Rethinking Healthcare

The health reform battle was lost before it started

Posting in Government

The only way we will ever cut health costs is by making hard choices on what we should be covering. Our present system puts politicians in charge of this. Comparative effectiveness gives data a chance.

In Washington, Democrats and Republicans continue arguing about health reform. Will we get a bill or won't we? Will it have a public option? What about abortion?

It doesn't matter. This battle was lost before it started.

The battle was lost in January, during the debate over what is now known as "the stimulus." A big hunk of that money, $19.2 billion, was to be spent automating doctors' offices and hospitals. This would save money, we were told.

How? It would let scientists access the country's entire health record for the first time. Instead of just looking at data from, say, the Framingham Heart Study, they would have health records from all 300 million of us.

With all that data we could finally know, definitively, what works and what doesn't. Strip the names out, strip out the addresses, phone numbers, every possible identifier, and that firehose of data would finally let us know what we should be paying for, and what we shouldn't be paying for.

The statistical science I described above is called comparative effectiveness. Remember what anti-reform zealot Betsy McCaughey (above) called this in January? "Getting between you and your doctor."

The charge that "government bureaucrats" would decide "who would live and who would die" forced the Administration to backtrack, and say that while we'll collect the data, we won't use it to make decisions.

This effectively killed health reform.

Health reform has always been based on two goals -- "bending the cost curve" and "covering everyone." Comparative effectiveness would let us meet that first goal.

Without it, we have a political process.  That's what is crazy about the Stupak Amendment nonsense. Not the abortion, but the fact that politicians were deciding what should be covered, based on political considerations.

That's what we have now.

States regulate insurance companies, which means state governments now decide what will be covered and what won't. It's an inherently political process. Do Christian Scientists have good lobbyists? Do chiropractors? You're out or you're in based, not on science, but on the political arguments you make and the political efforts you make on their behalf.

Partly as a result, the RAND Corp. says, one-third or more of all procedures performed in the U.S. are of questionable benefit. We're not paying for what works. We're paying for everything.

The only way we will ever cut the rate of health care inflation, let alone cut costs, is by making hard decisions on what we should be covering, through insurance or government, and what we shouldn't be covered. You can still get services that don't work -- just don't make me pay for them.

Our present system puts politicians in charge of this. Comparative effectiveness gives data a chance.

But we won't have comparative effectiveness. We decided that in January. So it doesn't really matter all that much whether Congress passes health reform.

The battle has already been lost.

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Dana Blankenhorn

Contributing Editor

Contributing Editor Dana Blankenhorn has written for the Chicago Tribune, Advertising Age's "NetMarketing" supplement and founded the Interactive Age Daily for CMP Media. He holds degrees from Rice and Northwestern universities. He is based in Atlanta. Follow him on Twitter. Disclosure