Health Care Faces the 'R' Word -- by Michael Kinsley
Even though more and more Americans have no health insurance at all, Americans consider health care to be a right. Not just that: We consider the best possible health care to be a right. Few would find it acceptable for a poor person to die of a medically curable disease for lack of money. Even fewer would find it acceptable that they themselves should die because the system won't spend the money to cure them. This is all in theory, of course. In practice, people die all the time because some effective treatment is too expensive. But whenever an issue gets drawn into the political system and becomes explicit, it becomes harder. That is what health-care reform will do to the question of rationing.
The Obama administration believes that health care can be made cheaper without any reduction in quality. It has evidence to back this up. According to the famous Dartmouth studies, health care costs two or three times as much per person in some places in America as it does in others, with no measurable difference in results. Atul Gawande's deservedly admired recent essay in the New Yorker makes a similar point. So in theory it's easy: Just figure out how the cheap places do it and apply this knowledge to bring down the cost in the pricier places.
The administration is investing great hopes (and $1.1 billion of stimulus money) in "comparative effectiveness research." Because we don't collect and compare in any systematic way the vast piles of data we have about individual patients and their treatment, we know astonishingly little about which treatments work and which are a waste of money. The administration is touting the figure of 30 percent of all health-care costs as spending that may accomplish nothing.
I suspect that what a billion-plus dollars' worth of research will find is that perhaps 30 percent of what we spend on health care is almost entirely worthless, or just barely better than a much cheaper alternative. Or it might be better and no one knows for sure.
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Being one of those who has no health insurance ['the great unwashed' as I call us uninsureds], I'll be glad when this thang is settled--though it'll be too late to benefit me. Next year, I become eligible for Medicare.
Still, it's about time the rest of the population can see a physician without breaking the bank, don't you think?