Irritating Things

It’s impossible to have a rational discussion about health policy when one side of the argument is irretrievably deceitful. Here are some things I find irritating, to say the least:

  • A White House that claims the way to control health care costs is to follow “evidence-based” guidelines, doing only procedures that are cost effective.
  • A White House that then uses taxpayer dollars to promote procedures that are not evidence-based or cost effective for blatantly political reasons.
  • A sycophantic press corps and fellow-traveling health policy bloggers who either remain silent or actually apologize for this hypocrisy.

Whether in the personage of Office of Management and Budget Director Peter Orszag or White House health adviser Zeke Emanuel or the president himself, the original message about health care spending was: we are spending too much money on items and procedures that are not good value for money. Writing in The New York Times, Emanuel, for example, claimed that Accountable Care Organizations (how ObamaCare wants care to be delivered) will save millions of dollars, in part “by avoiding unnecessary tests, drugs and procedures.”


“Momma said there’ll be days like this.” 

Further, President Obama has not restricted this approach to health care. Here is what he said the other day about his regulation czar, Cass Sunstein:

Cass has shepherded our review of existing rules to get rid of those that cost too much or no longer make sense, an effort that is already on track to save billions of dollars. With these reforms and his tenacious promotion of cost-benefit analysis, his efforts will benefit Americans for years to come. I can’t thank him enough for his friendship and for his years of exceptional service.

Contrast this concern for economic efficiency with the millions of dollars the administration has spent on Andy Griffith TV commercials and on other propaganda, telling senior voters about their right to a “free annual checkup” and encouraging them to go get it!

Turns out what is being billed as a “free medical checkup” and a “physical” is actually a “wellness exam.” Here is how AARP explains it:

During a wellness visit, the doctor measures the patient’s height, weight, body mass and blood pressure — and perhaps listens to his heart through his clothes…In other words, it provides a snapshot of the patient’s current health, as a baseline for future yearly visits, and is intended as a preventive service, a way of catching potentially serious health issues early.

Yet where in all the medical literature is there any evidence whatsoever that “wellness exams” for otherwise healthy people are cost effective? There isn’t any.

Then there is the latest administration effort to court women voters with ObamaCare’s promises of all manner of “free” services, including routine breast and pelvic exams, breast feeding advice, and even contraceptives. Health economists have known for a long time that preventive medicine does not save money, except in a few cases. The money that is saved, say, by early cancer detection in a patient who has cancer is overwhelmed by the costs of screening tens of thousands of people who don’t have cancer.

Even if it doesn’t save money, screening may be cost effective (a reasonable investment in health) in some cases. But the Obama administration has shown no interest at all in cost benefit analysis when it comes to women’s health. These days it is widely touting the benefits of the free mammograms ObamaCare will require, even as an article in the latest British Medical Journal questions whether mammograms ever make sense for otherwise healthy women.

As for sycophantic bloggers, I appeared on Hannity the other day with Chris Lillis, representing Doctors for America. After telling the radio audience how important evidence-based medicine is, Dr. Willis went on to claim that mammograms, Pap smears and all manner of other preventive procedures actually pay for themselves — thereby ignoring the whole of medical research for the past quarter of a century.

By the way, there are a few places that will call out the hypocrites in the health policy blogosphere, including the blogs of Avik Roy and Jason Shafrin. But there are far too few of them.

Comments (33)

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  1. Robert A. Hall says:

    Good thing you live in Texas, John, and not here in Crook County, IL where I live. You’d be irritated to death. Political dishonesty like this is The Chicago Way and the mother’s mike to machine Democrats like Obama. We are so used to it we hardly notice. With a sky-high murder rate, 85% of which is blacks murdering blacks according to a black spokesperson for Ceasefire Chicago, Chicago’s Mayor is busy keeping us safe from Chick-fil-A, whose owner has the same position on Gay Marriage Obama had six months ago. I will link to this from my Old Jarhead blog.

