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Tilting at Windmills

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September 17, 2007
By: Kevin Drum

NEWTERED....Later today Hillary Clinton will be unveiling her healthcare plan. The New York Times reports on a few of the details:

Clinton aides said her plan would preserve a large role for private insurance companies; would promote the use of health information technology and low-cost generic drugs; and would create a public-private institute to evaluate and compare drugs, devices and medical treatments.

You all know what I think of preserving a large role for private insurance companies: boo hiss. But the "public-private institute to evaluate and compare drugs, devices and medical treatments" is another matter entirely. That's a great idea. Why? Because it turns out that we're almost stupifyingly ignorant of what works and what doesn't in the wild west of modern medicine, and nobody in the private sector really has any incentive to change that. They just want to keep selling stuff.

So what about the federal government? Well, back in the day we had an agency called AHCPR that had a small budget to compare and analyze medical therapies. Unfortunately, Newt Gingrich didn't like the idea of a federal agency potentially putting the kibosh on lucrative but useless medical technologies (makers of useless medical technologies contribute to political campaigns too, after all), so after he took over Congress he whacked it. Shannon Brownlee, author of Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, tells the whole story in "Newtered," upcoming in our October issue:

There is surprisingly little government oversight of medical practice. The Food and Drug Administration, which many people imagine oversees it, in fact only regulates the marketing of drugs and devices....When it comes to medical procedures, the FDA has zero authority to make sure they actually work. If your surgeon wants to try removing your appendix through your back, that's between you and your surgeon and the hospital.

....Of our more than $2 trillion national health care bill, we devote less than one-tenth of 1 percent to answering the myriad questions about what actually works in medicine. What's the best way to get people to lose weight and exercise in order to prevent heart disease and diabetes? Nobody knows. Is a cesarean section necessary if a woman's previous child was delivered by cesarean? Can a million-dollar da Vinci surgical robot, touted by many hospitals that have purchased the device, really improve outcomes, or is it just a fancy way to spend money? If a man has prostate cancer, which remedy is best? There are four different surgeries, several types of implantable radioactive seeds, and multiple external radiation regimens to choose from. Macular degeneration, a disease that causes blindness in 200,000 Americans each year, can be treated with one of two drugs, Lucentis or Avastin, but there's no head-to-head evidence to show which one is better, or which one is best for a particular patient.

....All of which points to the need for a national strategy for improving the evidence base of medicine. We need an independent agency that would fund systematic reviews of the medical literature, as well as clinical trials to test the comparative effectiveness of everything from drugs to treatments. An agency that could help Medicare and other payers know what to cover, and what's still experimental. An agency, in short, that would look a lot like the AHCPR probably would today if it hadn't been derailed in 1996.

It doesn't much matter who does it, as long as the job gets done. It could be a new institute, as Senators Barack Obama and Hillary Clinton have called for. The NIH could take it on, provided the director could be persuaded that testing existing treatments is as important as finding new cures. Or, it could be a beefed-up version of the AHRQ.

Read the whole thing for more. You'll learn all about cardiac stents, spinal fusion surgery, radical mastectomies, and aggressive chemotherapy. What do they all have in common? Two things: (a) they're expensive, and (b) they don't work as well as most doctors think.

This whole topic, by the way, is sort of the red-headed stepchild of the universal healthcare debate. Mostly we talk about how to fund universal care and how to cover everyone, but it's equally important to talk about strategies for reining in costs. A serious program does both.

Kevin Drum 12:38 AM Permalink | Trackbacks | Comments (67)

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Comments

The more I think about it, the more I think that any solution the preserves insurance companies is doomed to failure.

The first, last and only step that matters is to get rid of the middleman.

Posted by: craigie on September 17, 2007 at 12:41 AM | PERMALINK

Oh, and this is why I'm not a big Hillary fan. She's way, way, way too keen on preserving the status quo for my taste. It's time for a revolution, and we won't get one from her.

Posted by: craigie on September 17, 2007 at 12:42 AM | PERMALINK

What craigie said. Times 100.

Posted by: shortstop on September 17, 2007 at 12:44 AM | PERMALINK

This sounds a bit like the Massachusetts plan, doesn't it? BTW, how has that been working?

