Hilzoy Cuts to the Heart of CER

You’re going to hear quite a bit of insane frothing blather over “Comparative Effectiveness Research” from Cons. Y’see, they don’t want objective folks making scientific determinations of whether insanely expensive medical treatments, devices and drugs are effective compared to cheaper treatments, etc. That would mean that corporations couldn’t make insane profits, and we can’t have that.

So they’ll pull out all the usual stops. They’ll bring out the Big Gubmint Boogeyman:

On January 23, Representative Tom Price (R-GA), a physician, sent out an “alert” through the Republican Study Committee, falsely warning that the CER legislation would create “a permanent government rationing board prescribing care instead of doctors and patients.” The true intent of the CER provision, Price warned, was “to enable the government to ration care” (emphases in original). “Every policy and standard will be decided by this board and would be the law of the land for every doctor, drug company, hospital, and health insurance plan.”

Make shit up:

Parallel arguments appeared in a letter sent January 26 to several influential members of Congress, cosigned by more than 60 advocacy groups, and again in a January 29 editorial in the Wall Street Journal. In an op-ed by columnist George Will that appeared in the Washington Post the same day, CER had morphed from a form of research into an imaginary new federal body with broad powers. Will named the agency “the CER” and claimed that with such a system, “Congress could restrict the tax exclusion for private health insurance to ‘insurance that complies with the Board’s recommendation.’…”

And go for a Godwin:

But the Heritage Foundation is a marvel of sanity and good sense compared to John Griffing in the American Thinker, who describes the language providing for CER as “a line that would sentence millions of people to death”, and adds, by way of explanation: “If you are picturing Germany circa 1930, you’re right on. With the passing of this bill, government, not doctors, will decide who receives care and who doesn’t, in essence, who lives and who dies.” Deacon for Life, for his part, calls it “Mengele-esque”. The idea that Hitler and Mengele’s great sin was conducting research into the comparative effectiveness of various medical treatments is, shall we say, peculiar.

Hilzoy notes all of the above, and then cuts to the heart of the matter:

More seriously, there is something about the arguments against CER that I have never understood. The opponents of CER claim that it will inevitably be used to make decisions about care. Insurers will not want to pay for care that is not effective, and so people will be deprived of the care they need. But notice what “deprived of care” means here. No one is seriously proposing to make it illegal to purchase whatever medical care you want on your own.

This means that even if your insurance company decides that it will not pay for some treatment that has been shown to be ineffective, you will, under any proposal being seriously considered, still be able to get that care; you just won’t be able to get someone else to pay for it. If not having someone else pay for your medical care counts as being “deprived of care”, then 46 million people are being deprived of care even as we speak — and that’s just the uninsured; it doesn’t include people who have insurance that doesn’t cover the treatments they need. And yet, strange to say, the opponents of CER generally do not see this as a problem.

Nope. Cuz, y’know, if private insurance companies deny treatment, that’s like totally okay. And who wants poor people to have medical care, right?

What the hysteria really comes down to is the Cons’ belief that private industry should have free rein to lie, cheat, and steal. They’re terrified of government-backed scientific research because that would put an end to all the fun.

Remember that when they try to spin CER as some kind of socialist Nazi government takeover of what little healthcare you currently enjoy.

Bring Me Government-Run Health Care

And remind me never to buy anything at Zales, ever:

In the coming debates over health care, when your Uncle Bob pulls out the old conservative trope asking, “would you really want government bureaucrats to be in charge of your health care?” give him this article:
Five months ago, Rose Camilleri was a superstar at the Zales outlet at Woodbury Common Premium Outlets.

In November, the diminutive grandmother with an Italian accent was flown to Dallas, home of Zales’ headquarters, where she was honored with a 1-carat diamond necklace for making $1 million in sales last year.


It was the fifth diamond Camilleri had earned during 4½ years at Zales, where she received nearly a dozen commendations.

“I loved my work,” she said. “I loved the people, and I loved it when people came in and asked for me.”

But in early March, Camilleri developed bronchitis and went for a chest X-ray and an MRI. Her doctor discovered an aortic aneurysm, a weakness in the wall of the aorta, which, without prompt treatment, might rupture and cause quick death.

Camilleri told Zales she would need surgery as soon as possible.

“I told my manager I can’t get upset because it could explode any minute,” she said. “I typed up a letter asking for time off and guidance from human resources.”

One week later, on March 14, she was asked to attend a meeting with a new regional manager.

“He said, ‘You’re terminated,'” Camilleri recalled. “I tried to keep myself very calm because I knew something could happen to me. I said, ‘You’re joking — you’ve never been in my store.’ He said, ‘It’s the best thing.'”

It also meant Camilleri had to postpone her March 26 surgery until she could convert her insurance to a self-pay plan known as COBRA.

Two weeks later, Camilleri had not even received the paperwork.

Her son e-mailed the Times Herald-Record.

