I’ve been getting a lot of interesting comments and emails about my last post. Many of them concern cost effectiveness research and rationing. It’s too much to answer them all, so let me try and make s few clarifications and further points.
1) I’m sorry, but I don’t think I’m making a straw man argument here. If you really need me to prove that many, many, many people think that government involvement, or cost-effectiveness, or even comparative effectiveness research leads to RATIONING, then you haven’t been paying attentions. Death panels, anyone?
2) In a similar vein, if you don’t think there are many people (including politicians) who think we do not ration right now, then you are not paying attention. Go ahead. Ask you representative if our health care system rations right now, and see what answer you get.
3) We are not currently in a system of markets and prices rationing effectively. We are in a system where if you can pay for care, or for decent insurance, you get it. Otherwise, it’s significantly more likely you can’t. Unless you’re over the age of 65, in which case, you’re almost positively getting it.
4) Converting to a “voucher” system as Rep. Ryan proposes will not result in the market all of a sudden rationing effectively. If you believe that, then you should believe that the PPACA exchanges will result in the same outcome. I don’t believe the PPACA will do so. I doubt conservative opponents of the PPACA believe it will do so either. So why will Rep. Ryan’s plan?
5) I don’t believe cost-effectiveness research is the be-all and end-all of medical decision making. I think it can be a powerful tool to help us make better decisions. I own all its limitations, but I don’t think the perfect should be the enemy of the good.
6) I get that there is a philosophical difference between many of us. I believe that a well informed and public panel can make rational decisions at the extremes of costs and care. I get that this scares the crap out of some of you. That’s why I content is has to be public, reversible, and accountable.
7) I’ve said this before and I will say it again:
[I] think we can have a panel of experts (which should include physicians) try and determine which care isn’t worth the money and stop spending as much public money on that. This will mean that if individuals want to get that care anyway, they have to pay for it themselves.
I’m not advocating for a system where rationing occurs in such a way that government or experts tell you how to spend your money. I’m advocating for a system where government/experts decide what government should spend its money on. People are free to spend their own money above that.