"Independent agency." Good luck on that "independent" bit. Who gets to pick the members? Decide the protocols? Can anyone name an example of an existing "independent agency" that actually works as advertised?

Hillary is apparently going to lose the election because she's too liberal for the conservatives, and insufficiently socialist for her base.

Posted by: harry on September 17, 2007 at 12:49 AM | PERMALINK

Getting rid of the middleman != single-payer. It's actually the ultimate middleman.

Posted by: pidgas on September 17, 2007 at 12:50 AM | PERMALINK

I think that any solution the preserves insurance companies is doomed to failure.

Yes. They not only don't add value (and can't), they subtract it. In a major way. They should all go away.

Politically, the only way I see it happening, though, is a catastrophic collapse of the system. Which is not an impossibility.

Posted by: jimBOB on September 17, 2007 at 12:51 AM | PERMALINK

One of my favorite examples is chloral hydrate, a safe, ridiculously cheap sleep med that's been around for a thousand years; doesn't interfere with REM sleep; close to non-addictive; reasonably effective. You will never see it compared with an expensive, highly touted new med under patent. Ever.

Posted by: ProfWombat on September 17, 2007 at 12:52 AM | PERMALINK

Revolutions are extremely difficult and rare in the federal govt. I'll be very happy if HRC is successful in what she proposes. It will be a giant step in what will need to be many more steps on the way to complete reform of our healthcare system. If you think a Dem Prez (any of them) could eliminate the private insurance industry in one fell swoop you are seriously delusional.

Posted by: Bush Lover on September 17, 2007 at 12:54 AM | PERMALINK

Hillary is apparently going to lose the election because she's too liberal for the conservatives, and insufficiently socialist for her base.

Actually, she's going to win the election, and excel at nothing so much as keeping the status quo humming along with only superficial changes. Which is going to be very good for a very few people, and very bad for the rest of Americans, Democratic or Republican.

Posted by: shortstop on September 17, 2007 at 12:54 AM | PERMALINK

If you think a Dem Prez (any of them) could eliminate the private insurance industry in one fell swoop you are seriously delusional.

No one thinks that. We just know that propping up a system that's completely underpinned by private insurance is not a real movement toward genuine reform. And as craigie says, it's doomed to failure.

Posted by: shortstop on September 17, 2007 at 12:58 AM | PERMALINK

Umm nitpick alert:

>..One day medical historians will look back at many current medical practices and see twenty-first-century equivalents of bloodletting and leeches.


Leeches have now become standard FDA medical treatments under certain conditions.

http://www.fda.gov/fdac/features/2004/504_leech.html

Posted by: Gar Lipow on September 17, 2007 at 1:03 AM | PERMALINK

If you think a Dem Prez (any of them) could eliminate the private insurance industry in one fell swoop you are seriously delusional.

1. Kinda funny for anyone calling itself "Bush Lover" to label someone else delusional
2. Nobody expects something this radical in one fell swoop, or even two. But I do expect someone who understands that this is the goal. Hillary does not.
3. Hillary (nor Bill, for that matter) has never been as liberal as the drooling Right paints her. In fact, their opposition to her, like so much that comes from that direction, makes no sense given any actual facts. They just make shit up, and then proceed on that basis.

Posted by: craigie on September 17, 2007 at 1:18 AM | PERMALINK

When I argue about single-payer health care, proponents keep telling me that freedom and choices would still be part of the medical care system, and that only the bills would be paid by the government.

For my part, I keep insisting that heavy regulation and the micromanaging of the medical care system are inevitable in any centralized concept. The end result will always be true socialized medicine, where all the providers are essentially under complete government control.

"Strategies for reining in costs." It would be interesting to see just how much weight this "independent agency" being talked about would throw around under a government health care system. I suspect quite a lot.

We can fantasize about such an agency being merely "advisory," but in reality, the strings tied to government payments would soon become anchor chains. Doctors who have other ideas about how to do things can go find another country to practice in, or manage with those few patients who would rather pay their own bills instead of having UberMedicare do it.

After all, when it comes down to it, it's really about control, isn't it?

Posted by: harry on September 17, 2007 at 1:19 AM | PERMALINK

Kevin,

I couldn't agree more. It's an excellent way to inform doctors' decision-making and to reduce medical costs.

