walkitout (walkitout) wrote,

health care reform

It looks like the Obama administration is basically going to take the Medicare part D funding problem, brandish it at the public at large, and use that to accomplish general reform. You want entitlements? All righty. We're going to regulate them.

About fucking time.

The starting point, obviously, is making it so that Medicare can negotiate drug etc. prices as a whole, the way the VA does. Duh. But the administration is not going to stop there; the stimulus bill included a little over a billion dollars to research what works best for conditions which there are competing treatments for. Now, this seems breathtakingly obvious. We have a lot of "variations" research, showing that you get different medical care depending on which doctor/hospital/whatever you happen to interact with. The variations research is pretty compelling -- paying more doesn't get you better care, and more care typically has worse outcomes. Spending a billion dollars figuring out how to get everyone the best care seems -- to me, anyway -- a relatively non-controversial idea.

Not so to actual doctors!


I have little respect for Dr. Chen, altho I do not typically mention her articles here. I figure I'm a little repetitive anyway. She ultimately comes out in favor of regulation, but not for anything like a reasonable reason. She goes, hey, the transplant process is heavily regulated and that works well. Umm. No actual comparative outcomes or anything but whatever. Her little story about the woman with the tumor and the Rose Parade also, very not compelling. Whatever. Failure to invoke variations literature is disturbing, but okay. She notes that there are third parties involved all the time, but fails to mention all the groups working separately on guidelines/practice standards/etc.

But at the end of the day, there is Kaiser. And Kaiser is All About We Run Our Doctors -- They Don't Run Us. Doctors are just more staff at Kaiser. And their outcomes are the best out there, and their costs are the best controlled. Kaiser is proof positive, start to finish, that studying what works works really well.

But apparently, doctors care _so much_ about their relationship with their patient, that outcomes don't really matter to them. Kinda like abusive parents.

Kinda creepy.
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