    Robert A. Hall
    Author: The Coming Collapse of the American Republic
    All royalties go to help wounded veterans
    For a free PDF of my 80-page book, write tartanmarine(at)

  2. Devon Herrick says:

    Last year I heard the annual physical was little more than a cursory review of physiological attributes that was conducted so fast as to have little actual value. Most of the items on the review list are probably already in the doctors file or would have already been tracked when the patient was in the office for anything else. I wonder if doctors are allowed to conduct this wellness exam in the course of unrelated office visits? If so, every senior will officially get the exam but most will likely not have any additional services beyond what they would have otherwise received.

  3. Larry says:

    John, I agree with you about the medical literature not agreeing with prevention ‘paying for itself’. I believe the only positive ROI is for stopping smoking.

    I would also say, that evidence based medicine only makes up about 30% of practices and procedures…10% we know we shouldn’t do and the other 60% is preference based. Which needs to become patient preference based.

    That being said, blood pressure screening is a very valuable surveillance activity. As we age our blood pressure tends to rise. High blood pressure is a co-morbid condition to heart attacks, strokes, diabetes and the need for renal dialysis.

    We are undertaking an effort in Rochester NY to demonstrate that blood pressure control can save significant sums while reducing suffering.

    Creating Community Collaboration to Improve the Care of Patients … › … › Vol 14 Issue 3

  4. Kyle says:

    Fortunately for the current administration, no one bothers to do their own research anymore.

    I have to disagree about their inability to use cost benefit analysis. Those Andy Griffith commercials are going to be money well spent, American votes at bargain prices.

  5. Chuck says:

    Honest policy debate has left the political arena, and has been replaced with hypocritical power games.

  6. Nichole says:

    Last year in the state of Texas, Bangs test for cattle became optional for most livestock yards. Bangs test were provided to make sure cattle didn’t have brucellosis or infections that could be passed to calves or another members of a herd. This decision for options in testing cattle was due the fact Texas has been brucellosis free for over ten years. Nevertheless, cattle can be moved from state to state with just paperwork. State troopers don’t blood test every cow, they just ask for a driver’s paperwork. No one really checks the health of the cattle. If brucellosis spreads that could cost a whole herd to be put down. If several cows are at a stock yard that bacterial can spread even quicker. This could cause the price of meat to rise or could cause a bacterial infection to be placed in steaks and hamburgers.
    American’s taxes and farmers paid out of pocket for unnecessary vet’s checking cattle, lab work, and administration fees. The state of Texas can try to keep their cattle free of brucellosis, but there is no guarantee that they maintain this status. We can maintain to stay free of certain health problems, but there is no guarantee that someone would end up with something. We could be like Texas and not see a disease for ten years. The same goes for free health checks in seniors. It can become costly for unneeded lab testing, but what happens if we can prevent a disease or virus that could be spread to other members in a community. That could be passed on to us by just sitting next to someone that came in contact with another person. Is that a risk we are really willing to take?

  7. Charlie Bond says:

    Hi John,

    It’s Monday, and the first thing I read is that you are suffering from irritable scowl syndrome. Just turn the other cheek, John. Wear two faces—politicians do it all the time. Put on the happy face.

    While there is much to be said about “evidence-based medicine”, we should be more concerned about “evidence-producing medicine”. Each year more tests are ordered and more prescriptions written by every doctor–not for the benefit of the patient sitting in front of them—but for twelve unseen, unknown citizens who might later be second-guessing the doctor. Eliminating the sheer waste of defensive medicine would go a long way to curing the health cost crisis.

    Having helped write California’s tort reforms, I not only support them as a model for the country, but I believe we could go even further through toward eliminating defensive medicine costs by promoting a private, free-enterprise solution— first party medical accident insurance. We no longer need the horrifically punitive effects of malpractice litigation to deter physician error, and we certainly can no longer afford the horrifically wasteful expenditures on defensive medicine.

    The evidence is conclusive that medicine that is purely based on producing evidence must be eliminated from our system.