On behalf of doctors, many of us do this already for ourselves. There's endless debates between doctors about "what really works," and evidence-based medicine is a key component of every residency training program. Review articles are written weekly in the major medical journals to try to sort these questions out.

Yes, there's still a lot of grey area. But the transition from an experience-based ("I learned it this way") to an evidence-based ("The data suggests...") system is bound to be gradual. Most of the evidence, after all, is new and constantly changing.

Point is, no serious doctor disagrees with your approach on this.

Posted by: Jonathan Dworkin on September 17, 2007 at 1:26 AM | PERMALINK

All due respect to the institution Jonathan Dworkin is talking about, but I think the point is that the conventions of testing medical procedures just aren't rigorous enough. The economic incentives on producers of medicines and medical devices contribute to that.

Posted by: Swan on September 17, 2007 at 1:34 AM | PERMALINK

"I couldn't agree more. It's an excellent way to inform doctors' decision-making and to reduce medical costs.

On behalf of doctors, many of us do this already for ourselves. There's endless debates between doctors about "what really works," and evidence-based medicine is a key component of every residency training program. Review articles are written weekly in the major medical journals to try to sort these questions out.

Yes, there's still a lot of grey area. But the transition from an experience-based ("I learned it this way") to an evidence-based ("The data suggests...") system is bound to be gradual. Most of the evidence, after all, is new and constantly changing.

Point is, no serious doctor disagrees with your approach on this.
"

Right right. That's why pharma companies spend so much money advertising to doctors --- because they know that they do everything based on rigorous science rather than the propaganda they heard recently.

Malcolm Gladwell has plenty of pretty horrific examples of just how badly doctors are failing in this respect:
http://www.newyorker.com/archive/2004/10/25/041025crat_atlarge

Posted by: Maynard Handley on September 17, 2007 at 1:58 AM | PERMALINK

This sounds a lot like Nice, the inappropriately named agency here (UK) that rather aggressively denies cutting edge medicines to patients, thus inciting the ire of patient advocate groups.

I suspect that's exactly what would happen if such an agency were to be created in the US. A new Alzheimers drug may postpone dementia only a few months, but try telling a patient's family it's not cost effective.

And with insurance companies still picking up the tab, you can bet this new evidence of lack of efficacy will be used to deny, deny, deny.

Posted by: KathyF on September 17, 2007 at 2:00 AM | PERMALINK

the fucking stupid voters would not know the difference unless her opponents run misleading ads againts her plan. it is too complicated but voters are genrally dumb and dumber so they believe whatever they are told via misleading ads.

Posted by: bob on September 17, 2007 at 2:07 AM | PERMALINK

"the 'public-private institute to evaluate and compare drugs, devices and medical treatments' is another matter entirely"

And why exactly should this institute be public-PRIVATE? If the public is to depend upon it then it should be purely public.

Posted by: Ross Best on September 17, 2007 at 2:46 AM | PERMALINK

"We need an independent agency that would fund systematic reviews of the medical literature, as well as clinical trials to test the comparative effectiveness of everything from drugs to treatments."

Oh, pleeease. So a bunch of bureaucrats or 'private' analysts will be crunching numbers to come up with the 'best,' and hopefully 'cheapest' treatment for 'everyone?' One little problem as I see it is that many drugs and treatments work for 'some' people but don't work for others. As Dr. Dworkin stated above, the bulk of medical journals today already spend a large proportion of their pages on treatment comparisons. Medicine is at its best a skill learned after years of experience and involves at least some intuition. To reduce medical treatment to the level of car mechanics sounds like a very bad idea to me. I accompanied an elderly friend of mine (on Medicare) to the doctor's a couple years ago. The doctor suspected she was suffering from a potassium deficiency. She wasn't able to have a CBC (complete blood check) because she had already had her two alloted tests for the year. When I said that either she would pay or I would pay for the test, he said that wasn't allowed. Limitations like these do not produce good health care. I can't imagine anyone wanting to become a doctor if his/her treatment choices were limited to one or two per diagnosis. Might as well let the 'independent' public/private agency analysts be the doctors as well.

Also, no way will I support any plan that leaves for-profit insurance companies as part of the health care mix. This whole plan really is just SO Hillary.