“We are told that it could take up to 45 days,” Charles Camilleri wrote. “I lay awake every night fearing the worst.”

Contacted by the Record, Zales would not comment. Charles Camilleri called Zales’ human resources, explaining it was a life-or-death matter, and he simply needed a fax from Zales to start the COBRA process. He was floored by the employee’s response.

“She said, “Well, if the surgery was rescheduled, then it’s probably not a life-or-death situation,” Charles Camilleri recalled. “I absolutely was blown away.”

Health care really shouldn’t be paid for by people who only make money by denying claims. What the fuck do you think is going to happen? But it’s not just national health insurance we need – we need laws on the books that make it very, very illegal for companies to pull this kind of shit.

I have a coworker now who’s fighting the company over disability claims for a neurological disorder that gets worse under stress, and another who’s on the verge of losing her job because of ovarian cancer. And this, mind you, is a union company – we have more protection than most.

It’s outrageous that sick people have to fight on three fronts: the illness, the insurance company, and their workplace. It’s time for this shit to change. Even Republican Olympia Snowe’s aware of that:

If Democrats are going to need some Republican votes to pass a major health care reform initiative, it looks like they should start with Sen. Olympia Snowe (R) of Maine.

Snowe hosted a “listening session” on health care reform this week and made it clear that she wants to support significant changes to the status quo. (thanks to reader A.F. for the tip)

Speaking to the members of the group before taking their testimony, Snowe, a senior member of the Senate Finance Committee, said the committee is determined to draft legislation by June and to have it ready for debate on the Senate floor by July. The last attempt to overhaul the nation’s health care system was proposed in 1993 and dissolved in “polarization and partisanship,” she noted.

“I believe the climate in Washington is different now,” Snowe said. Recognition is widespread that the nation’s health care system is unsustainable, ineffective and inequitable, she said, and the current economic crisis is only making things worse.

“This is precisely the right time” for national reform, Snowe said.

Snowe added that she expects to see a vote in the Senate before the end of this year.

“We have a totally dysfunctional system now,” she said. While like most Republicans she would prefer to see the private sector collaborate on an effective change, a government-run health care system may be the only way to get the job done, she said. [emphasis added]

Now, mind you, Snowe is sane, which puts her at odds with 99.9% of her party. But if even a Republican can clearly see how terribly broken our health care system is, it’s bloody well time to fix it.

Private insurers’ claims to be able to do so themselves – DENIED.

Another Noxious Bush Reg Bites the Dust

A few months ago, I alerted you to Bush’s little scheme to allow healthcare providers to redefine birth control as abortion and then refuse to provide the service. At the time, I gave you what I considered wise advice:

We can’t rely on Obama’s ability to roll these rules back. Better for the country if they’re never implemented at all.

It’s nice to be half-wrong sometimes. Looks like we can rely on Obama after all:

Today, the Obama administration plans to rescind the controversial “conscience rule,” which “allows healthcare workers to deny abortion counseling or other family planning services if doing so would violate their moral beliefs.”

That’s my President, that is. He’s not got a perfect record in rolling back Bush abuses – in fact, if a few things don’t change over the next week, a trip to the woodshed will be in order – but he’s doing a tremendous amount of good very, very quickly.

This is why I find it rather difficult to apply the Smack-o-Matic in his case. Every time I pick the damned thing up, he does something that makes me put it right back down. Y’know, little things like, oh, I dunno,

Ending the war in Iraq.

Restoring Superfund, making polluters pay, and ending tax breaks for the fossil fuel industry.

Planning a budget even Paul Krugman can love.

Going for healthcare reform.

Delivering a kick-ass speech that helps prepare the country for progressivism.

And that’s just a few items from the last few days.

It’s a good thing the Cons have been such raging idiots, or the poor Smack-o-Matic would be gathering dust. We can’t have that.

The following illustration describes the situation precisely:

Our President is practically MacGuyver. I’m loving this.

Thinking Brain Dog

Those of you reading from the most recent post on down should probably reference this first.

Now that you understand the state of Dana’s brain, you’ll understand why she needs a Thinking Brain dog. Thankfully, that service is ably provided by Cujo359, who takes a closer look at Daschle and points out why tax mishaps may be the least of his problems:

It’s funny how most of the attention lately has been on Daschle’s tax problems, when the problem we should be concerned about is how beholden he is to the very industries he’s supposed to ride herd on as Secretary of HHS. The Los Angeles Times adds:

According to financial disclosure forms filed with the Office of Government Ethics, Daschle also took in $153,200 in 2008 for giving speeches to healthcare companies and industry groups such as GE Healthcare, a leading manufacturer of medical devices.

A decade ago, Daschle’s wife did some work for the healthcare industry as well. In 1999 and 2000, Linda Daschle was among a group of lobbyists at Baker Donelson Bearman & Caldwell who represented the drug maker Schering-Plough Corp., which paid the law firm $470,000 over the two years, according to federal lobbying reports.