    Charlie Bond

    PS. Medicine is a constant evolution toward best practices and has been so for millenia. So,while I do believe that medical science is and should be “evidence-based,” unfortunately the phrase (which belongs to science not politics or government) is being subverted into a P4P synonym. And we as all know, P4P will work—just as soon as they standardize the human body and all the agents of injury and disease that can attack it.

  8. Bruce says:

    I’m also irritated.

  9. Stan Ingman says:


    Your review is too weak to proof your point. You need to go back to the desk to attack administration.


  10. Greg Scandlen says:

    Barack Obama — Vote for me and get free stuff.

  11. frank timmins says:

    Nichole asks, with regard to “unneeded lab testing”, ” (diseases)……could be passed on to us by just sitting next to someone that came in contact with another person. Is that a risk we are really willing to take?

    Yes I think so Nichole, but the point is not whether or not we choose to take the risk. Rather it is that we cannot afford not to “take the risk”. Put another way, the upside of “not taking the risk” is not worth the cost. The discussion of healthcare and its financing is not about what we hope for in a perfect world, but what we can actually make happen. What we cannot make happen is to insure that no “preventable” disease ever occurs.

  12. Patrick says:

    Greg- it’s:

    Barak Obama – vote for me and I’ll make someone else pay for your free stuff!

    How about a little truth in advertising!

  13. Bob says:

    So talking about “death panels” isn’t deceitful? Or referring to IPAB as a rationing board when it is explicitly prohibited from doing so? It seems to me that you may need to get your head out of the sand and call out the liars on your side if you expect posts like this to be viewed as anything but petty partisan screeds.

  14. Dr Bob Kramer says:

    Go back to Kramer’s rule of six, let physicians, not politicians make health care decisions, and return to the day when decisions were made case by case by honest doctors. We can’t trust the insurance cos, the pharma cos, the hospitals, the government, and many of the unscrupulous physicians who treat medicine as a business and not a profession, and have discarded the Hippocratic Oath for the hypocritic oath.

    Dr Bob Kramer

  15. Rick Jackson says:

    You are the most articulate and informed expert on Healthcare economics of anyone in the US! Please keep up the great work of educating America. Your truth will set us all free!

  16. Hoads says:

    The “preventive health care saves money” meme was always a ruse and succeeded by telling the lie often enough without enough punch back from those with the refuting evidence. I’m told by physicians that the “wellness visit” as prescribed and coded in Medicare is cumbersome and time-consuming with poor reimbursement so many (most?) physicians skip it.

    Obamacare agents understand and are trying to insert the Canadian/European model of healthcare where there are actually more doctor and hospital visits but less high tech healthcare. So we can all get a free physical, pap smear, immunization, etc. whooptedoo. Add it up, it’s most likely less than $250 per person per year we’re paying for anyway through higher premiums. But, people will be under the illusion they are getting “free healthcare” so it goes a long way towards ingratiating sheep to a national health service. Meanwhile, behind the scenes, tighter controls and regulations await the seriously ill whose voices are always the weakest.

  17. Larry Wedekind says:

    John, it is important to differentiate between “prevention” and “detection” when referring to “preventive testing or services”. The preventive tests you mention are actually “detection” tests; ie, Mammograms, Pap smears, BMI,and Blood pressure testing. Preventive services are things like disease management coaching and education, health clubs, exercise programs, diet couseling, smoking cessation programs, and wellness education. THese programs are not expensive and are often offerred free to Medicare advantage members.

    A true “head to toe physical assessment” is mainly a “detection” service and is only “prevention related” when the physician then educates the patient about a problem that he or she detects during the physical exam; like high blood pressure or an irregular heartbeat. I agree that Wellness exams are typically not cost effective, but a good “head to toe physicial exam” is generally very cost effective; especially when combined with patient education and compliance monitoring or coaching from a Care Coordination company.