Posted by: nepeta on September 17, 2007 at 3:52 AM | PERMALINK

"This sounds a lot like Nice, the inappropriately named agency here (UK) that rather aggressively denies cutting edge medicines to patients, thus inciting the ire of patient advocate groups."

Thanks for your input, Kathy. I can see this sort of situation developing easily.

Posted by: nepeta on September 17, 2007 at 3:55 AM | PERMALINK

Given how beholden Clinton is to megacorporates including insurance companies & big pharma, I don't trust any "health care" plan (or come to think of it, anything else, either) coming out of her campaign.

I really can't see why the extreme right hate her so much--she's got a LOT in common with them. Just ask Rupert Murdoch.

Posted by: Helena Montana on September 17, 2007 at 4:06 AM | PERMALINK

Clinton aides said her plan would preserve a large role for private insurance companies;

woohoo.... a reprise of her 90s plan....

Posted by: Disputo on September 17, 2007 at 4:46 AM | PERMALINK

The NICE website is here. I agree the title is creepily Orwellian, but it seems to work. The British press reports occasional rows about NICE refusing to let the NHS buy expensive new cancer drugs with marginal benefits. A lot depends on the exact powers you give the agency over reimbursement. But it hasn't SFIK been alleged that NICE's decisions are political rather than professional within a budget constraint.

Posted by: James Wimberley on September 17, 2007 at 5:12 AM | PERMALINK

Hillary's sell-out is complete. She is the wrong candidate, in so many ways, for this country at this time.

Posted by: The Conservative Deflator on September 17, 2007 at 6:40 AM | PERMALINK

James, the decisions may not be political but they are, as far as I can tell, often inhumane. Telling breast cancer patients they can't have the latest drug, when other patients--sometimes in Wales or Scotland--are allowed it? (Post-code lottery.) When the drug does show some benefit? Who decides how little benefit costs too much money? Is 6 months prolonged life worth £50k? But not £75k? Or how about a 10% chance of recovery? What's that worth?

I think politics isn't entirely a bad thing, when it takes into account human emotions.

Posted by: KathyF on September 17, 2007 at 7:19 AM | PERMALINK

"boo hiss" all you want but is it realistic to think we can just shut down an entire industry as large as the insurance industry?

I would love to see that too, but let's be realistic or nothing will ever change.

Posted by: lilybart on September 17, 2007 at 7:20 AM | PERMALINK

If you want some insight into the depth of overprescribing going on in this country, read the posting on Number Needed to Treat at The Last Psychiatrist. It gets underneath the statistics used by Pharma companies to justify their medications. It's a bit of a slog (statistics, after all), but it's well worth getting through.

Posted by: Andrew on September 17, 2007 at 7:21 AM | PERMALINK

A "public-private institute to evaluate and compare drugs, devices and medical treatments" is a terrible idea.

Countries like France and Sweden will steal ideas from it and make their systems look superficially better, which will give liberals ammunition to bring socialist medecine to America.

Posted by: Al on September 17, 2007 at 7:43 AM | PERMALINK

Jeebus, a twin to Bush plan - more Bush speak.

Clinton aides said her plan would preserve a large role for private insurance companies; would promote the use of health information technology and low-cost generic drugs; and would create a public-private institute to evaluate and compare drugs, devices and medical treatments.

It's like when Hillary voted for the bankruptcy bill - and when the voters were looking - than she voted against it.

I think it pretty clear Hillary is second coming of George Bush. More lies, more bullshit, more spin.

Wesley Clark is now talking about the coming war with Iran, and how to win it. He is also backing Clinton.

Before long - we going to be hearing Matt, Josh and Kevin telling us "what Hillary really intended to say" just like we get it from all those partisan Bushism pundits. Hillary is going to be telling us how we can't let oil fall into the hands of terrorist.

Hillary and her good buddy Westley Clark won't extact American from this war - they'll get it us more into it. The UN and NATO won't help Hillary any more then they would help Bush.

Posted by: Cheryl on September 17, 2007 at 7:56 AM | PERMALINK

She effectively lost my vote.

I'm not a single issue person, but including the insurance industry is ridiculous.

