This time, it is The American Academy of Otolaryngology:
We, too, are in favor of evidence-based medicine that supports quality patient care. President Obama’s statement highlights the complexity of medical decisions like this. However, the AAO-HNS is disappointed by the President's portrayal of the decision making processes by the physicians who perform these surgeries. In many cases, tonsillectomy may be a more effective treatment, and less costly, than prolonged or repeated treatments for an infected throat.
For the past several years, the Academy has been developing clinical guidelines based on evidence and outcomes research, including ‘Quality of Life after Tonsillectomy,’ a January 2008 supplement to the journal Otolaryngology—Head and Neck Surgery. We are in agreement with the President’s statement that physicians, patients, and hospitals should make the decisions, based on the evidence, about what’s best for patient care.
Key points in bold.
Hat Tip: Politico
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I think you forgot to highlight the part that states "We are in agreement with the President's statement" and "based on evidence", as that implies:
ReplyDeleteA) they agree and
B) he actually said what you highlighted and C) That those decisions must be based on some pre-existing context for such a treatment
And also the other bolded statement is (if I recall the speech correctly) most likely referring to the president stating that surgeons will intentionally perform procedures that are costly and less likely to be effective than simple medical treatments so as to make more money. That, I heard from doctors I am working for, pissed a lot of people off (even though 1 or two admitted to knowing someone who did it) Just throwing that out there, though I will admit it could also be taken the way you likely portrayed it.
And you know what, I wouldn't mind if it was just the doctor's making the decisions with the patients (in fact, that would be awesome). The only problem I see is that they aren't the ones who make the decision of how much is going to be payed out.This makes it a little difficult to say that only they and the patient can decide as the insurance companies also have a vested interest (profit, not very noble, but their right) to make sure the cost is as low as they can get away with while still keeping a customer. So even if you has a Doctor as brilliant as House diagnosing you and describing your treatment, you still would have to also worry about the insurance companies being willing to pay (side note: An insurance company actually said if House existed and you went to them, they would refuse to insure you). So unless you either get rid of the concept of health insurance completely (Awesome but unrealistic in the extreme) or find a way to get them to play ball, it will always be difficult to have it just be the physicians and patients making decisions.
PS. I kept it on 2 points and made it shorter this time.
Oh yeah, from his speach to the AMA:
ReplyDelete"Now, let me be clear -- I just want to clear something up here -- identifying what works is not about dictating what kind of care should be provided. (Applause.) It's about providing patients and doctors with the information they need to make the best medical decisions. See, I have the assumption that if you have good information about what makes your patients well, that's what you're going to do. (Applause.) I have confidence in that. We're not going to need to force you to do it. We just need to make sure you've got the best information available. ...(goes into a list of examples of hospitals)... So replicating best practices, incentivizing excellence, closing cost disparities -- any legislation sent to my desk that does not these -- does not achieve these goals in my mind does not earn the title of reform."
I just thought that that might interest you.
Do you know how he "incentivizes excellence" through comparative effectiveness? It'd be one thing just to get the information out there. I'm fine with that. But the only realistic way he "incentivizes" is through either mandating certain treatments (taking away the doctor's ability to make a decision based on the situation at hand), fining or subsidizing (which would disincentivize doing anything else). I just can't get behind that. Too much centralized bureaucracy.
ReplyDeleteP.S.
Before you go off about how insurance companies are bureaucracy, yes, but with proper market-driven reforms, they become just anyother company, which is far more effectiven than the government.
However, I agree that I would like to see health insurance eliminated entirely, and just make care up to a certain amount, as well as ALL catastrophic care, tax free. This way costs are driven down because people pay the brunt of what they're doing. But yeah, unfortunately too conservative for this country. Jim DeMint is proposing something similar, but all anyone knows is he's the "Waterloo" guy. Sad.
P.P.S.
THanks on the shorter message
Well, how about providing bonuses to doctors or hospitals who have great track records, such as Mayo Clinic. If you offered grants that awarded a hospital or individual doctors for doing great jobs (which could be judged by patient care, patient comfort and overall quality of care, which actually are currently tracked) that would be giving incentives to work harder for those levels without penalizing you for individual practices or what procedures you choose. It would also make hospitals compete to be better than the others and provide better care. Now, you could argue this is done when people choose to go to those hospitals, but if the government was rewarding better care then it means the costs of those hospitals could drop and allow more people access to them. Just an idea.
ReplyDeleteAnd you are right, if insurance companies are paying by quality and not quantity they would be more effective then the government. They just need to switch, and if they did, I would be happy with that.
The only thing I would be worried about is for them possibly pushing of the bottom line (profit) when it comes to coverage, as the "quality" care may become undercut by its cost (and thus not covered). It has happened before, where insurance companies will refuse to cover a non-experimental treatment that has been shown to be effective (such as a heart transplant) because they claim the cost does not justify the effectiveness (even if the only alternative is death) or that they will drag their feet hoping a patient will die so they do not have to pay for the treatment. I know that it shouldn't happen in an ideal market or world for that matter, but it does. I feel there should be some pressure from the government to at least insure that when something is necessary for a patients life (and they are not at fault for their predicament i.e. smoker with lung cancer) that they receive the coverage that they payed for.
P.S. And do you mean that it will be untaxed as in "no sales tax" type of no tax, or as in it will be able to be deducted from ones taxes, like charity? Cause the first hits me as too little, while the second sounds good, though could be costly and tricky to handle. Though if we used Fair Tax (as I know you have suggested), then that would answer both.
P.P.S. Tried to keep this one short too
Ok, gonna answer tax first. As you know, I support a consumption tax, of some sort. So yeah, not taxed would be the answer if we made the switch. But, if still using the (awful) income tax code, I mean deductable, just as employer-provided health care is today.
ReplyDeleteNow, back to the first point about offering incentives. I want to thank you for answering my problem about how to incentivize outcome, without using CE (my new abbreviation). See, this is what happens when conservatives and liberals have good, honest debates.
Finally, when it comes to effectiveness, as I've said many times before, health insurance isn't a real market right now, with a perverse mixture of incentives. Let us give a real market a shot before we assume that the government has to step in. We don't a avoid the death problem with CE, because, unfortunately, it can give the government the ability to save cost inflation by saying that someone has no chance and not covering them too, even if there is a slim chance. It happens all the time in public plans in other countries. Unfortunately, health insurance, gov't or otherwise, has problems, and more of them could get fixed by a market than by policy makers. It should at least be tried.