• Effectiveness versus cost-effectiveness

    One of the things that’s struck me as odd since I’ve been blogging is the partisanship that exists not only with respect to politics, but with respect to almost anything. Just about all the emails I get fall into one of two groups: total support or total opposition. No gray, no middle ground.

    Here’s an email from column A, with respect to my recent post on rear facing car seats.:

    Obviously you don’t have children or care for them. I would do anything to protect my baby including inconveniencing myself. I suppose you want to do away with car seats altogether because they cost money or are a pain?

    And here’s one from column B:

    This is just another example of paternalism rearing its ugly head. You people won’t be happy until you are dictating every last bit of our lives and have all but eliminated free choice. Why should anyone tell me how to protect my kids at all?

    Look, I have kids and I absolutely used car seats; I also use booster seats. I believe in doing reasonable things, even some unreasonable things, to protect my children. My argument in my recent post is that it feels to me that sometimes we only seem to focus on effectiveness, and not on the cost.

    Do rear facing car seats save more lives in 2 year olds than front facing car seats?  Yes. Therefore some believe we should do it. My complaint is that there is no focus on the other side – on cost. Not just the monetary cost (which I personally care less about), but the “cost” of inconvenience, fighting, discomfort, etc. Sometimes, if you make a kid miserable enough in the car seat, they may fight using it altogether.

    Now it may turn out the cost is small when compared to effectiveness. If so, we should change the policy. But I’d like someone to make that argument. I don’t like being told what to do based just on one side of the equation. Everything is a balance of good and bad, effectiveness and harm.

    I don’t understand why so many of you are against cost-effectiveness. Deep down inside, we all know it makes sense. Look at it this way: if I invent a pill tomorrow that extends your life by one day and costs a billion dollars, should insurance pay for it?  Of course not. We all know that’s not cost-effective. But because we all know that to be true, we all understand that such decisions are possible, if not necessary. So is it worth a million dollars? Still likely no. A thousand?  Maybe. A dollar? Absolutely.

    We can reason this out because we are focusing on both the good (effectiveness) and the bad (cost). We have to be able to do that. And that applies not only to the health care system, but also to all kinds of policy decisions. We have to talk about these things like adults, without resorting to fear mongering.

    Advocating for or against rear facing car seats for 2 year olds does not make you an uncaring sociopath nor a government stoolie. There’s a middle ground.

    To reiterate my point, I don’t doubt that there is an actual increase in saved lives if we increase the recommendations for rear facing car seats to two years of age. I don’t doubt that increasing it to three or higher would result in fewer casuatlies. I’d just like someone to make an argument about the relative benefits versus harms, so we can make an informed decision as to the best, and most reasonable policy.

    I’d like someone to convince me. I’m an adult. I’d like to be treated like one.

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    • “I’d like someone to convince me. I’m an adult. I’d like to be treated like one.”

      That’s the best argument I’ve read lately for providing good information and then letting people make up their own mind. Why is this a decision “we” should make for everybody? Each of us should make it for ourselves.

      Let’s take the politics away from these types of decisions, and I suspect the science will get better too.