One thing that’s quite striking in the health care debate is the lack of detailed analysis opponents are presenting in their arguments. Compare Ron Brownstein’s positive analysis of the Senate bill for example, with David Broder’s meandering, senility ramblings against it. Or this MIT economist’s favorable analysis of its impact on premiums with Krauthammer’s latest vague, error riddled column on the subject.
The anti-health care reform piece that I found most disappointing was this one, by Jeffrey S. Flier, a dean at the Harvard Medical School.
In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care’s dysfunctional delivery system. The system we have now promotes fragmented care and makes it more difficult than it should be to assess outcomes and patient satisfaction. The true costs of health care are disguised, competition based on price and quality are almost impossible, and patients lose their ability to be the ultimate judges of value.
Remarkably, he doesn’t name even one of these health-care leaders or economists! And it turns out this guy also produced some kind of glibertarian nonsense opposing health care in 1994.
I understand why the WSJ published the piece: they’re right-wing sociopaths with no journalistic integrity. But I wonder if the Harvard Medical School is happy to have this kind of fact-free garbage go out under their name. And It’s remarkable the extent to which wingers are happy to abuse their positions to forward the political agenda they favor.
Pigs & Spiders
Fact-o-phasia isn’t covered under the public option either.
bago
For proof of that you only need to look at the CBO scoring of the submitted plans. The republican plan barely keeps up with growth, and costs far more than the democratic plan currently under proposal. I don’t want to be tribalistic, but that is some serious weak sauce.
chrome agnomen
we live in a political world
love don’t have any place
we’re livin in times
where men commit crimes
and crime don’t have any face
licensed to kill time
Meandering Senility Ramblings would be an excellent name for a rock band. Maybe a folkie band.
Radon Chong
What about the other side of the coin? It is at least as striking that good, detailed arguments offered by pro-reform analysts have apparently no convincing force to them. What kind of a debate is it where one side can’t win because it offers transparently disingenuous, unconvincing arguments, and the other side can’t win because nobody wants to hear the truth? Maddening!
kay
We were getting dangerously close to discussing the Third Rail on health care, which is not the cost of health insurance, but the cost of health care. We were getting close to The Provider.
Am I surprised that the dean of the medical school saw fit to weigh in at this point? No, I’m not.
I love the idea that patients, at some future point in time, will develop an ability to judge “quality” of medical care.
First , we’ve been told for 40 years that only medical professionals are qualified to measure health care quality, and, second, treatment for a real medical issue is an area of specialized knowledge. Patients won’t be able to measure “value”. That’s why they don’t treat themselves. They don’t know how.
They’re overworked enough doing their own jobs, without taking a tutorial and comparing possible medical outcomes based on “value” or “quality”. It’s why we line up for every recommended test.
It’s the same freaking argument the finance sector uses. I’m supposed to learn and understand exotic financial instruments before buying a house , and if I don’t, or won’t, well, it’s buyer beware!
I think it’s too late. We may end up with a crappy health care bill, but people are actually thinking through health care delivery in this country, and the Dean isn’t going to be able to put that genie back in the bottle.
Ian
Put down the right-wing literature, and pick up a bong.
kay
@Radon Chong:
IMO, pro-reform analysts avoided addressing the cost of medical care like the plague.
They made limited arguments, because they were dodging that. They focused on access, or humanitarian concerns, all great goals, but they have to address COST. Why does it cost so much? Why does it cost so much more than people in other countries pay? Where is the money going, and why don’t we have better, more broadly beneficial outcomes? It can’t be dodged. The Senate health care bill actually tried to address that.
I think I read a thousand times that a public plan saves on the profit measure and administrative cost that insurance companies collect. True. But that’s a measure of care delivered per dollar. It has nothing to do with how many total dollars we spend. We can easily allocate 90% of every health care dollar to actual health care (not insurance profit or administrative costs) and still have total health care costs go up every year.
ppcli
“But I wonder if the Harvard Medical School is happy to have this kind of fact-free garbage go out under their name.”
