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July 23, 2009


"This is why we need reporters and pundits with policy expertise, not aspirations to be the next Maureen Dowd (or Broder or Koppel)."


Maybe it's not only the reporters who are snoozing.

The Administration's determination to drive down the cost of health care through mechanisms like best practices is likely to create a regime where very difficult societal and personal choices will have to be made, and made not by the patient and his physician but by an enhanced MedPAC or what Tom Daschle referred to as a Federal Health Board.

President Obama last night chose to characterize those choices as costless. We'll stop greedy doctors from performing unnecessary surgery ("[Y]ou know what, I make a lot more money if I take this kid's tonsils out.") We'll choose the cheaper of two equally effective treatments. ("If there's a blue pill and a red pill and the blue pill is half the price of the red pill and works just as well, why not pay half price for the thing that's going to make you well?") But those examples fail even to acknowledge the tough choices that will be made--involving a pill that is a bit more effective or has fewer side effects but costs substantially more, or a surgery that offers alleviation of pain or increased mobility but has no payoff in increased life expectancy.

I can't help feeling that if George W. Bush had so baldly misstated the real nature of the cost-cutting choices that will be made, Brendan would have come down on him hard with his usual incisive and withering analysis. We're still waiting.

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