The kindest cut

Jared Bernstein is well worth following. His latest post, which I recommend reading in full, shows why.

[T]he IPAB is a mechanism to control the cost growth of Medicare, to enforce, for example, the cost effectiveness I talk about here.  I recognize that one can twist this search for more efficient health care delivery into Ryan’s accusation [of rationing], but there is a fundamental difference between “denying care” and insisting of cost effective care.

Not paying for ineffective care is the kindest cut. One can certainly argue how to do it, to what extent it can be done without harming any patients, and so forth. But to not even try, in the name of “rationing,” is foolhardy. Don’t we want our tax and premium dollars spent wisely, thoughtfully, and not wastefully?

Do we not ask the same of any other avenue of expenditure? Health care is different for a lot of reasons, but it is not different in the sense that there are trade-offs. We can make them haphazardly and thoughtlessly or we can attempt to do better. I suggest we try “better.”


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