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How to Require Extra Rules for Opponents

Steven Pearlstein began his Friday Washington Post column with this line:

To most Americans, the language on Page 52 of the report of the House Committee on Appropriations would have seemed perfectly sensible.

He's picking a fight, but he intends to pretend that he's not fighting because only the other side is fighting what is supposed to be "perfectly sensible". Given that President Obama uses this tactic repeatedly to push the deficit spending bill, Pearlstein is not alone.

He continues:

The report spelled out the committee's rationale for including $1.1 billion for something called "comparative effectiveness research" in the massive economic stimulus bill. For those of not steeped in the argot of health policy, that's research done by doctors and statisticians who troll through large number of patient records to determine, for any particular disease, which treatments work best.

"By knowing what works best and presenting this information more broadly to patients and healthcare professionals, those [treatments] that are most effective . . . will be utilized, while those that are found to be less effective and in some cases more expensive will no longer be prescribed."

Those of us Pearlstein attempts to discredit are those who will ask the important question. It doesn't matter that comparative effectiveness research already occurs. Who will make those decisions? Stating without support that "nearly all experts agree [the effort] is a necessary first step to reforming a broken health-care system" does not dismiss the question.

After describing the opposition as a right-wing brushfire, he continues:

It's not that these various groups have no reason for concern. If comparative effectiveness research is done badly, or if the results are used simply as an excuse to deny insurance coverage for all expensive treatments, then there would be plenty of reason to get out the pitchforks and storm Capitol Hill. And there are surely examples from Britain and other countries of people being denied access to the latest drugs and procedures, including some that are significantly more effective than other treatments.

So, we're in agreement, right? What were we arguing about?

What the critics don't have, however, is any shred of evidence that the professionals who do this research are incompetent or have any but the best intentions in trying to figure out what treatments are the most effective for patients. ...

This is a bait-and-switch. We're not arguing about the ability or integrity of the researchers. No one said anything about that. The issue is who will make decisions resulting from the research. Pearlstein's desire to obfuscate the issue suggests he has an intention he doesn't want fully known. It's obvious since he spoke of experts he did not quote, but he gives it away as the paragraph continues:

... There is no reason to believe that once this clinical research is completed, it cannot be used in a disciplined, scientific way by physicians, economists and medical ethicists to determine whether there are drugs, tests, surgical procedures or devices that simply don't deliver enough benefit to justify their cost. ...

Physicians? Sure. Many could use a lesson about cost-benefit mixed with ethics. It's easy to fall into a pattern of inertia, despite evidence. But where do economists come into this? Again, who is making the decision? I don't think he means economists at insurance companies or parents as economic actors. As Pearlstein continues:

... And there is no reason we cannot set up reasonable procedures, overseen by independent health professionals, to protect patients who can demonstrate a special need for a treatment that is not normally cost-effective.

We finally get there. Patients need procedures to demonstrate a special need for "not normally cost-effective treatments". When not trying to pretend that is enlightened, it's called rationing. Regardless of an individual's willingness to pay, someone else must decide if it's cost-effective rather than first asking if the treatment is effective, followed by the question of how much it costs? That's government-run health care, despite Pearlstein's pretense that it is not.

Remember: Good, cheap, and universal. We can only have two. Yet, we actually try for three, despite Pearlstein reciting the tired lies that America denies "vital medical services to the 40 million Americans without health insurance". Lies, plural, because we do not deny care to the poor in the manner Pearlstein implies, nor are there 40 million Americans without insurance because of it's cost. He's advocating services without visible sacrifice. Why would anyone think the goal of this is government-run health care?

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