Well, my wife’s medical degree is from HMS and she’s still dialed in to a variety of networks there so I can kick in some input on that one. She and all the people she knows are horrified by what they regard as a shoddy and deceptive op-ed. But then they were even more horrified when Mack (RIP) was arguing from the platform of a Harvard Med School professorship that alien abductions were real. Academic freedom is a wonderful thing, but sometimes it can also be a real pain in the ass.
Edit: Woohoo! The edit function is back.
Little Macayla's Friend
At the very least, I wish every analysis of every bill by every group in every article would include a comparison with doing nothing, with what is actually happening, to the insured and to the uninsured in the U.S.
Every article.
/ off to my bike ride in the real world.
Marc
To be fair to Flier, he’s absolutely right that hiding the true cost of health care (through employer-provided insurance, which just passes the costs along to employees through stagnant wages) is one of the problems of our current system.
The problem with his op-ed is that his solution (Make patients pay directly! They can be the best judges of medical value! They’ll just have to be “smart shoppers”!) would only make things much, much worse. So yeah, most of the labels DougJ gave this are absolutely right: right-wing sociopathy, glibertarian nonsense.
But there’s another label we should use whenever someone pretends to use their deep, deep concern over the current system’s flaws as an excuse for doing nothing, or making the system even more hostile to patients by putting all the costs on their shoulders:
Jeffrey S. Flier is a concern troll. And concern troll is concerned.
Brachiator
@bago:
The Republicans have a plan?
This is one of those weird ideas that make sense to some conservatives and libertarians, but is meaningless in the real world. A patient pretty much wants to be cured of whatever ailment he or she has and be able to resume living his or her normal life.
I don’t see stagnant wages as being related to health insurance costs. And if an employee has limited or no choice with respect to a health insurance plan, knowing the cost is not meaningful. And plans, as in the case with some union benefits, which are free to the employee make cost almost a moot issue.
DougJ
Academic freedom is a wonderful thing, but sometimes it can also be a real pain in the ass.
I’m all for academic freedom, but it doesn’t apply to administration the same way it applies to professors. The fact that this guy is a dean is what is weird about it.
DougJ
To be fair to Flier, he’s absolutely right that hiding the true cost of health care (through employer-provided insurance, which just passes the costs along to employees through stagnant wages) is one of the problems of our current system.
True. What bothered me was “all the experts I talked to” and he doesn’t name a single expert. I think that’s just no acceptable in an opinion piece such as this.
kay
@Marc:
CNN keeps running this piece on a nearly-constant loop about a hotel owner who actually provides health care on-site to his employees.
It costs 2400 dollars a year, per employee.
His brainstorm breakthrough idea that they’re trumpeting?
He cherry-picks. You can’t work for him at all if you smoke, so there are no smokers visiting his clinic, and if the clinic tells you to lose weight, you do that, or he drops you from the plan.
No mention of whether he cherry picks for pre-existing conditions during the job interview process, but everyone else does, if they can work it within the law, so I imagine he is too.
CNN never mentions where his overweight and thus uninsured employees end up, which is the county emergency room.
He’s opposed to reform, and he thinks he’s “solved” health care.
vg
It’s nice to have these timely blog posts explaining why everyone who writes columns that cast doubt on initiatives we all favor is in fact a sociopath, asshole, or for one reason or another has no business writing in any publication of note. Too often I find myself reading a column like the one you link to and thinking about what the author has to say. If I had known he had something contrary to say back in 1994 too, I wouldn’t have even bothered.
I just don’t understand why the Wall Street Journal can’t find anyone to write columns critical of health care reform and so forth who aren’t just worthless assholes whose opinions don’t mean shit. Try harder, guys!
Brachiator
@kay:
A recent NY Times story might be an example of a more broadly beneficial outcome that goes well beyond limited considerations of health insurance costs (“Trying to Explain a Drop in Infant Mortality”).
Beej
Because they don’t want to.
This has been SATSQ.
M. Bouffant
Say, isn’t that a good argument for a single-payer system? We’ll make the delivery all functional & stuff, & care will be coordinated, not fractured. Good idea, Dean!!
Church Lady
@vg- :)
Napoleon
Wow, just like Broder didn’t.
