Sens. Kyl, McConnell, and Roberts Want to Preserve the Waste in Public Sector Health Care
Conservatives continue to be right to point out that achieving the sort of health care cost savings progressives are talking about is easier said than done. That said, I continue to be baffled as to how it is that they keep thinking the main point here is to castigate the progressives trying to make things better rather than castigating the people who are actually making the cost savings difficult. For example, Senators Jon Kyl (R-AZ), Mitch McConnell (R-KY), and Pat Roberts (R-KS) have introduced a new bill that would attempt to prevent Medicare and Medicaid from using comparative effectiveness research in order to ascertain which services should be paid for.
The basic political game here is clear enough. On the one hand, conservatives want to say that health reform is too expensive. On the other hand, they want to denounce any effort to control costs as evil rationing. It’s a nice partisan game. But the policy substance is insane. As Igor Volsky points out, CER doesn’t change the fact that decisions need to be made. Instead all this is going to do is waste money and deny patients the benefit of accurate information about which treatments work:
His latest effort prohibits the government from using “data obtained from the conduct of comparative effectiveness research…to deny coverage of an item or service under a Federal health care system.” The language compliments the GOP’s larger argument that Obama’s health care reform would usher in the era of European-style socialized-medicine and rationed care, but it ignores the government’s existing ability to make coverage decisions.
As Thomas Scully, the Administrator of the Centers for Medicare and Medicaid Services (CMS) from 2001-2003 pointed out in an interview with ThinkProgress, “you know, Medicare makes decisions on coverage all the time. I made decisions on coverage all the time….You got to do it the right way. But I think – I’ve always been a big fan of comparative effectiveness research if done correctly.”
In reaching coverage decisions the Center for Medicare and Medicaid Services relies on an evidence-based process, conducts internal research and consults outside assessments. Upon CMS’s request, fifteen experts on the the Medicare Evidence Development and Coverage Advisory Committee review, evaluate, and collect medical literature and technological assessments and examine the data based on effectiveness and appropriateness. Only then, does the panel of experts issue a coverage decision.
Again, if you want to take this as an example of how difficult it will be to reform Medicare and make it work, you’re welcome to do so. But please place your blame on the right people—on Kyl, on McConnell, on Roberts, and on others who want to block reform as a way of maintaining the viability of their partisan talking points. What we need in this country is a rational debate, in which conservatives at least stick to the story of being concerned about spending too much money, and then we can have a discussion about how to prevent that from happening.
17 Responses to “Sens. Kyl, McConnell, and Roberts Want to Preserve the Waste in Public Sector Health Care”
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June 17th, 2009 at 1:48 pm
I think it needs to be drilled into people’s heads that all forms of insurance require some amount of “rationing” when it comes to claims, regardless of whether or not the government is involved. Not that they don’t know this intuitively, but I think that particular word, “rationing”, needs to be demystified.
June 17th, 2009 at 1:52 pm
Those guys need to ban medical schools immediately.
After all, what do med schools do but teach doctors correct procedures that are based on comparative effectiveness research?
June 17th, 2009 at 2:05 pm
I want medicare to pay for my shoes to be plated in solid gold to correct my lower back pain. After all, you aren’t allowed to say it’s not comparatively effective.
June 17th, 2009 at 2:05 pm
DTM has it. All private insurance companies limit coverage to “reasonable and necessary” charges. All of them refuse to pay for treatments that are merely “experimental.” Do Kyl and McConnell think that Blue Cross pays for witch doctors?
Of course private companies draw lines about what they’ll pay for, and of course a ‘public option’ insurer will do the same. I’d prefer that these distinctions be drawn based on evidence of effectiveness. Kyl and McConnell would prefer ’size of donations.’ Let the debate begin.
June 17th, 2009 at 2:09 pm
“But please place your blame on the right people—on Kyl, on McConnell, on Roberts, and on others who want to block reform as a way of maintaining the viability of their partisan talking points.”
Yes, they are the right ones to blame here, Matt, but your analysis of their motives is rather weak. I don’t think that they’re nearly as concerned about “maintaining the viability of their partisan talking points,” as they are about continuing the obscenely large volume of campaign contributions flowing which they receive from the Insurance Industry, Pharma, and the medical devices folks.
What was that old saying…oh yeah, “follow the money.”
Good words for bloggers to keep in mind.
June 17th, 2009 at 2:11 pm
WSP,
You beat me to it. I type too damned slowly.
June 17th, 2009 at 2:13 pm
And while we’re on the subject of rationing health care, a helpful piece:
http://www.nytimes.com/2009/06/17/business/economy/17leonhardt.html?scp=1&sq=rationing&st=cse
June 17th, 2009 at 2:16 pm
What was that old saying . . . oh yeah, “follow the money.” Good words for bloggers to keep in mind.
I often wonder if Matt has some unstated reason for overlooking the likely pecuniary motives of the various actors he is discussing. Of course, a cynic might note that Matt himself is not a volunteer, and maybe he is afraid of a double-edged sword.
