statements he made about health care provisions in the spending bill that just passed Congress. An industry expert taking on a general commentator on health care policy hardly seems like a fair fight, but Mr. Paduda, as the author of his blog, has the right to choose opponents he considers worthy.

Leaving my cheap shots aside, Mr. Paduda's arguments are largely correct. As Mr. Limbaugh's comments echo recent commentary from other conservatives, it is important for those on the right, if they are to have anything constructive to contribute to the health care debate, to think more carefully about drivers of health care costs.

Conservative criticism of health care provisions in the bill have centered around the funding of "comparative research" that would be intended to determine the relative effectiveness of varying treatments. Opponents have argued that this starts the government down the path of health care rationing. While there may be some foundation for that concern, conservatives need to address the fact that, whether health care is financed through the private or the public sector, the utilization, or overutilization, of medical services is a major cost driver in American health care. Variations in medical practice also create significant concerns regarding the quality of care delivered. Those interested in the subject might start by looking here.

All of this is to say that any health care reform addressing costs must look at the issue of utilization. This is not to say that conservative concerns about this are lacking in validity. The federal government, for an increasing number of people, will evidently be the health care payer of both first and last resort. With regard to many problems, government regulators are better at using an ax than a scalpel when it comes to implementing policy decisions, and it is not difficult to imagine that health care will be managed on the basis primarily of financial, not medical, decision making.

People already believe this about private insurers. Of course, sometimes they are correct. However, even when private insurers correctly deny coverage for services that lack a sound medical basis, people assume that their doctor is trying to provide them with proper care and that the insurance company is only concerned with not having to pay.

Of course, regulators don't have to concern themselves with profits, and some would have us hope that would eliminate such thinking. However, regulators and lawmakers, at least in normal times, do have to deal with scarce resources and competing policy priorities. As such, it is not difficult to imagine that rationing based on purely financial considerations could become a legitimate concern.

However, that is an argument that requires nuance. There are a lot of moving pieces in the upcoming debate over health care reform. Those who would engage the debate constructively in order to seek genuine improvements in costs, breadth of coverage, and outcomes, would do well to bring scalpels, not axes, to the debate.

1 Comments:

Blogger Lanette said...

This may seem overly optimistic, but an arguement can be made that accurate comparative research with its results being widely implemented in patient care could have the effect of keeping the government out of healthcare by lowering health care costs. Surely, fiscal responsibility and finding ways to keep health care privatized is something conservatives should get behind.

10:02 PM  

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