    Early detection of impending illness is actually at the heart of prevention of high cost acute medical intervention once an illness has progressed too far, but only if the early detection occurs and the patient takes action appropriately. Care Coordination companies like mine prove on a daily basis that early detection through frequent doctor’s office and home-based visits lower the cost of healthcare significantly -like by 25%. This early detection and wellness education is NOT costly at all when provided in a corrdinated Medical Home environment and results in huge cost reduction through lower ER and hospital utilization. The studies that you refer to ignore that savings occur across the system of care as a result of decreased ER and hospital utilization across the system from early detection and wellness education.

  18. wanda j. jones says:

    Add the irritants of:

    False numbers about international health:

    Failure to understand or care about the probable externalities to be caused by these new rules and the counter-legal strategies people will adopt:

    Failure to justify adding these entitlements while they are actually shrinking prior entitlements:

    Allowing such a garbage-laden bill to be passed unilaterally by one party that hadn’t read it. It is a sloppy, slovenly piece of legislation. A high school kid could see that.

    Whether Obama gets the job again or not, this bill has to be hacked apart and a sensible multi-year plan created that takes all entitlements into account against the national debt.

    Wanda J. Jones, President
    New Century Healthcare Institute

    Most early detection can be automated.

  19. Uwe Reinhardt says:

    I agree with you, John, that there is plenty of hypocrisy or, to put it more kindly, cognitive dissonance (CD) in the debate swirling around health care. But don’t let it irritate you. It is not good for your health. Let it amuse you.

    For example, I am not at all irritated but merely amused to see on this blog posts and comments from your ever loyal devotees lamenting the allegedly enormous waste in the delivery of unnecessary health services in this country, and in other posts laments over the allegedly brewing shortage of physicians – the very decision makers over whose signature these unnecessary services are delivered. A serious thinker might think that if the supply of physicians were more taut, physicians would eschew the fluff and concentrate on more needed services.

    I am not at all irritated but merely amused to see you, John, wax mushy in one post of this blog about the wonderful cancer survival rates we achieve in this country — which allegedly makes ours the best health system in the world — while in this particular post you demand strict benefit-cost analyses for the very tests that beget the early diagnoses of cancers and longer survival rates from date of diagnosis – e.g., early diagnoses cervical cancer, breast cancer, colon cancer or prostate cancer. I’d diagnose yours as an acute case of CD. After all, you did not talk about B-C analysis when waxing mushy on the cancer survival rates.

    On the topic of benefit-cost analysis for medical tests or interventions, I teach my students that this is nice in concept, but very difficult in application. It requires us – get this! – to assign dollar values to clinical outcomes, say, to “quality adjusted life years” (QALYs).

    So, my friend, if you were an adviser to Obama – heaven forefend! – what would you tell him a QALY is worth, the value he should use in the B-C analysis you urge upon him? Does that value vary by income class? Or is the only relevant metric here what my life is worth to me, and yours to you, but not what someone else’s life– e.g., the neighbor’s kid’s – is worth? Let’s have your thoughts on it in a future post. And please give me a dollar figure or figures proper for the benefit cost analysis you ask for. If you want Obama to practice B-C analysis, he will need your input on this, John.

    You may recall, John, that when Obama initially intended in the stimulus bill to allocate $1 billion over the next 5 (or was it 10) years for cost-effectiveness analysis, he was vehemently attacked on it from the right and had to excise the word “cost” from the bill. Now it is just “clinical effectiveness analysis,” meaning, “does it work at all, costs be damned?” I don’t recall your writing a defense of Obama’s idea then. Perhaps you did and I missed it. Or were you abroad and missed the entire big debate in 2009?

    In fact, do you know, John, that those of us who defended the use of benefit-cost or cost-effectiveness analysis in health care were quickly branded Nazis for doing so? Our daughter gleefully e-mailed me a link to a story in which I was called a “notorious Nazi operative,” simply because at a panel discussion in DC I had come out like you do here, in favor of cost effectiveness analysis. Do you realize that for writing what you did in this post, you might be branded a Nazi by your buddies on the political right?

