Wednesday, July 08, 2009

Ir-rationing Health Care

So, there are billion-dollar investments being made to build prostate cancer proton treatment centers that may or may not be any more successful than older radiation therapies that doctors have been using for years. Or, more successful than doing nothing at all, for that matter.

Meanwhile, just as one example, the nation’s emergency rooms are crumbling into decay. Emergency rooms do not make a profit. They have very high overhead because they have to be ready for, well, emergencies. And many people who use emergency rooms can’t pay the bills. So many hospitals are closing or cutting back or downsizing emergency rooms.

(And the practice of using emergency rooms as default “free” clinics for the poor and uninsured not only adds to the burdens on emergency rooms; it is also probably the least cost-effective way anyone could think of to provide last-ditch health services to the poor and uninsured, which is another big reason our nations spends so much on health care.)

Anyway — it appears that if somebody is making money off a particular gizmo or course of treatment, the health insurance industry manages to find room in its heart to pay for it. However, the private insurance companies routinely refuse to cover people who have even minor “preexisting conditions” and drop customers whose ailments are money-losers.
One of the reasons the medical-industrial complex gets away with scamming us is that doctors themselves often do not know which treatment is most effective. There is remarkably little effectiveness testing going on. “Drug and device makers have no reason to finance such trials, because insurers now pay for expensive treatments even if they aren’t more effective,” Leonhardt writes. So the doctors often have little else to go on but what the sales reps tell them. And some doctors are as keen to boost their revenue streams as anyone else in the complex.

A critical part of President Obama’s health care proposal is called “comparative effectiveness research (CER).” CER is not, as the Right claims, a plan that would allow the government to countermand a doctor’s decisions based on cost-effectiveness studies. The common claim on the Right that CER is about rationing is a lie. The point behind CER is to fund the kind of effectiveness testing that is not being done now and provide that information to doctors and patients, so that doctors and patients can make more informed decisions about what course of treatment to pursue.
The mendacious anti-reform talking points repeated ad nauseam by the dittoheads of the Right are generated by a network of right-wing think tanks and other organizations that exist solely to influence public opinion. This network is very good at getting their propaganda uncritically parroted throughout mass media and the Internet, repeated over and over until it becomes “common knowledge.” And in many cases the deep pockets funding those think tanks are also heavily invested in the medical-industrial complex. And round and round it goes …

Read it all at The Mahablog

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