Waingro
See, you’re being all sarcastic and stuff, but that’s actually a perfectly accurate statement.
The Wall Street Journal Op-Ed Page: “We’re worthless assholes whose opinions don’t mean shit!”
Barry
DougJ: “But I wonder if the Harvard Medical School is happy to have this kind of fact-free garbage go out under their name. ”
Considering the contributions of the Harvard Econ Dept, B-School and Law School to our current situation, why not?
kay
@Brachiator:
Thanks. I have been fortunate enough not to require medical care, with the exception of a bizarre episode where I was the donor in a clinical trial for a bone marrow cancer treatment approach. That was horrible, but clearly an outlier.
I did get pregnancy care, however, and I didn’t have any money or insurance, and I ended up at a community clinic, and got great care, like the women in that article.
It was complete. I got nutrition advice, I got exercise advice, I got mental health advice ( recognition that pregnancy is emotional and stressful time) and I saw a doctor for twenty minutes a month. It was great, this team approach, and it was cheap. A sliding fee scale. I paid cash.
If I had my druthers, I would like to that sort of complete care for any medical problem I may end up with. I know that won’t work for everyone, and every condition, but I was impressed.
Brachiator
@kay:
Agreed. The main thing lacking in the NY Times article was any discussion of the costs of the various social programs involved. Still, it is a useful corrective for the easy assumption that simply more medical care (e.g. hospitals, pediatric ICUs, etc.) would be the solution to the infant mortality problem.
Mike G
The Wall Street Journal Op-Ed Page: “We’re worthless assholes whose opinions don’t mean shit!”
People whose arguments amount to window-dressing for, “I make more money out of the current health care mess, so fuck everyone else”, are pretty much worthless assholes by definition.
Mark S.
@M. Bouffant:
I’m sure Dr. Flier will get to that in his next column. I mean, you can’t just complain that the reform doesn’t do enough and then offer no constructive solutions, amirite? Otherwise, you are just a concern troll.
The only concrete proposal he seems to have is to change the tax laws concerning employer funded health care. But if that is all you do all you’re going to do is drive up the number of uninsured.
kay
@Brachiator:
We have a good county pre and post natal program here. I represent juveniles, and many of them get pregnant. Most of them go on to have the baby. They get nurse visits (like in the article). They bitch at the “babysitting” but they absolutely need help, particularly with diet and emotional issues.
I was not a teenager, and I benefitted tremendously from what amounted to incessant hectoring on diet during pregnancy. I could not put anything in my mouth without the voice of the nutrition counselor ringing in my ears. It worked. I got with the program.
One thing I liked about the House bill was the focus on public health.
I don’t care what anyone says, all you have to do is look at smoking cessation and seat belt and car seat use and immunization numbers and I think you have to conclude public health investment gives a lotta bang for the buck.
I’d like to hire a lot of allied health professionals, and have doctors in a supervisory and oversight role. I don’t need the big gun for every little problem.
Zach
Lindsey Graham was on This Week earlier today debate Bernie Sanders (way to pair one of the most moderate and generally reasonable Republicans with someone who isn’t even a Democrat, by the way) and said, paraphrasing: “And it’s going to mean higher premiums. We’re raising the debt by 2 trillion… 2.5 trillion if you include the next decade if we don’t cut Medicare, and you know we shouldn’t. And that means premiums are going to go up!”
Except that (1) premiums won’t go up for most people, (2) Medicare quality will be increased, and (3) the bill is completely paid for and results in a $140 billion surplus 2010-2019 that actually grows going forward (assuming that a Senator is talking about a Senate bill).
And this is the reasonable one; the one who Democrats will need to get, along with McCain, Snowe, and Collins, if Cap and Trade has a chance in the Senate.
kay
@Brachiator:
I’d love to see what effect a dental clinic would have. My clients are generally poor or lower middle class, and rural. They suffer. They have lousy diets and lousy hygiene training and no dental care as kids, and they just suffer lacking dental care.
They end up with dentures at 50, because they are actually missing work due to pain, so they wait and wait and eventually go to the next city over and get the flat rate “pull all your teeth and dentures” deal.