June 17th, 2009 at 2:17 pm
I wonder how much people really understand that the health care system in the US is a government grant of monopoly rents, much as Kings would give exlusive salt or silk import rights. Or that this means that it is an essential political capital arrangement, and that using a public option or a single payer or single provider system to lower “unnecessary profits” would damage the *real* political systems that revolves around the consent of the elites (you know, so you don’t have private armies and assasinations, etc, etc–the situation in Iran, in the end, has absolutely *everything* to do politically privileged economic actors).
People really gotta take this in account in fighting for a working health care system, both with more patience and more cleverness. The overall financial crisis has everything to do with political failures and not precisely economic failure. There are too many political actors dependent on sucking out profit away from maintaining (infrastructure) or improving systems (R&D), and now, there are no more industries that are genuinely profitable enough to support the patronage machines around the world. The fact that the US cannot support the health care system’s (or higher educational system, or many other systems) inflationary propensity anymores is just a reflection of the general crisis.
June 17th, 2009 at 2:20 pm
Conservatives don’t like the things that single payer health care requires to control costs. They think that what Obama is proposing is substantially the same as single payer in this respect. Moreover they think that the way to win a fight about health care is to do a better job than your opponent at hiding the costs of your approach. I tend to think it would be better if everyone was forced to be honest about costs, but in 1994 Clinton actually said how he would contain costs and conservatives didn’t respond by being similarly honest.
June 17th, 2009 at 2:26 pm
I often wonder if Matt has some unstated reason for overlooking the likely pecuniary motives of the various actors he is discussing.
Debating motives is a fool’s game. Since we have better arguments, we should try to get to the point where issues are argued on the merits. So I agree with Matt here.
June 17th, 2009 at 3:18 pm
Orthodontists must be geniuses. They live the lifestyle of the rich and famous. They must be much, much smarter than our teachers, Senators, or army colonels.
June 17th, 2009 at 6:38 pm
For example, Senators Jon Kyl (R-AZ), Mitch McConnell (R-KY), and Pat Roberts (R-KS) have introduced a new bill that would attempt to prevent Medicare and Medicaid from using comparative effectiveness research in order to ascertain which services should be paid for.
This should come as no shocker, because it’s entirely consistent with the traditional GOP stance in favor of a robust level of spending on the safety net.
June 17th, 2009 at 9:01 pm
Right, the insurance companies, the pharm corps and the lobbyists made me say this.
Ridiculous, insurance by its nature assumes profit from lack of “use”, i.e. insure 100 people, only 20 will want insurance to pay the cost (of the insured risk). Voila’ profit. As my Father told me almost 40 years ago as a newly minted underwriter for Bechtel’s captive insurance company, Industrial Indemnity, and you get a ton of money/profit which you invest to make a ton more money.
Wow, nothing has changed. The quality of care between patient and doctor should have nothing to do with insurance. Health insurance is not working because of the profit motive.
We need a public system like most sane countries, and get the profit corporation/greed operators out of the equation.
June 17th, 2009 at 9:48 pm
What we need in this country is a rational debate, in which conservatives at least stick to the story of being concerned about spending too much money, and then we can have a discussion about how to prevent that from happening.
And a pony. You forgot the pony.
June 18th, 2009 at 11:29 am
Debating motives is a fool’s game. Since we have better arguments, we should try to get to the point where issues are argued on the merits. So I agree with Matt here.
I can see the merits of that argument, so maybe that is Matt’s thinking. Still, I think every once in a while, taking the time to accurately describe what is happening is worth doing.
June 18th, 2009 at 4:18 pm
Several years ago I was in Germany with my wife and mother-in-law. While visiting one of the alpine castles, my mother-in-law slipped and fell breaking her leg below the knee and above the ankle. She was taken by ambulance to a local hospital where her bones were set and then she underwent two weeks of therapy at the hospital. When we told the hospital authorities that we did not have German health coverage, they held a meeting and then told us that they would charge us the going rate at a five star hotel. Our bill was $7,000.00. When my mother-in-law got home her doctor was amazed at the high level of technical expertise the doctors in Germany displayed. Then came the bad news. My mother-in-law’s insurance company refused to pay for the entire hospital bill and stuck my mother-in-law with a $2,000 of the $7,000 charge.
This is the premise: The profit motive in health care must be removed. The U.S. government runs four of the best engineering schools in the United States, the military academies, so why not run the best medical schools in the United States. All those students who want to become doctors, nurses, PAs, and LVNs and qualify for entrance should be allowed in. The education should be entirely free. In return the graduates will be assigned to different locals around the country and be paid about $75,000 to $150,000 per year. After 15 years the doctors and nurses will be allowed to practice privately on the side in addition to their government jobs. Since this is a rough draft, all the details could be worked out later such as hospital ownership etc. The point should be clear, flood the market with medical professional thereby driving down medical cost. Medicine becomes a service rather than a wealth generator.