I don't know that this is going to hurt the image of healthcare reform. But it probably isn't going to help:
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Wait, so what's the problem with this?
My but that was one longwinded question. But, yeah, not a good answer.
Then again, he made it on national TV three weeks ago and nobody noticed. Hmm.
This isn't that bad in terms of frightening people, but it is bad in the sense that Obama's only fall back is rhetoric bordering on drivel, and mass generalizations void of any data to explain how reforms will work. That and he's basically telling this nice woman that her mom would be toast under his watch.
He's talking about comparative effectiveness research and he's says that it'll save costs by helping patients and doctors make better informed decisions. What about this is controversial?
Because it's rarely the case that, "procedure X never works" in health care, but rather "procedure X works on a certain % of the population".
Watching the clip you get the idea that the President and his advisers will simply look at medical procedures, see what works and what doesn't and stop spending on what doesn't work.
Except for the old saying about "practicing" medicine. Many people need to go through multiple procedures, or take multiple drugs before finding the one that "worked".
You rarely know until after the fact that something turned out to be wasteful.
The best case we can hope for us that the Federal Government of the United States will literally dictate to individuals, albeit indirectly through various levels of pressure, funding, etc. what kind of procedures Americans can have.
The worse case is much more severe. Some people at the margins will go untreated, others left to suffer through drugs or operations that worked for most, but perhaps not for them, all so other people at the margin can get access to health insurance.
This really doesn't make sense...
It's only controversial if you take it as an answer to the question asked, which was, "Wuld you consider it cost-effective to give a pacemaker to a 99 year old?" The answer appears to be no, though he doesn't come out and say it. What is the pain pill supposed to do for arrhythmia other than ease her descent into death?
Okay yeah, I see your point.
I just want to recommend to people The NYT Magazine interview with Obama from April in which he discusses these issues more thoughtfully and eloquently than in the above clip. He tells a story about his grandmother that is especially pertinent to this.
http://tinyurl.com/md9eal
Oh, Megan, you're so thoughtful and fair-minded and detached. Not a partisan hack at all. That's why you choose to spread soundbytes like this one while pretending to ponder on its potential effect. Lovely.
And lately you're getting the commenters you deserve - the comment sections are getting increasingly boring and predictable; full of, not just ideologically biased, but uninformed, simplistic and plainly stupid remarks.
But to be fair, you occasionally find an unexpected take on the issues at hand, like this one from a today's post:
The new health insurance tax is only to be levied on Jews and Christians. Muslims aren't required to pay the new tax.
So it's not like there is not new blood out there to replace the commenters who are alienated by this sort of crap.
I was going to make some snarky comment wondering what kind of person stops to write a comment complaining about the quality of others comments, then I paused to admire the wonder if irony.
not to mention typos
It must be great to have such a capacity for wonder. Why, life must be a permanent adventure for you, sam! Just be sure to avoid staring directly at ant colonies and rainbows. You might drool to death.
Ah, that type then.
I'm not sure how to take this comment, but anyone who is paying attention knows that the new tax is only to be levied against Jews and Christians.
In this country, we have freedom of religion; and under Islam, it is a sin to gamble. Insurance is common form of gambling; and the state cannot force a Muslim to gamble.
In Massachusetts, when you file your tax return, you are asked whether you are a member of a religion which exempts you from paying the Masschusetts health tax. If you are a member of such a religion (and there is only one which fits this definition), then you do not have to pay the tax.
In Massachusetts, only Jews and Christians are required to pay the health insurance tax. Muslims are expressly exempted.
So, if you want to avoid the tax - the solution is simple:
Submit.
I'm pretty sure that exemption is for Christian Scientists (and possibly the Amish/Menonite groups as well), not for Muslims.
Since I live in Massachusetts, and file tax returns here, I can assure you sir that it was designed specifically for Muslims (the City of Boston recently helped build one of the largest Muslim mosques in the nation - a $16.5 million structure).
Not too many Amish hereabouts (see Pennsylvania).
Nimed, you are one of the best commenters here. I only bring this up because your comment is, I think, subpar for you. You usually bring up a wealth of information, statistics, and verifiable links that challenge the libertarian perspective. And, unlike the dime-store commenter, you avoid red herrings. But your last comment avoids the issue Megan raised, questions her motives, and brings up an unrelated issue rather than challenging her argument.
That question at hand is: did Obama acknowledge that "cost-effectiveness analysis" will lead to government analysts deciding peoples' proper treatment, regardless of what doctors and patients want?
Liberals usually decry cost-benefit analyses. Environmentalists scream bloody murder when somebody argues that an insignificant percentage of arsenic is OK in a water source if it would cost millions of dollars to remove the final traces. Doves find "collateral damage" arguments -- we had to burn the village in order to save it -- fundamentally immoral. And this is to say nothing for when an insurance company weighs the scales and denies coverage, say, to a smoker or a diabetic.
So is cost-benefit analysis OK when the government does it with healthcare? Are liberals finally beginning to see that cost-benefit analyses are sometimes rational, even if utilitarianism often forces us to ask uncomfortable questions? Did you read Peter Singer's utilitarian argument in favor of rationing? You can express outrage at the desire to quantify and compare things we consider priceless, but you cannot deny the cold, inflexible rationality of it all.
