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Sun., March 1, 2009

Smart Bombs: Unhealthy debate

Unhealthy debate

I’m skeptical that President Barack Obama can reach his ambitious goals on the budget deficit and health care, because he can’t meet the former without radical changes to the latter. Powerful forces are arrayed against health care reform and the cost-cutting that will be necessary to deliver broader coverage and a smaller deficit. Fact is, there’s a lot of money to be made off the inefficiency that courses through the U.S. system, and the beneficiaries won’t surrender those profits without a fight.

Just take a look at one issue that should be a slam dunk: a move to outcome-based medicine that channels dollars to the most effective treatments. Who could be against that? Well, there are the purveyors of less-effective treatments, but good luck building a marketing strategy around that. So the motto of this defense strategy will be “Stop the Rationing!”

Sarah Arnquist has the details at The Health Care Blog, where an array of experts hold forth. Money was set aside in the U.S. House of Representatives’ version of the stimulus bill to finance comparative treatment research, with an eye toward getting the most value for our health care dollars.

The push for research is prompted by the fact that the United States already spends far more than other developed nations on health care as a percentage of the economy, without covering 48 million people and without better outcomes to show for it. In addition, Dartmouth University has studied Medicare for 30 years and found a solid correlation between the supply of health care and how much Medicare is billed. The kicker is that greater spending on higher supply doesn’t yield better outcomes for patients. But all of those doctors, specialists and nurses still need to get paid, and that high-tech equipment needs to pay for itself.

In short, there’s a lot of dollars dripping down the drain, and it would be wise to tighten the spigot. Plus, everyone benefits when health care is more effective.

Comparative treatment research is used in England, Canada, Germany and Australia, but this fact provided opponents their “Aha!” moment. As in, “Aha! Government, not doctors, will be making health care decisions for you! Care will be rationed!”

Well, anonymous workers at insurance agencies make those calls now (if you weren’t already denied coverage for a pre-existing condition), and that hasn’t kept costs down or doctors and patients happy. The complaint isn’t about who chooses; it’s about who pays. If an ineffective procedure is rejected, somebody loses money. If it’s given the go-ahead, prices will eventually rise for everyone.

This should be one of the easier health care fixes. The fact that inefficiency has a powerful constituency doesn’t bode well for reform.

Smart Bombs is written by Associate Editor Gary Crooks and appears Wednesdays and Sundays on the Opinion page. Crooks can be reached at or at (509) 459-5026.

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