Inherent Political Failure of Technocracy
Supporters of Obamacare argued that it would reduce costs because decisions to fund or not fund certain procedures and drugs would be left to panels of experts (later derisively labelled "death panels").
I have argued many times that these panel's job is hopeless. Solutions and products that may be right for one person may be a waste for another situation, and there is absolutely no way they have the information or the scope to make decisions with any kind of granularity. One-size-fits-all solutions result.
But let's hold that thought for a minute. Let's presume that these supposedly non-political boards will make near-perfect decisions. Then what? Those decisions become the law of the land?
Hah. We have a parallel situation in the military, where DoD procurement supposedly acts as the disinterested expert, which Congress frequently ignores to pay off various constituencies.
If Congress is looking for New Year's resolutions, it could start by breaking the habit of funding programs the government doesn't want. A case in point is the attempt to throw another $450 million at the development of a second engine for the F-35 Joint Strike Fighter, a plan that Defense Secretary Robert Gates says the military doesn't need.
In what has become an annual ritual, Congress is weighing whether one of the largest weapons programs in history should support the development of F-35 engines by both General Electric and Pratt & Whitney. In 2001, GE's engine lost in the procurement competition to the one designed by Pratt & Whitney, as F-35 developers Lockheed Martin and Boeing preferred the latter version.
To hedge its technological risk, the Pentagon nonetheless sought financing for the GE engine as a backup through 2006 in case the Pratt & Whitney version fell short. That hasn't happened, and as budgets have tightened the Pentagon has understandably decided that it needs only one engine design. As Secretary Gates put it, "Only in Washington does a proposal where everybody wins get considered a competition, where everybody is guaranteed a piece of the action at the end."
The Pentagon's opposition hasn't stopped Congress, where the usual parochial suspects are still stumping for GE. And the White House appears to be bending.
Of course they are -- the GE CEO carried a lot of water for Obama on health care and energy policy, and will be expecting a pay back. Someone has to be terribly naive to believe similar shenanigans won't take place with health care.
But we don't have to wait to test this hypothesis. The fifty states all have must-carry rules in their states, which have a lot more to do with political pull than science - more here and here.
Jacob:
Oh man, let me introduce you to the Preventive Services Task Force! http://www.ahrq.gov/clinic/uspstfix.htm
Obamacare requires that insurance companies cover 100% of all services given an "A" or "B" rating by this noble and esteemed group that will clearly be above the influence of lobbyists and Congress. So yes, essentially law of the land.
Source: http://www.washingtonpost.com/wp-dyn/content/article/2010/07/14/AR2010071405995.html
January 7, 2011, 7:58 amIgnoramus:
Most of our spending on healthcare is for people with chronic illness (diabetes, heart disease, etc.) They don't get cured; the're illness needs to be managed.
What's often overlooked with chronic illness is the extent to which individual patient variability matters.
We have little hope of addressing this, the more that healthcare decision-making is centralized and bureacratized.
January 7, 2011, 8:12 amcaseyboy:
Death Panels, Hmmmm. Consider this issue in the context of the broader law, all 2,000 plus pages. Then consider that regulations must be written to implement the law (another 40,000 pages). The doctors who will be paid to provide “End of Life” consulting will also be evaluated under “Pay for Performance” rules specified elsewhere. Pay for Performance (PFP) is a system that provides “incentive” payments for physicians and hospitals to comply with cost-cutting goals of government and insurance companies. If a doctor advises his patient to follow an advanced treatment regiment that stands a good chance of success, albeit at higher cost how will that affect his PFP benchmark?
Section 3007 of HR 3590 states the costs are “expenditures per individual as determined appropriate by the Secretary” and the “Secretary may take into account the amount of growth in expenditures per individual for a physician compared to the amount of such growth for other physicians (benchmark)”. Section 10331 empowers the Secretary to define what a “quality physician” is and pay Medicare patients an “incentive” to see a “quality doctor”.
Hmmm let me see, favored doctors getting new patients, earning end of life consulting fees and earning incentives for being a low cost service provider. And all administered by unelected government bureaucrats who will not be subject to Senate confirmation. Anyone else see something wrong in this setup?
January 7, 2011, 12:26 pmMesa Econoguy:
Exactly Casey, and we wrote about a similar economic disconnect here:
http://devilish-details.blogspot.com/2009/08/unintended-consequences-of-paying.html
January 7, 2011, 5:04 pmMark:
One point about the perfectness of panels.
There is a common trope that we spend the most on a persons health care in the last six months of life, so these panels are suppose to cut the unnecessary expenditures in the last six months - since they won't help you live longer anyway.
The problem is that we only know you had six months left and can evaluate the expenses after you die. How do you know "six months before" a person will die?
I had a similar situation with a cat. I liked the cat, but i didn't think I would spend a grand on the cats medical care (about 2 grand today). The cat got sick and went to the vet. Seemed more sick went again, had a lump removed ... we didn't realize at the time it was the cats dieing days and the bills piled up, incrementally.
January 8, 2011, 5:33 am