It’s impossible to have a rational discussion about health policy when one side of the argument is irretrievably deceitful. Here are some things I find irritating, to say the least:
A White House that claims the way to control health care costs is to follow “evidence-based” guidelines, doing only procedures that are cost effective.
A White House that then uses taxpayer dollars to promote procedures that are not evidence-based or cost effective for blatantly political reasons.
A sycophantic press corps and fellow-traveling health policy bloggers who either remain silent or actually apologize for this hypocrisy.
Whether in the personage of Office of Management and Budget Director Peter Orszag or White House health adviser Zeke Emanuel or the president himself, the original message about health care spending was: we are spending too much money on items and procedures that are not good value for money. Writing in The New York Times, Emanuel, for example, claimed that Accountable Care Organizations (how ObamaCare wants care to be delivered) will save millions of dollars, in part “by avoiding unnecessary tests, drugs and procedures.”
“Momma said there’ll be days like this.”
Further, President Obama has not restricted this approach to health care. Here is what he said the other day about his regulation czar, Cass Sunstein:
Cass has shepherded our review of existing rules to get rid of those that cost too much or no longer make sense, an effort that is already on track to save billions of dollars. With these reforms and his tenacious promotion of cost-benefit analysis, his efforts will benefit Americans for years to come. I can’t thank him enough for his friendship and for his years of exceptional service.
Contrast this concern for economic efficiency with the millions of dollars the administration has spent on Andy Griffith TV commercials and on other propaganda, telling senior voters about their right to a “free annual checkup” and encouraging them to go get it!
Turns out what is being billed as a “free medical checkup” and a “physical” is actually a “wellness exam.” Here is how AARP explains it:
During a wellness visit, the doctor measures the patient’s height, weight, body mass and blood pressure — and perhaps listens to his heart through his clothes…In other words, it provides a snapshot of the patient’s current health, as a baseline for future yearly visits, and is intended as a preventive service, a way of catching potentially serious health issues early.
Yet where in all the medical literature is there any evidence whatsoever that “wellness exams” for otherwise healthy people are cost effective? There isn’t any.
Then there is the latest administration effort to court women voters with ObamaCare’s promises of all manner of “free” services, including routine breast and pelvic exams, breast feeding advice, and even contraceptives. Health economists have known for a long time that preventive medicine does not save money, except in a few cases. The money that is saved, say, by early cancer detection in a patient who has cancer is overwhelmed by the costs of screening tens of thousands of people who don’t have cancer.
Even if it doesn’t save money, screening may be cost effective (a reasonable investment in health) in some cases. But the Obama administration has shown no interest at all in cost benefit analysis when it comes to women’s health. These days it is widely touting the benefits of the free mammograms ObamaCare will require, even as an article in the latest British Medical Journal questions whether mammograms ever make sense for otherwise healthy women.
As for sycophantic bloggers, I appeared on Hannity the other day with Chris Lillis, representing Doctors for America. After telling the radio audience how important evidence-based medicine is, Dr. Willis went on to claim that mammograms, Pap smears and all manner of other preventive procedures actually pay for themselves — thereby ignoring the whole of medical research for the past quarter of a century.
By the way, there are a few places that will call out the hypocrites in the health policy blogosphere, including Avik Roy and Jason Shafrin. But there are far too few of them.