Posted by: SPIIDERWEB� on September 17, 2007 at 8:05 AM | PERMALINK

I'll state up front, I work for a health insurance company. Let me also make clear, I generally agree totally about the need for a universal-payer system of healthcare in the U.S. (I'm a big fan of the French system). I also want to state clearly, that I'm rather proud that the health insurance firm I work for (we're a small, single state plan affiliated with a major nationally known group) does NOT engage in any of the horrific cost-cutting tactics we all read about.
That said, I work in the department doing case/utilization management (so mostly nurses, and a few doctors), and they take providing the best care possible very seriously. But since our companies profits are dependent on the small/medium/large businesses who purchase our policies, and since those firms increasing are trying to cut medical costs, its in OUR interest to find ways to provide the best care possible at the lowest cost.
To that end, we've been working on "evidence-based medicine" for several years, conducting our own studies of such things as comparisons of different meds, best outcomes on NICU care, weight loss programs (currently very "in" amongst companies...recognition obesity costs money, so cutting excess weight is money in the bank) such as comparing therapy to surgery, etc. And we're expanding these studies every year into new areas, with the intent of determining what works best, cheapest, and we then pass that info along to our contracting providers (who, FYI, are about 99% of the state's doctors) and encourage them to use the results.
In the long run, it doesn't save a huge amount, but bit by bit it helps...

Posted by: Zoomie on September 17, 2007 at 8:08 AM | PERMALINK

There's an interesting chapter in T.R. Reid's book "United States of Europe" about his experiences with the British health care system. He asks for certain tests and procedures and is told repeatedly that the National Health Service's research indicates there is no reason for him to have such tests. This is something Americans will have a hard time accepting. And don't even get me started on the mess in the pharmaceutical/medical device business. Money is being spent to develop drugs that will make money (ED treatments) or to create "diseases" ("restless leg syndrome") that can be "treated" by lucrative drugs, rather than to develop drugs that might not make for great TV spots but actually cure diseases that affect large segments of the population.

Posted by: Debra on September 17, 2007 at 9:15 AM | PERMALINK

Blackwater License Being Pulled in Iraq
Forbes - 26 minutes ago
By BASSEM MROUE 09.17.07, 8:15 AM ET The Iraqi government said Monday that it was pulling the license of an American security firm allegedly involved in the fatal shooting of civilians during an attack on a US State Department motorcade in Baghdad.

Ah yes, the beginning of “take your privatization“ and get the *uck out.

So much for those “public-private institutes”.

The Iraqis are finding the meaning of democracy – it’s telling Americans to take their “vital national interest” and shove it.

Thank you mister Greenspan for telling the entire world body exactly what they already knew but needed an expert say so – and for Bush and Cheney’s total greed with a complete and lack of compassion or anything close to being fair (shows you how Christian – the Christian right really is with their holy leader Bushie and anything goes, no matter how brutal Bushie does it).

And it also looks like Paul Krugman is absolutely right and right on following the money. The Hunt oil contact is a last ditch effort to grab some oil on the way out of Iraq.

---what's interesting about this deal is the fact that Hunt, thanks to his policy position, is presumably as well-informed about the actual state of affairs in Iraq as anyone in the business world can be. By putting his money into a deal with the Kurds, despite Baghdad's disapproval, he's essentially betting that the Iraqi government - which hasn't met a single one of the major benchmarks Bush laid out in January - won't get its act together. Indeed, he's effectively betting against the survival of Iraq as a nation in any meaningful sense of the term.
The smart money, then, knows that the surge has failed, that the war is lost, and that Iraq is going the way of Yugoslavia. And I suspect that most people in the Bush administration - maybe even Bush himself - know this, too.

So unless the Kurds become their own sovereignty- the Hunt oil contract isn’t really legal and isn't worth anything.

Bush and Cheney will lose every Western oil contract in the Mideast and NO war will ever be able to put it back together again.

Posted by: Me_again on September 17, 2007 at 10:05 AM | PERMALINK

Well, in the US you don't get health care if you don't have the money, unless you are entirely indigent. You can liquidate your assets, if you have any, or you can go into debt- a bit more debt to add to the other chronic debts of the savings-poor American middle class.