    Now, John, let me ask you this: From which side of the political spectrum did these attacks on benefit cost analysis come, for the most part? (Hint: The Washington Times featured an editorial critical of Democrats, entitled “Efficiency in Health Care Can be Deadly,” adorning the editorial with a picture of Hitler. Is that a Liberal rag? And Senator Grassley in 2010 darkly talked about “killing Granny.” Is he a Liberal?]

    And who accused Obama of running death panels, over the use of benefit-cost or cost-effectiveness analysis that he was accused of advocating? When that happened in 2009, did you write a post reprimanding the hypocritical folks making this outrageous claim? Or, again, were you abroad at the time and missed the whole shebang?

    In April 2009 Newt Gingrich praised Gunderson Hospital in Wisconsin, 90% of whose patients had living wills. Newt claimed that we could save $30 billion a year if every Medicare beneficiary had a living will. Yet when an early version of the ACA in the House merely provided to pay doctors for helping their elderly patients think through writing such a will, Betsy McCaughey of NY later in the year viciously attached them on Fred Thompson’s radio show, claiming that Democrats in Congress mandated doctors to help elderly people cut their life short. At that point Newt stayed mute. Did you protest her outrageous lie in a post? Jon Stewart sure did. Look here:

    And did you take Sarah Palin to task for her outrageous comments on the issue?

    Earlier, in 1993, the National Cancer Institute concluded, on the basis of a cost-benefit analysis, that mammography for women under 50 was not cost effective. Using that information, the Clintons excluded such mammography from the basic benefit package of their health plan (something you apparently would approve, if I read your post correctly). Bernadine Healy, just after stepping down from running the NIH and then running for the Senate as a Republican, promptly wrote an op-ed piece featured in the WSJ accusing the Clintons of rationing health care. What do you make of that, John? Can you see what happens to politicians who act on benefit-cost analysis in this country?

    You lament that the “Obama administration has shown no interest at all in cost benefit analysis when it comes to women’s health.” Can you blame them, after being called Nazis for attempting the very thing, after seeing picture of Obama with a Hitler mustache all over DC? And tell me how many Republicans now in Tampa would show any interest in benefit-cost analysis for health care. Would Romney have the guts to say what you say in this post? Would the courageous, honest Paul Ryan?

    I could go on, but my point is this: There is a lot of hypocrisy and cognitive dissonance in political life, John, and it is found on both sides of the aisle, in equal measure. If you wish to function as a purely partisan hack, I give you an A for this post. You hit the target — not the virtue of B-C analysis, but Obama. On the other hand, if your intent is to fight hypocrisy and cognitive dissonance in political life, you should broaden your radar screen. If that was your goal, you get an F for this particular post for its judiciously narrow focus.

    Oh, yes. One cool final anecdote. While testifying before the House Energy and Commerce Committee in 2009, Congressman Gingrey (R-GA) took me to task for having written in the NYT that “the idea that life is priceless is romantic and silly.” He pointedly said it was “German thinking of another era.” I hope you would have jumped to my defense, had you sat next to me. In any event, I reminded him gently that our son invaded Iraq without a flack jacket and that a year later he had protected truck convoys in an unarmored Hummvy, clearly because the Pentagon, with Congress’ approval, did not deem our son’s life priceless. Personally, my wife and I thought that, on behalf of the hard pressed American taxpayer, they assigned our son’s life too low a price. We still do.

  20. Yaj Reizarb says:

    Prof Reinhardt:

    After reading through your post I found myself summoning Pauli and thinking, “That’s not right. It’s not even wrong.”

    No one is opposed to the principle of using various proxies for cost effectiveness to inform clinical decision making, any more than people oppose using nutritional information to determine what to eat.

    It’s clearly not the use of empirical evidence to inform decision making that opponents of the ACA object to – it’s who gets to make the decisions.