I think you could probably measure an area’s median income by how many over the counter dental remedies are carried at the drugstore. They’re treating themselves. They have favorite remedies.
Dentists finance the dentures, in-house. High interest. It’s a specialty. You could just cry.
Zach
There’s a transcript now:
He’s saying that Democrats don’t have the balls to cut Medicare to pay for it, but that Democrats shouldn’t cut Medicare to pay for it. I think.
Joey Maloney
And It’s
remarkableutterly typical the extent to which wingers are happy to abuse their positions to forward the political agenda they favor.Fixt for reality.
kay
@Zach:
That’s the argument. That Democrats won’t follow through and slow costs on Medicare.
Libertarians panicked on this last week, and came up with the “democrats won’t follow through” malarkey.
That’s the argument because Republicans know that real fiscal conservatives all know we have to slow costs on Medicare, and real fiscal conservatives should support the Senate bill for that reason alone.
I’m actually glad they’re lying about it. It must have hit home. This MUSTN’T get out! That Republicans are completely full of shit on fiscal conservatism, as on everything else.
Because you can’t get from A to B without slowing growth in Medicare costs, and they know it.
They’re just too chicken to do it.
Little Macayla's Friend
@kay:
I haven’t seen the CNN story, but if the hotel owner has more than 15 employees, I hope someone looks into any illegal cherry-picking.
E.g., :
__
Voluntary wellness programs (which I’m all for):
http://www.eeoc.gov/facts/diabetes.html
kay
@Little Macayla’s Friend:
There’s a million ways around it. If you have a gap in your work history, for example, I’m going to ask about that, and I do, because that’s a legit question.
What if the gap is there because you were sick as a dog with radiation treatments? You’re going to lie, or evade the question?
You’ll answer, and all of a sudden I find 15 reasons why you’re not the best hire.
I don’t think regulation works on this. I’m not going to say “because she’s a diabetic”. I’m going to say “I got a better applicant”.
This is true for a lot of things, by the way. Pregnancy, mental illness, substance abuse issues, race, gender, sexual orientation, whatever.
I’m not allowed to ask how old you are, but I can make a good guess with the date you graduated from high school, or college.
I don’t know about the wellness aspect. Maybe he’s in violation there.
Marc
@Brachiator:
They absolutely are, though you might say it’s the other way around: rising health care costs have driven up the cost of employer-provided insurance, which employers have taken out of wage growth.
Agreed with this, but what Flier is arguing is even more insidious: that if employees had to carry the cost of health care directly, themselves, they would buy much less insurance, they would get less health care, demand would fall, and prices would come down. Never mind that patients have little ability to judge the medical value of procedures, and even less ability to negotiate over price or shop around; or that having a serious health problem that needs treatment puts you in a terrible position as a “consumer” of health care.
Dr. Flier is deeply concerned over the problems of our nation’s health care system–so concerned that he opposes any efforts to fix them.
Brachiator
@Marc:
RE: I don’t see stagnant wages as being related to health insurance costs.
Wages have been stagnant across the board, even for people who don’t have health insurance, and for those whose insurance costs have not risen dramatically. And sadly, I don’t see that any of the health care proposals are going to bring down health insurance costs.
Flier is just full of it. Businesses can theoretically shop for better rates than individual employees, who also have no option to buy less insurance, but have to choose from a limited selection of employer plans or hideously more expensive private plans.
I also doubt that Flier personally follows any of the advice that he proposes for others. It’s really nonsensical.
gex
@kay: I’ve had that sort of thing happen. I was up for an IT job. After a two hour interview one day, I went back the next day to interview with the VP. It was down to two of us, and he saw the ring on my left hand. Asked me if I was married, which I answered truthfully (“no”). Probably figured out I was gay. Never heard back from them. Perhaps the other person was a better match, but I doubt it. I had 5 years and loads more experience than the other person. But what can you do? At least I can rest assured that he ended up with a worse employee.
Little Macayla's Friend
@kay:
Absolutely. Someone was commenting in an article elsewhere that one reason for complicated regulatory language was that lobbyists would add loopholes that way.
