Monday, December 14, 2009

Getting (Though Not Necessarily) What You Pay For

Comparative effectiveness is a term that people have been throwing around a lot lately. Those of a cynical persuasion (a group, yes, to which I sometimes ascribe myself to) are quick to point out that this is only a fancy term for rationing (yes, folks, I'm totally referring to health care here). Well, guess what, folks, it is rationing. It's rationing....and, yes, we need to do MORE OF IT!................................................................................................For those of you who aren't sure what I'm talking about, I refer you to one of President Obama's earlier speeches on health care. Remember when he brought up the two different colored pills; one of which was X dollars and effective, the other of which was X-5 dollars but equally effective - this, and of how we (i.e., the American public, taxpayers, the health care system, etc.) could save a lot of money if we all opted for the cheaper option? That, in a nutshell, is what comparative effectiveness means............................................................................................Of course, you probably also remember just how much President Obama was made fun of for these comments. What I'm here to tell you is that he shouldn't have been. This, in that, at least from what I can gather, there are countless examples of brand new (and, yes, extremely pricey) drugs and procedure that are either no better or negligibly better than what we had before (I refer you to Dr. Emanuel's book, "Healthcare Guaranteed" for some examples). I'm telling you, folks, if we EVER want to get a handle on this health care mess (the cost component of it, especially), we are going to have to do MORE with comparative effectiveness (rationing, if you prefer). 1) We're (i.e., the government, private industry, etc.) going to have to use the research that's already available. And 2) we're going to have to invest in the steady procurement of more of it. The future of the system is absolutely at stake.


Oso said...

you're entirely right, but it really flies in the face of a kind of entitlement that Americans seem to have.
Not saying I'm not an asshole in many ways, but I drive a 36 year old VW cause it gets me around without a hitch. Easy to maintain yada yada yada.
Lot of people who make in the ballpark of what I make (middle union wage)drive hella better cars.Not marginally better, I mean nice new cars. their kids too. Cars never meant much to me.

Point being,for every Will or Oso who understands Comparative Effectiveness and how it's a good thing and doesn't in any way provide less beneficial care there's a truckload of Yahoos who think it rips them off.
Ain't gonna be easy but you already knew that.

Commander Zaius said...
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Commander Zaius said...

It's rationing....and, yes, we need to do MORE OF IT!

I agree and from seeing what I see working at a hospital I'm afraid that no matter how people may howl other, more drastic, forms of rationing will eventually be used.

In the long run it won't matter if its insurance companies or the government but with the system close to breaking down now and with the baby boomers beginning their mad rush to heaven or hell its only going to get worse.

Will "take no prisoners" Hart said...

You never cease to amaze me with these analogies. Yet another excellent one. And, please, might I also add, Will and Oso aren't running for office, either (not obligated to cater to the yahoos, etc.).

Will "take no prisoners" Hart said...

You read my mind, double b. Whether it's a single payer government plan, private insurance, or a combination of the 2, we're going to have to make some tough choices. And, besides, if a rich person wants that more expensive pill, there's nothing that says he/she can't buy it him/herself. And the demographic point you raise is an important one, too

Commander Zaius said...

While I fully enjoy my life and want to keep it to the bitter end my living will even now states not to turn me into a cyborg and while my wife will seriously debate whether I even have a brain, once that badboy is lost my will also states to pull the plug quickly.

I can deal with the idea of being a few days on a ventilator withe the hope of getting better but after that someone is going to need to buy the boat for my viking funeral.

IrOnY RaGeD said...

I have no problem with choosing a less costly procedure or medicine if the outcome is equal or better, but who makes that call?

You, your doctor, or the government?
(which one is cash strapped and which one can you be sure has your best interest at heart?)

And what about poor old granny who needs an expensive operation to keep on living a few more years?

Will the government decide that it's more cost effective to just give her a pain pill to ease her passing?

Do you want yourself or a loved one to be on the other side of that equation?

IrOnY RaGeD said...

AND when the government starts paying your doctor is he STILL gonna care as much about your health when he's being paid crapola for his services?

Or will he start turning people on the government plan away like they're doing with medicaid right now?

IrOnY RaGeD said...

Not to mention that this plan would give the government unprecedented access to your entire life.

Just about anything you do or eat can affect your health and may have to be more strictly controlled you know.

Or maybe if they decide your lifestyle is unhealthy, maybe your cost effectiveness quotient goes down or something...

IrOnY RaGeD said...

"And, besides, if a rich person wants that more expensive pill, there's nothing that says he/she can't buy it him/herself...."

Yes and ONLY the rich will be able to afford quality health care.
Because the insurance companies that serve the middle class will go out of business. They can't compete with a non profit plan that has the taxpayers deep pockets to absorb the loss.

Also, under the plan proposed employers would have to pay a fee to carry a premium insurance plan for their employees and most if not all will drop their current plans, and abandon their employees to the government option.

Think about it, if this had anything to do with reducing healthcare costs, WHY ARE THEY TAXING EVERYTHING TO DO WITH HEALTHCARE???

From what I've read, they're talking about taxing not only premium insurance plans but medical devices as well.

IrOnY RaGeD said...

Ok, rant ended....LOL

Will "take no prisoners" Hart said...

The thing is, Volt, a lot of this stuff happens already. Like with private insurance and their drug formularies; paying for certain drugs and not for others (or they pay with a much bigger co-pay), paying for certain procedures and not for others. As for Medicare, that is really mucked up. They DON'T pay for things that they should (ambulance rides) but DO pay for a lot of things that they shouldn't (a lot of wasted procedures, tests, specialists during the final month of life). Doctors? I'm not completely sure that totally trust them, either. I mean, don't they push certain drugs due to deals with the drug companies? The bottom line is that we just can't afford everything anymore (baby boomers aging, people living longer, etc.)

Will "take no prisoners" Hart said...

Just for the record, Volt, I DON'T support what the Democrats have been pushing; expanding Medicare, Medicaid, creating a public option, etc.. I'm for vouchers, people being able to buy insurance across state lines, and health boards to set minimum standards of coverage and help resolve disputes (this to hopefully lessen malpractice claims). It's far from a perfect system but it's better than Canada, and it's better than what we have now.