That being said, I have also noticed a decline in commenter quality here lately. (I hope I haven't contributed.) In Megan's defense, a lot of the bad comments are coming because, for whatever reason, Instapundit has been linking just about every post here for the past couple of weeks. Nothing against Glenn Reynolds, but with his massive audience you inevitably reach deeper into a more uninformed crowd.
Obama is saying that providing research into best practices can help to bring down cost by helping people avoid unnecessary care.
It's not clear to me how you go from that to government analysts denying care to people. The government funding this research (regardless of how much stock you put into the findings) isn't the same as the government making final decisions on care based on that research.
I feel like you're making the next several steps for him when you hear this as government rationing.
They most certainly are if the government is the the one holding the purse-strings.
Dan, I think you might be being deliberately obtuse. The entire point of cost-effectiveness research is to figure out what is worth paying for and what isn't. Every time you go to the supermarket and compare prices between various brands of eggs before choosing one, you are performing cost-effectiveness research. Nobody does that "research" for abstract intellectual pleasure.
If, under a single-payer plan, the research isn't to decide what is "worth" paying for and what isn't, then what's the point? If cost-effectiveness doesn't guide rationing (or whatever term you want to use for it) decisions, then it will do absolutely nothing to control costs. Like if a parent says to a teenager "The Honda is safer, more affordable, and much more reasonable, but I'll still pay for the Ferrari if you really want it."
We've witnessed the demonization of "corporate bureaucrats" for making decisions based on economics rather than medicine. Dissatisfaction with this (often exaggerated) feature contributes to the desire for reform.
But now we find that government bureaucrats will make this a central part of the plan. Somehow the same feature that delegitimizes the free market mutates into a rational, necessary step solely because the government undertakes it, even though they explicity do so with the same motivation attributed to free market actors.
Sadly, this is entirely believable.
His answer doesn't seem so bad. I like his statement that we as a society have to have a discussion about where our medical priorities are and how to set limits. I'd just prefer we have that discussion before we go down the road to socialized medicine. Not after.
His answer is nearly incoherent. An honest, coherent answer might have been, "Yes- certain procedures/pharmaceuticals are going to be denied (not paid for by government), even if the person might benefit from it, because most of the people in his/her demographic grouping don't benefit from it." I think this is what he was trying to say, but either did a really, really poor job of it, or intentionally tried to obscure this sentiment. In politics honesty is the first casualty.
Wouldn't it have been refreshing if he had given the real answer?
"Look, lady, your mother was 99 years old. At that age, I wouldn't advise investing in green bananas, never mind $20,000 surgeries. If your family wants to pay for it with your money, fine, go ahead. But if your medical care is on the taxpayer dime, it just doesn't make sense. Take some pain pills. Ask Rush for some leftover Oxycontin. Ask your hoodlum grandson for some pot--what's the difference at that point?"
I thought Obama was smart and eloquent. I remember listening to Clinton with awe in these contexts, where even if one disagreed with his position, at least there was an attempt to listen, persuade. This guy does neither.
And yes, this woman gets to the crux of government health care. Who decides on what basis?
We will give you information that will help you make the right decision.
Derek
I would echo Derek, who I'm pretty sure meant he thought that Obama was supposed to be smart and eloquent, not that Obama came across that way here. Obama here is the smart but not brilliant or wise college student trying to fill up the time allotment with thoughtful-sounding drivel. And Clinton --- love him, hate him, or somewhere in-between --- the guy always knew what he was talking about, and why he wanted to do what he wanted to do. This guy; not so much. He wants to be transformational, but doesn't appear interested in even thinking through the tough issues, much less making decisions on them.
Was Obama saying that he would have put this lady's mom to sleep? I don't think so. But I don't think he was saying anything, and that's just about as scary.
And one more thing, more about the question than the answer. Under our existing system, this lady was sort of presumptively ineligible for the procedure (which was probably a reasonable presumption), but one of her docs concluded that she had a lot more going for her than the numbers might have indicated, and insisted that the specialist meet with her, and that specialist was persuaded that it was a worthwhile shot. Imagine that; physicians, using their experience and discretion to make what appears to have been a sound, if slightly outside the box, decision.
Something tells me that by the time the "reformers" are done, there won't be any outside the box anymore (in which case I suppose this lady's mom would have been in a box).
"but one of her docs concluded that she had a lot more going for her than the numbers might have indicated, and insisted that the specialist meet with her, and that specialist was persuaded that it was a worthwhile shot. Imagine that; physicians, using their experience and discretion to make what appears to have been a sound, if slightly outside the box, decision"
keep in mind that regardless of the results of the pace maker install, even if this woman's mother died on the surgery bed, the doctor would get paid the same. All this woman had to do was keep looking around for a doctor willing to get paid for it. This doctor wasn't a saint. He got paid regardless of the outcome.
It's just a simple fact that no insurance plan can needlessly pay for unwarranted procedures. One benefit of government medical insurance program is that these decisions are public as opposed to the complete surprise you get from the random plan your employer picked for you.
This woman's family has every right to decide to pay out of pocket for a procedure with long odds. And of course some people who do so will extend their lives by many years. But many others will pay $20k and die, and you just can't hope to solve the problems in healthcare if you believe insurance should cover any and every procedure, or even promising ones that have nit yet been proven. Experiment on your own dime I say.
From the comments in Youtube, it appears that the video is doctored. Check out this video instead - http://www.youtube.com/watch?v=6D8PXAt8HEY - from the 3:40 mark.