    We have a vast body of scientific knowledge regarding nutrition, but it doesn’t follow that investing a centralized bureaucratic apparatus beset with everything from Buchanan/Tullock public-choice problems to Hayekian knowledge-problem constraints the power to determine what food individual citizens can buy, from whom, and at what price will generate optimal outcomes – even in a totally homogeneous population with perfectly identical physiologies and preferences.

    We transfer many billions of dollars worth of wealth into the hands of individual consumers in the form of food stamps, but one seldom hears arguments that the fact that they using public money to fund such purchases endows the state with the right to control how they spend the funds. Given the arguments you’ve advanced in support of centralized control over spending on health care, this is rather surprising, as there’s no logical principle in your arguments that would preclude the state from doing so under the guise of superior efficiency.

    If you’ve developed a formal system of arguments that one can use to simutlaneously argue *against* an Affordable Food, Clothing, and Shelter act and still maintain support *for* the Affordable Care Act – I do hope that you’ll take a moment to provide a link for myself and other readers of this blog. Once you’ve done so you will have begun to address the real objections to the policies that you have championed.


  21. Uwe Reinhardt says:

    Mr. Reizarb:

    Thanks for your comments. Although they would make for a good debate in their own right, they do not strike me as germane to John’s or my post.

    John was blaming Obama for not using benefit-cost analysis to make a coverage decision concerning preventive care within public insurance program. He was not arguing in this post that Obama should not make such a decision in the first place and should not have covered preventive care with public funds.

    And my point to John was that Congress, and particularly the right of center in Congress, vehemently reject the use of benefit-cost analysis for coverage decisions and that quite a few folks on the right suggested that cost-effectiveness analysis in health care was a tool used by the Nazis. You should read my comment again.

    As to food stamps, I checked and there are, indeed, limits placed upon what can be bought with them. The state apparently has every right to do so (on behalf of taxpayers).

    Finally, I do not understand what you are after in your paragraph “If you’ve developed a formal system of arguments that one can use to simutlaneously argue *against* an Affordable Food, Clothing, and Shelter act and still maintain support *for* the Affordable Care Act – …” Why should I feel obliged to develop such a system?

  22. Marti Settle says:

    Excellent as usual, John.

    I had one mammogram when I turned 50 which was negative. I read the articles saying that mammograms were actually dangerous so I refrained from this silly and uncomfortable ritual for 15 more years. In that time I never had any problems. In December, 2007, I felt a lump in my left breast and after New Years went immediately to my doctor who examined it. His concern sent me directly two days later to have a mammogram. It detected the lump, they then performed a sonogram and then a needle biopsy. I did have a malignant cancer which was removed and I received treatment. Even then I was given a choice of no having radiation and chemo because I had caught it so early.

    My point is this. I saved my insurance company the cost of 15 mammograms through the years because I learned to perform self-examinations. My sister, on the other hand, has had regular mammograms. But, when she developed breast cancer it was too late. Her mammogram did not detect the growth that was under her right breast and therefore undectable because of the limitations of the compression bars of the device. She is in stage 4 cancer which has spread throughout her body. Mammograms are, for the most part, a waste of money. They should only be used if a woman detects a lump of feels something out of the ordinary. A good sign of cancer anywhere in the body is unexplained fatigue that lasts longer than two weeks.



  23. David C. Rose says:


    Here’s an open letter to President Obama and Ezekiel Emanuel…

    You believe that rapidly rising health care costs call for serious government action. But before jumping in, let me ask you a question. What do you think is the most relentless, inventive, clever, and creative mechanism for controlling the cost of nearly anything, any time, or any place? The answer, of course, is market competition.

    If it is controlled cost you want, it is competition you need. If it is competition you want, but you also want virtually 100% access, it is vouchers you need.

    But if it is control over 17% of the economy you desire, then by all means forget about vouchers or anything that approximates them (like premium support programs), because competition works automatically, is self-correcting, and won’t take orders from a master.