Bad news for those desperate for work, but personally I don’t want to work for employers like that. Since I’m a people, not a used car, I volunteer the info.
My hope was that the hotel owner’s apparent hubris would cost him.
kay
@gex:
I think I have benefitted from discrimination, indirectly. I got an intern summer before last who, quite frankly, had no business hiring on with me. He was just really high caliber, and my work is not glamorous or intellectually challenging, and he had no real interest in it. He just wanted a job.
It’s pretty down and dirty, and we do a lot of our own grunt work. We all file. We all make copies. We prepare our own exhibits. We do our own drafts. We can’t pay what he was worth.
I feel as if he wasn’t hired by a more lucrative office or prestigious specialty because he was openly gay, and this is a conservative area. He was great, he worked hard, and we had a lot of fun, because he was bright and funny, and he did his summer and went on to big city glory.
I will never get that lucky again, right?
kay
@Little Macayla’s Friend:
He seemed to get the contradiction. He doesn’t like “big brother” government, but he is the big brother, to his employees, and on some really personal issues.
There’s some other problems with the “company store” approach to health care. They are completely dependent on staying in his good graces to get health care. They’re mostly recent immigrants, and “at will” employees.
That’s a big stick he’s holding over some vulnerable people.
mclaren
Fact-free garbage remains doctors’ stock in trade. Most of the gullible dupes out there think doctors in America are scientists but the reality is that doctors have no conception of the scientific method. Doctors are far from the smartest people in our society: the typical medical school accepts 48% of all applicants, a guarantee of mediocrity. As a result, our mediocre not-very-bright doctors work by rules of thumb, and all too many of the procedures and treatments they prescribe either don’t work, or actually harm the patient.
Don’t believe me?
Take a look at Believing In Treatments That Don’t Work, a NYTimes articles on “how medical ideology gets in the way of evidence-based medicine.”
The fact that a few rogue doctors even have to talk about “evidence-based medicine” tells us how bad the medical profession in America really is. Consider the studies showing “angioplasty found to be a useless waste of money.”
Or contemplate the breathtaking fact that A Simple Surgery Checklist Saves Lives, cutting mortality by up to 60%. But of course most doctors refuse to implement this simple procedure.
Or persue this article about how “medicare rewards high costs and incompetence.”
Doctors get treated like gods in our society, but in fact most of ’em are not very bright, they pay no attention to the evidence, they have no concept of the scientific method, and they have very little knowledge or awareness of the actual clinical base of their treatments, their efficacy, or the known side effects of the drugs they prescribe.
“Fact-free garbage” is doctors’ stock in trade. Your plumber is smarter, and your computer repairman is a lot better diagnostician.
kay
@Little Macayla’s Friend:
He seemed to get the contradiction in his opposition to “big brother” government, when he’s the big brother as far as his employees and health care.
He mentions it.
It has another sort of horrible aspect, the “company store” approach. Their health care coverage is completely dependent on not pissing him off, and getting fired. That’s a big stick he’s holding, over some vulnerable people. Most of them are recent immigrants, and they don’t have any recourse at all. They’re “at will” employees.
Uncle Glenny
“I was over at the pit in Harvard Sqare, urinating against the wall, and I didn’t hear a single opinion in favor of health care reform. David Brooks will concur, once he gets his face out of that Arlington skateboarder’s butt.”
— Bill Kristol’s smegma
Marc
@Brachiator:
Health care isn’t the only reason for wage stagnation, but it is a big one:
http://www.washingtonpost.com/wp-dyn/content/article/2008/03/23/AR2008032301770.html
http://voices.washingtonpost.com/ezra-klein/2009/10/will_lower_health-care_costs_m.html
http://www.denverpost.com/commented/ci_13345409?source=commented-
And everybody’s health care costs have been going up, whether they see it or not. Employer-provided plans, and our tendency to view them as benefits rather than as wages, have concealed these rising costs from many workers; that’s one of the few things Flier gets right.
licensed to kill time
Someone’s been abusing the position of my reply arrow. This MUST be stopped! I will now submit a request for a new arrow, in triplicate, to the Dept of Redundancy Dept.