David Leonhardt, a regular columnist on economic matters for the New York Times, had an article in the April 6th issue of the Grey Lady entitled: “In Medicine, the Power of No.”
It is a defense of health-care rationing that could be amusing. The key there is “could be.”
It could be amusing if Mr. Leonhardt was writing the article tongue-in-cheek, but sadly, he was being ingenuously serious. His position seems to be that the entire cause of increases in the aggregate cost of health care in the United States is the uncontrolled and uncontrollable amount of health care demanded by we, the people.
Apparently we, the people, the poor, stupid, delusional, self-absorbed citizens, are waltzing into medical offices all over the nation and demanding more tests, more doctor visits, more of everything.
Now granted that Mr. Leonhardt is addressing the audience of the New York Times, all 22 of them, but really, is the idea that there has been a lemming like rush to demand more tests, medications and treatment realistic at all?
He even tries to use scare tactics, which, as we all know, are the tactics employed by unfeeling Republicans, Conservatives, Libertarians and those demented septuagenarians who frequent Tea Parties when the rallies don’t conflict with Lawrence Welk re-runs.
To quote Mr. Leonhardt from his article:
Consider that a recent study found that 15,000 people were projected to die eventually from the radiation they received from CT scans given in just a single year — and that there was “significant overuse” of such scans.
Hmmm? Fifteen thousand people who had CT scans are going to die – eventually. There is absolutely no way to refute that particular statement. But here’s a statement that Mr. Leonhardt can’t refute, either. Every person who crossed the street today will die – eventually. We can’t say when, but neither did he. We can’t attribute causality, but neither did he.
As for the phrase “significant overuse”, he refers to an earlier New York Times blog that he wrote in December 2009, titled “CT Scans and Health Care Reform” in which he quotes from an editorial in The Archives of Internal Medicine:
Radiation from the CT scans done just in the year 2007 will eventually cause 15,000 extra deaths, researchers reported in The Archives of Internal Medicine. And scan use continues to rise, so the death toll will probably grow. An editorial accompanying the research paper suggested that there appeared to be “significant overuse” of such scans.
Many of those scans, of course, bring in extra revenue for doctors, hospitals, medical-device companies and the like. The scans are also one small reason health costs are rising so rapidly and insurance has become unaffordable for so many people.
He tries to further his evidence by again quoting from The Archives of Internal Medicine editorial, which continues:
A recent Government Accountability Office report on medical imaging, for example, found an 8-fold variation between states on expenditures for in-office medical imaging; given the lack of data indicating that patients do better in states with more imaging and given the highly profitable nature of diagnostic imaging, the wide variation suggests that there may be significant overuse in parts of the country. (Emphasis mine).
So the Archives of Internal Medicine, while citing a lack of data, concludes that there is a significant overuse of certain diagnostic tests in certain parts of the country. Couldn’t the same lack of data lead to the conclusion that other parts of the country aren’t taking advantage of medical technology that’s available to them?
This accusation of excessive testing or treatment by The Archives of Internal Medicine sounds a lot like President Obama’s insinuation that doctors regularly amputate the feet of diabetic patients, or take out tonsils based solely on the revenue generation that’s possible from such procedures. A CT scan is a diagnostic test, not a treatment, so it can be inferred that the Archive and Mr. Leonhardt are complaining about too much testing.
Nowhere does he correlate to this “excessive” testing, which is obviously a real cost concern, with what has become known as defensive medicine as practiced in a society where lawyers troll (oops, I meant to say advertise, of course) for clients from among the patients of anyone with “M.D.” after their name. Nowhere does Mr. Leonhardt recognize the simple fact that the cold, heartless, greedy health insurance companies have made a cold calculation that they are better off paying for these “excessive” tests than deal with malpractice liabilities. So who is really the culprit in this scenario? The doctors who test too much, or the lawyers who sue too much?
Meanwhile, back at the article, Mr. Leonhardt defends the idea of medical rationing by the government as unavoidable. Not something he wants to see happen, you understand, but an unfortunate necessity. Sort of like taking over General Motors, major investment houses, AIG Insurance or the student loan program. Not something that the government wants to do, you understand, we are just forcing them to do it. Or, as he phrases it:
It’s easy to come up with arguments for why we need to do so. Above all, we don’t have a choice. Giving hospitals and drug makers a blank check will bankrupt Medicare. Slowing the cost growth, on the other hand, will free up resources for other uses, like education. Lower costs will also lift workers’ take-home pay.
When was the last time any administration gave a hospital or a pharmaceutical company a blank check for anything? The sad fact is that there are many physicians who refuse to accept any new patients who are covered by governmental health insurance. And why do they take such a heartless attitude? Well, perhaps it’s because they not only don’t get a blank check, they don’t even get a check that covers their costs for treating the patient.
In addition, if the government is demanding that all citizens purchase health insurance, insurance that has mandates for an enormous array of covered procedures, just where does the worker collect his freed up resources that increase his take-home pay?
There is one more fascinating point that Mr. Leonhardt brings up. He concludes the article with the idea that we pay for healthcare, not on the number of tests run, but on successful outcomes of treatment. Or, as he says:
The final step is the bluntest. It involves changing the economics of medicine, to reward better care rather than simply more care. Health reform doesn’t go nearly far enough on this score, but it is a start.
Pay based on performance? Again, if his article was meant to amuse the reader, he’s on the right track, if for doing nothing more than displaying incredible chutzpah in putting forth a pay for performance idea while the editors and publishers of the Times deride the very same idea when it’s applied to teachers. On the other hand, perhaps it’s not funny or amusing. Perhaps it is just pathetic.
Yes, there are lots of things that can be done to improve national health care, and they can be done economically. But to get the majority of Americans to support them, the Progressives need to stop the tone of condescension, and start arguing logically. Mr. Leonhardt’s article avoids supportable logical arguments and just regurgitates the talking points that Obama and his nomenklatura use when they are challenged on the Progressive dream of total governmental control over everything. Not that they want to, you understand.