Color me skeptical

Despite Elizabeth's generous description of me, I tend to be a little bit leery of writing too much about health care policy. While I feel very comfortable discussing the nuts and bolts of health care delivery (for example, I will confidently aver that bribery with stickers is laughably ineffective when shots are on the line), the intricacies of health care reform are both more complicated and more obscure than I can authoritatively claim to understand. Still, as an issue that is of pressing national importance and dear to my heart, I try to essay an opinion now and then.

With that disclaimer in place, I'd like to comment on Jonathan Cohn's recent post at The Treatment (TNR's health care blog). Mr. Cohn, who knows far more about the topic than I do, is somewhat unsure what to make of the overtures from the pharmaceutical and hospital industries that they are willing to make a deal with the Obama administration as efforts to reform the health care system proceed. He writes:
On Wednesday, according to the Washington Post, three groups representing the U.S. hospital industry will announce their willingness to give up $155 billion in revenue over the next ten years--money that the government can then use to help finance universal coverage, or some approximation thereof.

The deal, which the hospital groups are making with Senate Finance Chairman Max Baucus and the White House, has apparenlty been in the works for a while. Laurie McGinley and Phil Galewitz of Kaiser Health News first reported its emergence last week. It follows closely on the heels of a similar deal Baucus and the White House struck with representatives of the pharmaceutical industry in late June. And, broadly speaking, it's consistent with the pledge leaders of the health care industry made at the White House in early May: That they would support health care reform, even if it meant taking money out of their own pockets.

These agreements might seem merely symbolic. They are not. They are significant developments, both politically and substantively.

But are they also good developments, the sort that liberals should cheer? That's a bit more complicated. To be quite honest, I'm not sure I know the answer.
I must admit to feeling somewhat gratified that Mr. Cohn is as unsure as I am. The details of the deals seem a bit murky to me, but from what I understand, the pharmaceutical industry will kick in money to shore up the Medicare prescription drug benefit, and the hospital industry will cut costs by $155 billion over the next decade. Cohn's piece discusses some of the upsides and downsides, but what I was most interested in was this:
Perhaps the most important question to answer is what these industry groups are getting in return. Changing payments to the health industry isn't simply about generating savings that can finance expansions of insurance coverage. It's also about changing the behaviors of these industries--and, in so doing, creating a health care system that offers better quality care for less money.

To accomplish that, reform should ideally include measures like strengthening the hand of the Medicare Payment Advisory Commission (MedPAC), developing more data on comparative effectiveness (CE), or building a strong public insurance plan. But hospitals don't like the idea of a stronger MedPAC, drug makers are pretty hostile to good CE, and insurers (among others) hate the idea of a public plan. When the industries cut these deals, are they prying promises from [Senate Finance Committee chair Max] Baucus [D- Mont.] --or the White House--not to push too hard on these levers?

Considering how closely tied Baucus appears to be to the industries in question, I must admit to being more than a little bit skeptical. (Confidential to GJ: you can put this in the "Dan willingly criticizes the Democrats" file.) Based on nothing more than a certain familiarity with human nature and suspicions about corporate behavior, I have a hard time believing that either the drug companies or the hospital industry are making concessions out of the kindness of their collective hearts. I don't know much about MedPAC, but I do know that CE could potentially steer patients away from new and expensive brand-name drugs and toward older, cheaper generic alternatives that are just as effective (if not more so). Minimizing attention to CE would be in the pharmaceutical industry's interests, but not necessarily ours.

Cohn seems cautiously optimistic about what all of this means, and I'm certainly glad to see the major industries playing along with health care reform to any degree. But I can't swallow the idea that these concessions don't come with some kind of sweetener. It remains to be seen just what that may be.


  1. Such hard bitten criticism. I hope your knuckles will recover soon.

    All I can say is that if you love the military-industrial complex and the way it delivers cost effective innovation and products, you will love the medical-industrial complex too. All the same advantages of of a government monopsony, with the same business model as BoeingMcDonaldHugeAircrash to boot.

    The only result of this I can clearly see is good times ahead for incumbents and their campaign warchests. Good times, man, good times.

  2. Oh, I'm sorry. My criticism was too oblique? Insufficiently snide? I shall endeavor to do better in the future. In the meantime, I'm sure you can find plenty of appropriate commentary over at Redstate.com.

    And I've read that "If you like [government-sponsored program X]. you'll love [prospective government-sponsored program Y]" formulation on bumper stickers. Usually [GSP X] is the postal service, but I suppose "military-industrial complex" will do.

    I'm sure the people of France and Britain would be surprised to learn that there is nothing innovative about their government-sponsored health care systems.

  3. You think the medical-industrial complex will be different? How so? Same Congress, and I'm 100.00000% certain that the same "walnut row" of former Obamacare executives will line the top floor of hospital collectives and big pharma. Hide and watch.

    Insanity is doing the same thing and expecting a different result.

  4. Actually, I'm usually pretty impressed by the postal service.

  5. Elizabeth, don't forget about NASA. Or about the Army corp of engineers. And going back in history the Roman army corp of engineers, the Apian way and the aquaducts, no they were nothing.

    I suppose insanity is reading anything by gj and expecting anything original. I do have my hopes to be proven insane, but am starting to doubt it.


  6. As yes, NASA. Almost 40 years since the moon landings, and we're barely able to get to low earth orbit. They still hug and kiss when the shuttle lands. When the shuttle is retired, what do we have to take its place? Maybe Ares will be ready half a decade from now, if it doesn't double in weight. NASA is the poster child for wasted promise.

    I'm not saying government can't do excellent engineering. Our military fields some remarkable weapons. But, they aren't cheap, and they don't come in on schedule, and they for darn sure aren't built efficiently. Make our medical system a government monopsony like DoD, and we are certain to get the same result. You like the DoD procurement process, you'll love Obamacare.

  7. good lord GJ are you an ass. You have never heard of the Hubble, the Mars Rovers, the expeditions to the outer planets? The US essentially mothballed manned exploration and that is NASA's fault? And what the hell have you done? what contributions have you made to the advancement of humanity that you would mock the scientists at NASA so easily. You really are a pissant little man, all snark and infantile whining. OOOHHH look at me, I made fun of Obama. I am edgy and provocative. Your idea of argument is assertion, but anyone can destroy your assertions in but a moment.
    No, NASA is not perfect, it has had its share of bureaucrats, but dollar for dollar has brought about some of the most astounding leaps in mankind, and it took a Government to bring it about. I for one am proud of it.
    Really, why are you so needlessly stupid? Tell you what, spend a few days studying the Japanese Health care system, come back here and critique it, tell me why ours is better than theres. Bear in mind they have better outcomes at half the cost, show how that is doesn't work, or more likely show that you are a lazy and dumb ass and don't do any analysis. Just come here and piss.


  8. Hi, charo, switched back from the decaf, eh?

    Yes, I've heard of the Hubble, MR, the grand tour. I'll note that most of the work was done decades ago. Cite something modern, designed within the last 20 years.

    As far as the Japanese system, I'm not the one who has to justify changing everything. You put forward the claim, you defend it. That's the way logic works.