  24. Uwe Reinhardt says:

    To David C. Rose:

    The Medicare Advantage program basically is a voucher program, now serving about 25% of the elderly. Can you explain to me why, if competition is capable of controlling costs better than government-run insurance, under the MMA 03, Medicare Advantage plans have needed to be paid MORE per beneficiary than it would have cost under traditional Medicare for the same beneficiary?

    Should it not have been shooting fish in the barrel for the Medicare Advantage plans?


  25. frank timmins says:

    To: Uwe Reinhardt

    Although the Medicare Advantage program offers Medicare recipients options as to the type of plan benefits they adopt, one shouldn’t confuse Medicare Advantage with actual market driven healthcare financing.

    Most Medicare Advantage plans are merely re-branded HMOs which have few elements of free market tenets, and must negotiate payment schedules with healthcare providers (unlike Medicare).

  26. Uwe Reinhardt says:

    To Frank Timmins:

    Fair enough. So please describe to me exactly what you mean by “free market”? I am serious. I get confused reading this blog what people mean by it?


  27. Allan Jensen says:

    To:: Timmins, Reinhardt

    A free market requires a knowledgeable and motivated consumer and a provider (of either goods or services) which is willing to sell.

    I would offer that some level of payment above Original Medicare for Medicare Advantage is necessary for:: (1) MA plans must pay a negotiated rate to providers that in many, if not most, cases exceeds Medicare reimbursements; (2) insurance companies must accept the entire risk of funding Medicare benefits, without limit and must do so based on the enrollment they are able to achieve; and (3) statistics tend to support, particularly with respect to hospitals stays, a significant reduction in return visits.

    And finally, with respect to earlier comments about evidence based medicine, it is notable that there is a dramatic shortage of scientifically and population-wide data for most medical treatment categories. So-called “best practices” are more appropriately categorized as anecdotal than as scientifically proven. Here in Colorado, when we tried to craft a state-mandated plan based on evidence-based practices a few years ago, we discovered that there were too disease categories that contained enough “evidence” to warrant the designation.

  28. frank timmins says:

    To: Uwe Reinhardt

    The “free market” as it applies to healthcare has to do with the most basic of exchanges of service/payment between the patient and the doctor. This means being able to freely choose a doctor (and/or facility), decide exactly what services the doctor will provide, and being free to go elsewhere if the price for these services is (in the opinion of the buyer) not appropriate. This is where we start.

    As the treatment scenarios become more complicated and expensive and insurance becomes an important element, compromises must be made. But this is not about insurance. It is about healthcare, and that reality is what seems to be lost on the progressives.

  29. Hoads says:

    Allan Jensen you bring up an excellent point re: limited evidenced based research. Here lies another red flag for opponents of Obamacare. We are already witnessing the erosion of the scientific method as carefully crafted junk science fueled by everything but objectivity can easily win targeted converts. Obamacare pours money into government research centers such as NIH. Healthcare academia cannot hide it’s bias for Obamacare not to mention the huge numbers of liberal healthcare policy think tanks all in for Obamacare who pushed their agenda driven research that became the foundations for many of the pseudo factual premises used to sell Obamacare- [such as half bankruptcies due to medical bills, 98,000 people die from medical errors per year, WHO U.S. healthcare system 37th, amount of transfer costs from ER visits- these are just what I remember off the top of my head].

    Bottom line- in this day and time of voluminous data and computerized statistics, the integrity of research is always in question, easily manipulated and co-opted by the powers that be.

  30. Hoads says:

    Oops didn’t mean to submit yet– evidence based medicine used to support top down decision making is not to be trusted.

  31. Henry C GrosJean says:

    Great Blog
    Interesting dialogue.
    I got a kick out of the comment where “as we age our blood pressure tends to rise” is probably a true statement for the “sedentary” crowd!!

  32. Larry says:

    I am not sure what your background is, but rather than casting stones from afar you should attend a PCORI Board meeting and meet the people and understand the work that is going on to develop good patient centered outcomes research.

  33. jmitch says:

    Nice post, Dr. G. Thanks.
    Please note Prof. Reinhardt’s comments on CD.