The real war of the Republicans, and the DLC neoliberals, is against middle class risk sharing. The end result of their policies is an increasingly precarious middle class, a disenfranchised underclass and Gilded Age property accumulation for one percent at the very top. They sell it as liberty and choice but this is just cheap hucksterism.

How do we get politicians elected who will support not-for-profit risk sharing programs that include all Americans?

Posted by: bellumregio on September 17, 2007 at 10:08 AM | PERMALINK

This sounds a lot like Nice, the inappropriately named agency here (UK) that rather aggressively denies cutting edge medicines to patients, thus inciting the ire of patient advocate groups.

You have to have some entity whose job is to say no, or else you'll eventually end up devoting 100% of your GDP to health care. The entity isn't going to win any popularity contests, but you will have to have it.

Posted by: jimBOB on September 17, 2007 at 10:21 AM | PERMALINK

Well, in the US you don't get health care if you don't have the money, unless you are entirely indigent. You can liquidate your assets, if you have any, or you can go into debt- a bit more debt to add to the other chronic debts of the savings-poor American middle class.

Having just lost a very dear friend who delayed treatment until the last moment because he was temporarily without insurance and knew the bills would take every cent he had, and hearing the noises of disbelief and dismay when I tell people his story, I can attest that many people do not seem to be aware that this is the situation in the U.S. There's a vague sense of, "Oh, everyone can get healthcare at county hospitals, ERs, free clinics, etc." and no real understanding that you still have to pay for it unless you are, as you say, entirely indigent.

I suspect no serious reform will occur until everybody knows someone who's lost his or her life savings, home and every other asset to healthcare. We are also seeing more people who are too sick to work go on public aid because that's the only way they can get medical care--and, after they've spent their assets on huge medical bills, the only way they can eat. This is simply not a rarity anymore. People who never expected to require public assistance are finding themselves with no other choice.

Like any other significant social change, this requires personal experience for most people to get what's happening.

Posted by: shortstop on September 17, 2007 at 10:31 AM | PERMALINK

Such a public-private partnership already exists. Unfortunately neither the public nor the private sector funds it adequately. (It's the National Quality Forum, www.qualityforum.org.) Sen. Clinton is aware and I believe would fund NQF, and ask the private sector to do its share. The idea has merit.

Posted by: Chocolate Thunder on September 17, 2007 at 10:33 AM | PERMALINK

Perhaps the most important counterargument to right-wing propaganda against national health care is this: they will talk about "how much it costs" as if the program cost was an *additional* expenditure by the public. Of course, the true effective cost is how much her program costs minus what we already pay now. You might be surprised how often they actually try to generate confusion over this issue, and how many duhds actually fall for it.

Posted by: Neil B. on September 17, 2007 at 10:57 AM | PERMALINK

ProfWombat: One of my favorite examples is chloral hydrate, a safe, ridiculously cheap sleep med that's been around for a thousand years; doesn't interfere with REM sleep; close to non-addictive; reasonably effective. You will never see it compared with an expensive, highly touted new med under patent. Ever.

Interesting - didn't know about that one. Another example is lithium carbonate. Its potential value in treating bipolar disorder was known for decades before it was investigated thoroughly enough to be useful in clinical practice. No profit in an un-patentable inorganic compound.

Posted by: alex on September 17, 2007 at 11:30 AM | PERMALINK

proponents keep telling me that freedom and choices would still be part of the medical care system

"freedom and choices" don't exist anyway for the vast majority, even those with insurance--unless of course you mean the freedom to choose which plan causes you to go into debt and bankruptcy, and which one refuses to cover your treatment because of some "pre-existing condition" or because your illness was excluded from coverage altogether.

When health care is left to the forces of the "free market", it's all about money. They don't give a damn whether you live or die.

Requiring everyone to buy into some private health plan is no solution.

Posted by: haha on September 17, 2007 at 11:34 AM | PERMALINK

Does Experience Matter? (Clinton and JFK didn't think so)

This Video Is Showing That Obama can be president because two fmr presidents were
where he is right now, history proves experience makes an either worse president( nixon, bush, vp dick cheney, defense sec.rumsfeld)

http://www.youtube.com/watch?v=LBy3AKn_2Fk

Posted by: kyle on September 17, 2007 at 11:37 AM | PERMALINK

After all, when it comes down to it, it's really about control, isn't it?