Tom Daschle To Face Close Scrutiny

You might find it ironic that Republican Senators plan to grill Daschle on this matter, but Daschle’s own record shows how pervasive the revolving door culture can be in our nation’s capital. All I can say about the irony is that I’m just glad there are still two major parties in DC. If there were any fewer, we probably wouldn’t be hearing about this at all. [I do have to quibble over the “two major parties” portion of this post – unless, of course, major is defined as one party being a major pain in the arse and the other majoring in cluelessness. – ed.]

Even assuming Daschle was willing to say goodbye to all that, it’s unlikely that he’ll also be willing to work his wife out of a living.

All I’d heard on Daschle up until now was gushing praise. So it’s interesting to see another perspective and realize that if his nomination goes down in flames, it might not be such a horrible thing. It would even be thought-provoking if I were capable of thought this evening.

Cujo359 isn’t gentle on Daschle, but he’s absolutely brutal when it comes to Sanjay Gupta, Obama’s pick for Surgeon General. Considering that I thought Dr. Gupta was nothing more than a cheap stunt anyways, I’m delighted to see him getting mauled:

Equally unimpressive is President Obama’s choice for Surgeon General. Dr. Sanjay Gupta is, as many people are aware, a medical correspondent for CNN. Just that statement would be cause for suspicion about where his loyalties lie, given that so much commercial time is bought by insurance, pharmaceutical, and healthcare companies. As The New Republic observed:
For over six years, Gupta has been co-hosting “AccentHealth”—a CNN television segment beamed straight into doctors’ waiting rooms, sponsored in part by many of the major pharmaceutical companies. Touted on its website as an “integrated marketing opportunity” that allows companies to deliver their message “in a trusted environment,” the show has been underwritten by drug industry leaders Aventis, Pfizer, Procter & Gamble, Merck, and Warner Lambert.

Sanjay Gupta Treads the Ethical Line

But suspicion doesn’t equal guilt, so let’s look at what Dr. Gupta’s been up to. That same TNR article goes on to say:

At the same time, Gupta has been appearing on CNN’s primary broadcasts as an ostensibly objective medical authority, discussing the drugs produced by the very same pharmaceutical companies. In a November 2003 broadcast of CNN’s “American Morning,” Gupta described the benefits of the cholesterol-reducing drug Lipitor, which is produced by Pfizer…

It gets worse. And no, Dr. Gupta doesn’t make it out alive. Luckily, Cujo359, being our Thinking Brain dog, can readily suggest an alternative.

It’s a thought-provoking post. I haven’t even begun to extract all of the awesome bits, so head on over and have a look yourself.

Horror of Horrors: Socialized Medicine

To hear the Cons tell it, universal healthcare will be the End of Everything. Of course, for them, it seems that anything which benefits a broad swath of humanity is a Terrible Evil that Must Be Fought. So a story like this must truly strike terror into their shriveled little hearts:

[Our son] was first diagnosed by our pediatrician, a private sector doctor, who sent us to the (public) specialised pediatric hospital in Paris for additional exams. We did a scan and a MRI the same day, and that brought the diagnosis we know. He was hospitalised the same day, with surgery immediately scheduled for two days later. At that point, we only had to provide our social security number.

Surgery – an act that the doctor that performed it (one of the world’s top specialists in his field) told us he would not have done it five years before – actually took place the next week, because emergency cases came up in the meantime. After a few days at the hospital, we went home. At that point, we had spent no money, and done little more than filling up a simple form with name and social security number.

Meetings with the doctor in charge of his long term treatment, and with a specialised re-education hospital, were immediately set up, and chemiotherapy and physical therapy were scheduled for the next full year.

Physical therapy included a few hours each day in a specialised hospital, with a varied team of specialists (kinesitherapy, ergotherapy, psychologist, orthophonist) and, had we needed it, schooling. As we lived not too far away, we tried to keep our son at his pre-school for half the day, and at the hospital the other half. Again, apart from filling up a few forms, we had nothing to do.

My wife pretty much stopped working to take my son to the hospital every day (either for reeducation or treatment) – and was allocated a stipend by the government as caregiver, for a full year (equal to just under the minimum wage). Had we needed it, transport by ambulance would have been taken care of, free of charge for us (as it were, car commutes to the hospital could also be reimbursed).

During the chemiotherapy, if he had any side effects (his immune system being weakened, any normal children’s disease basically required him to be hospitalised to be given full anti-biotic treatment), we’d call up the hospital and just come around. Either of us could spend the night with him as needed. We never spent a dime when we did so.

Sounds absolutely awful, doesn’t it? I mean, who in their right mind would want to have state-of-the-art healthcare ready and available should a catastrophic illness strike? How can anyone expect to get better if they don’t have the invigorating fight with insurance companies (if you even have insurance), your employer (if you don’t get fired for missing too much work), and impending bankruptcy to look forward to?

Reading this diary made me realize exactly why the French sometimes look down on us as barbarians.