Friday, August 14, 2009

Voodoo Medical Economics

From the medical doctor (and conservative pundit) Charles Krauthammer's The Great 'Prevention' Myth column in the WaPo today:

In Obamaworld, as explained by the president in his Tuesday town hall, if we pour money into primary care for diabetics instead of giving surgeons "$30,000, $40,000, $50,000" for a later amputation -- a whopper that misrepresents the surgeon's fee by a factor of at least 30 -- "that will save us money." Back on Earth, a rigorous study in the journal Circulation found that for cardiovascular diseases and diabetes, "if all the recommended prevention activities were applied with 100 percent success," the prevention would cost almost 10 times as much as the savings, increasing the country's total medical bill by 162 percent. That's because prevention applied to large populations is very expensive, as shown by another report Elmendorf cites, a definitive review in the New England Journal of Medicine of hundreds of studies that found that more than 80 percent of preventive measures added to medical costs.

The DoctoRx approach to preventive health was and is simple. Eat right and exercise. And take your statin if your doctor recommends it; the same applies to high blood pressure treatment. The life you save, extend or improve the quality of is your own.

For health and "green" reasons, consider eating as little flesh of animals with legs as possible, especially those with four legs; gilled animals (e.g. fish) are OK health-wise although overfishing is a major ecological problem.

Preventing disease is good. It costs money, as do most good things. In fact, it costs lots of money. This is in my personal opinion money better spent than on pleasure trips to wherever, and it is better for the environment. But that's just my opinion. Other people may feel that the enjoyment of a bag of junk food a day is more important to them than better health. My usual response is to persuade them to do otherwise, and I favor price incentives to change their behavior along the lines of the price disincentives for smoking cigarettes that have been shown to decrease smoking rates. So there are ways to offset the good things that flow from prevention, but they do involve taxes and other revenue enhancement measures.

If Ronald Reagan could sign on to revenue enhancements year after year, so can the wannabe transformative President named Barack Obama.

What will not work is for any President to misrepresent prevention to be a cost saving when it is, truth be told, but another worthy but costly cause. That is voodoo medical economics. It will also not do for the most powerful lawyer in America to keep on misrepresenting doctors as getting rich from doing their jobs. Doctors as a class are far more trusted than politicians, and they do a better job, too. And successful doctors can't go from practicing medicine to trade on their connections to make millions of dollars a year as successful politicians, such as Tom Daschle (who like Al Gore hit the jackpot after losing a close election) and Bill Tauzin routinely do. And Angelo Mozilo did not personally refer mere physicians to Countrywide's VIP mortgage division. Need I vent further?

Even the rare doctor who makes a seven figure income, such as the most successful plastic surgeons (who do not work for insurance/Government rates), earn chump change compared with equally hard-working people in Big Finance who the Bushbama Continuity love so much (such as all of Goldman Sachs and such as Lawrence Summers, the $5 M man for 1 day a week work for a hedge fund after being forced out of Harvard).

When I, a moderate Democrat when I started medical practice, started complaining about Hillarycare to certain patients in the quiet of my consultation room, that may have been a harbinger that that "prequel" version of "Obamacare" was foundering. Are the President's attacks against physicians tied in to a similar phenomenon now?

Wait a bit and you will know more. Sadly, your knowledge of the facts of medical economics will have to come from elsewhere than this White House.

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