Posted by: harry on September 17, 2007 at 1:19 AM | PERMALIN
No, it isn't. It is about profit, as the most dangerouse and criminal events (Iraqu war) and Insurance industry is much more effective in controling people's lives than any UberMedicare

Posted by: Vinnie on September 17, 2007 at 11:42 AM | PERMALINK

My city's monopoly newspaper had a headline in Sunday's paper that said Hillary was going to require everyone purchase health insurance.

That is what I suspected she was up to.

Posted by: Brojo on September 17, 2007 at 11:45 AM | PERMALINK

If mandatory purchase of health insurance is to be demanded by the government of all its citizens, then at least the government could demand all insurance companies be mutual benefit societies rather than for profit corporations.

Posted by: Brojo on September 17, 2007 at 11:49 AM | PERMALINK

It never ceases to suprise me how unaware many people are of the actual aspects of Universal Health Care.

The French system and the British systems have the insurance companies play a large role. 86% of the French have supplemental insurance.

And while many consider the French system single payer it is NOT considered to be a single player system. It's a public/private hybrid mixture.In fact most universal health care systems are not single payer.

Posted by: Phil on September 17, 2007 at 12:03 PM | PERMALINK

"... the government could demand all insurance companies be mutual benefit societies rather than for profit corporations."
Posted by: Brojo on September 17, 2007 at 11:49 AM

Oh, what is a "mutual benefit society"?

Posted by: MarkH on September 17, 2007 at 12:10 PM | PERMALINK

This is a major weasel-point with insurance companies: refusing to pay via the "experimental medical procedure" surprise. Let's take that decision away from them and put it into a codified guide that all insurance companies must adhere to.

Posted by: Randy Kirchhof on September 17, 2007 at 12:11 PM | PERMALINK

In my view, insurance companies are not evil, they are merely capitalists. What makes them do evil is the fact that under the current system, profit motive and competition drives them to do things that are socially adverse. Deny care, deny coverage, etc. They are also only short-term focused, because people switch jobs, and consequently, insurance plans, so frequently.

If we can devise a system that aligns the profit motive more with our social motives, then a market for insurance can more efficiently allocate resources than a single payer, or government regulated one. I think there might be ways to do that. They need to be tried.

Frankly, you could throw down the gauntlet to the insurers with a baseline govt plan. "You guys are always saying that the private sector can do this better. Ok, go ahead, do it better." Give people vouchers to pay private insurance.

There's lots of things that can be done. I wouldn't write it off.

Consider Social Security. It's a retirement program. But for many people, it's not the only retirement plan they have in place, they also have supplemental retirement plans, 401(k) programs or TIAA or other things. This might work quite well.

Another thing is that when it comes to evidence-based medicine, I would expect insurers to be supporters.

Posted by: Doctor Jay on September 17, 2007 at 12:21 PM | PERMALINK

Craigie pretty much nailed it.

She is trying to please everyone in the discussion with a band-aid solution. It will be doomed to fail.

We need bold leadership on the issue. Someone who will stand up to big Pharma and big Insurance. Hillary is not the one to do it. She is a pure politician through and through. Smart, tough, but doesn't seem willing to tell them to be a part of the solution toss industry out on its keister and actually fix healthcare in this country.

Too much medicine certainly is an issue and it is primarily an issue because of profit and greed. Edwards seems to understand that for-profit healthcare is a huge part of the problem.

Posted by: Simp on September 17, 2007 at 12:24 PM | PERMALINK

As long as Hillary openly, explicitly, and repeatedly admits that the only reason the insurance companies are being left in the loop, even though they serve no useful purpose, is because they are too powerful to exclude, then I am on board!

Posted by: Michael7843853 G-O/F in 08 on September 17, 2007 at 12:38 PM | PERMALINK

Many insurance companies used to be mutual benefit societies. Many still have 'mutual' in their names. I wonder what deregulation allowed them to become for profit?

Mutual Benefit Society: Nonprofit associations created to protect their members against various economic and social risks. Members contribute to a common fund and are entitled to benefits from it according to prescribed rules and in case of need.

Posted by: Brojo on September 17, 2007 at 12:46 PM | PERMALINK

***

Posted by: mhr on September 17, 2007 at 12:59 PM | PERMALINK

Mutual Benefit Society- The opposite of the Ownership Society!

Posted by: bellumregio on September 17, 2007 at 1:49 PM | PERMALINK

The lack of evidence based decision making in the U.S. health care system can be shocking. Bypass surgery became a standard treatment, and millions of dollars were spent installing heart-lung machines in most hospitals, before it emerged that bypass surgery does not provide any (i.e. zero, nada) increase in survivability, only an increase in quality of life due to decreased pain. Maybe as a society we would have decided to spend the money anyway, but bypass surgery and its attendant capital costs were sold on the basis that it extended life.

The situation is similar with radical mastectomies; for years they were the standard treatment based on the principle that taking more tissue is better (a philosophy the meshes well with the surgical mentality). It wasn’t till a surgeon tried super radical mastectomies, and when he couldn’t demonstrate increased survivability had the insight to reverse course and look at modified mastectomies. Lo and behold, for many cases a modified plus chemo or radiation works better and is far easier on the patient. The example is the same; a procedure became standard treatment with out the studies being done to demonstrate its true efficacy.

By law the efficacy of new medical devices and drugs has to be demonstrated before they are released to market. As has been pointed out before, there are no formal requirements for any testing at all for medical procedures.

Posted by: fafner1 on September 17, 2007 at 1:53 PM | PERMALINK

"Many insurance companies used to be mutual benefit societies."

You're right, Brojo. Another problem with our health care system now is that beside for-profit insurance companies, many big hospitals and hospital groups are for-profit enterprises, with their CEOs (or whatever the equivalent is in the health industry) getting paid the same exorbitant salaries that are found in other industries.

Posted by: nepeta on September 17, 2007 at 2:01 PM | PERMALINK

Under Hillary's plan I could buy Medicare or some other type of coverage. Then I could leave this crummy job, since health insurance is the only reason I'm here. I like that.

Posted by: Horatio Parker on September 17, 2007 at 2:08 PM | PERMALINK

"By law the efficacy of new medical devices and drugs has to be demonstrated before they are released to market."

Well, theoretically yes. However, with the FDA in the pocket of Big Pharma, just about every drug gets approved that the drug industry wants approved. The FDA wouldn't even be able to function without the money it gets from Big Pharma. Wish I had a reference for that statement but alas, I don't.

Posted by: nepeta on September 17, 2007 at 2:10 PM | PERMALINK

According to a 2006 international Gallup poll, the US ranks 81st out of 115 countries in the fraction of people who have confidence in their healthcare system, and has a lower score than countries such as India, Iran, Malawi, or Sierra Leone.

This despite the constant mantra of how we've got the best system in the world...

Posted by: joe on September 17, 2007 at 2:20 PM | PERMALINK

Ezra seems to think that HillaryCare 2.0 is a pretty good plan. From his description, I like it.

Cheryl: Hillary didn't vote either for or against the bankruptcy bill. She did not vote that day as her husband was in surgery. She had stated prior to the vote that she was opposed to the bill. Let's let the GOP lie about Hillary for themselves, shall we?

Posted by: J Bean on September 17, 2007 at 2:42 PM | PERMALINK

"Mutual Benefit Society"? Sounds like Communism to me! Ayn Rand sure wouldn't approve!

[/John Birch Society Republicans]

Posted by: Gregory on September 17, 2007 at 2:45 PM | PERMALINK

Private health insurance is the PROBLEM, not part of the solution. The idea that health care should be driven by a profit motive is obscene and leads insurers to try to deny health care any chance they get (or can take by force or delay).

Also obscene, the salaries of for-profit health care CEOs.

Posted by: Cal Gal on September 17, 2007 at 4:18 PM | PERMALINK

"heavy regulation and the micromanaging of the medical care system are inevitable in any centralized concept"

Gee, Harry, you mean as opposed to the heavy regulation and micromanaging of medical care being done right this very minute by the for-profit health care insurers?

Take out the profit motive and you've got one big step forward.

Posted by: Cal Gal on September 17, 2007 at 4:20 PM | PERMALINK

No one needs health care insurance, but everyone could use affordable health CARE. Shame on Hillary for conflating the two. We've come to expect conflation from the Rethugs and don't want any from our candidates.

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